On March 23rd 2010 Allergan announced that the Food and Drug Administration (FDA) has approved BOTOX Therapy for the treatment of upper limb spasticity. This treatment will decrease the severity of increased muscles tone in multiple areas of the body. While this treatment is not meant to replace the usual standard care of rehabilitation regimens, it is an important discovery that will inevitably affect the treatment options for many patients.
Diffusion Tensor imaging (DTI) is an emerging tool for detecting Mild traumatic brain injury. A new study published Feb 10, 2010 in Neurology, shows that patients with minimal impairments on standard neuropsychological tests, damage is detectable by this technique. The results confirm that signs of injury may persist months after clinical recovery, suggesting DTI may have a place in longitudinal assessment of mTBI patients wider than currently practiced.
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Comments Off Transcutaneous electrical nerve stimulation has been used for over 40 years to treat a variety of conditions including low back pain. A recent meta-analysis of evidence based studies in painful neurologic disorders published in Neurology on Jan 12, 2010 (pages 173-176) shows that TENS is ineffective for low back pain (level A evidence). Probable efficacy was substantiated for painful diabetic peripheral neuropathy.
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Comments Off Multiple studies have shown that cervical dystonia can produce recurrent headaches that seem to get better when the patient is treated with Botulinum toxin. In a study published in Headache on Aug 16, 2005, A pilot study of Botulinum toxin A for headache in Cervical Dystonia, the author came to the conclusion in 44 patients that headaches improved in addition to cervical dystonia. for further information regarding this study and treatment of many other types of headaches with Botulinum toxin, also called Botox, please feel free to contact this office, at 561-638-8872.
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Comments Off This packet contains all the forms necessary for admission as a patient at the Center for Neuroscience if you were in an auto accident. Please print, complete all fields, and bring with you to your appointment.
The documents are bundled ino one Adobe PDF document. You will need the free Adobe PDF reader to open this file. The reader can be downloaded form Adobe here.
Click here to download the Auto Accident Patient Packet
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Comments Off This packet contains all the forms necessary for admission as a patient at the Center for Neuroscience. Please print, complete all fields, and bring with you to your appointment.
The documents are bundled ino one Adobe PDF document. You will need the free Adobe PDF reader to open this file. The reader can be downloaded form Adobe here.
Click here to download the New Patient Packet
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Comments Off The extensive set of tests that assess many factors affecting a patient’s ability to perform activities of daily living and work are Functional Capacity Evaluations. These tests include assessment of strength, flexibility, endurance, and body mechanics. Functional activities such as pushing, pulling, lifting, carrying, reaching and gripping are included in testing. The evaluation is broken down into three basic parts: intake interview, physical assessment, and functional assessment. Functional Capacity Evaluations are performed by licensed physical therapists. The testing usually takes 3-4 hours.
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Comments Off X-rays provide detail of the bone structures in the spine, and are used to rule out instability (such as spondylolisthesis), tumors, and fractures. Images of bones are made by directing an x-ray beam through the body. The calcium in bone blocks penetration of the x-ray beam and the image of the bones is picked up as a shadow on a film positioned on the other side of the patient. X-rays do not capture the images of discs and nerve roots, since they don’t contain any calcium. X-rays should not be performed in women who may be pregnant.
CT scans (computerized tomography). This specialized x-ray shows the bony vertebrae in detail. Like an x-ray, a CT scan works by directing an x-ray beam through the body. Then a computer is used to reformat the image into cross sections of the spine. This process is repeated at different intervals. As a result, the spinal canal can be imaged and assessed for specific conditions. With its excellent bony detail, CT scans are very useful for assessing fractures. Through multiple views, CT scans will image specific conditions such as lumbar disc herniation and lumbar spinal stenosis. CT scans should not be performed on pregnant women.
