The following forms are provided to help you and your doctor evaluate your sleep problems.  Print these forms, fill them out and bring to your appointment. If you are not sure what forms you need to fill out please contact us via e-mail or telephone.

Epworth Sleepiness Scale is helpful to assess daytime sleepiness (if you are tired, have reduced concentration, reduced job performance). It is used in diagnosis and follow up care of patients with insomnia, narcolepsy and sleep apnea.

Sleep Disorder Assessment is a useful screening tool for various sleep disorders. Patients with sleep complaints should start with this form.

Sleep Diary is a two week diary that documents your sleep and wake behavior patterns (time in bed, exercise, caffeinated drinks).

Insomnia questionnaire is used to assess the severity of difficulty falling and staying asleep.

Idiopathic Parkinson’s disease is the most common form of parkinsonism, a group of movement disorders that have similar features and symptoms. Parkinson’s disease is called idiopathic Parkinson’s because the cause is unknown. In the other forms of parkinsonism, a cause is known or suspected.

Parkinson’s results from the degeneration of dopamine-producing nerve cells in the brain, specifically in the substantia nigra and the locus coeruleus. Dopamine is a neurotransmitter that stimulates motor neurons, those nerve cells that control the muscles. When dopamine production is depleted, the motor system nerves are unable to control movement and coordination. Parkinson’s disease patients have lost 80% or more of their dopamine-producing cells by the time symptoms appear.

The cause of Parkinson’s disease is unknown. Many researchers believe that several factors combined are involved: free radicals, accelerated aging, environmental toxins, and genetic predisposition.

Diagnosis is based on symptoms and ruling out other disorders that produce similar symptoms.

Treatment centers on the administration of medication to relieve symptoms. Medication selection and dosage is tailored to the individual. Some of the medications used to treat PD include: Levodopa and carbidopa combined (Sinemet®), Bromocriptine (Parlodel®), Pramipexole (Mirapex®), Ropinirole (Requip®), Rotigotine (Neupro®), Amantadine (Symmetryl®)

Surgery is another method of controlling symptoms and improving quality of life when medication ceases to be effective or when medication side effects, such as jerking and dyskinesias, become intolerable. Not everyone is a good candidate for surgery. For example, if a patient never responded to, or responded poorly to levodopa/carbidopa, surgery may not be of any help. Only about 10% of Parkinson’s patients are estimated to be suitable candidates.

Definition: Peripheral neuropathy is a problem with the nerves that carry information to and from the brain and spinal cord. This produces pain, loss of sensation, and inability to control muscles.

Peripheral neuropathy occurs when these nerves fail to function properly, resulting in pain, loss of sensation, or inability to control muscles. In some cases, the failure of nerves that control blood vessels, intestines, and other organs results in abnormal blood pressure, digestion problems, and loss of other basic body processes. Peripheral neuropathy may involve damage to a single nerve or nerve group (mononeuropathy) or may affect multiple nerves (polyneuropathy).

There are numerous reasons for nerves to malfunction. In some cases, no cause can be identified.

Peripheral neuropathy is very common. Because there are numerous types and causes of neuropathy and scientists don’t always agree on the same definition of neuropathy, the exact incidence cannot be determined precisely.

Some people have a hereditary predisposition for neuropathy.

Prolonged pressure on a nerve is another risk for developing a nerve injury. Pressure injury may be caused by prolonged immobility (such as a long surgical procedure or lengthy illness) or compression of a nerve by casts, splints, braces, crutches, or other devices.

A detailed history will be needed to determine the cause of the neuropathy. Neurologic examination may reveal abnormalities of movement, sensation, or organ function. (See also entries on the specific nerve dysfunction.) Changes in reflexes and muscle bulk may also be present.

Tests that reveal neuropathy may include:

• EMG (a recording of electrical activity in muscles)
• Nerve conduction tests
• Nerve biopsy
• Blood tests to screen for medical conditions, such as diabetes and vitamin deficiency, among others.

Tests for neuropathy are guided by the suspected cause of the disorder, as suggested by the history, symptoms, and pattern of symptom development. They may include various blood tests, x-rays, scans, or other tests and procedures.

Treatment

The first steps of treatment are to identify and treat the underlying medical problem (such as diabetes) or remove the cause (such as alcohol). Other goals include controlling symptoms, curing the disorder if possible, and helping the patient gain maximum independence and self-care ability.

Definition: Numbness and tingling are abnormal sensations that can occur anywhere in your body, but are often felt in your hands, feet, arms, or legs.

Common Causes

There are many possible causes:

• Remaining in the same seated or standing position for a long time
• Injury to a nerve — for example, a neck injury may cause you to feel numbness anywhere along your arm or hand, while a low back injury can cause numbness or tingling down the back of your leg
• Pressure on the spinal nerves such as that due to a herniated disk
• Lack of blood supply to an area — for example, plaque buildup from atherosclerosis in the legs can cause pain, numbness, and tingling while walking (this is called vascular claudication)
• Other medical conditions, including Carpal tunnel syndrome, Diabetes, Migraines, Multiple sclerosis, Seizures, Stroke, Transient ischemic attack (TIA), Underactive thyroid
• Abnormal levels of calcium, potassium, or sodium in your body
• A lack of vitamin B12 or other vitamin
• Certain medications
• Toxic action on nerves, such as that from lead, alcohol, or tobacco
• Radiation therapy

Your doctor may also ask you questions to determine your risk for stroke, thyroid disease, or diabetes, as well as questions about your work habits and medications. Tests that may be done include:

• Blood tests such as CBC, electrolytes, thyroid function tests, and vitamin levels
• Imaging studies like a CT scan of the head, CT scan of the spine, MRI of the head, or MRI of the spine
• Electromyography and nerve conduction studies to measure how your muscles respond to nerve stimulation
• X-ray of the affected area
• Lumbar puncture to rule out central nervous system disorders

Ultrasound of neck vessels to determine your risk for TIA or stroke

Definition: Dizziness is lightheadedness, feeling like you might faint, being unsteady, loss of balance, or vertigo (a feeling that you or the room is spinning or moving).

