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Q.
What are the symptoms of epilepsy and how is this diagnosed?
A.
Epilepsy is a neurological disorder characterized by an abnormally high excitement of the brain which is manifested as uncontrollable behavior or convulsions with a loss of consciousness. There are multiple types of seizures. Loss of consciousness with convulsions is called a generalized type. In absence seizures patients have brief episodes of inattentiveness with a few seconds long fast eyelids blinking. In so called simple seizures a patient may experience episodes of unusual sensations and/or muscle twitching in a particular body area. “Complex seizure” type is characterized by a complex behavior with a patient being partially or completely unaware of that period of time. Duration of a seizure episode depends on its type and may range from a few seconds to several hours and even days. Unconsciousness or confusion during a seizure may be dangerous if happens during driving, swimming, or other risky activity. Multiple medications are available to prevent abnormal excitement of the brain and their use depends on the seizure type.


Q.
A relative has recently been diagnosed with dementia. When I take her somewhere, she is constantly saying that she has “been here before” and/or “seen this before”. She often says that I have taken her someplace that I never have. I believe she is experiencing extreme deja vu. Is this deja vu syndrome common in people with dementia?
A.
Deja vu is defined as “any subjectively inappropriate impression of familiarity of a present experience with an undefined past”. This means that a person should recognize that this is an abnormal sensation of familiarity and that this experience has never happened before. Deja vu had been described in patients with dementia, epilepsy, psychiatric disorders and as a side effect to medications. The prevailing opinion is that the majority of deja vu episodes is originated in the right anterolateral part of the brain (frontal and temporal lobes). Confabulation - filling the lost memories with fantasies - is much more common in dementia than déjà vu episodes. In case of confabulation a person is sure that sensation of familiarity is correct and can even describe the circumstances of a similar experience in the past though other people know that that had never happened.


Q.
I am having symptoms of stiffness of my neck and back muscles, tinnitus, blurring of vision, heaviness in head for many years. They have incapacitated my day to day life. My CT scan of head shows Mega Cisterna Magna. Could this be causing my symptoms?
A.
Your symptoms are not very specific and may be seen in many disorders. Mega cisterna magna consists of an enlarged space in the back of the cranium and is seen in about 1% of general population. This finding is usually considered to be benign though it can also be associated with several brain conditions which could be responsible for your symptoms. Neck problems can also be responsible for the sensation of a heavy head. I have had several patients whose tinnitus (ringing in the ears) was directly associated with neck pain. It is not possible to be more precise with the diagnosis without knowing more details about your condition. A thorough exam and additional tests are likely to be helpful in getting additional information.


Q.
I have a tingling sensation, pins and needles on my pinkie and ring finger, on all limbs, not just left hand. I’m 30 and aside from a little bit of hereditary hypertension, am in good condition. Any thoughts??
A.
Tingling in the hands may be of different nature. It can be due to problem in the brain, spinal cord or nerves in the arm. Interestingly enough the same nerve cells are responsible for different conditions listed above. Those neurons are located in the area of the brain located just above ear on the side opposite to the tingly hand. Brain lesions usually produce tingling or numbness on one side rather than both. The sprouts of these neurons called axons gather together and travel through the brain toward spinal cord which is consisted of millions of axons. The spinal cord runs from the neck down to sacrum inside the spine which protects it from damage. The axons are responsible for conduction of the electrical charges between the brain and the rest of the body. This is how our brain knows what the body is doing and can direct movements of the muscles and govern inner organs. When axons are compressed by arthritic spine in the neck, tingling and numbness are often felt in both hands. Both sides also may be involved with carpal tunnel syndrome - pressure on median nerve at the wrist. Treatment depends on the nature of the problem. There are different tests we perform in our office to clarify the type of disorder.


