Neurological Conditions and Treatment

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Stroke

A stroke, previously known medically as a cerebrovascular accident (CVA), is the rapidly developing loss of brain function(s) due to disturbance in the blood supply to the brain. This can be due to ischemia (lack of blood flow) caused by blockage (thrombosis, arterial embolism), or a hemorrhage (leakage of blood).As a result, the affected area of the brain is unable to function, which might result in an inability to move one or more limbs on one side of the body, inability to understand or formulate speech, or an inability to see one side of the visual field.

A stroke is a medical emergency and can cause permanent neurological damage, complications, and death. It is the leading cause of adult disability in the United States and Europe and the second leading cause of death worldwide. Risk factors for stroke include old age, hypertension (high blood pressure), previous stroke or transient ischemic attack (TIA), diabetes, high cholesterol, cigarette smoking and atrial fibrillation. High blood pressure is the most important modifiable risk factor of stroke.

Symptoms

The symptoms of stroke depend on what part of the brain is damaged. In some cases, a person may not even be aware that he or she has had a stroke. Symptoms usually develop suddenly and without warning, or they may occur on and off for the first day or two. Symptoms are usually most severe when the stroke first happens, but they may slowly get worse.

  • Starts suddenly and may be severe
  • Occurs when lying flat
  • Wakes you up from sleep
  • Gets worse when you change positions or when you bend, strain, or cough
  • Muscle weakness in the face, arm, or leg (usually just one side)
  • Numbness or tingling on one side of the body
  • Trouble speaking or understanding others who are speaking
  • Problems with eyesight
  • Changes in hearing
  • Change in alertness (including sleepiness, unconsciousness, and coma)
  • Personality, mood, or emotional changes
  • Confusion or loss of memory
  • Difficulty swallowing
  • Changes in taste
  • Difficulty writing or reading
  • Loss of coordination
  • Loss of balance
  • Clumsiness
  • Trouble walking
  • Dizziness or abnormal sensation of movement (vertigo)
  • Lack of control over the bladder or bowels

Treatment

A stroke is a medical emergency. Immediate treatment can save lives and reduce disability. Call 911 or your local emergency number or seek immediate medical care at the first signs of a stroke. It is important to get the person to the emergency room immediately to determine if the stroke is due to bleeding or a blood clot so appropriate treatment can be started within 3 hours of when the stroke began. Treatment depends on the severity and cause of the stroke. A hospital stay is required for most strokes.

Headaches

A headache or cephalgia is pain anywhere in the region of the head or neck. It can be a symptom of a number of different conditions of the head and neck. The brain tissue itself is not sensitive to pain because it lacks pain receptors. Rather, the pain is caused by disturbance of the pain-sensitive structures around the brain. Several areas of the head and neck have these pain-sensitive structures, which are the cranium (the periosteum of the skull, muscles, nerves, arteries and veins, subcutaneous tissues, eyes, ears, sinuses and mucous membranes).

Migraine

The typical migraine headache is unilateral (affecting one half of the head) and pulsating in nature and lasting from four to 72 hours; symptoms include nausea, vomiting, photophobia (increased sensitivity to light) and phonophobia (increased sensitivity to sound); the symptoms are generally aggravated by routine activity. Approximately one-third of people who suffer from migraine headaches perceive an aura—transient visual, sensory, language, or motor disturbances signaling the migraine will soon occur.

Initial treatment is with analgesics for the headache, an antiemetic for the nausea, and the avoidance of triggers. The cause of migraine headache is unknown; the most supported theory is that it is related to hyperexcitability of the cerebral cortex and/or abnormal control of pain neurons in the trigeminal nucleus of the brainstem.

