Neurology
Expert perspectives on neurological conditions, stroke management, movement disorders, and neuromuscular disease.
Recent Discussions
How do you treat idiopathic hypersomnia inadequately responding to modafinil?
I agree with @Dr. First Last. I usually start my patients on modafinil or armodafinil. If those do not work, I will try solriamfetol. I will supplement with as needed amphetamines as well. I do not often go straight to sodium oxybate/low-sodium oxybate, as you need the right patient for this medicat...
When would you consider testing for LGI1 antibodies in patients with unexplained neuropathic pain?
I would strongly consider testing CASPR2 and LGI1 antibodies in any patient with unexplained, subacute or chronic "neuropathic-sounding" pain (e.g. described as hot/burning, stabbing, "pins-needles", etc) especially if: exacerbated by heat, experienced diffusely in a "non-length dependent" pattern (...
How do you manage problematic disinhibited behaviors in patients with neurocognitive disorders?
This requires a problem-centered approach. I suggest the following thought process. Analyse the root cause: Is it disinhibition? Unmet needs? Under/Overstimulating environment? Medication side effect? For disinhibition (frontal lobe dysfunction): I have had success with gabapentin and low-dose Depa...
How would you manage a CVST secondary to a traumatic brain injury with the presence of intracranial hemorrhage?
When dealing with CVST after TBI, the mechanism of injury is not the same as a spontaneous CVST. There is often direct injury to the vein or the area overlying it. Given that these patients often have other traumatic injuries, and given the lack of clear evidence to support one therapy or another, I...
What patient factors most strongly influence your decision to start biologic agents in mild cognitive impairment?
1.Absence of need for anticoagulants ( this is exclusionary) 2. Absence of APOE e4 homozygosity (although we do treat e4 homozygotes, but with much greater precautionary measures - especially the dosing protocol) 3. High functional ability, and adherence to healthy lifestyle measures (exercise, die...
What is your approach to titration of sublingual cyclobenzaprine in your patients with fibromyalgia?
Follow the FDA instructions: start at 2.8 mg sublingually at bedtime for 14 days, if tolerating, then increase to 5.6 mg nightly starting day 15 onwards. Ensure the mouth is not too dry as saliva is needed for it to fully dissolve, which could take 2-3 mins. This may be a concern in patients with SI...
How do you evaluate and manage brain fog in patients with underlying rheumatic disease?
For Brain fog – Most important this is I stress to patients – there are likely MULTIPLE different things contributing to brain fog, so there are MULTIPLE different things we are going to have to work on to improve it. Active inflammation might be contributing, but there is likely several other facto...
How do you approach questions regarding clearance for elective surgery in patients with epilepsy?
I write a letter that gives a sense of how well-controlled the epilepsy is, emphasizes that ASMs should be taken on the morning of surgery as usual, and if hospital admission is needed, that they should be given on schedule during the admission as well. I then give some general tips on seizure first...
How do you approach treatment of suspected CNS vasculitis with a negative work up?
Suspected CNS vasculitis is, simply put, extremely challenging, most often because the diagnosis is difficult to make. Commonly, the diagnosis is suspected based upon non-invasive imaging showing an unusual distribution of infarcts and/or evidence of intracranial arteriopathy (CTA or formal DSA). I ...
What are your top takeaways in Neuro Oncology from ASCO 2025?
Aizer et al., JCO 2025 - A multi-instituitional Brigham Dana-Farber-led trial randomized 196 patients with 5-20 brain metastases to stereotactic radiosurgery (SRS) or hippocampal avoidance whole brain radiotherapy (HA-WBRT). Patients treated on the SRS arm had significantly less symptom burden, wit...