Category: Conditions

What is a TIA or Mini Stroke?

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Also known as a mini-stroke, a transient ischemic attack (TIA) is a temporary period of symptoms similar to those of a stroke. Unlike a stroke, it usually only lasts for a few minutes and doesn’t cause permanent damage. Read on to learn more about TIAs. 

About Mini Strokes

Even though a TIA doesn’t usually cause permanent damage to the same extent a stroke does. But a transient ischemic attack may be a warning. About 1 in 3 people who have a transient ischemic attack will eventually have a stroke, with about half occurring within a year after the transient ischemic attack.

Mini Stroke Symptoms

Transient ischemic attacks usually last a few minutes. Most signs and symptoms disappear within an hour, though rarely symptoms may last up to 24 hours. The signs and symptoms of a TIA resemble those found early in a stroke and may include sudden onset of:

  • Weakness, numbness or paralysis in your face, arm or leg, typically on one side of your body
  • Slurred or garbled speech or difficulty understanding others
  • Blindness in one or both eyes or double vision
  • Vertigo or loss of balance or coordination

You may have more than one TIA, and the recurrent signs and symptoms may be similar or different depending on which area of the brain is involved.

Preventing Mini Strokes

Knowing your risk factors and living healthfully are the best things you can do to prevent a TIA. Included in a healthy lifestyle are regular medical checkups. Also:

  • Don’t smoke. Stopping smoking reduces your risk of a TIA or a stroke.
  • Limit cholesterol and fat. Cutting back on cholesterol and fat, especially saturated fat and trans fat, in your diet may reduce the buildup of plaques in your arteries.
  • Eat plenty of fruits and vegetables. These foods contain nutrients such as potassium, folate and antioxidants, which may protect against a TIA or a stroke.
  • Limit sodium. If you have high blood pressure, avoiding salty foods and not adding salt to food may reduce your blood pressure. Avoiding salt may not prevent hypertension, but excess sodium may increase blood pressure in people who are sensitive to sodium.
  • Exercise regularly. If you have high blood pressure, regular exercise is one of the few ways you can lower your blood pressure without drugs.
  • Limit alcohol intake. Drink alcohol in moderation, if at all. The recommended limit is no more than one drink daily for women and two a day for men.
  • Maintain a healthy weight. Being overweight contributes to other risk factors, such as high blood pressure, cardiovascular disease and diabetes. Losing weight with diet and exercise may lower your blood pressure and improve your cholesterol levels.
  • Don’t use illicit drugs. Drugs such as cocaine are associated with an increased risk of a TIA or a stroke.
  • Control diabetes. You can manage diabetes and high blood pressure with diet, exercise, weight control and, when necessary, medication.

Schedule an Appointment 

Regional Neurological Associates has reopened with your safety in mind and we are seeing patients in-office. Our current office hours are: Monday – Friday from 9 am – 4 pm. If you have questions or concerns about your neurological health, call us at (718) 515-4347 to make an appointment. We are also pleased to announce that same-day appointments are now available.

We do ask that patients experiencing symptoms like fever, cough, or shortness of breath reschedule your appointment or schedule a telemedicine appointment. Please contact our office to change your in-person visit to a Telehealth visit (718) 515-4347. We thank you for your understanding and cooperation.

Are There Different Types of Dementia?

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World Alzheimer’s Month is in October, which is an ideal time for us to shine a light on the disease. We are going to explore the different types of dementia and discuss how not all dementia is not related to Alzheimer’s disease.

Dementia vs Alzheimer’s

Dementia and Alzheimer’s disease are sometimes used interchangeably. But they aren’t the same thing. Alzheimer’s is a disease in which dementia is a major component. Dementia is a term that refers to a group of brain conditions that may affect a person’s ability to think, remember, or remember. Also, people with dementia may lose visual perception, language skills, and the ability to contain their emotions. 

Even though dementia is common among older people, it is not considered a normal part of aging. It’s considered a health condition that needs to be monitored. 

Symptoms of Dementia

The different types of dementia have their own unique set of symptoms. However, many patients with dementia will exhibit several of the symptoms below:

  • Memory loss and distortion
  • Loss of vocabulary
  • Changes in mood and disposition
  • Faulty reasoning
  • Disorientation
  • Trouble with comprehension
  • Difficulty balancing
  • Lack of self-care tendencies
  • Change in appetite or eating habits
  • Loss of social skills
  • Disruptions in sleep-wake cycle

Types of Dementia

Alzheimer’s Disease

Alzheimer’s disease is the most common type of dementia. Between 60 and 80 percent of cases of dementia are caused by this disease, according to the Alzheimer’s Association. Early signs of Alzheimer’s disease include depression, forgetting names and recent events, and depressed mood. However, depression is not part of Alzheimer’s Disease. It’s a separate disorder that must be treated specifically. Occasionally, depressed older adults are misdiagnosed as having Alzheimer’s disease.

Alzheimer’s disease is characterized by brain cell death. As the disease progresses, people experience confusion and mood changes. They also have trouble speaking and walking.

Older adults are more likely to develop Alzheimer’s. About 5 percent of cases of Alzheimer’s are early-onset Alzheimer’s, occurring in people in their 40s or 50s.

