Neurology
Expert perspectives on neurological conditions, stroke management, movement disorders, and neuromuscular disease.
Recent Discussions
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.
When do you restart antiplatelet therapy in patients with hemorrhagic conversion of stroke?
This is a great question and not an uncommon clinical encounter for stroke neurologists. Indeed there is no one right answer. First, you may want to make sure that the observed ICH is true transformation of an ischemic lesion. Second, the degree of hemorrhagic transformation matters, I totally agree...
When do you incorporate Lyrica into the treatment strategy for patients with restless leg syndrome?
When it comes to treating RLS, my go-to medication is gabapentin. I rarely (and possibly could say never) prescribe dopamine agonists. Once you've treated one patient with augmentation and have seen the overwhelming discomfort it can cause a patient, you would likely feel how I feel about the dopami...
What preventive medications do you recommend for patients with cluster headaches?
As per the 2016 AHS guidelines, here are the recommended treatments for cluster headache prevention: Level A: Suboccipital steroid injection Level B: Civamide 0.025% 100 uL nasal spray daily Level C: Verapamil 360 mg, Lithium 900 mg, and warfarin (INR goal 1.5-1.9, reserved for refractory patients),...
Would you consider endovascular thrombectomy for acute stroke patients with large vessel occlusion (non-large core) but with poor functional baseline with mRS 3-4?
The Modified Rankin Scale (mRS) is a widely used tool for assessing functional status, ranging from 0 (no symptoms) to 6 (death). It provides a standardized framework for EVT decision-making based on a patient’s functional status and serves as a key criterion in EVT-related RCTs. While invaluable in...