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.
Posted in Botox, Movement Disorders, Pain, Podcast, Stroke and tagged Botox, Botox injections, cerebral, clinical, dystonia, FDA, headaches, migraine, Pain, spasm, spinal cord, Stroke by Dan Kassicieh, D.O.
Parkinson disease was first described by James Parkinson in 1817 Over the years, various medication therapies have been FDA approved for Parkinson disease. In the 1960s, Sinemet (carbidooa-levodopa) was approved. Sinemet was and still is the gold standard therapy for Parkinson disease. While it is the gold standard, it should not be the first drug used to treat Parkinson disease. It should be the third or fourth drug used. Early use of Sinemet can result in unwanted, irreversible side effects.
Dopamine agonist were FDA approved in the 1990s for first line Parkinson disease therapy. These medications mimic the effect of dopamine in the brain of Parkinson disease patients. Dopamine is the brain chemical that is deficient in these patients. Mirapex (pramipexole) and Requip (ropinirole) are two commonly used dopamine agonists in the treatment of Parkinson patients.
The newest dopamine agonist which was FDA approved for Parkinson treatment is Neupro. Neupro is unique in that it is a dopamine agonist patch medication. This transdermal patch system is applied once daily to clean, dry skin. The benefit is that Parkinson patients get a 24 hour continuous medication dosing. Patch application sites need to be rotated daily, to prevent skin irritation. Neupro comes in several dosage strengths. Like other Parkinson medications, the dose needs to be adjusted for ideal patient functioning, with minimal side effects.
Dopamine agonists can have potential side effects. This class of medication can cause symptoms of hallucinations, confusion, lowered blood pressure, drowsiness, sudden sleep attacks – particularly while driving. Other side effects include stomach upset, nausea and compulsive behaviors – including gambling, eating and hypersexuality.
Parkinson disease does not need to be a disabling condition. With careful neurological management and detail to your specific needs, a Parkinson patient can have an excellent, functional quality of life for many years.
Posted in Movement Disorders, Parkinson's disease and tagged Dr. Kassicieh, movement disorder, Movement Disorders, neurologist, Parkinson, Parkinson disease, Parkinson's disease, Sarasota Neurology by Dan Kassicieh, D.O.
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.
Posted in General Medicine, Memory Loss / Alzheimer's Disease / Dementia, Movement Disorders, Parkinson's disease and tagged Alzheimer's, anxiety, dementia, depression, hip fracture, Memory loss, neurologist, neurology, Parkinson, Parkinson's disease, Sarasota neurologist by Dan Kassicieh, D.O.
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.
Posted in Memory Loss / Alzheimer's Disease / Dementia, Movement Disorders and tagged brain, dementia, depression, drug, drugs, gait, memory, movement disorder, Movement Disorders, nerve, neurologist, neurology, Quality of Life, Sarasota, Sarasota Neurology by Dan Kassicieh, D.O.
Parkinson’s disease is the second most common neurodegenerative disorder, just behind Alzheimer’s disease. Parkinson’s disease is characterized by specific clinical symptoms including rigidity (stiffness), slowness of movement, unsteadiness (gait imbalance) and tremor. For the accurate diagnosis of Parkinson’s disease to be made, a patient needs to have 3 of the 4 major symptoms of the disorder. Each patient with Parkinson’s disease is different and may have differing degrees of each component of Parkinsonism. Not all patients with Parkinson’s disease have tremor. Some may have more instability of gait, shuffling or slowness of movement. There are several medications available that neurologists can use to treat Parkinson patients to alleviate their Parkinson symptoms and improve their overall quality of life. Unfortunately, there is a down side to this treatment. Patients who have been on Sinemet for a few years tend to develop motor fluctuations. Motor fluctuations include end-of-dose wearing off, where their functional abilities deteriorate before the next dose of medication is due. Other motor fluctuations include freezing and off time.
