Neurology
Expert perspectives on neurological conditions, stroke management, movement disorders, and neuromuscular disease.
Recent Discussions
Do you consider stopping zonisamide in a female patient with epilepsy who becomes pregnant?
There is nothing specific to zonisamide in this matter and the same question applies to any ASM except basically VPA. Should we stop the ASM if the woman becomes pregnant? I have never understood this question. If it's considered possible to discontinue the ASM due to pregnancy, it suggests that she...
Would you change an elderly, frail patient with atrial fibrillation who is already on a NOAC to VKA treatment?
I wouldn't on the basis of this study. Aside from the other limitations of the FRAIL-AF trial, this study only addressed the utility of switching a stable patient from VKA to NOAC and not vice versa. A patient who is doing well on an appropriately dosed NOAC may experience difficulty achieving adequ...
Do you get volumetric MRI in all patients with cognitive difficulties?
Yes, I find MRI very useful in assessing patterns of atrophy, as well as the degree of vascular changes in the brain. It can help confirm suspected diagnoses such as frontotemporal dementia or Alzheimer's disease.
Would you administer IV thrombolysis in a patient presenting with disabling stroke symptoms while on anti-amyloid therapy?
I agree with @Dr. First Last. There seems to be one case of catastrophic bleeding in the published literature. However, such events can occur with thrombolysis alone or in the context of other cerebrovascular conditions such as CAA, vascular malformations, and even severe WMH. While it's important t...
What is the practical application of alpha-synuclein seed amplification assay CSF testing for the diagnosis and management of Parkinson's disease?
The α-synuclein seed amplification assay (αSyn-SAA) sensitively identifies patients with Parkinson’s disease from cerebrospinal fluid (CSF) samples. A positive αSyn-SAA is proposed to "biologically define" Parkinson’s disease and anchor disease staging. A positive αSyn-SAA identifies aggregated α-sy...
How do you manage a patient with inclusion body myositis?
IBM is a slowly progressive disease with no proven treatment to date, unfortunately. The goals of care are to delay decline and maintain remaining muscle strength. The cornerstone of treatment is physical/occupational therapy. Blood flow restriction seems to anecdotally help some patients, pending t...
How would you best evaluate and manage a patient with hemiplegic migraine and a history of ischemic stroke?
Without further information, I would say that these two conditions, hemiplegic migraine and ischemic stroke, have nothing to do with each other. Hemiplegic migraine should be evaluated and managed as migraine with gepants ideal for abortive treatment and CGRP antibodies for preventive treatment if n...
Do you see a current or future clinical role of neurofilament light chain in the diagnosis or workup of multiple sclerosis?
I see the neurofilament light chain as a helpful tool for future MS monitoring. I don't believe it has a role in the initial diagnosis, as CNS damage generally causes elevations. However, research is exploring its prognostic potential for aggressive or highly active disease during the initial work-u...
What prompts you to consider prescribing different formulations of benzodiazepines for a seizure rescue medication?
I take care of adults with epilepsy, so I can't speak to the pediatric population well. For patients, with prolonged GTCs or clusters of seizures and who were previously prescribed rectal diazepam, I have transitioned many of them to nasal rescue medications with good effect and feedback from caregi...
How frequently, and in which situations do you use quantitative EEG for the detection and/or monitoring of delayed cerebral ischemia after aneurysmal SAH?
Almost never.