Gabapentin and Dementia Risk: What Patients and Colleagues Should Know

On August 30, 2025September 11, 2026 By Dr. Scott RennieIn NeurologyLeave a comment

Gabapentin is one of the most commonly prescribed drugs in the U.S., used for nerve pain, seizure disorders, and sometimes off-label for sleep or anxiety. I don’t prescribe it myself. It’s generally not a medication that gets started over telemedicine, but many of the patients I see are already on it, sometimes for years, by the time it comes up in our visit. Dizziness, fatigue, and the risk of misuse are the usual concerns. Now there’s new research raising concern about a possible link to dementia.

A study published in July 2025 in Regional Anesthesia & Pain Medicine looked at prescription records and medical outcomes for thousands of adults. This was a retrospective cohort study. In other words, the researchers didn’t assign patients to groups or give some people placebo pills. They looked back at existing data and compared outcomes between people who had taken gabapentin and those who had not (Lin et al., 2025).

That design matters. The gold standard in medical research is a randomized, double-blind, placebo-controlled trial, where patients are randomly assigned to receive either the medication or a placebo and neither patients nor researchers know who is in which group until the study ends. This approach minimizes bias and helps establish cause and effect. An observational study like this one, by contrast, can only show association. It tells us that patients on gabapentin had higher rates of dementia, but it can’t prove gabapentin caused it. Other factors, such as the underlying conditions that led to prescribing gabapentin, may have influenced the outcome.

Even with that limitation, the findings are striking. Adults aged 35 to 49 who filled six or more prescriptions were more than twice as likely to develop dementia and more than three times as likely to develop mild cognitive impairment compared to non-users. Adults aged 50 to 64 had a 29 percent higher risk of dementia and an 85 percent higher risk of mild cognitive impairment.

I tell patients not to stop gabapentin suddenly. For someone with a seizure disorder or severe neuropathic pain, stopping without a plan can be unsafe. But it may be time to review why a patient is on it and whether the benefit is still there. The pattern I run into is people staying on it. It gets started for something like restless legs, it helps at first, and then it just stays on the list long after symptoms have settled, because nobody goes back and revisits the prescription. Now there’s another reason to ask whether it still belongs there.

For families, this means paying attention too. If a parent or older relative is taking gabapentin, bring it up at their next appointment. Long-term prescriptions sometimes get renewed automatically. I don’t taper gabapentin myself. When it comes up in a visit, I tell the patient to bring it to their primary care provider, or whoever prescribes it for them, and talk through together whether it still makes sense.

One group is worth naming specifically, because they are easy to miss in a conversation about nerve pain. Gabapentin is among the non-hormonal options for hot flashes in the 2023 nonhormone therapy position statement from The Menopause Society (PMID 37252752), so a number of women in their fifties are taking it for vasomotor symptoms rather than for neuropathy, and may not think of themselves as being on a nerve drug at all.

If that is you, the same question applies and the answer is not automatically to stop. It is worth asking whether this is still the right drug for what you are actually using it for, particularly now that there are newer non-hormonal options for hot flashes that did not exist when many of these prescriptions were written.

Acute Flaccid Myelitis: A Mystery Illness in Washington State

On November 5, 2016September 11, 2026 By Dr. Scott RennieIn NeurologyLeave a comment

Recently, eight children in Washington State were diagnosed with acute flaccid myelitis (AFM). It is a rare condition that affects the central nervous system, specifically the spinal cord. It causes weakness in the arms or legs, and it can also produce facial drooping or weakness, difficulty moving the eyes, drooping eyelids, and trouble with speech or swallowing. As of September 2016, 89 people in 33 states had been confirmed with the illness, according to the CDC.

Diagnosis: If you think you or a family member has this condition, seek consultation with a medical provider. But how do you know whether AFM is causing the symptoms? A doctor may be able to make the diagnosis through a careful examination, and an MRI is sometimes helpful as well. Spinal fluid, which surrounds the brain and spinal cord, may be collected by a spinal tap (lumbar puncture) and can also aid in the diagnosis.

