Memory loss is a frequent patient complaint that I see in my office. Patients with this complaint are generally over the age of 65 but occasionally I will see someone in their 40s or 50s with this problem. For all patients, it is important to get a detailed history of when they first noticed the problem and has it been getting worse. What kinds of things do they forget. Does it happen all the time. A brief memory test, the MMPI can be performed. This simple test can give the physician a general idea on the degree of memory loss. Further tests should be performed such as a CT or MRI brain scan to look for stroke, hydrocephalus or other abnormalities. Simple lab screening for diabetes, low thyroid and vitamin deficiencies are commonly ordered.
Once testing has been completed, treatment can be started. For many younger patients, memory loss is due to a combination of stress, depression and other situational problems. It is rarely due to dementia or some other progressive neurodegenerative problem. Antidepressant medications are frequently helpful in these situations. By alleviating anxiety and depression, a patient’s “memory loss” can be cleared. Patient’s with persistent memory problems may need to undergo a further course of memory testing by a psychologist. This 4-6 hour testing session gives a detailed analysis of what type of memory problems a patient may be experiencing. This can range anywhere from depression to Minimal Cognitive Impairment to Alzheimer’s disease.
Minimal cognitive impairment is characterized by simple memory loss. Affected patient’s have difficulty remembering certain things, without having their global memory function and other aspects of thinking impaired. There is commonly underlying depression, but this is not the specific cause of their memory loss. In patients with Alzheimer’s disease or other dementias, short and intermediate term memory is more commonly affected. These patients can also have trouble with finding words, commonly misplacing objects and loss of social graces.
There are several medications that are used in treating memory loss. Aricept, Exelon and Razadyne are all similar in the was that they work to help slow down the progression of memory loss and dementia. Namenda is another memory loss medication that works differently than the other 3 medications. It can be used alone or in combination with one of the other memory drugs. The combination therapy has been shown to have a very significant, beneficial effect in some patients in improving their cognitive processing and memory function. It is important that a patient be evaluated as soon as a problem is suspected. Studies have shown that the earlier one of these medications is started, the better the patient does over the long run. While these medications do not have FDA approval for minimal cognitive impairment, some studies have shown that the memory loss medications are helpful in these cases as well.
Posted in Memory Loss / Alzheimer's Disease / Dementia and tagged Alzheimer's disease, Aricept, dementia, dementias, depression, Exelon, FDA approval, hydrocephalus, Memory loss, Memory Loss / Alzheimer's Disease, Minimal Cognitive Impairment, Namenda, neurodegenerative, Razadyne, Stroke by Dan Kassicieh, D.O.
Trigeminal neuralgia (also known as tic delaroux) is a disorder characterized by a severe, electrical shooting pain in the face. The trigger area on the face is typical around the nose or upper lip. Affected individuals experience a brief but intense electrical or burning pain on the affected side of their face. Trigeminal neuralgia typical affects only one side of the face. The cause of this disorder is unknown in most cases and it is not hereditary. On rare instances, there can blood vessels pushing up against the nerve. Patients with trigeminal neuralgia find that air blowing across their face, brushing their teeth, chewing, washing their face, putting on make up or drinking hot/cold beverage will trigger severe pain attacks. At times, talking can even trigger pain episodes. They can have trouble sleeping at night if they lay on the affected side. Although the majority of individuals with this condition are over the age of 50, it can begin at younger ages. Patients may have daily face pain attacks for weeks to months and then the condition will suddenly go into remission for a period of time. This remission period may last weeks to months but then reoccurs as severe as ever. Other less fortunate individuals have the pain continually.
Fortunately good non-narcotic medical treatment exists to control pain. The main medication used is an antiseizure medication called carbamazepine (Tegretol.) This medication is considered by many to be the drug of choice for treatment of this condition. Tegretol frequently provides excellent, prompt relief and control of facial pain. For patients who cannot tolerate Tegretol, or for those who do not respond, there are severe other antiseizure medications that can be helpful. These include Trileptal, Topamax, Lamictal, Neurontin and Lyrica. Another medication, which is not in the antiseizure class, is amitriptyline. It is important to note that narcotic pain killers do not work well for trigeminal neuralgia and should be avoided.
For patients with intractable trigeminal neuralgia that does not respond to the typically used medications, surgery may be an option for treatment. There are severe surgical procedures that can be effective. Radiofrequency rhizotomy is a commonly performed procedure that provides good pain relief for many patients. It is not an invasive procedure which increases the safety. Glycerol (alcohol) rhizotomy is a similar procedure that can be tried. Gamma knife surgery procedure is a noninvasive treatment using focused radio waves to ablate the nerves responsible for pain. These are the more common surgical procedures used to treat trigeminal neuralgia but should be reserved only for those patients who have not responded to several different medication trials.
For diagnosis, it is necessary to see a neurologist familiar with this condition. Patients all too frequently go to a dentist, thinking they have some type of dental problem. I have seen patients who have had multiple teeth taken out as well as root canals and yet their pain persists. This is because trigeminal neuralgia is not a dental problem. Do not suffer unnecessarily, get into to see a physician who can help.
Posted in Nerve Diseases, Nerve Pain and tagged amitriptyline, face pain, Lamictal, Lyrica, neuralgia, neurologist, Neurontin, radiofrequency rhizotomy, seizure, Tegretol, tic delaroux, Topamax, Trigeminal Neuralgia, Trileptal by Dan Kassicieh, D.O.
Kevin Pho, M.D. is a general medical physician who writes an interesting blog. His blog contains a wide variety of information on various medical topics and news interest stories. I put his blog site link on Sarasota Neurology because I feel that it adds a different twist, covering many subjects and topics that I could never hope to keep up with. Dr. Pho is obviously quite committed to maintaining his blog site, trying to post several times a day. Hope that you enjoy Kevin M.D. blog. For more information on neurology and what a neurologist does, please visit www.DrKassicieh.com.
Posted in General Medicine and tagged neurologist, Sarasota by Dan Kassicieh, D.O.