Conditions & Treatments

Amyotrophic lateral sclerosis (ALS), also known as, Lou Gehrig's disease

Early signs and symptoms:

• Difficulty walking or doing your normal daily activities
• Tripping and falling
• Weakness in your leg, feet or ankles
• Hand weakness or clumsiness
• Slurred speech or trouble swallowing
• Muscle cramps and twitching in your arms, shoulders and tongue
• Difficulty holding your head up or keeping good posture

ALS often starts in the hands, feet or limbs, and then spreads to other parts of your body. As the disease advances and nerve cells are destroyed, your muscles progressively weaken. This eventually affects chewing, swallowing, speaking and breathing.

ALS doesn't usually affect your bowel or bladder control, your senses or your thinking ability. It's possible to remain actively involved with your family and friends.

Diagnosis
Amyotrophic lateral sclerosis (ALS) is difficult to diagnose early because it may mimic several other neurological diseases. Tests to rule out other conditions may include:

• Electromyogram (EMG). During an EMG, your doctor inserts a needle electrode through your skin into various muscles. The test evaluates the electrical activity of your muscles when they contract and when they're at rest.
• Nerve conduction study. This study measures your nerves' ability to send impulses to muscles in different areas of your body. This test can determine if you have nerve damage or certain muscle diseases.
• Magnetic resonance imaging (MRI). Using radio waves and a powerful magnetic field, an MRI produces detailed images of your brain and spinal cord. An MRI can spot spinal cord tumors, herniated disks in your neck or other conditions that may be causing your symptoms.
• Blood and urine tests. Analyzing samples of your blood and urine in the laboratory may help your doctor eliminate other possible causes of your signs and symptoms.
• Spinal tap (lumbar puncture). Sometimes a specialist may remove a sample of your spinal fluid for analysis. A specialist inserts a small needle between two vertebrae in your lower back and removes a small amount of cerebrospinal fluid for testing in the laboratory.
• Muscle biopsy. If your doctor believes you may have a muscle disease rather than ALS, you may undergo a muscle biopsy. While you're under local anesthesia, a small portion of your muscle is removed and sent to a lab for analysis.

Treatment
Treatments can't reverse the damage of ALS, but they can slow the progression of symptoms, prevent complications and make you more comfortable and independent.

Two medications are currently approved by the Food and Drug Administration for the treatment of ALS.

Riluzole (Rilutek) — This drug appears to slow the disease's progression in some people, perhaps by reducing levels of a chemical messenger in the brain (glutamate) that's often present in higher levels in people with ALS. Riluzole is taken as a pill and may cause side effects such as dizziness, gastrointestinal conditions and liver function changes.

Edaravone (Radicava) — The FDA approved edaravone in 2017 based on six-month clinical trial that showed it reduced the decline in daily functioning associated with ALS. The drug is given via intravenous infusion (typically 10-14 days in a row, once a month), and side effects may include bruising, gait disturbance, hives, swelling and shortness of breath.

Aneurysms

An aneurysm is the abnormal bulging of an artery cause by weakness in the vessel wall. As the aneurysm grows, it often results in symptoms such as severe headaches and nausea. And if left untreated, it can potentially rupture, resulting in severe disability, cognitive loss, and death

In addition to the early detection and diagnosis of aneurysms, Health First Neurosciences provides a variety of traditional and cutting-edge techniques for the treatment of aneurysms. This includes surgical clipping, endovascular coiling, and endovascular embolization.

Plus, our interventional neuroradiologists are the only two in Brevard and Indian River counties to provide minimally invasive endovascular surgery on brain aneurysm repair. And patients can take comfort in knowing that our team is available 24/7 in the event of a ruptured aneurysm or other medical emergency.

Brain Tumors

A brain tumor is a mass or growth of abnormal cells in your brain or close to your brain.

Many different types of brain tumors exist. Some brain tumors are noncancerous (benign), and some brain tumors are cancerous (malignant). Brain tumors can begin in your brain (primary brain tumors), or cancer can begin in other parts of your body and spread to your brain (secondary, or metastatic, brain tumors).

Symptoms
The signs and symptoms of a brain tumor vary greatly and depend on the brain tumor's size, location and rate of growth.

