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Sami Aboumatar, MD
Thursday, January 27, 2011
As we struggle to improve the treatment of epilepsy, we often focus on finding a cure for the disease. Although this is always our hope and our goal, we should remind ourselves that we should implement the best up-to-date treatment as we continue our journey to find a cure. As clinical research and basic science try to reach this goal, the treatment and the management of epilepsy should reach every epileptic who is interested in the treatment and is able to afford it.
An army of healthcare providers and multispecialty teams are needed to do the job. To ensure quality care from the bench to the patient, quality measures are needed. While physicians and healthcare providers have different skills and different approaches to a particular medical disease, like epilepsy, quality measures will help standardize and improve the care at their practices. This might raise the bar for the accepted standard of care of epilepsy. These measures will be an incentive for medical care facilities, healthcare providers, and payers to constantly strive to achieve better care.
Several effective treatment options are available for epilepsy, but some are underutilized. For example, the effectiveness of epilepsy surgery and its positive impact on the quality of life of the candidate patients is undisputed. Yet, there is still a significant delay in referral for evaluation for epilepsy surgery5. Prolonged preoperative illness of more than 20 years was associated with increased risk of recurrent seizures6. Again, epilepsy measures might facilitate the early detection of the patient with medically refractory epilepsy who may be an appropriate candidate for epilepsy surgery.
The American Academy of Neurology recently published epilepsy measures to help improve epilepsy care1. Members are encouraged to use the measures in their practices. This is the first set of epilepsy measures that were developed and approved by a medical society. No set of measures will be perfect, so these will be revised periodically and reviewed every three years.
Following an extensive literature search, 160 relevant recommendations from 19 guidelines were reviewed by the American Academy of Neurology
(AAN) Quality Measurement and Reporting Subcommittee. The AAN panel agreed on 8 final epilepsy measures which were later approved by the Physician Consortium for Performance Improvement, PCPI. The AMA-convened PCPI is comprised of more than 170 national medical specialty societies and other medical organizations that are interested in improving the quality of patient care.
This is a brief description of the final 8 measures.1 Full description was published on Neurology website (www.neurology.org. January 2011; 76: 94-96 Data Supplement)3:
No. 1: Seizure type and current seizure frequency.
All visits with the type(s) of seizure(s) and current
seizure frequency for each seizure type documented in
the medical record.
No. 2: Documentation of etiology of epilepsy or epilepsy syndrome.
All visits with the etiology of epilepsy or epilepsy
syndrome reviewed and documented if known, or
documented as unknown or cryptogenic.
No. 3: EEG results reviewed, requested, or test ordered.
All initial evaluations with the results of at least one
EEG reviewed or requested, or if EEG was not
performed previously, then an EEG ordered.
No. 4: MRI/CT scan reviewed, requested, or scan ordered.
All initial evaluations with the results of at least one MRI
or CT scan reviewed or requested or, if a MRI or CT scan
was not obtained previously, then a MRI or CT scan
ordered (MRI preferred).
No. 5: Querying and counseling about antiepileptic drug side effects.
All visits where patients were queried and counseled
about antiepileptic drug side effects and the querying
and counseling was documented in the medical record.
No. 6: Surgical therapy referral consideration for intractable Epilepsy.
All patients with a diagnosis of intractable epilepsy who
were considered for referral for a neurologic evaluation
of appropriateness for surgical therapy and the
consideration was documented in the medical record
within the past 3 years.
No. 7: Counseling about epilepsy specific safety issues.
All patients who were counseled about context-specific
safety issues, appropriate to the patient’s age, seizure
type(s) and frequency(ies), occupation and leisure
activities, etc. (e.g., injury prevention, burns,
appropriate driving restrictions, or bathing) at least
once per year.
No. 8: Counseling for women of childbearing potential with Epilepsy.
All female patients of childbearing potential (12–44
years old) diagnosed with epilepsy who were counseled
about epilepsy and how its treatment may affect
contraception and pregnancy at least once per year.
Measure Exclusions:
In certain circumstances, a particular patient who otherwise meets the denominator criteria needs to be excluded from the denominator of a specific measure due to one of three reasons, medical, patient, or system reasons. There should be a clear and well documented reason to permit exclusion:
1- Medical Reason: Not indicated or contraindicated
2- Patient Reason:
a. Patient declined
b. Social or religious reasons
c. Other patient reasons
3- System Reason:
a. Services not available
b. Financial reason (no insurance coverage/payer –related limitations)
c. Other system reasons
Most physicians are familiar with clinical outcome measures and clinical guidelines. However, these new epilepsy measures are not intended to be clinical guidelines or standard medical care; rather they are intended to help physicians’ quality improvement. They are useful to calculate individual physician performance. Physicians might also find the measures useful to identify a particular patient population in their practices for clinical trials or other research.