Parkinson freezing is simply when a patient becomes “stuck” meaning they cannot move. This occurs more frequently when going through doorways, stepping up onto a curb or stair or when getting up to start walking. Freezing can also occur first thing in the morning, just when getting up out of bed. Freezing episodes can last for a second up to a few minutes. It is the goal of every Parkinson’s disease neurologist to minimize a patient’s amount of freezing, through various medications and dosing schedule changes. Off time can occur in two settings: one is predictable, usually at the end of the dosing interval but the other occurs randomly, without warning. These sudden off time events are more problematic as they tend not to respond as well to medication changes. Off time is troublesome for the patient and caregiver. Affected patients become virtually immobile, essentially frozen in place. There are different degrees of off time, but in all cases, the patient’s mobility and ability to function are severely impaired. Off time may last minutes to hours. For those patients with short duration off time, additional medication or shorter dosing intervals usually will help. Off time may also occur first thing in the morning when waking up. Even if Parkinson patients take their medications, it may be an hour or more before they are functioning normally. For patients with prolonged off times, usually greater than 45 minutes, there is treatment.
Apokyn (apomorphine) is a self administered injectable medication that rapidly relieves off time. Its duration of action is generally less than 2 hours. This is an ideal medication for patients with one or multiple daily freezing episodes. For those affected patients, Apokyn can literally give them their lives back, particularly when more waking hours are spent in the “off time” than in “on time.” For a patient or caregiver to administer Apokyn, some training is required. This is covered by the drug manufacturer and by Medicare. Side effects can include a drop in blood pressure, lightheadedness, nausea or vomiting. When initially starting a patient on Apokyn, medication to prevent nausea is given first. After being on the Apokyn for a few weeks, patients frequently can stop the antinausea medication.
If you are a patient or caregiver and feel that Apokyn may be of benefit, contact your neurologist or Parkinson disease specialist for more information. An excellent information package, with DVD, is available at no cost. The first step is to make the call to improve your quality of life. For more information, visit the website for Dr. Kassicieh at: www.DrKassicieh.com.
Posted in Movement Disorders, Parkinson's disease and tagged Alzheimer's, Alzheimer's disease, Apokyn, Dr. Kassicieh, neurologist, Parkinon's disease, Parkinson, Parkinson disease, Parkinson's disease, Quality of Life, Sinemet, website by Dan Kassicieh, D.O.
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.
Posted in Botox, Brain Stimulation, Memory Loss / Alzheimer's Disease / Dementia, Movement Disorders, Nerve Pain, Parkinson's disease, Stroke and tagged brain, Deep Brain Stimulation, Dr. Kassicieh, dyskinesia, dyskinesias, FDA, FDA approved, Memory loss, neurodegenerative, neurologist, Parkinson, Parkinson disease, Parkinson's disease, Parkinson-039s disease, Quality of Life, Sarasota Neurology, tremor, Vanderbilt University by Dan Kassicieh, D.O.
Neupro patches were approved by the FDA for Parkinson’s disease treatment in September 2007. They proved to be very effective in the control of Parkinson symptoms, as compared to the effects of other dopamine agonists including Mirapex and Requip. Unfortunately, in March, the FDA recalled Neupro due to problem with the patch delivery of the medications. What they found posed no imminent danger to patients. Rather what was happening was that the active drug, rotigotine, was crystallizing in the patch therefore not delivering the full dosage of medication to the patient. What would happen is that affected patients’ Parkinson symptoms would not be as well controlled. It is not clear if Neupro patches will be brought back to market as reported on Emaxhealth.
Dopamine agonists remain one of the main Parkinson treatment medication groups available to control Parkinson symptoms. These can be used as first line medications for early Parkinson’s disease, showing as good as an effect as Sinemet – the gold standard for treatment of Parkinson’s disease. Many feel that it is beneficial and studies have shown that starting early treatment with dopamine agonists can limit the long term side effects of starting Sinemet early. This is particularly true for delaying development of dyskinesia, which are involuntary movements of arms, legs and head. Dopamine agonists can also help to suppress tremor associated with Parkinson disease.
