Neurology
Expert perspectives on neurological conditions, stroke management, movement disorders, and neuromuscular disease.
Recent Discussions
In the interest of brain health, are you avoiding TCAs in migraine treatment due to increased dementia risk?
One more reason to abandon the old-fashioned non-specific preventive migraine medications: anticonvulsants, tricyclics, and calcium antagonists. The only class of old-fashioned medications that I still use, be it rarely, is that of the beta-blockers, with the exception of propranolol. There is good ...
Do you recommend or have any clinical experience with "migraine surgery"?
I do not as well. My understanding is that most of the plastic surgeons who perform this procedure have been trained by Dr. Bahman Guyuron, who developed the procedure. I think the published studies by Dr. Guyuron, showing some efficacy of this procedure, have a flawed methodology, and I do not thin...
What is your approach to a child with toe walking with a reassuring exam but a family history of difficulty walking?
For all children with toe walking, it is critical to perform a full neurological examination to look for CNS (i.e., CP/HIE or HSP) or neuromuscular (i.e., CMT, myopathy) issues. We also do NCV and EMG (the latter if indicated) even if the examination is normal and have found early CMT in a few of th...
Based on the FIREFLY-1 data, would you consider using tovorafenib monotherapy front-line in pediatric patients who have low grade gliomas that are only amenable to subtotal resection or are unresectable?
Not yet. I think it is important to wait for the results of FIREFLY-2 and also ACNS1831/ACNS1833. We have to keep in mind that the combination of trametinib and dabrafenib is already FDA-approved as frontline treatment for paediatric patients with BRAF V600 mutated LGG. This approval was based on th...
How would you prioritize physiotherapy and cognitive behavioral therapy for functional movement disorders in a resource-limited setting where access to both might be constrained?
I have a dedicated clinic for people with functional movement disorder/functional neurologic disorder (FMD/FND) in New York City and even in a city like New York, it is difficult or actually impossible to refer patients for appropriate therapy.For some people with rather straightforward cases, a ref...
What is the appropriate workup and treatment for patients with SMART syndrome following radiation for brain tumors?
Stroke-like migraine attacks after radiation therapy (SMART) is a late presentation after treatment for a CNS malignancy (or brain radiation for another cause; e.g., prophylactic cranial radiation). It is one of many late effects of radiation therapy. Others may include vasculopathy, cognitive dysfu...
What factors would guide your decision to safely resume anticoagulation for atrial fibrillation following a recent intracranial hemorrhage?
Whether a patient with atrial fibrillation and an intracerebral hemorrhage should resume anticoagulation depends on whether the bleed was attributed to cerebral amyloid angiopathy (CAA). Most patients with CAA should not be on long-term (lifelong) anticoagulation. If a bleed was attributed to hypert...
How do you explain the clinical benefit of lecanemab or donanemab to patients?
I do feel that the study outcomes are clinically meaningful, especially for patients with mild cognitive impairment due to AD. A clinically meaningful outcome is the ability to stay at an early symptomatic stage for a longer time than the natural history of the disease would otherwise allow. It appe...
How do you adjust the management of epilepsy in patients who are planning to fast?
Great question! During Ramadan, Muslims fast from dawn to sunset. They can take their medications before dawn and after sunset. In most cases, they can continue their current bid regimen without having to change to extended-release. Remind them of the importance of maintaining a good sleep schedule ...
Can giant cell arteritis present with a partial cranial neuropathy?
Giant cell arteritis (although giant cells on temporal artery biopsy are not a sine qua non) most typically presents to the neuro-ophthalmologist with ischemic optic neuropathy (usually anterior and sometimes posterior).Ophthalmoplegia is uncommon in GCA but has been attributed to oculomotor and abd...