General signs and symptoms caused by brain tumors may include:

• New onset or change in pattern of headaches
• Headaches that gradually become more frequent and more severe
• Unexplained nausea or vomiting
• Vision problems, such as blurred vision, double vision or loss of peripheral vision
• Gradual loss of sensation or movement in an arm or a leg
• Difficulty with balance
• Speech difficulties
• Confusion in everyday matters
• Personality or behavior changes
• Seizures, especially in someone who doesn't have a history of seizures
• Hearing problems

Diagnosis
If it's suspected that you have a brain tumor, your doctor may recommend a number of tests and procedures, including:

• A neurological exam. A neurological exam may include, among other things, checking your vision, hearing, balance, coordination, strength and reflexes. Difficulty in one or more areas may provide clues about the part of your brain that could be affected by a brain tumor.
• Imaging tests. Magnetic resonance imaging (MRI) is commonly used to help diagnose brain tumors. In some cases a dye may be injected through a vein in your arm during your MRI study.
• Other imaging tests may include computerized tomography (CT) scan and positron emission tomography (PET).
• Tests to find cancer in other parts of your body. If it's suspected that your brain tumor may be a result of cancer that has spread from another area of your body, your doctor may recommend tests and procedures to determine where the cancer originated. One example might be a CT scan of the chest to look for signs of lung cancer.
• Collecting and testing a sample of abnormal tissue (biopsy). A biopsy can be performed as part of an operation to remove the brain tumor, or a biopsy can be performed using a needle.

Treatment
Treatment for a brain tumor depends on the type, size and location of the tumor, as well as your overall health and your preferences.

• Surgery
• Radiation therapy
• Radiosurgery
• Chemotherapy
• Targeted drug therapy

Your physician will determine the best treatment plan depending on your specific case.

Dementia/Alzheimer’s Disease

Alzheimer's disease is the most common cause of dementia — a group of brain disorders that cause the loss of intellectual and social skills. In Alzheimer's disease, the brain cells degenerate and die, causing a steady decline in memory and mental function.

Symptoms

Memory

• Repeat statements and questions over and over, not realizing that they've asked the question before
• Forget conversations, appointments or events, and not remember them later
• Routinely misplace possessions, often putting them in illogical locations
• Get lost in familiar places
• Eventually forget the names of family members and everyday objects
• Have trouble finding the right words to identify objects, express thoughts or take part in conversations

Changes in personality and behavior

Brain changes that occur in Alzheimer's disease can affect the way you act and how you feel. People with Alzheimer's may experience:

• Depression
• Apathy
• Social withdrawal
• Mood swings
• Distrust in others
• Irritability and aggressiveness
• Changes in sleeping habits
• Wandering
• Loss of inhibitions
• Delusions, such as believing something has been stolen

Diagnosis
There's no specific test today that confirms you have Alzheimer's disease. Your doctor will make a judgment about whether Alzheimer's is the most likely cause of your symptoms based on the information you provide and results of various tests that can help clarify the diagnosis.

Physical exam
Your doctor will perform a physical exam, and is likely to check your overall neurological health by testing your:

• Reflexes
• Muscle tone and strength
• Ability to get up from a chair and walk across the room
• Sense of sight and hearing
• Coordination
• Balance
• Lab tests

Blood tests may help your doctor rule out other potential causes of memory loss and confusion, such as thyroid disorders or vitamin deficiencies.

Brain imaging

• Magnetic resonance imaging (MRI). An MRI uses radio waves and a strong magnetic field to produce detailed images of your brain. MRIs are used to rule out other conditions that may account for or be adding to cognitive symptoms. In addition, they may be used to assess whether shrinkage in brain regions implicated in Alzheimer's disease has occurred.
• Computerized tomography (CT). A CT scan produces cross-sectional images (slices) of your brain. It's currently used chiefly to rule out tumors, strokes and head injuries.
• Positron emission tomography (PET). During a PET scan, you'll be injected in a vein with a low-level radioactive tracer. The tracer may be a special form of glucose (sugar) that shows overall activity in various brain regions.
• Cerebrospinal fluid. In special circumstances such as rapidly progressive dementia or very young onset dementia, a cerebrospinal fluid examination may be performed. The spinal fluid can be tested for biomarkers that indicate the likelihood of Alzheimer's disease.