If you are still using Neupro patches, you should contact your treating neurologist or Parkinson specialist to get the weaning patches and titrate off this drug. Many other excellent treatments for Parkinson’s disease are available. For more information visit: Parkinson Doctor.
Posted in Movement Disorders, Parkinson's disease and tagged dopamine agonist, dopamine agonists, dyskinesia, Mirapex, Neupro, neurologist, Parkinson, Parkinson disease, Parkinson's disease, Requip, rotigotine, Sinemet by Dan Kassicieh, D.O.
Normal pressure hydrocephalus (NPH) is a rare disorder that is characterized by progressive gait difficulty, urinary incontinence and memory loss. Although the press has covered this topic extensively in both the written and video media, true normal pressure hydrocephalus remains quite uncommon. The underlying problem is actually an excessive build up of spinal fluid in the brain. The areas of the brain that stores this fluid are known as the ventricles. In NPH, the spinal fluid flows out of the brain but, due to reasons that are not entirely clear, there is a build up of excessive fluid in the brain. This results in enlarged ventricles causing a condition called communicating hydrocephalus.
Normal pressure hydrocephalus develops very slowly, over months to years. It is usually seen in individuals over the age of 65. As the ventricles slowly increase in size, affected patients begin to show signs of slowed, wide based, unsteady gait. Urinary incontinence may also develop during this time. Later during the disease process memory loss begins. All of the symptoms are very slowly progressive. Patients can be diagnosed incorrectly with Parkinson’s disease, Alzheimer’s disease, depression or just dementia.
The gait difficulty comes from the fact the the nerve fibers that control walking and balance become stretched as the ventricles enlarge. With this comes progressively worsening gait imbalance and falling. Patients may complain of weakness and fatigue. Patients will actually will tell you that their feet feel stuck to the ground, giving rise to the term magnetic gait. Memory loss seen in normal pressure involves mainly recall and slowness of thinking. Recognition of objects, tasks and individuals is better preserved. Without careful testing however, one can easily make the mistake of making an erroneous diagnosis of Alzheimer’s disease versus normal pressure hydrocephalus associated dementia. Urinary incontinence is a later finding in the disease process. There is an increasing need to urinate more frequently and urgently. If the dementia progresses too far, patients will become indifferent to their incontinence.
Diagnosis is made by obtaining an MRI or CT brain scan. The ventricles appear enlarged in the absence of brain atrophy (shrinkage.) As a normal process of aging, there is a certain amount of atrophy. It other conditions such as Alzheimer’s disease, alcoholism or in patient’s who have received chemotherapy, brain atrophy can be more prominent. The key in diagnosing NPH is that the degree of ventricular enlargement is out of proportion to the expected degree of atrophy. The degree of ventricular enlargement can be measured as a ratio to the degree of atrophy. The second step in diagnosis, after a complete neurological exam, is to do a diagnostic spinal tap (lumbar puncture.) During this procedure, 1-2 ounces of spinal fluid is drained off. The patient is then tested to see if their gait improves.
Treatment for confirmed cases of normal pressure hydrocephalus is a brain surgery procedure know as a ventriculoperitoneal shunt placement. In this procedure, a tube is placed in the ventricles and the other end drains into the abdomen. The tube is run under the skin. Spinal fluid is then absorbed in the abdomen. There is no known effective medical treatment for NPH. Early diagnosis and treatment is important as the gait disorder and urinary symptoms can be alleviated. Once the memory loss has begun, this cannot be reversed.
In order to have the accurate diagnosis of normal pressure hydrocephalus, a patient should be seen by a neurologist or neurosurgeon familiar with the condition. It is not necessarily easily diagnosed, even by experienced physicians. Nonspecific gait disorder is common with advancing age. Dementia is also common, particularly over the age of 70. Stroke, Parkinson’s disease and low thyroid can mimic the symptoms of normal pressure hydrocephalus. The main point is that of all these conditions, true normal pressure hydrocephalus occurs very rarely and is generally considered a diagnosis of exclusion of every other problem plus meet the diagnostic criteria listed above.