Q.
I injured myself almost two years ago and still have severe pain in my neck, shoulders and low back. I tried all possible treatments including pain killers, physical therapy, acupuncture and a chiropractor and nothing helps. I cannot do much because of pain. My doctor says that I should try surgery but I am afraid. What can be done besides surgery?
A.
You are suffering from a chronic pain syndrome - a painful condition due to different causes lasting for more then 6 months. Though the majority of patients are able to recover within a relatively short period of time after a trauma or a motor vehicle accident with medications, physical therapy and other treatments, some of the patients are not able to improve. There are many reasons for this and not all of them require a surgery. From our experience such patients have multiple painful points in tendons, muscles and joints which can be successfully treated with precise injection of powerful anti inflammatory medications without surgery. Injection is able to create a high concentration of medication for one to two weeks right where it is needed, which a pill form of the same medication cannot do. There are multiple forms of treatment for chronic pain besides what you have tried already and they should be tried before you consider a surgery. One of the reasons some patients are afraid of surgical treatment is that it is irreversible and in case of an unsuccessful surgery it can not be undone. With unsuccessful medications, injections there is no irreversible harm and an option of surgery can still be entertained. It is also important to mention that any treatment may have side effects like allergic reaction and others. More specific recommendations can be given only after a thorough examination.


Q.
I was recently diagnosed with shingles - it has been a very painful condition - can a neurologist help with the treatment for the pain?”
A.
Shingles or Herpes Zoster is a painful disorder of sensory nerves and is a late complication of a chicken pox viral infection. Every person who has been infected with chicken pox during their life span, whether by a wild virus or its vaccine form, is at risk of developing shingles when a dormant virus in sensory nerves becomes active. The first sign is usually increased skin sensitivity, pains of different intensities, and skin blisters which heal within 1-2 weeks. Unfortunately for some patients the pain progresses to a chronic condition and may remain for years. The use of different antiseizure medications has been found beneficial in decreasing the severity of pain in some patients. Pain killers may also be of benefit though can cause severe side effects and complications. Interventional pain management offers multiple effective options to control the pain of Herpes Zoster. Surgery is seldom necessary and does not have a reliable outcome since the pain has a tendency to come back in some cases. We combine the use of neurological and pain management approaches in our practice to achieve the maximal benefit in treating shingles pain.


Q.
Each time I work in the garden I have more pain in the neck, low back, shoulder, hip or knee up to the point that I can not do anything for a day or two. The over the counter medications do not help much anymore. I tried injections and they did not help much either. My doctor tells me that I do not need surgery. What can I do?
A.
It seems that most of your pains are due to mild to moderate degenerative changes. It is common that at some point patients do not have significant relief from non-steroidal anti-inflammatory medications, physical therapy, chiropractic manipulations or other conservative treatments and they are not surgical candidates. The majority of patients at such a stage are good candidates for pain management with injections. Discovery of all the painful spots and precise needle placement at the origin of pain is a key to successful pain relief with an injection. This is why “blind” injections often are not helpful. I have been using x-ray and ultrasound for the past 7 years to fi nd the origin of pain and always be sure that injection was placed in the proper place. Such precision helped relieve pain in many patients who were previously treated with blind injections and “did not respond”. Correctly performed injection is able to provide pain relief for many months. There are also other ways to help with pain relief for long periods of time.


Q.
Can a concussion leave any lasting neurological problems?
A.
Concussion usually has a benign course meaning that all its symptoms like headache, confusion, memory problems, sleep difficulties, problems with coordination and concentration will eventually disappear. Recovery can last from several days to several months and symptoms may range from mild to severe. It is accepted that concussion does not cause brain damage. Contusion is a more severe condition accompanied by brain changes on MRI like swelling or bleeding. Patients with contusion may have permanent symptoms. It is possible that contusion can produce mild brain changes not visible on brain imaging but leading to permanent neurological problems nevertheless. Another cause of a long term problem can be damage to the soft tissues of the head or neck causing chronic pain, headaches, dizziness, nausea and other symptoms. A thorough neurological evaluation and additional testing may be helpful in the diagnosis of possible brain damage or other conditions.


Q.
I have pain in my pelvic area radiating into both groins and vagina. I had many tests by primary doctor and gynecologist and all of them were normal. What can be done?
A.
There are many different structures in the pelvic area and genitalia which can be affected and produce pain. The painful conditions may include inflammation or impingement of a nerve or a muscle, chronic inflammation in the uterus or bladder, endometriosis and others to name a few. Unfortunately, diagnosing those conditions may be very difficult at times. Pain killers and pain modulating medications may be helpful. Those patients who do not get significant pain relief may benefit from the nerve injections in affected areas. There is no general advice for treatment of pelvic pain and different conditions are treated in different ways.