These measures can be useful for reporting to the payers. Currently, Centers of Medicare and Medicaid Services (CMS) Physician Quality Reporting Initiative (PQRI) are considering paying incentives (about 1%) to physicians who participate in the Physician Quality Reporting (Previously known as Physician Quality Reporting Initiative (PQRI). In 2011, the program name was changed to Physician Quality Reporting System (Physician Quality Reporting)2.
How to calculate a performance measure3:
Performance measure is a fraction created by three components:
1-Numerator (A): Patients who meet numerator inclusion criteria
2- Denominator (PD): patient who meet the denominator inclusion criteria
3- Denominator Exclusion (C): patients who have valid medical, patient, or system exclusions.
Numerator (A)
Performance = ----------------------------------------------------------------------
Denominator (PD) – Denominator Exclusions (C)
For example, to calculate performance measure No. 3:
Performance Numerator (A) Includes:
Patients who had the results of at least one electroencephalogram (EEG) reviewed or requested, or if an EEG was not performed previously, then an EEG ordered.
Performance Denominator (PD) Includes:
All patients with a diagnosis of epilepsy seen for an initial evaluation.
Denominator Exclusions (C) Include:
• Documentation of medical reason for not ordering an EEG if an EEG was not performed previously
• Documentation of patient reason for not reviewing or requesting EEG results or, if an EEG was not performed previously, for not ordering an EEG
• Documentation of system reason for not reviewing or requesting EEG results or, if an EEG was not performed previously, for not ordering an EEG
Then the above formula can be used to calculate the fraction.
Conclusion:
These measures will be a useful tool to many neurologists and other physicians who are caring for people with epilepsy. The hope is to optimize the current treatment options and standardize care. Further education regarding the classification of epilepsy and the appropriate use of the ICD codes will help implement the measures.
References:
1- Neurology 2011;76: 94-99
2- www.cms.gov . Accessed January 18, 2011
3- www.neurology.org . Neurology 2011; Appendix e-1
4- Trevathan E, Gilliam F. Neurology. 2003;61:432-433
5- Benbadis SR, et al, Seizure. 2003 Apr;12(3): 167-70
6- Yoon H.H, et al, Neurology 2003;61:445-4
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Soe Aung, MD Neurologist & Sleep Medicine Specialist
Tuesday, December 21, 2010
Stroke is the third leading cause of death and major cause of permanent disability in the United States. There are several medical conditions known to increase the risk of having a stroke such as lack of exercise, high blood pressure, diabetes, heart disease, smoking, and high cholesterol. However, the public is less aware that obstructive sleep apnea (OSA), a common disease, is increasingly considered as treatable risk factor of stroke.
OSA is the presence of repetitive episodes of upper airway obstruction during sleep. Symptoms include snoring, excessive daytime sleepiness, pauses in breathing during sleep, gasping for air and frequent waking from sleep. It is diagnosed by a trained physician usually with a help of a sleep study. In addition to sleep interruption, OSA can cause intermittent drops in blood oxygen levels during sleep. It can eventually lead to a disease of arteries called atherosclerosis, which is known to increase risk of having a stroke as well as a heart attack. OSA is associated with high blood pressure, a cause of stroke. In one study (Arzt et al in 2001), risk of having stroke is about 4 times higher in people with OSA.
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Wednesday, December 01, 2010
Andrea Natale, MD - Guest Contributor
Migraine, a neurovascular disorder affecting more than 29.5 million Americans, is characterized
by recurrent attacks of incapacitating headache associated with extreme sensitivity to light
and sound, nausea and vomiting. Although the cause and triggers of migraine is not fully
understood yet, it has been widely accepted as being caused by dilatation of blood vessels in
the brain, abnormal firings from unusually excitable brain nerve cells and/or inflammation of
the meninges.
Atrial fibrillation (AF) is the most common cardiac arrhythmia encountered in clinical practice.
It is characterized by chaotic and uncoordinated contractions of upper chambers of the
heart (atria) giving rise to an irregular and rapid heart rate. Treatment goals include restoring
the heart to normal rhythm, slowing the heart rate and preventing blood clot formation.
