Neurology
Expert perspectives on neurological conditions, stroke management, movement disorders, and neuromuscular disease.
Recent Discussions
Do patients on eculizumab or ravulizumab require repeat vaccination against meningococcal infection after a certain interval?
Yes, CDC recommends a booster Men B vaccine 1 year after completion of series and then every 2-3 years thereafter, and booster Men C every 5 years.
How do you manage asymptomatic patients with incidental findings of the carotid web?
Terrific question. I would certainly not pursue interventional treatment in asymptomatic patients with carotid web. The role of aspirin is also debatable and not conclusively proven. I would ensure vascular risk factors are controlled and consider starting aspirin if otherwise indicated based on ove...
How do you treat CIDP patients unresponsive to IVIG and steroids?
As a general rule, if a patient tentatively diagnosed with CIDP does not respond to an adequate trial of corticosteroids (e.g. 1 mg/kg prednisone daily for 1 month, or pulse methylprednisolone 500-1000 mg weekly for at least 4 weeks), and IVIG (loading dose of 2 g/kg, followed by 1 g/kg every 3 wee...
In light of the FDA approval of tofersen for SOD1-related ALS, what is your approach to counseling people who are presymptomatic genetic carriers of one of the monogenic ALS genes?
First of all, let's emphasize that there is no standard of care for the management of presymptomatic carriers of ALS genes. In other words, there is no strong scientific evidence in humans yet, that early initiation of any ALS treatment, will delay either the onset of clinical disease, or the progre...
Would you recommend temporary EVD or more permanently VPS to lower ICP?
We only place EVDs in patients who meet criteria with a GCS of 8 or less. If they are a GCS 9 or greater, we empirically manage cerebral edema if we think it is present, but do not monitor ICP with invasive devices. With regards to VPS, we never use them acutely to lower ICP. Shunts are only used i...
How do you manage radiation plexopathy?
This is a frustrating problem. I agree that there are no proven treatments for radiation plexopathy. However, chronic radiation injuries appear due at least in part to an ongoing inflammatory process. Interrupting this process with pentoxifylline and Vitamin E has been successful in reversing fibros...
How do you approach the management of interictal discharge burden in patients with generalized epilepsy syndromes (i.e. genetic)?
Assuming the patient has normal cognition, I simply treat clinically to target seizure freedom with minimal side effects.
Do patients with NPH/communicating hydrocephalus always require VPS?
This is a complicated question. Evaluations for NPH include monitoring for neurological improvement following a large-volume lumbar puncture or a lumbar drain trial. At our institution, we prefer a lumbar drain trial as it allows more volume to be removed over time and mimics the placement of a shun...
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