Neurology
Expert perspectives on neurological conditions, stroke management, movement disorders, and neuromuscular disease.
Recent Discussions
Do you find onabotulinumtoxinA injections effective for the treatment of trigeminal neuralgia?
I use botulinum toxin (off-label) for two face pain conditions, one rare, i.e., trigeminal neuralgia, and one common, i.e., temporomandibular disorder (TMD). For trigeminal neuralgia, I use a tiny needle to inject very small amounts of the toxin into the affected area of the skin and, if involved in...
What workup do you suggest for patients with concern for opsoclonus-myoclonus syndrome?
Opsoclonus-myoclonus syndrome (OMS) is characterized by fast and irregular multidirectional eye movements combined with generalized myoclonus and often ataxia. The common etiologies include paraneoplastic, autoimmune, and infectious/parainfectious causes. The approach in children and adults is diffe...
How do you treat persistent headache after a CVST diagnosis?
Follow the phenotype - usually migraine preventives, nerve blocks work well, or neuroleptics with gabapentin or Lyrica. Can be very difficult to treat.
At what point do you refer patients to neurology for evaluation of tics?
I will only refer to neurology if there are other neurologic signs or other movement issues.
Does a patient’s ability to get risk factors under control influence your recommendation for surgical vs. medical management of asymptomatic carotid disease?
Controlling risk factors is paramount, regardless of medical versus surgical management. For asymptomatic disease, primary prevention is the goal, as opposed to the secondary prevention measures we commonly reference.Since CREST-2 was published in late 2025, there has been a lot of discussion on how...
Do you counsel patients to acutely treat migraine with aura at the onset of aura or headache?
The timing of acute treatments for migraine attacks has been widely discussed for a number of years. Here are some principles: Once the pain begins, pain-free rates are higher if the patient treats early in the attack, while the pain is still mild. This is broadly true for triptans, NSAIDs, aspirin...
When have you found the Nidra TOMAC device to be helpful for refractory restless leg syndrome?
I have one patient who found it helpful with breakthrough symptoms in refractory RLS, but was unable to get enough coverage to continue using it.
How do you taper steroids for CAA-ri?
Thank you for the question. I have treated two patients so far for CAA-ri, one biopsy-confirmed. I also reviewed the literature on the entity. An oral steroid taper over several months is recommended to reduce the chances of recurrence. There’s no established standard timeline I have found. Monitori...
What is your approach to REM behavior disorder not adequately treated with melatonin and clonazepam?
Rule out comorbidities like sleep apnea or medications causing RBD. Optimize doses for melatonin and clonazepam, and consider dual therapy with these. Other options are gabapentin or pramipexole. Thanks,Sam Morkous
Do you consider bleeding risk in elderly, frail patients with atrial fibrillation to be similar for all NOACs?
I believe that apixaban carries a lower risk of bleeding, with particular reference to GI bleed, when compared to rivaroxaban and dabigatran. This is true in the population of AF patients at large and most probably in frail patients as well.