Vision disturbances, or aura, are considered a "warning sign" that a migraine is coming. The aura occurs in both eyes and may involve any or all of the following:

  • A temporary blind spot
  • Blurred vision
  • Eye pain
  • Seeing stars or zigzag lines
  • Tunnel vision

Not every person with migraines has an aura. Those who do usually develop one about 10 - 15 minutes before the headache. However, it may occur just a few minutes to 24 hours beforehand. Migraine headaches can be dull or severe. The pain may be felt behind the eye or in the back of the head and neck. For many patients, the headaches start on the same side each time. The headaches usually:

  • Feel throbbing, pounding, or pulsating
  • Are worse on one side of the head
  • Start as a dull ache and get worse within minutes to hours
  • Last 6 to 48 hours

Other symptoms that may occur with the headache include:

  • Chills
  • Increased urination
  • Fatigue
  • Loss of appetite
  • Nausea and vomiting
  • Numbness, tingling, or weakness
  • Problems concentrating, trouble finding words
  • Sensitivity to light or sound
  • Sweating

Treatment

Not all headaches require medical attention, and most respond with simple analgesia (painkillers) such as paracetamol/acetaminophen or non-steroidal anti-inflammatory drugs like aspirin, ibuprofen, or diclofenac. In recurrent unexplained headaches keeping a "headache diary" with entries on type of headache, associated symptoms, precipitating and aggravating factors may be helpful. This may reveal specific patterns, such as an association with medication, menstruation or absenteeism or with certain foods.

There are however two types of treatment for chronic headaches meaning acute abortive treatment and preventive treatment. Whereas the first is aimed to relieve the symptoms immediately, the latter is focused on controlling the headaches that are chronic. From this reason, the acute treatment is commonly and effectively used in treating migraines and the preventive treatment is the usual approach in managing chronic headaches. The primary goal of preventive treatment is to reduce the frequency, severity, and duration of headaches. This type of treatment involves taking medication on a daily basis for at least 3 months and in some cases, for over 6 months.

Alzheimer's

Alzheimer's disease (AD), senile dementia of the Alzheimer type, primary degenerative dementia of the Alzheimer's type, simply Alzheimer's (as a stand-alone attributive adjective noun), and folk-etymological names such as "old-timers' disease", is the most common form of dementia. This incurable, degenerative, and terminal disease was first described by German psychiatrist and neuropathologist Alois Alzheimer in 1906 and was named after him. Most often, it is diagnosed in people over 65 years of age,although the less-prevalent early-onset Alzheimer's can occur much earlier.

Although the course of Alzheimer's disease is unique for every individual, there are many common symptoms. The earliest observable symptoms are often mistakenly thought to be 'age-related' concerns, or manifestations of stress. In the early stages, the most common symptom is inability to acquire new memories, observed as difficulty in recalling recently observed events. When AD is suspected, the diagnosis is usually confirmed with behavioral assessments and cognitive tests, often followed by a brain scan if available.

Symptoms

As the disease advances, symptoms include confusion, irritability and aggression, mood swings, language breakdown, long-term memory loss, and the general withdrawal of the sufferer as the senses decline. Gradually, bodily functions are lost, ultimately leading to death. Individual prognosis is difficult to assess, as the duration of the disease varies. AD develops for an indeterminate period of time before becoming fully apparent, and it can progress undiagnosed for years. The mean life expectancy following diagnosis is approximately seven years. The early symptoms of AD can include:

  • Language problems, such as trouble finding the name of familiar objects
  • Misplacing items
  • Getting lost on familiar routes
  • Personality changes and loss of social skills
  • Losing interest in things previously enjoyed, flat mood
  • Difficulty performing tasks that take some thought, but used to come easily, such as balancing a checkbook, playing complex games (such as bridge), and learning new information or routines

Treatment

Unfortunately, there is no cure for AD. The goals in treating AD are to:

  • Slow the progression of the disease (although this is difficult to do)
  • Manage behavior problems, confusion, sleep problems, and agitation
  • Modify the home environment
  • Support family members and other caregivers

Multiple Sclerosis

Multiple sclerosis (abbreviated MS, also known as disseminated sclerosis or encephalomyelitis disseminata) is an inflammatory disease in which the fatty myelin sheaths around the axons of the brain and spinal cord are damaged, leading to demyelination and scarring as well as a broad spectrum of signs and symptoms. Disease onset usually occurs in young adults, and it is more common in women. It has a prevalence that ranges between 2 and 150 per 100,000. MS was first described in 1868 by Jean-Martin Charcot. MS affects the ability of nerve cells in the brain and spinal cord to communicate with each other effectively. Nerve cells communicate by sending electrical signals called action potentials down long fibers called axons, which are contained within an insulating substance called myelin.

