Neurology
Expert perspectives on neurological conditions, stroke management, movement disorders, and neuromuscular disease.
Recent Discussions
Have you changed your practice in treating CRAO with IV thrombolysis?
The recent THEIA trial had a limited sample size to draw conclusions, even though there was a non-significant trend of improved visual acuity initially in the thrombolysis group. Even the TenCRAOS trial had a small sample size with recruitment challenges, where subtle small differences cannot be acc...
How do you taper dopamine agonists for RLS in patients experiencing augmentation?
Slowly. Abrupt withdrawal from agonists can cause mood dysregulation (dopamine agonist withdrawal syndrome) and in RLS patients, would likely exacerbate RLS symptoms.Adding gabapentin to the regimen prior to slow withdrawal of the agonist would probably help avoid worsening RLS symptoms during this ...
What is your strategy to help prevent paclitaxel-related neuropathy?
There are no proven strategies for prevention of CIPN and the use of these supplements is not recommended. Some supplements such as acetyl carnitine can actually worsen neuropathy outcomes and some supplements such as B12, vitamin C, and others may negatively interact with chemotherapy and worsen di...
What experience do you have with paralysis or myasthenia-like symptoms developing on temozolomide?
This is not an established toxicity of temozolomide and would warrant further investigation.
Do you ever consider steroid treatment for grade 1 ICANS without CRS?
We typically do not, but these patients receive neurology consultation and are very closely monitored.
In patients presenting with disabling acute ischemic stroke symptoms early in the therapeutic window, would you consider anticoagulation reversal to enable administration of intravenous thrombolytics?
In short, 'no'. For patients who have a large vessel occlusion, there is the option of proceeding directly to EVT without thrombolysis. We know from the direct EVT trials that although concurrent or sequential thrombolytic drug treatment followed by EVT is better, it is better only by a small amount...
What are your preferred treatments for vasospasm in the setting of RCVS?
In the inpatient setting, I like nimodipine. However, in the outpatient setting, patients may not want to, may not be able to, or may not remember to reliably take the medication every 4 hours. As you can imagine, this would be quite disruptive to their overall daily schedule and possibly their qual...
How do you decide on the next therapy for post-ICI triple M syndrome (myositis/myocarditis/myasthenia) after steroids, PLEX, and IVIG?
The short answer is that there is no standard of care, and no way to reliably predict which of the third-line treatments will work best for each individual. As an introduction, 3M syndrome is a horrible combination of 3 immune-related adverse events (iRAEs) after ICI exposure for cancer, including m...
Do you recommend endovascular therapy in patients with isolated posterior cerebral artery stroke?
The general approach to acute ischemic stroke - (1) assess your patient for clinical suitability for EVT and then (2) look at your imaging - still applies to ischemic stroke due to PCA occlusion. For example, if the deficit is only a quadrantanopia in an elderly patient who already does not drive, t...
When should you avoid initiating beta blockers in a patient with myasthenia gravis?
In general, my opinion is that there are very few medications that are absolutely contraindicated in MG, and those are: botulinum toxin, aminoglycosides, macrolide antibiotics, and possibly magnesium supplements (unless the patient has dangerous hypomagnesemia). Many other drugs, especially drugs us...