Neurology
Expert perspectives on neurological conditions, stroke management, movement disorders, and neuromuscular disease.
Recent Discussions
How do you approach the diagnostic workup for patients with suspected Fabry's disease?
Quite simple- if you suspect the disease in a male, you can measure alpha galactosidase enzyme activity in blood; if normal the diagnosis is unlikely, if abnormal you can confirm with GLA gene sequencing. If you suspect the disease in a female (manifesting carrier), you should directly sequence GLA ...
What is your approach to determining if an SPEP abnormality is causal or coincidental in peripheral neuropathy work up?
Because the answer to this question is long and complex, I would refer to a nice recently published review of the topic in Continuum (AAN) which provides a detailed discussion and nice algorithms to investigate the monoclonal gammopathy and determine a possible relationship to the neuropathy (or lac...
Does aerobic exercise lead to any change in ability to perform ADLs in patients with Parkinson's disease?
In this article, improvement in overall fitness was seen in patients in the aerobic exercise group. I could not find a scale that specifically looked at ADLs in this study.In a meta-analysis and systematic analysis published in NPJ Parkinson's Disease, authors found aerobic exercise had beneficial e...
Are there specific sections of the MoCA which showed less change in patients in the exercise group?
We did not look into specific sections of the MoCA to test whether exercise influences certain cognitive domains more than others. However, with the use of a computerized behavioral task, we were able to show that patients who exercised became better at exerting control over their behavior. Specific...
What level of exercise do you recommend in patients with Parkinson's disease?
I recommend aerobic exercise for at least 30 minutes/day, 5 days a week. These recommendations are of course based on patient's physical ability. I usually advise using a stationary bicycle and if that is not possible, a recumbent bicycle for aerobic exercise. This way if there is bad weather or una...
Does time since diagnosis play a role in benefits of exercise when studying patients with Parkinson's disease?
That is an excellent question. This was not addressed in this article. I would think that, and I think there are studies to suggest that the benefits of exercise may be more in the early to mid-stage of the disease when gait is intact.
Do you recommend any dietary modifications for patients with HSAN1?
HSAN1 is a hereditary autosomal dominant sensory and autonomic neuropathy caused by SPTLC1 or SPTLC2 mutations in the serine palmitoyl transferase enzyme. This enzyme is critical for proper formation of sphingolipids which are essential components of peripheral nerve axons. Mutations in the SPTLC1 o...
How do you counsel pregnant patients with myasthenia gravis?
I generally discuss an action plan with female patients considering pregnancy, particularly emphasizing the importance of managing MG symptoms beforehand. Evidence indicates that patients under good control before pregnancy usually remain stable throughout. Treatment for MG during pregnancy typicall...
How do you diagnose and treat patients with cervicogenic headache?
I struggle with cervicogenic headaches. Conceptually, it is a secondary headache disorder with headache attributed to a disorder of the cervical spine and its component bony, disc, and/or soft tissue elements. The ICHD-3 criteria help make this causal attribution. If a headache begins in relation to...
Should the schedule of disease modifying therapy medication administration be changed if patient has received high dose steroids for an MS exacerbation?
This is an interesting question. I usually do not withhold or change the schedule of disease-modifying therapy while treating acute relapses with high-dose steroids. This overlap may be a concern for agents such as anti-CD20 monoclonal antibodies in which induced inflammation and subsequent cell dea...