Platelet rich plasma (PRP) has been used medically since the late 1990’s. Dentists were the first to use this natural healing mechanism to improve outcomes of dental surgery and tooth extractions. PRP has been used since 2000 for accelerated healing during surgery, following orthopedic, thoracic and cardiac surgical procedures. PRP has found wide use in non-surgical orthopedic treatment of knee and shoulder pain. It can be used for a variety of common sports injuries.

Platelet rich plasma can heal injured tendons, ligaments, muscle, cartilage and bone. Major league sports has discovered the incredible natural healing effects of PRP. Major sports leagues have adopted PRP therapy as one of the first line treatments of their injured athletes. Professional sports has recognized the economic value of PRP in that one PRP treatment costs $1500-2000 as compared to the typical orthopedic surgery which can range from $35,000 – 75,000.  Treatment with platelet rich plasma has virtually no down time and does not require months of physical rehabilitation. Healing time is faster than with surgery and the complication rate is negligible. Professional athletes can get back in the game faster. The International Olympic Committee has approved the use of PRP in Olympic candidates and athletes. Platelet rich plasma has become an early treatment option in the treatment of professional athletes that have suffered muscle, joint, tendon and ligament injures.

NFL Players Who Have Received PRP

Hines Ward: Multiple PRP Treatments

Hines Ward: Multiple PRP Treatments & 2 Super Bowl Wins!

Hines Ward, the Pittsburgh Steelers wide receiver, has use platelet rich plasma therapy on at least two occasions  for a torn medial collateral ligament — a knee injury. The use of PRP allowed him to go on and win two Super Bowls. Mr. Ward has attributed his ability to play to receiving PRP.

Other NFL players have successfully been treated with PRP for various injuries. Troy Polamalu, a Steeler’s defensive safety, has had his share of traumatic injuries. As one of the top defensive players, Polamalu has had repeated trauma to his knees. He had one significant MCL injury for which he had PRP therapy.

Donald Jones of the Buffalo Bills and Andre Dixon of the Hartford Colonials have also had PRP therapy for their injuries -all with excellent success.  Houston Texans wide receiver Andre Johnson suffered a high ankle sprain. To expedite the recovery process, Johnson underwent platelet rich plasma therapy.

These professional athletes were able to get back to playing football in only a few short weeks, instead of the normal 2-4 months of healing and rehabilitation time it take for more conventional therapies. Surgical treatment would sideline these highly trained athletes for a whole season. NFL physicians have discovered that PRP is the answer to getting these players healed quickly, with needing to resort to surgery. Platelet rich plasma regenerates new, stronger tissue in these injured players.

Major League Baseball and PRP


Alex Rodriguez: 5-time PRP Recipient

Alex Rodriguez: 5-time PRP Recipient

Alex Rodriguez, one of Major League Baseball’s most famous players used five PRP treatments to accelerate healing and recovery following hip surgery that left him in pain. His trainers were amazed to see how much faster A-Rod was able to get back into playing baseball.

Takashi Saito suffered an elbow injury in his pitching arm while playing as a Pitcher for the LA. At 38, surgery was not a good option, as recovery could have taken as much as 9 months. He had PRP therapy and was able to resume pitching in only a few weeks. Saito credited his unlikely recovery from a partially torn ulnar collateral ligament to PRP therapy.

Takashi Saito in his 2009 Season with the Boston Red Sox

Takashi Saito in his 2009 Season with the Boston Red Sox

In one year, Major League Baseball’s 30 teams had 519 players who spent 28,602 days on the disabled list for injuries sustained while playing baseball. This represented $455 million in total salary sitting idle, as these athletes were sidelined. PRP therapy can and does have a major effect in reducing recovery and down time.

National Basketball Association and PGA

One of the most famous basketball players, Kobe Bryant, has had several arthroscopic knee surgeries for right knee pain. He went to Germany to receive platelet rich plasma therapy. Being in his 30’s, he did not see more surgery as a good alternative. The promise of non-surgical, more rapid improvement with PRP therapy for his knee pain convinced this basketball legend to undergo therapy. Similarly professional golf star, Tiger Woods has undergone platelet rich plasma therapy more than once following ACL reconstructive surgery. His knee pain continued after surgery and he went with PRP with beneficial results.

