Neurology
Expert perspectives on neurological conditions, stroke management, movement disorders, and neuromuscular disease.
Recent Discussions
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...
How do you evaluate and treat patients with suspected POTS?
POTS is diagnosed based on increased heart rate of more than 30 beats per minute in adults and more than 40 beats per minute in adolescents with no major drop in blood pressure from supine to standing or after tilt table from supine to 70 degrees upright. Many patients have POTS as an isolated cond...
How has your use of B-cell depleting therapy for MS changed during the COVID-19 pandemic?
There may be no "correct" answer to this question. In my practice, I have not altered my prescribing of B cell therapies. Although we have seen reduced antibody responses in MS patients on B cell therapies, this has not definitively been associated with a significantly increased risk of COVID infect...
How long do you continue immunotherapy (ie rituximab) in patients with NMDAR encephalitis with initially severe disease but a good trajectory of recovery?
Assuming there may be no evidence of teratoma on transvaginal U/S and or other modalities of examination (in females, some cases are described that show abnormalities in the ovary ONLY following HPE upon oophorectomy) and since there is always the risk of recurrence even with bilateral oophorectomy,...
How do you decide on initiation of treatment with steroids or immunomodulatory therapy in patients with statin-induced myopathy versus statin-induced autoimmune necrotizing myopathy?
In the setting of limited experience, in patients with statin induced necrotizing polymyositis (HMG-CoA reductase antibody mediated necrotizing myositis), the best approach is typically steroids (prednisone 20mg or so), IViG 2gm/kg every 4 weeks, and potentially CellCept at 2000 to 3000mg per day, w...