Parkinson’s disease is a complex constellation of symptoms. As reported in the August 30, 2011 issue of Neurology, neurologist care of Parkinson patients greatly improves their quality of life and long term clinical outcome. Parkinson disease affects approximately 1 million Americans. It is only second to Alzheimer’s disease as a common neurodegenerative illness. Early diagnosis, recognition of associated symptoms and comorbidities as well as comprehensive care are necessary if a Parkinson patient’s long term clinical outcomes and quality of life are to be maintained.

Neurology has commonly not been taught in the detail that is necessary in most medical schools. Medical students graduate, generally with a limited understanding of neurological diseases and the treatment required for each. Neurology has a vast scope of illnesses, each requiring intimate knowledge and understanding of the disease process as well as the treatment required to optimize patient well being and life quality. It is beyond the scope of medical school, internship and even family medicine or internal medicine residencies to train the young physician sufficiently in the details of neurological disease.

Across the United States, 15-20% of all visits to a primary care doctor’s office (family physician or internal medicine) involve a neurological complaint. While simple problems such as back or neck pain can easily be treated, more complicated illnesses such as Parkinson’s disease, migraine headaches, seizures and multiple sclerosis should be managed by a neurologist – particularly a sub-specialist neurologist in the disease process needing treatment. Surveys in the United States, Europe and Asia show that both medical students and general physicians do not feel as comfortable in managing neurological problems as they do other common medical problems.  The article in Neurology clearly shows that Parkinson patients, managed by a neurologist, have overall better outcomes than those managed by family physicians.

Parkinson patients managed by  a neurologist have  an earlier diagnosis. This leads to starting treatment earlier. With early intervention, patient functioning can be maintained and optimized. This allows for the patient and their families to enjoy more quality time together with an increased ability to engage in social activities and travel. The study reported in Neurology, looked at over 138,000 Parkinson patents. The finding of this study showed that about 20% of patents with Parkinson’s disease never see a neurologist. These patients had a higher rate of falling, hip fractures, nursing home admission and death at an earlier age.

Parkinson patents cared for by a neurologist, by contrast, significantly had fewer hip fractures. Hip fractures are a major cause of disability and death in the elderly. Inherent to Parkinson patients is gait instability and a tendency for stumbles and falls. Falling prevention is a main goal in all elderly patients, but particularly those with Parkinson’s disease. Unfortunately, many who suffer a hip fracture may become wheelchair confined, even with successful hip fracture repair.  One third of all patients who suffer a hip fracture will die within a year of their fracture! The annual cost of managing a patient with a hip fracture is $20,000 per person – not including medical costs. With detailed care of all of a Parkinson patients symptoms, a neurologist can better prevent these patients from falling and suffering fractures.

The second finding of this study was that Parkinson patients getting state-of-the-art care by a neurologist had a lower probability of being admitted to a nursing home. While most Parkinson patients do not need nursing home care, those with more advanced disease, Parkinson related dementia or complications such as hip fractures frequently need skilled nursing facility placement. Parkinson’s disease is complex condition. Not only are the motor symptoms a major problem, but so are the cognitive and psychological problems that go along with this disease. Depression and anxiety occur in over fifty percent of Parkinson patients. Early recognition and treatment  is critical for improved patent and caregiver quality of life. Dementia is also a common problem. It can start as mild memory loss but will progress. Neurologists are sensitive to these problems and there are medications as well as dietary supplements that help to improve these problems.

The final finding of the Neurology study was that there was a statistically significant increase in the six year survival of patients with Parkinson’s disease managed by a neurologist. There are multiple reasons why this may be the case, including earlier use of the many types of medications used in Parkinson management, treatment of coexisting psychiatric problems and addressing the multitude of other medical problems that are frequently associated with Parkinson’s disease.

