JWM Neurology

Headaches

2011-09-28T11:53:00.000-07:00

Keith R. Ridel, MD
JWM Neurologist

Headaches are a common problem not only for adults but also in children of all ages. Most are mild and self limited; caused by hunger, dehydration or stress. However, many patients go on to develop migraines. In adults, a migraine is a throbbing headache on one side of head, lasting more than four hours, that is severe enough to interfere with activities. It is often associated with nausea, vomiting and sensitivity to light and sound. What parents need to realize is that migraine headaches in children are very different in that they are much more variable in their location, quality, severity and associated symptoms.

The vast majority of headaches in adults and children are benign, meaning they are not caused by anything dangerous. However, your doctor must be mindful of dangerous signs and symptoms that could point to a more serious problem causing headaches. Some of these include headaches that:
• Wake the patient from sleep or are worse in the morning on wakening;
• Progressively worsen in severity and frequency despite treatment;
• Cause vision changes, personality changes and weakness or numbness.

There are many treatment options for headaches that can both prevent and treat headaches when they occur.

JWM Neurology Welcomes Saju Abraham, MD

2011-09-22T10:00:00.000-07:00

Neurologist Saju Abraham, MD has joined JWM Neurology.

Dr. Abraham received his medical degree from St. James School of Medicine in Bonaire, Netherland Antilles. He completed his Neurology Residency at the University of Illinois in Chicago and his Epilepsy Fellowship at the University of Michigan in Ann Arbor.

He sees patients with all types of neurological conditions.

His areas of expertise include:

Epilepsy and seizures

EEG and Video EEG

Stroke

Multiple Sclerosis

Brain and spinal cord injuries

Parkinson's disease and movement disorders

Neck, back and arm pain

Headaches

Alzheimer's disease

Tourette Syndrome: What Makes Some Brains Tic?

2010-10-25T12:59:00.000-07:00

Keith R. Ridel, MD
JWM Pediatric Neurologist

Tics are a symptom of Tourette Syndrome. Tourette Syndrome is a disorder where a person has at least one vocal and at least two movement tics for more than one year, usually beginning before puberty. Not every person who has tics has Tourette Syndrome. If the tics last less than one year, the diagnosis is Transient Tic Disorder. Persons with other neurologic or psychiatric disorders may also have tics.

Tics are usually brief movements or sounds. They may be simple actions that we all do, such as blinking or humming, done too often. The tic should look or sound the same each time, at least for a while. Usually, in Tourette’s, tics move to different locations over time. Also, tics may become more complex, such as repeating a certain word or tapping a certain way. Young children may not be aware of their tics, but older children and adults often feel a sensation inside, an urge to tic. Holding a tic in may cause stress; letting it out may relieve it.

No one knows for sure what is different about the brain of a person who has Tourette’s. The brain contains 10 billion neurons that communicate with one another in complex ways, controlling thoughts, emotions, movements, and body functions. Studying a living brain to see why it behaves as it does is challenging for neuroscientists, but there are some new clues about why some brains tic.

Information travels to our brain through nerves in our faces, bodies, arms, and legs.

For example, information that a bug is sitting on my arm must travel from the skin on my arm, up my arm to my spinal cord, then up to my brain.

Then it must travel to the cortex, the surface of my brain, so I can become conscious of the location of the sensation (left forearm), the meaning of the sensation (a hungry mosquito), and perhaps some emotions associated with the sensation (fear, irritation).

Then my cortex will form a plan (rotate left arm gently, swat mosquito with right hand) and issue a command to execute the action (rapid movement of flattened right hand onto mosquito on left forearm).

Beneath the brain’s surface are some important structures that communicate within the brain in complex circuits. These areas affect how the information about the mosquito gets to the surface of the brain. These areas also affect how we move in response to sensations. One of these areas that seems to be important in Tourette’s is called the Striatum (rhymes with “I ate ‘em”). The striatum is part of many important brain circuits. Although the striatum looks pretty much the same in people who tic and people who don’t (you can’t diagnose Tourette Syndrome with a brain MRI), there are some new research brain scans that show that areas of the striatum “light up” when someone tics, or tries to hold their tics in. In Tourette’s, it may be that the striatum works differently, in how it regulates sensory information coming in, in how it affects urges to respond to those sensations, or both.

