Migraine and other headache conditions are a common cause of pain. Migraine headaches are the leading cause of temporary disability in the work force. Fortunately, there are many medications that can be used to prevent and treat migraines.

The first therapeutic event which needs to happen is the correct diagnosis of migraine to be made. Patients can have multiple headache types. Headaches which are severe enough to limit activity and are associated with light and sound sensitivity with nausea and sometimes vomiting are most likely migraines. Migraines usually have a pulsating, heartbeat type pain – made worse by movement.

A common type of headache which can mimic migraine is occipital neuralgia. Occipital neuralgia starts at the base of the skull. There the occipital nerve exits the spine and runs up the back of the skull to the forehead. This nerve carries pain fibers. If it becomes irritated, due to trauma, “sleeping wrong” or just routine daily activities; occipital neuralgia headache occurs. The pain can be just as severe as a true migraine. The pain can be on one side, both sides or even isolated to the front of the head. Diagnosis of occipital neuralgia is made by gently pushing at the base of the skull, over the occipital nerve. If this reproduces the headache symptoms, the diagnosis of occipital neuralgia is made. The most effective treatment for occipital neuralgia is a simple injection in the upper neck in the region of the occipital nerve.

Botox was approved by the FDA in 2011 for treatment of intractable migraines. Botox migraine treatment is not for everyone. In order to have insurance or Medicare to pay for Botox, certain criteria must be met. These criteria include:

– 15 headache days a month
– Failed various migraine prevention medications
– AEDs
– Antidepressants
– Certain blood pressure medications
– muscle relaxants
– physical therapy
– migraines must be incapacitating causing missed work or school

All of these criteria must be met before insurance will authorize and pay for Botox therapy for migraines. Once approved, Botox for migraine is a simple, in-office procedure. For experienced migraine doctors, giving Botox for migraine takes about 20 minutes. Botox does not work immediately to relieve intractable migraines. Effects can be felt as soon as two weeks but maximum benefit is at 6 weeks after Botox treatment. Duration of pain relief can be from 6-8 weeks. With repeated Botox treatment for migraine headache, there is a cumulative benefit in many patients. The minimum time in between Botox treatments is 90 days.

For optimum migraine control, affected patients should be treated every 3-4 months. This results in the best migraine control. This in combination with oral medication migraine prevention therapy.

In conclusion, Botox is effective treatment for many headache patients with chronic, intractable migraines. Proper diagnosis and treatment must be given. For insurance to pay for Botox for migraine, specific criteria must be met. If you suffer from persistent, frequent headaches, call Sarasota Neurology today for an appointment. Start improving your quality of life today.


Posted in Botox, Migraines / Headache, Pain, Vertigo / Dizziness and tagged , , , , , , , , , , , , , , by

In this episode of the Sarasota Neurology Podcast, Dr. Kassicieh, a recognized Parkinson’s disease expert, provides an overview of the disease and current techniques for managing it.

Share

×

Parkinson’s disease is the second most common neurodegenerative disease seen in the United States. Only Alzheimer’s disease is more common. They both share the common fact that they are progressive neurological diseases that result in patients losing functional ability. Alzheimer’s disease affects memory, the ability to remember how to do things and general loss of mental function. Alzheimer’s patients are mostly not aware of the fact that they are neurologically deteriorating. They will make excuses for their memory short comings. Like Parkinson’s disease it is important to recognize Alzheimer’s early so that treatment can be started and outcomes will be improved.

Parkinson’s disease is primarily a progressive loss of the ability to move normally. There is a gradual slowing of movements as well as doing routine tasks such as shaving, dressing and getting ready to go out. Walking is affected and patients tend to shuffle with a forward stoop. Although tremor is common in Parkinson’s patients, not all have this. The converse is true: not everyone with tremor has Parkinson’s disease. There are many treatment available for Parkinson patients to improve their quality of life.

Not everything that shakes is Parkinson’s. If you are concerned that you or someone you love may be suffering from this or another movement disorder, 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 movement disorder specialist in your area.