The conclusion for Parkinson patients and their family or caregivers is to get that patient into see a neurologist, particularly a neurologist who specializes in movement disorders. Patients want more control over their life, improved quality of life and the ability to remain functional as long as possible. This is true for the Parkinson patient as well. Take control of your life, contact Sarasota Neurology for consultation and management of your Parkinson’s disease. It will most likely be the best thing you could do for yourself – for the rest of your life.


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Huntington’s disease is a neurodegenerative disease that is a genetic, progressive neurological disorder that slowly takes away a persons ability to walk, talk, and reason. It is characterized by the initial subtle symptoms of change in personality and motor skills ability. As the condition progresses, patients develop involuntary movements known as chorea (hence Huntington’s Chorea.)  The word chorea comes from the Greek word choreia, which means “to dance”, which describes the uncoordinated, jerky body movements associated with the condition. Other motor symptoms eventually appear and may include difficulty speaking, walking or writing.  It was reported in detail in 1872 by the American physician, George Huntington (1850-1916).

Symptoms of Huntington’s disease usually appear between the ages of  35-44 years old. Affected individuals can show a general lack of coordination and an unsteady gait.  Other symptoms include  depression, mood swings, forgetfulness, clumsiness, and involuntary twitching. As the disease progresses, concentration and short-term memory decrease and involuntary movements of the head, trunk and limbs increase. Huntington’s dementia eventually occurs. Patients will have memory loss associated with difficulty in abstract thinking, planning and avoiding inappropriate behavior.

In 1993, scientists discovered the gene that causes Huntington’s disease. HD is a genetic mutation stemming from the formation a chain of abnormal DNA sequences. There are four building blocks of DNA. Repeating DNA chains of cytosine-adenine-guanine (CAG) code for the protein glutamine, an amino acid. As a result, these long glutamine chain proteins clump together and are toxic to brain cells (neurons.) The more CAG repeat sequences there are, the more severe the symptoms of HD.  Scientists have also discovered the more severely the gene is mutated, the earlier the onset of the disease.

There is no known cure for Huntington’s disease at this time .  There are, however, treatments which can be employed to reduce the severity of some symptoms.  Tetrabenazine was developed specifically to reduce the severity of chorea in HD. Other drugs that help to reduce chorea include Haldol, Risperdal and other neuroleptic medications. Valium like drugs known as benzodiazepines may also be helpful. Rigidity can be treated with antiparkinsonian drugs, and myoclonic hyperkinesia can be treated with valproic acid. Depression is common in HD and can be managed with medications in the serotonin reuptake inhibitor family, such as Prozac or citolopram.

Huntington’s Disease profoundly affects not only the patient, but the entire family — physically, emotionally, socially and economically.  Since there is no known cure and the prognosis is poor, a plan of action should be developed jointly with a qualified neurologist who specializes in movement disorders so that the patient’s quality of life can be maintained as long as possible. Your neurologist can also help you locate and connect to some of the many support groups, organizations, and resources available to help with both the patient and the family and caregiver(s).

Innovative research is underway and aims to find better treatment options and ultimately hope and a cure for this debilitating condition.  If you suspect that you or someone you love may be suffering from Huntington’s Chorea, contact Sarasota Neurology for an appointment.


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Much has been said and written about caffeine over the past half century. There have been over 20,000 studies conducted looking at the various effects and benefits of caffeine over this period of time. Numerous studies have demonstrated the tremendous health benefits that can be derived from regular daily consumption of caffeine, most commonly delivered through the consumption of coffee or energy drinks such as Red Bull or similar beverage. All of these have a high caffeine content.  In almost any way that caffeine is consumed, there are certain health benefits that it delivers. Despite all the negative press that has been attributed to caffeine, there has never been a study that has shown that caffeine has long term negative health effects, quite the contrary. The vast majority of studies have shown some beneficial effect in the regular consumption of coffee and caffeine. In that sense, caffeine is truly one of nature’s own wonder drugs.

