Neurological Institute

Alzheimer disease is a disease that affects the brain and nervous system. It happens when nerve cells in the brain die. The disease gets worse over time. It is a type of dementia.

The following are the most common symptoms of Alzheimer disease. But not everyone has all of these symptoms. Symptoms may include:

• Memory loss that affects job skills, especially short-term memory loss
• Difficulty doing familiar tasks
• Problems with language
• Confusion about time and place
• Poor judgment
• Problems with abstract thinking
• Misplacing things
• Changes in mood or behavior
• Changes in personality
• Loss of desire to do things
• Loss of the ability to know who people are. This even includes people whom the person knows well such as a child or spouse.

The symptoms of Alzheimer disease may look like other health conditions or problems. Always see your healthcare provider for a diagnosis.

What causes Alzheimer disease?

Doctors do not know what causes Alzheimer disease. They think it might be caused by one or more of these:

• Age and family history
• Certain genes
• Abnormal protein deposits in the brain
• Environmental factors
• Immune system problems

How is Alzheimer disease diagnosed?

No single test can diagnose Alzheimer disease. A healthcare provider will first rule out other conditions. But the only way to confirm a diagnosis of Alzheimer disease is to examine the brain after death. An autopsy can show changes in the brain that mark the disease.

It’s important to find out if the dementia is caused by an illness that can be treated. A healthcare provider will do thorough exams of the person’s nervous system. The provider may also do:

• Complete health history. This may include questions about overall health and past health problems. The provider will see how well the person can do daily tasks. The provider may ask family members about any changes in behavior or personality.
• Mental status test. This may include tests of memory, problem solving, attention, counting, and language. Neuropsychological testing may also be done. This will likely be a series of tests that assess your brain function. It usually involves answering questions and doing certain tasks.
• Standard medical tests. These may include blood and urine tests to find possible causes of the problem.
• Brain imaging tests. CT, MRI, or position emission tomography (PET) may be used to rule out other causes of the problem.

How is Alzheimer disease treated?

Your healthcare provider will figure out the best treatment for you based on many factors including overall health, age, condition, and more.

Medicines are often used to help people maintain mental function and carry out daily activities. 

At this time, Alzheimer disease has no cure. There is no way of slowing down the progression of this disease, and no treatment is available to reverse the changes that the disease brings on. But new research findings give reason for hope. Several medicines are being studied in clinical trials to see if they can slow the progress of the disease or improve memory for a period of time.

Some medicines are available to help manage some of the most troubling symptoms of Alzheimer disease. These symptoms include:

• Depression
• Behavior problems
• Sleep problems

Exercise and social activities are important to help manage the disease. So are good nutrition, a healthy lifestyle, and a calm and well-structured environment.

What are the complications of Alzheimer disease?

Alzheimer disease is a progressive disease. This means that memory problems and problems with doing daily tasks gradually get worse. Each person is affected differently, but people with Alzheimer disease have mood and behavior problems that make it difficult for family members to care for them. As a person is less able to care for himself or herself, families or others must help with personal care, meals, and daily activities. People with advanced Alzheimer disease will most likely need to stay in a place that specializes in care of people with memory disorders.

Living with Alzheimer disease

Care programs for people with Alzheimer disease differ depending on the symptoms a person has and how far along the disease is. These programs can help a person and his or her family manage the disease.

Any skills lost will not be regained, but the following tips can help people and families living with Alzheimer disease:

• Plan a balanced program of exercise, social activity, good nutrition, and other health lifestyle activities.
• Plan daily activities that help to give structure, meaning, and goals for the person.
• As the person is less able to function, change activities and routines to let the person take part as much as possible.
• Keep activities familiar and satisfying.
• Allow the person to do as many things by him or herself as possible. The caregiver may need to start an activity, but allow the person to complete it as much as he or she can.
• Give "cues" to help the person. For example, label drawers, cabinets, and closets to let the person know what is in them.
• Keep the person out of harm's way by removing all safety risks. These might include car keys and matches.
• As a caregiver, understand your own physical and emotional limits. Take care of yourself and ask for help if you need it.

