Neurology
Expert perspectives on neurological conditions, stroke management, movement disorders, and neuromuscular disease.
Recent Discussions
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 ...
Would you consider anticoagulation for a young patient with a recent embolic stroke and newly diagnosed global cardiac hypokinesis with ejection fraction of less than 25%?
Yes, I would consider anticoagulation but the evidence is indirect. There is reasonable data in persons with heart failure with reduced ejection fraction that ischemic stroke is reduced with anticoagulation compared to antiplatelet therapy alone. But essentially all large RCTs are limited in that th...
How do you apply the 2HELPS2B score into clinical decision making for determining duration of cEEG testing?
I think there are two important issues to note: Always remember that the study was based on a 1-hour screening EEG, not a typical 20-minute routine. This may or may not make a difference in finding sporadic epileptiform abnormalities or BIRDs. Most of the time you do not need to use this score. Fo...