National Tennis and World Soccer

Rafael Nadal: PRP Recipient

Rafael Nadal: PRP Recipient

Other major national and international sports have recognized PRP therapy as an outstanding alternative to “standard” conservative therapy and certainly its benefits over surgical intervention. World tennis star, Rafael Nadal underwent PRP therapy after injuring his knee. His physician, Dr. Mikel Sanchez, described platelet rich plasma as a miraculous regenerative treatment. Indeed, that is what PRP does, regenerates new tissue. Major League Soccer players have also discovered the potential for better, rapid healing with PRP therapy.

Jonathan Bornstein, one of the top new young stars in soccer, twisted his knee resulting in a torn ligament. Facing the prospect of being out of playing soccer for 10 weeks, Bornstein elected to have PRP for his knee injury. He was back to running in 3 weeks and was ready to resume playing soccer only 2 weeks later. The list of professional athletes in a broad range of Major League sports, who have undergone platelet rich plasma therapy is growing every week. This list is beyond the scope of this article. The conclusion though is that PRP therapy is here to stay in the treatment of these injured, highly trained athletes.

PRP therapy is considered to be acceptable medical therapy by the International Olympic Committee, World Anti-Doping Agency and most professional sports association. Platelet rich plasma therapy is distinctly not blood doping and has been ruled on by the IOC and WADA as well as professional athletic associations.

Platelet rich plasma is a unique, non-surgical therapy to heal injured tissue. The platelets contain growth factors, cytokines and other agents that trigger the healing cascade. The difference is that with PRP therapy, a massively concentrated amount of platelets and tissue regeneration proteins are injected directly into the damaged tissue. The body uses the same natural healing process for injuries but not in this high concentration. With this high concentration of healing platelets and growth factors, injured tissues can be regenerated and healed in only a few weeks. The new tissue formed is stronger and healthier. Many patients can have pain relief in 3 weeks. Many other painful conditions can be treated with PRP. If you suffer from joint, muscle, tendon or back pain – contact Sarasota Neurology for PRP therapy in Sarasota.

Photo Credits: tomcoolinmiami (Hines Ward) Keith Allison (Alex Rodriguez) Keith Allison (Takashi Saito) Francisco Diez (Rafael Nadal)

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Platelet Rich Plasma PRP Therapy in Sarasota Fl for Joint and Foot Pain


Patients are being treated currently at Sarasota Neurology with PRP (platelet rich plasma) for a wide variety of joint pain and other pain issues. Among the more common uses for PRP are knee pain, shoulder pain and other painful conditions such as plantar fasciitis, tennis elbow, some types of low back pain. PRP can also be used in patients that have residual joint pain from having had orthopedic arthroscopic knee or shoulder surgery.

PRP works to heal painful joints by using the patients’ own natural healing mechanism. The injured or damaged tissue in the joints, ligament and tendons or muscle send out chemical signals that there is injury or incomplete healing. PRP has receptors on the active platelets that seek out these damaged tissues. The PRP graft then biologically and molecularly attach to the damage tissue and trigger the natural healing process of making new collagen. This process takes six weeks to have a full effect although actual healing can continue for up to three months.

PRP may be used in some patients as an alternative to having surgery on their knees, rotator cuffs or in many cases of plantar fasciitis (foot pain). Sarasota Neurology offers many new and innovative uses for PRP. This highly effective treatment is ideal for patients who would prefer to avoid the cost, pain and recovery time involved in having surgery for the same problem.

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Does Insurance Cover Botox Injections for Migraine Headaches?

