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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, 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.

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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 , , , , , , , , , , , by

As a neurologist who sees many patients with neck, back and various joint pains, I practice an area of medicine known as neuro-orthopedics. As such, I treat patients for their pain without surgical intervention. Many patients with neck, back and joint pain (knee pain, shoulder pain, elbow pain, etc.) can be successfully treated without invasive surgery and the many risk that go along with this. With surgery there is also a prolonged recovery time and need for extensive rehabilitation. The area of medicine that applies to successfully treating patients without surgery or use of narcotic medications is known as regenerative medicine. In this field, platelet rich plasma is injected into the affected joint, tendon, ligament or soft tissue area that has pain and is failing to heal completely. Tendons attach muscle to bone and ligaments attach bones to bones. Platelet rich plasma (PRP) is the concentrated healing components of the blood. Only one percent of the blood contains the bioactive proteins and platelets that are involved in healing. Through a specialized process, we can take the patient’s own blood and concentrate the platelets and bioactive proteins up to 500%. This small amount of concentrated PRP is then injected into the joint or other body area, that needs regeneration, after local anesthetic is administered. The PRP graft is then activated with thrombin and the healing process begins. Using the patient’s own blood eliminates the risk of transmitting disease and prevents graft rejection. PRP also has the benefit of being antimicrobial, killing off bacteria thereby limiting the risk of infection. David Crane, MD published an excellent overview of platelet rich plasma.

Platelet rich plasma works by first being injected into the affected area and activated. The activated platelets attach themselves to the damaged tissue, whether that be tendons, ligaments, muscle or bone. The platelets release alpha granules and dense particles. The small packets contain powerful bioactive proteins that begin the healing process. The alpha granules contain clotting factors, growth factors, cytokines and adhesion molecules. These substances allow the PRP graft to attach to the damaged tissue and start recruiting other healing cells to migrate into the area. The dense particles contain proteins that allow the platelets to clump together, forming the structural matrix of the PRP graft.

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Posted in Back Pain, General Medicine, Nerve Pain, Pain, Platelet Rich Plasma and tagged , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , by

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 , , , , , , , , , , , , , , , , , by

Stroke occurs when a blood vessel in the brain becomes blocked or ruptures. The most common form of stroke is due to blockage of a blood vessel. Blood vessel blockage is caused by a condition known as
atherosclerosis, commonly known as “hardening of the arteries.” This is the most common type of stroke. Stroke is one of the three major leading causes of death in the United States. The other two are heart attack and cancer. Stroke is the leading cause of disability in the U.S. It is for this reason that it is much wiser to focus on stroke prevention in the first place rather than trying to limit the damage with stroke treatment after event has occurred. High blood pressure (hypertension) is the single biggest, treatable risk factor for stroke. In the 1970s, there was a push by the medical community to aggressively treat high blood pressure to lower the risk of stroke, premature heart disease and kidney failure. One cannot feel that their blood pressure is elevated but the damage to major body organs (heart, brain, kidneys) continues on. It is only when these organs start to fail or a stoke occurs, will it become apparent that a given individual may have hypertension. On occasion, patients with untreated hypertension may have headaches. Fortunately checking one’s own blood pressure is easy. This can be done at your doctor’s office, pharmacies or the local fire department. If you have high blood pressure with the top number greater than 150 or the lower number greater than 85, you need to see a physician for treatment. Fortunately there are many different types of medication to treat high blood pressure. Many patients can be successfully treated with a single drug, for mild hypertension. Individuals with moderate to more severe hypertension, multiple drug therapy may be necessary. With the aggressive push to treat high blood pressure, the rate of stroke in the United States has dropped dramatically over the past two decades. There is a class of blood pressure medication, the ACE inhibitors, that have been shown in well designed clinical studies to significantly reduce the risk of stroke independent of their ability to lower blood pressure. Current evidence based medicine strongly suggests that addition of an ACE inhibitor should be done in patients with high blood pressure, even if their blood pressure is adequately controlled on other agents. Ideal blood pressure range should be with the upper number (systolic) being less than 130 and the lower number (diastolic) less than 80.

It has been well known for several decades that aspirin thins out the blood. Cardiologists have used aspirin extensively for 30 years to lower the risk of having a heart attack. Aspirin slows down the formation of clots by blocking the clumping of platelets to form blood clots. In 1994 a hallmark study, the Antiplatelet Trialists’ Collaboration, was published demonstrating the clear benefit of aspirin in the prevention of stroke and transient ischemic attacks (TIA, “mini strokes”.) In 1998, the FDA approved labeling of aspirin for the prevention of TIA and stroke. Dosage recommendations in the range of 81-325 mg daily should be used. Unfortunately aspirin does not entirely prevent stroke or TIA from occurring. Other blood thinning agents can be used in patients who fail aspirin therapy. The other two agents are Plavix and Aggrenox. Either agent can be used in patients who have had a TIA or stroke while taking aspirin. In patients who have no history of heart disease, Aggrenox is the preferred agent. Plavix is preferred in those patients who have known coronary artery disease.

