Neurology
Expert perspectives on neurological conditions, stroke management, movement disorders, and neuromuscular disease.
Recent Discussions
How do you do approach treatment of a recurrent gliosarcoma?
Primary gliosarcoma remains a challenging clinical conundrum. There are no curative therapies and little to no high level evidence to guide decision-making. Most approaches have followed patterns similar to those used for recurrent glioblastoma. The outcomes are usually poor. However, it does help, ...
What is the optimal management for a patient with Tourette Syndrome with severe tics that preclude the patient from lying still for radiation?
A patient with Tourette syndrome (TS) this significant is likely to have an outpatient neurologist; certainly a discussion regarding medical options to help movement elements in the short-term warranted. While behavioral therapy plays a large role in the long-term management of TS, certain medicatio...
Are there features of a nerve biopsy that help distinguish late nerve damage from vasculitis versus from a demyelinating disease?
Chronic demyelinating processes can have features of demyelination on nerve biopsy including thinly myelinated fibers, remyelinating fibers, onion bulb formation, myelinated fiber loss, and axonal regeneration, as well as variable degree of inflammation. Late vasculitic neuropathy would show axonal ...
What is the importance of finding a positive titer for FGFR3 and what treatment would be advised for these patients?
The significance of positive FGFR3 antibodies in patients with neuropathy, and the optimal treatment regimen for those patients remain to be determined. Based on the largest case series of FGFR3-IgG + patients to date, the antibodies seem to be associated predominantly, if not exclusively, with non-...
What abortive migraine treatment is preferred in pregnant patients?
Sumatriptan has a good safety record in pregnancy based on pregnancy registries and studies.
Would you recommend a CGRP inhibitor for migraine prevention in pregnant patients?
No, I would never recommend the use of a CGRP inhibitor during pregnancy (or for a woman breastfeeding for the matter). Currently, there exist five anti-CGRP preventative options with a sixth most likely to be FDA approved here shortly. Of the five currently approved CGRP inhibitors for migraine pre...
What treatments would you recommend in patients with adult-onset Rasmussen’s encephalitis after the patient is on two or more AEDs?
There is no anti-seizure medication of choice. It is a (hemispheric) focal epilepsy. If it is really Rasmussen's, it is a progressive disorder, and eventually, it results in a hemiplegia with progressive hemispheric atrophy on MRI, so surgical treatment (hemispherectomy) should be considered early r...
At what point could starting AEDs be considered for patients with recurrent simple febrile seizures?
Assuming this is a young child, it is a subtype of "provoked" seizures. It is reasonable to treat if they are frequent or severe. Any ASM will do. Wean off like any other ASM treatment: slowly and gradually. Febrile seizures should not occur after the age of 5 or so.
How do you limit the onset of new strokes in patients with Moya-Moya syndrome?
In patients with Moya Moya, the most effective way to limit strokes is through EC-IC bypass surgery, preferably done at a high volume center. There is no consensus about whether direct or indirect bypass is the best choice.
Should patients with clinically isolated syndrome be started on medication?
Since the 2017 revisions to the McDonald criteria, many patients previously categorized as clinically isolated syndrome (CIS) can be reclassified as relapsing remitting MS with the additions of including symptomatic enhancing lesions and oligoclonal banding on CSF in dissemination in space and time ...