Questions discussed in this category
How do you decide if and when to send patients with AChR+ ocular myasthenia gravis for thymectomy?
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.
For example, the patient may have other findings such as an elevated CRP. Would you diagnose SLE, or would you want to see other serologies or finding...
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.
How should IVIG and either biologic injections or infusions be spaced?
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?
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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Papers discussed in this category
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Muscle & nerve, 2012-06
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Muscle & nerve, 2019 Nov 06
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Brain : a journal of neurology, 2016-05
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Clin Neurophysiol Pract, 2018 Apr 05
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Lancet,
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Ann Neurol,
Neurology, 2021 Oct 11
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Curr Opin Rheumatol,
Chest, 2010-05
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Neurology, 2020 Nov 03
Ann Rheum Dis, 2017 Dec
Rheumatology (Oxford, England), 2017-06-01
Autoimmun Rev, 2012 Jul 05
J Immunol Methods, 2016 Feb 18
Lancet Neurol, 2021 Jul
Muscle & nerve, 2010-08
The Laryngoscope, 2016-01
Journal of the neurological sciences, 2011-09-15
J Peripher Nerv Syst, 2021 Jul 30
Neurology, 2020 Jan 20
Eur J Neurol, 2019 Aug 12
J Neurol Neurosurg Psychiatry, 2015 Jan 27
J Clin Neuromuscul Dis, 2018 Sep
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N Engl J Med, 2020 Sep 3
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The Pediatric infectious disease journal, 2018 Oct
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Clin Neurophysiol Pract, 2019 Jul 12
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Amyotroph Lateral Scler, 2009 Aug
Neurology, 2019-01-22
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Medicine (Baltimore), 2016 Aug
BMJ, 2021 Jun 23
The New England journal of medicine, 1993-12-30
Cureus, 2022 Oct 24
Journal of clinical apheresis, 2022 Feb 04
Cutis, 2023 Aug
Journal of translational internal medicine, 2019 Dec 31
Journal of vascular surgery, 2016 Sep
Journal of surgical orthopaedic advances, 2014
The Physician and sportsmedicine, 1992-11
The American journal of sports medicine, 2015 Sep 02
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Diabetes care, 2011-09
Nutrients, 2023 Aug 18
Endocrine reviews, 2019 Feb 01
European journal of neurology, 2011 Nov 25
Neurology, 2007 Apr 03
European journal of neurology, 2023 Oct 10
Journal of pain research, 2017 Jan 27
JAMA neurology, 2018-12-01
Journal of neuroimmunology, 2022 Apr 09
Neurology, 2011-03-22
Neurology(R) neuroimmunology & neuroinflammation, 2021 May 18
The New England journal of medicine, 2003-10-16
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Lupus, 2024 Jan 16
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Scientific reports, 2022 Feb 15
Clinical neurology and neurosurgery, 2020 Sep 28
JAMA neurology, 2015 Aug
Journal of epidemiology, 2015 May 02
Muscle & nerve, 2015-09
Amyotrophic lateral sclerosis : official publication of the World Federation of Neurology Research Group on Motor Neuron Diseases, 2010-12
Journal of neurology, neurosurgery, and psychiatry, 2020 Jun 23
Journal of neurology, 2023 Jun 28
Annals of neurology, 2020 Jan 06
Lancet (London, England), 2014-06-14
Molecular genetics and metabolism, 2022 Jul 26
Muscle & nerve, 2023 Nov 17
Seminars in neurology, 2008-04
Seminars in neurology, 2019 Oct 22
Frontiers in neurology, 2024 Jan 17
Neurology, 2001-07-24
The European respiratory journal, 2019-06
Neurology, 2024 Jul 30
Therapeutic advances in neurological disorders, 2019 Sep 14
Continuum (Minneap Minn), 2022 Dec 1
Medicine, 2021 Jan 08
Curr Rheumatol Rep, 2023 Aug
NeoReviews, 2021 Jan
Journal of clinical pharmacology, 2023 Jun
Muscle & nerve, 2024 Oct 14
Muscle & nerve, 2017-03