Q.
My 82 year old husband recently developed Parkinson’s disease, which is progressing rapidly with shaking hands, lightheadedness, etc. He is taking medications and has seen several doctors, but none are able to help. Can you suggest any other treatment?
A.
Shaking hands, lightheadedness and other symptoms may be a part of many disorders, not only Parkinson’s Disease. Treatment options depend on the patient’s diagnosis. Movement disorders, stroke, seizures, degenerative brain conditions and other neurological problems may present like this as well. There is no universal medication which can be used to treat all of these conditions. Diagnostic tests may be very helpful in making the diagnosis and may include brain imaging (MRI or CAT Scan), recording of the brain electrical activity (EEG - electroencephalography), studying of the brain blood flow (carotid ultrasound and transcranial Doppler), blood work and others. The quality of shaking, coexistence of other symptoms, the order of the symptoms onset, the speed of progression and other pertinent information is as helpful in making the diagnosis as a thorough physical exam or specific tests. This is why it is very important to bring a written history of the disease development and other data to the appointment.


Q.
I never get headaches but occasionally have a sharp pain in my head. these last only a fraction of a second and have been in different areas. Are these typical or when would I know to seek medical treatment?
A.
Sharp stabbing pain in the head may be due to different reasons. When no reasons are  found during an exhaustive testing it might be an “ice pick” headache, which is very short and can be extremely painful. Trigeminal neuralgia, neuralgia of the scalp nerves are only a few of many other possibilities. Eye redness and tearing  during a short headache are part of a distinct, though rear, headache type. There are also secondary headaches due to detectable causes like aneurysm, upper neck arthritis, shingles, pain from the scar or due to jaw joint inflammation and others. Though a short headache can be perceived as a minor problem, it should not be neglected. There is no such a thing as a “typical headache”. Proper investigation will help to establish the diagnosis and  treatment if necessary.


Q.
“I have suffered through 4 bouts of severe rotational vertigo in the last year. One diagnosis was atypical meniere’s (hearing is not affected and tinnitus is no worse during an attack than during an attack-free period) A second diagnosis was vestibular migraine (or migraine associated vertigo). Are there any diagnostic criteria that would help to determine what the cause of this vertigo is - symptoms that would lead towards a diagnosis of one rather than the other?”
A.
Dizziness is a lay term for any sensation of loss of balance or discoordination, while vertigo is a sensation of motion either of yourself or your surroundings like spinning, whirling or rocking and unsteadiness is a sensation of legs being unreliable in keeping the body in an upright position. Vertigo is usually a problem of the inner ear and unsteadiness- of the nerves in the legs. Vertigo symptoms can be caused by multiple conditions. The majority of these conditions are benign though brain tumor, bleeding or stroke can cause those symptoms as well. It may be difficult sometimes to differentiate one cause of the vertigo from another. Thorough history, exam, testing and observations are helpful.


Q.
I have a headache in the back of my head. My neurologist said it was a migraine though treatments did not help. What can be done?
A.
Though migraine can present with a headache in the back of the head, its location is usually frontal or temporal. Other migraine features include throbbing pain, nausea, increase in pain with bright light, loud sound and movement. A headache in the back of the head may be due to different reasons including a nerve inflammation, impingement of the upper neck nerves due to spine problems, radiating pain from the spine itself, disease of the blood vessels and many others. Many conditions may provoke a trigeminal nerve irritation and cause migraine-like symptoms which are resistant to treatment because it is not just a migraine. Some of the causes are life-threatening and may present with only a mild headache. Thorough evaluation and testing are helpful in establishing diagnosis and appropriate treatment. New medications are now available as well for the migraine treatment.


Q.
I have a painful burning sensation on the outer surface of my thigh down to the knee.
A.
You may be suffering form a condition known as meralgia paresthetica (thigh pain). It is caused by injury, compression or disease of the lateral cutaneous nerve of the thigh. First described by Bernhardt 130 years ago it is still widely under recognized. Up to 35% of patients with leg pain may suffer from it. It happens in all age groups but is more common in pregnant females, overweight people or diabetics. In all these conditions the nerve is susceptible to pressure from the uterus, weight of the belly or tight clothes like jeans or hard belt. Diagnosis is based on clinical picture, examination, EMG to rule out different other nerve conditions. Similar pain can be caused by pelvic fracture or cancer, diabetes or lower back problem. My personal choice is to perform palpation of the thigh under ultrasound to see the diseased nerve. Anti-inflammatory medications and elimination of pressure on the nerve including weight loss and avoidance of restrictive clothing or heavy belts helps many. If this does not work I perform steroid injection under ultrasound guidance which usually resolves the pain.


