Neurology
Expert perspectives on neurological conditions, stroke management, movement disorders, and neuromuscular disease.
Recent Discussions
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.
What is the most effective treatment for a patient with persistent post-stroke headache?
Although I have tried many of the traditional preventive treatments such as topiramate, propranolol, candesartan (esp if HTN), and amitriptyline (esp if insomnia), the results are variable at best. I believe that CGRP mab are safe in this situation and are probably the best option for episodic migra...
What would be the workup and the treatment of choice for isometric tremor?
Any tremor which is not accompanied by parkinsonism should prompt the same workup. It requires basic labs as well as checking thyroid function. Isometric tremor occurs when contracting muscles against an un-moving object, so the diagnosis is often in the description.
How do you manage neuropathic chemotherapy agents in patients with underlying multiple sclerosis?
I would make sure that if they do have B and T cell immunosuppressive effects (I would check their FDA access data records, phase 3 clinical trials, other drug sites that detail their MOA) and I am convinced that my MS drugs (if the patient is on any) are not needed, I would discontinue such therapy...
What are the best treatment options for persistent post-traumatic headaches when first line agents like TCAs have failed?
Would treat post-traumatic headache according to the primary headache disorder phenotype.Post-traumatic headaches statistically most often have a migraine disorder phenotype. So if one does not respond to TCA as a preventative medication then I would consider other migraine disorder preventative med...