Neurology
Expert perspectives on neurological conditions, stroke management, movement disorders, and neuromuscular disease.
Recent Discussions
Under what circumstances do you decide to place an EVD for patients with cerbellar ischemic stroke?
Although placement of an EVD in a patient with cerebellar infarction can be lifesaving, I rarely use it as a sole treatment for that condition due to the risk of upward herniation. Typically, when the cerebellar infarction has created enough mass effect to cause hydrocephalus, the patient also requi...
Will OCEANIC-STROKE change your approach to secondary stroke prevention for high-risk TIA and non-cardioembolic stroke?
I would consider the OCEANIC-STROKE study a major contribution to the literature on secondary stroke prevention. The study included only noncardioembolic and nonlacunar strokes, with evidence of intracranial or general atherosclerosis (at least one of the above categories). It showed a significant b...
Do you utilize neurofilament light chain to guide your treatment strategy for multiple sclerosis?
I do not routinely use serum neurofilament light chain levels to guide treatment decisions. The vast majority of my patients with relapsing-remitting MS are already on high-efficacy therapy, so it would not change my DMT management. In patients with progressive disease, the NfL trend over time is on...
Would you consider adding gabapentin off label for use in the treatment of glioblastoma at this time?
As an author on the paper, let me emphasize the findings and speculate on the implications. Recently, a number of laboratories have unraveled stunning preclinical and mechanistic findings demonstrating the ability of a subset of malignant glioma cells to usurp neuronal circuitry to promote tumor gro...
What experience do you have with paralysis or myasthenia-like symptoms developing on temozolomide?
I have not had a patient with this adverse effect. Mechanistically, I am not sure how this would be explained by the drug. I would recommend a workup for other contributing factors. I was unable to find any reports in the literature of TMZ-induced MG.
When do you consider testing for anti-IgLON5 disease in patients with parkinsonism?
Anti-IgLON5 disease is a rare and intriguing entity with an expanding phenotype. It has features of both autoimmune (antibody against a cell adhesion molecule, response to immunotherapy in some cases) and neurodegenerative (tau deposition, gradual course) disorders. Unlike many other autoimmune pres...
How, if at all, do you anticipate incorporating Pixclara PET into the evaluation of suspected recurrent or progressive glioma after treatment?
In pediatric high-grade glioma, I think there's an opportunity to use it selectively when conventional MRI leaves uncertainty between true progression and treatment-related change (pseudoprogression), rather than as part of routine surveillance. The clearest need is in diffuse midline glioma after r...
What types of cardiac conduction abnormalities would lead you to avoid using tricyclic antidepressants?
I wouldn’t say it is a definite contraindication. But, I would want to be sure it is a longstanding patient and they are seeing a cardiologist regularly. Then, if the QTc were within reason, I would consider it; but it wouldn’t be high on my list of options.
Has the April 2026 Cochrane review on anti-amyloid antibodies changed how you counsel older adults with early Alzheimer's disease about whether to pursue treatment with lecanemab or donanemab?
The April 2026 Cochrane review has not fundamentally changed my counseling, but it has strengthened my caution. It reinforces that lecanemab and donanemab clearly remove amyloid, yet any average clinical benefit appears small and remains difficult to interpret confidently given the numerous threats ...
How effective have you found acupuncture for treatment of chronic migraine?
I would prefer to educate a patient interested in acupuncture for severe headaches about all the other treatments that are available. However, if they would still like to pursue acupuncture, I would support them, just like Dr. @Dr. First Last would say. Some patients can get better, although it is n...