Neurology
Expert perspectives on neurological conditions, stroke management, movement disorders, and neuromuscular disease.
Recent Discussions
In patients with Duchenne Muscular Dystrophy who have an exon 51 mutation, do you treat with both prednisone and Eteplirsen?
How do you approach the management of patients with one clinical demyelinating event and MOG+ antibody status?
I do not always treat a MOG+ single event (isolated optic neuritis, isolated transverse myelitis, or ADEM-like presentation) as it is possible that it might be a one-time-only event (as might occur after a viral illness or vaccination). If there has been "dissemination in time", then I would conside...
How do you approach the management of Holmes tremor?
Holmes tremor (HT) is characterized by a low frequency (<4.5Hz), large amplitude and irregular rest, action and postural tremor, often affecting the proximal muscles. The exact pathophysiology of HT remains unknown, however, lesions involve the cerebello-thalamo-cortical or dentato-rubro-olivary pat...
How do you tailor seizure medications in patients who become pregnant or are family planning?
There are basic guidelines for planning pregnancy: folate 4 mg QD, good prenatal care. All seizure medications are basically comparable except valproate as far as birth malformation. Monotherapy if possible, and low dose if possible. Modern medications are generally preferred over old ones. For the ...
In what situation do you use nerve blocks in patients with headache?
Great resource: Blumenfeld et al., PMID 23406160. Times that I personally consider nerve blocks: 1) Headache management during pregnancy, but with lidocaine nerve blocks2) Migraine especially if significant allodynia 3) Occipital neuralgia4) Trigeminal autonomic cephalgia including cluster headache ...
For patients with post-stroke headaches, what treatment do you typically recommend?
First off, I usually recommend treating the headache based on phenotype. So if the headache meets ICHD-3 criteria for migraine, then treat as migraine.Great resource for current treatment recommendation in general for migraine: Ailani et al., PMID 34160823.In terms of considerations specific for str...
What workup do you start in patients with evidence of demyelination on EMG/NCS?
Workup of a demyelinating neuropathy depends on the most likely diagnosis based on history and examination of the patient. Some electrophysiological features may also help differentiate an acquired from a hereditary demyelinating neuropathy- for example, multifocal conduction blocks, non-uniform con...
How do you differentiate motor neuron disease from limb girdle muscular dystrophy on electrodiagnostic testing?
I would primarily differentiate these diseases based on history and clinical examination. Motor neuron disease looks like a neuropathic disease, and you are looking for that mix of upper and lower motor neuron signs (hyperreflexia paradoxically found with fasciculations and atrophy). This evolves ov...
What is your approach to checking serum vWF antigen levels in adult patients with CNS vasculitis for monitoring disease activity?
I never have checked them but I am aware of interest in this by the Hamburg group. (Ref) Following disease activity in CNS-V is challenging but reduction/clearing of pleocytosis is important to us. Also now being able to look at serial direct vascular wall imaging is of interest and appears to corre...
How do you determine if a patient is safe to drive after having a PCA infarct?
In many patients with PCA infarction, the answer is clear, that they cannot safely drive. In my state, the law requires 140 degrees of lateral vision for driving privileges, not met by patients with homonymous hemianopsias. These patients need to be told that they cannot legally drive, and this need...