Neurology
Expert perspectives on neurological conditions, stroke management, movement disorders, and neuromuscular disease.
Recent Discussions
Should a trial of cenobamate (Xcopri) be required before referring a patient for epilepsy surgery?
First, I would like to declare my conflict of interest that I am a speaker for Xcopri/SK Life. That being said, I only speak for things I truly use and believe in. My general teaching to learners is this (not saying there cannot be exceptions): I would not use Xcopri first line because there are bet...
How do you manage Moya-Moya disease medically for patients that are unable to receive EC-IC bypass?
It depends on the cause. Usually for patients either moya moya disease (in contrast to moya moya syndrome where symptomatic patients would benefit from EDAS or surgical management ) due to atherosclerosis or radiation induced if someone has continued ischemic events or silent infarcts on aspirin mon...
What has been your experience with CGRP-targeted medications for vestibular migraine?
As with every migraine treatment, there are non-responders, super-responders, and patients in between, but in my experience there is a clear signal that CGRP-targeted therapies are worth trying in vestibular migraine, particularly in patients with significant side effects from or contraindications t...
How do you manage orthostatic symptoms from autonomic neuropathy due to diabetes?
Try conservative measures such as hydration, pressure stockings, abdominal binder, exercises, and precautions prior to positional change. Addition of midodrine or other medications like flourinef and adjustment of doses of their antihypertensive medications. There are other medications that can be u...
What clinical features predict visual recovery from optic neuritis in NMOSD?
The main clinical feature associated with outcomes is the severity of vision loss at nadir. The more severe the vision loss, the higher the risk of poor outcomes. However, there can be patients with very severe vision loss (no light perception) who can still recover to 20/20. The correlation with ra...
How do you manage daytime somnolence without a clear cause?
One of the newer agents for wakefulness-promoting agents is Sunosi, which has a higher affinity for DAT and NET compared to any other agent (Wellbutrin, Provigil, Nuvigil, Adderall).
What workup do you recommend for otherwise healthy migraine patients that develop dizziness with episodes?
The workup should exclude other potential causes of vertigo including CNS disorders, and Meniere's disease, with neurology examination, MRI brain, videonystagmography, or electronystagmography. An article also evaluated vestibular migraine versus migraine without vertigo and found in several studies...
Is there a subset of patients you feel benefit from gabapentin for migraine prophylaxis?
Useful in patients with other comorbidities, such as fibromyalgia, neuropathy/neuralgia, anxiety, and sleep disorders. It is not the most effective migraine preventive, but when going down the list and the patient has tried others without enough relief, it may be an option to try. Daytime sedation, ...
How do you balance the risk of unnecessary treatment with acyclovir against the risk of delaying treatment in encephalitis cases where CSF pleocytosis is absent?
Treatment with IV acyclovir should start as soon as the diagnosis of Herpes simplex encephalitis is considered. Since the question states that CSF pleocytosis is absent, then CSF has been obtained. PCR for HSV should be obtained on that CSF. Early in my career, when acyclovir was investigational and...
Is a remote history of seizures a contraindication to dalfampridine for patients with multiple sclerosis?
Yes, any history of seizure is a contraindication to using dalfampridine. Patients with any history of seizures, even remote, were excluded from the clinical trials of dalfampridine, and it is listed as a strict contraindication on the FDA label.