Unfortunately no insurance company covers Botox therapy for generic headaches. Many will cover Botox for chronic migraines, which have been unresponsive to standard preventative therapies. In 2011, the FDA approved Botox for treating chronic migraines which have been unresponsive to an adequate trial of preventative medications. Preventative medications do not include the use of any narcotic pain killers. Insurance companies have made it difficult for patients to obtain Botox payment authorization, by putting in place numerous qualification barriers – if they cover Botox at all.

Insurance companies do require extensive documentation of treatment with other migraine preventative therapies from the 4 Migraine Prevention drug groups: 1) Anti-hypertensive (blood pressure) medications, 2) Anticonvulsants, 3) Antidepressants and 4) Muscle Relaxants – all which must have been tried for a minimum of 30 days and failed each or any combination of the four classes. A medical letter documenting all your prior migraine prevention treatment you have received is needed. Additionally, documentation is required for how many migraine days per month you suffer from.

In summary, this letter from your neurologist must document the following:

  1. Adult patient diagnosed with chronic migraine headaches.
  2. Having fifteen or more migraine days per month, with the headache lasting over four hours or more.
  3. Migraines having been present for over six months. 
  4. Headaches are not due to abortive medication overuse – “rebound headaches.”
  5. Poor responsiveness to abortive medications, specifically in the triptan class of drugs.
  6. Persistent, recurrent migraines despite trials of at least 1 medication in each of the 4 classes of migraine preventative drugs:
a. Antidepressants: amitriptyline, nortriptyline, fluoxetine, escitalopram, citalopram, venaflaxine.
b. Anticonvulsants: valproic acid, topiramate, gabapentin
c. Antihypertensives: propanolol, nadolol, Verapamil
d. Muscle relaxants: Baclofen, cyclobenzaprine

Continued insurance coverage and payment for Botox injections for chronic migraine prevention is considered medically necessary, by insurance companies, when migraine headache frequency is reduced by 7 headache days or more, per month – as compared to pretreatment with Botox – at the end of the initial therapy treatment AND with documentation of the same with each successive treatment. All of the criteria listed above must be met before each Botox therapy session will be approved by insurance or Medicare.

Given the frequency by which insurance companies frequently deny Botox, even after approval, you will be financially responsible for payment of every Botox treatment. Due to the difficulty and time consuming process of getting Botox authorization from the insurance companies, for treatment of chronic migraine, it has become necessary that each patient obtain their own authorization number for each Botox treatment. We will provide you with the required letter, documenting the pertinent facts. You can get assistance with Botox through their Botox Patient Assistance Program Hotline. For more information please click on the link below.



Required codes for Botox migraine therapy: Chronic migraine: 346.71; Botox: J0585;Botox Migraine injection: 64615. You will need authorization for all three codes.

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Podcast: Stroke – Prevention of Cardiovascular Disease

In this episode of the Sarasota Neurology Podcast, Dr. Kassicieh, a recognized expert in stroke prevention, provides an overview of  current techniques for preventing and managing risk of stroke.

Stroke is the third leading cause of death in the United States. This combined with heart attacks and heart disease result in over 2 million deaths a year.

The common underlying cause is vascular disease or hardening of the arteries. Heart attack and stroke can be prevented with simple life style changes and medications. Treatment of high cholesterol, high blood pressure and stop smoking will significantly lower risk of suffering from these devastating conditions. This combined with supplements and simple medications, such as aspirin with have a dramatic impact in reducing risk for stroke and heart attack.

Listen to this report to find out how you can reduce your risk of suffering from a stroke, heart attack or other cardiovascular disease.

If you are concerned that you or someone you love may be at risk for stroke, please call (941) 955-5858 or click here to schedule your appointment today. If you’re outside the Sarasota area and unable to travel here, please locate a neurologist in your area.

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Migraine and other headache conditions are a common cause of pain. Migraine headaches are the leading cause of temporary disability in the work force. Fortunately, there are many medications that can be used to prevent and treat migraines.

The first therapeutic event which needs to happen is the correct diagnosis of migraine to be made. Patients can have multiple headache types. Headaches which are severe enough to limit activity and are associated with light and sound sensitivity with nausea and sometimes vomiting are most likely migraines. Migraines usually have a pulsating, heartbeat type pain – made worse by movement.