There are nerve tests that may help confirm the diagnosis, though they need to be done 7 to 10 days after the onset of illness.

Causes: A number of viruses have been thought to be possible causal agents, including enteroviruses (polio among them), West Nile virus, Japanese encephalitis, St. Louis encephalitis, and various adenoviruses.

AFM is not the only cause of weakness in the arms or legs. Other causes include viral infections, environmental toxins, genetic disorders, and Guillain-Barré syndrome (GBS). Neurological conditions such as stroke (cerebrovascular accident) can also cause weakness in an arm or leg, or facial drooping, so it’s important to seek medical attention immediately and call 911 if you or someone you know develops these symptoms.

Treatment: No specific treatment exists for AFM. A neurologist may be consulted to help with the diagnosis and to make recommendations.

If you or your child is having problems walking or standing, or develops sudden weakness in an arm or leg, contact a medical provider right away.

I hope you have found this information useful. Wishing you the best of health,

Why is the Side of My face Drooping? All about Bell’s Palsy

On June 28, 2012September 11, 2026 By Dr. Scott RennieIn Neurology1 Comment

I am Scott Rennie, DO, board certified in Family Medicine and Obesity Medicine. I practice entirely by telemedicine, licensed in all 50 states. Most of my work now is weight loss, metabolic health and menopause care. If this was useful, Start here lists what I write about now.

A few weeks ago a family brought their son in to the clinic because one side of his face including his eye and lips were not moving symmetrically with the other side. Of course they were worried about the possibility of him having a stroke. He’d had an upper respiratory infection that started about one week before and had a slight fever with runny nose. He’d never had any neurological problems before. He had a condition called Bell’s Palsy. Bell’s Palsy is a problem with the nerves on one side of the face and it causes the muscles of the face to have decreased ability to move. The muscles of the face can become weak or even paralyzed. Patients often complain that one of their eyelids starts drooping or they drool out one side of their mouth. When they smile, one half of the mouth doesn’t seem to move. Most people who get Bell’s palsy recover entirely but a small number of patients have symptoms for the rest of their life. Causes: Inflammation of the facial nerve on one side of the face is the cause of Bell’s palsy. A virus is the cause and there is some evidence that it’s the virus that causes cold sores (Herpes Simplex Virus – HSV) that causes the condition. Other viruses may cause Bell’s palsy however including the viruses that cause Chicken Pox and Mononucleosis. Symptoms: When the facial nerve because inflamed from the virus, and the nerve may swell and get pinched as it travel’s through some tight spaces in the face. If this happens it can cause weakness and even paralysis of the muscles of the face so you may see: 1) Drooping of one eyelid 2) Eyebrow that sags 3) Corner of the mouth that does not move or sags 4) One eye might not close completely 5) Loss of taste in the front of the tongue 6) Loud noises may cause pain on the side of the dysfunction If your eye is not able to fully close, this can lead to dryness of the eye, so it’s important to seek treatment to prevent eye damage. Treatment: There is a specific treatment, and it is time-sensitive: a course of oral corticosteroids started early, ideally within 72 hours of the symptoms beginning, is the one thing shown to improve the odds of full recovery. Seeing a medical provider promptly also matters in order to: 1) Ensure the proper diagnosis, because the symptoms may be confused with a stroke or other neurological problems which can be dangerous if not treated appropriately 2) Prevent damage to the cornea of your eye from dryness 3) Steroids such as prednisone may be given to reduce the swelling of the affected facial nerve – this works better when started within the first 2-3 days of symptoms 4) Antiviral medications such as acyclovir are sometimes given in hopes that they will help the body overcome the virus more quickly, however studies have not found any added benefits from using antiviral medications for Bell’s palsy Recovery/Prognosis: People who have less severe symptoms seem to recover more rapidly and have a better chance of full recovery. If you are getting better within the first three weeks, the chances are better that you will totally recover. A small group of people however have permanent moderate to severe muscle weakness in their face from Bell’s palsy. Rare effects: If there is severe damage to the facial nerve, it may heal in a disorganized fashion. I have one patient who was bothered by tears coming from their eye when they salivate (before eating). I’ve also had a patient whose eye would close whenever he smiled. Fortunately this is not common with Bell’s palsy. I hope that you have found this information useful. Wishing you the best of health,