Certain brain chemicals called neurotransmitters (used by neurons to communicate with each other) also appear to be abnormal in the brains of persons with Tourette’s. These include dopamine, which is involved in many movement disorders, and serotonin, which is involved in many mood disorders, such as depression and obsessive compulsive disorder. Currently, these chemical differences are difficult to measure. However, for many persons with Tourette’s, medicines, which block dopamine or increase serotonin can be helpful.

Tourette’s is an area of active research. New studies should increase our knowledge of what makes some people tic. Children with tics are often sent to child neurologists for evaluation and management.

Pediatric Neurologist Dr. Keith Ridel Joins JWM Neurology

2010-07-22T05:41:00.000-07:00

Pediatric Neurologist, Keith Ridel MD, has joined JWM Neurology.

Dr. Ridel received his medical degree from the University of Cincinnati College of Medicine in Cincinnati, Ohio. He completed his Pediatric residency and Child Neurology fellowship at Cincinnati Children’s Hospital Medical Center in Cincinnati, Ohio.

Dr. Ridel sees infants, children and teenagers with general neurology problems.

His areas of expertise include:
• Seizure
• Headache
• Sleep disorders
• Seizures
• Tics and movement disorders
• Neuromuscular disorders
• Neck, back and arm pain
• Brain and spinal cord injuries
• Genetic neurological disorders
• EEG/Video EEG testing

Dr. Adam Fisch Joins JWM Neurology

2009-08-20T09:14:00.000-07:00

Dr. Adam Fisch joined JWM Neurology and is a board certified neurologist and sleep disorders medicine physician.

He has special interests in sleep medicine/EEG/EMG. Dr. Fisch is originally from Indianapolis and received his medical degree from Indiana University School of Medicine. He completed his neurology residency and sleep medicine fellowship at Washington University School of Medicine in St. Louis, Missouri.

Dr. Fisch is an avid educator and has lectured to medical students, rehabilitation therapists and neurology residents at many different universities. He also recently authored a book titled Neuroanatomy: Draw it to Know It, published by Oxford University Press, for which he won the “2009 Washington University in St. Louis Leonard Berg Prize for Research During Residency” Award. He has since created neuroanatomy tutorials available on http://www.drawittoknowit.com/.

Dr. Fisch sees patients with general neurology problems and sleep disorders.

Free Women's Sleep Disorders Seminar

2009-04-29T13:53:00.000-07:00

JWM Neurology & Holder Mattress Factory Present a FREE Seminar:

"Common Treatable Sleep Disorders in Women"

Having trouble sleeping? You’re not alone! In this free seminar, Meredith Cousin, MD, a neurologist and sleep disorders specialist with JWM Neurology will talk about conditions that
influence sleep patterns and keep you from waking up rested. From sleep apnea and Restless Legs Syndrome to insomnia and hormone/pregnancy-related sleep issues, you’ll learn about common sleep disorders that can be treated.

Holder Mattress experts will demonstrate the correlation between a properly constructed mattress and a good night's sleep.

• Thursday, May 21st
• 6:00 p.m.
• Holder Mattress Factory:
1422 S. Rangeline Rd., Carmel, IN
(116th St. and Rangeline Road)

Space is limited so please R.S.V.P.

• Holder Mattress 317-848-2939
• JWM Neurology 317-308-2828, ext. 1604

Refreshments will be served.

Common Questions About CPAP

2009-01-02T12:29:00.000-08:00

If you’ve been diagnosed with sleep apnea, chances are good that you have been told to wear a CPAP mask while you sleep in order to treat the condition. CPAP is an acronym that stands for Continuous Positive Airway Pressure. Typically, a face mask is connected to a pump and forces air into the nasal passages to stimulate proper breathing.