Treatment
Current Alzheimer's medications can help for a time with memory symptoms and other cognitive changes. Two types of drugs are currently used to treat cognitive symptoms:

• Cholinesterase inhibitors. These drugs work by boosting levels of a cell-to-cell communication by providing a neurotransmitter (acetylcholine) that is depleted in the brain by Alzheimer's disease. The improvement is modest. Cholinesterase inhibitors can improve neuropsychiatric symptoms, such as agitation or depression, as well.
• Memantine (Namenda). This drug works in another brain cell communication network and slows the progression of symptoms with moderate to severe Alzheimer's disease. It's sometimes used in combination with a cholinesterase inhibitor. Side effects may include constipation, dizziness and headache.

Epilepsy

Epilepsy is a central nervous system disorder (neurological disorder) in which nerve cell activity in the brain becomes disrupted, causing seizures or periods of unusual behavior, sensations and sometimes loss of consciousness.

Symptoms
Because epilepsy is caused by abnormal activity in brain cells, seizures can affect any process your brain coordinates. Seizure signs and symptoms may include:

• Temporary confusion
• A staring spell
• Uncontrollable jerking movements of the arms and legs
• Loss of consciousness or awareness
• Psychic symptoms

Symptoms vary depending on the type of seizure. In most cases, a person with epilepsy will tend to have the same type of seizure each time, so the symptoms will be similar from episode to episode.

When to see a doctor
Seek immediate medical help if any of the following occurs:

• The seizure lasts more than five minutes
• Breathing or consciousness doesn't return after the seizure stops
• A second seizure follows immediately
• You have a high fever
• You're experiencing heat exhaustion
• You're pregnant
• You have diabetes
• You've injured yourself during the seizure
• If you experience a seizure for the first time, seek medical advice.

Diagnosis
To diagnose your condition, your doctor will review your symptoms and medical history. Your doctor may order several tests to diagnose epilepsy and determine the cause of seizures.

• Neurological examination. Your doctor may test your behavior, motor abilities, mental function and other areas to diagnose your condition and determine the type of epilepsy you may have.
• Blood tests. Your doctor may take a blood sample to check for signs of infections, genetic conditions or other conditions that may be associated with seizures.

Your doctor may also suggest tests to detect brain abnormalities, such as:

• Electroencephalogram (EEG). This is the most common test used to diagnose epilepsy. In this test, doctors attach electrodes to your scalp with a paste-like substance. The electrodes record the electrical activity of your brain.
• Computerized tomography (CT) scan. A CT scan uses X-rays to obtain cross-sectional images of your brain. CT scans can reveal abnormalities in your brain that might be causing your seizures, such as tumors, bleeding and cysts.
• Magnetic resonance imaging (MRI). An MRI uses powerful magnets and radio waves to create a detailed view of your brain. Your doctor may be able to detect lesions or abnormalities in your brain that could be causing your seizures.
• Functional MRI (fMRI). A functional MRI measures the changes in blood flow that occur when specific parts of your brain are working. Doctors may use an fMRI before surgery to identify the exact locations of critical functions, such as speech and movement, so that surgeons can avoid injuring those places while operating.
• Positron emission tomography (PET). PET scans use a small amount of low-dose radioactive material that's injected into a vein to help visualize active areas of the brain and detect abnormalities.
• Single-photon emission computerized tomography (SPECT). This type of test is used primarily if you've had an MRI and EEG that didn't pinpoint the location in your brain where the seizures are originating.
• Neuropsychological tests. In these tests, doctors assess your thinking, memory and speech skills. The test results help doctors determine which areas of your brain are affected.

Treatment
Doctors generally begin by treating epilepsy with medication. If medications don't treat the condition, doctors may propose surgery or another type of treatment.

Migraines

A migraine can cause severe throbbing pain or pulsing sensation, usually on just one side of the head. It's often accompanied by nausea, vomiting, and extreme sensitivity to light and sound.

Migraine attacks can cause significant pain for hours to days and can be so severe that the pain is disabling.

