Neurology
Expert perspectives on neurological conditions, stroke management, movement disorders, and neuromuscular disease.
Recent Discussions
How would you approach evaluation and treatment of a patient on pembrolizumab therapy who presents with symmetric, proximal, upper extremity and lower extremity painful weakness without an elevated CK?
Pembrolizumab, like other checkpoint inhibitors, is associated with a number of immune mediated neuromuscular syndromes including GBS/CIDP, a myasthenic syndrome, and myositis. A patient with symmetric proximal weakness and normal CK could have any of the above conditions. Normal CK does not exclude...
What is your approach to Tardive Dyskinesia when VMAT2 inhibitors are ineffective or unaffordable?
In established cases of tardive dyskinesia, in which withdrawal-emergent dyskinesia has been ruled out, and dyskinesia has persisted despite a sufficient washout interval after removal of the offending agent, VAM2 inhibitors such as valbenazine and deutetrabenazine are used for pharmacotherapy. If t...
How should the possibility of more chronic forms of autoimmune encephalitis influence our neuronal antibody testing thresholds for patients with slower progressive cognitive decline?
I will disclose that I am not a cognitive/behavioral neurology specialist nor a neuroimmunologist per se, but I would exercise caution in interpreting the conclusions of the paper that was cited. I went over the paper briefly, and I realized that 28 patients were diagnosed with "autoimmune dementia"...
Has the April 2026 Cochrane review on anti-amyloid antibodies changed how you counsel older adults with early Alzheimer's disease about whether to pursue treatment with lecanemab or donanemab?
The April 2026 Cochrane review has not fundamentally changed my counseling, but it has strengthened my caution. It reinforces that lecanemab and donanemab clearly remove amyloid, yet any average clinical benefit appears small and remains difficult to interpret confidently given the numerous threats ...
How do you approach timing of repeat plasma p-tau217/Aβ42 monitoring to detect conversion in MCI due to suspected Alzheimer’s disease?
I think that this question is purely “academic” and not relevant for clinical practice. If a patient has clear evidence of MCI based on history and bedside cognitive testing results, and ptau217/Αβ42 ratio falls within the intermediate/non-diagnostic range, then the appropriate course of action, if ...
When do you consider using stimulants in patients with cognitive impairments secondary to traumatic brain injury?
Perhaps most importantly, prescribing medication to address cognitive difficulties conveys hope to TBI patients that even if they have suffered structural brain damage, they can improve. Though the improvement may be fairly small, it can have important implications for better general functioning. We...
When would you consider testing for LGI1 antibodies in patients with unexplained neuropathic pain?
I would strongly consider testing CASPR2 and LGI1 antibodies in any patient with unexplained, subacute or chronic "neuropathic-sounding" pain (e.g. described as hot/burning, stabbing, "pins-needles", etc) especially if: exacerbated by heat, experienced diffusely in a "non-length dependent" pattern (...
How do you navigate conversations with patients who are reluctant to start high-efficacy DMTs due to infection risk?
The central message is that the choice is not between treatment and “no risk,” but between the risks of therapy and the risks of inadequately treated MS. Active MS can cause irreversible disability, and disability itself increases infection risk through impaired mobility, bladder dysfunction, dyspha...
How do you counsel patients with GCA on the benefits of steroids who have already experienced vision loss?
I first tell the patient they are at considerable risk for further visual loss in the same eye or the other eye over the next 1-2 weeks. I also let them know that, even though their risk of visual loss has been reduced, their best option for preventing further visual loss is immediately starting hig...
How do you implement antipsychotics in the management of agitation in Alzheimer’s patients?
The answer to how you implement antipsychotic medication in the management of agitation in a patient with Alzheimer's dementia involves several steps, outlined here: Ensure the agitation is not related to an acute medical condition and/or delirium. In this case, it is important to treat the underlyi...