The use of caffeinated beverages  by humans is documented  since the 15th century. Over the past 100 years there has been an explosive growth in the manner that we get our daily “caffeine fix.” Coffee has been a staple beverage in most countries and cultures of the world. Prepared in various ways, it is all still derived from the humble coffee bean. There are many different types of coffee beans and many more ways to roast and grind the bean. The combination of these factors leads to preparation of coffee and related drinks. Caffeine is also added to various soft drinks and energy drinks, which gives these beverages the ability to make a person feel a “boost” in energy and alertness. In contrast to regular, black coffee – the healthiest of caffeinated beverage genre – many coffee preparations, soft drinks and any energy drink contain high quantities of sugar and/or fat. It is these ingredients that may contribute to the undeserved reputation that coffee or caffeine is not healthy. Of the regular, commercially available coffee, Starbucks has the highest caffeine content coffees.

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The FDA has approved two additional medications specifically for the treatment of fibromyalgia symptoms. The first drug to ever be approved for fibromyalgia treatment was Lyrica. Lyrica was developed as an anti-seizure medication and has FDA approval for this and treatment of painful diabetic neuropathy. Since its initial release, the FDA approved its use for symptomatic treatment of fibromyalgia.

Cymbalta was the second drug to be FDA approved for the treatment of fibromyalgia. This has been a tremendous addition to treatment of this disabling condition. The most recent medication approved for FM treatment is Savella. Prior to the FDA approval of these three medications, there were no proven effective treatments for fibromyalgia. What is fibromyalgia?

Fibromyalgia (FM) is a syndrome of diffuse muscle pains, fatigue, subjective weakness and multiple points of tenderness in spinal muscles (neck pain, back pain) as well as extremities. Other symptoms can be seen with FM. Mental clouding known as fibromyalgia fog is seen in some patients. These patients have a poorly understood clouding of their ability to think clearly. They are able to function but just feel slower in their ability to think and some have memory difficulties as well. It should be made clear that these patients do not have dementia. Fatigue is quite prominent and patients do not seem to be able to be able to get enough rest or restorative sleep. Sleep hygiene is frequently disturbed. Affected individuals have difficulty falling asleep or staying asleep, primarily due to their pain. There is a higher incidence of restless legs syndrome and sleep apnea in FM patients. Other common neurological conditions seen include headache, which is often a mixed headache disorder. Patients complain of a dull low grade daily headache combined with intermittent migraine-type headaches. Due to the chronic refractory nature of their pain and associated symptoms, there is a high incidence of depression in FM patients. It is absolutely necessary to recognize this depression and treat it aggressively to improve the quality of life for FM patients.

The precise cause of FM is not clearly understood. Frequently there is a history of preceding physical trauma. This can be seen after motor vehicle accidents with significant physical trauma or after other physically traumatic events. Some patients may develop FM after particularly severe infections or prolonged acute illnesses. There is a genetic component to FM as it tends to run in families. Put another way, if you have a first degree relative who suffers from FM, you have a higher chance of developing this condition than the general population. There is a clear female predominance of this condition. The exact mechanism of the muscle pain is also not well understood. Extensive study of the muscles has failed to reveal any muscle abnormality. EMG studies in affected patients are normal. More recent theories include the concept of central sensitization. In central sensitization, the FM patient’s brain has a different perception of pain signals. These patients seem to have marked hypersensitivity to lower degrees of pain impulses. These impulses are magnified to a much greater degree in FM patient as compared to the general population.

