Neurology
Expert perspectives on neurological conditions, stroke management, movement disorders, and neuromuscular disease.
Recent Discussions
What markers on EEG can help predict/detect postoperative or ICU-related delirium?
The interest in the use of EEG for delirium prediction/detection has increased in recent years. Postoperative delirium (POD) is common and is linked to adverse long-term cognitive outcomes. Preoperative EEG biomarkers of postoperative delirium may aid in risk stratification and implementation of pre...
What are some methods you use to limit or decrease the development of post-ICU PTSD in patients?
The following strategies are employed: While in ICU: For a patient who is intubated and sedated --> limiting sedation, promoting nighttime sleep (with NAP protocols, sleep aids etc.), addressing delirium and pain, (sleep wake cycles, minimizing narcotics and benzodiazepines, etc.), maintaining awake...
How does your decision to use high-efficacy disease-modifying treatments (HET) differ, if at all, when treating late-onset relapsing-remitting multiple sclerosis?
For late-onset patients who still have evidence of active disease (gad-enhancing lesions on MRI within the past 1-2 years), I will treat with HET, such as anti-CD20 therapy. Older individuals tend to have less ability to fully recover post-relapses than younger persons. I would be more hesitant to u...
How many times one can use IVIG in GBS?
There is currently no evidence supporting the efficacy of a second dose of IVIg or the addition of IVIg after PLEX in GBS. Clinical trials investigating complement inhibitors in GBS are ongoing, although conclusive results are pending. Encouraging results have emerged from a small Japanese study. Co...
In patients with indomethacin-responsive hemicrania continua, what are the optimal strategies for long-term dosing of indomethacin to maintain symptom control and minimize adverse effects?
I do consider the long-term use of indomethacin for whatever indication an issue because of potential gastrotoxicity and nephrotoxicity. The potential gastrotoxicity I addressed by combining the indomethacin with a proton-pump inhibitor (PPI) and checking the blood every 1/2 year for a decrease in h...
What are the factors that you would consider for the use of ESA in patients with anemia of CKD with a history of stroke or TIA?
Large clinical trials of ESA have indicated increased stroke risk with these medications with TREAT reporting the highest stroke incidence. In this study, "baseline history of cerebrovascular disease was a strong predictor of experiencing a stroke during follow-up; patients with a history of stroke ...
When do you stop dantrolene in a patient with neuroleptic malignant syndrome?
Dantrolene is typically used to treat severe NMS, although the data supporting its use is mixed. The biggest risk with the therapy is hepatotoxicity. It is reasonable to discontinue dantrolene once the hyperthermia and severe muscle rigidity have resolved, or earlier if there is concern for liver in...
When do you evaluate patients with Parkinson's disease and cognitive decline for concurrent Alzheimer's disease?
Parkinson’s disease (PD) often includes Alzheimer’s disease (AD) “co-pathology” in up to 80% of cases. This challenges the notion that PD is a synucleinopathy; it affects many proteins beyond α-synuclein. Thus, cognitive decline in PD may be associated with AD pathology, and one of the strongest pre...
What is your diagnostic approach to patients referred for central sleep apnea on PSG but normal overnight EEG and MRI?
In lab titration study, starting with CPAP (first-line treatment, can work in many cases). If remains, BiPAP-S titration is next (usually same night) with minimum EPAP titrated to prevent apneas and IPAP to prevent hypopneas but care as to avoid too much pressure support and over ventilation. Failur...
What baseline visual testing, if any, do you recommend at diagnosis for patients with multiple sclerosis who deny visual complaints?
I do a baseline eye exam with visual acuity, OCT RNFL, and fundus photos yearly. If I see any abnormalities, then I might consider a repeat exam in six months. If all is normal and there's no history of optic neuritis, I do yearly appointments. If they are on DMTs that have eye side effects, then I ...