MRI (magnetic resonance imaging). This non x-ray study allows an evaluation of the spinal cord and nerve roots. It produces detailed images of discs and the spinal cord. An MRI images the spine by using a magnet that goes around the body to excite hydrogen atoms. After the atoms return to their normal level of excitation, they emit energy that is picked up on a scanner. There is no radiation with the magnet, so the scans may be performed on pregnant women. However, patients with a pacemaker implanted in their heart should not have a scan because the magnetic field will cause the pacemaker to malfunction. Also, anyone who works around metal should first have an x-ray of their eye sockets to ensure there are no metal filings in their eyes, which the magnetic field may cause to migrate and damage the eye. The scan is performed while the patient is lying in a fairly tight tunnel for 45-60 minutes. Some patients may not be able to tolerate this confined space, however newer generation scanners are designed with more open space.
Myelogram (injection of a dye or contrast material into the spinal canal) is utilized to diagnose disorders of the spinal canal and cord, such as nerve compression causing pain and weakness. The test is usually performed on an outpatient basis at a hospital or other medical facility by a neuroradiologist. Neuroradiology is a sub-specialty of radiology that conducts studies of the central nervous system. A myelogram requires introduction of radiographic contrast media (dye) into the sac (dura) surrounding the spinal cord and nerves. The patient lies on his/her stomach during the test. After the skin area has been numbed, the dye is injected into the spinal sac followed by x-rays, CT, or MRI scans. After the images are processed, a neuroradiologist interprets the results and sends a report to the referring physician. Following the myelogram, the patient is taken to a recovery area where he/she rests lying down with the head elevated for several hours. Once at home, quiet non-strenuous activities are recommended for 24 hours to allow the puncture site to heal. Plenty of fluids (e.g. water, juice) should be consumed to clear the dye from the body.
CT scans (computerized tomography) with Myelogram. When combined with a myelogram, a CT scan provides for excellent nerve detail. The myelogram adds some additional risk and expense to the CT scan, but provides substantial information about the nerve roots. A myelogram consists of injecting a radiographically opaque dye (dye that is picked up by x-ray) into the sac around the nerve roots, which in turn lights up the nerve roots. The CT scan follows and shows how the bone is affecting the nerve roots. This is a very sensitive test for nerve impingement and can pick up even very subtle lesions (injuries). The main risk with CT scans is that they use x-ray beams and should not be performed on pregnant women. The main risk with a myelogram is the potential for a spinal headache. The spinal headache usually resolves in one to two days with rest and fluids, and seems to be more common for patients with a history of migraine headaches.
Discography, or discogram, is a diagnostic tool used to determine the structural integrity of an intervertebral disc (or discs) and to find out if a particular disc is responsible for the patient’s back pain. Provocative Discography is a form of discography that replicates the patient’s ‘discogenic’ pain. The term discogenic is defined as a pain syndrome characterized by local or radicular pain cause by nerve root compression. The test is performed on an outpatient basis in a hospital or medical facility, by either a radiologist or surgeon.
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Comments Off EMG (electromyography) and Nerve Conduction Tests evaluate nerve and muscle functions. These tests can establish if a nerve is pinched, give a numeric value to how severely it is pinched, and often where it is pinched. The test can last anywhere from half an hour to an hour. The quality of the results is particularly dependent on the skill of the person administering the test. During the Nerve Conduction portion of the test, electrodes, much like EKG patches, are placed along the known course of the nerve. The nerve is stimulated with a tiny electrical current at one point. The nerve must then transmit the signal along its course, and an electrode placed further down the arm or leg captures the signal as it passes it. A healthy nerve will transmit the signal faster and stronger than a sick nerve. The EMG portion of the test measures the electrical activity in muscles. Muscles normally receive constant electrical signals from healthy nerves, and in return “broadcast” their own healthy electrical signals. During the EMG portion of the test, the doctor places acupuncture-like needles into the muscles to record the electrical signal from the various muscles in the arm or leg. If a muscle doesn’t receive adequate signals from a sick nerve, it broadcasts signals, which show the muscle is confused. From the Nerve Conduction Test and the EMG’s, the doctor can correlate which nerves are pinched and the seriousness of the condition. This information can then be used to help formulate further treatment plans.
ELECTROENCEPHALOGRAMS (EEG) are often necessary to rule out seizure activity and to look for focal slowing of the brain that would indicate injury of the brain.
