Neurology
Expert perspectives on neurological conditions, stroke management, movement disorders, and neuromuscular disease.
Recent Discussions
Do you ever use amantadine or modafinil to aid in the rehabilitation of patients with ischemic strokes?
No randomized controlled trials of amantadine or modafinil for the treatment of disorders of consciousness (DoC) after ischemic strokes have been completed. A retrospective study of ICU patients with DoC after ischemic stroke found that amantadine, modafinil, or a combination may be useful in improv...
What is your approach to discontinuing immunotherapy in stable MOGAD?
IfIf stable on therapy x 1 year I will discontinue without taper and follow closely
Are triptans contraindicated for migraine treatment in patients with sickle cell disease?
Although triptans are not formally contraindicated in sickle cell disease, many SCD patients have silent cerebral infarcts and significant cerebrovascular vasculopathy, which are absolute contraindications to triptans. A thorough assessment for silent strokes, such as MRI/MRA, is recommended, and ex...
What is your approach to determining eligibility for hospice in persons with Alzheimer's disease?
We strongly recommend early hospice enrollment for patients with dementia as soon as they meet eligibility criteria. In our approach, we carefully evaluate both functional and cognitive decline. One area that is often overlooked, however, is nutrition. When a patient with Alzheimer’s disease begins ...
Can needle EMG or nerve conduction studies cause transient MRI abnormalities, such as apparent inflammation, edema, or enhancement of a nerve, that could be mistaken for neuritis on subsequent imaging?
Yes—needle EMG can create small, transient post-procedure MRI/MR-neurography abnormalities at needle insertion sites, including focal T2/STIR hyperintensity interpreted as edema and occasional small hematoma, which can potentially be mistaken for local pathology if the timing is not recognized. In a...
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 long can demyelinating findings persist on nerve conduction studies (NCS) after AIDP illness?
This question was studied in a retrospective review in Muscle and Nerve (Guémy et al., PMID 36814082) in a group of patients with AIDP. At least one feature of demyelination was present in 23% of the cohort (14 out of 61) up to 2 years after the onset of the AIDP-like illness. Using the EFNS-PNS cri...
Is there a subset of patients you feel benefit from gabapentin for migraine prophylaxis?
As far as I am concerned and based on my experience using gabapentin in clinical practice and clinical research, it is only consistently helpful for the treatment of insomnia if it consists predominantly of problems falling asleep, not due to restless legs syndrome or a delayed sleep phase disorder.
What are your go-to options for managing ICU delirium in patients with contraindications to antipsychotics?
Evidence for Ramelteon (Yu et al., PMID 36726202)Delirium with behavioral disturbances Depakote Clonidine Propranolol, especially with TBI Non pharmacological Make sure they're closer to the nursing station. Constant re-orientation. Shades open during the day and close at night. Bring anything they ...
When do you restart anticoagulation in patients with atrial fibrillation who just had an ischemic stroke?
The recent ELAN trial (Fischer et al., PMID 37222476) and now the published CATALYST meta-analysis (Dehbi et al., PMID 40570866) all support the concept that early anticoagulation (within 4 days of stroke) with a DOAC is safe and effective. There appears to be no interaction with clinical factors su...