Headaches and Migraine
What causes migraine headaches?
Migraine headaches are very severe headaches that tend to occur on one side of the head and are often accompanied by symptoms like nausea, extreme sensitivity to light or sound, or visual issues like tunnel vision or blurry “spots.” Although the precise cause of migraines is not known, studies have found people with a family history of migraines are more likely to have the headaches themselves, and they can also be triggered by factors like alcohol, stress or hormonal fluctuations.
Migraine Mimics & Other Cephalgias
How is it diagnosed?
Having an accurate diagnosis for headaches is essential for ensuring the most appropriate care is provided in order to achieve relief of pain and related symptoms. Diagnosis begins with a detailed patient medical history and a review of the symptoms to help differentiate among different types of headaches, including migraine headaches, cluster headaches, tension headaches and other types of headaches. A physical exam will also be performed, and some patients may be asked to keep a diary or log of their symptoms. Additional testing including blood tests, CT scans, x-rays and MRIs may be ordered to rule out other conditions that can cause head pain and to aid in diagnosis and treatment.
What treatments are available for chronic headaches?
Treatment for chronic headaches depends on the type of headache and its underlying cause. Some headaches can be treated or even prevented with medication or with some simple procedures known as NERVE BLOCKS or with BOTOX injections to interrupt nerve signaling that may be cause or contributing to symptoms. Lifestyle changes may also be helpful.
Neuro-ophthalmology are vision problems that relate to the nervous system. Vision disturbances can be caused by disorders of the optic nerve, central nervous system (brain and spine), eyeball movement and pupil abnormalities.
The symptoms of neuro-ophthalmology disorders depend on the type:
What is multiple sclerosis?
Multiple sclerosis, or MS, is a chronic and degenerative condition that occurs when the body’s immune system attacks the protective myelin sheath that covers nerves. As the myelin is damaged, signaling between nerves and along the nerve pathways gradually becomes more and more disrupted, resulting in problems with movement and motion and interfering with other functions. The progression of multiple sclerosis can vary from one person to another, and often, symptoms can “flare up” or become worse for a period of time, then lessen in severity during a period of remission. In others, the disease steadily and progressively becomes worse over time.
What causes MS?
It’s unclear what triggers multiple sclerosis, but researchers believe it’s caused by a genetic mutation or possibly stems from childhood infections that cause an abnormal development in the body’s immune system. Women are two times as likely to develop multiple sclerosis as men, and it also occurs more commonly among people with a family history of the disease as well as those of Northern European descent.
How is MS diagnosed?
To date, there is no specific test that can definitively diagnose multiple sclerosis. Instead, the disease is diagnosed based on a careful review of symptoms, an in-depth personal and family medical history, a physical examination and medical testing to rule out other possible diseases or conditions that cause similar symptoms. Blood tests, diagnostic imaging studies, nerve conduction tests and other evaluations may be ordered to aid in diagnosis. In a few cases, a small sample of cerebrospinal fluid (the protective fluid that surrounds the central nervous system) may be extracted for evaluation in a lab.
What treatments are available for multiple sclerosis?
Although there is no cure for multiple sclerosis, there are many treatments that can be used to lessen the severity of symptoms and even help slow the progression of the disease. Corticosteroid injections can be very helpful in managing some symptoms, and immune-suppressant drugs can help slow the progression of the disease by preventing the immune system from attacking the protective myelin sheath. Other medications can help prevent or reduce the frequency of relapsing symptoms following periods of remission. Patients with MS will need ongoing care customized for their evolving needs to help manage symptoms over time.
Oral treatments currently approved by NICE
Infusion & Injection treatments
OTHER NEURO-INFLAMMATROY CONDITIONS
What causes strokes?
Strokes occur when the blood supply to the brain is interrupted, depriving one or more areas of the brain of vital oxygen supplies. Most often, the disruption to blood flow is caused by a clot that lodges in one of the carotid arteries, major arteries located on either side of the neck that supply blood to the brain or narrowing or blockage in one of these arteries. These are called ischemic strokes, and they account for about 90 percent of all strokes. Less commonly, strokes can occur when blood vessels in the brain rupture and bleed, causing what’s known as a hemorrhagic stroke. Both types of stroke can cause temporary or permanent impairment of functions like speech, cognition or movement, depending on where the stroke occurs, and some strokes are serious enough to cause death.