Vascular Dementia

The second most common type of dementia is vascular dementia. It’s caused by a lack of blood flow to the brain. Vascular dementia can happen as you age and can be related to atherosclerotic disease or stroke.

Symptoms of vascular dementia can appear slowly or suddenly, depending on what’s causing it. Confusion and disorientation are common early signs. Later on, people also have trouble completing tasks or concentrating for long periods of time.

Vascular dementia can cause vision problems and sometimes hallucinations as well.

Dementia with Lewy Bodies

Dementia with Lewy bodies, also known as Lewy body dementia, is caused by protein deposits in nerve cells. This interrupts chemical messages in the brain and causes memory loss and disorientation.

People with this type of dementia also experience visual hallucinations and have trouble falling asleep at night or fall asleep unexpectedly during the day. They also might faint or become lost or disoriented.

Dementia with Lewy bodies shares many symptoms with Parkinson’s and Alzheimer’s diseases. For example, many people develop trembling in their hands, have trouble walking, and feel weak.

Parkinson’s Disease

Many people with advanced Parkinson’s disease will develop dementia. Early signs of this type of dementia are problems with reasoning and judgment. For example, a person with Parkinson’s disease dementia might have trouble understanding visual information or remembering how to do simple daily tasks. They may even have confusing or frightening hallucinations.

This type of dementia can also cause a person to be irritable. Many people become depressed or paranoid as the disease progresses. Others have trouble speaking and might forget words or

Frontotemporal Dementia

Frontotemporal dementia is a name used to describe several types of dementia, all with one thing in common: They affect the front and side parts of the brain, which are the areas that control language and behavior. It’s also known as Pick’s disease.

Frontotemporal dementia affects people as young as 45 years old. Although scientists don’t know what causes it, it does run in families and people with it have mutations in certain genes, according to the Alzheimer’s Society.

This dementia causes loss of inhibitions and motivation, as well as compulsive behavior. It also causes people to have problems with speech, including forgetting the meaning of common words.

Creutzfeldt-Jakob Disease

Creutzfeldt-Jakob disease (CJD) is one of the rarest forms of dementia. Only 1 in 1 million people are diagnosed with it every year, according to the Alzheimer’s Association. CJD progresses very quickly, and people often die within a year of diagnosis.

Symptoms of CJD are similar to other forms of dementia. Some people experience agitation, while others suffer from depression. Confusion and loss of memory are also common. CJD affects the body as well, causing twitching and muscle stiffness.

Wernicke-Korsakoff Syndrome

Wernicke’s disease, or Wernicke’s encephalopathy, is a type of brain disorder that’s caused by a lack of vitamin B-1, leading to bleeding in the lower sections of the brain. Wernicke’s disease can cause physical symptoms like double vision and a loss of muscle coordination. At a certain point, the physical symptoms of untreated Wernicke’s disease tend to decrease, and the signs of Korsakoff syndrome start to appear.

Korsakoff syndrome is a memory disorder caused by advanced Wernicke’s disease. People with Korsakoff syndrome may have trouble:

  • processing information
  • learning new skills
  • remembering things

The two conditions are linked and are usually grouped together as one condition, known as Wernicke-Korsakoff syndrome. It’s technically not a form of dementia. However, symptoms are similar to dementia, and it’s often classified with dementia.

Wernicke-Korsakoff Syndrome can be a result of malnutrition or chronic infections. However, the most common cause of this vitamin deficiency is alcoholism. Sometimes people with Wernicke-Korsakoff syndrome make up information to fill in the gaps in their memories without realizing what they’re doing.

Mixed Dementia

Mixed dementia refers to a situation where a person has more than one type of dementia. Mixed dementia is very common, and the most common combination is vascular dementia and Alzheimer’s. According to the Jersey Alzheimer’s Association, up to 45 percent of people with dementia have mixed dementia but don’t know it.

Mixed dementia can cause different symptoms in different people. Some people experience memory loss and disorientation first, while others have behavior and mood changes. Most people with mixed dementia will have difficulty speaking and walking as the disease progresses.

Normal Pressure Hydrocephalus

Normal pressure hydrocephalus (NPH) is a condition that causes a person to build up excess fluid in the brain’s ventricles. The ventricles are fluid-filled spaces designed to cushion a person’s brain and spinal cord. They rely on just the right amount of fluid to work properly. When the fluid builds up excessively, it places extra pressure on the brain. This can cause damage that leads to dementia symptoms. 

According to Johns Hopkins Medicine, an estimated 5 percent of dementia cases are due to NPH.

Some of the potential causes of NPH include:

  • injury
  • bleeding
  • infection
  • brain tumor
  • previous brain surgeries

However, sometimes doctors don’t know the cause of NPH. Symptoms include:

  • poor balance
  • forgetfulness
  • changes in mood
  • depression
  • frequent falls
  • loss of bowel or bladder control

Seeking treatment as early as possible can help a doctor intervene before additional brain damage occurs. Normal-pressure Hydrocephalus is one of the types of dementia that can sometimes be cured with surgery.

Huntington’s Disease

Huntington’s disease is a genetic condition that causes dementia. Two types exist– juvenile and adult-onset. The juvenile form is rarer and causes symptoms in childhood or adolescence. The adult form typically first causes symptoms in a person when they’re in their 30s or 40s. The condition causes a premature breakdown of the brain’s nerve cells, which can lead to dementia as well as impaired movement.

