Neurology
Expert perspectives on neurological conditions, stroke management, movement disorders, and neuromuscular disease.
Recent Discussions
How are you counseling your patients with ALS taking sodium phenylbutyrate and taurursodiol on continuing treatment in light of the negative phase 3 trial results?
AMX0035 also known as phenylbutyrate and taurursodiol received accelerated approval from the FDA in 9/2022 following a phase II trial demonstrating a preliminary signal of efficacy. A larger phase III placebo-controlled trial (PHOENIX trial) with >600 subjects was recently completed and, unfortunate...
What would be the main indications for opting for biosimilars over an original biologic, outside of insurance barriers?
A timely question, as we head to 2023! The only reason to use biosimilars is for the broad purpose of resource stewardship. There isn't a medical reason to prefer a biosimilar over a reference product (or vice versa), because if a product were found to have a significantly different therapeutic effe...
Do you recommend antiplatelet therapy for patients who have suffered stroke due to CADASIL?
That is a great question. There are no studies to demonstrate the efficacy and safety of aspirin for secondary stroke prevention specifically in CADASIL but this argument holds true to various other subgroups where aspirin is routinely used. I would favor using aspirin 81 mg daily in those who have ...
Which type of botulinum toxin do you use for the initial and sequential treatment of dystonia?
I prefer Xeomin based on relative cost, patient assistance programs, and sample availability to use at initial visits to start injections right away.
How do you utilize at-home seizure monitoring devices for your patients with epilepsy?
Absolutely! All video recordings are useful; home videos, cellphones, security cameras, etc.Benbadis, PMID 36891282
How do you approach treatment of patients with brachioradial pruritus?
In my experience, I have been asked to treat this condition twice so far, and the results were not great. As I consider it a neuropathic syndrome, I usually start with alpha-2-delta calcium ligands like gabapentin or pregabalin, and I may also try antidepressants like TCA or duloxetine. Some dermato...
What workup do you recommend for patients with symptoms suggestive of saphenous neuropathy?
In most cases of isolated saphenous neuropathy, the etiology is pretty straightforward, as it usually occurs after surgery or injury/trauma at the medial knee. Another common cause of more distal saphenous neuropathy is saphenous vein harvesting for CABG surgery (less common nowadays). When there is...
How do you counsel patients with postmedian sternotomy plexopathy?
Brachial plexopathy after median sternotomy is not very common. Its frequency varies in different studies but it's most likely between 0.5-5%. The most likely mechanism is traction of the anterior rami of the C8>T1 roots, often associated with a fracture or upward displacement of the first rib. A re...
Is there a role for inpatient EMG/NCS in patients who present with rhabdomyolysis with unclear etiology?
Great question. This is something we are frequently asked to do, but frankly, it is useless most of the time or perhaps it doesn't add any information to what we already know. When a person presents with myalgia, muscle weakness, and very high CK levels (defined as well over 10 times the upper limit...
What is your preferred VMAT2 inhibitor to treat tardive dyskinesia; tetrabenazine, valbenazine, or deutetrabenazine?
The base cost of tetrabenazine is much lower than valbenazine or deutetrabenazine, so I generally prefer it. However, due to insurance factors, valbenazine or deutetrabenazine can have lower out-of-pocket costs for some patients. From a purely clinical management perspective, tetrabenazine is much ...