Neurology
Expert perspectives on neurological conditions, stroke management, movement disorders, and neuromuscular disease.
Recent Discussions
Is there a subset of patients you feel benefit from gabapentin for migraine prophylaxis?
Useful in patients with other comorbidities, such as fibromyalgia, neuropathy/neuralgia, anxiety, and sleep disorders. It is not the most effective migraine preventive, but when going down the list and the patient has tried others without enough relief, it may be an option to try. Daytime sedation, ...
Can needle EMG or nerve conduction studies cause transient MRI abnormalities, such as apparent inflammation, edema, or enhancement of a nerve, that could be mistaken for neuritis on subsequent imaging?
Yes—needle EMG can create small, transient post-procedure MRI/MR-neurography abnormalities at needle insertion sites, including focal T2/STIR hyperintensity interpreted as edema and occasional small hematoma, which can potentially be mistaken for local pathology if the timing is not recognized. In a...
How do you decide when to order an EEG to evaluate for non-convulsive status epilepticus in a patient admitted with acute encephalopathy?
This can be a challenging question to answer given the broad differential of acute encephalopathy and how available EEG is at your hospital. At centers with easily available EEG capabilities, the threshold to obtain an EEG will be lower. I will also assume this question is related to patients who ha...
How do you treat nocturnal leg cramps?
Nocturnal leg cramps are similar to daytime leg cramps, but stretching may be less convenient to use as a remedy, as sleep can be further disrupted. Treating and preventing leg cramps typically utilizes some combination of hydration and electrolytes but sometimes, medications can help. Consider the ...
How do you balance the risk of unnecessary treatment with acyclovir against the risk of delaying treatment in encephalitis cases where CSF pleocytosis is absent?
Treatment with IV acyclovir should start as soon as the diagnosis of Herpes simplex encephalitis is considered. Since the question states that CSF pleocytosis is absent, then CSF has been obtained. PCR for HSV should be obtained on that CSF. Early in my career, when acyclovir was investigational and...
How should the possibility of more chronic forms of autoimmune encephalitis influence our neuronal antibody testing thresholds for patients with slower progressive cognitive decline?
I will disclose that I am not a cognitive/behavioral neurology specialist nor a neuroimmunologist per se, but I would exercise caution in interpreting the conclusions of the paper that was cited. I went over the paper briefly, and I realized that 28 patients were diagnosed with "autoimmune dementia"...
Do you recommend any medical management for patients with evidence of intracranial atherosclerosis without evidence for stroke?
I would focus more on primary prevention strategies, including lifestyle modifications and high-intensity statin therapy if LDL is elevated. The evidence supporting antiplatelet therapy for primary prevention in patients with stroke risk or intracranial atherosclerosis is either lacking or not stron...
Is a remote history of seizures a contraindication to dalfampridine for patients with multiple sclerosis?
Yes, any history of seizure is a contraindication to using dalfampridine. Patients with any history of seizures, even remote, were excluded from the clinical trials of dalfampridine, and it is listed as a strict contraindication on the FDA label.
How does comorbid epilepsy influence your decision on antipsychotic medications?
In general, epilepsy is not a contraindication to the use of antipsychotic medications if they are needed despite the known risk of lowering the seizure threshold. In general, the risk of seizures for most antipsychotics is low, though some antipsychotics, such as clozapine, olanzapine, and quetiapi...
How do the five-year ublituximab OLE results influence your treatment paradigm with anti-CD20 drugs for multiple sclerosis?
The 5-year ublituximab OLE strengthens my approach to using anti-CD20/high-efficacy therapies early in relapsing MS, including ublituximab as a long-term option. I would still put these data in the context of individualized risk stratification, such as immunoglobulin monitoring, infection vigilance,...