Neurology
Expert perspectives on neurological conditions, stroke management, movement disorders, and neuromuscular disease.
Recent Discussions
How do you manage a symptomatic meningioma and associated vasogenic edema in a poor performance status patient?
Superficially, this resembles a straightforward question, but in reality, it is very nuanced, with numerous variables driving decision-making. My sequential "thought-experiment" in a situation like this would proceed as follows:1. Why does the patient have poor KPS? Are there underlying comorbiditie...
How do you counsel young adults with antibody-negative necrotizing myopathy on prognosis and long-term monitoring/treatment?
The first step is to rule out other conditions that are associated with necrotizing myopathy, that can affect treatment and prognosis, like malignancy, thyroid disease, or genetic muscle diseases. History, physical exam, basic laboratory work-up, family history, age-appropriate malignancy screening,...
How do you prescribe Perampanel for use in patients with refractory status epilepticus?
LD: 6-12 mg MD: 12 mg/day Use not recommended in severe renal impairment (CrCl <30 ml/min). Consider dose reduction in mild to moderate hepatic impairment. Use is not recommended in severe hepatic impairment.
How do you approach the management of acute attacks of MOGAD-associated optic neuritis?
If vision loss is severe and has not improved after corticosteroids/IVIG, I would consider plasma exchange (PLEX). Although we do not have controlled studies of PLEX in MOGAD, it is often used for cases of fulminant demyelination in other neuroinflammatory disorders.
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?
Active SPMS is considered a form of relapsing MS, thus any disease modifying therapy approved for relapsing forms of MS, including siponimod, is appropriate.
When do you consider deep brain stimulation in patients with Huntington's disease?
DBS targeted at either the globus pallidus interna or subthalamic nucleus has been used to treat many forms of dystonia. Occasionally, dystonia can predominate in Huntington's disease, rising to the level to consider DBS. However, the response is generally fairly limited, and side effects can be sub...
What treatment modalities do you offer patients who have ataxia?
This is a great question; thank you for posting it. Approaching management for ataxia like many neurodegenerative movement disorders is a two-pronged approach of physical/occupational/speech therapy and oral therapeutics.Physical therapy can improve balance and mobility in hereditary and cerebellar ...
At what intervals do you obtain DEXA scans for patients on antiseizure medications?
Do you ever attribute oscillopsia to a cortical lesion?
"Oscillopsia may be defined as an optic illusory movement of a viewed stationary object." (Bender, 1965)The overwhelmingly most common causes are 1) an abnormal vestibular-ocular reflex (VOR) due to peripheral or central vestibulopathy or extraocular muscle paresis and 2) nystagmus (Caveat: patients...
What workup do you recommend for patients with stabbing headaches?
Stabbing headaches, also called icepick headaches or jabs & jolts, are severe pains in the head, often occurring spontaneously but sometimes caused by coughing or sneezing, lasting for seconds. They are so intense that they make the sufferer grab his or her head. They generally occur infrequently in...