Symptoms associated with Huntington’s disease include impaired movements, such as jerking, difficulty walking, and trouble swallowing. Dementia symptoms include:

  • difficulty focusing on tasks
  • impulse control problems
  • trouble speaking clearly
  • difficult learning new things

Schedule an Appointment

Regional Neurological Associates has reopened with your safety in mind and we are seeing patients in-office. Our current office hours are: Monday – Friday from 9 am – 4 pm. If you have questions or concerns about your neurological health, call us at (718) 515-4347 to make an appointment. We are also pleased to announce that same-day appointments are now available.

We do ask that patients experiencing symptoms like fever, cough, or shortness of breath reschedule your appointment or schedule a telemedicine appointment. Please contact our office to change your in-person visit to a Telehealth visit (718) 515-4347. We thank you for your understanding and cooperation. 

Are There Different Types of Migraine?

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Migraine is more than just a bad headache. It is a neurological disease that has subtypes that may present with a variety of symptoms beyond head pain. There are several types of migraine that have different characteristics. 

8 Types of Migraine

1. Migraine without Aura (Common Migraine)

Migraine without aura is also called common migraine. Symptoms include pulsing or throbbing pain on one side of the head. Sensitivity to light (photophobia), sensitivity to sound (phonophobia), nausea, and vomiting are also symptoms of this type of migraine. Pain may worsen during physical activity. Symptoms typically last between 4 and 72 hours. If the attack lasts beyond 72 hours, it is referred to as status migrainosus.

2. Migraine with Aura (Classic Migraine)

Migraine with aura is a type of migraine that includes symptoms like sensory and visual changes. These visual changes are referred to as an “aura” and can include seeing spots, zigzags, or flashes of light. Other symptoms may include difficulty speaking clearly or tingling and numbness on one side of the body. These symptoms can last anywhere from 10 to 60 minutes. Often these symptoms are a signal that a severe headache is about to occur.  

3. Silent Migraine

A silent migraine may also be called an Acephalgic Migraine. This type of migraine does not include head pain as a symptom. Instead, people experience an aura, visual disturbances, dizziness, nausea, or other migraine symptoms. Silent migraine often affects people who get other types of migraine as well and it can be brought on by the same triggers. 

4. Hemiplegic Migraine

This type of migraine has symptoms similar to a stroke. People who have hemiplegic migraine experience weakness on one side of the body, loss of sensation, and/or a sensation described as “pins and needles” on one side of the body. Someone having a hemiplegic migraine may also experience visual aura symptoms but no head pain. These episodes can for just a few hours or for several days.

5. Retinal Migraine

A retinal migraine is a type of migraine that causes visual disturbances in one eye before the headache phase of the migraine attack. Visual symptoms may include temporary blindness, seeing twinkling lights (scintillations), or having areas of decreased or lost vision (scotoma). The headache phase of the migraine begins within 60 minutes of the visual symptoms. According to the American Migraine Foundation, retinal migraine is most common in women during their childbearing years. 

6. Menstrual Migraine

If an individual has severe headaches accompanied by other symptoms of migraine that occur between 2 days before their period and in the first 3 days of flow, they may be menstrual migraines. Menstrual migraine is triggered by the drop in estrogen levels that occur just before a menstrual period.  True menstrual migraine headaches only occur before the menstrual flow, but many women who are migraine suffers may experience headaches both around their menses at at other times.  Your neurologist may be able to adjust your therapy based on your pattern.  

7. Abdominal Migraine

Abdominal migraine is typically seen in children between the ages of 5 and 9 but can occur in adults as well. Children who experience abdominal migraine may experience other types of migraine as adults. Abdominal migraine typically consists of abdominal pain, nausea, and vomiting as primary symptoms. The pain can be moderate to severe and is usually located in the middle of the abdomen and is often described as a dull or “sore” type of pain. Attacks can last between 2 and 72 hours.

8. Chronic Migraine

According to the International Headache Society, chronic migraine is defined as a headache occurring on 15 or more days per month for more than three months. And on at least 8 days per month, the headache must have the features of migraine headache.  This tends to be the most debilitating form of migraine and one of the most disabling afflicting humanity.  Many people who have this type of headache, forget about the daily headaches that they experience, and only “count” the severe migrainous headaches, and don’t realize that they have chronic migraine.  Fortunately, although this condition is quite debilitating, it is also quite treatable, and there are even specific therapies that are developed just for chronic migraine.  If you think that you have chronic migraine, it is important to see your neurologist.

Regional Neurological Associates is happy to report we are reopening to see patients in-office for conditions like migraine. Patients can now make same-day appointments and expect to be treated with the best care and attention. Our current office hours are: Monday – Friday from 9 am – 4 pm. If you have questions or concerns about your neurological health, call us at (718) 515-4347 to make an appointment.

While we are pleased to be seeing patients in the office again, we ask that anyone experiencing symptoms like fever, cough, or shortness of breath reschedule your appointment or schedule a telemedicine appointment.  Please contact our office to change your in-person visit to a Telehealth visit (718) 515-4347.

