Neurology
Expert perspectives on neurological conditions, stroke management, movement disorders, and neuromuscular disease.
Recent Discussions
If memantine were started 6 weeks after completion of radiation to base of skull, would you expect any potential benefit?
There is currently no credible high-quality data to support the use of memantine in focal brain RT for primary or metastatic brain tumors, regardless of whether the hippocampus is in the radiation field. Therefore, I would not prescribe memantine during or after RT in such a clinical setting. In my ...
Do you use vitamin B6 to help with Keppra irritability?
I am an adult epileptologist and do not routinely prescribe pyridoxine for neuropsychiatric adverse effects of levetiracetam. I do see this done a lot more in the pediatric population, where there is more data than is available in the adult population (though still not of very high quality). Anecdot...
How will you counsel patients regarding ARIA?
It is possible that with real-life experience and further study, blood biomarkers will be validated as early detection signs of ARIA, but right now we are left with MRI. I believe that we need a lot more real-world data about these drugs before we consider alternative ways to diagnose and screen for...
Do you screen adults in your practice with sickle cell disease for silent cerebral infarcts?
The details of the ASH guidelines regarding adults are complex. It was not my practice to screen all patients. More than 50% of adults have silent infarction. Screening requires MRI and this, according to the guidelines, needs careful attention to many details before it is reliable. There are no pro...
Would you hold CGRP (calcitonin gene-related peptide) monoclonal antibodies such as Eptinezumab-jjmr (Vyepti) before, during, or after lung SBRT?
No, I will not hold CGRP monoclonal antibodies during lung SBRT as at present, there is no data suggesting the detrimental effect of doing so. Moreover, the drug is conveniently given q 3months while SBRT is usually completed within 2 weeks. Therefore, most lung SBRT can be scheduled outside of the ...
Is there a role for unilateral hippocampal sparing?
There is some lateralization of hippocampus function which may impact decision making.The left hippocampus seems to play more of a role in episodic verbal memory, while the right plays more of a role in spatial processing. Our neurosurgeon has told me before that a left hippocampectomy is much worse...
How do you approach the workup of transverse myelitis without any abnormality on spine MRI?
If you are highly suspecting TM on clinical features, and other etiologies seem unlikely, then consider LP, checking labs (autoimmune, demyelinating, infectious, metabolic, etc), starting immunotherapy (if infection is unlikely, maybe check with Infectious Disease on that decision), and then in a fe...
Do you ever refer patients for surgery with significant peripheral neuropathy and lumbosacral radiculopathy?
A few factors should be considered to help with making the decision such as asymmetry of distal weakness related to lumbosacral radiculopathy, presence or absence of active denervation on needle EMG especially denervation in the proximal muscles of affected root/paraspinal muscles or asymmetric dene...
How do you approach the treatment of restless leg syndrome in pregnancy?
External leg compression device like home Scd’s can be helpful.
Do you send only serum paraneoplastic panels or also include CSF evaluation in patients with concern for paraneoplastic neuropathy?
Ideally, you should send both serum and CSF. There are several cases where the antibodies are positive only in CSF and not in serum.References: Graus et al., PMID 34006622 McKeon et al., PMID 21422462