Key points about Alzheimer disease

• Alzheimer disease is a disease that affects the brain and nervous system. It gets worse over time.
• Alzheimer disease affects a person’s memory, thinking, personality, emotions, and ability to care for himself or herself.
• Alzheimer disease has no cure.
• Medicines may help with some of the symptoms.
• Caregivers need to be aware of their own needs and ask for help as needed.
• Over time a person with Alzheimer disease will most likely need to stay in a place that specializes in care for people with this disease.

Recovering from a Concussion

Although most people recover fully after a concussion, how quickly they improve depends on many factors, including: their age, how healthy they were before the concussion, and how they take care of themselves after the injury.

Rest and time are the most important factors in recovering from a concussion. Rest is necessary because it helps the brain to heal, which takes time. “Toughing it out” and ignoring symptoms often makes them worse. Under the supervision of their healthcare provider, a person with a concussion should gradually resume normal work and school activities only when symptoms have reduced significantly. If symptoms return or new symptoms appear, it means the patient is pushing himself too hard. A person with a known or suspected concussion should not return to play until he is evaluated and given permission by an appropriate healthcare professional.

Strategies for Recovery

In the first few weeks after a concussion, experts advise that you limit physical exertion, focus on getting enough sleep, and gradually return to your work and school activities and responsibilities. Athletes need to be particularly careful to avoid another injury to the head during the period that they are recovering from a concussion. You might talk to your physician about short-term treatments for headaches, sleep difficulties, and irritability or you might try yoga, meditation, or massage to help to lessen your symptoms. Again, it is important to remember that your symptoms will usually go away on their own. Research has shown that knowing that symptoms may occur, and that they are a normal part of the recovery process, can help people to recover faster.

We have an assessment and treatment tool that helps to re-set the brain’s internal timing for improved cognitive and motor functioning after a neurological change such as with a brain injury, concussion, and stroke. Physical, occupational, and speech therapists are certified providers that utilize this tool as appropriate to assist in better patient outcomes.

More Tips for Recovering from a Concussion

• Avoid activities that are physically demanding (e.g., weightlifting/working-out) or require a lot of concentration. They can make your symptoms worse and slow your recovery.
• Get plenty of sleep at night and rest during the day. 
• Avoid activities, such as contact or recreational sports that could cause another blow or jolt to the head. (It is best to avoid roller coasters or other high speed rides that can make your symptoms worse or even cause a concussion.)
• Because your ability to react may be slower after a concussion, ask your healthcare professional when you can safely drive a car, ride a bike, or operate heavy equipment.
• Talk with your health care professional about when you can return to work. Ask about how you can help your employer understand what has happened to you.
• Consider talking with your employer about returning to work gradually and about changing your work activities or schedule until you recover (e.g., work half-days).
• Take only those drugs that your health care professional has approved.
• Do not drink alcoholic beverages until your health care professional says you are well enough. Alcohol and other drugs may slow your recovery and put you at risk of further injury.
• Write down the things that may be harder than usual for you to remember.
• If you’re easily distracted, try to do one thing at a time. For example, don’t try to watch TV while fixing dinner.
• Consult with family members or close friends when making important decisions.
• Do not neglect your basic needs, such as eating well and getting enough rest.
• Avoid sustained computer use, including computer/video games early in the recovery process.
• Some people report that flying in airplanes makes their symptoms worse shortly after a concussion.

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CHI Health Neurological Institute at CHI Health Immanuel offers the Functional Gait Recovery Program to help those patients who qualify. This program offers a multi-specialty team approach where you will have an aggressive one or two week outpatient treatment plan that is arranged for you by our neurology, mental health, and physical therapy staff. This dedicated team will work with you one-on-one to meet your individual goals. At the end of the program you will have a final visit with your neurologist to confirm your improvement, and you will be given tools to continue your recovery once the intense phase of the program is over.

What is Functional Gait Disorder?

A functional gait or movement disorder means that there is abnormal movement of part of the body due to a malfunction in the nervous system. This type of movement is involuntary and the symptoms cannot be explained by another neurological disease or medical condition.

What are the Signs and Symptoms?