10 Early Signs of Alzheimer’s Disease

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Alzheimer’s disease is the most common type of dementia. According to the Alzheimer’s Association, it accounts for 60-80% of dementia cases. For Alzheimer’s & Brain Awareness Month this June, we’ll be reviewing the early signs of Alzheimer’s Disease. If you know the signs of Alzheimer’s, you may be able to detect it early. 

Early detection may have benefits. Getting an early diagnosis can allow people to participate in clinical trials for the latest therapies. It is also possible that taking FDA-approved medications and making brain-healthy lifestyle changes when you have early-stage dementia can be beneficial.

1. Memory Loss

Most people associate Alzheimer’s disease and dementia with memory loss. So, it’s not surprising that one of the early signs of Alzheimer’s is forgetting things even recently learned information. People in the early stages of the disease may also forget important dates and rely on memory aids like reminder notes. They may also frequently repeat questions that you have already answered because they have forgotten the answer.

2. Difficulty Planning or Solving Problems


3. Confusion About Time Or Place

Another early sign of Alzheimer’s disease is confusion about dates, seasons, and the general passion of time. It may be difficult for them to process things that are not happening immediately, so referencing things that are happening in the future or things that happened in the past may cause confusion. They may also forget where they are or how they got somewhere.

4. Difficulty Completing Familiar Tasks

A person in the early stages of Alzheimer’s or dementia may find themselves unable to do things that they have been doing for years. They may be driving and forget the route they’ve taken home for 25 years. They may have trouble completing simple tasks like writing a to-do list or cooking a meal.

5. Personality and Mood Changes

If someone is experiencing sudden mood or personality changes, that could be a sign of Alzheimer’s disease. They may become fearful, anxious, depressed, or confused. They may become more easily upset, especially when they are out of their comfort zone in unfamiliar surroundings.

6. Trouble with Visual Images

Sometimes people with Alzheimer’s disease have vision problems. They may find it difficult to identifying or distinguishing between colors. Their judgment of distance or spatial relations may decline as well. This can make activities like driving difficult or impossible. 

7. Problems with Speaking or Writing

The person may find it difficult to have conversations and put together sentences. They might call things by the wrong name. This can make it hard for them to join in on conversations. Coupled with memory loss, this can cause them to repeat the same anecdotes or stories over and over.

8. Misplacing Things

One of the early signs of Alzheimer’s disease is misplacing things. People don’t just forget where they put things, but they will put items in unusual places. It is also difficult for them to retrace their steps to look for the lost item. In some cases, people with this symptom may be convinced someone stole the item they’re looking for.

9. Poor Judgement & Decision-Making

If someone is in the early stages of dementia, they may make poor decisions regarding things like money. They may also decide that things like staying clean or well-groomed are not important and stop caring for themselves in that way. 

10. Withdrawal from Professional & Social Activities

Many people with Alzheimer’s disease or dementia will withdraw into themselves. They may not be able to start or maintain conversations so they will avoid social situations and conversations at work. 

Regional Neurological Associates is happy to report we are reopening to see patients in-office. Patients can now make same-day appointments and expect to be treated with the best care and attention. Our current office hours are: Monday – Friday from 9 am – 4 pm. If you have questions or concerns about your neurological health, call us at (718) 515-4347 to make an appointment.

While we are pleased to be seeing patients in the office again, we ask that anyone experiencing symptoms like fever, cough, or shortness of breath reschedule your appointment or schedule a telemedicine appointment.  Please contact our office to change your in-person visit to a Telehealth visit (718) 515-4347.

6 Types of Aphasia

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Aphasia is an impairment language caused by an injury to the brain, usually due to stroke. There are several types of aphasia that affect language skills in different ways. According to the National Aphasia Association (NAA), 2 million people in the United States have aphasia and have lost all or some ability to use words. However, almost 85% of Americans say they’re not familiar with the term aphasia. That’s why Aphasia Awareness Month in June is so important.

Quick Facts About Aphasia

  • Aphasia is an impairment of language that can affect both the production and comprehension of speech and impair a person’s ability to read and/or write.
  • Aphasia is always caused by an injury to the brain
  • Stroke is the most common cause of brain injury that leads to aphasia
  • Other brain injuries from head trauma, infections, or tumors can also cause aphasia
  • Aphasia can be mild and only affect a single aspect of language OR
  • It can be so severe that is incredibly difficult to communicate with the patient
  • Most commonly, multiple aspects of communication are impaired
  • Some people can recover from aphasia, but if they have it longer than 2 or 3 months it is unlikely they will recover

Visit the National Aphasia Association for more facts about the condition and tips for communicating with someone with aphasia.

Types of Aphasia

1. Global Aphasia

Global aphasia is the most severe type of aphasia. It is caused by injuries to multiple parts of the brain that are responsible for processing language. Patients with global aphasia can only produce a few recognizable words. They can understand very little or no spoken language. However, they may have fully preserved cognitive and intellectual abilities that are not related to language or speech. Global aphasia may be apparent immediately following a stroke or brain trauma. While this type of aphasia can improve as the brain heals, there may be lasting damage.

2. Broca’s Aphasia

Broca’s aphasia is also called non-fluent or expressive aphasia. Patients with Broca’s aphasia have partial loss of their language ability. They have difficulty speaking fluently and their speech may be limited to a few words at a time. Because they can only get a few words out at a time, their speech is described as halting or effortful. They are usually able to understand speech well and maintain the ability to read but may have limited writing abilities. 

