Questions discussed in this category
Especially in an inpatient setting when EMG is not immediately available.
In light of the publication in Bril et al., PMID 39506903.
When do you use specialized panels for neuropathy? Which panels do you typically use?
In light of the recent publication by Menon et al., PMID 39079067 regarding the risk of converting to generalized MG as related to use of immunosuppre...
E.g., a patient with newly diagnosed CIDP who is wheelchair-bound.
Is a biopsy or EMG helpful in confirming the etiology? What is the best treatment for sarcoid neuropathy?
Patients often see a dietician at ALS centers, but what do you discuss with patients before they have a formal consult with a dietician?
I’ve seen literature supporting use of IV pulse dose steroids, though I’ve noticed some have come up with their own various oral regimens ...
E.g., PEG tube placement.
What dosage do you start with?
Particularly the increased risk for ALS in patients with DM in East Asian populations: Vasta et al., Neurological Sciences 2021.
Will you still favor starting with steroids and traditional immunosuppressive agents, move IVIG earlier in your treatment strategy, or start with IVIG...
Will these results change your practice?
These are new medications and, to my knowledge, there is no agreed-upon standardized approach as to when they should be used.
The patient returned with recurrent subjective sensory or motor deficits. The initial GQ1B was >1:6400. Two years later, GQ1B was 1:3200.
Presuming failure/intolerance of steroids, MMF, azathioprine, maintenance IVIg
Can this guide further treatment/prognosis?
How would you treat a patient with necrotizing myopathy with positive anti-HMHCoR Ab (and low TIF1 gamma) that failed prednisone + Cellcept, IVIG + Ce...
Are there any environmental exposures you ask about for newly diagnosed ALS patients?
B5 deficiency can be seen in patients with burning feet syndrome, do you typically screen for this when assessing for neuropathy?
How does this strategy change depending on the acuity or chronicity of the symptoms?
What do you recommend for surveillance and when to start the “three R’s” (riluzole, radicava/edaravone, and relyvrio (sodium PB/TUDC...
Do you switch MG patients from Soliris to Vyvgart due to cost, and with switching do you have a recommended wash out period?
Is there any role for a surgical intervention in patients with distal weakness, who has marked peripheral neuropathy but also lumbosacral radiculopath...
What is the best way to treat late onset myasthenia gravis (in this case, age >90)? Would the newer complement inhibitors be safe? Steroids in this...
How do you account for a normal EMG/NCS in the setting of prolonged clinical symptoms suggestive of a radiculopathy? How do you explain this to patien...
Do you see improvement with treatment such as IVIG?
In patients with hx of metastatic cancer, presenting with unilateral proximal arm weakness. No checkpoint inhibitors use.
Which CSF lab...
When it seems fairly certain that this is a drug effect is it something that can just be monitored or requires a change in approach?
Assouline et al., PMID 24411632 recommend delivering 500cGy x 4 fractions = 2000cGy on days 1, 3, 8, 10. Do you follow this schedule, treat every othe...
Is there any data supporting this?
In patients with suspected CIDP, does the use of imaging—MRI (thickening or abnormal enhancement of cervical/lumbar nerve roots or brachial/lumb...
Is there a role for using a trial of pyridostigmine as a diagnostic aid in a patient with suspected (but not confirmed) myasthenia gravis?
Does your management change in any way?
In patients presenting with likely statin-induced myopathy versus statin-induced autoimmune necrotizing myopathy - how do you approach the decision re...
How do you counsel young adults with antibody-negative necrotizing myopathy on prognosis, risk of recurrence, and long-term monitoring/treatment?
For patients who present with elevated myoglobin in the setting of normal creatinine kinase and exercise intolerance, what work up process do you typi...
What referrals do you recommend/imaging orders?
How do you decide if and when to send patients with AChR+ ocular myasthenia gravis for thymectomy?
I teach my students/residents that they should hardly ever get routine X-rays in patients presenting with radicular symptoms. MRI far better for seein...
Is there a role for immunomodulatory therapy?
At what point do you consider genetic testing?
Are there any reasons you avoid therapy?
Are there any alternative treatments?
How long do you wait (from onset of symptoms) to do a EMG/NCS in a patient with GBS?
Myositis specific antibodies and pathology results often take weeks to result. In which cases do you start therapy before the diagnosis is solid...
What other workup/clinical examination findings do you look for?
Is there is a particular pattern of extraocular motility restriction in Miller Fisher syndrome?
What are common side effects to look out for with Eteplirsen?
Ie through electrodiagnostic, imaging, and otherwise?
Given the slow recovery of nerve damage, what would you expect to see on a repeat EMG after treatment? Continued denervation or just sequelae of past ...
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