Neurology
Expert perspectives on neurological conditions, stroke management, movement disorders, and neuromuscular disease.
Recent Discussions
How do you counsel patients on how to take abortive migraine medications during the prodrome period?
I do not routinely counsel patients to take abortive treatments during prodrome. It would depend on headache frequency. It would be hard if their headache frequency is high, such as >8-10 headache days per month, as they may run out of their abortive treatment. If they have low headache frequency an...
What level of relief do you target with acute migraine treatments before you think there is diminishing returns on trialing a different agent?
What I try to do abortively for my migraine patients is to find them a medication, currently generally a triptan or a gepant, that they tolerate without side effects and that consistently provides them with full relief of their headaches within 2 hours of treatment. Excellent tolerability is key bec...
When do you find benefit in sequencing different dopamine receptor blockers for emergency treatment of migraine?
I know that these medications given intravenously have been found effective abortively in randomized, double-blinded, placebo-controlled trials. Prior to the advent of the triptans in the early nineties, I often treated migraine headaches abortively with metoclopramide 10 mg orally, in 15 minutes, f...
How does osteoporosis or fracture risk affect your use of CGRP monoclonal antibodies?
As far as I know, this is a purely theoretical concern. Time will tell, and, in addition, we have very effective treatments available for osteoporosis, if this is an issue.
When should you seek hyperbaric oxygen therapy for patients with CRAO?
I usually pursue hyperbaric oxygen therapy within the 24-hour window from symptom onset for CRAO. This can be performed following TNK if given. In reality, though, there are multiple barriers to achieving this, including: Few centers offer hyperbaric oxygen therapy Labor intensive Difficulty with i...
What medications are preferred and contraindicated for insomnia in patients with a recent stroke or traumatic brain injury?
There are no clinical trials or level I evidence about insomnia management in stroke patients to delineate which medications are off the bat contraindicated. Data is variable on it- some based on mouse models, based on GABAergic medications. That said, the incidence of new-onset insomnia post stroke...
What is your approach to managing hallucinations in dementia?
Hallucinations in dementia can be categorized in many ways. To begin to conceptualize a management approach, it is useful to distinguish between various types of clinical presentation: pre-existing psychosis in a patient who then develops dementia; new onset psychosis in a patient with dementia; pre...
How do you counsel post-menopausal women interested in hormone replacement therapy as a treatment for multiple sclerosis?
No post menopausal treatment, including hormone replacement, can be construed as a disease-modifying treatment for MS. Dr. Avasarala
What have you found helpful in counseling patients with migraine reluctant to take preventative medications?
I think all of the responses here are very reasonable, but often the hesitancy is based less on resistance to a specific medication than on the self-stigmatization we see in patients with chronic headache, migraine, or other primary or secondary headaches. Because migraine is not a life-threatening ...
What treatment strategies can reduce the risk of post-concussion syndrome after an acute injury?
When evaluating a patient for their acute concussion, it is important to screen in the history for known factors that can prolong recovery if unaddressed. These include: sleep, hydration, mood issues, lack of activity for more than 48 hours, history of migraines, ADHD, anxiety, and depression. In th...