3. Mixed Non-Fluent Aphasia

Patients with this type of aphasia have limited and effortful speech, similar to patients with Broca’s aphasia. However, their comprehension abilities are more limited than patients with Broca’s aphasia. They may be able to read and write, but not beyond an elementary school level.

4. Wernicke’s Aphasia

Wernicke’s aphasia is also called fluent aphasia or receptive aphasia. It is referred to as fluent because while these individuals have an impaired ability to comprehend spoken words, they do not have difficulty producing connected speech. However, what they say may not make a lot of sense and they’ll use nonsense or irrelevant words in their sentences. Often, they do not realize that they are using the incorrect words. Someone with Wernicke’s aphasia will probably have an impaired ability to read and write and lose much of their language comprehension ability. 

5. Anomic Aphasia

A person who suffers from anomic aphasia is unable to come up with the right words for what they want to talk about. They have a grasp on grammar and speech output, but they simply cannot find the words to discuss what they want to. When they speak, it is often vague and they might seem like they are “talking around” the thing they can’t describe. They also have difficulty finding words when they write. 

6. Primary Progressive Aphasia (PPA)

PPA is a neurological syndrome in which someone loses their ability to use language slowly and progressively. While most other forms of aphasia are caused by stroke, PPA is caused by neurodegenerative diseases like Alzheimer’s Disease. PPA progresses as the tissue in the language centers of the brain deteriorates over time. Because this form of aphasia is associated with degenerative disorders, PPA is eventually accompanied by other symptoms of dementia or memory loss.

Regional Neurological Associates is happy to report we are reopening to see patients in-office. Patients can now make same-day appointments and expect to be treated with the best care and attention. Our current office hours are: Monday – Friday from 9 am – 4 pm. If you have questions or concerns about your neurological health, call us at (718) 515-4347 to make an appointment.

While we are pleased to be seeing patients in the office again, we ask that anyone experiencing symptoms like fever, cough, or shortness of breath reschedule your appointment or schedule a telemedicine appointment.  Please contact our office to change your in-person visit to a Telehealth visit (718) 515-4347.

10 Early Signs of Multiple Sclerosis

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Multiple sclerosis is a chronic disease that affects the central nervous system. MS can be difficult to diagnose because the symptoms are unpredictable. Not everyone has the same symptoms and the severity of some symptoms differ from person to person. While not every person with MS has the same symptoms, there are some common early signs of multiple sclerosis that you should be aware of.

1. Vision Loss

One of the most common early signs of multiple sclerosis is vision loss. While there are many conditions that may cause vision problems, this symptom of MS is marked by pain and vision loss in only one eye. People may experience blurred vision or even vision loss in one eye that is accompanied by severe pain that lasts more than a couple of days. If you experience any kind of unusual vision problem, you should seek medical attention, but if you have this kind of vision loss, it could be an early sign of MS and you should see a doctor.

2. Facial Paralysis

Facial paralysis is a distressing symptom no matter the cause. While facial drooping is often a sign of other disorders such as Bell’s palsy, Lyme disease, or even stroke, it may be an early sign of MS. No matter what is causing the facial paralysis, you should get immediate medical help to address the problem. 

3. Weakness in Limbs

If you are experiencing ongoing weakness or numbness in your limbs, it could be an early sign of multiple sclerosis. The sensation may be similar to the tingling or numbness that you experience when your leg “falls asleep” when in one position for too long. Or it may present as weakness in the arms or legs. However, this tingling, numbness, or weakness does not resolve itself once you’ve gotten out of the awkward position and moved around. If this type of symptom persists for more than a day or so, you should seek medical attention to find the cause. 

4. Pain and Spasms

Persistent or chronic pain may be symptoms of MS. According to the Multiple Sclerosis Association of America, more than 50% of people with MS identify pain as a significant symptom. Pain may occur in the back, hips, legs, and arms. 

5. Muscle Spasms

Muscle spasms or spasticity are also commonly associated with multiple sclerosis. People with spasms experience painful and uncontrollable jerking movements of their extremities, usually the legs. People sometimes experience stiffness in their muscles and joints along with the spasms. 

6. Persistent Dizziness

Dizziness and vertigo can be symptoms of many different disorders, some more serious than others. Dizziness that is an early sign of multiple sclerosis is often severe and lasts for two days or more. Walking may be difficult, even when you’re walking through spaces with few or no obstacles because you feel like your equilibrium is off. Lack of coordination and balance are also associated with this type of dizziness and people often report feeling lightheaded. These symptoms often occur when standing up. If you experience persistent dizziness or vertigo, it’s always a good idea to see a doctor so you can be evaluated for different conditions.

7. Chronic Fatigue 

Many people with MS experience unexplained fatigue. Chronic fatigue is caused by nerve deterioration in the spinal column. Fatigue usually appears suddenly and can last for weeks before improving. According to the National Multiple Sclerosis Society, about 80% of people experience fatigue as one of the early signs of multiple sclerosis.

8. Bladder and Bowel Problems

Bladder and bowel problems may be symptoms of multiple sclerosis. They may occur as early signs, but almost 80% of people with MS develop bladder problems like overactive bladder, incontinence, urinary frequency, or urinary urgency.

