Neurology
Expert perspectives on neurological conditions, stroke management, movement disorders, and neuromuscular disease.
Recent Discussions
What is your approach to management and surveillance in low grade traumatic blunt ICA injury?
For blunt cerebrovascular injury (BCVI), I use the Biffl scale to evaluate the extent of vessel trauma. The extracranial neck vessels, such as the cervical ICA or VA, are most commonly affected. The Biffl classification consists of five categories, with Grade 1 representing a low-grade injury. This ...
How often do you consider lamotrigine in patients with myoclonic epilepsy?
When considering juvenile myoclonic epilepsy, I frequently prescribe lamotrigine, especially if a person of childbearing potential. However, I counsel on the possibility that it may exacerbate or not completely control the myoclonic seizures. When considering progressive myoclonic epilepsies (PMEs),...
How do you approach the psychiatric symptom management of Huntington’s Disease?
The neuropsychiatric features of Huntington's disease are not as consistent as the motor or cognitive features. Still, they can cause substantial disability, be prominent early in the disease, and even occur as initial features. The majority of Huntington’s disease (HD) mutation carriers experience ...
What is your approach to DVT prophylaxis in patients who require IVIG but are at increased risk for thrombotic events?
I am unaware of any published data to guide the decision-making for this topic. Empirically, I recommend low-dose aspirin in patients >50 who have to get long-term IVIG especially if there are a lot of underlying risk factors for thrombosis like diabetes, immobility, etc. Again, this is not an evide...
What leads you to consider a non-oral form of levodopa for the treatment of Parkinson’s disease?
I agree with Dr. @Dr. First Last's excellent review. Consider non-oral forms of medication when there are concerns about dysphagia. Additionally, if the dosing frequency becomes too high (e.g., five times a day of levodopa), and the patient finds it difficult to maintain this schedule, consider long...
How do you approach driving clearance when someone has an RNS that is showing seizure activity, but neither the patient nor the patient's family is reporting seizures?
The answer may vary depending on the state, but from what I know, most states operate similarly. The determining factor isn't whether or not you're experiencing a seizure but whether you are having driving-impairing events. Therefore, the specific findings detected by the RNS (such as repetitive spi...
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...