Dr. Neelam Goyal completed her medical school education at SUNY Downstate in Brooklyn, NY. She then finished her neurology residency including chief year followed by a fellowship year in neurophysiology with a focus on neuromuscular disorders and EMG nerve conduction studies at Stanford University Medical Hospital,.
After graduation, she joined the faculty of Stanford University School of Medicine in 2012 as a Clinical Assistant Professor of Neurology and Neurological Sciences in the division of Neuromuscular Medicine. She took on the position of co-Director of the Muscular Dystrophy Association/ALS Clinic in 2016. In 2020, she was promoted to Clinical Associate Professor. She serves on multiple committees within Stanford, including the Clinical Assistant Professor Appointment and Promotions Committee and
Health Information Management Committee, as well as multiple committees within the American Association of Neuromuscular and Neurodiagnostic medicine (AANEM).
Dr. Goyal specializes in the diagnosis, management, and electrophysiological testing of neuromuscular disorder (including SFEMG), with expertise in immune-mediated disorders (myositis, myasthenia gravis, CIDP, and vasculitis) and ALS. Her research interest include monitoring and management of short and long-term toxicity of immunosuppressive agents. She also provides botulinum toxin for treatment of sialorrhea in ALS patients.
- Myasthenia Gravis
- Inclusion body myositis
- Neuromuscular Disorders
Clinical Associate Professor, Neurology & Neurological Sciences
Member, Health Information Management Committee, Stanford Hospital & Clinics (2020 - 2023)
Member, Clinical Assistant Professor Appointment and Promotions Committee, Office of Academic Affairs (2020 - 2023)
Co-Director, Muscular Dystrophy Association Clinic, Stanford Hospital and Clinics (2016 - Present)
Honors & Awards
Stanford Leadership Development Program, Stanford University School of Medicine (2020-2021)
Clinical Effectiveness Leadership Training, Stanford University School of Medicine (2019-2020)
Robert Fisher Resident Teacher of the Year, Stanford University (2011)
Alpha Omega Alpha Membership, SUNY Downstate (2006)
Boards, Advisory Committees, Professional Organizations
Member, Workshop Committee, AANEM (2019 - Present)
Member, Education Resource Committee, AANEM (2019 - Present)
Member, Neuromuscular Medicine Self-Assessment Exam Committee, AANEM (2015 - 2018)
Member, Muscular Dystrophy Association (2012 - Present)
Member, American Association of Neuromuscular Medicine (AANEM) (2012 - Present)
Member, American Academy of Neurology (AAN) (2008 - Present)
Fellowship: Stanford University Clinical Neurophysiology Fellowship (2012) CA
Residency: Stanford University Neurology Residency (2011) CA
Internship: Winthrop University Hospital Internal Medicine Residency (2008) NY
Medical Education: SUNY Downstate School of Medicine Registrar (2007) NY
Board Certification: American Association of Neuromuscular, Electrodiagnostic Medicine (2013)
Board Certification: American Board of Psychiatry and Neurology, Neurology (2011)
Current Research and Scholarly Interests
Dr. Goyal specializes in the diagnosis, management, and electrophysiological testing of neuromuscular disorder (including SFEMG), with expertise in immune-mediated disorders (myositis, myasthenia gravis, CIDP, and vasculitis) and ALS. Her research interest include monitoring and managing toxicity of immunosuppressive agents. She is co-director of the MDA clinic, and provides botulinum toxin for treatment of sialorrhea for ALS patients.