Stroke Warning Signs: What to Know About CVA and TIA

On June 25, 2012August 30, 2026 By Dr. Scott RennieIn NeurologyLeave a comment

I saw a patient the other day who was in her 30’s and was brought in the other day because she suddenly stopped speaking (we call this aphasia) and became weak and confused. Patient’s sometimes come to the urgent care with symptoms of stroke or meningitis and these symptoms can be extremely anxiety provoking. Stroke or CVA (Cerebral Vascular Accident) is the term that medical providers use to describe an event where part of the brain goes without blood for too long. There may be permanent damage to the brain as a result. The blood supply to the brain can get cut off if an artery in the brain or neck gets clogged or closes off or if there is an artery in the brain that starts bleeding. Sometimes a patient may have a stroke and there are no permanent effects, while other people may lose important functions in their brain permanently. The individual that I saw the other day became unable to speak and it was unclear if she was able to understand what was being said. Symptoms: The symptoms of a stroke depend on which area of the brain is affected. Some symptoms of stroke may be recognized by the acronym FAST – Face – Does the person’s face look uneven or droop on one side? Arm – Does the person have weakness or numbness in one or both arms? Does one arm drift down if the person tries to hold both arms out? Speech – Is the person having trouble speaking? Does his or her speech sound strange? Time – If you notice ANY of these signs of stroke, call 9-1-1. You need to act FAST because the sooner the treatment begins, the better the chances of recovery Diagnosis: Stroke is usually diagnosed based on the patient’s symptoms and specialized studies such as a CT scan (Cat Scan) of the brain, or perhaps an MRI of the brain. Other tests might include ultrasound of the arteries in the neck and echocardiogram (ultrasound of the heart). Treatment: The type of treatment depends on the cause of the stroke. For patients who are having a stroke due to clogged arteries to the brain, they might receive medication to break up the clot or have a procedure to remove the blood clot. They might also start medications to prevent future clogged blood vessels such as aspirin or clopidogrel (Plavix), or, when the stroke came from atrial fibrillation, a direct oral anticoagulant such as apixaban (Eliquis) or rivaroxaban (Xarelto), which have largely replaced warfarin (Coumadin) for that purpose. Patients who have damage in the brain that make it difficult for them to walk might be treated with physical therapy to help them regain mobility. Sometimes it’s necessary for these patients to spend some time in an assisted care facility where there are nurses, physical therapists, occupational therapists and speech therapists available to help in the recovery process. An assessment may be done at the patient’s house to look for possible safety problem areas and give the patient devices and tools to help the patient be able to retain independence in their home. Prevention: You can lower your risk of stroke by: 1) If you have high blood pressure, keep your blood pressure in the normal range 2) If you have diabetes, keep your blood sugar under good control 3) Check your cholesterol and make sure your bad cholesterol and triglycerides are not elevated 4) Avoid smoking 5) Exercise for 30 minutes a day or longer on most days 6) If you are overweight – work on weight loss 7) Do not drink more than one alcoholic drink/day if you are female or more than two if you are a male 8) Make sure you take your medications as directed by your physician I hope that you have found this information useful. Wishing you the best of health,

Head Injury: Is It a Concussion or Something More Serious?

