Negroski Neurology


OUR SERVICES

     Epilepsy     Parkinson Disease      Muscular Dystrophy   Multiple Sclerosis            

Symptoms we evaluate
  
Weakness, Tremors, Numbness, Pain, Dizziness, Confusion, Memory Loss, Falls, Tingling, Loss of Balance, Seizures, Depression, Fainting, Hallucinations

Conditions we treat
Multiple Sclerosis, Parkinson Disease, Muscular Dystrophy, Dystonia, Epilepsy, Headache, Essential Tremor, Stroke, ALS, Alzheimer Disease, Peripheral Disease, Normal Pressure, Hydrocephalus, Dementia


Diagnostic Services and Procedures
EMG (Electromogram), NCS (Nerve Conduction), AEP (Auditory Evoked Potentials), VEP (Visual Evoked Potentials), EEG (Electroencephalogram), MRI (Magnetic Resonance Image),  CT (Computed Tomography) Deep Brain Stimulation, Botox Injections, LP (Lumbar Puncture)

Click here for more information on our Testing and Procedures

 


We understand that being diagnosed with a Neurological disorder can be confusing and scary for some patients but we are here to offer you the most up to date information  and treatment for these conditions.  Remember, being informed is the best way to deal with your diagnosis and will help you lead a healthier life. 
 

Here we have some information to help you understand the most common Neurological problems and the treatments we offer our patients.  Just click on the disorder below and you will see the complete description

Alzheimer Disease    
ALS   
Epilepsy
Multiple Sclerosis 
Muscular Dystrophy 
Parkinson Disease  
Peripheral Neuropathy



Alzheimer Disease  

Alzheimer's disease is the most common cause of dementia, the loss of intellectual and social abilities severe enough to interfere with daily functioning. In Alzheimer's disease, healthy brain tissue degenerates, causing a steady decline in memory and mental abilities.  Alzheimer's disease is not a part of normal aging, but the risk of the disorder increases with age. About 5 percent of people between the ages of 65 and 74 have Alzheimer's disease, while nearly half the people over the age of 85 have Alzheimer's.
 
Alzheimer's disease may start with slight memory loss and confusion, but it eventually leads to irreversible mental impairment that destroys a person's ability to remember, reason, learn and imagine. Everyone has occasional lapses in memory. It's normal to forget where you put your car keys, or to blank on the names of people whom you rarely see but the memory problems associated with Alzheimer's disease persist and worsen. People with Alzheimer's may:  

 -Repeat things
 -Often forget conversation or appointments 
  
 
 
-Routinely misplaces things, often putting them in illogical locations
 -
Eventually forget the names of family members and everyday objects 
 -Mood swings 
 -Distrust in others 
 -Increased stubbornness 
 -Social withdrawal
 -Depression

 -Anxiety


People with Alzheimer's may initially have trouble balancing their checkbook, a problem that progresses to trouble recognizing and dealing with numbers. It may be a challenge for those with Alzheimer's to find the right words to express thoughts or even follow conversations. Eventually, reading and writing also are affected. People with Alzheimer's disease often lose their sense of time and dates, and may find themselves lost in familiar surroundings. Solving everyday problems, such as knowing what to do if food on the stove is burning, becomes increasingly difficult, eventually impossible. Alzheimer's is characterized by greater difficulty in doing things that require planning, decision making and judgment. Once-routine tasks that require sequential steps, such as cooking, become a struggle as the disease progresses. Eventually, people with advanced Alzheimer's may forget how to do even the most basic things. 

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ALS  
Amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig's Disease, is a disorder that involves motor neurons in the brain and spinal cord that causes generalized weakness.  ALS is classified is a neurodegenerative disorder.  In degenerative illnesses (like Alzheimer's and Parkinson Disease) certain nerve cells die faster and in greater numbers than they are supposed to.  In ALS, the nerve cells that control motor movement - called motor neurons - are the cells that are dying.

Motor neurons extend from the brain to the spinal cord and from the spinal cord to every muscle in the body under voluntary control.  Certain muscle groups are most affected, including the muscles of the face and throat (bulbar muscles), the arms, the legs, and the muscles involved in breathing.  Weakness is the principal symptom. 