Symptoms
Migraines often begin in childhood, adolescence or early adulthood. Migraines may progress through four stages: pro-drome, aura, headache and post-drome, though you may not experience all stages.

Pro-drome
One or two days before a migraine, you may notice subtle changes that warn of an upcoming migraine, including:

• Constipation
• Mood changes, from depression to euphoria
• Food cravings
• Neck stiffness
• Increased thirst and urination
• Frequent yawning

Aura
Aura may occur before or during migraines. Most people experience migraines without aura.

Each of these symptoms usually begins gradually, builds up over several minutes and lasts for 20 to 60 minutes. Examples of migraine aura include:

• Visual phenomena, such as seeing various shapes, bright spots or flashes of light
• Vision loss
• Pins and needles sensations in an arm or leg
• Weakness or numbness in the face or one side of the body
• Difficulty speaking
• Hearing noises or music
• Uncontrollable jerking or other movements
• Sometimes, a migraine with aura may be associated with limb weakness (hemiplegic migraine).

Attack
A migraine usually lasts from four to 72 hours if untreated. The frequency with which headaches occur varies from person to person. Migraines may be rare, or strike several times a month. During a migraine, you may experience:

• Pain on one side or both sides of your head
• Pain that feels throbbing or pulsing
• Sensitivity to light, sounds, and sometimes smells and touch
• Nausea and vomiting
• Blurred vision
• Lightheadedness, sometimes followed by fainting
• Post-drome

Post-drome
Post-drome occurs after a migraine attack. You may feel drained and washed out, while some people feel elated. For about 24 hours, you may also experience:

• Confusion
• Moodiness
• Dizziness
• Weakness
• Sensitivity to light and sound

When to see a doctor
Migraines are often undiagnosed and untreated. If you regularly experience signs and symptoms of migraine attacks, keep a record of your attacks and how you treated them. Then make an appointment with your doctor to discuss your headaches.

See your doctor immediately or go to the emergency room if you have any of the following signs and symptoms, which may indicate a more serious medical problem:

• An abrupt, severe headache like a thunderclap
• Headache with fever, stiff neck, mental confusion, seizures, double vision, weakness, numbness or trouble speaking
• Headache after a head injury, especially if the headache gets worse
• A chronic headache that is worse after coughing, exertion, straining or a sudden movement
• New headache pain if you're older than 50

Treatment
Treatment is dependent on the patient and doctor recommendation. Some treatment options include:

• OnabotulinumtoxinA (Botox)
• Pain relievers (such as Advil, Motrin IB, etc)
• Triptans
• Anti-seizure drugs
• Antidepressants

Multiple Sclerosis

Multiple sclerosis (MS), is a long-lasting disease that can affect your brain, the optic nerves in your eyes and spinal cord. It can cause problems with balance, basic body functions, muscle control and vision.

The effects are often different for everyone who has this condition. Some people have mild symptoms and do not require treatment while others may have trouble getting around and performing daily tasks.

MS happens when your immune system attacks myelin, a fatty material which wraps around your nerve fibers to protect them. Without this outer shell, your nerves become damaged and scar tissue may form.

Damage from this means your brain can’t send signals through your body correctly. Your nerves also don’t work as they should to help you move and feel. Because of this, you may have symptoms like:

• Blurred or double vision
• Depression
• Feeling tired
• Muscle weakness or spasms
• Numbness and tingling
• Pain
• Poor bladder or bowel control
• Problems focusing or remembering
• Sexual problems
• Trouble walking

The first symptoms often appear between the ages of 20 and 40.

Some people, after suffering from the first symptoms, may experience “attacks” or “relapses,” when the condition gets noticeably worse. Typically, the relapses are followed by times of recovery when symptoms improve. However, for some, the disease continues to worsen over time.

In recent years, scientists have found many new treatments that can help prevent relapses and slow the effects of this condition. Comprehensive MS care begins with the diagnosis and lasts a lifetime. Learn how to work with our Health First Medical Group Neuroscience team to reduce disease activity, manage symptoms and maintain your quality of life.

In addition to the early detection and diagnosis of MS, Health First Neurosciences provides a variety of traditional and cutting-edge techniques for the treatment of MS. Take comfort in knowing you are in good hands and that our team is available 24/7 in the event of a medical emergency.