Antiarrhythmic drugs and radiofrequency catheter ablation (RFCA) are the mainstay of therapy
for AF, RFCA being considered as the treatment of choice in drug-refractory AF patients.
Atrial septal defects (ASD), including patent foramen ovale (a condition with a defect in the wall
between the two atria); have been linked to an increased prevalence of migraine headaches
in the general population. During catheter ablation, the wall between right and left heart
is routinely perforated (a procedure called trans-septal puncture or TSP) to gain access to
the left heart. TSP causes an iatrogenic atrial septal defect (ASD) with a transient right-to-
left shunt which can predispose patients to stroke and migraine. In two different studies,
with 571 and 183 patients in whom TSP was performed, the incidence of migraine was 0.5%
and 2.2% respectively and the migraine was transient and resolved without any sequelae. In
separate studies, complete resolution or improvement of migraine was noticed with the ASD
closure. Additional case-studies have also reported incidence of AF occurring during episodes of
migraine with aura while the cardiac rhythm was normal in the absence of migraine.
All these reports evidently demonstrate an association between AF, TSP during RFCA and
migraine, but fail to clearly define the nature of it. Additionally, very little is known about the
impact of catheter ablation (for AF) on the natural course of pre-existing or newly-occurring
migraine.
Texas Cardiac Arrhythmia Institute (TCAI) and NeuroTexas Institute (NTI) at St. David’s
HealthCare are collaboratively conducting a prospective study to explore;
- - the nature of association between AF and migraine
- - if catheter ablation influences the incidence and clinical course of migraine in patients with
or without a previous migraine history
- - effect of catheter ablation on migraine status of AF patients with or without comorbidities
such as hypertension, diabetes, obesity, high cholesterol, and respiratory diseases like asthma
and chronic obstructive pulmonary disease
- - association of migraine with any specific type of AF; namely paroxysmal, persistent or long-
standing persistent
- - impact of therapeutic Coumadin, a blood-thinner which is routinely used during RFCA, on
the prevalence and clinical course of migraine
Information obtained from this study will provide insight into a better understanding of the nature
of relationship of AF with migraine; which would be useful in efficient risk-stratification and patient
management.
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Muhammad Munir, MD, PhD
Wednesday, September 29, 2010
Radiculopathies or pinched nerves are clinical conditions caused by compression or damage of the nerve roots at the spine level. Radicle is Latin for root. In the spine there are seven vertebrae in the neck, 12 in the chest and five in the lower back plus the tailbone. Radiculopathies are therefore labeled as cervical (neck), thoracic (chest), and lumbosacral (lower back). The vertebral bodies are separated by discs that provide cushion from downward compression and provide space between the vertebrae for the nerve roots to exit. The spinal cord travels through a tunnel in the vertebral bodies and connects the brain to the rest of the body by sending nerve roots out. At each inter-vertebral level on either side, a pair comprising of one sensory and one motor nerve root leaves the spinal canal through an opening in the vertebral bones called foramen. The sensory nerve roots transmit all the sensations such as pain, touch, temperature, and movement from a specific area of the body back to the spinal cord. The motor nerve roots transmit the signal from the spinal cord to a specific group of muscles to move them.
Symptoms due to any specific nerve root compression or damage depend on the degree of involvement of sensory and/or motor nerve roots and also on the number of levels involved. When the nerve roots are affected at more than one level, it is termed a polyradiculopathy. Symptoms include loss of strength, loss of sensations, and abnormal sensations or a combination of the above in the affected nerve root territories. Common symptoms include pain, numbness, tingling, burning, cramping etc. in the specific territory of the affected nerve root(s). Weakness may develop in a specific set of muscles supplied by the affected nerve root(s). Focal pain in the neck, chest, or lower back may accompany because of local structural changes. Pain radiating or shooting from neck or back into the specific nerve root territories is a common symptom. For example cervical radiculopathy at C6 on the right side may cause numbness and pain in the right thumb and index finger that are supplied by C6 sensory nerve root and may cause weakness of right deltoid and biceps muscles that are supplied by the C6 motor nerve root. Pain in the lower neck may also radiate into the right arm and hand.