Here are some common questions our sleep disorders physicians are asked about CPAP along with their answers. If you are having trouble with your CPAP be sure to speak to your physician. Many sleep disorders labs have regularly scheduled CPAP clinics where patients can go and get their problems worked out.

My CPAP mask is uncomfortable and does not fit properly. What should I do?
Often times, patients have to try out a few different masks before they get a proper fit. Masks can also be individually adjusted to fit comfortably. If you are having problems contact your health care provider to see what can be done.

Is there one CPAP mask that fits all people?
No, unfortunately there is not. Everyone’s facial shape and features are different, therefore there are a variety of masks available. It’s important you find the right one with the proper fit to ensure you are able to wear your CPAP consistently.

Do I need to wear my CPAP every night?
Consistency is the key in treating disorders such as sleep apnea. Therefore, it’s important to wear your mask every night. The more you wear it, the more you’ll get used to sleeping comfortably. Sleep apnea actually causes you to stop breathing several times during sleep and is therefore a very dangerous condition. It can cause stroke or heart attack if left untreated.

My throat gets dry when I use my CPAP. Is this normal?
Yes, this is a common complaint. Many CPAP machines come with a humidifier control which helps control dry mouth. If your particular model does not have this function, ask your health care provider about upgrading or trading in your machine.

How long will it take my CPAP to become effective?
Everyone is different, however, it can range from several weeks to a few months. It all depends on your diagnosis. The key is to wear your CPAP every night (or day if you are a shift worker) once you’re fitted. It will be uncomfortable and awkward at first, but once patients get into the habit, it becomes a routine part of sleep hygiene.

Pregnancy and Sleep

2008-06-24T14:02:00.000-07:00

Pregnant and sleeping for two or more? If so, your sleep quality may change – especially by your third trimester.

Increased sleep complaints during pregnancy are often due to endocrine and physiologic changes in the body. The increase in progesterone that accompanies pregnancy naturally increases fatigue, raises body temperature, increases respiratory rate and intensifies the need for frequent urination. Physical changes such as the increase in abdominal mass and vascular load all lead to poor sleep quality.

Often during the first trimester, there is an increase in total sleep time and the need for naps; however, sleep quality can be poor due to frequent awakenings during the night.

Initial changes in sleep patterns typically occur in the first 12 weeks of pregnancy and then increase during the third trimester and early postpartum weeks. Be aware of:

slight decreases in Rapid Eye Movement (REM) sleep
decrease in deep sleep
decrease in sleep efficiency
increased awakenings after initially falling asleep

Women who have never before snored may begin to do so when pregnant. Snoring in expectant mothers is caused from inflammation in the nasal passages. This can lead to Obstructive Sleep Apnea, caused by a blockage in the airway, which is a very dangerous condition. It can cause death if not treated.

A condition known as Restless Legs (RLS) can also develop during the third trimester of pregnancy which causes an uncontrolled urge to move the legs. A contributing factor often may be iron or folic acid deficiency, so be sure to tell your doctor if you have these symptoms.

The best tips for a good night’s sleep when expecting: learn to relax utilizing breathing and other relaxation techniques. A warm shower or bath may also be helpful.

Why Do My Hands Shake?

2008-04-11T13:58:00.000-07:00

Essential Tremor is a common neurologic disorder affecting millions of people. It is not a dangerous condition, however, while it is not life-threatening, those who have tremors may feel self-conscious, and the tremors may make it difficult to perform everyday activities. It generally affects adults over the age of 65, but there are cases of Essential Tremor in youth.

Symptoms may include any of the following:

1. Parts of your upper body, (such as the head, hands, voice, eyelids, and arms) shake uncontrollably, and worsen when performing tasks such as holding a glass, talking, eating, writing.
2. Shaking worsens with stress and caffeine intake.
3. Shaking diminishes while resting, and disappears during sleep.
4. Family members may have a history of tremor.

There is currently no test to pinpoint Essential Tremor. MRIs and other scans usually are normal. Your neurologist can rule out other possible causes of tremors, such as side effects of certain medications you may be taking or other underlying medical conditions.

