Neurology
Expert perspectives on neurological conditions, stroke management, movement disorders, and neuromuscular disease.
Recent Discussions
Would you consider adding gabapentin off label for use in the treatment of glioblastoma at this time?
As an author on the paper, let me emphasize the findings and speculate on the implications. Recently, a number of laboratories have unraveled stunning preclinical and mechanistic findings demonstrating the ability of a subset of malignant glioma cells to usurp neuronal circuitry to promote tumor gro...
How have you refined your approach to disclosing a new diagnosis of dementia to a patient and their family?
I tend to think about this disclosure as layers of an onion. My general layers are: Explain what dementia is (and is not) and how we got to that diagnosis. Something like "You and your family have noticed memory problems, and the testing we just did confirms that. The memory problem appears signifi...
Have you had success with the Cala Trio device for essential tremor?
I have had a couple of patients who find it useful to calm their hand tremor for about 60-90 minutes after using the device. They may use it before they are going to an event, or before they plan to do an activity that involves the use of their dominant hand. (NOTE: You can only use it for one limb....
How do you approach anti-seizure medication management when it was started by another team for a seizure-naive patient before/after craniotomy for a tumor?
I would refer you to Dr. @Dr. First Last's answer to a similar question (https://www.themednet.org/question/15031) which beautifully summarizes data and guidelines. I usually counsel patients that everyone regardless of their medical history has a certain risk of seizure under physical stressors, th...
How do you utilize tools such as MMT8 in clinical practice when evaluating myositis?
We test hip flexors in every patient as well as the traditional muscles tested in MMT-8. I agree that it is not ideal that MMT-8 does not include these muscles. In fact, we test all large muscle groups - UE and LE as well as the finger flexors and extensors for complete assessment - then extrapolate...
How do you approach treatment of a glioblastoma in pregnancy?
Glioblastoma during pregnancy could be treated safely (to mother and fetus) with certain precautions and modifications. Collaboration and consultation with the patient’s obstetrician are essential. External shielding over the patient’s abdomen during treatment will decrease the external scatter radi...
How do you approach immediate management of paraspinal extramedullary hematopoiesis in patients with transfusion-dependent thalassemia when lesions are enlarging or causing neurologic symptoms?
In general, the goal of transfusion therapy in transfusion-dependent thalassemia (TDT) is to suppress ineffective erythropoiesis. It is the rationale for maintaining a higher pre-transfusion hemoglobin level, at 9.5-10.5 g/dl, well above the general threshold for PRBC transfusion used in oncology pa...
Over what time frame do EMG/NCS of AIDP patients normalize?
Answering this question is complicated due to the concept of reversible conduction failure in GBS. This concept was introduced by Kuwabara in 1998 (1) and it describes a subset of patients who often had preceding diarrheal illness from Campylobacter and very high GM1-IgG antibody titers, who would n...
How do you treat postherpetic neuralgia not adequately responding to oral neuropathic pain medications, lidocaine, and capsaicin?
By the Q, it is assumed all PO meds and topicals have failed. There are other compounding options but none with high-quality EBM support (i.e., gabapentin, TCA, camphor/menthol, pregabalin, ketamine, NSAIDs, CBZ…). Therefore, if PO and topical treatments fail, only procedures remain. IV therapy - l...
What considerations do you take regarding using valproic acid in men who are hoping to conceive with a partner?
This recommendation was based on an analysis of one retrospective study, with data being re-analyzed, in addition to case reports and animal studies. It seems to me that it's too soon to be making rash decisions about treatment, but informing patients of the possibility and uncertainty seems reasona...