Neurology
Expert perspectives on neurological conditions, stroke management, movement disorders, and neuromuscular disease.
Recent Discussions
How do you decide when to extend rituximab redosing beyond a 6 month interval for replasing multiple sclerosis?
In light of the published study, the discussion that I've had with patients revolves around utilizing CD19/CD20 counts to guide infusion frequency.
Do any subgroups of headache patients benefit more from neuromodulation devices compared to pharmacologic treatment?
I think patients with episodic cluster headache benefit greatly from external vagus nerve stimulation (gammaCore) use. This device aborts cluster attacks and has a preventative action as well for future attacks during a cluster bout. It allows for more than 2 treatments per day if the patient is hav...
How do you approach treatment of a glioblastoma in pregnancy?
Glioblastoma during pregnancy could be treated safely (to mother and fetus) with certain precautions and modifications. Collaboration and consultation with the patient’s obstetrician are essential. External shielding over the patient’s abdomen during treatment will decrease the external scatter radi...
How would you balance the risk of intracranial hemorrhage with thrombosis of mechanical valves in patients with infective endocarditis?
I'm not sure that there is a good answer to this question. If you look at it segmentally, clearly, patients with mechanical valves require anticoagulation, especially in the mitral position. In patients with endocarditis and native valves, whether or not to anticoagulate the patient after or before ...
In older adults with mild cognitive impairment, do you ever prescribe cholinesterase inhibitors and/or memantine?
This is a great question, and of course, "do you ever" will get you in trouble every time! Let me start by saying that, in general, I do not prescribe these drugs for MCI. Cholinesterase inhibitors are clearly indicated for the mild-moderate stage of some kinds of dementia (some people would include...
Cost and access aside, when might you prefer to start a patient on a triptan instead of a gepant for acute migraine therapy?
For me, the triptans are first line for migraine abortion. They have been on the market for well over three decades, we have a lot of experience with them, a lot of clinical-trial information is available on them, and also in special populations like teenagers and adolescents, as well as pregnant wo...
When should we order a DaT scan in patients suspected of Parkinsonism syndrome?
I believe that a good clinical examination can tell you if a patient has parkinsonism or not and that is the same answer one gets from a DaTscan. If the findings are too subtle, then re-examine the patient at intervals. So my answer is it is not necessary. I emphasize "my" answer because not everyon...
What are your recommendations for screening for sleep disorders in patients with IDD?
Sleep disorders are very common for people with IDD. One consideration, in particular, is in patients with Down Syndrome because of the shape of their mouth and large tongue. They have a very high rate of sleep apnea, obstructive sleep apnea in particular, which can be seen even in children. You wo...
Does global brain atrophy increase risk for intracranial bleed after fall in older adults?
It depends on the location of the hemorrhage. Subdural bleeding/hematoma is much more likely in elderly people with brain atrophy and a fall. Epidural hemorrhage is much more common in young patients. Intracerebral hemorrhage is more related to risk factors such as hypertension in middle age and amy...
Do 5HT4 agonists such as Metoclopramide actually lead to improvement in symptoms for patients with diabetes related gastroparesis?
Yes, sometimes when the gastroparesis is frequent or the symptoms are tough, I do use Reglan to help. By the time they wind up in the hospital, they are really willing to have me use anything on them that might help. I explain to every patient the side effects of Reglan, including tartive dyskinesia...