Neurology
Expert perspectives on neurological conditions, stroke management, movement disorders, and neuromuscular disease.
Recent Discussions
In pediatric patients with low-grade gliomas showing prolonged response or stable disease on tovorafenib, how would you adjust the duration of therapy?
This is a one-million-dollar question. As far as I know, the design of FIREFLY-2 includes a fixed duration of treatment, and this is also the case for ACSN1833 (selumetinib trial). It will be important to look at the PFS of the patients who discontinued tovorafenib and compare with the results of ch...
How often do you screen for cerebral aneurysms in patients with autosomal dominant polycystic kidney disease who do not have a family history of intracranial aneurysms or for whom the family history is unknown?
We recently wrote an editorial about this topic. Our conclusion was as follows: "considering the potential for morbidity and mortality in this unique population at risk for ICAs with possibly higher-than-average risk of rupture, we believe that presymptomatic screening for ICA in all individuals wit...
How do you treat patients with blepharospasm?
Botulinum toxin injections.
How do you treat benign fasciculation syndrome?
Reassurance. Just telling the patient that it isn’t ALS and it’s a benign and common condition will often suffice. If it doesn’t suffice: Address anxiety with psychotherapy, medications, or both. Reduce caffeine intake, and ensure the patient gets adequate sleep. If the first and second options don...
In what clinical scenarios do you utilize post-cardiac arrest targeted temperature management (TTM)?
There still is a role for TTM in post-cardiac arrest patients. The Targeted Temperature Management After Cardiac Arrest: A Systematic Review was a systematic review of six randomized clinical trials with a total of 3870 participants that were examined. Of these, 2,767 participants were treated with ...
How do you determine timing and frequency of stability scans for a patient with spontaneous, non-aneurysmal intracerebral hemorrhage?
We typically obtain a follow-up “stability scan” about 6 hours from the index scan. The AHA guidelines do not mention a specific timeframe. Situations, where we would consider sooner repeat imaging, would be clinical deterioration (increase in NIHSS by 4 or more points or decline in GCS by 2 or more...
Which interventions have you found effective for managing sensory sensitivities in children with autism spectrum disorder?
Sensory sensitivities are very common in ASD and are listed as one of the four aspects of the core symptoms under the restricted, repetitive behaviours, interests or activities criteria of the DSM-5. Depending on the sensitivity, therapeutic interventions can be designed and implemented by occupatio...
Do you ever utilize a steroid pulse in patients who are pregnant with status migrainosus?
According to ACOG, if steroids are use oral prednisone 20mg po QID x2d or methylprednisone dosepak is preferred over dexamethasone due to lower fetal exposure. Dexamethasone could be considered even parenterally if these do not work and attack is particularly refractory. However, they recommend that...
How do you differentiate between functional neurologic disorder from other underlying movement disorders?
Functional movement disorder (FMD), like most movement disorders, is a clinical rule-in diagnosis based on specific diagnostic criteria and clinical features of the patient's presentation. The examination and the phenomenology of the exhibited movements are key to diagnosing FMD. Variability, distra...
Do you use triptan medications in patients with asymptomatic critical intracranial artery stenosis?
Although the triptans are selective vasoconstrictors for the cranial non-cerebral circulation, I would not use them here for medicolegal reasons. Instead, I would use a gepant for abortive migraine treatment, which I think is the abortive migraine medication of choice in patients with demonstrated c...