A common type of headache which can mimic migraine is occipital neuralgia. Occipital neuralgia starts at the base of the skull. There the occipital nerve exits the spine and runs up the back of the skull to the forehead. This nerve carries pain fibers. If it becomes irritated, due to trauma, “sleeping wrong” or just routine daily activities; occipital neuralgia headache occurs. The pain can be just as severe as a true migraine. The pain can be on one side, both sides or even isolated to the front of the head. Diagnosis of occipital neuralgia is made by gently pushing at the base of the skull, over the occipital nerve. If this reproduces the headache symptoms, the diagnosis of occipital neuralgia is made. The most effective treatment for occipital neuralgia is a simple injection in the upper neck in the region of the occipital nerve.

Botox was approved by the FDA in 2011 for treatment of intractable migraines. Botox migraine treatment is not for everyone. In order to have insurance or Medicare to pay for Botox, certain criteria must be met. These criteria include:

– 15 headache days a month
– Failed various migraine prevention medications
– AEDs
– Antidepressants
– Certain blood pressure medications
– muscle relaxants
– physical therapy
– migraines must be incapacitating causing missed work or school

All of these criteria must be met before insurance will authorize and pay for Botox therapy for migraines. Once approved, Botox for migraine is a simple, in-office procedure. For experienced migraine doctors, giving Botox for migraine takes about 20 minutes. Botox does not work immediately to relieve intractable migraines. Effects can be felt as soon as two weeks but maximum benefit is at 6 weeks after Botox treatment. Duration of pain relief can be from 6-8 weeks. With repeated Botox treatment for migraine headache, there is a cumulative benefit in many patients. The minimum time in between Botox treatments is 90 days.

For optimum migraine control, affected patients should be treated every 3-4 months. This results in the best migraine control. This in combination with oral medication migraine prevention therapy.

In conclusion, Botox is effective treatment for many headache patients with chronic, intractable migraines. Proper diagnosis and treatment must be given. For insurance to pay for Botox for migraine, specific criteria must be met. If you suffer from persistent, frequent headaches, call Sarasota Neurology today for an appointment. Start improving your quality of life today.

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While PRP is effective in stimulating new hair growth and thickening existing hair, its effect lasts up to 12 months. In order to sustain fuller hair, PRP needs to be given about every 9 months. With a successful hair transplant surgery, the effects are significantly longer in

duration. Properly done hair surgery transplants may last years. However, hair surgery is a complicated process that must be done with precision to have desirable outcomes. The final outcome may not be seen for a year. The effects of PRP on hair growth can usually be seen in 3 months with the duration of full effect for about 9 months. Think of PRP as a long acting fertilizer for your hair and scalp. Your lawn need fertilizer to be added at least twice a year to sustain a lush lawn. The same can be said about your hair needing PRP to sustain a dramatically better appearance. This helps patients to have a better quality of life.

female-hair-loss-slider-6Research published by Geoge Cotsarelis, M.D.has shown that the density of hair follicle stem cells is the same in bald areas of the head as it is in areas that are growing hair. Further research by Dr. Fabio Rinaldi has shown that platelet rich plasma can stimulate these hair follicles in bald areas (alopecia) to activate and grow new hair. Another study on patients affected with hair loss showed thickening of the hair shafts after administration of PRP, resulting in a fuller appearance of growing hair.  At this time, no other therapy has shown to more consistently stimulate new hair growth. PRP is FDA approved for use in human for treatment of a variety of medical conditions. Further research is being done to better understand the process. Hopefully, one day a medication will be able to be used to more effectively reactivate these dormant hair follicles.

There are many advantages of getting PRP for hair growth over conventional hair transplant surgery. The following is a chart comparing the two:

PRP Hair Surgery
Cost $1500 $6000+
Procedure Time 1 hours 5-6 hours
Recovery Time None 3 weeks for healing
Hair Growth 3-6 months 6-12 months
Risk of Infection <1% 1-2%

Learn More About Cosmetic PRP

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In this episode of the Sarasota Neurology Podcast, Dr. Kassicieh discusses Platelet Rich Plasma  and Regenerative Medicine.