Radiculopathies are often caused by disc herniations that compress the nerve roots in the foramen as they exit the spinal canal. The disc herniations are quite often caused by some form of trauma and tend to occur in younger people more often than in older people. The other common cause is narrowing of the spinal canal called spinal stenosis that occurs due to a combination of factors including disc degenerations, osteophyte or bone spur formation, ligament hypertrophy, and spondylolisthesis (degeneration and misalignment of vertebrae). In rare cases focal compression on the nerve roots due to causes such as inflammation or malignancy can produce a similar picture.
Diagnostic evaluation usually includes clinical examination, imaging studies, and electrodiagnostic studies. Clinical examination may shows loss of sensations, weakness, and decreased reflexes in specific nerve root territories. Imaging studies such as MRI or CT scan are used to visualize the spinal structures. MRI is the preferred imaging modality because it shows the soft tissues such as discs and nerves better than the CT scan does. A CT myelogram may be used in selected cases to visualize the nerve roots and their surroundings. An EMG nerve conduction study can help to determine the nature and extent of nerve root injury and can help to distinguish it from other causes of numbness, pain, and weakness affecting the same areas.
Treatment of radiculopathies is based on the symptoms, the degree, and the cause of damage to the nerve roots. In mild cases conservative treatment including a combination of physical therapy, anti-inflammatory drugs, muscle relaxants, pain killers, and traction therapy may resolve the symptoms. Epidural injections containing steroids and local anesthetics can produce significant relief, though often temporary, by reducing the inflammation. More advanced techniques such radio frequency ablation (RFA) may be helpful in some cases. Surgical decompression is required when there is clear clinical or laboratory evidence of nerve root damage. In some cases surgical decompression is needed to control pain especially if conservative management does not resolve the symptoms. Surgical treatment may involve removal of the problematic disc or disc fragment and stabilization of the spine with fusion and hardware placement. Regeneration of damaged nerve roots is a slow process and dependent on the length of the nerve from the spine to the target organ. Depending upon the nature and location of damage, the regeneration can take several months to sometimes years to complete after the surgery. For example a nerve root injury in the lumbar spine may take upto three years to complete. Therefore it is important to quickly determine the nature of radiculopathies and treat them accordingly to prevent further damage and to allow them to heal.
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Douglas "Kit" Fox, MD, Neurosurgeon, Executive Medical Director
Monday, March 15, 2010
Trigeminal neuralgia (TN), also known as tic doloureux, is a paroxysmal lancinating pain that occurs in one or more of the distributions of the trigeminal nerve. The pain often occurs with sensory stimulation to the face or teeth, with patients being unable to eat or have anything touch their face. Spontaneous remission is common, with patient often having prolonged periods where they are symptom-free. This occurs in the general population in 4/100000 people but in those with multiple sclerosis have an incidence of 2/100. Vascular compression from an artery at the root entry zone, tumor involvement, and development of a plaque can cause trigeminal neuralgia, which is likely an ephaptic transmission in the nerve from demyelinated pain fibers. Of note, there is no correlation of TN with herpes zoster infection, as the pain with herpes zoster is constant and not paroxysmal.
Once determined to be the cause of a patient’s pain, multiple therapies are available. Medical therapy is usually with carbamazepine, baclofen, and/or gabapentin. Nearly 70% of patients will have complete or tolerable relief with medications. Surgical options include
nerve blocks or ablations, percutaneous rhizotomy with radiofrequency or glycerol, microvascular decompression (MVD), nerve sectioning, and stereotactic radiosurgery. MVD is the most durable treatment providing sustained relief at ten years in 70% of patients treated.
The incidence of facial anesthesia is reduced compared to percutaneous rhizotomy. This does require surgery, however, and the inherent risks that go along with the procedure including CSF leak and aseptic meningitis. Patients with multiple sclerosis that have a
plaque at the dorsal root entry zone will respond better to steretactic radiosurgery or percutaneous rhizotomy.
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Michael Hummer, MD, Neurologist
Tuesday, February 16, 2010
Chorea is a classical neurological illness, the name of which derives from both Latin and Greek referring to dance or choral dance. Chorea has been described since the Middle Ages and describes a syndrome of brief, rapid, abrupt, involuntary movements coming from random muscle contractions. The pattern of movement may at times give the impression that the patient is restless or fidgety. Chorea is an uncommon but nevertheless very interesting neurological condition. In the Middle Ages, the most common form of chorea was most likely Sydenham’s chorea, which is a postinfectious chorea related to side effects from rheumatic fever and antibodies in the bloodstream resulting from beta hemolytic group Streptococcus. The frequency of this disorder has declined continually over the years and it is very uncommon at this time.
