male-hair-loss-slider-1

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


Posted in General Medicine, Platelet Rich Plasma 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

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

Migraine headaches are a common medical condition in the United States, affecting approximately 12% of the entire population. It is estimated that there are 35-45 million migraine and headaches sufferers in the U.S.  An unfortunate fact is that only 50% of all headache and migraine patients are medically treated. Individuals with different types of headaches (or migraines) are either undiagnosed or undertreated. In the 21st century, it is not necessary to suffer needlessly from migraine headache – the number one medical cause of temporary, total disability in the United States.

A new migraine medication has been approved by the FDA for use in treatment of acute migraine attacks. This new medication is called Sumavel DosePro.  Sumavel is an injectable form of the well known migraine medication: sumatriptan. Sumatriptan was first released in United States in 1992 as Imitrex injectable and subsequently the tablet form. Imitrex injectable system uses a small needle to administer the medication, sumatriptan. While this was one of the most effective treatments for acute migraine attacks, it did involve a minor needle stick. For patients who did not tolerate the thought of a needle stick, even this excellent therapy was not an option for them. Sumavel overcomes this problem by the use of a unique, needle-free injector system. Sumavel uses pressurized air to administer the medication. This is demonstrated in this video.

Sumavel comes in a self-contained injector kit. There is no need for alcohol swabs or drawing up sumatriptan into a syringe. With Sumavel a migraine patient, experiencing an acute migraine attack, needs only to snap of the safety cap, flip the small injector lever and press the injector firmly against the skin on the lower, outer abdomen or thigh. Pressurized nitrogen (a neutral gas) causes the sumatriptan change into an aerosol form and this is literally pushed through the skin into the subcutaneous tissue. This delivers a full dose of sumatriptan (6 mg) into the patient. Therapeutic effect and migraine relief can occur in as few as ten minutes. When the injector releases the pressurized air, you will hear and feel a pop noise.  There is a slight stinging sensation when the medication is pushed across the skin, but there is no needle involved. The used injector can then be disposed of in any trash receptacle. As there is no needle, special disposal is not necessary. Most insurances cover this new, novel migraine therapy.

Migraine headaches remain a major health problem in the United States. Migraines are a leading cause of missed school and work. For migraine sufferers who have too many headache attacks, this can lead to the risk of losing their job. This is unnecessary as many excellent and effective migraine control therapies are available. If you suffer from migraines, cluster headaches or any type of headache, do yourself a favor – call Sarasota Neurology for an appointment. As a migraine specialist, Dr. Kassicieh can help to improve your quality of life, control your migraines and give you your life back.


Posted in Migraines / Headache 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.

(more…)


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

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

Migraine headaches are one of the most common neurological problems seen. There are an estimated 30 million affected American patients. Despite its common occurrence, fifty percent of affected individuals remain untreated. Why are there so many patients with migraine? A new report in Neurology Reviews has shed some light on migraine risk factors and how they progress.

In this study, conducted by neurologist and headache specialist Dr. Richard Lipton, they found that patients with chronic daily headaches were more likely to be female, overweight and depressed. Other risk factors for daily headaches include head injuries and snoring. Patients also contribute to developing daily headaches by overusing analgesics such as aspirin, ibuprofen or acetomenophen containing compounds – particularly those containing caffeine. Prescription medications containing narcotics, barbiturates and caffeine for migraine treatment also increased risk of more headaches. The overuse of all pain relievers results in rebound headaches. The more headaches you have the more medication you take – the more medication you take the more headaches you have. This cycle must be broken by stopping regular analgesic consumption.

Dietary factors play an important role migraine progression. Excessive caffeine or regular soda consumption constitute significantly to increased number of headaches. Major stress events clearly contribute to migraine progression. Obesity, defined by having a Body Mass Index (BMI) of greater than 30 was associated with a five times greater risk of developing chronic daily headache. The triptan medications, such as Imitrex, Maxalt and others, are excellent choices for treating acute migraine attacks. When they are overused, they can put a patient with frequent headaches at risk for progression to chronic daily headaches. In general, individuals with four headache days per month or less, who take any of the above medications, are not at risk for progression of their headaches to daily headache. If you have more that 4 headache days per month or frequently take pain relievers for headaches, you should see a neurologist headache specialist for evaluation and treatment. The first step to improve your quality of life is to pick up the phone and call.


Posted in Migraines / Headache 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

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.


Posted in Memory Loss / Alzheimer's Disease / Dementia, Migraines / Headache and tagged , , , , , , , , , , , , , , , , , , , by

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.


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