Services

The Community Neurologic Center offers comprehensive diagnostic and therapeutic services for adults and children with disorders of the central and peripheral nervous system. Sophisticated neurophysiological evaluations, including electroencephalography, electro-myography and evoked potential testing are provided. The faculty has expertise in diverse areas such as multiple sclerosis, seizures, stroke, movement disorders, headaches and pain, infectious disease, neuromuscular diseases, peripheral neuropathies, neuro-oncology, behavioral neurology and developmental disorders.

We provide the latest treatment with Botox for variety diseases. Subspecialty neuropsychological testing is also available. All of our faculty are certified by the American Board of Psychiatry and Neurology. Consultations for all neurological problems are provided on a referral basis, as well as medical management for patients with chronic neurological diseases.

The Community Neurologic Center offers state-of-the-art evaluation and treatment of memory and behavioral disorders associated with Alzheimer's disease, Parkinson's disease, and vascular disease. The staff is expert at distinguishing memory changes resulting from these and other disorders from those associated with normal aging. We are experienced in the pharmacological treatment of memory impairment and in the management of secondary symptoms of dementia such as agitation, hallucinations, and sleep disorders.

Our practice treats many neurological conditions, including the following:

DIAGNOSTIC PROCEDURES AND OTHER SERVICES

Our physicians, assisted by our highly trained technical staff, perform the following diagnostic, therapeutic, and interventional procedures and services:

Ambulatory EEG

An ambulatory EEG test is a non-invasive analysis of the electrical activity of the brain over an extended period of time. Twenty-two electrodes are attached on the scalp in various locations through which electrical impulse activity is recorded. Two patches will be place on your chest to monitor electrocardiograph activity. This will take approximately 1 hour and 30 minutes. Upon leaving this appointment you will receive a diary to record all of your activities and symptoms. Take normal medication and resume normal activity unless otherwise instructed. The next day you are to come to the office to have the electrodes removed. This will take approximately 30 minutes. In preparation for this test you must wear a blouse or shirt that buttons down the front and your hair must be clean and dry. Please be advised that due to residual adhesive from the electrodes, you will need to shampoo your hair after the electrodes are removed.

Botox Injections

Our Community has relied on Dr. Lekah for his expertise in the field of Neurology and his dedication to excellence in caring for patients with brain, spine, muscle and nerve disorders. In order to enhance his services, Dr. Lekah has successfully used BotoxTM therapy for many years, which is extremely safe and effective for treating a variety of neurological disorders, including:

• Muscle spasms associated with neck and back pain
• Stiff limbs associated with Multiple Sclerosis, Cerebral Palsy, Strokes
• Writers cramp
• Spasmatic Torticollis (involuntary neck movement)
• Tension-type headaches, chronic daily headaches, migraine type headaches
• Hemi-facial spasms (involuntary movement of face and eye closure)
• Segmental dystonia (involuntary movement of limbs, neck or trunk)

Dr. Steven V. Lekah emphasizes high quality neurologic care and utilizes the latest technology to help our Community.

Brainstem Auditory Evoked Potential

Auditory evoked potential checks the pathways from the ear to the brain. Two electrodes are placed on the scalp and one electrode is place on each ear. Earphones are placed over your ears and various sounds will be used for testing. No preparation is needed. This test will take approximately 30 minutes. Take normal medication unless otherwise instructed.

Carotid Ultrasound Examination

Carotid ultrasound is a non-invasive diagnostic examination used to evaluate the condition of the major arteries in the neck. These arteries, called the Carotid arteries, supply the brain with blood. During the exam, an ultrasound transducer will be placed on an area of the neck over the arteries, producing an image displayed on a video screen. This test will take approximately 30 minutes, and is completely painless. No preparation is necessary for this exam; however, a low cut, loose fitting shirt or blouse will allow for better access. Take normal medication unless otherwise instructed.

Carotid Artery Blockage

• Cerebral Catheterization and Angioplasty
  Cerebral catheterization is a technique where a catheter (thin tube) is navigated under X-ray guidance to a brain blood vessel. Angiography is an X-ray examination of the arteries and can be used to study the arteries throughout the body. Cerebral angiography is the examination of the brain blood vessels. Cerebral angiography is typically done to determine the location of the blocked artery, how severe the blockage is, and what is causing the blockage. Another common reason is to see if there is an aneurysm (ballooning of an artery).