People with Functional Gait Disorder may have a combination of the following problems while walking:

• Dragging of one leg
  
• Sudden knee buckling or collapse
  
• Small, slow steps
  
• Excessive swaying
  
• Extra movements of arms and legs that disrupt balance
  
• Crouching
  
• Anxiety about falling
  

Factors that may increase your risk of Functional Gait Disorder include:

• Having a neurological disease or disorder, such as epilepsy, migraines or a movement disorder
• Having a mental health condition
• Recent stress, physical or emotional trauma
• History of physical or sexual abuse or neglect in childhood
• Family history of functional neurologic disorder

How is it diagnosed?

Diagnosis involves a clinical assessment by a neurologist, who will examine you and may do tests to rule out other conditions that can cause difficulty walking. A mental health professional may also be included in this process.

Treatment

Treatment will depend on your type of functional disorder and what signs and symptoms you are experiencing. Treatment is tailored to each patient and can include physical, occupational, and mental health therapies. The therapy approach is specifically designed for those with functional disorders and includes techniques different from the standard therapies you might have had in the past.

The Functional Gait Recovery Program is the only specially-designed program in the region for people suffering from this condition. If you or your doctor feel this program is right for you, please call our office to schedule your initial evaluation with Dr. Burnett.

Headaches and migraines are often interchanged when discussing headache pain, but there are slight differences between the two. A migraine can cause severe throbbing pain or a pulsing sensation, usually on one side of the head; while a severe headache is more constant, steady type pain. Migraines are 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.

 There are two types of migraines, which are defined by how often headaches happen.

• Episodic migraine: fewer than 15 headache days per month, some of them being migraine. 
• Chronic Migraine: 15 or more headache days per month, with headaches lasting four hours or longer, for at least three months, some being migraine.

What are the Signs and Symptoms?

Migraines or headaches usually begin early in a person’s life – childhood, adolescence or early adulthood. Migraines and headaches typically progress through four stages: prodrome, aura, headache and post-drome (although some may not experience all stages).

Prodrome – 1 - 2 Days before a migraine, possible changes that could occur:

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

Aura – Before or during a migraine, possible disturbances include:

• Visual disturbances – flashes of light or wavy, zigzag vision
• Touching sensations (sensory) disturbances – like pins and needles sensation
• Movement (motor) disturbances – muscles seem weak
• Speech (verbal) disturbances – slurred or difficult speech

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

Migraine Attack – Usually lasts from 4 - 72 hours During this time one 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/or vomiting
• Blurred vision
• Lightheadedness, possibly followed by fainting

Post-drome – Occurs for about 24 hours after a migraine headache attack. During this time, the following symptoms could occur:

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

How are Headaches and Migraines Diagnosed?

A patient’s medical history, physical and neurological exams diagnose a headache disorder. Additional optional lab tests – such as MRIs, blood tests, and Spinal Fluid analyses – help physicians rule out other diseases.

Procedures used to diagnose a migraine are generally used to rule out other possible causes of the symptoms. In addition to a complete medical history and physical examination, some procedures that may be used include:

• Blood tests - Various blood chemistry and other laboratory tests may be run to check for underlying conditions.
  
• Sinus x-rays - A diagnostic imaging procedure to evaluate for congestion or other problems that may be corrected.
• Magnetic resonance imaging (MRI) - A diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body.
  
• Computed tomography scan (also called a CT or CAT scan) - A diagnostic imaging procedure that uses a combination of X-rays and computer technology to produce horizontal, or axial, images (often called slices) of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than standard X-rays.
  
• Spinal tap (also called a lumbar puncture) - A special needle is placed into the lower back, into the spinal canal, which is the area around the spinal cord. The pressure in the spinal canal and brain can then be measured. A small amount of cerebral spinal fluid (CSF) can be removed and sent for testing to determine if there is an infection or other problems. CSF is the fluid that bathes the brain and spinal cord.

What Happens After Diagnosis?

The CHI Health Neurological Institute multidisciplinary team offers highly trained experts that enable us to offer comprehensive migraine and headache care which begins with the diagnosis and lasts a lifetime. Our goal is to work with the patient to reduce occurrences, manage symptoms and maintain the highest quality of life.

