Neurology
Expert perspectives on neurological conditions, stroke management, movement disorders, and neuromuscular disease.
Recent Discussions
When do you consider testing for anti-IgLON5 disease in patients with parkinsonism?
Anti-IgLON5 disease is a rare and intriguing entity with an expanding phenotype. It has features of both autoimmune (antibody against a cell adhesion molecule, response to immunotherapy in some cases) and neurodegenerative (tau deposition, gradual course) disorders. Unlike many other autoimmune pres...
How do you utilize corticosteroids in the management of CIDP?
The first question when discussing corticosteroids in CIDP is whether they should be a first or second-line treatment. Most guidelines and expert opinions consider both IVIG and steroids as first-line treatments for CIDP. In practice, many neurologists start with IVIG rather than steroids especially...
How do you utilize cytokine panels in your clinical practice?
It's become easier to order cytokine panels that get processed locally in my hospital. However, I think we're still far from knowing how to interpret these or make clinical changes as a result. While it's tempting to think, "If TNF is elevated, I will give the patient a TNF inhibitor, which will mak...
How do you distinguish between episodes of vascular steal and seizures in patients with an AVM?
Distinguishing between vascular steal and seizures in patients with AVMs can be challenging, but certain patterns may help. Vascular steal occurs when blood is shunted through the AVM nidus, bypassing the surrounding tissue and causing regional or global oligemia. The shunting can result in transien...
What is your disease modifying treatment of choice for a patient with relapsing remitting multiple sclerosis with treated, well controlled HIV?
Copaxone.
How does one interpret an SPEP showing potentially obscured but non-quantifiable M-spike however an IFE showing monoclonal protein?
Not all patients with monoclonal gammopathies make a detectable paraprotein on SPEP, or, in some cases like IgA gammopathies, it may be 'hidden' in the beta-region of the SPEP, or the rare IgD and IgE gammopathies may be too low to detect on the SPEP. In addition, for the 15-20% of patients who have...
Do you find IVIG to be an effective maintenance therapy for myasthenia gravis?
I do find IVIG to be helpful for maintenance treatment. I have several patients who report to me that they like the regimented nature of maintenance IVIG therapy, and there is a perception of predictable response (improvement in the days following a dose, followed by a plateau phase, followed by a p...
At what stage of the neuropathy workup do you screen for B6 toxicity?
In my experience, vitamin B6 deficiency due to poor oral intake is very uncommon. However, toxicity may occur with supplementation typically more than 2 gm/day, although chronic use of 50 mg/d may also be a cause. Vitamin B6 is present in many supplements and toxicity may cause direct damage to the ...
Do you warn patients about suicidal ideation when starting anti-seizure medications?
Yes. I always discuss with every patient the FDA's warning on increased risk for suicidal ideation and behavior when I start an antiseizure medication (ASM). Here are the reasons: Nowadays, patients go to the internet and review the adverse events of prescribed medications. In the case of ASMs, the...
Do you try to treat the acidosis resulting from acetazolamide in patients with IIH?
In general, I do not treat the acidosis of acetazolamide use as it occurs in everyone taking the drug. I only treat it if the symptoms of the acidosis interfere with the patient's activities of daily living.