On March 9, 2012August 30, 2026 By Dr. Scott RennieIn NeurologyLeave a comment

Head injuries are common all year long in the urgent care setting. In the winter months, skiing or snowboarding is one of the leading causes of head injuries. In the summer months, more sports injuries occur with the improved weather in the Seattle area. Most head injuries are not associated with brain injury or longer-term complications. Rarely, however more significant injuries may develop which could be due to bleeding around the brain. Causes of head injuries: Most of the time falls are the cause, but motor vehicle accidents, pedestrian or bicycle accidents and sports-related trauma also cause head injuries. In the medical setting, we also have to be alert for signs of child abuse as well. The risk of brain injury depend on the type of trauma and the age of the patient. Higher risk injuries: 1) High speed motor vehicle accidents 2) Fall from a great height 3) Being hit by a high speed, a heavy or sharp object 4) Inflicted injury such as abuse Symptoms of head injuries: 1) Scalp swelling 2) Loss of consciousness/passing out – Happens only 5% of the time and usually lasts less than 60 seconds 3) Headache – Occurs in 20% of patients. In children who are too young to speak, they may become irritable. 4) Vomiting – occurs in about 10% of patients. Children who have a head injury and vomit, do not necessarily have a serious brain injury. 5) Seizures – Less than 1% of patients have a seizure right after a head injury. A few of these patients will have a serious head injury. We will usually do a CT scan of the head if the patient has a seizure. 6) Concussion – common symptoms include confusion or inability to remember events around the time of the injury, headache, vomiting, and dizziness. When to seek help: 1) The patient has recurrent vomiting 2) The patient has a seizure (convulsion) 3) The patient loses consciousness after the injury 4) Severe headache after the injury, or it worsens with time 5) Head injury in a child with behavior change (lethargic, difficulty to wake, extremely irritable, other abnormal behaviors). 6) Difficulty walking, is clumsy or has lack of coordination 7) Slurred speech or confusion 8) Dizziness that is not resolving 9) Blood or watery fluid comes from ears 10) The patient is a child less than 6 months of age 11) There is a cut that will not stop bleeding after pressure is applied for 10 minutes 12) The patient fell from a height greater than 5 feet, or was hit with a high speed object or with great force 13) Patient’s friends/family are concerned about how the patient is acting When do I need a Cat Scan/CT Scan of the brain? A CT scan is a special X-ray that expose children/adults to radiation and should be avoided if possible. Sometimes, however a Cat scan will be recommended to diagnose more severe injuries. Some possible symptoms which may prompt your medical provider to order a CT scan are: 1) Prolonged loss of consciousness 2) Persistent or severe memory loss/confusion 3) Persistent vomiting 4) Seizure 5) Severe, persistent or worsening headache 6) Suspicion of intentional injury (abuse) 7) Behavioral changes (lethargy, decreased alertness, extreme irritability) 8) Signs of skull fracture such as a bulging fontanel or skull deformity 9) Abnormal neurological exam 10) Severe scalp bruising or swelling in a very young child Why not an MRI? We use CT scanning instead of an MRI to look for brain injury in most head injuries because it is available at most hospitals, and CT is relatively quick compared to MRI. MRI requires patients – including children to be completely still for at least 30 minutes and that can be challenging. Head injury treatment at home: 1) Rest, but only briefly. A day or two of reduced activity is right after a concussion, then a gradual return to light activity that does not provoke symptoms. Prolonged strict rest and a darkened room were once standard and are no longer advised, because they slow recovery rather than speed it 2) If the head is bleeding, clean the area with soap and water and apply pressure with gauze. If bleeding does not stop, the child should be evaluated 3) Tylenol may be given in most cases for pain/headache. If the headache worsens, please have the child evaluated (see above). Monitoring after head injury: The patient should be observed for signs of worsening injury. Please call your healthcare provider if any of the following are noted: 1) Vomiting more than once or vomiting continues for 4-6 hrs after the injury. 2) Severe/worsening headache 3) Becomes more drowsy or hard to wake up. 4) Confused or not acting normally. 5) Has trouble walking, talking or seeing 6) Develops stiff neck. 7) Has a seizure (convulsion) or any abnormal movements or behaviors. 8) Cannot stop crying – children 9) Has weakness or numbness involving one side of the body. Return to normal activities: Patients who have sustained a concussion are at a risk for serious or even fatal complications of they have a second injury within a short time after the first injury – this is called second impact syndrome. It important not to participate in high impact sports or risky activities for 6 weeks. Post-concussion syndrome: Sometimes the patient who has sustained a head injury may develop a group of symptoms in the first few days after the injury called “post concussion syndrome.” These symptoms can include headaches, anxiety, irritability, dizziness, or impaired memory or concentration. In 85-90% of patients, this resolves within a few weeks-few months after the injury. There isn’t any specific treatment for post-concussion syndrome. Head injury prevention: 1) Wear a bicycle helmet when riding bikes, skating , sledding or participating in activities where you may hit your head 2) Install car seats/booster seats correctly. At least a booster seat is needed until the child is at least 4 feet 9” tall. Individual states may have additional regulations about the use of booster/car seats. 3) Use gates on stairways to prevent injuries in infants/young children 4) Install window guards on all windows above the first floor 5) Do not use wheeled baby walkers 6) Teach kids to safely cross the street. Young children should never cross the street alone. 7) Discuss sports safety with your healthcare provider. Be sure that a child has appropriate protective equipment. I hope that you have found this information useful. Wishing you the best of health,

