Neurology
Expert perspectives on neurological conditions, stroke management, movement disorders, and neuromuscular disease.
Recent Discussions
What would be your approach to the consideration of the use of antiamyloid monoclonal antibodies for nonamnestic Alzheimer's disease with a positive biomarker for brain amyloid pathology?
Because treatment appropriateness is based on the stage of cognitive impairment, we base our evaluation on whether the patient meets criteria for mild cognitive impairment or early-stage dementia. We do not use cognitive testing cutoffs, even in amnestic Alzheimer's disease, as staging accounts for ...
When should you suspect that palatal tremor could be a functional neurologic disorder?
Essential palatal myoclonus (also called essential palatal tremor) is idiopathic, often considered functional (psychogenic) in many cases, and typically involves rhythmic contractions of the tensor veli palatini muscle, whereas non-essential (symptomatic) palatal myoclonus is secondary to identifiab...
How do you approach workup and management of hyperhidrosis?
Oral anticholinergics
Do you routinely administer desmopressin to patients with intracerebral hemorrhage who are also on anti-platelet therapy?
I routinely administer desmopressin in patients presenting with ICH if they are on dual antiplatelets but not single antiplatelets. The evidence for this is limited, but it has not revealed any harm.
How does topiramate fit into your treatment paradigm for prevention of episodic migraine?
1.) Topiramate has excellent evidence for efficacy, including better than the evidence for beta blockers, amitriptyline, and venlafaxine, which this guideline recommended as first-line. I have a hard time saying these meds should be recommended as first-line over topiramate due to the reliance on ol...
Would you consider intravenous thrombolytics for an acute spinal ischemic stroke?
I would not use thrombolytic therapy for an acute spinal ischemic stroke. There is no good information about the benefits and risks of this therapy in this clinical situation.
When do you consider discontinuing disease modifying therapies for multiple sclerosis?
Certainly, age is increasingly being defined as a factor that influences disease evolution. There are some articles that suggest 55 years might be a 'turning point' to discontinue disease modifying therapies but my preference, particularly when there is no radiological or clinical worsening over the...
What biomarkers best predict the response to B-cell depleting therapies in MS?
I would say that checking CD19 counts is helpful to monitor response to B-cell therapy, but it is not useful in predicting response. I used to check this before and after starting B-cell therapies, but ultimately did not find it useful. I now only check it if someone has breakthrough disease activit...
What have been your experiences with anti-CGRP therapies for hemiplegic migraine?
I think it is important to point out that true hemiplegic migraine is very rare. Many patients are incorrectly diagnosed with (sporadic) hemiplegic migraine, and actually have sensory aura or *MUMS. These patients can absolutely have CGRP-targeted medications.In terms of true hemiplegic migraine, I ...
How do you approach the management of poorly controlled migraines during pregnancy?
This is an excellent question and area of frequent discussion. You can start with Lidocaine nerve blocks: occipital, supra-orbital, and temporal. Sometimes, just IV fluids will help for acute migraines. Other options include Reglan, caffeine, and APAP. If in the second trimester, I will do steroid t...