9. Cognitive Changes

According to the National Multiple Sclerosis Society, about 50% of people with MS experience cognitive changes. These changes may include the ability to learn and remember things, organize, focus, problem-solve, and organize. 

10. Mood Changes and Depression

Emotional changes and even clinical depression are common symptoms of MS. Depression is more common in people with chronic conditions like MS. While mood changes may be early signs of multiple sclerosis, clinical depression may not develop until later in the disease’s progression.

At Regional Neurological Associates, we specialize in diagnosing and managing a number of neurological conditions including multiple sclerosis. If you have concerns about any symptoms you’re experiencing or want to discuss an existing MS diagnosis, call (718) 515-4347 to make an appointment.

What You Need to Know About Stroke Recovery

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May is National Stroke Awareness Month, so we’re taking the opportunity to dive deeper into the subject. According to the Centers for Disease Control and Prevention (CDC), more than 795,000 people in the US have a stroke each year. Stroke recovery looks different for every survivor, but there are certain things you should know if you or a loved one have had a stroke.

Staying Informed is Crucial

Whether you are a stroke survivor or the caregiver of someone who has had a stroke, you need to be well-informed by the healthcare team. Keep a record of all prescribed medications and any potential side effects. And if you have questions, don’t be afraid to ask them even if you think it sounds silly.

Stroke Recovery Takes Time

An important part of stroke recovery is setting and managing realistic expectations. Every patient is different, so there is not a set timeline for recovery. Gains may be made slowly over time or they may happen quickly. Just be sure to keep consulting the healthcare team throughout recovery and discuss any concerns you have.

There Are Different Types of Therapies to Consider

Depending on the severity of the stroke and the type of impairments the stroke survivor has afterward, different kinds of therapy might be needed. These include:

  • Speech therapy
  • Occupational therapy
  • Physical therapy
    • Motor-skill exercises
    • Range-of-motion therapy
    • Constraint-induced therapy
    • Mobility training
    • Technology-assisted physical activities
  • Psychological evaluation & treatment
  • Experimental therapies
    • Noninvasive brain stimulation
    • Alternative medicine
    • Biological therapies
      • Stem cell therapy (only done in clinical trials)

You Can Reduce the Risk of Another Stroke

Stroke survivors are at a high risk of having another stroke. You can reduce the risk of another stroke by making sure the patient eats a healthy diet, gets exercise, and maintains a healthy weight. It’s crucial that they take all prescribed medications as instructed, participate in therapy, and sees their healthcare provider regularly.

And if you aren’t familiar with the signs of stroke already, become familiar so you can act quickly if another stroke occurs. Remember, think FAST:

  • Face drooping
  • Arm weakness
  • Speech difficulty
  • Time to call 911

Monitor Any Falls

People who suffer from strokes often fall, however you shouldn’t just shrug this off as a part of stroke recovery. Serious falls can cause injury and frequent falls may be a sign of decline. If a fall results in severe pain, bleeding or bruising, you should go to the emergency room for treatment. If the patient has more than two minor falls in a six month period, talk to their physical therapist and doctor. 

Stay Alert for Emotional Changes 

Changes in attitude or behavior may be a sign you need to make adjustments to your stroke recovery plan. Getting advice from the patient’s care team can help with managing emotional turmoil. And staying alert can help prevent post-stroke depression, which can get in the way of recovery. According to the American Stroke Association, as many as 30 – 50% of stroke survivors experience depression post-stroke. Talk to the survivor’s care providers about forming an action plan to prevent post-stroke depression.

Measuring Progress Helps

Keeping track of how much progress someone is making during stroke recovery is important for a number of reasons. Even small gains should be recorded because the rate of improvement can dictate how much therapy a patient needs. Progress should be measured so that the Functional Independence Measure Score (FIMS) can be adjusted. This score includes things like mobility and communication skills and should improve weekly in most stroke survivors.

Needs May Change With Time

Depending on the improvements or declines during stroke recovery, services may need to be adjusted. In fact, Medicare coverage for certain rehabilitation services changes based on a stroke survivor’s physical function. If there is any change in function, then their eligibility for certain therapies.

Ask for Help When You Need It

Caring for someone recovering from a stroke can be emotionally and physically exhausting. Make sure you know where to get help, and then make sure you actually reach out when you need to. This includes help with getting the care you or your loved one needs or just getting support for yourself. Ask your healthcare provider for help if you are being denied services. Find support stroke caregiver support groups and other community resources to help you take care of yourself.

At Regional Neurological Associates in New York, we are experts at managing a range of neurologic conditions including strokes and neuromuscular disorders. If you have questions or concerns about your neurological health, call us at (718) 515-4347 to make an appointment.


Botox for Pain Relief: How it Works

Cosmetic procedures. African-american woman getting botox injection in forehead; blog: Botox for Pain Relief: How it Works


Most people are familiar with Botox injections as cosmetic procedures, but many people don’t know about the benefits of botox for pain relief. Botox is effective for treating chronic pain as well as for cosmetic purposes. For people who have a chronic migraine or another headache disorder, these injections can provide much-needed relief and greatly improve their quality of life.

When is Botox for Pain Relief Used?

