Neurology
Expert perspectives on neurological conditions, stroke management, movement disorders, and neuromuscular disease.
Recent Discussions
When do you typically check vitamin B5 levels in patients with peripheral neuropathy?
I do order B5 level in people with burning feet and sometimes the result does show low level. I usually prescribe Sublingual vitamin B complex and folic acid as most of the time if a person is deficient in one, then they can have multiple vitamin deficiency, and we are not checking all in usual clin...
When do you pursue MR imaging in patients who present for migraine evaluation?
Age Criteria: Extreme of ages is an indication for Neuroimaging. Especially if it's a new patient. (Ages 6 and under and 50 and above.) Onset Criteria: Any new-onset headache (even full-filling migraine criteria) with onset < 6 months and change in headache pattern (both symptoms or severity) < 6 mo...
How do you evaluate asymptomatic patients referred for benign intracranial hypertension?
"Benign intracranial hypertension" is not really the preferred term for pseudotumor cerebri or idiopathic intracranial hypertension (IIH) anymore, as the phenomenon can lead to permanent vision loss and thus cannot be considered truly benign. Having said that, if the patient has no symptoms (no blur...
Do you maintain an age cutoff for the use of triptans in healthy older patients without cardiovascular risk factors?
I do not have an age cutoff for the use of triptans in older patients. I do not perform routine screening for coronary artery disease in aging patients already on triptan therapy. I do recommend 5HT1f agonist or CGRP antagonist over triptans if they have documented CAD, peripheral vascular disease o...
When do you use levocarnitine in patients on Depakote therapy for seizures?
No, unless they have elevated ammonia or LFt levels related to VPA. Hope this helps!
Do you treat patients with riluzole who have ALS and a valosin-containing protein mutation?
Yes. Riluzole is a glutamate antagonist; motor neuron damage due to glutamate-related excitotoxicity is a theme in ALS pathophysiology regardless of the genetic mutation that may cause ALS. Based on this, and the lack of any available VCP-specific treatments, I see no reason not to offer riluzole in...
How frequently do you check AED levels in patients with stable epilepsy?
Once a year except in adults except for women in childbearing age every six months. In patients with liver /kidney disease, more frequently. In children, it's different the younger the kid the higher the frequency.
Do you ever do surveillance MR imaging in patients with stable exam and history of cardioembolic stroke?
I typically do not do an MRI unless a patient is having symptoms.
Is IL-6 inhibition an option in patients who are going to be rechallenged with checkpoint inhibitors after previously developing ICI-mediated temporal arteritis?
There are reports of using IL-6R inhibition in combination with checkpoint inhibitor therapy in other scenarios (e.g. inflammatory arthritis, cytokine release syndrome). So this would be a reasonable consideration if the oncologist feels strongly that further ICI therapy is beneficial.
Which triptans do you use in stroke induced migraines?
If the stroke is ischemic, I do not use triptans and would consider a non-constrictive acute care medication such as a gepant (e.g. ubrogepant or rimegepant) or ditan (i.e. lasmiditan). If the stroke is hemorrhagic and the cause has been corrected, I would use any triptan. I have a long term experie...