Neurology
Expert perspectives on neurological conditions, stroke management, movement disorders, and neuromuscular disease.
Recent Discussions
What is your approach for monitoring disability progression in patients with MS?
My standard approach to MS patient visits includes asking about past/chronic symptoms and whether they are stable or worsening. I also ask a review of (neuro) systems with particular focus on gait change, bladder dysfunction, and cognitive concerns, as these are strongly associated with disease prog...
Would you consider anti-IL-5 therapy (mepolizumab or benralizumab) to either prevent or treat the more severe manifestations of eosinophilic granulomatosis with polyangiitis, such as "infiltrative" (e.g., cardiomyopathy, pulmonary infiltrates, or gastroenteritis) or "vasculitic" (e.g., neuropathy, palpable purpura, or glomerulonephritis)?
Yes, I would consider early starting biologics for infiltrative EGPA.
What are your preferred beta blockers for migraine prevention treatment?
Beta blockers, originally developed for cardiovascular disease, were serendipitously discovered to reduce the frequency and severity of migraine attacks in the late 1960s. They remain the most widely used class of prescription preventive medications for migraine. Among beta-blockers, only propranolo...
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...
When would you consider using occipital nerve blocks to treat episodic cluster headaches?
For many years, it has been known that occipital nerve blocks containing steroids help for a few days in episodic cluster headache. But giving steroids by mouth for 3-5 days also works well and lasts for several days (for migraine attacks, I prefer occipital nerve blocks with local anesthesia and no...
Would you consider giving platelet transfusion in a patient with spontaneous intracerebral hemorrhage who is on an irreversible antiplatelet agent such as prasugrel?
This question seems logical, but in fact, there has been a clinical trial, the PATCH trial, that found no benefit of platelet transfusion; in fact, both deaths and poor outcomes were more prevalent in the platelet transfusion group than in the control group.
What treatments, after appropriate dose reductions/delays, do you offer for patients with oxaliplatin-induced cold allodynia/dysesthesia?
The primary treatments that I use for cold-induced oxaliplatin neurotoxicity are reducing the oxaliplatin dose and limiting the duration of oxaliplatin treatment (usually not more than 16 weeks of oxaliplatin-containing therapy in the initial line of treatment). Medications that are effective for pa...
How do you manage glioblastoma presenting with leptomeningeal dissemination?
Hospice is a very legitimate option. As physicians, we recommend this far too infrequently.
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...
How do you decide on the speed and target of blood pressure reduction for spontaneous intracranial hemorrhage?
I think the target and speed of blood pressure reduction in ICH depend on several variables, including initial SBP, clinical stability, hematoma size, and renal function. For patients presenting with SBP >220, I typically aim to lower the pressure to around SBP 160 over the first 12 hours, then grad...