Q.
My son who is 21, has had several bouts of vomitting for the last 6 years. No doctor seems to be able to give a diagnosis. Isn’t it possible that he could develop cancer in the esophogus from the stomach acid repeatedly going up his throat? He has not been diagnosed with GERD. Could this be neurologically related?
A.
There are multiple neurological causes of nausea and vomiting. Abdominal Migraine presents with nausea, vomiting, inconsistent abdominal pain and some symptoms of migraine, though not necessarily with the headache itself. This is a clinical diagnosis since there are no tests for the migraine. Children younger then ten-years-old are affected the most, though abdominal migraine is seen in adults as well.  Another possibility is an inner ear disorder when vomiting may start suddenly with a vertigo of different degree. An increase in the intracerebral pressure and seizures may also present with sudden vomiting even without other symptoms. There are other neurological conditions which may be associated with vomiting. In any case the diagnosis is not straight-forward and will require thorough exam and possibly additional testing.


Q.
I have constant pain if you turn your right hand around and look at the thumb, it is right above where the bottom of the thumb meets the wrist. It has become progressively more chronic especially when I am attempting to open a jar and do yard work. At night my thumb and middle finger seem to go numb. My family practitioner stated it was a neuropathy. Is there a treatment and or surgery like carpal tunnel to alleviate this problem?
A.
The condition you have described may be due to different causes including a nerve impingement, a joint or tendon inflammation and others. There are different tests to diagnose the cause of pain. For example, in our office I perform ultrasound imaging of the soft tissues to find the pain source. Treatment may require taking pills, injection of an anti-inflammatory medication or even surgery and should be tailored to the problem. In my experience, the majority of patients with similar complaints were able to improve with treatment within days or weeks.


Q.
My mother is a fit 79 and for the last few months has experienced a certain amount of numbness and a loss of use in her right leg and foot. She has had an MRI scan which didn’t show anything - could this be Motor Neurone Disease?
A.
The term “Motor Neuron Disease” means exactly what it states - a problem with strength and movements because these are functions of muscles and nerves connected to them - all together they comprise a “Motor System”. Numbness is a function of the Sensory System and not the Motor System, so the problem in the letter is likely something different. The fact that the author has “numbness and a loss of use in her right leg and foot” rather testifies for the problems with the nerves (motor and sensory) coming to the right leg. An MRI scan may be non-diagnostic in many conditions and neurological evaluation and additional tests are necessary to make the diagnosis and provide treatment.


Q.
I have a sudden onset of hypoglossal nerve palsy with very subtle twitching movements. My primary physician said to keep an eye on it but it is worrisome to me. Should I seek a neurologists opinion or wait?
A.
The hypoglossal nerve manages tongue muscles. Its palsy is uncommon and presents with atrophy of the tongue on one side. The hypoglossal nerve originates in the back of the brain inside of the skull and has a complicated course on its way down to the tongue. The nerve can be damaged anywhere during its course. Tumors are the most common cause of the nerve damage though trauma, stroke, carotid artery disease, multiple sclerosis, autoimmune nerve damage and infection are also seen. The approach to management of such a problem depends on other symptoms and also on the exam and tests findings. Neurologist may help in assessment and decision making.


Q.
I am 59 yrs old and have been experiencing progressively worsening cognitive dysfunction for the past 6 months. (unable to perform familiar work related tasks, difficulty with reading and math, forgetting names/words, getting lost while walking in familiar neighborhood) Have been found to have carotid stenosis 60% left and 40% right could this be related? MRI shows minimal diffuse ischemic changes. Would neuropsychological testing be helpful?
A.
Progressive cognitive problems may be due to different conditions. Among them are chronic infections, metabolic or endocrine disorders like diabetes mellitus or hypothyroidism, problems with kidneys, liver and heart, side effects of medications, significant psychological stress or small seizures, just to name a few. Carotid stenosis in the 40- 60% range is considered mild to moderate and should not produce any cognitive problems without a stroke. Neuropsychological testing is helpful, especially in recognizing a stress related cognitive problem. Multiple tests are available in our practice to pinpoint the cause including EEG, carotid and cranial arteries blood fl ow investigation and others.