What are transient ischemic attacks?
Like an ischemic stroke, transient ischemic attacks (TIAs, sometimes called “mini-strokes”) occur as a result of arterial blockage. However, TIAs are very brief and appear to resolve on their own – but that doesn’t mean they don’t cause damage. A single TIA is not life-threatening, but they often act as a precursor to a major stroke, and over time, multiple TIAs can cause deterioration in certain areas of the brain, causing both functional and cognitive deficits.
What are the symptoms of strokes?
The American Heart Association recommends people memorize the acronym F.A.S.T.:
Other symptoms include limb paralysis or numbness, especially when limited to one side, problems with vision and severe headache.
What risk factors are associated with strokes?
Strokes have been associated with several risk factors, including:
People with any of these risk factors should consider stroke screening including Doppler ultrasound of the carotid arteries to look for signs of narrowing or blockage that could increase their risk of having a stroke.
Dystonia & Movement disorders
We evaluate and treat all types of movement disorders, including:
- Tremor disorders
- Essential Tremor
- Orthostatic Tremor
- Tremor secondary to various causes including medications, trauma, metabolic conditions, endocrine disorders (like thyroid or parathyroid disease), tumors, paraneoplastic syndrome, autoimmune disorders, radiation, toxins and heavy metals, etc.
- Focal, multifocal, segmental or generalized dystonia
- Idiopathic, genetic, and secondary dystonia
- Craniofacial dystonia (including blepharospasm, jaw dystonia, tongue dystonia, Meige syndrome, and spasmodic dysphonia)
- Cervical dystonia or torticollis
- Trunk or limb dystonia; writer’s cramp; musician’s dystonia; occupational dystonia
- Lubag syndrome or X-linked dystonia-parkinsonism
- Cerebellar Ataxia
- Restless Legs Syndrome and Periodic Limb Movements of Sleep
- Tics and Tourette’s syndrome
- Chorea, ballism and Huntington’s disease
- Other movement disorders
- Paroxysmal dyskinesias
- Psychogenic movement disorders
- Gait disorders or imbalance
- Hemifacial spasm
- Tardive dyskinesias
- Painful legs moving toes syndrome
Movement Disorder Treatment
Our services range from early diagnosis and medical management to advanced interventions. We balance our medical interventions with noninvasive therapies and innovative neuro-wellness programs – addressing not only your condition, but your total health and well-being. Advanced treatment includes botulism toxin injections and the option for leading-edge surgical treatment called deep brain stimulation and specialized therapeutic and rehabilitative treatment to our patients
- Botulinum toxin injections for a variety of neurological conditions
- Dystonia (blepharopasm, jaw dystonia, tongue dystonia, Meige syndrome, cervical dystonia, trunk dystonia, limb dystonia, writer’s cramp)
- Hemifacial spasm and other facial dyskinesias
- Tremor (of head or upper limb)
- Migraine headaches not sufficiently treated by oral medications; myofascial pain syndrome
- Spasms and limb spasticity (from stroke, multiple sclerosis, spinal cord injury, etc)
- Hypersalivation (drooling) and hyperhydrosis (excessive sweating)
- Motor tics
- Painful legs moving toes
Parkinsons disease & PD plus syndromes
Parkinson disease is a complex progressive neurological disease involving the loss of neurons in a part of the brain called the “substantia nigra.” This results in a reduction in the amount of dopamine, a chemical messenger or neurotransmitter. When this important chemical in the brain is depleted, the symptoms of Parkinson’s disease develop.