Botox injections are used for pain relief for several conditions. In neurology, Botox is used primarily for the treatment of chronic migraine. However, it can be used for pain relief in other instances. The most common uses of Botox for pain relief are:

  • Chronic migraines
  • Tension headaches and other headache disorders
  • Nerve pain
  • Chronic neck and back pain
  • Arthritis

How It Works

Botox for pain relief uses a diluted form of botulinum toxin type A. Small amounts of the diluted toxin is safe to inject into the muscles to relieve the pain associated with migraine,  headache disorders, nerve pain, and other types of chronic pain. Botox helps treat headache disorders like migraine when injected into the pain fibers associated with headaches. For treatment of other types of pain, the injections function the same way but are given in different areas. Botox works by blocking the release of chemicals that activate a pain response in the brain.

What to Expect

During the procedure, the doctor will ask the patient to contract their muscles to help identify the treatment sites. After determining the locations for the Botox injection, the physician will give the injection. These injections typically contain a mixture of botulinum toxin and saline solution or local anesthetic. Between five and 10 injections in multiple areas may be needed to successfully relax tense muscles. The procedure usually takes about 5 minutes. 

Shortly after administering the Botox injection, patients may experience mild side effects such as swelling, bruising, and some pain. Rarely, patients will experience nausea, a temporary headache, and other flu-like symptoms. However, most complications are short-term and resolve without medication. Patients can apply ice to the treatment site and take over-the-counter pain killers to reduce any discomfort. 

Other Injections for Headache and Migraine Relief

The Botox injection should begin working within 10 to 14 days, with long term pain relief lasting anywhere from three to four months. Therefore patients may need additional medications to ensure sustained pain relief. These medications may include peripheral nerve blocks or sphenopalatine ganglion blocks. Both of those medications can quickly treat migraines and severe headaches. Patients see results in minutes rather than days. Peripheral nerve blocks also help with other symptoms related to migraines including light and noise sensitivity, and nausea.

Benefits of Botox for Pain Relief

Botox is particularly helpful in treating chronic migraine because it has long-lasting results. Patients experience considerable pain relief for months at a time. At Regional Neurological Associates, we recommend a series of injections to the scalp, neck, and shoulders about 4 times a year. If you are experiencing symptoms of chronic migraine and want to learn more about how Botox may help, call (718) 515-4347 to make an appointment.

5 Depression Treatment Options

Male Patient With Headache In A Clinic; blog: 5 Depression Treatment Options


According to the National Alliance on Mental Illness, more than 17 million adults in the US have at least one major depressive episode each year. That’s 7% of the country’s population. Because this illness is so common and can have such a large impact on someone’s life, there is a great interest in depression treatment options. Every person suffering from clinical depression is unique and not everyone responds to the same treatments. However, there are five types of depression treatments that have been proven to be effective in many people.

1. Medication

Selective Serotonin Reuptake Inhibitors (SSRIs)

These medications are some of the most common drugs used for depression treatment. SSRIs block the absorption of serotonin by particular brain nerve cells. That makes more serotonin available for mood regulation. While SSRIs cause fewer side effects than many antidepressants, they may cause insomnia, weight gain, and sexual dysfunction.

Serotonin-Norepinephrine reuptake Inhibitors (SNRIs)

SNRIs work by increasing levels of serotonin and norepinephrine. These medications keep those chemicals available by preventing them from being reabsorbed. They may cause side effects like headaches or nausea.

Tricyclic Antidepressants

These medications are older and work in a similar way to SNRIs but may have more side effects than newer drugs.

Norepinephrine-Dopamine Reuptake Inhibitors (NDRIs)

These antidepressants increase concentrations of mood-regulating chemicals in the brain. They sometimes cause anxiety and weight gain. However, they produce the least amount of nausea and sexual dysfunction.

Atypical Antidepressants

These are antidepressants that don’t fit into the other common categories.

Other Medications

Other types of medications like those used for anxiety or as stimulants may be combined with the above antidepressants as part of depression treatment. If a patient has bipolar depression, then a mood stabilizer is typically added to an antidepressant. 

2. Therapy

Therapy is often part of depression treatment plans. Three common types of therapy used to treat depression are cognitive-behavioral therapy (CBT), psychodynamic therapy, and interpersonal therapy (IPT)

Cognitive Behavioral Therapy (CBT)

In cognitive-behavioral therapy, the focus is on changing negative thinking patterns. There is a lot of research that shows that CBT helps with the symptoms of depression. It is a structured form of therapy and sometimes it is only recommended for a limited course of treatment for 8 t 16 weeks. The aim is for the person to catch themselves when they are having negative thoughts and then redirect their thoughts using coping techniques.

Psychodynamic Therapy 

Psychodynamic therapy focuses on recognizing patterns of behavior and examining a person’s unconscious thought processes. This type of therapy also looks at past experiences so the feelings associated with those experiences can be resolved.

Interpersonal Therapy (IPT)

In this type of therapy, the patient is encouraged to look at their personal relationships and evaluate how they interact with others. They learn how to improve their relationships through an understanding of how they relate to other people.