Evoked Potentials (EP) are sometimes ordered to assess the speed of electrical conduction across the spinal cord. If the spinal cord is significantly pinched, the electrical signals will travel slower than usual. SSEP’s may also be used to monitor spinal cord function during surgical procedures, although since the spinal cord ends before the lumbar spine, this is usually of limited value during lumbar spinal surgery and it is used more often in cervical (neck) or thoracic (chest) spine surgery.
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Comments Off Whenever necessary we provide referral to other qualified board certified Specialists throughout South Florida. Referrals to the following disciplines are available:
- Orthopedic surgeons
- Neurosurgeons
- Urologists
- Psychiatrists
- Internists & General Practitioner
- Physiatrists
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Comments Off If you choose to have surgery, your physical condition and your mental attitude will determine your body’s ability to heal. It is important to approach your surgery with confidence, a positive attitude, and a thorough understanding of the anticipated outcome.
The decision to have surgery includes weighing the risks and benefits involved. You will make the final decision, so please ask questions about anything you do not understand.
If you are trying to determine the treatment you may want to look into conservative treatments.
If your chronic pain has not responded to conservative treatment and prevents normal lifestyle activities, your doctor may recommend surgery. The goal of surgery is to correct the problem creating the pressure on, or irritation of nerves, causing symptoms of pain and weakness.
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Comments Off Many patients improve without surgery. We usually try non-surgical treatments for the first few weeks. These treatments may include a short period of rest, oral medications, physical therapy, exercise, or epidural steroid injection therapy. Additional therapies such as ultrasound, electric stimulation, hot packs, cold packs, and manual (“hands on”) therapy may be prescribed to reduce your pain and muscle spasm, which will make it easier to start an exercise program. Traction may also provide pain relief for some patients. Bracing, such as a lumbar corset, may help relieve your back pain. The goals of non-surgical treatment are to reduce the irritation of the nerves and disks and to improve the physical condition of the patient to protect the spine and increase overall function. If your chronic pain prevents normal lifestyle activities, your doctor may recommend surgery.
Physical Therapy is an exercise program used to treat common back problems with conditioning before and/or after surgery. A range of modalities may be used to help alleviate, correct or prevent your pain from reoccurring, including massage, aquatic therapy, electrical stimulation, ultrasound, stretches and strengthening, traction, heat and cold therapy. Rehabilitation programs are customized to the patients’ specific needs. The therapist, whose training and experience provides expert guidance in recuperation, teaches the patient how to utilize therapy at home. Honest patient feedback and a good working relationship between therapist and patient are crucial to recovery.
Acupuncture is a 5000-year-old Chinese art of healing that involves the insertion of very fine, sterile, disposable needles into specific parts of the body. This technique stimulates and activates the body’s immune and healing systems. By incorporating Western knowledge and techniques, acupuncture has evolved into an acceptable and sought after scientific method of treatment for many common physical and psychological disorders.
Chiropractic comes from the Greek word Chiropraktikos, meaning “effective treatment by hand.” All chiropractors use a standard procedure of examination to diagnose a patient’s condition and arrive at a course of treatment. Chiropractors use the same time-honored methods of consultation, case history, physical examination, laboratory analysis, and x-ray examination as any other doctor. In addition, they provide a careful chiropractic structural examination, paying particular attention to the spine.
It is important to understand that “chiropractic” like physical therapy is a form of therapy and should be delivered under the guidance of OUR MEDICAL NEUROLOGIST.
Massage Therapy affects the body as a whole. Massage is known to increase the circulation of blood. The direct mechanical effect of rhythmically applied manual pressure and movement used in massage can dramatically increase the rate of blood flow. Also, the stimulation of nerve receptors causes the blood vessels (by reflex action) to dilate, which also facilitates blood flow. For the whole body to be healthy, the sum of its parts — the cells — must be healthy. The individual cells of the body are dependent on an abundant supply of blood that supplies nutrients and oxygen and carries away wastes and toxins. So, it is easy to understand why good circulation is so important to our health and why massage can be beneficial for the entire body due to its effect on circulation alone.
Medical Pain Management and Injection Therapy On occasion we may recommend that you get injections or management of your medications. Any of the medications/injections listed below may be recommended/administered. All medications should be taken as directed.