Posted in Memory Loss / Alzheimer's Disease / Dementia, Movement Disorders and tagged Alzheimer's, Alzheimer's disease, brain surgery, dementia, depression, gait, hydrocephalus, lumbar puncture, Memory loss, Memory Loss / Alzheimer's Disease / Dementia, neurologist, normal pressure hydrocephalus, Parkinson, Parkinson's disease, shunt, spinal fluid, spinal tap, Stroke, urinary incontinence by Dan Kassicieh, D.O.
Myasthenia gravis is a rare disorder of muscle weakness, affecting approximately 70,000 individuals in the United States. Many confuse this with multiple sclerosis. Multiple sclerosis is a central nervous system disorder affecting the insulation (myelin) on nerve cells in the brain and spinal cord. In contrast myasthenia gravis is a muscle disease where transmission of electrical impulses to the muscle fail. This results in the muscle not contracting fully, resulting in weakness. This condition can selectively affect the eye muscles, muscles of the head and neck or be generalized affecting all muscle, including the diaphragm. If the diaphragm is involved, patients can have varying degrees of breathing problems, including respiratory failure.
Myasthenia gravis (MG) is the standard model of a neurological autoimmune disorder. It is the the best understood of all autoimmune diseases. In autoimmune diseases, the body’s immune system fails to recognize a particular body system as being part of “itself.” In MG, the immune system does not recognize the transmitter receptors for acetylcholine (the muscle communication transmitter) as being part of the body’s own system. The immune system for antibodies against the receptors and attacks them. With fewer receptors on the muscle membrane, the muscle does not get the full chemical message to contract. This causes affected individuals to have weakness in the muscles affected by MG. These antibodies can be detected by a blood test for acetylcholine receptor antibodies. It is important to note, however, that not all patients with myasthenia will have a positive antibody test, known as a false negative (as high as 25%.) Particularly patients with ocular myasthenia frequently have negative tests. This does not mean that they do not have the condition.
Diagnosis of myasthenia is based on a careful medical history and detailed neurological exam. All patients with MG have some degree of visual symptoms including double vision or eyelid drooping. The presence of variable eyelid drooping, particularly if it shifts from side to side, is virtually diagnostic of myasthenia gravis. Confirmatory tests can include EMG testing and a chemical test known as the Tensilon test. Tensilon (edrophonium) is a chemical that temporarily blocks the enzyme that stops the action of acetylcholine. This has the effect of making the acetylcholine receptors that are “on” stay on longer, thereby combating weakness. Patient’s with suspected myasthenia can be given Tensilon. This short acting drug will temporarily reverse the weakness that myasthenic patients have. Other lab work should be performed to exclude other muscle diseases, thyroid problems or other metabolic problems that could cause muscle weakness.
Once the diagnosis is made, patients can be treated with Mestinon ( pyridostigmine.) Mestinon is a long acting version of Tensilon and works by inhibiting cholinesterase, the chemical that breaks down acetylcholine. If we did not have this enzyme, we could not relax our muscles. When acetylcholine is removed from the muscle receptor the muscle no longer contracts. Mestinon works well for symptomatic relief of the muscle weakness and associated symptoms of MG. Other symptoms associated with weakness can include chewing and swallowing difficulties, weakness of breathing with shortness of breath and generalized weakness. Double vision and drooping eyelids, conditions made worse by being in bright sun light, are frequent complaints.
