Neurology
Expert perspectives on neurological conditions, stroke management, movement disorders, and neuromuscular disease.
Recent Discussions
At what absolute lymphocyte count do you consider alternative/discontinuing DMT in a patient with MS on fingolimod (or other S1P modulator)?
I have asked this question for a long time, and get different answers. When a patient is hovering below 500, I start to wonder if it’s worth the long term risk/benefit. If they aren’t having infections and are young/healthy I usually leave them alone. If they’re getting older (50s and up) we have th...
When patients develop headaches from luspatercept, do they tend to improve over time?
I've seen two common scenarios with this. One is headaches related to hypertension as a result of luspatercept. By treating the hypertension, the headaches often improve. If the headaches are in the absence of hypertension, I do use a low dose beta blocker to see if it helps, and have had some resul...
Do you typically get muscle MRI in patients with symptoms of myopathy?
Not routinely, but there are some scenarios where MRI is useful. Selection of muscle to biopsy in a chronic progressive myopathy. In the past, we used to select muscles based on the degree of weakness on the MRC scale and the EMG findings. One would avoid muscles with MRC strength of 3/5 or less or...
In what clinical scenarios do you utilize neuromuscular ultrasound?
This is a very open-ended question and the answer can be several pages long. Neuromuscular ultrasound overall is an extremely valuable tool that complements EMG and allows the examiner to assess peripheral nerve and muscle ANATOMY, which EMG cannot do. Therefore, this test can be diagnostically help...
How do you approach the diagnostic workup for patients with suspected Fabry's disease?
Quite simple- if you suspect the disease in a male, you can measure alpha galactosidase enzyme activity in blood; if normal the diagnosis is unlikely, if abnormal you can confirm with GLA gene sequencing. If you suspect the disease in a female (manifesting carrier), you should directly sequence GLA ...
What is your approach to determining if an SPEP abnormality is causal or coincidental in peripheral neuropathy work up?
Because the answer to this question is long and complex, I would refer to a nice recently published review of the topic in Continuum (AAN) which provides a detailed discussion and nice algorithms to investigate the monoclonal gammopathy and determine a possible relationship to the neuropathy (or lac...
Does aerobic exercise lead to any change in ability to perform ADLs in patients with Parkinson's disease?
In this article, improvement in overall fitness was seen in patients in the aerobic exercise group. I could not find a scale that specifically looked at ADLs in this study.In a meta-analysis and systematic analysis published in NPJ Parkinson's Disease, authors found aerobic exercise had beneficial e...
Are there specific sections of the MoCA which showed less change in patients in the exercise group?
We did not look into specific sections of the MoCA to test whether exercise influences certain cognitive domains more than others. However, with the use of a computerized behavioral task, we were able to show that patients who exercised became better at exerting control over their behavior. Specific...
What level of exercise do you recommend in patients with Parkinson's disease?
I recommend aerobic exercise for at least 30 minutes/day, 5 days a week. These recommendations are of course based on patient's physical ability. I usually advise using a stationary bicycle and if that is not possible, a recumbent bicycle for aerobic exercise. This way if there is bad weather or una...
Does time since diagnosis play a role in benefits of exercise when studying patients with Parkinson's disease?
That is an excellent question. This was not addressed in this article. I would think that, and I think there are studies to suggest that the benefits of exercise may be more in the early to mid-stage of the disease when gait is intact.