Neurology
Expert perspectives on neurological conditions, stroke management, movement disorders, and neuromuscular disease.
Recent Discussions
What are best practices to avoid misdiagnosis of multiple sclerosis in patients over 50 years old?
The onset of MS in patients over 50 years old is unusual. At the same time, there are a greater number of conditions, many of them quite common (i.e., chronic microvascular disease), that cause white matter disease that can mimic MS in patients over 50 years. Given that MS incidence is less and MS m...
What types of cardiac conduction abnormalities would lead you to avoid using tricyclic antidepressants?
I wouldn’t say it is a definite contraindication. But, I would want to be sure it is a longstanding patient and they are seeing a cardiologist regularly. Then, if the QTc were within reason, I would consider it; but it wouldn’t be high on my list of options.
Do you perform EMG and repetitive nerve stimulation in patients with ocular myasthenia gravis, particularly those who are AChR-positive, to assess for electrophysiological evidence of generalized disease?
There is already quite some literature about this question. I have included a recent reference that identified the predictors of generalization of ocular MG in 122 patients evaluated over 24 years in Malaysia. To summarize, in multivariate analysis, positive anti-AChR antibodies, positive RNS (OR 4....
How do you approach prescribing oxcarbazepine when the patient is on an oral contraceptive?
I first would want to ask what the reason is for oxcarbazepine and if there is a safer alternative for pregnancy. If it's for epilepsy, then I would go with lamotrigine. However, if the patient is stable on oxcarbazepine, then I would lower the dosage. I would strongly encourage an IUD, which is loc...
When do you attribute tremors to lamotrigine?
Not a side effect of LTG, but tremors are common and patients love to attribute everything to medications.
How do you counsel patients with epilepsy who are interested in purchasing a seizure dog?
I recommend getting a dog because it can enhance their quality of life, similar to enjoying a glass of wine or relaxing in a Jacuzzi :-). However, I do not consider it as a medical treatment so it should be at their expense.
Does anyone have concern with giving oral antiseizure medications to patients receiving TPN because of suspected malabsorption syndrome?
Any gastrointestinal issue that alters the transition and absorption of anti-seizure medications can affect seizure medication levels in the blood. So anything from bariatric surgery to malabsorption syndrome, from TPN to prolonged constipation. Essentially, these GI issues can alter the pharmacokin...
How long do you hold pyridostigmine prior to EMG / nerve conduction study in patients with suspected myasthenia?
At least 12 hours prior to repetitive stimulation or SFEMG, per AANEM practice parameter. In our lab we recommend 24 hours if possible. Geiger and Katirji, Myasthenia Gravis and Related Disorders pp 131–152
When do you consider pembrolizumab for the treatment of progressive multifocal leukoencephalopathy?
Progressive Multifocal Leukoencephalopathy (PML) treatment remains a big challenge; the different etiologies leading to PML (HIV, malignancy, primary immunocompromise, iatrogenic, etc.) play a role in the heterogeneity of approach and outcomes. It's helpful to think of potential treatments based on ...
How do you decide when to treat transient global amnesia with antithrombotic therapy?
Most cases are idiopathic and do not require treatment. However, as we had earlier reported in 1086, TGA secondary to ICH. Similarly, there can be other etiologies precipitating TGA, including ischemic stroke. Antithrombotic therapy will be useful in cases precipitated by an ischemic stroke/ TIA. Th...