Neurology
Expert perspectives on neurological conditions, stroke management, movement disorders, and neuromuscular disease.
Recent Discussions
Have you seen improvement in non-migraine-type headaches with the usage of drugs targeting CGRP?
For prevention, I have only used the 4 monoclonal antibodies or the 2 preventive gepants for documented migraine with and without aura, and also for cluster headache. I tend to use the one that is approved for cluster headache, eptinezumab, at the higher dose of 300 mg via IV infusion. For acute car...
When do you consider ambulatory EEG to assess for future seizure risk in someone with seemingly resolved acute symptomatic seizures?
Generally, when I am unsure if the known events are truly symptomatic or whether they may represent more of a risk of recurrence without the "acute" etiology.
How would you manage leptomeningeal disease of the spine in the setting of prior WBRT?
This is an extremely challenging clinical situation. The decision points depend on treatment goals: If the goal is local palliation, simply treat local areas of disease, e.g. spinal segments. If effective systemic therapeutic options are available, obviously consider those first, including intrathe...
Do you recommend life long aspirin 81 mg daily for non-specific T2 white matter hyper-intensities on MRI brain?
"Non-specific" means non-specific, indeed, and ASA risks of bleeding increase with age.
What behavioral interventions have you found most effective for managing self-injurious behavior in autism?
I think you'll find some good information in this related post: https://www.themednet.org/question/21993
How do you treat restless leg syndrome in patients with end-stage renal disease?
Based on the 2025 guidelines for RLS in patients with ESRD, I would recommend first checking iron studies and using IV iron sucrose if ferritin and transferrin saturation meet the criteria since the use of iron in this population has moderate certainty of evidence. If an iron infusion is not helpful...
How can you differentiate vessel wall enhancement related to CNS vasculitis versus atherosclerotic changes on MRA brain vessel wall imaging?
On MRA brain vessel wall imaging (vWI), central nervous system (CNS) vasculitis typically presents with concentric, uniform vessel wall enhancement and thickening, reflecting a diffuse inflammatory process involving the entire circumference of the vessel wall. In contrast, atherosclerotic changes mo...
What would prompt you to consider a sleep study for narcolepsy in a child or adolescent with new-onset hallucinations?
It would depend on other elements of the history. The age of the child, the timing of the hallucinations, particularly if they are associated with sleep, onset or awakening, other hypersomnia disorder symptoms, and the child's psychiatric history. Generally, I have a very low threshold for an in-lab...
How do you manage a patient who has history consistent with juvenille myoclonic epilepsy (JME) but does not have the classic polyspike pattern on EEG?
They should be managed like any idiopathic generalized epilepsy (IGE), since JME is but a specific subtype of IGE. SO, broad-spectrum ASMs only.
How do you approach weaning treatments for CIDP in remission?
I usually treat CIDP patients with IVIG first, unless there is a contraindication (e.g., history of anaphylactic reaction, very recent thrombotic event, or worsening kidney function in a person who is not yet on dialysis). I use the regimen proposed by the ICE trial, with a loading dose of 2 g/kg fo...