Treatment of FM can be difficult. Over-the-counter analgesics such as aspirin, ibuprofen, naproxen or Tylenol-like products may provide some temporary relief. Some patients may get benefit from a non-narcotic analgesic tramadol. Narcotics should be avoided due to the risk of abuse and addiction. Currently the state-of-the-art treatment in FM is using one of the three agents: Lyrica, Cymbalta or Savella. Lyrica is an antiseizure drug that also has proven effects in certain painful conditions, including FM. Cymbalta and Savella are both antidepressants that elevate the levels of norepinephrine in the brain. Norepinephrine is a major brain neurotransmitter. Higher levels of this transmitter somehow suppress the pain signals in the brain. These are nonnarcotic, nonaddictive medications. They also have added benefit in that they are antidepressants and can treat the depression that so often accompanies the pain of FM. Certainly some type of regular exercise can benefit patients. Each patient needs to find the particular exercise program that they can do without triggering worsening of their fibro pain. Water based or other nontraumatic exercises are the best in this regard.

Fibromyalgia can also be managed by appropriate, well balanced diet. Eat regularly with adequate daily intake of fruits and vegetables. In some patients, a dietary consultation can be helpful in designing a more appropriate diet. Adequate, restorative sleep is critical in controlling and improving the quality of life in fibro patients. If necessary, a mild sleeping agent can be employed. Despite these measures, FM patients will still have good and bad days. On the bad days, one must recognize this and have a more restful, less stressed day.

The first step in getting better, is to see a physician that specializes in treating fibromyalgia. Adequate laboratory testing should be performed to rule out more serious conditions such as thyroid disease, other muscle diseases, rheumatoid arthritis or other connective tissue disorders.


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There are many studies that have shown excellent health benefits from taking omega 3 type fish oil. Omega 3 oils are found in fish oils, flax seed and several vegetable oils including canola, soybean and olive oils. There are different components to these oils that provide health benefits. The DHA and EPA oils in fish oil have been linked to reducing hardening of the arteries and lowering triglycerides. They also have the benefit of lowering blood pressure and heart rate to a mild degree. This all results in an overall reduction in risk for coronary artery disease, heart attack, sudden death, irregular heart beat and stroke. Fish oil can also have a blood thinning effect to reduce abnormal blood clotting, similar to that of aspirin. This latter effect is a two edge sword because too much fish oil can increase the risk for serious bleeding. Generally three grams (3000 mg) daily or less is considered safe. Daily intake of Omega 3 should come from dietary sources with no more than 2000 mg (2 grams) coming from supplements.

Omega-3 is derived from high fat containing fish such as albacore tuna, salmon, flounder, pompano, anchovies, sardines and mackerel. Fish in the equatorial regions around South America have a higher content of Omega 3 than do those caught in the more northern areas around Scandinavia and Iceland. Interestingly flax seed, flax oil and kiwi fruit contain higher amounts of Omega 3 oils than do that of fish. Flax seed can be added to cereal, baked goods or eaten alone. Fish oil capsules are available in 1000 mg and 1200 mg sizes. It is important to not confuse Omega-3 oils with Omega-6 oils. Omega-6 oils do not confer the health benefits that Omega-3 fish oils do. Omega-6 is found in high concentrations in various types of vegetable oils derived from the following: corn, safflower, sesame, soybean, sunflower and walnuts. It is important to reduce the consumption of Omega-6 oils as they compete with Omega-3 oils, thereby decreasing the benefit from Omega-3 fish oils. Eating fish twice a week is the standard recommendation, in addition to taking any supplements.

There have been many studies showing the beneficial effects of Omega-3 oils. The main benefit comes from reduction of hardening of the arteries (atherosclerosis), reduced coronary artery disease, decreased risk of heart attack and potentially fatal heart beat rhythms. Omega-3 oils have also been shown in some studies to have a brain cell protective effect in such conditions as Alzheimer’s and Parkinson’s disease. Fish oils can improve memory to a degree. Several studies have shown that 2000-3000 mg of Omega-3 oil intake daily, has a potent antiinflammatory action as that of high dose ibuprofen. Patients with arthritis or rheumatoid arthritis may benefit from Omega-3, without the risks associated with taking
antiinflammatory drugs for extended periods (such as bleeding stomach ulcers, kidney and liver damage.) It should be noted that the fish oil capsules have a more robust effect for reducing inflammation than that of flax seed oils.

