Resident & Fellow Section

Featured Commentaries

The Role of Twitter in Neurology Residency Recruitment in 2020 and Beyond

The COVID-19 pandemic affects neurologic care and how clinicians treat conditions during this time. We plan to highlight blogs from residents and fellows on their experiences during the pandemic, and we hope these will be useful teaching tools for other residents and fellows around the globe.

Featured: Aaron S. Zelikovich1, Eric C. Lawson2, and Matthew S. Robbins1 I Read full post
(1) Department of Neurology, New York-Presbyterian Hospital, Weill Cornell Medicine (New York); (2) Department of Neurology, Emory University School of Medicine (Atlanta)

The Role of Twitter in Neurology Residency Recruitment in 2020 and Beyond

“The COVID-19 pandemic has brought an unprecedented set of challenges for neurology residency applicants in 2020. To overcome these challenges, many applicants have turned to social media and Twitter in particular to engage in the recruitment season in the absence of the usual in-person experiences.”

Additional Invited Commentaries

Katherine Fu, MD
Call for Papers on “Cortical Careers”—Emerging Career Paths in Neurology
[Read Post]

Fabio Nascimento, MD, and Joseph S. Kass, MD
David & Goliath revisited: an opportunity to grow
[Read Post]

Shashank Agarwal, MD
Invited Commentary: What do we know about leukoencephalopathy in COVID-19 patients?: Neurological complications of COVID-19
[Read Post]

Other Residents & Fellows News

Roy Strowd
Welcoming a New Team: excited for a new team of RFS resident editors
[Read Post]

Jens Witsch
Invited Commentary: Rule out this, rule in that: strokes and stroke mimics
[Read Post]

October 14, 2020

View All Featured Commentaries

New e-Pearl of the Week: Isolated Bulbar Amyotrophic Lateral Sclerosis (IBALS)
e-Pearls archive: Now Searchable! | Submit an e-Pearl

Isolated Bulbar Amyotrophic Lateral Sclerosis (IBALS)

Isolated Bulbar Amyotrophic Lateral Sclerosis (IBALS), regional ALS variant, presents with insidious onset dysarthria, dysphagia, pseudobulbar affect with initially preserved respiratory function. Pathological signs include jaw hyperreflexia, tongue fasciculation, and Hoffman’s sign. IBALS constitutes 4% of motor neuron disease and is more prevalent in females with a slightly delayed mean age of onset compared to typical ALS (61 vs 58 years).^1,2 Electrodiagnostic studies show denervation changes restricted to bulbar muscles (fibrillation potentials, positive sharp waves, large polyphasic motor units) with preserved CMAP amplitudes in limbs. Diagnostic work-up includes MRI brain/cervical spine. Differentials include bulbar-onset ALS, myasthenia gravis, and space-occupying bulbar lesions. Lack of progression for six-months distinguishes IBALS from bulbar-onset ALS. Multimodality management includes symptomatic such as Dextromethorphan/quinidine for pseudobulbar affect and supportive measures including gastrostomy in early stages and PAP therapy in advanced stages.³Efficacy of riluzole has not been studied in IBALS. Survival rate is better than bulbar onset ALS (75% vs 45% at 54 months).¹

References
1. Jawdat O, Statland J, Barohn R, Katz J, Dimachkie M. Amyotrophic Lateral Sclerosis Regional Variants (Brachial Amyotrophic Diplegia, Leg Amyotrophic Diplegia, and Isolated Bulbar Amyotrophic Lateral Sclerosis). Neurol Clin 2015;33:775–785.
2. Talbott EO, Malek AM, Lacomis D. The epidemiology of amyotrophic lateral sclerosis. Handb Clin Neurol 2016:225–238.
3. Smith R, Pioro E, Myers K et al. Enhanced Bulbar Function in Amyotrophic Lateral Sclerosis: The Nuedexta Treatment Trial. Neurotherapeutics 2017;14:762–772.
Submitted by Maryam Bahadori, MD, Tehran University of Medical Sciences (Tehran, Iran), and Faisal Khan MD, DABSM, DABPN, Consultant Neurologist, Sugarland Neurology and Sleep Texas (Sugar Land, Texas)

Maryam Bahadori and Dr. Khan report no disclosures.