  The procedure involves inserting a thin tube (catheter) at the top of the leg after giving local anesthetic to numb the skin and deep tissues. The catheter is then navigated under X-ray guidance into a blood vessel that carries blood to the brain. When the catheter is in desired position, contrast (X-ray dye) is injected through the catheter while X-ray pictures are taken. Usually, several contrast injections and several sets of X-rays are needed to complete the examination. After the examination is finished, the catheter is removed. Pressure will be applied at the site of catheter insertion for 20 minutes to stop the artery from bleeding. The entire procedure takes between one to two hours to complete.

• Percutaneous Transluminal Angioplasty and Stenting (PTAS) of Carotid Artery
  Percutaneous transluminal angioplasty is an interventional technique where a blocked blood vessel is opened with a balloon. A stent (spring like device) is then inserted across the blockage to prevent the vessel from collapsing. PTAS has been used successfully to open blocked arteries of the heart for number of years. The same technique is used successfully to treat the blocked carotid artery.

EEG

An EEG is a non-invasive analysis of the electrical activity of the brain. Twenty-seven small disc electrodes are placed on the scalp in various locations through which electrical impulse activity is recorded. In preparation for this test please come with clean dry hair with no gel or hair spray. Take normal medication unless otherwise instructed. Test time will be approximately 45-60 minutes. Please be advised that due to residual conductive gel from the electrodes, you will need to shampoo your hair after the electrodes are removed.

NOTE: There are two types of EEGs that the physician can order, depending on the patient's condition as follows:

1. Sleep deprived EEG: Night before scheduled appointment you must stay awake throughout the night so that you will sleep, or at a minimum, be drowsy during your test.

2. Awake EEG: Night before scheduled appointment you can maintain normal sleeping pattern (i.e. full night's sleep).

EMG and Nerve Conduction Studies

EMG and Nerve Conduction Studies are special tests used to detect nerve and muscle problems. EMG (electromyography) measures the electrical activity of the muscles. Nerve Conduction Studies evaluate the ability of nerves to transmit sensory information and stimulate muscles. Recording electrodes are attached to your skin and a mild electrical stimulus is sent through your nerves and the responses are recorded. The second part of the test involves a small needle electrode, which is gently inserted into the muscle. The muscle will be tested at rest and tested as it contracts. Do not apply any lotion, oils, creams, or perfumes to your skin the day of the test. No preparation is needed; this test will take approximately 45 minutes. Take normal medication unless otherwise instructed.

Epidural Blood Patch

Approximately 10% of patients undergoing a diagnostic lumbar puncture will experience a persistent headache, which although harmless, may be quite uncomfortable. Most post-lumbar puncture headaches resolve spontaneously with rest, oral medications and fluids. Those headaches that remain may be treated in our office with an epidural blood patch.

This procedure, which takes about 30 minutes, involves withdrawing one tube of blood from the patient's forearm. The blood is then slowly injected in the low back where the initial lumbar puncture needle was inserted, into the epidural space, which anatomically lies just in front of the spinal fluid space.

As the injected blood clots, a "patch" is formed over the hole produced by the original lumbar puncture needle, and the headache quickly resolves, often in 20-30 minutes. Epidural blood patching is 90% effective in ameliorating post-lumbar puncture headaches. The most common side-effect is temporary soreness in the lumbar region, which responds to local heat and anti-inflammatory medicine. Other complications, including infection, pain and bleeding, are extremely rare.

Evoked Potentials

Evoked potentials are non-invasive assessments of the nerve pathways.

Intraoperative Monitoring

Intra-operative monitoring (IOM) assesses the integrity of neural pathways in both the central nervous system (brain and spinal cord) and the peripheral nervous system during surgery. This monitoring is utilized in spinal orthopedic surgery, neurosurgery, cardiac and urological procedures, otolaryngological surgery and peripheral nerve reconstruction.

IOM can help the surgeon in two ways:

1. when neural pathways may be at risk of injury during surgery from some secondary effect the surgeon can be notified and investigate the cause of injury and then reverse that injury before it does permanent damage;

2. to help guide the surgeon in the amount of resection being done on a specific area.

The second method allows the surgeon to get most of the bad area out without hurting the good area.