In MS, the body's own immune system attacks and damages the myelin. When myelin is lost, the axons can no longer effectively conduct signals. The name multiple sclerosis refers to scars (scleroses—better known as plaques or lesions) particularly in the white matter of the brain and spinal cord, which is mainly composed of myelin. Although much is known about the mechanisms involved in the disease process, the cause remains unknown.

Symptoms

Symptoms vary, because the location and severity of each attack can be different. Episodes can last for days, weeks, or months. These episodes alternate with periods of reduced or no symptoms (remissions). Fever, hot baths, sun exposure, and stress can trigger or worsen attacks.

It is common for the disease to return (relapse). However, the disease may continue to get worse without periods of remission.

Because nerves in any part of the brain or spinal cord may be damaged, patients with multiple sclerosis can have symptoms in many parts of the body. Muscle symptoms include:

  • Loss of balance
  • Muscle spasms
  • Numbness or abnormal sensation in any area
  • Problems moving arms or legs
  • Problems walking
  • Problems with coordination and making small movements
  • Tremor in one or more arms or legs
  • Weakness in one or more arms or legs
  • Constipation and stool leakage
  • Difficulty beginning to urinate
  • Frequent need to urinate
  • Strong urge to urinate
  • Urine leakage (incontinence)
  • Double vision
  • Eye discomfort
  • Uncontrollable rapid eye movements
  • Vision loss (usually affects one eye at a time)
  • Facial pain
  • Painful muscle spasms
  • Tingling, crawling, or burning feeling in the arms and legs

Treatment

Disease-modifying treatments reduce the progression rate of the disease, but do not stop it. As multiple sclerosis progresses, the symptomatology tends to increase. The disease is associated with a variety of symptoms and functional deficits that result in a range of progressive impairments and disability. Management of these deficits is therefore very important. Both drug therapy and neurorehabilitation have shown to ease the burden of some symptoms, though neither influences disease progression. Some symptoms have a good response to medication, such as unstable bladder and spasticity, while management of many others is much more complicated. As for any patient with neurologic deficits, a multidisciplinary approach is key to improving quality of life; however, there are particular difficulties in specifying a 'core team' because people with MS may need help from almost any health profession or service at some point. Multidisciplinary rehabilitation programs increase activity and participation of patients but do not influence impairment level. Medications used to slow the progression of multiple sclerosis are taken on a long-term basis, they include:

  • Interferons (Avonex, Betaseron, or Rebif), glatiramer acetate (Copaxone), mitoxantrone (Novantrone), and natalizumab (Tysabri) are approved for treating MS
  • Methotrexate, azathioprine (Imuran), intravenous immunoglobulin (IVIg) and cyclophosphamide (Cytoxan) may also be used if the above drugs are not working well

Steroids may be used to decrease the severity of attacks. Medications to control symptoms may include:

  • Medicines to reduce muscle spasms such as Lioresal (Baclofen), tizanidine (Zanaflex), or a benzodiazepine
  • Cholinergic medications to reduce urinary problems
  • Antidepressants for mood or behavior symptoms
  • Amantadine for fatigue

The following may help MS patients:

  • Physical therapy, speech therapy, occupational therapy, and support groups
  • Assistive devices, such as wheelchairs, bed lifts, shower chairs, walkers, and wall bars
  • A planned exercise program early in the course of the disorder
  • A healthy lifestyle, with good nutrition and enough rest and relaxation
  • Avoiding fatigue, stress, temperature extremes, and illness

Epilepsy / Seizures

Epilepsy is a common chronic neurological disorder characterized by seizures. These seizures are transient signs and/or symptoms of abnormal, excessive or hypersynchronous neuronal activity in the brain. About 50 million people worldwide have epilepsy, and nearly two out of every three new cases are discovered in developing countries. Epilepsy becomes more common as people age. Onset of new cases occur most frequently in infants and the elderly. As a consequence of brain surgery, epileptic seizures may occur in recovering patients.

Symptoms

Epilepsy is usually controlled, but not cured, with medication. However, over 30% of people with epilepsy do not have seizure control even with the best available medications. Surgery may be considered in difficult cases.[8][9] Not all epilepsy syndromes are lifelong – some forms are confined to particular stages of childhood. Epilepsy should not be understood as a single disorder, but rather as syndromic with vastly divergent symptoms but all involving episodic abnormal electrical activity in the brain.