Managing migraines and headaches is an ongoing process, beginning with the very first symptoms and continuing throughout the years. It’s never too soon or too late to think about how to access high quality, comprehensive, interdisciplinary care.

“Movement disorders” is a term used to identify a group of neurological conditions that cause abnormal movements of the head, a single limb, or sometimes the entire body. Movement disorders can produce either an increase or a decrease in movement in a way that interferes with normal functioning.

The CHI Health Neurological Institute specialists will work with patients on individualized treatment plans that can help with recovery from and management of symptoms.

What Problems Does a Movement Disorders Specialist Evaluate?

• Problems with walking, balance, or falls
• Clumsiness and trouble using your hands
• Excessive muscle stiffness and spasms
• Speech difficulty: slurred speech, soft speech, spasms of the mouth or tongue, tics
• Tremors: uncontrollable shaking
• Myoclonus: rapid, random jerks of a limb or the body
• Chorea: excessive writhing or fidgeting movements
• Dystonia: excess muscle tightness producing tremors, cramps, or twisting of the head or limbs
• Involuntary blinking and winking of one side of the face
• Head drop: trouble lifting up the head, which could be from muscle tightness, weakness, or both
• Any loss of control over movement

What are Examples of Movement Disorders?

• Parkinson's Disease: a condition more likely with aging that causes slowness, stiffness, tremors, walking problems, and imbalance
• Parkinsonism: what we call the above symptoms if caused by something besides Parkinson's disease, such as Multiple Systems Atrophy, Corticobasal Ganglionic Degeneration, or Progressive Supranuclear Palsy
• Essential Tremor: a condition that causes shaky limbs, head, and voice and tends to run in families
• Cerebellar Ataxia: a name for a variety of conditions that cause clumsiness of gait, slurred speech, vision, and swallowing problems
• Huntington’s Disease: an inherited condition that produces chorea (excessive involuntary movements), imbalance, and memory problems, among other symptoms
• Restless Legs Syndrome: a funny feeling that produces a compulsion to move and pace at night
• Tardive Dyskinesia: involuntary facial movements produced as a side effect of some medications
• Cervical Dystonia: twisting and tremors of the neck
• Writer’s Cramp: twisting and tremors of the hand and arm while writing
• Hemifacial Spasm: twitching and winking of one side of the face
• Tourette Syndrome and Tics: when a person feels compelled to execute a voluntary movement or noise repeatedly
• Functional Movement Disorder: a condition in which abnormal voluntary movements occur, but knowledge that the movements are voluntary is lost

How are Movement Disorders Diagnosed?

There are many movement disorders and each has its own unique testing or evaluation process. A patient’s medical history, neurologic exams and lab tests – such as MRIs, CTs, blood tests, and spinal fluid analyses – help physicians rule out other diseases and confirm the specific movement disorder diagnosis.

What Happens After Diagnosis?

The CHI Health Neurological Institute multidisciplinary team offers highly trained experts that enable us to offer comprehensive movement disorder care which begins with the diagnosis and lasts a lifetime. Our goal is to work with the patient to reduce disease activity, manage symptoms and maintain the highest quality of life. Most movement disorders are treatable. Many conditions respond to medication or botulinum toxin (Botox) injections.

Some conditions eventually require surgery:

• Focused Ultrasound (Available at CHI Health): Incisionless procedure for the treatment of essential tremor. 
• Deep Brain Stimulation (Coming soon to CHI Health): Implantation of a “pacemaker for the brain.” 

Managing movement disorders is an ongoing process, beginning with the very first symptom and continuing throughout the disease or disorders course. It’s never too soon or too late to think about how to access high quality, comprehensive, interdisciplinary care for movement disorders.

What is MS?

