Neurology
Expert perspectives on neurological conditions, stroke management, movement disorders, and neuromuscular disease.
Recent Discussions
In what cases, if any, do you find the use of naltrexone to augment lifestyle interventions (i.e., cognitive behavioral therapy, graded exercise therapy) for chronic fatigue to be helpful?
Absolutely no.
How do you manage stroke-related abulia?
There is surprisingly little recent evidence-based guidance on this front. Most therapeutic options focus on agonism or potentiation of dopamine in the frontal-subcortical circuits. Depending on the center and provider, options include psychostimulants. Any type might do but I prefer methylphenidate...
Do you recommend pre-emptive anti-epileptic treatment for patients with spontaneous ICH?
This question also applies to other scenarios such as ischemic stroke, brain tumors, and TBI. Many neurologists do not, but neurosurgeons often do. The evidence for this is very limited, so a reasonable answer is as follows. 1) Yes, if an EEG shows epileptiform discharges. 2) Evidence or not, modern...
How do you counsel patients and caregivers on dietary interventions for autism?
Whole foods diet, e.g., Whole30.com. All the information on that website is free. I will remove common food allergens. Remove all synthetic food dyes. 100% organic to protect the microbiome. Consider a spore-based probiotic for a few months.
What are outpatient strategies to mitigate taxane-induced peripheral neuropathy?
At the present time, there are no established means for preventing taxane-induced neuropathy other than limiting the dose that is given. In patients who are receiving taxane therapy and have developed significant neuropathy, ASCO guidelines suggest that discussion should be had with patients with re...
Do you test for genetic ataxias prior to making a diagnosis of cerebellar-type Multiple System Atrophy?
It depends. If there is no family history of ataxia, neuropathy, significant dysautonomia, or RBD, then I do not. I might consider getting a DaT scan or Synone skin testing to further reinforce the diagnosis of MSA-C (knowing that a DaT scan may be negative here, too). If, on the other hand, there i...
How do you counsel patients and doctors on antibiotic avoidance in myasthenia gravis?
I generally recommend avoiding aminoglycosides and most macrolides in MG. The rationale is that there are alternative effective antibiotics for most of the infections covered by the above categories. With fluoroquinolones, however, it's not that simple, because there are some infections that are uni...
Do all patients referred for acute symptoms of TIA or minor stroke require additional imaging with CT/MR angiography, in addition to admission/observation?
Regardless of whether symptoms are minor, improve, or resolve, it is important to obtain vessel imaging to evaluate the underlying head and neck vasculature, as this may guide additional treatments (e.g., carotid revascularization, ICAD management, dissection management, carotid-web management, etc....
Will you do Botox or use injectable CGRP monoclonal antibodies in patients on anticoagulation?
I use Botox and injectable CGRP monoclonal antibodies in patients on anticoagulation. I do not check INR prior to using Botox if patients are on AC. I have been practicing headache medicine since 2013 and have never noticed increased bleeding in patients on AC during a Botox procedure. The injection...
How do you counsel patients on the benefits of immunotherapy for anti-MAG neuropathy?
Not a simple issue. True anti-MAG neuropathy is typically indolent, primarily distal sensory. No treatment has been identified for the neuropathy alone, although there have been and continue to be some treatments in development. So the treatment for anti-MAG neuropathy rests on the treatment of the ...