Trigger Point Injections are injections of local anesthetics (sometimes combined with corticosteroids) directly into painful soft tissue or muscles along the spine or over the back of the pelvis. While generally useful for localized pain, trigger point injections do not help heal a herniated lumbar disc.
Epidural Injections or “blocks” may be recommended if you have severe leg pain. These are injections of corticosteriod into the epidural space (the area around the spinal nerves), performed by a doctor with special training in this technique. The initial injection may be followed by one or two more injections at a later date, and should be done as part of a comprehensive rehabilitation and treatment program.
Selective Nerve Root Sleeve Block is an injection like an epidural, but it is injected around the nerve root sheath. This is used for leg and arm pain and for determining which nerve root is responsible for your pain. It can be therapeutic and diagnostic. You will need a driver to take you home and no pain medications should be taken after midnight the night before your injection.
Facet Injections are injections of corticosteroids and local anesthetics directly into the painful facet joints of your low back. This helps reduce pain and inflammation. If helpful, they can be followed by a Facet Rhizotomy, in which the sensory nerve in this joint is disabled giving long-term relief.
Sacroiliac Joint Blocks are injections that are primarily used for diagnosing and treating the low back pain associated with sacroiliac (SI) joint dysfunction. The SI joint lies next to the spine and connects the sacrum (bottom of the spine) with the pelvis (hip). In an SI joint block approach, a physician uses fluoroscopic guidance (live x-ray) and inserts a needle into the sacroiliac joint to inject lidocaine (a numbing agent) and a steroid (an anti-inflammatory medication). It takes a highly skilled and experienced physician to be able to insert a needle into the sacroiliac joint. An SI joint block may be repeated up to three times per year. For the treatment to be successful, the injection should be followed by physical therapy and/or chiropractic manipulations to provide mobilization and range of motion exercises.
If you continue to have back pain despite surgical intervention, your doctor may recommend you for consideration of a Dorsal Column Stimulator (DCS). This stimulates the cord for symptomatic pain. Performed by a surgeon in conjunction with a pain management specialist.
Oral Medications used to control pain are called analgesics. Most pain can be treated with non-prescription medications such as aspirin, ibuprofen, naproxen, or acetaminophen. If you have severe persistent pain, your doctor might prescribe narcotics for a short time. Sometimes, but not often, a doctor will prescribe muscle relaxants. All medication should be taken only as directed.
Nonsteroidal anti-inflammatory medications (NSAIDS) are analgesics and are used to reduce swelling and inflammation. These include aspirin, ibuprofen, naproxen, and a variety of prescription drugs. If your doctor gives you anti-inflammatory medications, you should watch for side effects such as stomach upset or bleeding. Chronic use of prescription or over-the-counter NSAIDS should be monitored by your physician for the development of any potential problems.
Corticosteroid medications – taken orally or by injection – are sometimes prescribed for more severe back and leg pain because of their very powerful anti-inflammatory effect. Corticosteroids, like NSAIDS, can have side effects. Risks and benefits of this medication should be discussed with your physician.
Antidepressants – These drugs may be effective treatments for specific types of pain, or pain with specific causes. For example, antidepressants will be prescribed to help relieve certain types of neuropathic pain — it doesn’t necessarily mean your doctor thinks you are depressed. There are risks, side effects and drug interactions with any medication, so a medical professional should always be consulted prior to taking medications.
If you are trying to determine the treatment you may want to look into surgical treatments.
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Comments Off Our physician will take your medical history and perform a physical examination. After diagnostic testing to confirm your diagnosis and locate the source of your pain, our physician will determine which treatment is most beneficial to you. A course of action will be designed and decided upon by you and your physician.
The best treatment for each patient must be based on an accurate diagnosis. Although it is appealing to have the latest procedure, the newest medication, the smallest micro-surgery or arthroscopic surgery, best treatment must be appropriate for each individual patient’s condition. Treatment must also be based on scientific evidence, not marketing on television or in news magazines. At the Center for Neurology and Pain Management, we pride ourselves on making correct and complete diagnoses, and then offering our patients the most effective treatment for their unique problems.
Brain or Spine surgery is rarely necessary and must be taken seriously. It is imperative to select the right procedure for the right patient at the right time.