However, weakness is often preceded by cramps and muscle twitching, non-specific symptoms that can occur in a variety of benign disorders.  (Accordingly, many patients who are aware of this fact worry unnecessarily that their cramps at night might represent the first signs of ALS).  Other ALS symptoms include stiffness (spasticity), muscle wasting (atrophy), swallowing difficulty, slurred speech, walking difficulty, weight loss, pain, and even respiratory difficulty/failure.  Diagnosis is made by an experienced neurologist.  The history provided by the patient and the clinical examination are the two most important elements in diagnosis, as no definitive test exists.  EMG, MRI, and laboratory testing must be done in all patients to identify possible mimics of ALS, including some treatable disorders.

There is no known cure for ALS, but there IS treatment.  Treatment includes medicine, nutritional supplements, respiratory support (CPAP), and therapy.  Most ALS patients eventually make their way to a Muscular Dystrophy Association (MDA)/ALS Clinic.  Locally, this clinic is directed by Dr. Hanes.  The clinic itself is run through an association between the MDA and Sarasota Memorial Hospital and is located at the Institute for Advanced Medicine on Rand Boulevard.  Each clinic visit includes a supportive multidisciplinary team approach consisting of providers the neurologist, a pulmonologist (lung doctor), a psychologist, physical therapists, occupational therapists, speech therapists, the MDA facilitator, and a support group. The prognosis in ALS is variable.  The weakness in some patients progresses rapidly; in others, progression occurs very slowly - over many years or even a decade.  If ALS is suspected it is important to make a swift and accurate diagnosis, establish with a multidisciplinary ALS clinic, and to get
the care you need and deserve

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Epilepsy 
Epilepsy is a disorder that disrupts the transmission of electrical signals inside the brain. Although you may assume that epilepsy always causes episodes of uncontrolled movements and loss of consciousness, the condition is actually quite variable. Symptom episodes — known as seizures — are often subtle, causing strange sensations, emotions and behavior. Some people with epilepsy simply stare blankly span.
 
About one in 100 people in the United States has experienced an unprovoked seizure at some point in life. However, a solitary seizure doesn't mean you have epilepsy. Many people — for example, children with high fevers — experience one seizure and then never have another one but after you've had two seizures, the chance that you'll have additional seizures increases dramatically. At least two unprovoked seizures are required for a diagnosis of epilepsy. The onset of epilepsy is most common during childhood and after age 65, but the condition can occur at any age. Treatments may leave you free of seizures, or at least reduce their frequency and intensity. Many children with epilepsy even outgrow the condition with age.   

Epilepsy is caused by abnormal activity in brain cells, seizures can affect any process your brain coordinates. A seizure can produce temporary confusion, complete loss of consciousness, a staring spell, or uncontrollable jerking movements of the arms and legs.  Symptoms vary depending on the type of seizure. In most cases, a person with epilepsy will tend to have the same type of seizure each time, so the symptoms will be very similar from episode to episode. But some people have many different types of seizures, with different symptoms each time.

Doctors classify seizures as either partial or generalized, based on how the abnormal brain activity begins. When seizures appear to result from abnormal activity in just one part of the brain, they're called partial or focal seizures. Seizures that seem to involve all of the brain are called generalized seizures. In some cases, seizures can begin in one part of the brain and then spread throughout the rest of the brain. 

Simple partial seizures- These seizures don't result in loss of consciousness. They may alter emotions or change the way things look, smell, feel, taste or sound. 

Complex partial seizures- These seizures alter consciousness, causing you to lose awareness for a period of time. Complex partial seizures often result in staring and nonpurposeful movements — such as hand rubbing, lip smacking, arm positioning, vocalization or swallowing.

Absence seizures (petit mal)- These seizures are characterized by staring, subtle body movement and brief lapses of awareness. 

Myoclonic seizure- These seizures usually appear as sudden jerks of your arms and legs.

Atonic seizures- Also known as drop attacks, these seizures cause you to suddenly collapse or fall down.