Lastly, high cholesterol has been implicated in the development of accelerated atherosclerosis. There have been studies that have shown some correlation of high cholesterol with the increased risk of having a stroke. Multiple, double-blind, placebo controlled studies have shown that the use of cholesterol lowering statin drugs for cholesterol reduction results in an average of a 27% overall secondary risk decrease in stroke. Studies are ongoing to show if statins may help in primary prevention of stroke and TIA. At this time, it is prudent to be on a statin drug, for cholesterol reduction. The currently available statins include: Lipitor, Zocor, Pravachol, Crestor or Mevacor if you have a cholesterol over 200. The marked benefit of this class of drugs on the reduction of stroke and cardiac events (35%) is dramatic and strongly supports more aggressive treatment for high cholesterol (hyperlipidemia.) The objective is to have a total cholesterol less than 180, good cholesterol (HDL) of greater than 50 and bad cholesterol (LDL) less than 100. A recent study published in the journal Stroke reported that discontinuing statin therapy in the year after a stroke is associated with a significant increase in the risk for death, even in the absence of heart disease.

Medications are not the only treatment for stroke prevention. Smoking is associated with a 2-3 times greater risk of stroke and bleeding in the brain. Smoking also contributes to the accelerated development of heart disease, emphysema and peripheral artery disease. Chantix is a new medication that received FDA approval to help stop smoking. Exercise is important in maintaining overall body conditioning and weight control. This in turn leads to an overall lowering of blood pressure and cholesterol. In summary, stroke prevention is much easier and cost effective than fixing the problem after someone has a stroke. This approach to stroke reduces mortality and disability for the entire United States population. The cost saving are in the hundreds of billions of dollars over stroke treatment. If you feel that you are at risk for stroke, contact a neurologist for evaluation and treatment.


Posted in General Medicine, High Cholesterol, Stroke and tagged , , , , , , , , , , , , , , , , , , , , , , , , , , , , by

The FDA has recently approved the dementia fighting drug Exelon in a patch form. The new formulation, Transdermal Exelon, offers patients a new and unique way to get medication which can help with improving cognitive function and slow down memory loss in patients suffering from Alzheimer’s disease. The new patch is also FDA approved for patients with Parkinson associated dementia. This is the second patch approved for use in treatment of Parkinson disease. The other is Neupro, a transdermal patch containing the dopamine agonist rotigotine.

Transdermal Exelon joins the group of other medications used to treat Alzheimer’s disease, such as Aricept, Razadyne and Namenda. The patch for of Exelon offers the advantage of not having to take a pill twice daily, continuous medication administration through the skin and less stomach upset. Another advantage is that the patch demonstrated beneficial effects equivalent to the maximum oral dosing of this medication. The problem with the oral medication was intolerance due to nausea and vomiting. While much less, there were some reports of stomach upset with Transdermal Exelon. Another side effect, common to most patch medications, was that of skin irritation. The patch needs to be changed daily and administration sites should be rotated, not using the same site more than once every two weeks. While Exelon, Aricept and Razadyne are in the same chemical family of memory disorder drugs – the acetylcholine esterase inhibitors – Namenda is in a class by itself. For this reason, it can be used in combination with any of the other three. Studies have shown that there is a beneficial effect in improving cognitive function with combining these two different types of medication. Studies are looking into the use of these medications for patients with mild cognitive impairment. These are individuals who have some memory loss but do not fit the criteria to be diagnosed with dementia. Depression, manifesting as dementia, also needs to be excluded.

Alzheimer’s disease is a chronic debilitating illness that slowly robs patients of their memory, cognitive abilities and ability to function independently. They become more and more dependent on others to provide care and transportation for them. Even dressing, eating and bathing become impossible for them to perform without assistance. With the availability of these new memory drugs, the progression of the debilitating symptoms of Alzheimer’s disease and Parkinson disease associated dementia can be slowed down. Some patients actually show functional improvement. Unfortunately, none of these medications halt the progression of the disease. Eventually their quality of life deteriorates and others will need to assist with care giving. The benefit of these medications is that they significantly slow the progression of the disease, possibly keeping loved ones at home, instead of a nursing home, for anywhere from 6-18 months. If you have a loved one with memory loss, early diagnosis and treatment is important. Studies are ongoing to show that with earlier treatment, patients do better over extended periods of time. Bring your family member with memory loss to a neurologist for a complete evaluation.


Posted in Memory Loss / Alzheimer's Disease / Dementia, Parkinson's disease and tagged , , , , , , , , , , , , , , , , , , , , , , by