There are two types of symptoms: motor (movement) and non-motor (non-movement). Common motor symptoms include: tremor, slowness of movement, stiffness and impairment of balance later. Non-motor symptoms vary from person-to-person and more so than the motor symptoms. They can include, low-blood pressure, constipation, speech difficulties , depression, Fatigue, Sleep problems, osteoporosis etc
Challenging Cases – Some conditions mimic Parkinson’s but doesn’t have actual disease, they are challenging to non specialists and needs specialist input
Atypical Parkinsonisms are most likely to affect people in their 50s and 60s, and include disorders such a:
- Dementia with Lewy bodies (DLB), which is second only to Alzheimer’s disease as a degenerative cause of dementia
- Progressive supranuclear palsy (PSP), a disorder that affects patients’ vision and balance
- Multiple system atrophy (MSA), which involves the autonomic nervous system (the part of the nervous system that controls internal functions such as digestion, heartbeat and breathing) and can affect coordination
- Corticobasal syndrome (CBS), a rare atypical Parkinsonian disorder in which symptoms often involve one side of the body more than the other
Dementia from Parkinson’s disease
Initially, Parkinson’s disease causes physical symptoms. Problems with cognitive function, including forgetfulness and difficulty with concentration, may arise later. As the disease gets worse with time, many people develop dementia, which causes profound memory loss and makes it difficult to maintain relationships with others.
Parkinson’s disease dementia can cause problems with:
- Speaking and communicating with others
- Being able to solve problems
- Understanding abstract concepts
- Difficulty paying attention
If you have Parkinson’s disease and dementia, eventually you probably won’t be able to live by yourself. Dementia affects your ability to care of yourself, even if your Parkinson’s disease allows you to physically perform daily tasks
Living with Parkinson’s Disease
- Coping with Parkinson’s disease, the motor system disorder, can be frustrating because of its common symptoms—trembling, stiffness (often called rigidity), slow movements, and the loss of balance and coordination. A good deal of that frustration comes from the loss of control that you once had over your body. It can also be emotionally overwhelming to know that there is currently no cure for the disease.
- Nonetheless, people have a number of tools at their disposal for better managing the symptoms of Parkinson’s disease and living a healthy, enjoyable life. Here’s what can help
Epilepsy is not just one condition, but a group of many different ‘epilepsies’ with one thing in common: a tendency to have seizures that start in the brain. Epilepsy is usually only diagnosed after a person has had more than one seizure. Not all seizures are due to epilepsy. Other conditions that can look like epilepsy include fainting, or very low blood sugar in some people being treated for diabetes. On this page, when we use the term ‘seizure’ we mean epileptic seizure.
Anyone can develop epilepsy, at any time of life. It happens in people of all ages, races and social classes. Epilepsy is most commonly diagnosed in children and in people over 65. There are over half a million people with epilepsy in the UK, so around 1 in 100 people.
Different epilepsies are due to many different underlying causes. The causes can be complex, and sometimes hard to identify. A person might start having seizures because they have one or more of the following.
- A genetic tendency, passed down from one or both parents (inherited).
- A genetic tendency that is not inherited, but is a new change in the person’s genes.
- A structural (sometimes called ‘symptomatic’) change in the brain, such as the brain not developing properly, or damage caused by a brain injury, infections like meningitis, a stroke or a tumour. A brain scan, such as Magnetic Resonance Imaging (MRI), may show this.
- Structural changes due to genetic conditions such as tuberous sclerosis, or neurofibromatosis, which can cause growths affecting the brain
EEG Q & A
What is an EEG?
EEG stands for electroencephalogram, a test used to evaluate and measure the electrical activity in the brain. EEGs use small discs called electrodes that are placed on the scalp. These electrodes pick up tiny electrical impulses in the brain and transmit them via wires to a machine that creates a graph depicting the activity.
When are EEGs used?
EEGs are used to diagnose an array of issues related to the brain, including:
- epilepsy and other seizure disorders
- brain tumors
- encephalopathy (brain dysfunction)
- encephalitis (brain inflammation)
- brain injury
- sleep disorders including apnea
How is an EEG performed?
EEGs are noninvasive and painless. Measurements of the skull are taken first to determine the optimal placement of the electrodes, then the skin in these areas may be carefully cleaned of oils to enable the electrodes to adhere better. In some cases, the electrodes may be attached to a close-fitting cap instead of directly to the scalp. Then, the electrodes are connected to the EEG machine using a series of wires. EEGs may be conducted while the patient is awake or during sleep. During the test, patients may be asked to open and close their eyes, read or perform other simple activities to measure the brain’s activity. EEGs performed on patients who are awake typically take about an hour.