Headaches: Migraine, Cluster, Tension and Chronic Daily Pain

On February 29, 2012August 30, 2026 By Dr. Scott RennieIn Neurology2 Comments

We see patients with headaches in the medical clinic almost everyday. Although they are usually not life threatening they can be quite debilitating. Several different types of headaches have been described in the literature including: 1) Tension/Muscle contraction type headache 2) Migraine headache 3) Chronic daily headache 4) Cluster headache Muscle contraction/Tension headache symptoms: pressure or tightness around both sides of head or neck, mild to moderate pain that is steady and usually does not throb, pain is generally not made worse with activity, pain can increase or decrease in severity, there is often tenderness in the muscles of the head, neck or shoulders. Migraine headache symptoms: migraines are a type of headache that seems to get worse with light, noise or motion. Some people have nausea and vomiting with this type of headache. Migraines can last for a few hours to up to 3 days. Migraine triggers: Some possibilities include: Stress, anxiety, worry, menstral periods, birth control pills, fatigue, lack of sleep, hunger, certain foods or drinks (wine, any alcohol, aged cheeses, nutrasweet, MSG, nuts), etc. Cluster headache symptoms: Cluster headache are more rare. They begin quickly without any warning and reach their peak within just a few minutes. The headache is usually deep, excruciating, continuous and feels explosive, although can be pulsatile and throbbing. The attack may happen up to 8x/day but usually only lasts for a short time (between 15 minutes – 3 hours). The pain usually is around the eyes or temples and rarely starts in the face, neck, hear or side of the head. It’s always on one side, and never on both sides of the head. Most people who get this type of headache are very uncomfortable and can be restless and pace or rock back and forth when the attack occurs. Cluster headaches can be associated with tear production, eye redness and runny nose, sweating and pale skin. These types of headaches can begin at any age but have a genetic component. Chronic daily headache/Medication overuse headache: Headaches that occur as frequently as every day or present more than 15 days per month or at least three months are considered chronic daily headaches. Most people with this type of headache have migraine or muscle contracture type headaches as the underlying type. If you use medications frequently to treat headaches, a vicious cycle can occur where the frequent headache cause the patient to take medication frequently (non-prescription or prescription) and then a rebound headache occurs as the medication wears off. Some types of medication that can cause these rebound headaches are: 1) Narcotic medications such as vicodin or Percocet 2) Butalbital medications such as Fiorinal or Fioricet 3) NSAIDS such as Advil, Motrin, Aspirin 4) Triptans (such as Imitrex) 5) Excedrine (aspirin, caffeine and acetaminophen combo) Other types of headaches: Sinus headache or post-trauma headache Danger signs of headache: Seek medical attention of you have any of the following: 1) Headache is the worst headache of your life 2) Headache comes on suddenly and becomes severe within seconds or minutes 3) Occurs with a seizure, personality change, confusion or passing out 4) Beings right after vigorous exercise or a minor injury 5) New headache and is accompanied by numbness, weakness or vision changes. Do I have a brain tumor? Headaches do occur in approximately 50% of people with brain tumors. However, headaches are common and tumors are rarely found in people who are being evaluated for headaches. If you are concerned about the possibility of brain tumor, please see a medical provider. Treatment of headache: The treatment is tailored to the individual patient. Treating the underlying cause of the headache is the most efficient way to reduce the pain and frequency of headaches. Sometimes a headache diary can be helpful for people who have frequent and severe headache in order to help determine what might be triggering the headache. For migraines, we break the treatment into two groups: acute management of the headache (medication you can take immediately for relief), and preventive management which include medications you can take on a regular basis to reduce the frequency of headaches that occur in the future. Some medications which might be used to treat and acute headache are pain relievers such as aspirin, Tylenol, Toradol, Excedrine, Triptans(such as Imitrex) for migraine, anti-nausea agents such as Reglan or Phenergan, Ergotamines, and for migraine the newer CGRP-targeted drugs, meaning the gepants such as ubrogepant and rimegepant taken at onset. Opioids do not belong on that list. They work briefly, and they are one of the most reliable causes of the rebound headache described above. For migraine prevention, commonly prescribed medications include beta blockers (propranolol is an example), tri-cyclic antidepressant medications such as amitriptyline, anti-seizure medications such as Depakote, Neurontin or Topamax, calcium channel blockers such as Verapamil. Neurologists are doctors that specialize in the diagnosis and treatment of headaches. To find a neurologist near you check out the American Academy of Neurology website at: http://patients.aan.com/findaneurologist/ I hope that you have found this information useful. Wishing you the best of health,