Regenerative medicine is a new, exciting branch of medicine which deals with healing injured or damaged tissue with the body’s own natural healing mechanism. To do this, Platelet Rich Plasma (PRP) is extracted from the patient’s own blood. Using blood from the patient eliminates the risk of transmission of blood born disease, viruses and other infectious agents. PRP is then injected into the area of the body that needs intensive healing and tissue regeneration.



PRP therapy works especially well for injured tendons and ligaments, and is uniquely suited for those difficult knee and shoulder injuries. Even patients who have had knee or shoulder surgery but still have pain can have dramatic benefit and pain relief from PRP therapy.

PRP is revolutionary therapy in that it avoids surgery. It is done as an outpatient procedure, so there is no recovery time or rehabilitation to deal with. If you have joint pain, you may be an excellent candidate for PRP therapy. Call now to schedule an evaluation to see if you would benefit from PRP therapy.

To schedule an appointment, please call (941) 955-5858 or you may request an appointment here.

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In this episode of the Sarasota Neurology Podcast, Dr. Kassicieh, a recognized Parkinson’s disease expert, provides an overview of the disease and current techniques for managing it.



Parkinson’s disease is the second most common neurodegenerative disease seen in the United States. Only Alzheimer’s disease is more common. They both share the common fact that they are progressive neurological diseases that result in patients losing functional ability. Alzheimer’s disease affects memory, the ability to remember how to do things and general loss of mental function. Alzheimer’s patients are mostly not aware of the fact that they are neurologically deteriorating. They will make excuses for their memory short comings. Like Parkinson’s disease it is important to recognize Alzheimer’s early so that treatment can be started and outcomes will be improved.

Parkinson’s disease is primarily a progressive loss of the ability to move normally. There is a gradual slowing of movements as well as doing routine tasks such as shaving, dressing and getting ready to go out. Walking is affected and patients tend to shuffle with a forward stoop. Although tremor is common in Parkinson’s patients, not all have this. The converse is true: not everyone with tremor has Parkinson’s disease. There are many treatment available for Parkinson patients to improve their quality of life.

Not everything that shakes is Parkinson’s. If you are concerned that you or someone you love may be suffering from this or another movement disorder, please call (941) 955-5858 or click here to schedule your appointment today. If you’re outside the Sarasota area and unable to travel here, please locate a movement disorder specialist in your area.

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In this episode of the Sarasota Neurology Podcast, Dr. Kassicieh, a recognized expert  in clinical Botox, provides an overview of  current techniques for treating dystonia, muscle spasm (which may be associated with pain), spasticity from stroke or brain injury with Botox.



Botox was first FDA approved for medical use in 1989. Since then, Botox has found many medical uses to treat clinical conditions that were previously difficult to treat. Conditions such as cervical dystonia, blepharospasm, hemifacial spasm and spasticity such as that seen in cerebral palsy, stroke or spinal cord injuries have all been successfully managed with Botox.

Other similar products such as Dysport and Xeomin all have uses for cervical dystonia. Most recently, Botox was approved for use for treatment of chronic migraine headaches. Listen for more information on the clinical use of Botox and other similar products.

If you would like to learn more about the benefits of Botox, please call (941) 955-5858 or click here to schedule your appointment today. If you’re outside the Sarasota area and unable to travel here, please locate a neurologist in your area.

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lower_back_painFailed back syndrome, or lumbar post-laminectomy syndrome, is the term given to patients who have had back surgery for back pain, but continue to have pain after surgery. Even worse, their back pain can be worse after the surgery. The main problem is the fact that low back pain is not an indication for back surgery – any more than neck pain is an indication for neck surgery (failed neck surgery: cervical post-laminectomy syndrome). Surgery done for the sole purpose of relieving neck or back pain is doomed to failure. Many spine surgeons make the false assumption that if a patient has back pain and there is a spine MRI abnormality – this is the cause of the pain and surgery to “fix” the MRI abnormality, and consequently the back pain, is necessary. In actuality, just the opposite is true. Most causes of neck or back pain cannot be identified and more importantly, do not require spine surgery.

