Too often people who have not had chronic headaches or migraines, as well as many in the medical professional, simply do not recognize how deeply these conditions impact the quality of life on people suffering with them. That is not the case here are Premier Neurology Institute. Our providers and staff recognize that migraines can be the worst pain that humans can suffer and even if the pain can be controlled, the associated symptoms of vomiting, severe light or sound sensitivity and cognitive impairment are often just as debilitating. Even though a migraine is not a life threatening disorder, it all too often steals precious days of life from people.
Here at PNI, Dr. Vehra and Dr. Liu aid our patients by clarifying the differences and classifications according to the symptoms a person reports in our office or via a virtual evaluation/examination. This collaborative teamwork between physician and patient is the best path for treating chronic headaches and/or the manifestations of migraine.
A migraine is one of the most common and often most debilitating forms of headache. It is classically characterized by unilateral (one side of the head), location often behind one eye, pulsating (throbbing) quality, worsening by routine activity and by its moderate or severe intensity of pain. A migraine is typically accompanied by nausea or vomiting and or light and sound sensitivity. However, we now recognize that just as many people who have classic migraine symptoms will have variations of migraines with bilateral pain, steady pressure pain, and pain in the neck or back of the head more so than the front. Previously those with head pain pressure or pain in the back of the head were misdiagnosed as tension headache that often would suggest that the person is having trouble dealing with stress. We now accept that most headaches that are severe enough to interfere with life are migraines irrespective of the location or type of the pain. Only 20% of people with migraines have the flashing light aura before the headache so it is more common to have a migraine without the aura.
If left untreated, or if frequent analgesics medications are used, the episodic migraine can transform to a daily headache pattern with intermittent severe intensifications. Often this is confused with mixed migraine and tension headaches but most often is a continual lower grade smoldering migraine that erupts frequently into a severe migraine. Unless the daily headache cycle can be controlled, the episodic severe migraine pain cannot be prevented.
Movement disorders are diseases that affect a person’s natural movements. This may include slowed or limited movement (hypokinetic) or increased or over active movement (hyperkinetic).
There are a wide range of movement disorders. Examples of hypokinetic movement disorders include Parkinson's disease and Parkinsonism although the tremor aspect is too much movement in the resting state. Examples of hyperkinetic movement disorders include Dystonia, Chorea and Huntington's disease, Ataxia, Essential Tremor, and Restless Legs syndrome, to name a few.
Spasticity is more of a motility disorder in that there may not be enough movement such as after a stroke, but at the same time, muscle tone is increased causing further restriction of normal movement. Some of these conditions are hereditary while in others, no genetic cause has been found as of yet. There may be an interplay of the environment with a genetic predisposition that causes many of these disorders to come to the surface. Genetics loads the gun but the environment pulls the trigger.
The diagnosis of the type of most movement disorders is made clinically which means that the diagnosis is based on the symptoms you are experiencing and what is found on the examination. Occasionally certain imaging studies (such as CT or MRI) or blood studies, including genetic testing, can support a diagnosis although in even severe movement disorders, the scans and lab studies are usually normal since the cause is more of an electrical or chemical disturbance in the brain and not something that can be seen on a scan or detected in the blood. Treatment of movement disorders depends on the diagnosis.
Some of the more common diagnoses treated here at Premier Neurology Institute are as follows:
Parkinson’s Disease or Parkinsonism
Patients with Parkinson’s Disease or Parkinsonism have characteristic symptoms of slowed movements, rigidity and a resting tremor. A major part of the pathology of Parkinson’s is a decreased ability to produce the neurotransmitter dopamine that is critical for normal movement. Medication treatment for this disorder includes strategies to increase the availability of dopamine in the brain or stimulate the brain dopamine receptors. Examples of some of medications are Sinemet, Mirapex, Requip, Azilect and soon to be many others used alone or in combinations specific for each person.
Dystonia is a type of movement disorder caused by excessive contraction of certain muscles that may be spasmodic or induced by stimuli or certain movement. There are hereditary generalized dystonia that begin in childhood in the great majority of the cases.
The most common type of dystonia are focal dystonia involving just a small portion of muscles in one region of the body. The types of focal dystonia include abnormal contraction of muscles in the neck (cervical dystonia), eyelids (blepharospasm), jaw or mouth (oral-mandibular), voice (laryngeal) or hand (such as writer’s cramp). Therapy for dystonia typically involves injections in carefully selected muscles with one of the botulinum toxins (Botox, Myobloc, Dysport or Xeomin) . Dr. Vehra and Dr. Liu are both trained to utilize all four of these botulinum toxin therapies and collectively have over 15 years of experience working with these treatments. Which one is chosen for each person depends on individual circumstances. Additionally, some patients may respond favorably to oral pharmacologic therapy or surgical therapy to treat their dystonia.
The most common type of tremor is Essential Tremor. It is a progressive tremor that often involves the upper extremities, but can also involve the head, voice, tongue and legs. One of the most common misdiagnoses is labeling the head tremor very commonly associated with cervical dystonia or limb dystonia as essential tremor for which the treatment is very different. The tremor of Essential tremor in the upper extremities is often present with activity (action, like drinking a cup of coffee or writing) or while extending the arms out (postural). Some patients choose not to treat their tremors with medicines, and prefer using hand weights, stress/relaxation techniques or biofeedback as therapy. For others, treatment for Essential Tremor can involve medical management, surgical therapy and sometimes Botulinum toxin administration.
The Memory Disorders Team here at Premier Neurology Institute is dedicated to assist and provide treatments that improve the quality of life for patients dealing with memory loss and related cognitive changes, as well as for their families. Memory disorders are diagnosed by an evaluation that includes a neurology, physical, and neuropsychological evaluations including laboratory tests, review of the patient’s past medical and family history and medications that the patient is current taking. A CT or MRI scan may also be ordered to help rule out other causes.
The clinic provides a comprehensive program for evaluating memory disorders.
MEMORY SERVICES AT PREMIRE NEUROLOGY INSTITUTE INCLUDE:
Initial medical, neurological, and neuropsychological assessments
Screening labs, imaging, EEG, and other diagnostics
Assessment of mood and memory
Education and resource referral for patient and family
Neuropsychological and psychosocial evaluations
Referral to other specialist consultations as necessary
Community resources and support groups
Here at Premier Neurology Institute we offer diagnostic tests and treatment modalities accessible to patients with epilepsy. We provide a thorough diagnostic evaluation including different electroencephalogram options. Our routine in office EEG or in home set up and removal of ambulatory EEG. Both are gold standards in diagnosing epilepsy. If indicated, in addition to anti-epileptic drugs, epilepsy surgery evaluation may be discussed to know if this may be an option for improved patient outcomes.
Our goals are to help patients understand epilepsy, learn about the latest therapy options, and make informed decisions about their treatment.