Omega-3 oils can reduce total triglyceride levels and increase “good” cholesterol (HDL) levels. These oils also have an overall beneficial effect on the blood vessels, both in increasing blood flow and improving the health and stability of the vessel walls themselves. This effect is in part responsible for the risk reduction in having a stroke or heart attack as well as patients with problematic varicose veins and leg pains due to peripheral vascular disease. A word of caution: in patients with congestive heart failure, consultation with your cardiologist is first advised. As fish oil has a blood thinning effect, you should check with your doctor if you are taking prescription blood thinners. Additional benefits from Omega-3 fish oils have been shown in improving retinal (visual) function and possibly slowing down macular degeneration. Studies in psychiatric conditions have demonstrated Omega-3 beneficial effects in reducing depression, lessening memory loss and improving memory function.


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Recent studies have suggested that qualifying Parkinson patients benefit from earlier treatment with deep brain stimulation, as reported in Clinical Neurology News. The study indicates that younger Parkinson disease patients are more likely to benefit from early brain stimulator treatment. There is information that may suggest that this therapy may have a protective effect in delaying the progression of Parkinson’s disease. Deep brain stimulation (DBS) was FDA approved in 2002 for treatment of Parkinson’s disease. Symptoms that are best controlled include tremor and dyskinesias although brain stimulation can also help reduce freezing and off time. Younger Parkinson patients develop motor complications such as dyskinesias, off time and freezing much earlier than older patients with Parkinson’s disease. As reported by Dr. David Charles, a Vanderbilt University Medical Center Parkinson neurologist, “No therapy…has bee shown to slow the progression of Parkinson’s.” The previous thinking was to wait until a patient had severe motor complications that could not be controlled with medications prior to considering DBS therapy. The new thinking, and research, is exploring benefits of DBS in earlier stages of Parkinson’s disease. In various reported cases, patients not only benefited from better control of their Parkinson motor symptoms but also had improved quality of life. Added advantages is that Parkinson patients treated earlier with DBS used less medications over an 18 month period, as shown in one small study. There are two studies currently looking at the benefits of early DBS therapy in Parkinson patients: EARLYSTIM is a French study and a smaller study at Vanderbilt University are in progress. It should be noted that Parkinson’s disease is a progressive neurodegenerative disorder. Even patients with DBS therapy do have progression of their symptoms. Memory loss can be a part of the Parkinson syndrome and is not helped by DBS therapy. DBS is not a substitute for optimal neurological and medication management of Parkinson symptoms. Dr. Kassicieh, at Sarasota Neurology, provides medical and neurological management for patients with Parkinson’s disease and brain stimulators. For more information click here.


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Post-concussion syndrome (PCS) results from injuries to the head. This can range from mild concussions (being struck on the head) to severe head injuries. Not always does the degree of head trauma correlate with the degree and symptoms of PCS. It is estimated that approximately 60-80% of patients suffering a moderate to severe concussion, traumatic brain injury (TBI), will develop PCS. In milder head injuries, PCS will develop up in up to 40-50% of injured individuals. Loss of consciousness is not a requirement for development of PCS. It is not even a requirement that there be a direct head injury. Patients who have sudden jerking movements of the head, particularly in car accidents, with out direct head trauma can suffer from PCS. Risk factors for development of PCS can include lower education level, drug or alcohol abuse, prior head injuries, or preexisting depression or anxiety. The recognition and diagnosis of the symptoms of PCS are important in helping affected patients to return to normal a quickly as possible.