A Study of TAK-079 in People With Generalized Myasthenia Gravis
Myasthenia gravis is an autoimmune condition that causes muscle weakness. Autoimmune means the body makes antibodies that attack its own cells and tissues. These types of antibodies are also known as autoantibodies. People with generalized myasthenia gravis have a weakness in many muscles. TAK-079 is a medicine to help people with generalized myasthenia gravis. The main aim of this study is to check if people with generalized myasthenia gravis have side effects from 2 doses of TAK-079. Other aims are to learn if TAK-079 improves their clinical condition and lowers their autoantibody levels. At the first visit, the study doctor will check if each person can take part. For those who can take part, participants will continue with their standard medicines for this condition during the study. Each participant will have a check-up by the study doctor. Then, the participants will have 1 of 3 treatments: - A low dose of TAK-079. - A high dose of TAK-079. - A placebo. In this study, a placebo looks like TAK-079 but does not have any medicine in it. Participants will not know which treatment they received, nor will their study doctors. This is to help make sure the results are more reliable. For each treatment, participants will receive injections just under the skin, once a week for 8 weeks. The study doctors will check for side effects from the study treatments. The study doctors can stop or delay the injections in each participant if needed. Then, the study doctors will continue to check for side effects for up to 24 weeks after treatment. They will also check the clinical condition of the participants, including their autoantibody levels.
A Safety and Tolerability Study of ARGX-113 in Patients With Myasthenia Gravis Who Have Generalized Muscle Weakness.
This is a Long-Term, Single-Arm, Open-Label, Multicenter Phase 3 follow-on trial of the ARGX-113-1704 study to evaluate the safety and tolerability of ARGX-113 in patients with gMG. Patients who have completed at least 1 cycle of treatment and at least 1 year of trial ARGX-113-1705 and have started Part B are eligible to enroll in the open-label trial ARGX-113-2002 to receive efgartigimod by SC administration.
Stanford is currently not accepting patients for this trial.
An Efficacy and Safety Study of Ravulizumab in ALS Participants
The purpose of the study is to assess the efficacy and safety of ravulizumab for the treatment of adult participants with ALS.
Stanford is currently not accepting patients for this trial.
Safety and Efficacy Study of Ravulizumab in Adults With Generalized Myasthenia Gravis
The primary purpose of this study is to evaluate the safety and efficacy of ravulizumab for the treatment of participants with generalized myasthenia gravis (gMG).
Stanford is currently not accepting patients for this trial.
Safety and outcomes with efgartigimod use for acetylcholine receptor-positive generalized myasthenia gravis in clinical practice.
Muscle & nerve
Multiple novel therapies have been approved for patients with myasthenia gravis. Our aim is to describe the early experience of efgartigimod use in acetylcholine receptor antibody-positive generalized myasthenia gravis (AChR+ve gMG).This multicenter retrospective study included AChR+ve gMG patients from five major neuromuscular centers who were treated with efgartigimod and had both pre- and post-efgartigimod myasthenia gravis activities of daily living (MG-ADL) scores. Information regarding MG history, concomitant treatment(s), MG-ADL and other MG-specific measures, laboratory data, and adverse events were recorded.A total of 37 patients (M:23, F:14) with a mean age of 65.56 (±14.74) y were included in this cohort. A total of 36/37 patients completed at least one cycle and 28 patients completed at least two cycles of efgartigimod. A total of 72% (26/36) of patients had a clinically meaningful reduction (≥2 point change) in MG-ADL after the completion of the first cycle of efgartigimod (mean pre-efgartigimod 8.02) (±3.09) versus post-efgartigimod 4.33 (±3.62). Twenty-five percent (9/36) achieved minimal symptom expression status after one cycle and 25% (7/28) after the second cycle. Treatment benefit was sustained after cycle 2. Three out of four patients with thymoma in this cohort had clinically significant reductions in MG-ADL scores. Immunoglobulin G (IgG) levels decreased by about 60% (n = 10). One patient had a relapse of Clostridium difficile infection resulting in the discontinuation of therapy. Four patients had mild side effects.Efgartigimod led to clinically meaningful improvement in MG-ADL in diverse AChR+ve gMG patients but treatment frequency to achieve optimal symptom control needs to be explored.