Support Groups
Click here to access the Brevard County Eau Gallie MS Self-Help Group website
Click here to access the Mid-Florida National MS Society Chapter website

Resources
Click here to access the National Multiple Scleorsis Society website

Parkinson’s Disease

Parkinson's disease is a progressive disorder of the nervous system that affects movement. It develops gradually, sometimes starting with a barely noticeable tremor in just one hand.

Symptoms
Parkinson's signs and symptoms may include:

• Tremor. A tremor, or shaking, usually begins in a limb, often your hand or fingers. You may notice a back-and-forth rubbing of your thumb and forefinger, known as a pill-rolling tremor. One characteristic of Parkinson's disease is a tremor of your hand when it is relaxed (at rest).
• Slowed movement (bradykinesia). Over time, Parkinson's disease may reduce your ability to move and slow your movement, making simple tasks difficult and time-consuming. Your steps may become shorter when you walk, or you may find it difficult to get out of a chair. Also, you may drag your feet as you try to walk, making it difficult to move.
• Rigid muscles. Muscle stiffness may occur in any part of your body. The stiff muscles can limit your range of motion and cause you pain.
• Impaired posture and balance. Your posture may become stooped, or you may have balance problems as a result of Parkinson's disease.
• Loss of automatic movements. In Parkinson's disease, you may have a decreased ability to perform unconscious movements, including blinking, smiling or swinging your arms when you walk.
• Speech changes. You may have speech problems as a result of Parkinson's disease. You may speak softly, quickly, slur or hesitate before talking. Your speech may be more of a monotone rather than with the usual inflections.
• Writing changes. It may become hard to write, and your writing may appear small.

When to see a doctor
See your doctor if you have any of the symptoms associated with Parkinson's disease — not only to diagnose your condition but also to rule out other causes for your symptoms.

Diagnosis
No specific test exists to diagnose Parkinson's disease. Your doctor may order tests, such as blood tests, to rule out other conditions that may be causing your symptoms.

Imaging tests — such as MRI, ultrasound of the brain, SPECT and PET scans — may also be used to help rule out other disorders.

In addition to your examination, your doctor may give you carbidopa-levodopa, a Parkinson's disease medication. You must be given a sufficient dose to show the benefit, as low doses for a day or two aren't reliable. Significant improvement with this medication will often confirm your diagnosis of Parkinson's disease.

Sometimes it takes time to diagnose Parkinson's disease. Doctors may recommend regular follow-up appointments to evaluate your condition and symptoms over time.

Treatment
Parkinson's disease can't be cured, but medications can help control your symptoms, often dramatically. In some later cases, surgery may be advised.

Your doctor may also recommend lifestyle changes, especially ongoing aerobic exercise. In some cases, physical therapy that focuses on balance and stretching also is important. A speech-language pathologist may help improve your speech problems.

Peripheral Neuropathy

Peripheral neuropathy, a result of damage to your peripheral nerves, often causes weakness, numbness and pain, usually in your hands and feet. It can also affect other areas of your body.

Symptoms
Signs and symptoms of peripheral neuropathy might include:

• Gradual onset of numbness, prickling or tingling in your feet or hands, which can spread upward into your legs and arms
• Sharp, jabbing, throbbing, freezing or burning pain
• Extreme sensitivity to touch
• Lack of coordination and falling
• Muscle weakness or paralysis if motor nerves are affected

If autonomic nerves are affected, signs and symptoms might include:

• Heat intolerance and altered sweating
• Bowel, bladder or digestive problems
• Changes in blood pressure, causing dizziness or lightheadedness

Diagnosis
Peripheral neuropathy has many potential causes. Besides a physical exam, which may include blood tests, diagnosis usually requires:

• A full medical history. Your doctor will review your medical history, including your symptoms, your lifestyle, exposure to toxins, drinking habits and a family history of nervous system (neurological) diseases.
• Neurological examination. Your doctor might check your tendon reflexes, your muscle strength and tone, your ability to feel certain sensations, and your posture and coordination.