Multiple sclerosis (MS) is a disease that affects the central nervous system (the brain and spinal cord) and can be disabling throughout acute relapses and its progression. MS is an autoimmune disease where the body’s immune system begins attacking its own tissues, specifically myelin (the protective covering of nerve fibers) and causes communication problems between the brain and the rest of the body. In time, the disease can cause the nerves themselves to deteriorate or become permanently damaged. Signs and symptoms of MS vary from person to person due to the amount of nerve damage and which nerves are actually affected. Severity of effects range, and some patients may experience long periods of remission without any new symptoms, while other can have more aggressive course with fast accumulation of lesion load. Currently there is no cure for multiple sclerosis, although there are 15 FDA approved medications that can modify disease course. They have been found through clinical trials to reduce the number of relapses, delay progression of disability, and limit new disease activity. CHI Health Neurological Institute specialists will work with patients on individualized treatment plans that can help with recovery from and management of symptoms.

What are the Signs and Symptoms?

Multiple sclerosis signs and symptoms differ greatly from person to person. The progression of the disease and the location of nerves affected play a big part. Symptoms could include the following:

• Numbness or weakness in one or more of the limbs; typically occurs on one side of the body at a time
• Partial or complete loss of vision; usually in one eye at a time, often with pain during eye movement
• Prolonged double vision
• Tingling or pain in parts of the body
• Electric-shock sensations that occur with certain neck movements, especially bending the neck forward
• Tremor, lack of coordination or unsteady gait
• Muscle stiffness and cramps
• Slurred speech
• Fatigue
• Cognitive difficulties
• Dizziness
• Problems with bowel and bladder function

How is MS Diagnosed?

There is no single test that can diagnose MS. A patient’s medical history, neurologic exams and radiologic tests — such as MRIs of brain/spinal cord are the most important initial steps. Spinal Fluid analyses and additional lab tests are frequently done and help physicians rule out other diseases and confirm the MS diagnosis. 

What Happens After Diagnosis?

The CHI Health Neurological Institute multidisciplinary team offers highly trained experts that enable us to offer comprehensive MS care which begins with the diagnosis and lasts a lifetime. Our goal is to work with the patient to reduce disease activity, manage symptoms and maintain the highest quality of life. Managing MS is an ongoing process, beginning with the very first symptoms and continuing throughout the disease course. It’s never too soon or too late to think about how to access high quality, comprehensive, interdisciplinary care. 

At the Neurological Institute on the CHI Health Immanuel campus, we take a collaborative practice approach to the treatment of Parkinson’s disease.  Our neurologists work closely with a Doctor of Pharmacy from Creighton University who specializes in the pharmacologic treatment of neurologic disorders.  Patients have individual appointments with their neurologist, and also with the pharmacist who continues to see them on a regular basis.  As a team, they make treatment decisions to ensure patients achieve the best outcomes. This approach is unique to CHI Health’s Neurological Institute, where we recognize that collaboration between the specialties is the best approach to ensuring that patients with Parkinson’s disease get the finest and most comprehensive care possible.

Medications for the control of the motor symptoms of Parkinson’s disease remain the cornerstone of treatment. In general, medication therapy focuses on the replacement and regulation of the activity of the neurotransmitters (primarily dopamine, which is involved in the control of movement). The choice of medications is highly patient-specific and is dependent upon many factors including the severity of symptoms, the presence of other pre-existing medical conditions, the age and current needs of the patient, and the potential for interactions with other medications that the patient might be receiving. The goal is always to achieve a balance between symptom control and side-effects.

