Neurology
Expert perspectives on neurological conditions, stroke management, movement disorders, and neuromuscular disease.
Recent Discussions
How do you treat episodes of profuse sweating in Parkinson’s patients?
By far most common situation is OFF-related hyperhidrosis, such as overnight OFF, and so this needs to be explored with patients paying close attention to when these things tend to happen and whether they correlate with motor worsening; trials of dopaminergic dose alterations could be considered and...
How do you account for a normal EMG/NCS in the setting of prolonged clinical symptoms suggestive of a radiculopathy?
There are several references, but basically the sensitivity of NCS/EMG for radiculopathy is not great to begin with. In the context of radiculopathy, electrodiagnostic studies are mostly useful for picking up on motor axon loss because you are primarily assessing the amplitude of compound muscle act...
What is your preferred medical treatment of carpal tunnel syndrome that recurs after carpal tunnel release?
I am supposing that patient has initial recovery and symptoms are happening at least after a year. A good history to know is it really CTS or tenosynovitis. A repeat EMG/NCV test and compare from pre-release surgery to see how much improvement happened. If numbers are close to normal and surgery don...
When do you investigate for genetic causes in a young patient presenting with new-onset Parkinsonism?
I rarely order genetic testing for Parkinsonism, as I do not feel that it alters management. However, should a patient still be of child-bearing potential, a genetics consult can be helpful, and testing could be done as part of family planning. There is active research examining the utility of genet...
What would your next line treatment be for a patient previously treated with repeat resection, craniospinal irradiation, and initial cisplatin/vincristine/CCNU with medulloblastoma?
As you will agree, this is an extremely unfortunate situation. I am assuming this patient has progressed either while on therapy or soon after completion? Depending on his age, a potential option is to enroll him on any available clinical trials. PBTC58 study uses intrathecal omburtumab along with c...
When treating sialorrhea in ALS patients, what treatment schedule do you use?
I have treated one patient. We used 12 Gy in 3 fractions, delivered twice weekly. The dose was based on a systematic review that did not show a dose response above 12 Gy. Hawkey et al., PMID 26152655The 2015 study above also showed equivalency in response to therapy with 10 Gy in 2 fractions and 20 ...
Does use of imaging influence diagnostic accuracy and patient outcome in patients with suspected CIDP?
YES, it does. MRI and/or ultrasound abnormalities are supportive of the diagnosis of CIDP in the appropriate context and this has been acknowledged in the most recent version of EAN/ENS consensus guidelines for CIDP in 2021 (Van den Bergh et al., PMID 34085743).In practice, imaging is most valuable ...
How would you treat a patient with small fiber neuropathy and elevated FGFR3 titers of 6000?
Assuming no other cause of neuropathy has been found, the short answer is symptomatic treatment with meds for neuropathic pain like gabapentin, pregabalin, tricyclics, other antidepressants, etc. I will explain why immunotherapy with IVIG is probably NOT the way to go. FGFR3 antibodies were describe...
How would you manage anti-platelet therapy in patients presenting with ischemic stroke and have a history of von Willebrand disease?
I follow the ASH ISTH NHF WFH 2021 guidelines, recommendation 3: "In patients with VWD and cardiovascular disease who require treatment with antiplatelet agents or anticoagulant therapy, the panel suggests giving the necessary antiplatelet or anticoagulant therapy over no treatment (conditional reco...
Are there any risk factors for IO induced rhabdomyolysis and how do you approach and manage it?
IO can affect the muscle in many ways. There is a myasthenia gravis and myositis overlap. I am not sure we know whether it is rhabdomyolysis versus a CK leak vs steroid myopathy vs muscle necrosis due to something else. Did the patient have EMG or muscle biopsy? There is a lot we do not understand a...