The severity of symptoms can vary greatly, from simple staring spells to loss of consciousness and violent convulsions. For most people with epilepsy, each seizure is similar to previous ones. The type of seizure a person has depends on a variety of things, such as the part of the brain affected and the underlying cause of the seizure.

An aura consisting of a strange sensation (such as tingling, smelling an odor that isn't actually there, or emotional changes) occurs in some people prior to each seizure.

Treatment

Epilepsy is usually treated with medication prescribed by a physician; primary caregivers, neurologists, and neurosurgeons all frequently care for people with epilepsy. However, it has been stressed that accurate differentiation between generalized and partial seizures is especially important in determining the appropriate treatment. In some cases the implantation of a stimulator of the vagus nerve, or a special diet can be helpful. Neurosurgical operations for epilepsy can be palliative, reducing the frequency or severity of seizures; or, in some patients, an operation can be curative

Parkinson's Disease

Parkinson's disease is a degenerative disorder of the central nervous system. It results from the death of dopamine-containing cells in the substantia nigra, a region of the midbrain; the cause of cell-death is unknown. Early in the course of the disease, the most obvious symptoms are movement-related, including shaking, rigidity, slowness of movement and difficulty with walking and gait. Later, cognitive and behavioural problems may arise, with dementia commonly occurring in the advanced stages of the disease. Other symptoms include sensory, sleep and emotional problems. PD is more common in the elderly with most cases occurring after the age of 50. Modern treatments are effective at managing the early motor symptoms of the disease, mainly through the use of levodopa and dopamine agonists.

As the disease progresses and dopamine neurons continue to be lost, a point eventually arrives at which these drugs become ineffective at treating the symptoms and at the same time produce a complication called dyskinesia, marked by involuntary writhing movements. Diet and some forms of rehabilitation have shown some effectiveness at alleviating symptoms. Surgery and deep brain stimulation have been used to reduce motor symptoms as a last resort in severe cases where drugs are ineffective. Research directions include a search of new animal models of the disease and investigations of the potential usefulness of gene therapy, stem cell transplants and neuroprotective agents. Medications to treat non-movement-related symptoms of PD, such as sleep disturbances and emotional problems, also exist.

Symptoms

Symptoms may be mild at first. For instance, the patient may have a mild tremor or a slight feeling that one leg or foot is stiff and dragging. Symtoms include:

  • Automatic movements (such as blinking) slow or stop
  • Constipation
  • Difficulty swallowing
  • Drooling
  • Impaired balance and walking
  • Lack of expression in the face (mask-like appearance)
  • Muscle aches and pains (myalgia)
  • Problems with movement
  • Difficulty starting or continuing movement, such as starting to walk or getting out of a chair
  • Loss of small or fine hand movements (writing may become small and difficult to read, and eating becomes harder)
  • Shuffling gait
  • Slowed movements
  • Rigid or stiff muscles (often beginning in the legs)
  • Shaking, tremors
  • Tremors usually occur in the limbs at rest, or when the arm or leg is held out
  • Tremors go away during movement
  • Over time, tremor can be seen in the head, lips, tongue, and feet
  • May be worse when tired, excited, or stressed
  • Finger-thumb rubbing (pill-rolling tremor) may be present
  • Slowed, quieter speech and monotone voice

Treatment

When an acute stroke is suspected by history and physical examination, the goal of early assessment is to determine the cause. Treatment varies according to the underlying cause of the stroke, thromboembolic (ischemic) or hemorrhagic. A non-contrast head CT scan can rapidly identify a hemorrhagic stroke by imaging bleeding in or around the brain. If no bleeding is seen, a presumptive diagnosis of ischemic stroke is made.

Neuropathy

Peripheral neuropathy is a problem with the nerves that carry information to and from the brain and spinal cord. This can produce pain, loss of sensation, and an inability to control muscles. "Peripheral" means nerves further out from the center of the body, distant from the brain and spinal cord. "Neuro" means nerves. "Pathy" means abnormal.

