JWM Neurology CME Seminar

The neurologists at JWM Neurology are conducting their biennial “Neurology Connection” CME seminar for physicians, nurse practitioners and physician assistants on Saturday, March 8th at the Marten House Hotel and Conference Center in Indianapolis.

Visit our website for a registration brochure with more information including registration details, agenda, speakers and CME credit information.

Welcome Joshua S. Neucks, MD

The physicians at JWM Neurology would like to introduce our new Neurologist, Joshua S. Neucks, MD.

Dr. Neucks received his medical degree from Indiana University School of Medicine in Indianapolis where he also completed his Neurology Residency, serving as Chief Resident. He has two master’s degrees, including a Master of Science in Cellular and Integrative Physiology from IU School of Medicine.

Dr. Neucks sees patients with general neurology problems.

His areas of expertise include:

• Epilepsy and seizures
• EEG and Video EEG
• EMG
• Stroke
• Multiple Sclerosis
• Brain and spinal cord injuries
• Parkinson’s disease and movement disorders
• Neck, back and arm pain
• Headaches
• Alzheimer’s disease
• Botox injections

Central Indiana Neurology Joins JWM Neurology

Central Indiana Neurology (CIN) located in Anderson, Indiana has joined JWM Neurology.

Our collaborative partnership together will enable us to combine and serve a larger geographic area in Central Indiana as well as continue to better serve our patients and referring physicians. Between JWM and CIN, we now have eleven locations including offices in: Indianapolis, Carmel, Mooresville, Franklin, Kokomo, Anderson and Elwood.

JWM welcomes Central Indiana Neurology physicians, Larry Blankenship, MD, Charles Howe, MD, Christopher Rocco, MD, Caroline Stevens, DO and their staff.

Welcome Sara L.P. Schrader, MD

The physicians at JWM Neurology would like to introduce our new Neurologist, Sara L.P. Schrader, MD.

Dr. Schrader received her medical degree from Indiana University School of Medicine in Indianapolis. She completed her Neurology Residency and Clinical Neurophysiology Fellowship at Mayo School of Graduate Medical Education in Phoenix, AZ.

Dr. Schrader is originally from the South Bend area. She recently served as a Major in the United States Air Force as a Staff Neurologist/Neurophysiologist at the San Antonio Military Medical Center in Texas.

Dr. Schrader sees patients with general neurology problems.

Her areas of expertise include:

• Epilepsy and seizures
• EEG and Video EEG
• EMG
• Stroke
• Multiple Sclerosis
• Brain and spinal cord injuries
• Parkinson’s disease and movement disorders
• Neck, back and arm pain
• Headaches
• Alzheimer’s disease

Headaches

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

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?

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

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

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.

Common Questions About CPAP

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.

Why Do My Hands Shake?

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.