Q.
As a result of childbirth and/or epidural I had a peroneal nerve damage 7 months ago, seemingly mild as there is no foot drop. The numbness and pain in my calf/foot/thigh do not go away at all and get worse when I carry the baby. MRI was normal. I wonder if there is a chance that it will go away on its own ( as suggested by my neurologist a few months ago), or do I need to be doing anything else to improve it and if I should avoid picking up my baby?
A.
Numbness and pain testifies for a nerve damage. Peroneal nerve symptoms are usually located below the knee. Symptoms in the thigh may be due to additional peripheral nerve damage and this is not unusual. Symptoms involving the whole leg can be from saphenous nerve (if the inside of the leg is involved), sciatic nerve (if pain spreads from the buttock to the hill in the back of the leg) or due to the impingement of a lumbar root in the spine. Pain and other symptoms worsening with the weight load increase are more commonly seen in a sciatic nerve or lumbar root impingement. Pain radiating to the small toe is likely due to the first sacral root involvement, to the big toe- due to the fifth lumbar root, lateral calf-due to the forth and above the knee is due to the third lumbar root involvement. In our office we routinely utilize nerve conduction studies and soft tissue ultrasound to pinpoint the problem. Precise diagnosis is impossible without a neurological examination and appropriate testing. Treatment depends on the nature and severity of the problem and may range from medications to steroid injections. Read more at www.nscenter.org.


Dr. Kaplan's Role in Wellness

Dr. Kaplan has been a founder and Medical Director of “Neurological and Stroke Care, PLLC”, a private practice in Schenectady since 2002. Having practiced medicine for more than 25 years he specializes in the diagnosis and treatment of patients with neurological diseases and chronic pain. He considers himself a good student first of all:

“Medicine literally explodes with new knowledge and it’s impossible to be a good physician without relentless learning.”

He started practicing medicine in Samara, Russia at the age of 23 as a general surgeon already having had several scientific publications and patents. After Dr. Kaplan and his family had moved to the United States he completed four years of Neurology Residency at Albany Medical Center. His training was finessed by two years in the Columbia University Stroke Fellowship program working as an attending physician at Columbia-Presbyterian Hospital in New York, learning from internationally renowned stroke experts, treating stroke patients, utilizing cutting edge scientific methods, participating in stroke research, presenting at international conferences, and also working on two Masters degrees – one in Epidemiology and Clinical Research and another in Health Care Management and Policy.

He returned to Schenectady to open his private practice.

“I did not want to be influenced by business goals of big medical centers offering employment. I value interactions with my patients above anything else and am able now to give them as much time and attention as necessary.”

Patients appreciate Dr. Kaplan for his dedication to see patients on a short notice if necessary and because of his depth of knowledge and experience.

Dr. Kaplan is the only physician in the Capital Region with Board Certifications in four fields of medicine. Board Certification is the highest mark of integrity of physician’s knowledge and skills and is awarded after a thorough peer review and examination. He is a Diplomate of American Board of Psychiatry and Neurology. His second Board Certification is in Vascular Neurology – he is one of two Board Certified physicians and the only with fellowship training in this field in the Capital Region. Dr. Kaplan is also the only neurologist in the Capital Region certified in the methods of ultrasound brain vessels testing . Such high level of expertise attracted to him patients from as far as Buffalo. Headaches is the third area of expertise and he is the only physician in the Capital Region with Board Certification in Headache Medicine. He is well known for never giving up on his headache patients. Not only migraine patients themselves but also their families chose Dr. Kaplan to manage this difficult condition. Management of neck pain in headache patients has evolved over the years into a comprehensive diagnostic and treatment program covering a variety of pain conditions. He received his fourth medical Board Certificate from the American Board of Interventional Pain Physicians.

Dr. Kaplan became a Fellow of Interventional Pain Practice after successful completion of a unique and prestigious hands-on exam in Interventional Pain Management. Dr. Kaplan personally participates in devising the treatment plan for every patient in his practice with the help of Nurse Practitioner Steve LaPlante. In spite of having a busy professional life Dr. Kaplan is also a Founder and President of the Connecting Link, Inc., a cultural non-profit organization in the Capital Region. His wife, Dr. Irina Kaplan, is practicing Family Medicine in the same practice.

This general Information is not intended to provide individual advice. Please make an appointment with a physician to discuss you particular situation and needs.
 

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