The four cardinal patterns of peripheral neuropathy are polyneuropathy, mononeuropathy, mononeuritis multiplex and autonomic neuropathy. The most common form is (symmetrical) peripheral polyneuropathy, which mainly affects the feet and legs. The form of neuropathy may be further broken down by cause, or the size of predominant fiber involvement, i.e., large fiber or small fiber peripheral neuropathy. Frequently the cause of a neuropathy cannot be identified and it is designated idiopathic. Neuropathy may be associated with varying combinations of weakness, autonomic changes, and sensory changes. Loss of muscle bulk or fasciculations, a particular fine twitching of muscle, may be seen. Sensory symptoms encompass loss of sensation and "positive" phenomena including pain. Symptoms depend on the type of nerves affected (motor, sensory, or autonomic) and where the nerves are located in the body.

One or more types of nerves may be affected. Common symptoms associated with damage to the motor nerve are muscle weakness, cramps, and spasms. Loss of balance and coordination may also occur. Damage to the sensory nerve can produce tingling, numbness, and pain. Pain associated with this nerve is described in various ways such as the following: sensation of wearing an invisible "glove" or "sock", burning, freezing, or electric-like, extreme sensitivity to touch. The autonomic nerve damage causes problems with involuntary functions leading to symptoms such as abnormal blood pressure and heart rate, reduced ability to perspire, constipation, bladder dysfunction (e.g., incontinence), and sexual dysfunction.

Symptoms

The symptoms depend on which type of nerve is affected. The three main types of nerves are:

  • Those that carry sensations (sensory)
  • Those that control muscles (motor)
  • Those that carry information to organs and glands (autonomic)

Neuropathy can affect any one or a combination of all three types of nerves. Symptoms also depend on whether the condition affects the whole body or just one nerve (as from an injury). Longer nerves are more easily injured than shorter ones, so it is common for you to have worst symptoms in the legs and feet than in the hands and arms.

Treatment

Many treatment strategies for peripheral neuropathy are symptomatic. Some current research in animal models has shown that neurotrophin-3 can oppose the demyelination present in some peripheral neuropathies. A range of drugs that act on the central nervous system such as drugs originally intended as antidepressants and antiepileptic drugs have been found to be useful in managing neuropathic pain. Commonly used treatments include using a tricyclic antidepressant (such as amitriptyline) and antiepileptic therapies such as gabapentin or sodium valproate. These have the advantage that besides being effective in many cases they are relatively low cost.

Pinched Nerve (Radiculopathy)

Radiculopathy is not a specific condition, but rather a description of a problem in which one or more nerves are affected and do not work properly (a neuropathy). The emphasis is on the nerve root (Radix = "root"). This can result in pain (radicular pain), weakness, numbness, or difficulty controlling specific muscles. In a radiculopathy, the problem is at or near the root of the nerve, along the spine. However, the pain or other symptoms may manifest in an extremity through a process called referred pain. For example, a nerve root impingement in the neck can produce pain and weakness in the forearm. Likewise, an impingement in the lower back or lumbar-sacral spine can be manifested with symptoms in the foot. Polyradiculopathy refers to the condition where more than one spinal nerve root is affected.

Treatment

Ideally, effective treatment aims to resolve the underlying cause and restores the nerve root to normal function. Common mainstream treatment approaches include physical therapy, medication, and relaxation. A comprehensive systematic review found moderate quality evidence that spinal manipulation is effective for the treatment of acute lumbar radiculopathy. Only low level evidence was found to support spinal manipulation for the treatment of chronic lumbar and cervical spine-related radiculopathies, and no evidence was found to exist for treatment of thoracic radiculopathy.

Carpal Tunnel Syndrome

Carpal Tunnel Syndrome (CTS) is idiopathic median neuropathy at the carpal tunnel. The pathophysiology is not completely understood but can be considered compression of the median nerve traveling through the carpal tunnel. The National Center for Biotechnology Information and highly cited older literature largely structural, genetic, and biological, with environmental and occupational factors such as repetitive hand use playing a minor and more debatable role. More recent research by Lozano-Calderón has cited genetics as a larger factor than use, and has encouraged caution in ascribing causality. The main symptom of CTS is intermittent numbness of the thumb, index, long and radial half of the ring finger. The numbness usually occurs at night because we tend to sleep with our wrists flexed and is relieved by wearing a wrist splint that prevents flexion.