3. Lifestyle Changes for Depression Treatment

Some people find lifestyle changes helpful when dealing with depression. These changes can be used in combination with other therapies and medication;

  • Getting enough sleep
  • Eating well
  • Staying active
  • Finding motivation and purpose
  • Learning coping techniques for stress
  • Find support from family members, friends, or another social circle

4. Electroconvulsive Therapy (ECT)

ECT is a type of brain stimulation therapy used for people who do not respond to other kinds of treatment. ECT used to be known as electroshock therapy, but it has evolved an incredible amount since it was first used. Today, ECT involves a precise transmission of short electrical impulses to the brain. ECT generally has good outcomes for patients that are suicidal and do not respond to drug therapies or psychotherapy. However, the side effects of ECT may include confusion and short-term memory loss in rare cases.

5. Transcranial Magnetic Stimulation (TMS)

TMS is similar to ECT, but it uses magnets instead of an electrical current. TMS is safe and non-invasive. It is often recommended for people who can’t tolerate medications well like the elderly, pregnant women or adolescent children. TMS uses focused magnetic pulses that activate or suppress specific areas of the brain. This normalizes the brain circuits associated with psychiatric or neurological conditions.

At Regional Neurological Associates, we embrace the connection between psychiatry and neurology and are pleased to offer our patients mental health treatments like TMS. Two of our neurologists have training in both fields. 

Whether you are seeking treatment for a mood disorder like depression or you need to manage a condition like ADD, our team can help. To see if you might benefit from depression treatment at Regional Neurological Associates, you can complete this depression severity assessment and call (718) 515-4347 to make an appointment.

6 Things to Know About Brain Injuries

Close up of MRI brain : Lower part of brain ( eyes , temporal lobe of cerebrum , cerebellum , brain stem); blog: 6 Things to Know About Brain Injuries


March is Brain Injury Awareness Month. The campaign is led by the Brain Association of America, with a goal to raise public awareness of brain injuries. They aim to de-stigmatize brain injuries and empower those who have survived a brain injury. The Brain Injury Association of America is also dedicated to providing resources for those living with brain injury.

1. Traumatic Brain Injury (TBI)

Not all brain injuries are classified as traumatic brain injuries (TBIs), but they do affect a lot of people each year. According to the Centers for Disease Control and Prevention (CDC), there were almost 3 million TBI-related hospitalizations, ER visits, and deaths in the United States in 2014 (the last year with a complete data set). A traumatic brain injury is one that is caused by an external force or action. Causes of traumatic brain injuries include:

  • Falls (most common)
  • Motor vehicle accidents
  • Military attacks
  • Bomb blasts
  • Violence
  • Gunshot wounds

2. Non-Traumatic Brain Injury (NTBI)

A non-traumatic brain injury (NTBI) is one that is not caused by an external force or action. Causes of non-traumatic brain injury (NTBI) include:

  • Stroke (most common)
  • Lack of oxygen
  • Tumors
  • Illness
  • Brain infections/inflammation
  • Other infections

3. There are Many Physical Symptoms

The physical symptoms of a brain injury may be noticeable immediately or they may present themselves a while after the incident that caused the injury. Physical symptoms that may indicate someone has a brain injury include:

  • Headaches
  • Loss of balance
  • Lack of coordination
  • Trouble speaking
  • Trouble swallowing
  • Seizures
  • Changes in sleep patterns
  • Blurred vision
  • Other vision problems
  • Changes in sensory abilities
  • Loss of bladder or bowel control
  • Changes in sexual function
  • Trouble moving normally

4. There May Be Mental and Emotional Symptoms

While physical symptoms may be easier to notice, brain injuries can cause mental and emotional changes as well. If you notice the following things in someone after a fall or accident, seek medical attention because they may be a symptom of a brain injury:

  • Confusion
  • Personality changes
  • Depression
  • Memory impairment
  • Lack of concentration
  • Mood swings
  • Difficulty forming sentences
  • Disorientation
  • Short attention span
  • Forgetfulness
  • Inappropriate behavior

5. Certain Treatments are Available

Treatments for brain injuries are available, however, it’s important to keep in mind that the road to recovery might be a long one. And full recovery may not be possible. Everyone involved will have to make changes. Depending on the nature and severity of the injury, recommendations for treatment may include:

  • Medications
    • Anti-seizure drugs
    • Diuretics
  • Surgery
    • Blood clot removal
    • Skull fracture repair
    • Stopping bleeding in the brain
  • Rehabilitation
    • Occupational therapy
    • Physical therapy
    • Speech therapy
    • Vocational counseling
    • Recreational therapy

The team caring for someone with a brain injury may grow to include therapists for the above treatments as well as a neuropsychologist, social worker, TBI nurse specialist, or a physiatrist.

6. Support is Important

If a family member or loved one experiences a brain injury, they will need a support system to cope. Both caregivers and the person with brain injury are going to have to adapt to a new way of life. There are resources available online to learn coping skills. The neurologist or other provider giving them care can also point in the right direction. They may also recommend physical or occupational therapy.

If you are the primary caregiver to someone with a brain injury, be sure to keep an eye on symptoms so you can communicate with their physicians if needed. You might be the best source of information on how their condition is progressing based on their moods, intellect, and communication skills. 

Regional Neurological Associates is home to board-certified neurologists who have expertise in treating a range of neurologic conditions, including stroke, which can cause brain injury. If you have concerns about neurological disorders like peripheral neuropathy, call (718) 515-4347 to make an appointment.