Neurology
Expert perspectives on neurological conditions, stroke management, movement disorders, and neuromuscular disease.
Recent Discussions
Do you treat HIV/AIDS-associated CNS vasculitis with antiretrovirals alone or in combination with steroids?
This is a tough question and like most viral associated forms of vasculitis i.e., HCV, VZ, other... of unclear immunopathogenic mechanisms, it is approached empirically. Antiviral therapy is the cornerstone but at least short-term immunosuppression is generally needed in the acute phase as host medi...
How frequently do you monitor EKGs for patients newly initiated on lacosimide?
In patients who are over the age of 50, smokers, or others with a higher risk of heart disease, I get an EKG at baseline and then at a maintenance dose. During treatment, if the patient reports any new potential cardiac symptoms like palpitations, PVCs, SOB, etc, I will get another EKG.
When do you start to cross-titrate from steroids to CellCept in patients with Myasthenia Gravis?
It depends on the severity of the MG. In more severe cases, such as patients hospitalized for MG exacerbation with severe dysphagia, aspiration, or respiratory failure requiring ICU, we often prescribe steroids and CellCept simultaneously after IVIG or PLEX treatment, without cross-titration. I usua...
How do you treat persistent headache after RCVS?
To my knowledge, there are no published studies to guide treatment decisions for headaches related to RCVS. Therefore, I would base treatment on the headache phenotype. In my experience, the most common phenotype is chronic migraine. Literature suggests that a prior migraine diagnosis is a risk fact...
Do you ever utilize lacosimide in patients with atrial fibrillation?
Yes. I would get screening ECG to look for P-R interval if there is history of conduction abnormalities such as bradycardia, fainting, cardiomyopathy etc.
In patients with confirmed medically refractory bitemporal epilepsy, how do you decide on DBS vs RNS for treatment?
While the data suggests that the two interventions have similar efficacy (up to ~70% reduction in seizures on average in responders), the RNS provides the benefit of long-term electrocorticography. Over time, it may become apparent that the majority of the patient’s seizures come from one side, prov...
What is your approach to a toddler-aged patient with speech apraxia without other autistic features?
Evaluate for a hearing issue, broader developmental concerns, and dysarthria/bulbar symptoms. The diagnosis and management of childhood speech apraxia can be made by pediatric SLP.
How would you approach the treatment of checkpoint-inhibitor-mediated temporal arteritis?
Temporal arteritis or GCA is a rare immune related adverse event due to immune checkpoint inhibitor (ICI) therapy. Corticosteroids are the first line treatment, along with holding the ICI. As there have been limited cases, there is not evidence for IVIG in this setting.
How do you utilize skin punch biopsy to assess for alpha-synuclein in patients with parkinsonism?
Before starting autonomic training in Boston (with the creators of a test that looks for cutaneous synuclein/amyloid/small fiber density), I used the technique on several patients. It was actually quite helpful; one patient had an idiopathic autonomic failure (with several risk factors for it) and a...
Do you continue to use Botox to treat chronic migraine in a patient who becomes pregnant?
First of all, my use of botulinum toxin for the preventive treatment of chronic migraine has dramatically decreased since I started working with the CGRP antibodies in the context of clinical trial research in 2012. I find them to be much more effective than botulinum toxin, equally well if not bett...