For patients that have persistent symptoms, despite Mestinon therapy, clinicians will frequently employ the use of immunosuppressant therapy that will dampen the response of the immune system. This has the effect of limiting the destruction of the acetylcholine receptors on the muscle membrane surface. The most commonly used drug for this is Prednisone, a steroid drug, frequently used to treat autoimmune disorders. Although Prednisone works very well, it has its downside. Prednisone side effects can include weight gain, elevated blood sugar, cataracts, accelerated osteoporosis and other serious medical problems. Other immunosuppressants have been used with success. These include Imuran (azathioprine), cyclosporine, Cytoxan (cyclophosphamide) and CellCept (mycophenolate.) While being helpful in treating MG, these powerful immunosuppresants have their own lists of potential side effects. The purpose of immunosuppressant therapy is to cause myasthenia to go into remission. This is not always successful.
For patient’s with a severe worsening of their myasthenia symptoms, hospitalization may be necessary. Higher dosage, intravenous steroids can be given in combination with a blood filtering technique, known as plasmaphersis. The latter is used to filter out the acetylcholine receptor antibodies. A surgical technique, thymectomy, can be used to remove the thymus gland in the chest. This gland is responsible for making the cells that make the acetylcholine receptor antibodies.
Myasthenia gravis is a serious neurological condition and autoimmune disease characterized by muscle weakness that can affect vision, swallowing, breathing and general activities. Serious complications, including respiratory failure, can develop for untreated patients. Affected individuals should seek out care from a board certified neurologist, preferably one specializing in movement disorders or neuromuscular disease.
Posted in Movement Disorders, Nerve Diseases, Nerve Pain and tagged acetylcholine, autoimmune, autoimmune disease, autoimmune diseases, azathioprine, cyclophosphamide, cyclosporine, immune system, immunosuppressant, Mestinon, movement disorder, Movement Disorders, multiple sclerosis, muscle weakness, myasthenia, Myasthenia gravis, mycophenolate, neurologist, neuromuscular disease, plasmaphersis, Prednisone, Tensilon, thymectomy by Dan Kassicieh, D.O.
One of the most frustrating neurological conditions is restless legs syndrome (RLS.) It is characterized by an intense overwhelming need to move your legs at night or when sitting or resting. This can be so severe that affected individuals have difficulty sitting through a movie or driving in a car for any distance. Occasionally RLS can be associated with abnormal sensation, particularly in the feet and lower legs. The abnormal sensory symptoms are a form of peripheral neuropathy that is associated with RLS. Symptoms can be so severe as to be an impairment to sleep and feeling of well being. RLS is consider to be a form of sleep disorder, even though individuals can have symptoms during the day, while awake. New research findings that were reported in the New England Journal of Medicine indicates that there is a genetic component to RLS. There are many who doubt the actual existence of RLS but those affected with this condition would disagree. As a movement disorder specialist, having seen many patients with this condition, there is no question that it is real. To ignore the medical literature and scientific evidence on the existence of RLS is foolish.
RLS can markedly impair the quality of life of affected individuals. They typically have chronic sleep deficit with a higher incidence of depression. The recent report on the genetic linkage of families with members affected with RLS is fascinating. Another common sleep condition, periodic limb movements of sleep, shows a stronger genetic correlation to run in families due to a specific genetic sequence variant at the 6p chromosome. Many of these individuals have RLS. If one isolates out the patients with RLS only, the genetic linkage becomes less clear. It is perhaps that RLS represents a subset of individuals with some chromosomal variation. This may serve as a marker for potential development of RLS in patients who have a history of RLS or periodic limb movements of sleep. These individuals can also have trouble with elevation in their blood pressure as well as other conditions associated with long standing sleep deprivation. There are several excellent treatment options for RLS including the dopamine agonists, Klonopin, low dose mild narcotics and other medications. If you are affected with this condition, it is important to get medical help as excellent treatment exists to control symptoms.
Posted in Movement Disorders and tagged dopamine agonist, dopamine agonists, Klonopin, movement disorder, Neuropathy, periodic limb movements, Peripheral Neuropathy, Quality of Life, Restless Legs Syndrome, RLS, sleep disorder by Dan Kassicieh, D.O.