Chorea can be caused by multiple conditions, the most important of which from a neurobiological perspective is Huntington disease or Huntington’s chorea. Huntington’s chorea is a slowly progressive, familial, neurogenetic disease that causes disorder of muscle control, emotional control, cognitive ability, and involuntary movements. Huntington disease was first well described by Dr. George Huntington when he concisely reported affected families in New York state in a paper "On Chorea and Choreiform Affectations" published in 1894. Chorea can also be caused by stroke, lupus erythematosus, or a variety of other less common genetic, infectious, and drug related causes.
Huntington disease is, arguably, one of the most important causes of chorea from neurobiological, social, and economic standpoints. Huntington disease is a genetic disorder of an autosomal dominant type which basically means that there is a 50% chance of inheriting the gene from an affected parent and, therefore, a 50% chance of inheriting the condition. These genes produce a protein called huntingtin which, with an abnormal huntingtin gene, is excessively produced and produces progressive neurodegeneration widely throughout the brain, but in particular in deep structures called the corpus striatum. Absence of the normal huntingtin gene causes embryonic death in mice and it seems that the normal huntingtin gene supports the normal health of nerve cells in the brain. It is felt that the excessive production of huntingtin gene produces its abnormal effects by a gain in function rather than a loss in function.
Prevalence of affected individuals in the United States is approximately 1 in 10,000 and with a resultant approximately 30,000 people affected. Since it is an autosomal dominant disorder, both sexes are equally predisposed to this disease and the disease is present worldwide. There is some prevalence correlated with European ancestry and Huntington disease is rare in Japan and China. There are no proven ways to prevent the onset or progression of Huntington disease. The diagnosis can be made on the basis of clinical presentation, adequate family history, physical findings, and genetic testing. Prognosis is, for a slowly progressive course, over 10 to 25 years. Emotional symptoms such as depression tend to occur in the early to middle stages of the disease with sleep disruption and motor decline in the middle to late stages of the illness.
Various medications are available to treat symptoms in chorea and a new medication has been approved by the FDA for treatment of the muscle movements themselves. Other treatment is available for psychiatric symptoms. Luckily, Huntington’s chorea is a very uncommon condition, but this condition is being actively pursued with scientific investigations using electronic and genetic testing.
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Sara Austin, MD, Neurologist
Friday, January 08, 2010
Of the 3 nerves going to the forearm and hand that make the hand move, the ulnar nerve is arguably the most important as it provides all of the fine finger control, and much of the thumb movement. This nerve supplies the sensation to the 4th and 5th fingers, both the top and palm surface of the hand, and also the sensation of the hand just below the 5 finger.
The most common symptoms associated with a damaged ulnar nerve is numbness on the 5th finger side of the hand, aching in the hand, a feeling of coldness of the 4th and 5th fingers and possibly finger weakness. If the nerve damage is severe, the back of the hand will have a “hollowed out” appearance between the thumb and index finger because of muscle atrophy. Very severe ulnar nerve damage would cause the hand to look flat with the 4th and 5th fingers curled down.
The most common injury associated with the ulnar nerve is when the nerve is compressed as it travels around the elbow, either by direct pressure or prolonged positioning of the elbow joint at a 90 degree angle. Cellphone use is a common cause of ulnar nerve problems, as is sitting for long periods of time with the elbows on a hard surface.
Less commonly, the ulnar nerve can be compressed at the wrist, in which case the hand will be very weak but without the associated numbness that occurs with compression at the elbow.
Usually conservative treatment is the option of choice, but in cases of severe injury, a surgical consultation may be indicated. An electromyography (EMG) is a diagnostic for evaluating and recording the activation signal of muscles and is the preferred method of properly assessing an ulnar nerve injury, which can be facilitated by an EMG Board Certified neurologist.
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Juan Latorre, MD, Physical Medicine & Rehabilitation
Thursday, December 24, 2009
With approximately 12,000 new cases of spinal cord injury (SCI) each year with roughly 259,000 persons living with a traumatic SCI in the US, rehabilitation treatment plans must be individualized based on other factors such as age, co-morbidities, body habitus and level of motivation. It is also imperative to assess and manage the various affected systems. Muscle paralysis is often the most recognized sequela arising from SCI but other common complications include neuropathic pain, spasticity, heterotropic ossification, orthostatic hypotension, autonomic dysreflexia, DVT, CAD, atelectasis, pressure ulcers, depression, neurogenic bladder and bowel dysfunction, and in males neurogenic impotence and infertility.
