Neurology
Expert perspectives on neurological conditions, stroke management, movement disorders, and neuromuscular disease.
Recent Discussions
What is the significance of elevated fractionated catecholamines in POTS?
Dear Dr. @Dr. First Last,I don't think we understand the pathophysiology of POTS well enough to comprehensively answer this question.There are a number of technical issues that come into play when drawing serum catecholamines.First of all, many things can elevate catecholamines temporarily: exercise...
How do you manage TTFields for a patient with glioblastoma in the setting of disease progression?
Continuation of Tumor Treating Field (TTF) therapy at progression is an individualized decision for each patient.In the EF-14 trial upon which TTF was approved for newly diagnosed GBM after chemoradiotherapy, TTF was able to be continued until second progression. In this study, 18% more patients wer...
How would you work up focal periventricular leukomalacia presenting in adulthood?
This depends on the location, appearance, size, and PMH of the patient. However, I usually start with giving contrast (aware it is encephalomalacia) and as known, most won't enhance. What is the age of this adult patient? Is there any previous history to suggest MS? If ischemic, why did it happen? D...
What medication do you consider in patients who cannot take indomethacin or triptans with a diagnosis of Hemicrania Continua?
1) DIAGNOSIS First, ensure you have the correct diagnosis. If purely unilateral but no convincing and significant ipsilateral cranial autonomic symptoms, the much more likely diagnosis is migraine. Also, consider cervicogenic headache in these cases. Hence, you would treat as migraine. If convincing...
Do you ever check antibodies against EBV as part of a workup for MS in a patient with white matter lesions of unclear etiology on MRI?
Generally, we do not check for antibodies against either viral capsid antigen (VCA) or Epstein Barr nuclear antigen (EBNA) for our patients with MS or when MS.EBV is considered a common infection. A large portion of the adult population, 90-95%, is seropositive for EBNA antibodies (Lincoln et al., P...
How do you manage drug-induced thrombocytopenia when the implicated drug is essential?
I feel obliged to answer this one as a question of medical sociology as much as a direct medical question, because "essentialness" is nearly always in the eye of the beholder, and I have not personally been in the position of the hematologist who has to confront this question with an interventional ...
What is the role of x-ray of the cervical or lumbar spine in patients presenting with radicular symptoms?
I agree that X-rays are useless the vast majority of the time. You can of course pick up lytic lesions from metastasis or plasmacytoma, or other bone-based cancers. Sometimes flexion/extension films are helpful, since MRIs are almost always static and supine (until dynamic MRIs obtain more widespre...
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.