Neurology
Expert perspectives on neurological conditions, stroke management, movement disorders, and neuromuscular disease.
Recent Discussions
What would be your approach to the consideration of the use of antiamyloid monoclonal antibodies for nonamnestic Alzheimer's disease with a positive biomarker for brain amyloid pathology?
Because treatment appropriateness is based on the stage of cognitive impairment, we base our evaluation on whether the patient meets criteria for mild cognitive impairment or early-stage dementia. We do not use cognitive testing cutoffs, even in amnestic Alzheimer's disease, as staging accounts for ...
Do you consider immunosuppression in patients with a history of Sjogren's disease and clinical features of inclusion body myositis?
My short answer is no. The phenotype and MRI findings described in this case suggest IBM and recently published consensus criteria for the diagnosis of IBM require only the presence of endomysial lymphocytic inflammation in muscle biopsy as a mandatory criterion, along with supportive clinical pheno...
Which patients do you find respond best to DHE nasal powder for acute migraine?
Unfortunately, I do not think that we can predict how patients will respond to any acute treatment. In patients who are naive to prescription abortive treatments in the US, we cannot predict which prescription abortive treatment will be effective, so the choice depends largely on the cost, insurance...
When should you suspect that palatal tremor could be a functional neurologic disorder?
The late Dr. Hallett and others have suggested that essential palatal tremor or myoclonus is largely functional, based upon the appropriate history of variability and entrainment, plus, in some cases, electrophysiologic data as well. As a general rule, functional disorders should be diagnosed based ...
What is your preferred first-line treatment for chronic fatigue in patients with long COVID-19?
Assuming that a thorough workup for other causes of fatigue (anemia, thyroid dysfunction, sleep apnea, etc.) has been performed and is negative, no single medication has been proven by a randomized placebo-controlled trial to help chronic fatigue in PASC. Anecdotally, my colleagues who treat PASC ha...
How do you approach workup and management of hyperhidrosis?
Oral anticholinergics
How will you select patients with brain metastases for TTFields?
The METIS trial restricted eligibility only to patients with brain metastases from non-small cell lung cancer. Therefore, we would not be able to extrapolate these results and data to other tumor types and histologies. Indeed, a post hoc analysis of the data did demonstrate a greater impact in patie...
Do you routinely administer desmopressin to patients with intracerebral hemorrhage who are also on anti-platelet therapy?
I routinely administer desmopressin in patients presenting with ICH if they are on dual antiplatelets but not single antiplatelets. The evidence for this is limited, but it has not revealed any harm.
How does topiramate fit into your treatment paradigm for prevention of episodic migraine?
1.) Topiramate has excellent evidence for efficacy, including better than the evidence for beta blockers, amitriptyline, and venlafaxine, which this guideline recommended as first-line. I have a hard time saying these meds should be recommended as first-line over topiramate due to the reliance on ol...
What pharmacological management do you consider in patients with Autism Spectrum Disorder whose primary behavior is aggression?
As with all of my child patients, my approach is never to medicate behavior but rather to medicate suffering. This means that I view “aggression” of all forms as a kind of communication that something is wrong inside and that other means of effective communicating or managing that discomfort or what...