The symptoms of PCS may develop immediately or make take days to several weeks to become apparent. Headaches and dizziness are the most common complaints in patients with PCS. These however are not the only symptoms that can be associated with PCS. Varying degrees of memory loss, concentration difficulty, anxiety, depression, irritability, emotional and behavioral disturbances, insomnia and personality changes. The headaches can vary from mild, dull, generalized headache to severe migraine like headaches. These headaches usually occur daily and can be quite debilitating. Dizziness can be anywhere from lightheadedness to a spinning type of dizziness known as vertigo. Patient can have irritability, anxiety and depression, partly due to the head injury but also from the persistence of their symptoms. Insomnia frequently accompanies these other psychological symptoms. In more severe case, behavioral changes can occur. Patients can become impulsive and irrational in their behavior. Psychological changes are more apparent later in the course of PCS. Decreased ability to concentrate and slowness in mental function can occur, particularly in higher functioning individuals.

Treatment for PCS is primarily time. Many of the symptoms of PCS will clear within days to a few weeks. A typical time for clearing of symptoms is usually 3 months and as much as 6 months. In 10-15% of the cases it can take a year or more for improvement. The earlier the diagnosis is made, generally the better the outcome. Headaches and dizziness complaints most commonly bring the patient to a doctor’s office. Patients may have tension headaches, migraine headaches or a condition known as occipital neuralgia. The latter is an injury to the occipital nerve at the base of the skull. The most effective treatment for this condition is an occipital nerve block. Other headache conditions are treated with the usual preventative migraine medications protocols. As anxiety, irritability and depression are common symptoms of PCS, the antidepressant medications are the most effective treatment for both the headaches and psychological symptoms. Antidepressant medications have been used for decades in controlling migraine and other headache disorders. Over-the-counter analgesics can be used to relieve headache and neck pains. Narcotics should be avoided as they are addictive and do not help the overall patient outcome.  Mayo Clinic has an excellent, comprehensive summary of post-concussion syndrome.

In patients who have persistent complaints of memory loss, concentration difficulties, forgetfulness, anxiety and depression, neuropsychological testing followed by counseling can be helpful in patient management and improvement of symptoms. Testing is usually not done for at least 3-6 months following the head injury. This is because so many patients will spontaneously improve over this time period. Once testing is completed, the psychologist can help the patient through counseling to improve their overall well being. Other diagnostic tests may be performed and can include MRI brain studies, EEG or PET scan.

Prognosis for patients with PCS is excellent in the majority of the cases. Most patients are back to their normal baseline within a few weeks, with a few taking as long a 3 months. It is far less common for patients to continue having symptoms beyond this. It is estimated that only about 15% of patients with PCS will have symptoms a year or more. Early treatment by experienced neurologists or other physicians who have training in treatment of concussion, traumatic brain injuries and post-concussion syndrome are important in improving a patient’s quality of life in as short of period of time as possible.


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Many patients over the age of 65 complain of memory loss and are concerned they have dementia. Others attribute their memory loss to aging. While there is a very mild degree of memory loss associated with aging, it is usually not significant. For example, forgetting where you put your keys or where you parked your car. These are not serious memory problems. A more problematic degree of memory loss, while not dementia, is called Mild Cognitive Impairment (MCI). MCI is characterized by an increase level of forgetfulness. There are two primary types of MCI: (1) Amnestic MCI (2) Non-amnestic MCI. In patients affected with amnestic MCI, they have significant memory and recall difficulty. There is a stronger association with this type of MCI with Alzheimer’s disease. Non-amnestic MCI usually does not progress to Alzheimer’s disease but may go on to other types of dementia. The good news is that about fifty percent of all patient’s with MCI never progress to Alzheimer’s or any other dementia. MCI can also spontaneously improve and clear.

The American Academy of Neurology published criteria for the diagnosis of MCI: (1) Individuals reporting their awareness of memory difficulty – preferably confirmed by a spouse or child; (2) Measurable memory loss greater than would be expected for age; (3) Normal general thinking and reasoning skills; (4) Ability to perform routine daily activities. Frequently patients with MCI have specific areas in which they are having memory trouble whereas patients affected with dementia have more global memory difficulties. Also quite frequently, patients with dementia are unaware of having any memory problem at all.