View details for DOI 10.1002/mus.27974
View details for PubMedID 37695277
- Scapular Winging In Patients With Anti-Hydroxy Methyl Glutaryl CoA Reductase (HMGCR) Antibody Positive Immune Mediated Necrotizing Myopathy (IMNM): A Case Series LIPPINCOTT WILLIAMS & WILKINS. 2023
- Clinical Experience With Efgartigimod For Treatment Of Acetylcholine Receptor Antibody Positive Generalized Myasthenia Gravis LIPPINCOTT WILLIAMS & WILKINS. 2023
- Response to "Polyradiculitis Complicating SARS-CoV-2 Vaccinations is Not Infrequent". The Neurohospitalist 2023; 13 (2): 210-211
Current status of clinical outcome measures in inclusion body myositis: a systematised review.
Clinical and experimental rheumatology
OBJECTIVES: Sporadic inclusion body myositis (IBM) is a debilitating idiopathic inflammatory myopathy (IIM) which affects hand function, ambulation, and swallowing. There is no approved pharmacological therapy for IBM, and there is a lack of suitable outcome measure to assess the effect of an intervention. The IBM scientific interest group under IMACS reviewed the previously used outcome measures in IBM clinical studies to lay the path for developing a core set of outcome measures in IBM.METHODS: In this systematised review, we have extracted all outcome measures reported in IBM clinical studies to determine what measures were being used and to assess the need for optimising outcome measures in IBM.RESULTS: We found 13 observational studies, 17 open-label clinical trials, and 15 randomised control trials (RCTs) in IBM. Six-minute walk distance, IBM-functional rating scale (IBM-FRS), quantitative muscle testing, manual muscle testing, maximal voluntary isometric contraction testing, and thigh muscle volume measured by MRI were used as primary outcome measures. Twelve different outcome measures of motor function were used in IBM clinical trials. IBM-FRS was the most used measure of functionality. Swallowing function was reported as a secondary outcome measure in only 3 RCTs.CONCLUSIONS: There are inconsistencies in using outcome measures in clinical studies in IBM. The core set measures developed by the IMACS group for other IIMs are not directly applicable to IBM. As a result, there is an unmet need for an IBM-specific core set of measures to facilitate the evaluation of new potential therapeutics for IBM.
View details for DOI 10.55563/clinexprheumatol/ifacv3
View details for PubMedID 36762744
Current status of clinical outcome measures in inclusion body myositis: a systematised review
CLINICAL AND EXPERIMENTAL RHEUMATOLOGY
2023; 41 (2): 370-378
View details for Web of Science ID 000952863200024
- Response to "Polyradiculitis Complicating SARS-CoV-2 Vaccinations is Not Infrequent" NEUROHOSPITALIST 2022
Improving Patient Outcomes through Standardized Protocols when prescribing Glucocorticoids
LIPPINCOTT WILLIAMS & WILKINS. 2022
View details for Web of Science ID 000894020500036
IMPROVING PATIENT OUTCOMES THROUGH STANDARDIZED PROTOCOLS WHEN PRESCRIBING GLUCOCORTICOIDS
WILEY. 2022: S23
View details for Web of Science ID 000813311100048
- Guillain-Barre Syndrome with Rapid Onset and Autonomic Dysfunction Following First Dose of Pfizer-BioNTech COVID-19 Vaccine: A Case Report NEUROHOSPITALIST 2022
- Investigating Late-Onset Pompe Prevalence in Neuromuscular Medicine Academic Practices NEUROLOGY-GENETICS 2021; 7 (6)
Investigating Late-Onset Pompe Prevalence in Neuromuscular Medicine Academic Practices: The IPaNeMA Study.
