Neuro-immunology   

Are there situations when you would choose it over Rituximab?

Does JC Virus Ab status play a role in your decision?

In light of recent publication by Bsteh et al., PMID 39197111 that examined the outcomes in the treatment of RMS based on isolated MRI findings.

Is it necessary to do a taper afterward and what would be the recommended tapering schedule/duration? 

Is this consistent with VZV immunity that is just seronegative on lab testing?

Can you elaborate on reasons for a non-quantifiable SPEP and how does one follow the paraprotein?

How long do you monitor before re-treatment or moving to another agent like IVIG?

Do you generally recommend anti-diarrheals, dietary modifications, or consider this an unacceptable side effect and move to other therapies? 

What criteria do you use to distinguish tumefactive MS from non-tumefactive MS?

Is it dependent on which DMT the patient is on?

If not, are there any serum or CSF tests you consider to be helpful?

E.g., a patient with newly diagnosed CIDP who is wheelchair-bound.

Is a biopsy or EMG helpful in confirming the etiology? What is the best treatment for sarcoid neuropathy?

Does this ever prompt you to change DMTs?

Is there utility when classic inflammatory markers (ESR,CRP) or disease specific markers (C3, C4, dsDNA) do not correlate with patients disease activi...

Question asked in light of Langer-Gould et al., PMID 38507657.

Specifically, do you check for any of these: ACE, Vitamin D 1,25, serum lysozyme, soluble IL2 or Adenosine deaminase levels?

For example, the patient may have other findings such as an elevated CRP. Would you diagnose SLE, or would you want to see other serologies or finding...

Does the number of bands matter in making the diagnosis? Does it make a difference whether isolated or also in the serum? How do you interpret other r...

Are there emerging biomarkers that help distinguish the phenotypes in the absence of evaluation over time?

E.g., JC virus antibody titer, absolute lymphocyte count, etc.

How should IVIG and either biologic injections or infusions be spaced?

Do you treat with only an IV steroid pulse or do you use an oral steroid taper as well? How long of a taper do you typically use?

In addition, what formula do you use to calculate the IgG index?

Are there any instances where you would prefer a biosimilar rather than the reference product? 

Anecdotally, the diagnostic yield in these patients seems quite low, yet autoimmune encephalitis is often invoked in such patients, particularly in th...

If a patient has classic TM symptoms but a normal MRI, are there specific causes you look for?

When it seems fairly certain that this is a drug effect is it something that can just be monitored or requires a change in approach?

How do you approach low IgG levels on these medications?

Do you just use antibiotic prophylaxis if therapy is started prior to meningococcal vaccination?

Based on this review (Melamed and Lee, PMID 31998289), patients with MS on several DMTs may be at higher risk for certain cancers. How does this play ...

For example, a GAD65 Ab of 0.07 when the cut-off is 0.02. Does this answer change if you consider adult vs pediatric populations?

Instead of waiting for the antibody test to result, if you have a high suspicion for NMDAR encephalitis, is there a role for giving rituximab alongsid...

What is the diagnostic yield and complication rate in your experience? 

Do you wait for a second clinical event or start immunomodulatory therapy right away?

Specifically, what do you do if there is minimal improvement with IV steroids and/or IVIG?

Are there any specific patient populations that you are no longer routinely recommending to start B-cell depleting medications? For example, are you l...

Based on the results of the recent longitudinal analysis linking EBV infection and MS (Bjornevik et al., PMID 35025605), can negative EBV antibodies (...

For example, a clinically stable patient on eculizumab, do you continue it indefinitely?

Ex. optical coherence tomography, visual-evoked potentials

Thoughts on sarilumab vs methotrexate, or just treat with steroids alone

Small study in pediatric PACNS have evaluated this as a potential marker (Cellucci et al., PMID 22740622)

If not, how often do you repeat pelvic imaging?

Do you approach things differently if a rare variant like this is suspected? Is the Balo's subtype more similar to RRMS or PPMS?