The multisystem involvement of SCI makes the rehabilitation of these patient one that requires a comprehensive and multidisciplinary team approach, aimed at maximizing not only functional outcomes but also neurological recovery. Whatever the future in SCI holds we now know that people with SCI can live a happy and fulfilling life within the constrains of their impairments. With a collaborative effort of specialty physicians and a comprehensive rehabilitation program, the SCI patient stands to gain a more favorable outcome for achieving optimal clinical goals.
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Anant Patel, MD, Neurosurgeon
Wednesday, October 21, 2009
Movement disorder is a group of neurodegenerative diseases that primarily affects the motor and movement processes. The most common disorders include Parkinson’s disease (PD), Essential tremor (ET) and Dystonia.
Medications can be effective in the early treatment of these movement disorders. However, with the progression of disease, medications alone become ineffective. In PD, long-term management is often complicated with development of motor fluctuation and dyskinesia (involuntary dance like movement). In theses patient dyskinesias can be even more disabling then PD symptoms. Approximately 50 % of these patients will develop motor fluctuation and dyskinesia after 5 years of treatment with medication. Furthermore, only 50 % of tremor may respond to medication.
Surgical treatment for PD and ET has been around since the 1950’s. Early surgical intervention involved ablation of specific basal ganglia nuclei. However, lesioning became less effective with progression of the disease and bilateral lesions were often associated with severe complication involving speech, balance and walking. With further research, it was found that stimulation of these nuclei simulates the effects of a lesion without permanent destruction of tissue. In addition, the process is reversible and more importantly the stimulation is adjustable as the disease progresses. Therefore, Deep Brain Stimulation (DBS) has become the surgical treatment of choice for movement disorders.
DBS surgery is preformed in several stages using either the Frame or Frameless approach. The frameless approach uses infrared optics to achieve submillimeter accuracy needed in placement of the leads. The small stereotaxic frameless frame mounts on the skull over a small burr hole opening. This allows patients complete freedom to move their head and body on the operating table and thereby making it a comfortable experience. The DBS electrode is stereotaxically placed into the target nuclei. The patients are awake during this part of the surgery and intraoperative testing is preformed with stimulation of the electrode to ensure excellent response without any adverse side effects. The final stage of the procedure involves connection of the electrode leads to the implantable pulse generator (IPG), which is placed under the skin of the chest or abdomen. The IPG can be programmed to deliver electric stimulation to achieve desired results.
DBS is certainly not a cure for these neurodegenerative disorders by any means. However, it certainly gives us an incredible tool to modulate neuronal activity and thereby preserving function and quality of life for many of these patients with disabling symptoms.
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Bryan Atkinson, MD, Neurologist
Monday, October 05, 2009
Peripheral neuropathy is a common neurological condition. Neuropathy means "pathology of nerves" or "something wrong with the nerves" and peripheral neuropathy most often refers to symptoms of numbness or pain in the toes and feet or in the hands. Diabetes, including early or pre-diabetes, is the most common cause of peripheral neuropathy in the U.S. but many other conditions are associated with the diagnosis.
People with immunological disease such as Lupus may develop a peripheral neuropathy. Neuropathy can occur due to medications such as Chemotherapy or to toxicity from chronic alcohol use. Nutritional deficiencies, such as B12 deficiency, can cause neuropathy and infections such as AIDS or Lyme disease can injure the peripheral nerves. A genetic abnormality or Charcot-Marie-Tooth disease is at times identified as the cause. In over 30% of cases a specific cause of neuropathy cannot be identified and in these cases the neuropathy does not typically lead to any severe impairment.
The evaluation of symptoms suggestive of peripheral neuropathy includes laboratory testing for associated medical conditions, such as the conditions reviewed above, along with the direct evaluation of the peripheral nerves and muscles with NCS/EMG testing. Treatment depends on the underlying medical diagnosis with careful management of underlying conditions such as diabetes to help prevent further progression of the neuropathy. Medications such as elavil, neurontin, or lyrica may be used to help relieve the pain and burning that may be present. Ankle or wrist braces are at times needed for patients with weakness, and self-inspection of the feet for cuts or injuries is important in patients with significant sensory loss.
Peripheral neuropathy is common neurological condition and the physicians of the NeuroTexas Institute are able to provide expert evaluation and management of this often treatable diagnosis.
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