Deep brain stimulation is an innovative way to control severe tremor or some of the motor symptoms of Parkinson’s disease. This medical device was approved by the FDA in 1997 for treatment of patients with severe tremor that was not controlled by medications. A few years later, it was approved for treatment of Parkinson tremor and dyskinesias (involuntary head, arm and leg movements.) The main deep brain stimulation unit, manufactured by Medtronic, is called Activa Soletra. This is a small pacemaker-like device that is placed under the skin, just under the collar bone. The small electrode wire is then run under the skin, behind the ear and through the skull. The electrode tip is placed in a specific area in the brain that is responsible for tremor and dyskinesia control. A patient may need one or both sides done with a stimulator unit, depending on the severity and nature of their movement disorder. The risk of brain stimulator therapy is low other than at the immediate time of surgery. Once healed, patients can expect fewer side effects from deep brain stimulator therapy than from the several medications they may have to take to control their Parkinson symptoms. It should be noted that the best possible result from brain stimulator therapy will not exceed that of a Parkinson patient’s best response to levodopa therapy. Essential tremor patient’s can generally expect to completely stop medications that they are on for tremor control. Brain stimulator therapy is a safe, scientifically proven method for control of disabling tremor or other limb movements. It does not substitute for Parkinson medication but may help in reducing the amount of medication a patient has to take.


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Restless legs syndrome is a movement disorder that affects approximately 10% of the American population. Affected individuals have the uncontrollable urge to move their legs, particularly at night when sleeping. Symptoms can also occur with sitting for prolonged periods of time such as when driving, flying or watching a movie. If the condition worsens, the arms can also be affected. Patients with RLS can have a numbness, burning or tingling sensation in their extremities. RLS causes significant sleep difficulties and over time, chronic sleep deprivation. Patients can find it difficult to fall asleep or are awakened repeatedly at night from their legs moving. This will also disturb their bed partner’s sleep. Another movement disorder called Periodic Limb Movements frequently accompanies RLS, affects patients. PLM occur only when a patient is asleep.
RLS and PLMs can be effectively treated with readily available medications that are effective for most individuals. Requip was approved by the FDA one year ago and Mirapex November 2006 for treatment of RLS. Improved quality of sleep results in lessening of a risk of medical problems. Job security and quality of life are also dramatically improved. Physicians specializing in sleep or movement disorders should be consulted for diagnosis and treatment.


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It is estimated that migraine and other headache disorders affect 30-40 million Americans. The unfortunate fact is that only 50% of these individuals seek out treatment. It is one of the leading causes of missed time from work and social functions. Untreated migraines can have a devastating effect on affected individuals’ quality of life. Migraine is one of the leading causes of temporary total disability in the U.S. work force. This is an unfortunate statistic which could be dramatically improved with earlier recognition and more aggressive treatment of migraines and other disabling types of headache. The main features of the migraine syndrome are recurrent moderate to severe headaches that interfere with activity. Associated migraine symptoms include light and noise sensitivity, nausea, occasionally vomiting and sinus congestion. Most so called “sinus headaches” are actually migraines and have nothing to do with sinus problems whatsoever. Cluster headaches are the most severe form of headache. While considered a type of vascular headache, they are put in a different category to be differentiated from migraines. This is by the International Headache Society classification of all headache disorders.

Patients experiencing a migraine attack prefer to lay down in a quiet dark room with an ice pack on their head or neck. There are excellent, non-narcotic medications that can be used to abort a migraine attack. Migraine treatments to stop an acute attack include the triptan medications such as Imitrex, Maxalt, Zomig, Relpax, Frova, Axert and Amerge. There are other medications that can be used to prevent migraines from occurring. Topamax and Depakote have FDA approval for migraine prevention. The first step is for the patient to schedule an appointment with a headache and migraine specialist.


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The FDA recently approved a new Parkinson medication for use in patients that are having problems with off time and freezing. The new drug is called Zelapar. It is a rapidly dissolving tablet whose active ingredient is selegeline. Many of you may have tried selegiline in the past (marketed as Eldepryl.) The new formulation of selegiline allows the drug to be absorbed into the bloodstream through the mouth instead of the stomach. This has the advantage that the medication bypasses going through the liver. All medications absorbed through the stomach and intestines pass through the liver first, which results in clearing much of the medication before it has time to provide benefit. Zelapar allows the selegiline to “go around” the liver so that patients will experience a better therapeutic response to the medication. I have used this on a number of patients who had problems with freezing, increasing off time or just need for higher doses of Sinemet. The added benefit of Zelapar is that it avoids having to increase the total daily Sinemet dosing. More than 50% of the patients have had benefit. Like all medications, Zelapar does not work for everyone and like other anti-Parkinson medications, it has the potential for side effects. It is important that patients with Parkinson’s disease or other movement disorders to be treated by neurologists that have more specialized training in these complex conditions.


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Welcome to Sarasota Neurology’s new web blog site. This site is dedicated to helping patient’s get up-to-date information on different neurological conditions. I am a board certified neurologist, practicing in Sarasota Florida. I specialize in treating migraine and other head, neck and face pain disorders as well as most movement disorders. These include Parkinson’s disease, dystonia, tremor, blepharospasm, hemifacial spasm, limb dystonia and spasticity and restless legs syndrome. As part of the Florida Headache & Movement Disorder Center, we also treat patients with various disorders of sleep such as narcolepsy, cataplexy, nocturnal leg cramps and other conditions that cause patients to move or twitch while they are sleeping. Of course, other important neurological problems will be discussed. I will post the latest reliable information for you to review. You will notice that almost all of the conditions discussed involve seeing a neurologist. If you are in the Sarasota treatment area, we would be happy to schedule you for a consultation.  Occasionally, I may put other items of interest on this site. Suggestions are always welcome but I would ask that you fax them to my office in Sarasota. Please visit my main website at: DrKassicieh.com

Welcome to Sarasota Neurology blog site.

Dr. K


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