Neurology
Expert perspectives on neurological conditions, stroke management, movement disorders, and neuromuscular disease.
Recent Discussions
What is your approach to the management of persistent encephalopathy following ischemic injury to bilateral thalami?
This is a challenging case to manage and can be resistant to interventions. I am assuming when you say encephalopathy, you are meaning disorders of consciousness (DoC), in which the patient is comatose or somnolent. In those cases, generally speaking, we will start dopaminergic medications, usually ...
What are some alternatives to dexamethasone for brain edema in patients who are allergic, have an intolerance, or refuse the medication?
Dexamethasone is one of the most frequently prescribed medications in neuro-oncology clinics. Dexamethasone is often favored over other corticosteroids owing to its lower mineralocorticoid effects and high potency as well as essentially 1:1 oral to IV ratio meaning that we use similar IV and oral do...
Do you often encounter compressive neuropathies such as carpal tunnel syndrome in patients with spastic cerebral palsy?
The issue of movement disorders and spasticity, in particular, is very problematic in people with cerebral palsy. I think, unfortunately, what often happens as these patients grow into adults, is that conditions like compressive neuropathies are simply not thought about. As people with cerebral pals...
How do you counsel patients on the cognitive effects of DBS for Parkinson's disease?
Cognitive effects after DBS procedures are multifactorial. Many times, patients are affected by Parkinsonian motor manifestations, such as dyskinesia or tremor, and treating these problems successfully with DBS and subsequent medication adjustments can help substantially with cognitive performance. ...
How do you manage levodopa in a patient with Parkinson's and RLS with augmentation?
Levodopa is known to cause augmentation or worsening of restless leg syndrome (RLS) symptoms (Högl et al., PMID 19756826). There are varying reports of RLS correlation with Parkinson disease (PD) with most studies noting an association (Ondo et al., PMID 11890847; Peralta et al., PMID 19691124; Calz...
What is your approach to evaluating Tardive Dyskinesia in nonverbal patients?
Nonverbal patients can still be affected by TD, so if there is a significant functional impact, treatment can still be offered. If a patient is completely unable to communicate, it is difficult to assess for side effects or symptomatic improvement, so the risk-to-benefit analysis would be largely un...
How do you counsel glioblastoma multiforme patients on which types of clinical trials to pursue?
This is a great question! In general, I think that a clinical trial gives someone access to promising therapies (and of course glioblastoma is an aggressive tumor for which we have no cure), but enrolling in one may not feel like the right decision for all patients (for a variety of reasons). I thin...
What is your approach to seronegative presumed pediatric autoimmune encephalitis?
My approach is to prove that the patient has that condition through objective testing (labs, imaging, tissue sampling) instead of having a "presumed" diagnosis as I do not treat patients based on presumptions...
How do you treat rotational vertebral artery syndrome?
I usually take a multidisciplinary approach to treating these patients. I start the patient on an antithrombotic [at least antiplatelet and if any thrombus due to stasis (or significantly slow flow in those who have had a stroke due to thromboembolism from the area of stasis specifically) then antic...
In what circumstances would you consider use of IDH inhibitors in high-grade astrocytomas?
Please forgive me for the length and directness of my response, but I believe it is important to first go over the INDIGO trial and explain why, in my opinion, it was a highly questionable study, with multiple significant methodological flaws and dubious evidence of Vorasidenib's efficacy.INDIGO tri...