Neurology
Expert perspectives on neurological conditions, stroke management, movement disorders, and neuromuscular disease.
Recent Discussions
How do you determine candidacy for selective dorsal rhizotomy in spastic cerebral palsy?
The answer to this question is simultaneously straightforward and yet hotly debated! I take a fairly practical and simple approach. Here is my take from a neurologist’s perspective: Any child with cerebral palsy with predominant spasticity (minimal to no dystonia) who has some ambulation that is imp...
What is your approach to light sedation in pediatric EMG?
How do you counsel patients with ALS on the benefits of enteral nutrition?
I agree with Drs. @Dr. First Last and @Dr. First Last but what I find frequently is that patients are reluctant to have PEG because of a number of psychological factors; fear of the surgery, fear of having a tube, fear of disease progression, fear that it will keep them alive indefinitely as in the ...
When do you recommend genetic testing in patients with neuropathy?
I would do genetic testing in any chronic progressive polyneuropathy that defies explanation after routine lab testing and is associated with at least one of the following features: positive family history early onset (<35-40) abnormal foot appearance-pes cavus, hammertoes motor predominant symptom...
What abortive and preventative treatments have you found to be helpful for a vestibular migraine?
I still treat using the same medication guidelines as for any migraine presentation. I am more likely to try venlafaxine in these patients. For off-label/guidelines, I am also more likely to try gabapentin and acetazolamide. In addition to pharmacologist management, I have a low threshold to refer f...
What imaging do you recommend for patients with suspected CSF leak?
I recommend getting an MRI brain.
What workup do you recommend on patients with suspected ischemic cranial nerve six palsy?
The conventional wisdom is that 90% of isolated ischemic (or "vasculopathic") 6th nerve palsies recover in 6 months or less. Diagnostic certainty of this etiology is increased if the patient is hypertensive, diabetic, or maybe has hyperlipidemia or tobacco use. The real problem for the non-ophthalmi...
How would you manage cognitive changes in a patient with memory impairment and significant brain atrophy with no diagnostic testing consistent with Alzheimer's disease?
It would depend on the clinical history, pattern of atrophy, and diagnostic biomarkers. If I had a patient with a typical clinical history of AD with progressive episodic memory loss substantiated by neuropsychological testing, IADL impairment, and hippocampal atrophy on imaging, I probably would no...
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...