What is an ambulatory EEG?
While “standard” EEGs take about an hour to perform in the office, ambulatory EEGs are performed over a longer period of time, typically a day or more, to enable doctors to gather information about the brain’s activity throughout daily routines and activities. During the test, the patient wears a small portable recording device that’s attached to the electrodes on the scalp. The electrodes are covered with a cap or hat. Patients will be asked to perform their regular routines and to keep a diary of their activities to help the physician identify patterns or issues.
What is a video EEG?
Video EEGs use video monitoring performed at the same time as the EEG to “match” a person’s physical activity during the test. Video EEGs can be very useful in patients with seizures, including those with epilepsy. Video EEGs usually record sounds as well to determine if the patient makes any noises during a seizure or other event.
Nerve & Muscle disorders
- Damage to the peripheral nerve (peripheral neuropathy) which may present with numbness, tingling and weakness
- Muscle damage (myopathy/muscular dystrophy) resulting in cramps, muscle wasting and weakness
- Neuromuscular junction disease (myasthenic syndromes) which cause weakness and fatigability
Will take a comprehensive medical/neurological history and perform a detailed neurological examination. Other tests that may be required include blood samples, CT or MRI scans and neurophysiological studies such as EMG/NCS (tests on the nerves and muscles)
EMG Q & A
What are nerve studies and why are they performed?
Nerve studies are diagnostic evaluations of nerve activity used to identify and assess the extent of nerve damage and to guide therapy and treatment. They’re also used to manage treatment of specific nerve or neuromuscular diseases and disorders like multiple sclerosis or myasthenia gravis.
What is an NCS?
NCS stands for nerve conduction studies, evaluations designed to assess the efficiency of the nerves in accurately transmitting signals from specific muscles to the brain. Nerve conduction studies are often performed to determine the cause of pain, numbness and other nerve-related symptoms and to assess the extent nerve damage in a specific area. To perform the study, electrodes are placed on the skin and used to monitor reaction times when the nerve is stimulated by tiny electrical impulses.
What is an EMG?
EMG stands for electromyelogram (or electromyogram), a test that’s used to assess nerve or electrical activity in the muscles when they’re at rest and when they’re flexed or contracted. EMGs are used to help diagnose and treat spasms, numbness or weakness in the muscles and to determine the cause of those symptoms. EMGs can be conducted using electrodes placed on top of the skin or by placing a tiny needle probe directly into the muscle. Tiny currents transmitted through the probe help track electrical activity in the muscle fibers to determine if an issue related to a problem with the muscle tissue, with the nerves that control the muscle, or with the way the nerves and muscles interact.
What is an NCV?
NCV stands for nerve conduction velocity test, and it’s used to measure or assess how well specific nerves are transmitting the tiny electrical impulses or nerve signals that help control muscle movements and other functions. NCVs typically are performed to help diagnose nerve damage and the extent of that damage and to evaluate certain diseases of the nerves or the muscles. During the test, tiny electrical impulses are transmitted to the nerves via special electrodes. Then the nerve “reaction times” are monitored and measured to determine how quickly and how far nerve signals are transmitted along the nerve pathway.
Otology & Dizziness
Dizziness Q & A
What is the difference between dizziness and vertigo?
Dizziness is a feeling of lightheadedness or of becoming faint. Vertigo is the sensation that the room is spinning around you. Both dizziness and vertigo can occur when lying down, sitting down or standing, and both can cause problems with balance as well as increasing the risk of falling.
What causes dizziness and vertigo?
While dizziness, vertigo and other issues affecting balance can be alarming, they’re usually benign and due to an underlying issue like an ear infection or low blood pressure. Vertigo is most commonly associated with issues affecting the inner ear, including infections and nerve-related problems. A few people may experience vertigo as a symptom of a condition called benign paroxysmal positional vertigo which causes feelings of spinning when the head is placed in different positions, especially when lying down. Lightheadedness is often linked with a decrease in blood pressure, but it can also be caused by some types of infections or by low blood sugar. People with migraines also frequently have bouts of dizziness, either accompanied by headache or occurring even when head pain is absent. In a few cases, dizziness and balance problems are linked with problems in the brain or nervous system.
