Neurology
Expert perspectives on neurological conditions, stroke management, movement disorders, and neuromuscular disease.
Recent Discussions
What is your approach to DVT prophylaxis in patients who require IVIG but are at increased risk for thrombotic events?
I am unaware of any published data to guide the decision-making for this topic. Empirically, I recommend low-dose aspirin in patients >50 who have to get long-term IVIG especially if there are a lot of underlying risk factors for thrombosis like diabetes, immobility, etc. Again, this is not an evide...
What leads you to consider a non-oral form of levodopa for the treatment of Parkinson’s disease?
I agree with Dr. @Dr. First Last's excellent review. Consider non-oral forms of medication when there are concerns about dysphagia. Additionally, if the dosing frequency becomes too high (e.g., five times a day of levodopa), and the patient finds it difficult to maintain this schedule, consider long...
How do you approach driving clearance when someone has an RNS that is showing seizure activity, but neither the patient nor the patient's family is reporting seizures?
The answer may vary depending on the state, but from what I know, most states operate similarly. The determining factor isn't whether or not you're experiencing a seizure but whether you are having driving-impairing events. Therefore, the specific findings detected by the RNS (such as repetitive spi...
How do you utilize corticosteroids in the management of CIDP?
The first question when discussing corticosteroids in CIDP is whether they should be a first or second-line treatment. Most guidelines and expert opinions consider both IVIG and steroids as first-line treatments for CIDP. In practice, many neurologists start with IVIG rather than steroids especially...
How do you utilize cytokine panels in your clinical practice?
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...
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.