Neurology
Expert perspectives on neurological conditions, stroke management, movement disorders, and neuromuscular disease.
Recent Discussions
What do you use to treat cramping in Kennedy's disease?
Trial of low dose testosterone 40mg orally daily as needed is worth to consider to combat symptoms since there is not specific cure. It seems working for paramyotonia congenita symptoms having similar symptoms of muscle cramps, pain and in many cases subjective weakness over years.
Does pregabalin contribute to esophagitis or gastroparesis?
Based on personal experience, no. Regarding gastroparesis, it appears that pregabalin is frequently used for the abdominal pain related to gastroparesis with acceptable results and without worsening of gastric motility: https://www.tandfonline.com/doi/full/10.2147/CEG.S362879
What is your approach to managing a patient with a history of tardive dyskinesia on a VMAT2 inhibitor, presenting with parkinsonism and found to have an abnormal DAT scan?
I have seen multiple experts use both VMAT2 inhibitors and levodopa simultaneously in these instances, though reluctantly so. It depends on the severity of TD and PD (which is obviously exacerbated by VMAT2 inhibitors) and which symptoms are most bothersome for the patient. Some options include: R...
When should headache treatment be escalated to inpatient IV lidocaine?
Overall, there is a lack of data (few studies) supporting the use of IV lidocaine. There are safety concerns, especially in the pediatric population. The other barrier is lack of expertise, most institutions need a sedation/anesthesia team for IV lidocaine administration even if it's done in outpati...
How do you interpret the finding of identical bands in CSF and serum in patients being evaluated for MS?
To show inflammation within the CNS compartment, generally, you need to show bands present in the CSF that are not seen in the serum.
What is your workup for CSF studies when evaluating for possible CNS Lupus?
CSF studies for CNS lupus are most important in ruling out non-lupus CNS problems, e.g. infections and malignancy. So you want to target CSF studies toward the differential diagnosis of the presenting CNS phenotype. Typically these would include cell counts with diff, glucose, total protein, CSF IgG...
Would a surgical decompression be indicated in a patient with amyloidosis and severe median neuropathy at the wrist?
Yes, of course, if the median neuropathy is symptomatic. I am not aware of any literature suggesting lower rates of success with carpal tunnel release surgery in patients with various amyloidosis subtypes compared to non-amyloid CTS.
Would you recommend anti-platelet or anticoagulation in a patient with recurrent strokes, CADASIL, and Antiphospholipid Syndrome?
It depends on the circumstances (e.g. co-morbidities). Would use neither for CAA alone.
Is there practical utility from obtaining CSF autoantibodies in patients with suspected neuropsychiatric systemic lupus erythematosus?
I typically obtain serum and CSF autoimmune encephalopathy panels based on a patient's APE2 score. A score of 4 or more is predictive of having positive serum or CSF antibodies and can be applied to patients with neuropsychiatric lupus and help stratify who to test. I would start the workup with MRI...
What would you recommend for a patient with MS on dimethyl fumarate with recent exacerbations including optic neuritis and new enhancing brain lesions who wishes to go on more intensive therapy such as a B-cell depletion but recently required treatment for shingles?
While live vaccines are still generally discouraged for patients with MS, there is ample evidence that most vaccines are unlikely to trigger new MS lesions. One option then would be to vaccinate with Shingrix, a recombinant vaccine, before starting B-cell therapy. Generally, I would wait at least 2...