Neurology
Expert perspectives on neurological conditions, stroke management, movement disorders, and neuromuscular disease.
Recent Discussions
What are your top takeaways from AHS 2026 Scientific Session?
1. Earlier, phenotype-driven treatment of post-traumatic headache (PTH) is gaining momentum. Early treatment of post-traumatic headache using both acute and preventive strategies is increasingly favored, with management tailored to headache phenotype and risk factors for persistence. Nutraceuticals ...
How do you manage patients with chronic migraine as well as medication overuse headaches?
I agree with Dr. @Dr. First Last about the treatment for chronic migraine and MOH for patients on opiates and/or barbiturates. If they are taking frequent opiates, I prefer to have a pain management doctor detoxify them. In the past, I slowly decreased their medication while giving them long-acting ...
How do you counsel patients and caregivers about the trajectory of cognitive decline in Parkinson’s disease?
I address the subject of cognitive impairment fairly early in PD, since patients may notice mild deficits in multitasking and attention even within the first few years of diagnosis. Strategies such as making lists and breaking down individual tasks are effective in preserving independence. Worsening...
What patient factor led to performing a direct bypass rather than an indirect bypass for treatment of moyamoya?
The honest answer is that the evidence for selecting a direct or indirect bypass is limited and imperfect. There are no large randomized controlled trials and most data comes from retrospective cohort studies and meta-analyses. The key factors favoring direct bypass for moyamoya are age, cerebrovasc...
When do you select cholinesterase inhibitors vs NMDA-antagonist medications in patients with moderate Alzheimer’s dementia?
Cholinesterase inhibitors should be given to all patients (unless there is a contraindication) with Alzheimer's dementia since this class slows cognitive and functional decline as well as reduces all-cause mortality. Memantine, an NMDA receptor antagonist, is only FDA-approved for moderate to severe...
In patients with medically-refractory left temporal epilepsy, and left dominant language and memory, how should you approach surgical intervention?
The approach is tailored to the individual patient and their particular case. If the neuropsychological profile suggests they have significant deficits already in verbal memory, then the risk is usually not as significant for them to notice a clinically meaningful post-surgical decline as it is for ...
What are your preferred second-line medications for trigeminal neuralgia?
My first line is oxcarbazepine or carbamazepine. The second line is gabapentin. Then, in no particular order, baclofen and lamotrigine. Other options to try: pimozide, tizanidine, phenytoin, valproic acid. If 1 agent does not provide good control, I refer to a surgeon as we try a 2nd agent.
Under what circumstances would you place an EVD for Hunt Hess 1 or 2 patients with subarachnoid hemorrhage secondary to a ruptured cerebral aneurysm?
I would place an EVD for a ruptured aneurysm in patients who are clinically doing very well (Hunt Hess 1 or 2) if they have imaging evidence of ventriculomegaly.
Which patients do you find respond best to DHE nasal powder for acute migraine?
Unfortunately, I do not think that we can predict how patients will respond to any acute treatment. In patients who are naive to prescription abortive treatments in the US, we cannot predict which prescription abortive treatment will be effective, so the choice depends largely on the cost, insurance...
When do you consider prescribing memantine for migraine treatment?
Memantine is well-tolerated and shows excellent efficacy for prevention in both chronic and high-frequency episodic migraine. The main limitation is that it is not FDA-approved, and payors use this as an excuse to deny coverage in favor of less-well-tolerated, and often less efficacious but cheaper ...