Neurology
Expert perspectives on neurological conditions, stroke management, movement disorders, and neuromuscular disease.
Recent Discussions
How do you approach treatment of a glioblastoma in pregnancy?
Glioblastoma during pregnancy could be treated safely (to mother and fetus) with certain precautions and modifications. Collaboration and consultation with the patient’s obstetrician are essential. External shielding over the patient’s abdomen during treatment will decrease the external scatter radi...
What have you found helpful in counseling patients with migraine reluctant to take preventative medications?
I think all of the responses here are very reasonable, but often the hesitancy is based less on resistance to a specific medication than on the self-stigmatization we see in patients with chronic headache, migraine, or other primary or secondary headaches. Because migraine is not a life-threatening ...
What treatment strategies can reduce the risk of post-concussion syndrome after an acute injury?
When evaluating a patient for their acute concussion, it is important to screen in the history for known factors that can prolong recovery if unaddressed. These include: sleep, hydration, mood issues, lack of activity for more than 48 hours, history of migraines, ADHD, anxiety, and depression. In th...
Would you consider adding gabapentin off label for use in the treatment of glioblastoma at this time?
As an author on the paper, let me emphasize the findings and speculate on the implications. Recently, a number of laboratories have unraveled stunning preclinical and mechanistic findings demonstrating the ability of a subset of malignant glioma cells to usurp neuronal circuitry to promote tumor gro...
What extended window thrombolysis protocols are your institutions implementing?
Regulatory guidelines set time epochs for IV thrombolysis at 3h (US) and 4.5h (rest of the world). Recent guidelines are similar globally, supporting a 4.5h time window. The Canadian guidelines state that: “Intravenous thrombolysis beyond 4.5 hours may be considered, in consultation with a physician...
What is your approach to managing hallucinations in dementia?
Hallucinations in dementia can be categorized in many ways. To begin to conceptualize a management approach, it is useful to distinguish between various types of clinical presentation: pre-existing psychosis in a patient who then develops dementia; new onset psychosis in a patient with dementia; pre...
Should ASPECTS be used to determine eligiblity for thrombolysis beyond 4.5 hours?
Non-randomized studies showed this approach was not associated with increased risk of hemorrhage. The only trial -TWIST trial aimed to determine whether IV TNK given within 4.5 hours of awakening improves functional outcome in patients with ischemic wake-up stroke selected using non contrast CT head...
In older adults with mild cognitive impairment, do you ever prescribe cholinesterase inhibitors and/or memantine?
This is a great question, and of course, "do you ever" will get you in trouble every time! Let me start by saying that, in general, I do not prescribe these drugs for MCI. Cholinesterase inhibitors are clearly indicated for the mild-moderate stage of some kinds of dementia (some people would include...
How does progression independent of relapse activity (PIRMA) influence your decision to change treatment in relapsing remitting multiple sclerosis?
In a patient who is progressing in the absence of relapse activity, I typically do not change DMT and instead focus on managing the symptoms directly. Such as physical therapy or walking aids, physical worsening, cognitive rehab, OT for fatigue issues, or counseling if mood issues are contributing t...
Cost and access aside, when might you prefer to start a patient on a triptan instead of a gepant for acute migraine therapy?
For me, the triptans are first line for migraine abortion. They have been on the market for well over three decades, we have a lot of experience with them, a lot of clinical-trial information is available on them, and also in special populations like teenagers and adolescents, as well as pregnant wo...