Risk factors for MCI and mild memory loss include such things as high blood pressure, lower educational levels, lack of physical and mental activities and vascular disease. Vascular dementia is seen in patients that have had multiple small strokes. Abnormally low blood pressure, particularly in patients with significant brain vascular disease (hardening of the arteries) can be a cause of reversible memory loss. Depression can cause a condition of memory loss known as pseudo-dementia syndrome of depression. Fortunately this is treatable and the “memory loss” is reversible in this condition.

In those patients affected with MCI, they can go on to develop dementia, usually Alzheimer’s disease. The true incidence is difficult to measure and ranges between 27-65% depending on which study one reads. Some studies have shown that the use of memory loss medications such as donzepil (Aricept®) can help improve memory function and potentially slow the progression of memory loss. It should be noted that in patients over the age of 70, approximately 12% will have some degree of memory difficulty. This is highly variable from patient to patient.

In summary, if you have a sense that you have memory difficulty, do not attribute it to normal aging. Consider seeing a neurologist trained in evaluating memory disorders and Alzheimer’s disease. You have everything to gain by improving your quality of life.


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Namenda (memantine) is the newest medication used in the treatment of Alzheimer’s disease. New research has shown that Namenda may be effective in treating patients with both migraine and tension headaches. The study done by John Krusz, PhD, MD showed that some patients with chronic migraines that did not do well with other headache treatments, did well with Namenda therapy. Of the migraine sufferers, there was a 56% drop in the number of migraine attacks. In patients with tension headaches there was a 62% drop in the numbers of attacks. This study was well reviewed on the website, Help for Headaches and Migraines.

Migraine and other headaches are chronic medical conditions that require aggressive preventative treatment. Many therapies have been tried but no cure has been found. Botox treatment has been promoted by the press but no clinical studies have showed that it is superior in migraine treatment than placebo. Having said that, there are certainly patients that have had migraine and headache reduction after Botox therapy.

It is important to note that the use of Namenda, Botox and most other migraine treatments are off-label uses of these and other medications. The majority of medications routinely used in the prevention of migraines are off-label. This is the standard of care in most headache clinics. If you suffer from migraines that prevent you from routine activities or interfere with work, you need to seek out help from a qualified neurologist who specializes in migraine headache treatment.


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Normal pressure hydrocephalus once again appears in the news. Zig Ziglar, a well known motivational speaker, recently was diagnosed with normal pressure hydrocephalus. About a year ago, Mr. Ziglar had suffered a fall down a flight of stairs, as referenced on a blog from Michael Pink. His family had noticed that Mr. Ziglar was having some memory loss associated with gait unsteadiness.  The characteristic clinical symptoms of normal pressure hydrocephalus are gait unsteadiness, memory loss and urinary incontinence. The exact cause of this condition is unknown but what happens is there is a build up of water (spinal fluid) on the brain. Diagnosis is difficult to make and one should see a neurologist familiar with the condition. The treatment for this is putting a special tube in the brain, known as a shunt. This is a fairly routine neurosurgical procedure.

For the diagnosis of normal pressure hydrocephalus, a patient should first have a CT scan or MRI brain scan. If the spaces in the brain that contain spinal fluid (ventricles) are enlarged, the patient should then have a spinal tap. About an ounce of spinal fluid taken drained off. Then the patient will have gait testing to see if their walking improves. If it does but then worsens a few hours later, the diagnosis is made. A brain shunt can then be permanently put in by a qualified neurosurgeon. Patient’s with true normal pressure hydrocephalus can show dramatic improvements in their ability to walk with gait training rehabilitation. The urinary incontinence will also improve. Unfortunately, if they have a degree of short term memory loss, this procedure will have little if any effect on restoring memory. It is this author’s hope that Zig Ziglar has improved and is doing well with his new brain shunt. To find out more about Zig Ziglar, check his blog site.


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