Currently there is no cure, but if you find that your tremors are making your everyday tasks difficult, medications are available to alleviate the tremors. There are also techniques you can use to reduce stress – which may help lessen the severity of symptoms. Surgery is also an option for severe cases. However, if you experience other symptoms in addition to the tremors, you should contact your physician immediately.

Sleep and Menopause, An Imperfect Match

2008-02-20T11:47:00.000-08:00

If you’re among the 40-50 million women in America going through menopause, your sleep quality may not be what it once was. At least 40% of women suffer sleep problems resulting from menopausal-related symptoms. Here are some interesting statistics that may affect you. According to the National Sleep Foundation, as many as 61% of menopausal and post-menopausal women polled reported frequent insomnia. Most women also find that the time between turning out the lights and actually falling asleep is increased during menopause. About 20% of women in menopause sleep less than 6 hours a night. These issues, along with frequent arousals throughout the night, can cause fatigue.

Why does sleep quality lessen with menopause?

Decreased production of estrogen is the culprit for many symptoms of menopause, including hot flashes. Menopausal women often have difficulty with sleep efficiency because hot flashes cause frequent awakenings during the night. Most women may experience hot flashes for about a year, but 25% can experience them for up to 5 years.

Snoring, which can lead to Obstructive Sleep Apnea (OSA), is also more prevalent and severe in post-menopausal women. With OSA, breaks occur in your breathing while you are asleep. It’s a very serious but treatable sleep disorder and one which you should speak to your physician about right away.

How can you sleep better?

There are solutions your physician can recommend to help you sleep better. Hormone Replacement Therapy (HRT) at low doses can help minimize symptoms of menopause and therefore lessen the effects on poor sleep. However, there are associated risks, and your doctor can decide if this treatment is right for you. There are other medications and supplements he/she can prescribe as well.

The best things you can do on your own to help you sleep better during menopause are:

1. exercise regularly, but never within a few hours of bedtime,
2. avoid heavy, spicy or acidic meals, alcohol, nicotine, and caffeine before bedtime,
3. wear lightweight clothes to bed, and
4. control your nighttime environment with comfortable temperatures. For example, use a fan to help circulate the air.

If your symptoms become uncomfortable, you cannot find ways to help yourself sleep better, or if you start to have feelings of depression or anxiety, contact your physician to map out a plan.

Recognize the Risk Factors for Stroke and Stroke Symptoms

2008-01-22T17:05:00.000-08:00

There are many risk factors for stroke, including high blood pressure, cigarette smoking, age, family history of stroke, and gender. Unfortunately, strokes affect men and women at any age, not just the elderly. Although more men get strokes than women, the death rate for women is much higher than for men. Women, especially under the age of 55 can have additional risk factors for stroke that may include:

- Having migraines accompanied by flashing spots or blind spots,
- Having diabetes, lupus or other autoimmune diseases,
- Having had a miscarriage or some other clotting disorder,
- Taking birth control pills, even if the pills are low in estrogen, and
- Using hormone replacement therapy.

What symptoms do you need to recognize if you believe that a loved one may be having a stroke? To easily identify common symptoms in both men and women, ask the person to:

1. Smile. Look to see if one side of the face droops.
2. Raise both arms. Does one arm hang downward?
3. Repeat a simple sentence. Are they slurring words? Can they repeat the whole sentence?
4. Do they experience difficulty seeing in one or both of their eyes?
5. Do they experience a severe headache and not know why?
6. Do they have trouble walking or keeping their balance?

Sometimes women may have additional possible stroke symptoms which can include:
- Hiccups
- Nausea
- Face and limb pain
- Chest pain
- Shortness of breath
- Palpitations
- General overall weakness

If you suspect you or your loved one is having a stroke, call 9-1-1 immediately. Time is a critical factor. The longer you wait, the more serious the consequences.