Available Medications

• Carbidopa/Levodopa: one of the oldest medications used for the treatment of Parkinson’s disease. The medication is given as a direct replacement for dopamine. While it remains the most potent medication for the treatment of Parkinson’s disease, it has the potential to induce involuntary movements called dyskinesias after several years of exposure. The introduction of this medication for a patient is therefore carefully timed.
• Continuous infusion carbidopa/levodopa: Recently, a new formulation of carbidopa/levodopa given by continuous infusion into the gastrointestinal tract has become available for patients with very advanced disease. A specially trained team of practitioners is available to provide this new formulation to eligible patients.
• Dopamine agonists: a group of medications that work like dopamine in the body. They are less potent than carbidopa/levodopa, but are good options as initial therapy for many patients in the earlier stages of the disease, or as an addition to other medications as Parkinson’s disease progresses. They can also help increase the effectiveness of carbidopa/levodopa when the effects of the latter start to diminish due to disease progression.
• MAO Inhibitors and COMT Inhibitors: used in the treatment of Parkinson’s disease to constrain the activity of enzymes involved in the metabolism or breakdown of dopamine. In this way, they can enhance the effect of dopamine-replacing medications, and also the patient’s own dopamine. MAO Inhibitors are sometimes used alone early in therapy, but they may also be added to other medications as the disease advances. COMT inhibitors are only used in conjunction with carbidopa/levodopa.
• Anticholinergics: oldest medications used in the treatment of Parkinson’s disease. They do not affect dopamine or dopamine receptors directly. Rather, they work to correct the imbalance between dopamine and another neurotransmitter called acetylcholine. The overactivity of acetylcholine is believed to play a role in the tremor that is characteristic of Parkinson’s disease.
• Amantadine: medication developed for use to prevent and treat influenza. Its ability to help patients with Parkinson’s disease was discovered by happenstance during clinical trials. It is generally not used long-term for the treatment of Parkinson’s disease as its effects tend to be mild, and the disease usually progresses beyond the ability of the medication to control symptoms fairly quickly. However, the drug has been found to be helpful for patients who develop carbidopa/levodopa induced dyskinesias, or involuntary muscle movements.

Treatment of the Non-Motor Symptoms of Parkinson’s Disease

Though we usually think of Parkinson’s disease in terms of its classic symptoms (tremor, rigid muscles, slow movement and problems with balance), there are a number of other associated conditions that patients may face. The following symptoms are frequently experienced by Parkinson’s disease patients:

• Psychiatric diagnoses (depression, dementia and psychotic symptoms),
• Low blood pressure/dizziness
• Gastrointestinal dysfunction (constipation and nausea)
• Sleep disorders (restless legs, insomnia or excessive sleepiness during the day)

Sometimes these problems are directly related to the medications that we use to treat Parkinson’s disease. Other times they are experienced as part of the disease itself. The neurology care team can help patients navigate these complications with careful medication adjustment, and the addition of other treatment strategies when necessary.

Treating Advanced Disease

Because there are currently no medications that have been proven to slow the advancement of Parkinson’s disease, eventually other strategies may need to be employed. Surgical procedures are sometimes utilized to help control advanced Parkinson’s disease.

Deep Brain Stimulation

One such procedure is the implantation of a device called a deep brain stimulator. This device works through electrodes that are placed strategically in the brain. Other surgeries may be done to decrease activity in areas of the brain that are responsible for causing tremor.

Medications

Medications for self-injection by the patient may also be employed to combat resistance to drug therapy that develops with Parkinson’s disease progression. Our skilled neurology team can work with patients and caregivers to determine if any of these interventions is the appropriate one, and implement the chosen strategy to maintain the functional ability of the patient for as long as possible.

View more resources from Parkinson's Nebraska.

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What is a Neuromuscular Disease?

Neuromuscular diseases affect nerves and muscles, and can cause sensory loss, weakness and even loss of muscle control. The providers at the CHI Health Neurological Institute understand that quality of life is important and that neuromuscular diseases can make every day things like walking, talking and breathing more difficult.

Our CHI Health Neurological Institute at Immanuel was named a CMTA Center of Excellence for 2023!

Neuromuscular Diseases We Treat

Motor Neuron Diseases: In motor neuron diseases, nerve cells called motor neurons progressively lose function and cause weakness.

• ALS (Amyotrophic Lateral Sclerosis or Lou Gehrig’s Disease)
• Kennedy’s Disease/Spinal Bulbar Muscular Atrophy (SBMA)
• Primary Lateral Sclerosis
• Spinal Muscular Atrophy

Muscular Dystrophies:

• Congenital Muscular Dystrophy (CMD)
• Duchenne/Becker Muscular Dystrophy (DMD/BMD)
• Fasciascapulohumeral Muscular Dystrophy (FSHD)
• Limb-girdle Muscular Dystrophy (LGMD)
• Myotonic Dystrophy (DM)
• Oculopharyngeal Muscular Dystrophy (OPMD)

Myopathies/Myositis:

• Congenital Myopathies
• Dermatomyositis
• Distal Myopathies
• Immune-Mediated Necrotizing Myopathy
• Inclusion Body Myositis
• Metabolic Myopathies
• Polymyositis

Neuromuscular Junction Diseases:

• Congenital Myasthenic Syndromes
• Lambert-Eaton Myasthenic Syndrome (LEMS)
• Myasthenia Gravis (MG)

Peripheral Nerve Disease

• Chronic Inflammatory Demyelinating Polyneuropathy (CIDP)
• Charcot-Marie-Tooth Disease (CMT)
• Mononeuropathy Multiplex
• Vasculitic Neuropathies and other immune-mediated neuropathies
• Transthyretin (TTR) Amyloid Polyneuropathy and other familial amyloid polyneuropathies

Mitochondrial Diseases:

• Friedreich’s Ataxia
• Mitochondrial Myopathies

How are Neuromuscular Diseases Diagnosed?

• Medical history, neurological exam, lab tests (serum and cerebral spinal fluid), CTs, MRIs
• NCS/EMG (Nerve Conduction Study/Electromyogram)
• Neuromuscular Ultrasound
• Skin Biopsy
• Muscle or Nerve Biopsy

Treatment

The diagnosis and care of a neuromuscular disorder can be challenging.  Treatment will depend on your type of neuromuscular disease and what symptoms you are experiencing. 

The Neurological Institute at CHI Health Immanuel offers routine clinic visits with our neuromuscular specialist to determine the best treatment options for each individual patient. 

What services do we offer:

• Forearm exercise test 
• NCS/EMG (Nerve Conduction Study/Electromyogram)
• Neuromuscular Ultrasound
• Neuromuscular Clinic
• Multi-disciplinary Neuromuscular Clinic/ALS Clinic
• Skin biopsy for small fiber neuropathy

EMG

Nerve Conduction Studies (NCS) and Electromyography (EMG) evaluate the function of nerves and muscles and are always completed together. During NCS, small shocks are given to different nerves and the signal traveling through the nerve is recorded. During EMG, small needles are inserted into muscles so the neurologist can see and hear electrical signals made by the muscles when they are both resting and moving. EMG/NCS can be performed on arms and/or legs or even the face depending on patient symptoms.

Your doctor may order an EMG if you have signs or symptoms that may indicate a nerve or muscle disorder. Such symptoms may include:

• Tingling
• Numbness
• Muscle weakness
• Muscle pain or cramping

EMG results are often helpful to diagnose or rule out a number of neuromuscular conditions:

• Muscle disorders, such as polymyositis
• Diseases affecting the connection between the nerve and the muscle, such as Myasthenia Gravis
• Disorders of peripheral nerves, such as Carpal Tunnel Syndrome or peripheral polyneuropathy
• Disorders that affect the motor neurons in the brain or spinal cord, such as Amyotophic Lateral Sclerosis
• Disorders that affect nerve roots, such as a herniated disc in the spine

Neuromuscular Ultrasound

Neuromuscular ultrasound (NM US) uses high-frequency and dynamic ultrasound technology to visualize the structure of nerves and muscles. It is highly useful as an adjunct to the clinical evaluation and EMG/NCS (which assesses function of nerves and muscles). It is performed and interpreted by the same neurologist.

Multi-disciplinary Neuromuscular Clinic/ALS Clinic

Treatment may also require the expertise of different fields. The CHI Neurological Institute offers this program to help those patients that qualify.

This program offers a multi-disciplinary team approach to improve quality of life by preserving strength and mobility. Treatment is tailored to each patient and includes a Neuromuscular Neurologist and Physical Therapist. It may also include an Occupational Therapist, Speech Therapist, Respiratory Therapist, Wheelchair/Mobility Specialist, social worker, nurse and clinic coordinator. 

What to expect from your visit:

During your visit, you will be evaluated by our team and they work together to identify the areas that need to be addressed to maximize quality of life and independence throughout the continuum of disease progression. We work closely with the patient and their family to provide education and training.  

For information or to schedule an appointment, call the CHI Health Neurological Institute at (402) 717-0070.