2021; 7 (6): e623
We investigated the prevalence of late-onset Pompe disease (LOPD) in patients presenting to 13 academic, tertiary neuromuscular practices in the United States and Canada.All successive patients presenting with proximal muscle weakness or isolated hyperCKemia and/or neck muscle weakness to these 13 centers were invited to participate in the study. Whole blood was tested for acid alpha-glucosidase (GAA) assay through the fluorometric method, and all cases with enzyme levels of ≤10 pmoL/punch/h were reflexed to molecular testing for mutations in the GAA gene. Clinical and demographic information was abstracted from their clinical visit and, along with study data, entered into a purpose-built REDCap database, and analyzed at the University of California, Irvine.GAA enzyme assay results were available on 906 of the 921 participants who consented for the study. LOPD was confirmed in 9 participants (1% prevalence). Another 9 (1%) were determined to have pseudodeficiency of GAA, whereas 19 (1.9%) were found to be heterozygous for a pathogenic GAA mutation (carriers). Of the definite LOPD participants, 8 (89%) were Caucasian and were heterozygous for the common leaky (IVS1) splice site mutation in the GAA gene (c -32-13T>G), with a second mutation that was previously confirmed to be pathogenic.The prevalence of LOPD in undiagnosed patients meeting the criteria of proximal muscle weakness, high creatine kinase, and/or neck weakness in academic, tertiary neuromuscular practices in the United States and Canada is estimated to be 1%, with an equal prevalence rate of pseudodeficiency alleles.Clinical trial registration number: NCT02838368.
View details for DOI 10.1212/NXG.0000000000000623
View details for PubMedID 36299500
View details for PubMedCentralID PMC9595038
Exome testing most useful for people with recessive CMT
WILEY. 2021: 141–42
View details for Web of Science ID 000626893200065
Response Rates in Placebo arm of MG Clinical Trials
LIPPINCOTT WILLIAMS & WILKINS. 2019
View details for Web of Science ID 000475965905213
Long-term safety and efficacy of eculizumab in generalized myasthenia gravis.
Muscle & nerve
INTRODUCTION: Eculizumab is effective and well tolerated in patients with anti-acetylcholine receptor antibody-positive refractory generalized myasthenia gravis (gMG; REGAIN; NCT01997229). We report an interim analysis of an open-label extension of REGAIN evaluating eculizumab's long-term safety and efficacy.METHODS: 117 patients received eculizumab (1,200 mg every 2 weeks) for 22.7 months (median).RESULTS: The safety profile of eculizumab was consistent with REGAIN; no cases of meningococcal infection were reported during the interim analysis period. MG exacerbation rate was reduced by 75% from the year before REGAIN (p<0.0001). Improvements with eculizumab in activities of daily living, muscle strength, functional ability and quality of life in REGAIN were maintained through 3 years; 56% of patients achieved minimal manifestations or pharmacological remission. Patients who received placebo during REGAIN experienced rapid and sustained improvements during open-label eculizumab (p<0.0001).DISCUSSION: These findings demonstrate the long-term safety and sustained efficacy of eculizumab for refractory gMG. This article is protected by copyright. All rights reserved.
View details for PubMedID 30767274
Making sense of antisense oligonucleotides: A narrative review
MUSCLE & NERVE
2018; 57 (3): 356–70
Synthetic nucleic acid sequences that bind to ribonucleic acid (RNA) through Watson-Crick base pairing are known as antisense oligonucleotides (ASOs) because they are complementary to "sense strand" nucleic acids. ASOs bind to selected sequences of RNA and regulate the expression of genes by several mechanisms depending on their chemical properties and targets. They can be used to restore deficient protein expression, reduce the expression of a toxic protein, modify functional effects of proteins, or reduce toxicity of mutant proteins. Two ASOs were approved by the U.S. Food and Drug Administration in 2016: eteplirsen for Duchenne muscular dystrophy and nusinersen for spinal muscular atrophy. Clinical trials in amyotrophic lateral sclerosis and familial amyloid polyneuropathy are ongoing. We review the chemistry, pharmacology, and mechanisms of action of ASOs, preclinical data, and clinical trials in neuromuscular diseases and discuss some ethical, regulatory, and policy considerations in the clinical development and use of ASOs. Muscle Nerve 57: 356-370, 2018.
View details for PubMedID 29105153