Neurology
Expert perspectives on neurological conditions, stroke management, movement disorders, and neuromuscular disease.
Recent Discussions
What is the practical application of alpha-synuclein seed amplification assay CSF testing for the diagnosis and management of Parkinson's disease?
The α-synuclein seed amplification assay (αSyn-SAA) sensitively identifies patients with Parkinson’s disease from cerebrospinal fluid (CSF) samples. A positive αSyn-SAA is proposed to "biologically define" Parkinson’s disease and anchor disease staging. A positive αSyn-SAA identifies aggregated α-sy...
How do you manage a patient with inclusion body myositis?
IBM is a slowly progressive disease with no proven treatment to date, unfortunately. The goals of care are to delay decline and maintain remaining muscle strength. The cornerstone of treatment is physical/occupational therapy. Blood flow restriction seems to anecdotally help some patients, pending t...
How would you best evaluate and manage a patient with hemiplegic migraine and a history of ischemic stroke?
Without further information, I would say that these two conditions, hemiplegic migraine and ischemic stroke, have nothing to do with each other. Hemiplegic migraine should be evaluated and managed as migraine with gepants ideal for abortive treatment and CGRP antibodies for preventive treatment if n...
Do you see a current or future clinical role of neurofilament light chain in the diagnosis or workup of multiple sclerosis?
I see the neurofilament light chain as a helpful tool for future MS monitoring. I don't believe it has a role in the initial diagnosis, as CNS damage generally causes elevations. However, research is exploring its prognostic potential for aggressive or highly active disease during the initial work-u...
What prompts you to consider prescribing different formulations of benzodiazepines for a seizure rescue medication?
I take care of adults with epilepsy, so I can't speak to the pediatric population well. For patients, with prolonged GTCs or clusters of seizures and who were previously prescribed rectal diazepam, I have transitioned many of them to nasal rescue medications with good effect and feedback from caregi...
How frequently, and in which situations do you use quantitative EEG for the detection and/or monitoring of delayed cerebral ischemia after aneurysmal SAH?
Almost never.
For stroke patients with ablated paroxysmal atrial fibrillation without known recurrence and ICAD, would you recommend dual antiplatelet therapy or anticoagulation with or without an antiplatelet agent?
I would use DAPT for three months after the stroke. I do not see evidence for either anticoagulation or protracted DAPT for ICAD.
At what point should aspirin therapy for stable cardiovascular disease be discontinued in patients with a diagnosis of chronic cerebral microbleeds or possible Cerebral Amyloid Angiopathy?
I would continue low aspirin indefinitely.
How do you counsel patients on the outcomes of endovascular treatment of acute basilar artery occlusion?
I take a multidisciplinary approach towards counseling patients and their families about outcomes of endovascular treatment of acute basilar artery occlusion with the help of my interventional colleagues. We discuss with them the gravity of acute basilar artery occlusion (with disabling deficits) an...
What is the importance of finding a positive titer for TS-HDS and what treatment would be advised for these patients?
TS-HDS antibodies were first described by investigators from Washington University in St. Louis (2003) in five patients with painful sensory axonal neuropathy [1]. Further studies by the same group indicated that TS-HDS antibodies were associated with prominent neuropathic pain in the upper extremit...