Neurology
Expert perspectives on neurological conditions, stroke management, movement disorders, and neuromuscular disease.
Recent Discussions
Would you consider antithrombotic therapy in a patient with refractory migraines and antiphospholipid syndrome?
Yes.
Should a trial of cenobamate (Xcopri) be required before referring a patient for epilepsy surgery?
First, I would like to declare my conflict of interest that I am a speaker for Xcopri/SK Life. That being said, I only speak for things I truly use and believe in. My general teaching to learners is this (not saying there cannot be exceptions): I would not use Xcopri first line because there are bet...
How do structural and functional findings on echocardiogram influence your decision to anticogulate ESUS cases?
This is a great but very difficult question. It is important to remember that currently, there is NO randomized controlled trial data that provides evidence for anticoagulating patients with ESUS, and the ad hoc analysis of the Arcadia trial you mention simply does not change this. Arcadia specifica...
What are your ISC 2026 top takeaways?
The most important presentation was the OCEANIC-STROKE trial showing that asundexian plus antiplatelet therapy was superior to antiplatelet therapy for secondary stroke prevention. The drug will likely be FDA-approved and change clinical practice. The CHOICE-2 trial of adjunctive i.a. thrombolysis a...
Are there any biomarkers, imaging, or other clinical information that can be used to better choose effective therapies for super refractory status epilepticus?
SRSE is a syndrome not a diagnosis. The key determination is if this is immune-mediated, infectious, structural, metabolic, genetic, or drug/toxic-induced. For example, if the lumbar puncture shows significant pleocytosis, in the presence of flare changes in the medial temporal lobes, especially in ...
In patients presenting with disabling acute ischemic stroke symptoms early in the therapeutic window, would you consider anticoagulation reversal to enable administration of intravenous thrombolytics?
In short, 'no'. For patients who have a large vessel occlusion, there is the option of proceeding directly to EVT without thrombolysis. We know from the direct EVT trials that although concurrent or sequential thrombolytic drug treatment followed by EVT is better, it is better only by a small amount...
How do you approach tapering high dose continuous infusions for status epilepticus in patients experiencing serious medication-related toxicity?
This is done with continuous EEG monitoring. It depends on how long the patient has been on these infusions and what doses they are at, if there is sufficient coverage with non-infusion ASMs (either IV or oral). There is no one particular strategy, but what is typically done is reducing by up to 25%...
What is the role of inebilizumab in the maintenance treatment of IgG4-related disease?
Inebilizumab may play an important role in the maintenance treatment of IgG4-related disease (IgG4-RD), particularly in patients at high risk for relapse. These are typically patients with multi-organ involvement and elevated serum IgG4 levels who initially respond well to corticosteroids but tend t...
When is the earliest you escalate treatment for prolonged migraine attacks to parenteral or emergency-level care?
After about 36 hours of status migrainosus.
In patients with suspected RCVS, is there a role for preventative CCB if headache has resolved/now asymptomatic?
In short, the use of CCBs in RCVS is only for the prevention of thunderclap headache (TCH) recurrence. Since their purpose is to prevent TCH recurrence, they are often used when the patient is asymptomatic as well (i.e., even after the index TCH has resolved). They do have no impact on eventual clin...