You may want to look into conservative treatments or surgical treatments.
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Comments Off Automobile fires are very common. They can be caused by gas explosions that shoot debris with great force. Car parts can become shrapnel in the explosion.
The depth of the wound has three classifications: first degree, second degree, and third degree. First degree, or superficial, burns involve only the epidermis. A second degree and third degree, or partial or full thickness burn, involve both the epidermis and dermis, and the hair, nerves and sweat glands (and sometimes muscle and bone).
Burn Treatment
1. Skin Grafts
2. Exercise
3. Pressure Garments
4. Cosmetic Surgery
Cosmetic Surgery
Skin smoothing surgery is used to clear irregularities caused by skin scarring during the healing process. The severity of the burn depends on several factors: your age, previous health, where the burn is, how big the burn is, and how deep the burn is.
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Comments Off Serious injuries often involve fractures. A careful survey of the whole body is required soon after the injury to make sure that no bones are broken. X-rays, CT scans, bone scans or MRI scans are needed to rule out fractures.
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Comments Off Routinely ignored by most doctors are the symptoms of memory loss and attention difficulty which often translates in slowed speed of mental processing and reduced ability to solve problems. These symptoms require further assessment by our Neurologist and Neuropsychologist.
Treatment
Medicines are available. Cognitive rehabilitation (CR) can also help when performed under the guidance of a Neuropsychologist.
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Comments Off Infrequently seen but these symptoms have disastrous and embarrassing consequences for the people who suffer from them. Most other doctors never ask questions about these conditions and hence the injuries causing them are not discovered in a timely fashion. Delay in treatment can result in permanency of the condition.
Even if no neurological cause for impotence is discovered treatment is available for this serious condition.
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Comments Off These are symptoms or nervous system injury and need prompt neurological evaluation to prevent permanent nervous system injury.
Nerve studies, MRI or other scans may be utilized by our Neurologist to study these conditions and to treat the root cause of the symptoms. It is noteworthy blind chiropractic and physical therapy treatments without determining the cause of patient’s numbness and tingling can lead to serious consequences.
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Comments Off Direct injury to the eye ball, nerves behind the eye or the nerve pathways in the brain may get injured in automobile accidents and require prompt attention and treatment by a neurologist and ophthalmologist. Blurring of vision is also extremely common and requires a careful neurological assessment and testing.
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Comments Off Central Nervous System (Brain and Spinal Cord) injury and Peripheral nervous system injury (Nerves, roots and muscles) can lead to paralysis. If not treated quickly it can become permanent.
Treatment
Medicines or surgery depending upon the level and type of injury. Chiropractic and physical therapy can only be used under the direction of a Neurologist.
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Comments Off Car accidents are a leading cause of head and brain injuries. Brain injury can occur when the head has been struck usually by striking an object such as a windshield or the brain undergoes a sudden acceleration/deceleration movement (as in a whiplash injury) without direct external trauma to the head. Many brain injuries are the result of bruising, bleeding, twisting or tearing of brain tissue. Damage to the brain may occur at the time of the accident, or develop over time as tissues swell and bleed within the head.
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Comments Off Shoulder joint pain is seen either with direct injury to this joint or as referred pain/ radicular pain from the neck. An MRI of the shoulder is often needed when range of motion of the shoulder produces pain or there is suspicion of a dislocation.
Treatment
Our medical doctor will do the initial evaluation and may order further tests such as X-Rays and MRI scan. Medicines and physical therapy usually helps.
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Comments Off Knee pain is quite common and is usually related to jamming the knee against the interior of the car. This may occur because of torn cartilage, ligaments or bony contusions. The nerves around the knee may also be damaged. Hip pain is often referred to the knee.
Treatment
Most minor injures to the knee respond to physical therapy and medicines prescribed by our medical doctor. Some patients will need X-ray and MRI scans and nerve tests to look for deeper injuries.
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Comments Off Uncommonly seen after the accidents and positively indicates an injury to the head. This can be an indicator of serious bleeding in or around the brain but may also occur with injury to the inner ear where our balance control system resides.