How are dizziness and vertigo diagnosed and evaluated?
Diagnosis of dizziness and balance issues begins with a review of symptoms and a physical exam, accompanied by an in-depth medical history to look for risk factors and “clues.” Additional evaluations like blood tests, diagnostic imaging, auditory testing and in-office evaluations of reflexes may also be performed or recommended.
What treatments are available for dizziness and other balance problems?
Because most dizziness and vertigo symptoms are related to underlying issues like ear infections, low blood pressure or glucose imbalances, treating those issues typically helps resolve balance-related symptoms. Referrals may be made to ear, nose and throat specialists, endocrinologists or other specialists as needed. When tests reveal a more serious underlying issue related to nervous system disorders, treatment will focus on addressing those issues to determine if symptoms resolve.
Cognitive & Memory clinics
Memory Problems Q & A
Are all memory problems a symptom of a serious underlying medical issue?
Minor memory “slips” are very common and generally are nothing to worry about. But when memory problems become pervasive and chronic, they can be a sign of a more serious underlying problem, and having a professional evaluation by a neurologist can help determine that cause so appropriate treatment can be provided.
What causes chronic memory issues?
Temporary memory loss issues can be caused by treatable issues like:
- alcohol or drug abuse
- head injuries
- use of some types of prescription medications
- mental health issues including depression and anxiety disorders
Other types of memory loss are caused by dementia, including Alzheimer’s disease, or from tiny strokes called transient ischemic attacks or TIAs. These issues affect the structure of the brain and are associated with permanent memory loss and other symptoms. Symptoms of these types of underlying medical causes include:
- problems finding words to describe abstract concepts like feelings or situations
- asking the same question over and over
- getting lost easily or having difficulty finding a way home
- changes in mood or behavior
- taking a long time to perform simple, everyday tasks like getting dressed
How are memory problems evaluated and diagnosed?
Diagnosing memory problems begins with a review of the patient’s symptoms and the impact those symptoms are having on the patient’s life and the lives of his or her loved ones. An in-depth patient history and a physical exam with cognitive function tests can also provide important information. In some cases, MRI, CT scan or other testing may be performed to look for changes in the brain tissue, or Doppler ultrasound imaging may be used to evaluate the blood vessels that lead to the brain. The tests and evaluations used will depend largely on the patient’s specific symptoms and medical risk factors.
How are memory problems treated?
Treatment for memory problems is highly variable and requires a customized, patient-centered approach for optimal results. Today, there are many medications and other therapies available to help people with memory problems. At New York Neurology Associates, we provide patient-centered care using the most advanced options to help patients understand the cause of memory issues and get the most appropriate treatment to relieve symptoms or slow the progression of underlying diseases.
Sleep medicine & Sleep related disorders
Sleep and Sleep Related Disorders:
- Narcolepsy and Excessive Daytime Sleepiness
- Obstructive Sleep Apnoea (OSA)
- Dental Sleep Disorders
- Restless Legs Syndrome
- REM Sleep Behaviour Disorder
- Sleep Walking and Sleep Terrors
- Circadian Rhythm Disorders
- Chronic Fatigue Syndrome
- Medical and Psychiatric Sleep Disorders
- Stress and Occupational Related Sleep Disorders
- Menstrual Associated Sleep Disorder
- Sleep Disorders in Pregnancy and the Postpartum Period
Pain management & Botulinum treatment
At our centre every patient is treated as an individual with a unique set of problems requiring a tailored therapeutic approach, we understand that your pain is real and we will formulate a plan to break the cycle of pain with care and compassion.
- LOW BACK PAIN
- CERVICAL SPINE DISORDERS, LOW BACKPAIN,COCCYDYNIA
- DEGENERATIVE DISC DISEASE,DEGENERATIVE SPINAL CONDITIONS
- LUMBAR SPINE DISORDERS,MUSCLE STRAIN,MYELOPATHY
- NEUROPATHIC PAIN, SCIATICA,SPINAL STENOSIS
- THORACIC SPINE DISORDERS,TRAUMA
- TUMORS,WHIPLASH,WORK OR ACCIDENT RELATED INJURIES