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FAQ

What is neurology?

Neurology is a specialty of medicine which deals with the diagnosis and treatments of diseases that affect the nerves, nervous system and muscles. Many of these diseases which are common include Alzheimer’s, Parkinson’s, multiple sclerosis, epilepsy, peripheral neuropathy and migraine headache to name a few.

How long does it take to become a neurologist?

Training to become a neurologist is four years after completion of medical school. However, many Neurologists continue their training in what is called a fellowship, this is a particular focused area within neurology. These fellowships are an additional one to two years.  So the grand total including college, medical school and specialty training is around 13 to 14 years.

What should I expect on my first visit?

When you see your neurologist for the first time, you will state your main problem. From that problem,  you will be asked questions specific to it. This is what we call history of present illness. This will help to focus on where your problem is coming from and what could be causing it.

Will the Neurologist order tests?

Based on the history of your problem, the neurologist may order blood test, imaging studies and electrodiagnostic studies to look for the underlining causes of your problem.  Some of these studies may be done in the hospital or the office.

What tests are done in his office?

The tests typically done in the neurologist office include EEG (electroencephalogram) and EMG (Electro myography)

What is an EEG?

An EEG is what we call an electroencephalogram. This test requires small electrodes to be placed on the head and monitors the electrical activity of the brain. We like to have the patient fall asleep during his test to see how the brain reacts during wakefulness and sleep. This test is extremely important and helpful in the diagnosis of epilepsy and use with patience with memory loss. It is painless and last about 1/2 an hour or 45 minutes.

What is an EMG?

An EMG is actually a two part test. The EMG is Electromyography, the second part of this test is the NCV which stands for nerve conduction velocities. These tests are used in combination with each other. Typically, the nerve conduction study is the one that is done first and measures the impulse strength and the speed of the nerve, this helps us to determine what portion or part of the nerve has been affected. The EMG utilizes a very small needle which is inserted into the muscle. Essentially this needle is an antenna allowing us listen to the electro-activity of the muscle. During this test the neurologist will have you contract your muscle to see how the nerve and muscle are responding.

What is a small fiber Biopsy?

The nerves that are found in the extremities are divided into large fibers and small fibers.  The previously mentioned EMG and nerve conduction study evaluates large fiber function.  However, many times these tests will be normal despite having significant burning, numbness or tingling in the feet. The next test to evaluate these nerve fibers is a skin biopsy. This is a very small biopsy of the skin in the lower extremities and sometimes upper extremities. This test is relatively non painful. Once the piece of skin tissue is obtained it is sent to the lab where it is looked at under a microscope and the nerve fibers are actually counted. If there is a loss of nerve fiber density this would suggest a small fiber neuropathy.

So, what is your diagnosis?

Once all of the information has been obtained and the laboratory studies and imaging have been looked at, your follow up appointment you will be explained what may be happening to your nervous system to cause your symptoms. Once the diagnosis is made, treatment options can be discussed. In the past, treatment options have been extremely limited and it was just a short time ago many neurological diseases had no treatments. However, with the advances of modern medicine and pharmacology many of the untreatable’s now have many options. Your neurologist will explain these options to help you make an educated decision on which therapy you would like to proceed with.

Do treatments have side effects?

Each patient is an individual. Many of the therapeutic medications that we use can be taken without side effects. However, the approach that will be taken is usually to start as a low dose and slowly increase it as needed. This approach minimizes any side effect. Many patients have no side effects at all where a few others may experience them.

Are there other options than medicine?

Medication maybe the number one choice for your condition. However, many times medications only help alleviate the symptoms of your condition. Therefore, it is extremely important to look at the whole body in general. That’s why we feel it’s extremely important to address a healthy nutritional diet, restful sleep, exercise and wellbeing. Utilizing all of these will strengthen your body and help you adapt to your underlining condition.

Are there cures for neurological diseases?

Many of the neurodegenerative diseases have no cure. Treatment and therapies are typically symptomatic or supportive in nature. Some treatments however have been shown to slow the progression of some diseases.

Do you recommend vitamins?

As previously noted, we look at the importance of nutrition in the health of a human being. The

Standard American Diet (SAD Diet) is essentially a non-nutritious diet. Fiber has been removed, artificial sweeteners and sugar have been added as well as coloring and preservatives. In a very healthy organic diet, additional supplementation with vitamins would not be necessary. Unfortunately, very few of us are able to obtain that type of diet. So, yes, vitamin supplements can be extremely helpful and important in trying to maintain a healthy lifestyle. Certain brands maybe more efficient and reliable than others.  Many times focusing on certain foods may fulfill the nutritional requirements of a supplement.

Does insurance cover my care?

Most insurances do cover the office visits and diagnostic procedures, as well as medications. However, this is different for each insurance company. Certain medications may be found on insurance formularies and others may not be covered at all. This is always a conundrum in determining what is the best treatment for you and your condition, rather than using a medication that is recommended by the insurance company. Nutritional supplements are typically not covered. However, the price of a nutritional supplement for an entire year is about half of the cost of a pharmaceutical medication for a month.