By reducing the incidence of surgically induced neurological deficits, IOM improves surgical outcome, which decreases short and long-term medical costs, morbidity and mortality.

Lumbar Puncture

A lumbar puncture (also known as a spinal tap) is a procedure to obtain spinal fluid for analysis to exclude infection, inflammation, tumors, autoimmune disorders and markers for a variety of inherited and acquired illnesses. This fluid is known as "cerebrospinal fluid" or "CSF".

The procedure is performed in a short stay unit at the hospital and usually takes 10-15 minutes to complete followed by a 2 hour observation period before home discharge. Fasting is NOT required prior to the test and you should take all of your regular medications on schedule. When you go home, you will be on a "light activity" schedule for the next 24-48 hours. If you tend to be anxious about testing, please ask your doctor if a mild sedative would be useful before you come for the procedure.

The lumbar puncture is done in a side-lying or sitting position in bed after a local anesthetic is given in the lower area of the spine. A spinal needle is inserted below the area where the spinal cord ends, the pressure may be measured, and fluid is withdrawn for analysis. Patients may feel some pressure as the needle is placed, but on occasion, the needle brushes by a nerve root causing a jolt of pain from the back into the leg/foot which usually subsides when the needle is repositioned. The spinal fluid is replenished within several hours.

Test results may take from 1 day to 2 weeks (depending on which tests have been ordered) and you should call your physician for results and further instructions once the results are available for review.

Patients can experience a variety of symptoms AFTER the lumbar puncture including:

• Severe headaches

• Nausea/vomiting/lightheadedness

• Dizziness/balance problems

• Visual blurring or light/noise sensitivity

If any of these occur, please call your physician for further instructions. Treatment of these post-spinal symptoms may involve bed rest, hydration, a variety of medications and in some cases, an epidural blood patch. Symptoms may start one or two days after the spinal tap and may last for several days, so please do not hesitate to call us if you are experiencing any of the above symptoms.

Nerve and Muscle Biopsy

A biopsy is a minor surgical procedure in which tissue is removed for analysis and special studies to make a histological diagnosis. Accurate tissue diagnosis is often needed to select the right treatment for specific diseases. Nerve and muscle biopsies are performed under local anesthesia.

A nerve biopsy entails removal of a small nerve (the sural nerve) in the lateral ankle region. Patients with neuropathy (nerve damage) for which there is no clear cause may require a nerve biopsy. This 30-45 minute procedure is safe and painless, though complications can include ankle swelling, tenderness and numbness, infection and poor surgical wound healing.

Muscle biopsies involve surgical removal of either thigh or shoulder muscle through a one inch skin incision. This procedure is very useful in diagnosing or ruling out muscle conditions such as polymyositis, dermatomyositis, muscular dystrophy, mitochondrial disorders and myopathies. Muscle biopsies take about 30 minutes to perform, and complications may include local pain and cramping, swelling and infection.

Both nerve and muscle biopsies require sutures, which are removed in the office in 7-10 days. Wound care is simple, and detailed written instructions, as well as pain medications and antibiotics (when needed) are provided prior to discharge from the hospital.

Neuropsychological Services

Sophisticated testing and assessment for memory and behavioral disorders performed by our neuropsychologist Letitia P. Libman, M.S., PhD. From consultation and evaluation, to long term counseling and research, neuropsychologist works closely with the neurologists to ensure an accurate assessment and mutually agreed upon medical and psychological treatment plan geared toward recovery for both the patient, and family/caregiver. These services are performed in outpatient, rehabilitation, and inpatient settings.

Somatosensory Evoked Potential

Somatosensory evoked potential checks the pathway from the limbs to the brain. Several electrodes are placed on the scalp, neck, shoulder, and wrist for upper extremities; and on the scalp, back, knee, and ankle for lower extremities. A mild electrical stimulus is administered at either the wrist or the ankle and responses are then recorded. No preparation is needed. This test will take approximately 45 minutes. Take normal medication unless otherwise instructed.

Visual Evoked Potential

Visual evoked potential checks the pathway from the eyes to the brain. Three electrodes are placed on the scalp. One eye is covered while the other is tested using a checkerboard screen. No preparation is needed. This test will take approximately 30 minutes. Take normal medication unless otherwise instructed.