Neurology
Expert perspectives on neurological conditions, stroke management, movement disorders, and neuromuscular disease.
Recent Discussions
What is your first-line therapy for acute migraine treatment in the ER?
When guidelines are based on well-done, randomized trials, I tend to pay more attention to them. The most recent 2025 guidelines for treatment of migraine in the ER, first author Dr. @Dr. First Last, are excellent. Giving IV prochlorperazine cautiously may be a good start. Depending on the timing of...
Would you consider using DOACs as a bridge to warfarin instead of heparin or LMWH?
I would feel very comfortable bridging with apixaban, given its relatively short half-life and fairly quick absorption. I think it is very similar to bridging with Lovenox. More importantly, it usually takes at least 24 hours until heparin IV gets to therapeutic levels - it is often too high or too ...
What follow-up monitoring would you recommend for an adult with self-resolved idiopathic acute pupil-sparing third nerve palsy?
Pupil-sparing third nerve palsy is a relatively common presentation for neuro-ophthalmologists. They typically resolve completely by 12 weeks, and I will typically follow them until they are fully resolved, watching them once a month. The most common are microvascular and associated with a variety o...
Are there any serum markers that can be used to measure disease response to multiple sclerosis therapies?
sNfL/pNfL (neurofilament chain) is the most validated serum biomarker for MS disease activity and treatment response, but it is still not used as standard-of-care routine monitoring. It has several limitations, including nonspecificity as it can be elevated in cases of recent stroke/TIA, trauma, sei...
What are your ISC 2026 top takeaways?
The most important presentation was the OCEANIC-STROKE trial showing that asundexian plus antiplatelet therapy was superior to antiplatelet therapy for secondary stroke prevention. The drug will likely be FDA-approved and change clinical practice. The CHOICE-2 trial of adjunctive i.a. thrombolysis a...
When should surgical tumor resection be considered in patients with a low-grade glioma?
In adults with low-grade gliomas, there is substantial evidence suggesting that aggressive, early surgical resection improves outcomes and survival (Jakola et al., PMID 23099483). Historically, this has been particularly true for tumors that carry an IDH mutation or 1p/19q codeletion. This survival ...
How do you decide which patients would benefit from ECAP-closed loop spinal cord stimulation?
The EVOKE trial enrolled patients with chronic, intractable back and leg pain refractory to conservative therapy - including both persistent spinal pain syndrome (PSPS) type 1 and 2, with the following eligibility criteria: Overall, back, and leg pain VAS ≥60 mm Oswestry Disability Index 41–80 Stab...
What objective measures do you use to test for gait improvement after large volume LP for NPH treatment?
For objective measures, we use a timed 10-meter walk test before and after the large-volume tap test. It measures walking speed and step count. In addition, we use the Clinical Global Impression Scale of Change (CGI-C) by the clinician and by the patient.
For which patients would you consider offering a spinal cord stimulator for management of autonomic dysfunction?
The use of SCS for its effects on the autonomic nervous system is one of the more interesting applications of neurostimulation. We’ve known for years that SCS has a potent sympatholytic effect, and it has been used for peripheral and cardiac ischemia extensively. This use has been more prevalent in ...
How do you counsel patients who develop DVT or atrial fibrillation requiring anticoagulation when being treated with lecanemab or donanemab?
I believe until further data/studies are available, I would prefer not to use anticoagulation (at least long term) without comprehensive discussion among other treating physicians depending on the indication. The lecanemab appropriate use recommendations (Cummings et al., PMID 37357276) recommend ag...