Neuro-immunology

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

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How do you approach the workup of transverse myelitis without any abnormality on spine MRI?

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

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At what absolute lymphocyte count do you consider alternative/discontinuing DMT in a patient with MS on fingolimod (or other S1P modulator)?

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Should the schedule of disease modifying therapy medication administration be changed if patient has received high dose steroids for an MS exacerbation?

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When do you order SSEPs for evaluation of multiple sclerosis?

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How would you approach the treatment of erosive inflammatory arthritis (RA or SpA) in a patient with multiple sclerosis on ocrelizumab who has failed csDMARD therapy?

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Does COVID-19 infection (and use of Paxlovid or other antivirals) affect your decision on timing of maintenance anti-CD20 mAb therapy (eg Rituxan, Ocrevus) in patients with multiple sclerosis?

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How often do you monitor CD-19 counts and immunoglobulin levels in MS patients on B-cell depletion therapy?

How do you approach low IgG levels on these medications?

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Do you recommend continuous antibiotic prophylaxis for patients on complement inhibitors such as eculizumab?

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

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How do you approach DMT choice in a patient with MS with a history of cancer?

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 ...

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What factors influence whether you treat a suspected flare of NMOSD (neuromyelitis optica spectrum disorder) with pulse dose steroids versus plasmaphereis?

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For patients with MS on natalizumab, at what JC virus antibody titer do you consider switching DMTs?

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How do you approach the symptomatic management of Lhermitte's phenomenon in a patient with MS?

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What is your treatment approach for multiple sclerosis related fatigue?

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How would you manage a patient with secondary progressive multiple sclerosis manifesting with increased neuropsychiatric manifestations (ex. psychosis) with no recent changes on brain MRI?

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How do you approach a mildly positive finding on an autoimmune encephalitis panel when there is no other evidence of encephalitis (such as elevated CSF protein, abnormal imaging, or EEG findings)?

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?

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For a patient with high suspicion for NMDA receptor encephalitis, is there a role for giving rituximab along with methylprednisolone & IVIG (all three together) while the CSF anti-NMDAR antibodies are still pending?

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...

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When do you prescribe a steroid taper after the high dose IV course for a multiple sclerosis exacerbation?

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In what patients would you consider adjunctive IVIG for Sjogren's-related neuropathy?

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How long do you continue immunotherapy (ie rituximab) in patients with NMDAR encephalitis with initially severe disease but a good trajectory of recovery?

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Would you consider spinal cord biopsy for an intramedullary cord lesion with disabling neurological deficits and no diagnosis despite a comprehensive workup?

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

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How do you approach the treatment of SREAT (steroid-responsive encephalopathy with autoimmune thyroiditis) after initial pulse dose steroids?

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How do you approach the management of patients with one clinical demyelinating event and MOG+ antibody status?

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

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How do you approach the timing of COVID-19 vaccination for patients with multiple sclerosis on B-cell depleting therapies?

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How do you approach the management of acute attacks of MOGAD-associated optic neuritis?

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

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How has your use of B-cell depleting therapy for MS changed during the COVID-19 pandemic?

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

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In those with a history of anti-NMDA encephalitis with identified teratoma s/p resection and clinical symptom improvement, is there a role for monitoring anti-NMDA antibody titer as a marker of disease recurrence?

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Do you ever check antibodies against EBV as part of a workup for MS in a patient with white matter lesions of unclear etiology on MRI?

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

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How long do you maintain a patient with seropositive Neuromyelitis Optica Spectrum Disorder on disease modifying therapy?

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

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How do you approach transitioning MS patients from Ocrevus to Tysabri or vice versa?

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When is brain biopsy useful/warranted as part of the diagnostic work-up in patients with suspected primary CNS angiitis?

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When would you consider checking JC virus prior to initiating biologic therapy?

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For patients with a new diagnosis of active secondary progressive multiple sclerosis (SPMS) without prior trials of disease-modifying therapy, do you treat with siponimod or do you start with a different DMT?

1 Answer available