Neurology
Expert perspectives on neurological conditions, stroke management, movement disorders, and neuromuscular disease.
Recent Discussions
Is unilateral intracranial EEG monitoring ever appropriate in the pre-surgical workup for presumed non-lesional epilepsy?
Of course it is, when the side is clearly known, based on EEG, semiology, or imaging, but the more precise localization is not. Common examples are temporal but mesial vs lateral is unclear, and frontal vs temporal neocortical.
What AEDs prevent spikes and sharp waves?
Good question, but the way it is phrased makes it difficult to answer: Generally, all ASMs can suppress seizure activity and interictal discharges to some degree. There is a huge difference among the subtypes of epilepsy, for example in IGE and LGS, there may be a correlation between the interictal...
How does the FDA safety warning on the cardiac effects of lamotrigine, based on in vitro data, inform your clinical practice?
I am aware of it and will be careful in using it with patients who have any conduction abnormalities, though that doesn't mean I won't use it. I have been using it for many years (my program during fellowship was a research site for bringing it to the US) and never had a problem with it.
What is the most effective treatment for a patient with persistent post-stroke headache?
Although I have tried many of the traditional preventive treatments such as topiramate, propranolol, candesartan (esp if HTN), and amitriptyline (esp if insomnia), the results are variable at best. I believe that CGRP mab are safe in this situation and are probably the best option for episodic migra...
What would be the workup and the treatment of choice for isometric tremor?
Any tremor which is not accompanied by parkinsonism should prompt the same workup. It requires basic labs as well as checking thyroid function. Isometric tremor occurs when contracting muscles against an un-moving object, so the diagnosis is often in the description.
How do you manage neuropathic chemotherapy agents in patients with underlying multiple sclerosis?
I would make sure that if they do have B and T cell immunosuppressive effects (I would check their FDA access data records, phase 3 clinical trials, other drug sites that detail their MOA) and I am convinced that my MS drugs (if the patient is on any) are not needed, I would discontinue such therapy...
What are the best treatment options for persistent post-traumatic headaches when first line agents like TCAs have failed?
Would treat post-traumatic headache according to the primary headache disorder phenotype.Post-traumatic headaches statistically most often have a migraine disorder phenotype. So if one does not respond to TCA as a preventative medication then I would consider other migraine disorder preventative med...
How do you approach the diagnosis and treatment of recurrent neurosyphilis in a previously treated patient?
This question is answered by CDC guidelines: https://www.cdc.gov/std/treatment-guidelines/neurosyphilis.htm A patient with neurosyphilis needs to get serial non-treponemal (VDRL/RPR) tests from serum after completion of the 14-day IV penicillin course (3,6,9,12 and 24 months). A 4-fold reduction of ...
How often do you monitor CD-19 counts and immunoglobulin levels in MS patients on B-cell depletion therapy?
This is a very timely question and one that is largely unresolved. There is currently no consensus on whether or how frequently gamma globulin levels should be monitored. Similarly, there is no consensus regarding the frequency of CD19 monitoring.Monitoring CD19 counts after rituximab therapy for pa...
In what conditions can you see roving eye movements?
Roving eye movements are seen in comatose patients with intact oculomotor/ brainstem function. These movements can be conjugate or dysconjugate with no pathological significance between the two. Movements are usually horizontal, but vertical eye movements can also occur. Their presence rules out psy...