Neurology
Expert perspectives on neurological conditions, stroke management, movement disorders, and neuromuscular disease.
Recent Discussions
Do you typically give GI prophylaxis when providing patients with steroid taper for status migrainosus?
I usually do a 3-6 day taper with prednisone, dexamethasone, or medrol dose pack for status migrainous. Occasionally, I have done a 12-day taper if the status migrainous is prolonged. I have not used GI prophylaxis.
What is your approach to a completely resected WHO grade II meningioma?
Any attempt toward a definitive answer to this question will at best be too cursory and at worst will jar Pandora’s box, but let’s give it a shot. How to optimally approach patients following gross total resection (GTR) of a WHO grade 2 meningioma remains sufficiently uncertain that 2 randomized tri...
Have you found that migraine prevention treatments help non-specific vestibular symptoms in migraine patients?
Yes, vestibular symptoms can respond to migraine treatments in patients with a history of migraine. SNRIs may help more with vestibular symptoms, or adding an SSRI to migraine prophylactic treatment can help.
What is the minimum headache or migraine days per month that you would consider starting preventative migraine therapy?
I would start thinking about preventive therapy when headaches get to be about 4-6 times a month. This is the number at which there is evidence that headaches will start to progress to chronic, which is considered to be 15 times a month. If a patient is increasing their abortive use or each migraine...
When have you found hypnosis helpful for parasomnia?
Usually, when treating NREM parasomnias such as sleep terrors and sleepwalking, the patient has to practice the techniques every night in addition to removing identified triggers.
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...
Do you view the difference between oral and sublingual cyclobenzaprine as clinically significant?
Yes. Oral cyclobenzaprine—a TCA analogue structurally identical to amitriptyline aside from a single double bond—has been used off-label for fibromyalgia for many years. Despite long-standing anecdotal benefit, a prospective placebo-controlled RCT showed only transient improvement at 4 weeks, with n...
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...
Do you recommend surveillance MRI for patients with MOGAD?
I do not recommend regular surveillance MRI for all patients. It really depends on the case as some MOGAD patients are very stable and don't even require treatment, whereas others can be quite aggressive and resistant to all treatments. The field is still emerging and our understanding of silent dis...
Would patients receiving targeted therapies be eligible for TTFields for brain metastases?
It is unknown whether NSCLC brain patients receiving targeted therapies should also receive TTFields. The most common patients would be those harboring EGFR mutations or ALK rearrangement. This would need to be studied and should not be presumed to be safe, as other unforeseen toxicities have occurr...