Neurology
Expert perspectives on neurological conditions, stroke management, movement disorders, and neuromuscular disease.
Recent Discussions
In advanced Parkinson’s disease, how should clinicians assess symptom management and quality of life when patients are no longer able to communicate themselves?
This is challenging and why palliative care professionals are not familiar with neurodegenerative conditions, questions their efficacy in helping our patients. Using validated tools can help such as the ESAS-rPD. This scale can be used to assess response to interventions. Family members may be able ...
When do you recommend neuropsychiatric testing in patients with post-concussive syndrome?
I typically ask the patient what scenarios they experience cognitive issues. The various examples they provide usually relate to difficulty following conversations, forgetfulness within their working memory, and concentration/focus. In the post-concussion patient, they typically have developed adjus...
Have you found that migraine prevention treatments help non-specific vestibular symptoms in migraine patients?
I would say no to this question, so I would encourage further workup to identify the source of the vestibular symptoms.
What techniques do you use to help reduce procedural pain for headache injection treatments?
In my clinic, none of the providers, to my knowledge, use any specific techniques to reduce procedural pain. We do offer ice packs that patients can use during or after a procedure. We do Botox and pericranial nerve blocks. It would be difficult to coordinate using REN prior to procedures. I suppose...
What are the best practices for centers interested in providing anti-amyloid therapies for early Alzheimer's to ensure treatment delivery success?
I would use the same criteria for AAA treatment as those required for entering AAA clinical trials. Overall, our center has not had difficulty with ensuring that patients have timely MRIs before treatments. I enlist caregivers and patients to remind me when they are scheduled for their next infusion...
How are you using CYP2C19 genotyping for determining dual antiplatelet therapy for stroke?
In my practice, P2Y12 assays are the primary tool I rely on for guiding dual antiplatelet decisions. They are more widely available across clinical settings, whereas CYP2C19 genotyping requires infrastructure that is not always accessible outside of large academic and tertiary centers. CYP2C19 ident...
What pharmacological management do you consider for self-injurious behavior in patients with autism spectrum disorder?
This is a great question but requires a nuanced answer. It all depends. In short, what I think the clinician needs to know is whether the patient with ASD and self-injury has a treatable condition that is driving self-injury. Perhaps the most critical is whether the patient has a medical problem tha...
What is the role for inpatient limited-montage EEG recording?
Unequivocal YES! For purposes of detecting severe seizures that cause brain injury (i.e., high seizure burden, status epilepticus), a reduced montage EEG is more than adequate, performs equivalently, and in fact BETTER because of the Clarity AI algorithm which continuously monitors, interprets, and ...
How do you counsel patients who want to understand why sublingual cyclobenzaprine works to relieve their fibromyalgia pain and other related symptoms?
I like to set the stage with patients and make sure they clearly understand the link between sleep disruption and pain sensitivity, particularly in the context of central pain and fibromyalgia. One of my rheumatology attendings during fellowship used to explain this using classic sleep research from...
How do you counsel B cell-depleted multiple sclerosis patients on the benefits of regular COVID-19 vaccinations?
The fact that B cell-depleted patients render a blunted antibody response is not unexpected, but antibodies do not protect from viral infections - cells do. To measure a proper vaccine response, one wants to test T cells from patients to see if they are able to kill viral infected cells. This is wha...