Symptoms

  • Numbness or tingling in the thumb and next two or three fingers of one or both hands
  • Numbness or tingling of the palm of the hand
  • Pain extending to the elbow
  • Pain in wrist or hand in one or both hands
  • Problems with fine finger movements (coordination) in one or both hands
  • Wasting away of the muscle under the thumb (in advanced or long-term cases)
  • Weak grip or difficulty carrying bags (a common complaint)
  • Weakness in one or both hands

Treatment

There have been numerous scientific papers evaluating treatment efficacy in CTS. It is important to distinguish treatments that are supported in the scientific literature from those that are advocated by any particular device manufacturer or any other party with a vested financial interest. Generally accepted treatments, as described below, may include splinting or bracing, steroid injection, activity modification, physiotherapy, regular massage therapy treatments, chiropractic, medications, and surgical release of the transverse carpal ligament.

According to the 2007 guidelines by the American Academy of Orthopedic Surgeons,[52] early surgery with carpal tunnel release is indicated where there is clinical evidence of median nerve de-nervation or the patient elects to proceed directly to surgical treatment. Otherwise, the main recommended treatments are local corticosteroid injection, splinting (immobilizing braces), oral corticosteroids and ultrasound treatment. The treatment should be switched when the current treatment fails to resolve the symptoms within 2 to 7 weeks. However, these recommendations have sufficient evidence for carpal tunnel syndrome when found in association with the following conditions: diabetes mellitus, coexistent cervical radiculopathy, hypothyroidism, polyneuropathy, pregnancy, rheumatoid arthritis, and carpal tunnel syndrome in the workplace.

Tremors

A tremor is an involuntary, somewhat rhythmic, muscle contraction and relaxation involving to-and-fro movements (oscillations or twitching) of one or more body parts. It is the most common of all involuntary movements and can affect the hands, arms, eyes, face, head, vocal cords, trunk, and legs. Most tremors occur in the hands. In some people, tremor is a symptom of another neurological disorder. A very common kind of tremor is the chattering of teeth, usually induced by cold temperatures or by fear.

Symptoms

The tremor is usually most obvious in the hands, but may affect the arms, head, eyelids, or other muscles. The tremor rarely affects the legs or feet. People with essential tremor may have trouble holding or using small objects such as silverware or a pen. The shaking usually involves small, rapid movements -- more than 5 times a second. Specific symptoms may include:

  • Head nodding
  • Shaking or quivering sound to the voice if the tremor affects the voice box
  • Difficulty writing, drawing, drinking from a cup, or using tools if the tremor affects the hands

The tremors may:

  • Occur when you move (action-related tremor), and may be less noticeable with rest
  • Come and go, but generally get worse as you age
  • Get worse with stress, caffeine, and certain medications
  • Not affect both sides of the body the same way

Treatment

There is no cure for most tremors. The appropriate treatment depends on accurate diagnosis of the cause. Some tremors respond to treatment of the underlying condition. For example, in some cases of psychogenic tremor, treating the patient’s underlying psychological problem may cause the tremor to disappear.

Memory Loss

Memory loss can be partial or total and it is normal when it comes with aging. Sudden memory loss is usually a result of brain trauma and it may be permanent or temporary. When it is caused by medical conditions such as Alzheimer's, the memory loss is gradual and tends to be permanent. Brain trauma is not the only factor that can cause sudden memory loss. It may appear as a side effect of statin drugs that are used as treatment for those who have hypercholesterolemia. Major causes of sudden loss of memory are strokes. Other causes are long lasting and recurrent illnesses such as meningitis or epilepsy . Memory loss temporary or permanent can also result from chemical imbalances, exposure to toxic substances, allergies or vitamin deficiencies.

Treatment

Memory loss can't be treated unless it is caused by a reversible condition. The treatment is greatly dependent on the primary cause of the condition. When memory loss is a symptom of a more severe disease, it may be reversed as soon as the underlying condition is identified and cured. Memory loss due to aging cannot be cured but the symptoms may be improved by following the prevention measures. Treating mild cases of memory loss may consist of herbal medications or a change in lifestyle. The other dietary supplements along with good quality and long sleep and avoiding potential risk factors may also improve the general status of the patient.


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