Tomic- clonic seizures (grand mal)- The most intense of all types of seizures,these are these are characterized by a loss of consciousness,body stiffening and shaking, and sometimes tongue biting or loss of bladder control.  

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Multiple Sclerosis
 
  
The unpredictable history and uncertain response to various therapies are just some of the many problems faced by people with MS.  Often times because of these fears, patients have an uncertain outlook on life that increases fear of striving for new opportunities, activities, or relationships.  Over the past decade, there has been a tremendous increase in the knowledge regarding the reason people develop MS.  MS attacks the central nervous system, namely the brain and spinal cord.  MS does not effect the muscles themselves, but does effect the brain or spinal cord control of the muscles, and is one of the most common disabling, chronic disorders that effect young adults.  The first symptoms usually appear during early adulthood, with the peak age of 20 to 40 years.  

The diagnosis MS rests in the history of neurological problems in the patient, physical and neurological examinations, and the use of additional test such as MRIs of the brain and spinal cord, electrical studies of the eyes and ears, blood tests, and spinal fluid analysis which requires spinal tap. In the last decade the MRI had been the most effective way of diagnosing MS which often times alleviates the need for other tests.  Our group is actively involved in research using some of the newer drugs for MS including oral medications instead of injectable drugs.  

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Muscular Dystrophy
  
Muscular Dystrophy (MD) is a group of inherited muscle diseases in which muscle fibers are unusually susceptible to damage. Muscles, primarily voluntary muscles, become progressively weaker. In the late stages of muscular dystrophy, fat and connective tissue often replace muscle fibers. Some types of muscular dystrophy affect heart muscles, other involuntary muscles and other organs.  

The most common types of muscular dystrophy appear to be due to a genetic deficiency of the muscle protein dystrophin. There's no cure for muscular dystrophy, but medications and therapy can slow the course of the disease.  Signs and symptoms vary according to the type of muscular dystrophy. In general, muscular dystrophy symptoms may include: 
 

Progressive crippling, resulting in fixations (contractures) of the muscles around joints and loss of mobility.  Many specific signs and symptoms vary from among the different forms of MD. Each type is different in the age of onset, which parts of the body the symptoms primarily affect and how rapidly the disease progress 


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Parkinson Disease
 

Parkinson Disease is a progressive, degenerative brain disorder that affects millions of people around the world. The main abnormality that causes PD seems to be related to loss of certain nerve cells (neurons) in a part of the brain called the substantia nigra. However, we know that in fact it is a whole-brain disease, involving just about every area studied so far. To date, it is unclear exactly why these cells die or deteriorate, although there are clues from genetic and environmental studies suggesting a multi-factorial origin. Normally, the substantia nigra cells produce a neurotransmitter known as dopamine, which is used to communicate with other parts of the brain. Dopamine allows smooth, coordinated function of the body's muscles and movement.  When approximately 80% of the dopamine-producing cells are damaged, the symptoms of Parkinson Disease appear.

The key signs of Parkinson Disease are

-  Bradykinesia (slowness of movement) 
-  Postural Instability (difficulty with balance)
-  Tremors 

For more information and treatment options, click the links below
     

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Peripheral Neuropathy
 

Nerves are like electrical wires:  there is a cable in the center, surrounded by a layer of insulation.  Both are needed for successful routing of messages between different parts of the body and nervous system.  Some neuropathies affect the insulation (demyelinating) while others cut the cable (axonal).  In general, axonal neuropathies are more common and are, unfortunately, more difficult to treat than demyelinating neuropathies.


Diagnosis and Management:  Diagnosis is typically suggested by the patient's primary care physician and confirmed by an experienced neurologist.  The patient's story and exam are crucial.  EMG is indispensable in the diagnosis as this test helps to characterize the location, pathology, severity, and time course of the neuropathy.  Laboratory testing is employed in an attempt to identify a specific cause.  Treatment is individualized to each patient based on cause, type, severity, and rapidity of progression.  Treatment may include oral medication, infusions, therapy, pain medication, or supplements. 

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