For Women, Getting a Good Night’s Sleep is Not Just a Dream

2008-01-08T11:46:00.000-08:00

If you’re a woman, getting a poor night’s sleep is more common than you think, and you are not alone. According to the National Sleep Foundation’s 2007 Sleep in America survey, 60% of women say they only get a good night’s sleep a few nights per week or less. Sixty-seven percent of women experienced sleep problems at least a few nights each week, while 46% experience sleep problems every night.

As a woman, you need to realize that a bad night’s sleep doesn’t “just go with the territory” in a busy daily schedule. Getting a good night’s sleep is vital to your health and taking care of your responsibilities. Women with poor sleep habits may experience daytime sleepiness and other risks such as:

High stress levels
Increased health issues and weight gain
Drowsy driving (which can lead to motor vehicle accidents)
Decreased ability to concentrate
Poor job/school performance

Rather than relying on caffeine, sugar or nicotine to get you through the waking hours, create a healthy sleeping pattern in your life by:

Maintaining a regular bedtime and wake time throughout the week (including weekends).
Exercising regularly (never within a few hours of bedtime).
Staying away from long naps (those longer than 30 minutes).
Considering the bed only for sleeping and sexual intercourse.
Avoiding heavy or spicy meals, alcohol, nicotine and caffeine at bedtime.
Developing a routine in getting ready for bed – including relaxation time and soothing activities.
Getting adequate exposure to bright light during the day.
Wearing comfortable clothes to bed.
Controlling your nighttime environment with comfortable temperatures, noise and light levels and a comfortable bed/mattress.

Sleep problems for women tend to increase with age. Factors such as PMS, pregnancy, motherhood, pain and menopause also contribute to poor sleep habits.

Working the Night Shift Can Affect Sleep Patterns

2007-12-04T06:42:00.000-08:00

Do you work the night shift? If so, it could be disrupting your sleep habits and patterns. But, don’t worry – help is available! For the purposes of this post, we’ll define shift work as anything performed outside the hours of 9:00 am and 6:00 pm.

The underlying problem with shift work is that our bodies are designed to sleep at night. Shift workers “sleeping at the wrong time” often have less hours of sleep at a lower quality. This can lead to serious health problems, accidents on the job, and traffic accidents. Sleepy drivers take higher risks and have slower reaction time. If you work the night shift, be aware of these judgment errors that often occur:
· Overestimated performance
· Slower reaction time
· Decreased peripheral vision
· Poor multitasking
· Decreased vigilance
· Decline in motor dexterity

Here are some hygiene tips to help you regulate your sleep:
· Nap before coming to work, or immediately after work prior to driving home.
· Expose yourself to bright light prior to starting work.
· Limit your exposure to light upon returning home in the morning.
· Continue this schedule on your nights “off” if possible.
· Develop a relaxing sleep ritual before bed.
· Sleep in a cool, dark, quiet environment.
· Protect your sleep time.
· Get adequate sleep prior to your shift.

If you still find you have problems staying awake/focusing during your shift and/or falling asleep when you get home, talk to your physician. Sleep disorders are treatable and controllable.

Neuro Tip: Over-the-Counter Headache Remedies May Actually Aggravate Your Headaches

2007-11-07T07:43:00.000-08:00

If you find yourself constantly taking over-the-counter remedies to relieve headaches, you may want to reconsider. Not all headaches are alike, and not all can be controlled with these medications. Some can even cause you to have what are called “rebound” or recurring headaches. While television commercials and magazine ads continue to tout that these medications can relieve your pain, most only temporarily mask the symptoms. You should check with your physician before you take them. Many of these medications contain caffeine, which can cause your headache to worsen because of its stimulant side effects.

Here’s a quick lesson in headaches. They can be classified into categories and are often treated differently:
· Migraine
· Tension
· Cluster
· Hormone-related
· Rebound

Migraine headaches can be debilitating and often occur more often in women. They can be caused by stress, hormone fluctuation and changes in barometric pressure. Tension headaches can affect anyone, can occur often and regularly and may be caused by fatigue, stress and certain medical conditions. Cluster headaches occur in groups, so patients may suffer from multiple headaches in a day. Men are more susceptible to these headaches than women.

