Neurology
Expert perspectives on neurological conditions, stroke management, movement disorders, and neuromuscular disease.
Recent Discussions
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...
Based on its mechanism of action, do you think sodium phenylbutyrate and taurursodiol could have benefit in other neurodegenerative disorders?
Yes. Mitochondrial dysfunction (Kim et al., PMID 35682574) are present and believed to be important in driving the progression of several neurodegenerative diseases. Amylyx is currently investigating this drug in patients with Alzheimer's disease (Amylyx Pharmaceuticals announces oral presentation o...
How do you manage a diabetic patient with generalized myasthenia gravis post thymectomy previously treated with Imuran?
There is some additional information required to answer this question, specifically: a) did the patient have thymoma on pathological exam? and perhaps the most important b) What was the clinical status of the patient's MG prior to thymectomy (severity, MG ADL/QMG scores)? and c) Was azathioprine the...
What is your treatment approach for a recurrent brainstem glioma?
Recurrent brainstem glioma is a very challenging situation. One could consider participating in a clinical trial if available, especially one that targets some of the known mutations in the tumor (such as histone h3, TP53, ATRX, ACVR1, and others). We have previously re-irradiated a few patients at ...
How does failure to recover clinically after >2 years in a patient with suspected diabetic amytrophy shift diagnostic and therpeutic approach?
The natural history of diabetic amyotrophy is to improve after deficits have reached a nadir; the improvement can be incomplete, but usually occurs within 12-18 months from the onset of symptoms. Therefore, if there are persistent but stable deficits 2 years after the onset of symptoms this may repr...