Neurology
Expert perspectives on neurological conditions, stroke management, movement disorders, and neuromuscular disease.
Recent Discussions
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 ...
Do you ever delay starting levodopa in patients with Parkinson's disease?
With LEAP and the 5-year follow-up study, we can feel comfortable deciding to start patients early on levodopa to maximize quality of life via motor symptom control. In this study, there were no differences in UPDRS scores, the prevalence of wearing off, or levodopa equivalent daily dose between the...
Are the laws regarding prescribing C-2 medications different for mail order pharmacies?
This is an important question and very timely considering the increase in mail order pharmacies. As a practitioner, you can prescribe medications to patients within your state through legitimate mail-order pharmacies located in different states because these pharmacies are licensed to operate acros...
Is there a role to continue aspirin in patients with myeloproliferative disorders who have never had a thrombotic event that are starting DOAC for stroke prophylaxis with newly diagnosed atrial fibrillation?
Aside from treating erythromelalgia, transient ischemic attacks (TIA) such as ocular migraine or documented atherosclerotic disease, aspirin has no role in the management of the MPN, despite the widely published recommendations for its use, particularly in so-called "high risk" polycythemia vera (PV...
Would you avoid combining JAK inhibitors with IVIG given the risk of thromboembolism?
The evidence for this is not very clear and limited. I think a honest discussion about the risk of JAKs and IVIG with the patient will be the most important; but as long as there is no clotting history or high risk of DVTs/PEs, and this is documented, and if a patient needs both medications to attai...
How do you counsel patients to reduce post-procedure side effects with onabotulinumtoxinA (Botox) for chronic migraine?
I caution them to not rub/itch the injection sites especially around the corrugators and frontalis sites for the rest of the day. Some people will recommend for 24 hours, but honestly while sleeping they could roll onto their face or rub their face anyway. I also do not recommend they do significant...
Do you always biopsy patients who present with classic skin findings of dermatomyositis?
I actually very rarely perform a skin biopsy to confirm dermatomyositis, much like I rarely biopsy classic psoriasis or classic eczema. Because I see dermatomyositis frequently enough in my practice, most times, I can confidently diagnose it by physical examination alone. I reserve performing skin b...
How do you manage the developmental and behavioral regression seen in Down Syndrome Disintegrative Disorder (DSDD)?
Thank you for this important question. One of the keys is to ensure that the change and regression being seen is DSDD or something else. Sometimes, this is confused with Alzheimer's seen in older individuals with Down syndrome. DSDD is seen in much younger people, late teens, and 20's as a more rapi...
How do you utilize FDG PET in the evaluation of dementias?
FDG PET is a regional map of glucose utilization in the brain. It tends to show reduced activity in specific areas in early Alzheimer's disease. It can complement MRI, which shows patterns of atrophy, rules out strokes, etc. Neither test is biologically specific for AD, which would require an amyloi...
Would you avoid triptans in patients with CADASIL?
Most patients with CADASIL have migraines with aura (including hemiplegic migraine and the severe form known as CADASIL encephalopathy). There is no evidence contradicting the use of triptans in CADASIL specifically. However, smaller studies and systematic reviews, and meta-analyses have shown that ...