Failed back syndrome (FBS) has many different causes. Some of these are a direct result of surgery: operating at the wrong level, failure to remove the entire herniated disc fragment, trauma to the exiting nerve root, continued pressure on the nerve root, scar tissue and inflammatory changes at the site of surgery. Back surgery typically involves removing some of the boney part of the spine. This can result in spinal instability. This causes additional spine pain. Predisposing factors to FBS include smoking, diabetes and obesity.

Persistent low back pain, following back surgery, may be due to any number of causes. The surgery itself causes scar tissue to form, which can cause more spine joint pain. Spinal hardware, such as screws put in to stabilize the spine, can cause pain. These screws are put into the vertebral bodies to secure metal plates or other hardware to stabilize the spine. This is frequently done plus inserting bone fragments, for a spine fusion procedure, to further add more stability. The screws can cause pain in and of themselves. They can be put in incorrectly or touch a nerve root. The spinal fusion can fail to take and therefore the spine is not as stable as it should be. All of these things combined can result in additional pain or worsening of existing pain. Taking the screws out does not always result in clearing the pain – plus this requires another back surgery, leading to a viscous cycle.

Back surgery fails for a number of reasons. The three main reasons for failed back surgery are:

1. Surgery was not indicated in the first place for pain treatment,
2. The surgical procedure performed never would have achieved the desired outcome,
3. Correct surgery performed but did not get the intended results.

The main message here is that there are many reasons not to have back surgery. Unfortunately, over 500,000 Americans undergo spine surgery annually. Over 50% will have little or no relief for of the symptoms. It is not unusual to find patients such as this who have had two or more spinal surgeries – both neck and back operations. The majority do poorly. Failure rate with second spine surgery is about 70%. Three or more spine surgeries experience greater than 90% failure rate.

FBS symptoms include persistent, dull back pain, which varies in intensity. Patients can have sharp back pains that may radiate down one or both legs – sciatica. In almost all cases of failed back syndrome, more surgery is the worst thing that can be done, as this only compounds an already bad situation. Most of these patients are disabled and are on narcotics for pain relief. Narcotics are addictive and surgery is not reversible.

Fortunately there is non-surgical, non-narcotic treatment for patients with post-surgical neck or back pain. Platelet rich plasma (PRP) therapy is a simple, in-office procedure that can naturally provide dramatic, lasting relief. PRP (platelet) therapy does not require anesthesia, rehabilitation or any down time. Platelet rich plasma (PRP) is derived directly from your own blood. PRP is blood plasma with a high concentration of platelets. Contained within platelets are the active healing proteins and growth factors that promote new tissue regeneration. Growth factors are necessary to initiate tissue healing and regeneration. With concentrated amounts of these proteins in an injured area, healing and tissue repair is started and accelerated. Stem cells, respond to the growth factors, into the area, further aiding in healing. Healing can occur in various tissues including tendons, ligaments, muscle and bone – as stem cells will change into whatever damaged tissue is needed. Along with tissue repair, the regeneration process also stimulates new blood vessel growth to promote healing process.

Here in Sarasota, platelet rich plasma therapy is available. At Sarasota Neurology, Dr. Kassicieh, a Sarasota PRP doctor, has been doing platelet rich plasma therapy for tissue regeneration (regenerative medicine) since 2009. He has successfully treated several hundred patients with back and joint pain – all without surgery. Our success rate in treating failed back syndrome, knee pain, shoulder injuries and even plantar fasciitis is over 80%. Many patients become pain free. If you have persistent cervical (neck) or back (lumbar) spine pain, call now for a consultation for platelet rich plasma (PRP) therapy with a board certified neurologist and PRP doctor.

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