Hormone-related headaches are caused by fluctuation in the body’s hormones and are more common in women. Men, however, can suffer from these as well. These are often precipitated by women’s menstrual cycles, use of birth control pills, and pregnancy. Rebound headaches can occur from taking the wrong type of medication – often those purchased over-the-counter. Not only can these medications cause rebound headaches, they can cause other health problems down the road.

The lessen here is to understand which type of headache you have before you take medication. Headaches can be controlled but you need to seek appropriate treatment by a healthcare professional. Think of this comparison: You wouldn’t treat the stomach flu with over-the-counter sinus medication. Headaches are no exception. Different headaches require different treatments. Talk to your physician if you suffer from headaches.

Memory Loss

2007-10-26T06:31:00.000-07:00

We had many people visit our booth at the Senior Fair in Indianapolis to get “mini memory assessments” conducted by our JWM Neurology physician and nurse practitioner.

Several people that stopped by were somewhat reluctant to find out “if they had memory issues or problems”. While we certainly understand the anxiety that accompanies this, we encourage people to proactively take charge of their health.

Just because you have a memory issue does not mean that you have Alzheimer’s disease. It’s a misconception that many people believe. Issues with memory can be due to a number of factors – many of which can be controlled. Here are just a few things that can cause temporary memory issues:

· Sleep disorders
· Taking various types of medications
· Alcohol consumption
· Migraine headaches
· Depression
· Parkinson’s disease
· Other health conditions/diseases

If you are having memory problems, you should contact your physician for a consultation. Have a family member accompany you to the appointment to function as your eyes and ears.

Having Trouble Sleeping?

2007-10-09T11:18:00.000-07:00

If you’re having trouble sleeping, you’re not alone. According to the National Sleep Foundation, more than 40 million Americans suffer from sleep disorders. Some of the more common sleep problems include: sleep apnea (stops breathing during sleep), insomnia (inability to fall asleep), narcolepsy (falling asleep during waking hours), hypersomnia (causes excessive sleepiness) and Restless Legs Syndrome (causes a crawling or tingling pain while trying to fall asleep).

If you suffer from any of these problems, see your physician right away. These conditions are all controllable.

Here are some hygiene tips that may help you get a better night’s sleep.

· Maintain a regular sleep/wake schedule.
· Avoid caffeine, especially 4 to 6 hours before bedtime.
· Avoid nicotine, especially near bedtime.
· Avoid alcohol before sleep.
· Exercise regularly; avoid vigorous exercise within 3 to 4 hours of sleep.
· Avoid heavy meals before bedtime.

Join Us At Indianapolis Senior Expo

2007-09-24T09:34:00.000-07:00

JWM Neurology will have an educational exhibit at the Indianapolis Senior Expo on Thursday, October 4th. The Expo will take place at the Indiana State Fairgrounds from 8:30 am to 2:00 pm. For more information, visit www.seniorexpos.com and click on “Indianapolis”. It’s always a great place with lots of vendors and booths full of information for mature adults.

Meet JWM Neurology Sleep Disorder’s Specialist, Raymond Loffer, MD and Nurse Practitioner, Gina Davis. They will be on hand to answer your questions about sleep disorders and neurological diseases and conditions. We will also be handing out sleep disorder quizzes and memory quizzes.

2007-07-09T13:37:00.001-07:00

Welcome to the JWM Neurology blog. The goal of our forum is to provide up-to-date news and information about neurology-related topics as well as tips to help patients manage their neurologic conditions.

Some of the items we’ll cover include:
• Stroke
• Alzheimer’s disease
• Headache
• Epilepsy
• Parkinson’s disease
• Sleep disorders
• Multiple sclerosis
• Neuro-ophthalmology
• Neck, back, and arm pain
• Tremor
• Brain and spinal cord injuries
• Brain tumors
• Nerve and muscle disorders
• JWM clinical research trials
• Neurology tests and how to prepare for them

We want our blog to be a valuable tool and thank you for viewing it. Feel free to visit us at http://www.jwmneuro.com/ for further information.