Posted in Parkinson's disease, Podcast and tagged , , , , , , , , , , , by

Sarasota Neurology is proud to announce the addition of Nora Davis, ARNP to the practice. In addition to her medical experience of 20 years, she has had extensive training and interest in dermatology to enhance patients’ facial appearance. Nora brings to Sarasota Neurology her expertise in skin health and rejuvenation. Additionally, with her medical experience and interest in neurology, she is seeing neurology patients as well. Dr. Kassicieh has had over 20 years of experience in performing Botox therapy for many different medical conditions. As a bonus, doing Botox for cosmetic purposes came naturally. Since 2009, he has been doing platelet rich plasma therapy (PRP), the first Sarasota platelet rich plasma doctor doing non-surgical neuro-orthopedics. Platelet rich plasma therapy is done in the office, using your body’s own natural ability to heal itself. PRP therapy can also be used for cosmetic purposes in hair growth and natural, non-surgical face lifts.
Nora is a Board Certified, Advanced Registered Nurse Practitioner, who has been practicing medicine for over 25 years, trained in dermatology aesthetic procedures and most recently joined an Osteopathic specialist, Sarasota neurologist Dr. Daniel Kassicieh. She has her Master of Science Degree from the University of South Florida. Nora is a member of the American Academy of Nurse Practitioners, Southern Gulf Coast Nurse Practitioner Council, Board member of the American Cancer Society of Charlotte County and Certified American Heart Association CPR instructor.
Five years ago Nora entered the dermatology field of Medical Aesthetics. In primary care Nora found a passion in dermatology. Beauty in treating and preventing skin conditions such as acne, rosacea, and skin cancer became her main focus. She has had extensive education and training in aesthetics for facial skin care, laser therapy, Botox, Juvederm and other treatments to reduce or eliminate facial wrinkles and other signs of aging. The goal is to avoid She is an educator and clinician with the Obagi® skin care systems. Additionally she does chemical peels, and performs facial injectable procedures. She focuses on tissue regeneration for wrinkles, laxity, brown spots, dryness and dullness. This, combined with platelet rich plasma therapy to replace facial collagen is the ultimate in facial skin care. Nora promotes wellness and beauty for health management in all ages. She is dedicated and committed to providing the best possible care to her patients to feel and look their best. It is all about quality of life – if you look better, younger – you feel better. Call Sarasota Neurology now for your appointment for a new youthful look and start to reverse the effects of aging.


Posted in Uncategorized and tagged , , , , , , , , , , , , , , , by

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 , , , , , , , , , , by

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

Patients are being treated currently at Sarasota Neurology with PRP (platelet rich plasma) for a wide variety of joint pain and other pain issues. Among the more common uses for PRP are knee pain, shoulder pain and other painful conditions such as plantar fasciitis, tennis elbow, some types of low back pain. PRP can also be used in patients that have residual joint pain from having had orthopedic arthroscopic knee or shoulder surgery.

PRP works to heal painful joints by using the patients’ own natural biological healing mechanism. The injured or damaged tissue in the joints, ligament and tendons or muscle send out chemical signals that there is injury or incomplete healing. PRP has receptors on the active platelets that seek out these damaged tissues. The PRP graft then biologically and molecularly attach to the damage tissue and trigger the natural healing process of making new collagen. This process takes six weeks to have a full effect although actual healing can continue for up to three months.

PRP may be used in some patients as an alternative to having surgery on their knees, rotator cuffs or in cases of plantar fasciitis (foot pain). Beginning in early 2011, Sarasota Neurology will be offering a new and innovative uses for PRP. This highly effective treatment is ideal for patients who would prefer to avoid the cost, pain and time involved in having surgery for the same problem. Check back with us in February to get more details of this exciting treatment with PRP in Sarasota.


Posted in Back Pain, Pain, Platelet Rich Plasma and tagged , , , , , , , , , , , , , , , , , , , , , , , by

Carpal tunnel syndrome is the most common “pinched nerve” condition that neurologists see. It is a form of compression neuropathy The typical patient comes in with complaints of hand or arm pain associated with one or more numb fingers. There is usually sparing of the little finger. This painful numbness will frequently wake affected patients from their sleep. They will complain of a swollen feeling in their hand (or both hands) associated with painful numbness affecting all but the little finger.

Carpal tunnel syndrome is caused by compression of the median nerve (the “carpal tunnel nerve”) as it pass under the carpal tunnel ligament. The carpal tunnel is located at the wrist. There is a small band of tissue across this to hold down the median nerve and vein. When the carpal tunnel becomes too narrowed, the median nerve becomes “pinched” and the vein is compressed. This combination of events results in the hand becoming numb and swollen. Carpal tunnel symptoms frequently occur only at night, during sleep. This is because we all have a tendency to sleep with our wrists slightly flexed. This position further narrows the carpal tunnel, causing symptoms. As the carpal tunnel narrows further, with time, patients will develop daytime hand numbness. Holding a newspaper, magazine or steering wheel can bring on symptoms. In more severe cases hand grip weakness can occur. Patients find that they have difficulty removing jar lids or may drop objects. Carpal tunnel syndrome occurs in both hand about 50% of the time.

CTS is diagnosed, most commonly by a neurologist, on the basis of the patient’s symptoms and detailed neurological exam. Electrical diagnostic testing, nerve conduction studies (NCV), are necessary to confirm carpal tunnel syndrome – particularly if surgery is being considered. Many patients can have carpal tunnel symptoms and have normal NCV studies. These patients are not candidates for surgery. The standard of care medical treatment for CTS is wearing a cock-up wrist brace. These braces prevent wrist flexion, thereby reducing the pressure on the median nerve. Frequently patients can “cure” their CTS with wearing a brace. For more severe symptoms with abnormal NCV studies, surgical decompression may be indicated. This is a procedure done under local anesthesia. A small incision is made at the wrist and the carpal ligament is cut. This relieves the pressure on the median nerve. Success rate for this surgery is approximately 90%.

If you feel that you have carpal tunnel syndrome, you should see a neurologist and have diagnostic studies performed. Most patients will do well with conservative, non-surgical treatment. For more detailed information click here.


Posted in Nerve Diseases, Nerve Pain, Neuropathy and tagged , , , , , , , , , , , , , , , , by