Your doctor may order tests, including:

• Blood tests. These can detect vitamin deficiencies, diabetes, abnormal immune function and other indications of conditions that can cause peripheral neuropathy.
• Imaging tests. CT or MRI scans can look for herniated disks, tumors or other abnormalities.
• Nerve function tests. Electromyography records electrical activity in your muscles to detect nerve damage. A probe sends electrical signals to a nerve, and an electrode placed along the nerve's pathway records the nerve's response to the signals (nerve conduction studies).
• Other nerve function tests. These might include an autonomic reflex screen that records how the autonomic nerve fibers work, a sweat test, and sensory tests that record how you feel touch, vibration, cooling and heat.
• Nerve biopsy. This involves removing a small portion of a nerve, usually a sensory nerve, to look for abnormalities.
• Skin biopsy. Your doctor removes a small portion of skin to look for a reduction in nerve endings.

Treatment

• Pain relievers. Over-the-counter pain medications, such as nonsteroidal anti-inflammatory drugs, can relieve mild symptoms. For more-severe symptoms, your doctor might prescribe painkillers.
• Anti-seizure medications. Medications such as gabapentin (Gralise, Neurontin) and pregabalin (Lyrica), developed to treat epilepsy, may relieve nerve pain. Side effects can include drowsiness and dizziness.
• Topical treatments. Capsaicin cream, which contains a substance found in hot peppers, can cause modest improvements in peripheral neuropathy symptoms. You might have skin burning and irritation where you apply the cream, but this usually lessens over time. Some people, however, can't tolerate it.
• Antidepressants. Certain tricyclic antidepressants, such as amitriptyline, doxepin and nortriptyline (Pamelor), have been found to help relieve pain by interfering with chemical processes in your brain and spinal cord that cause you to feel pain.
• Various therapies may also help ease the signs and symptoms of peripheral neuropathy

Strokes

Stroke is the number 4 cause of death in the U.S., and the number 1 cause of adult disability. At Health First Neurosciences, our expert and advanced approach to stroke care and treatment is one of the many way we're working to reduce the instance of stroke. And while we treat the majority of stroke cases with more traditional methods and minimally invasive options aren't right for everyone, we are the only facility in the area to use the biplane endo/angio suite, which can expand the window of time that stroke patients can be treated by up to 12 hours. (Traditionally, the window is 3-4 hours after the onset of stroke symptoms.)

Other Treatments
Health First Neurosciences also offers a comprehensive list of alternative and more traditional treatments, including intravenous tPA (a medication that dissolves blood clots and is administered through an IV), which is most commonly the first choice in stroke treatment when given within three hours after the onset of stroke systems.

While treatment methods differ by the individual needs of the patient, patients can take comfort in knowing that our team will be there when you need them. And if need be, so is our life-saving biplane endo/angio suite technology.

More On The Biplane Endo/Angio Suite
How does this operating suite help save lives and prevent brain damage?
It allows patients to be treated after the window of safety for traditional stroke treatments, including intravenous tPA, has passed. And by providing real-time three-dimensional image guidance, it helps the interventional neurologist see exactly where the catheter-based clot retrieval device needs to go, and further ensures that no areas of blood clots are overlooked. It even eliminates the need to transfer patients to another room for scanning during the procedure

Click to view our Biplane Endo / Angio Suite Tour

What Is A Stroke?
A stroke occurs when blood flow to a part of the brain stops, depriving the brain of the blood and oxygen it needs. Also known as a "brain attack", a stroke can cause a large number of brain cells to die, which can result in permanent disability and death. If you or a loved one is experiencing the symptoms of a stroke, it is imperative to call 9-1-1 or seek medical attention immediately.

Other Conditions

In addition to cutting-edge treatments for stroke and aneurysms, Health First Neurosciences specializes in the prevention, diagnosis, and treatment of various other chronic brain conditions. This includes:

• Brain hemorrhages and bleeding disorders
• Arteriovenous malformations of the brain (AVMs)
• Arteriovenous (AV) fistula repair
• Carotid stenosis and carotid stenting
• Stroke due to embolization and vasospasm
• Diagnostic cerebral angiography

Plus, since our team and facility are available 24/7, patients can take comfort in knowing that we'll be on call to respond to any complications or emergency needs.