Treatment
Medicines and maneuvers are available to fix this problem quickly. The doctor may also do necessary tests to look for serious injuries.
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Comments Off A very common injury type commonly ignored by most physicians because of their own lack of knowledge and due to the common belief of society to underestimate the importance of psychological injury and its affects on the general health of the person. This may take the form of anxiety about driving, looking back frequently in the mirror when in a car, or avoidance of the highways. Some people may avoid the site of the accident. They may have trouble sleeping and may get flashbacks of the injury. A post-traumatic stress disorder may develop.
Treatment
Fortunately all of the above symptoms and diagnosis are treatable and respond to medications and/ or psychotherapy at our center. We have skilled doctors and psychologist who can evaluate and treat these diagnoses promptly.
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Comments Off Car accidents place enormous strains on the body. The sudden force and deceleration from a car accident may compress or damage the back. The complicated bones and discs that form the spine can be seriously damaged. Car accidents may cause herniated (slipped) discs, ruptured discs or spinal (vertebrae) fractures.
An added problem is that the spinal cord travels through the back. The spinal cord transmits signals for movement and pain through the body, so spinal cord injuries can cause severe pain and may require therapy to treat.
More severe injuries of the spinal cord can lead to paralysis.
Recovering from Pain and Suffering
These injuries may have severe consequence for work and everyday life. If you have suffered from a severe back injury, you may require years of therapy and treatment. You may not be able to do certain everyday activities.
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Comments Off Whiplash hurls your head violently backward (hyperextension) and forward (hyperflexion) injuring your neck. The injury is worse if the neck was turned to the side at the time of the accident. Whiplash is the most common injury resulting from car accidents. Whiplash can cause injury to inter-vertebral joints, discs, and ligaments, cervical muscles, and nerves. Whiplash is often encountered along with concussions and more serious injury. The effects of whiplash can be short term or life long, and can leave the neck forever vulnerable to injury. The injury can also extend to shoulders and arms. Whiplash leads to long-term disability in 10% of people injured in car accidents. Approximately 1,000,000 people are exposed to whiplash injury in the U.S. every year. Nearly 25% of these cases result in chronic pain and disability. 1 in 7 whiplash victims will still have significant pain more than 3 years after the accident.
Whiplash can be diagnosed with a simple physical examination or using x-rays. X-rays will also be used to see if there are any fractures of the vertebrae and the extent to which the alignment of the neck has been altered. After a whiplash injury your neck’s natural curve may be reversed, which unevenly distributes the weight of your head and may further misalign the vertebrae. This condition can lead to arthritic degeneration and recurring pain.
If you are taken from the accident in an ambulance to a hospital you’ll probably be put in a hard neck brace on a back board- as a preventive measure to avoid more serious injury to your neck.
Diagnosis
Whiplash can be diagnosed with a simple physical examination or using x-rays. X-rays will also be used to see if there are any fractures of the vertebrae and the extent to which the alignment of the neck has been altered. After a whiplash injury your neck’s natural curve may be reversed, which unevenly distributes the weight of your head and may further misalign the vertebrae.
Treatment
If you are taken from the accident in an ambulance to a hospital you’ll probably be put in a hard neck brace on a back board- as a preventive measure to avoid more serious injury to your neck. The courses of treatment will vary depending on the extent of your injury and if you have injury to inter-vertebral joints, discs, and ligaments, cervical muscles, or nerve roots: Physical therapy consisting of heat, cold, traction, cervical collar, trigger point therapy, ultrasound, massage, and neck exercises. Urgent Neurological evaluation and treatment can help with a quick recovery. Physical and Chiropractic therapy of whiplash helps with realigning of the neck and helps regain muscle flexibility.
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Comments Off These are extremely common after car injury or other injuries to head and neck. Although more serious conditions like blood clots have to be considered but usually these headaches have their origin in the nerves around the head and upper neck. These headaches respond quite well to proper medical treatment including medicines, physical and chiropractic therapy when administered under the care of a neurologist.
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Comments Off - Center for Neuroscience
and Pain Management
3 Office Locations:
Main Office: 561-638-8872
Main Fax: 561-638-8874
Business Hours: 9-5pm
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