First Aid for seizures

On February 18, 2011August 30, 2026 By Dr. Scott RennieIn NeurologyLeave a comment

When people ask about first aid for seizures, I usually start with the basics. Carry medical identification. If an emergency happens, it helps bystanders and providers know you have a seizure disorder and what to do next. Family, friends, and coworkers should also know how to respond. Safety comes first, and the details matter.

It’s important to think about daily risks. Someone with uncontrolled seizures should be cautious around high places, moving equipment, hot stoves, or machinery. Staying active is still encouraged, but some activities call for extra planning. Swimming, climbing, or gymnastics are safer when another person is present who understands seizures and knows basic life-saving skills. Even routine things like bike riding or canoeing can be made safer with helmets and life jackets.

Medication is another cornerstone. If you’ve been prescribed an anticonvulsant, don’t stop it suddenly or change the dose without talking to your doctor. The exact drug and dose depend on the type of epilepsy and factors like weight, age, and other health conditions. Watch out for drug interactions, including with over-the-counter medications. Pharmacists are a good resource when you’re not sure. Alcohol should also be avoided since it can interfere with seizure control.

If someone has a seizure, the steps are simple but crucial. Loosen anything tight around the neck. Move sharp objects away to reduce injury risk. Don’t try to hold the person down. Don’t put anything in the mouth. Let the seizure run its course. When it’s over, place the person on their side so the airway stays clear. Often, there’s confusion after the event, so it helps to stay close until they’re fully awake.

Not every seizure requires a trip to the hospital. If it ends in a minute or two and the person has a known diagnosis of epilepsy, observation may be enough. Call an ambulance if the seizure lasts more than five minutes, if seizures repeat without recovery in between, or if the person doesn’t regain awareness. Extra caution is needed if there are other medical conditions such as diabetes or heart disease.

Children can have many types of seizures, and the approach shifts depending on what you see. With a generalized tonic-clonic seizure, keeping the airway open and the head protected are priorities. With absence seizures, observation and careful note-taking matter more. If awareness is altered but movements continue, guiding the child to a safe place is often the best step. Any first seizure in a child should prompt medical evaluation, and some types such as infantile spasms need urgent attention.

Education matters as much as medication here. Bystanders who know to move objects away, stay calm and wait it out change how the whole event goes.

This is for general information only and not meant as medical advice for an individual patient. If you or someone you love has seizures, discuss a personalized plan with your healthcare provider.

Wishing you the best of health,

Dr. Scott Rennie

Category: Neurology

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