Most causes of dizziness are not serious and either quickly resolve on their own or are easily treated.

Common Causes

Lightheadedness happens when there is not enough blood getting to the brain. This can happen if there is a sudden drop in your blood pressure or you are dehydrated from vomiting, diarrhea, fever, or other causes. Many people, especially as they get older, experience lightheadedness if they get up too quickly from a lying or seated position. Lightheadedness often accompanies the flu, hypoglycemia, common cold, or allergies.

More serious conditions that can lead to lightheadedness include heart problems (such as abnormal heart rhythm or heart attack), stroke, and severe drop in blood pressure (shock). If any of these serious disorders is present, you will usually have additional symptoms like chest pain, a feeling of a racing heart, loss of speech, change in vision, or other symptoms.

The most common causes of vertigo are benign positional vertigo and labyrinthitis. Benign positional vertigo is vertigo that happens when you change the position of your head. Labyrinthitis usually follows a cold or flu and is caused by a viral infection of the inner ear. Meniere’s disease is another common inner ear problem. It causes vertigo, loss of balance, and ringing in the ears.

Much less commonly, vertigo or feeling unsteady is a sign of stroke, multiple sclerosis, seizures, a brain tumor, or a bleed in your brain. In such conditions, other symptoms usually accompany the vertigo or imbalance.

Call your doctor if:

• You have never had dizziness before.
• Symptoms you have had in the past are different (for example, last longer than usual, are worse than before, or are interfering with your daily activities).
• Medication is the suspected cause. Talk to your health care provider before making any changes to your medication.

You have any hearing loss.

Definition: Epilepsy is a brain disorder involving repeated seizures of any type.

Seizure disorders affect about 0.5% of the population. Approximately 1.5-5.0% of the population may have a seizure in their lifetime. Epilepsy can affect people of any age.

Risk factors include a family history of epilepsy, head injury, or other condition that causes damage to the brain.

Symptoms

The severity of symptoms can vary greatly, from simple staring spells to loss of consciousness and violent convulsions.

The diagnosis of epilepsy and seizure disorders requires a history of recurrent seizures of any type. A physical examination (including a detailed neuromuscular examination) may be normal, or it may show abnormal brain function related to specific areas of the brain.

An electroencephalograph (EEG), a reading of the electrical activity in the brain, may confirm the presence of various types of seizures. It may, in some cases, indicate the location of the lesion causing the seizure. EEGs can often be normal in between seizures, so it may be necessary to do prolonged EEG monitoring.

Tests may include various blood tests to rule out other temporary and reversible causes of seizures, including: CBC, Blood chemistry, Blood glucose, Liver function tests, Kidney function tests, Tests for infectious diseases, CSF (cerebrospinal fluid) analysis. Tests for the cause and location of the problem may include: Head CT or MRI scan and Lumbar puncture (spinal tap)

Treatment

Anti-convulsants (medications) taken by mouth may reduce the number of future seizures. How well medicine works depends on each individual’s response to the drug. The type of medicine used depends on seizure type, and dosage may need to be adjusted from time to time. Some seizure types respond well to one medication and may respond poorly (or even be made worse) by others. Some medications need to be monitored for side effects and blood levels.

Epilepsy that does not respond to the use of several medications is called refractory epilepsy. Certain people with this type of epilepsy may benefit from brain surgery to remove the abnormal brain cells that are causing the seizures. Others may be helped with a vagal nerve stimulator, which is implanted in the chest. This stimulator can help reduce the number of seizures.

Sometimes, children are placed on a special diet to help prevent seizures. The most one is the ketogenic diet.

Patients should wear medical alert jewelry so that prompt medical treatment can be obtained if a seizure occurs.

Definition: A transient ischemic attack is a “mini-stroke” caused by temporary disturbance of blood supply to an area of the brain, which results in a sudden, brief decrease in brain function.

In a TIA, the blood supply is only temporarily blocked. For example, a blood clot may dissolve and allow blood to flow normally again. A TIA is different than a small stroke. The symptoms of TIAs go away in less than 24 hours, usually less than one hour. TIAs do not show lasting changes on CT or MRI scans. (Small strokes do show changes on such tests.) TIAs are like warnings that a true stroke may happen in the future if something is not done to prevent one.

Atherosclerosis (”hardening of the arteries”) is a condition where fatty deposits occur on the inner lining of the arteries. This condition dramatically increases the risk for both TIAs and stroke. Approximately 80-90% of people who have a stroke due to atherosclerosis had a TIA episode before.

Symptoms

Symptoms of TIA are the same as those that occur in stroke and include the sudden development of:

• Numbness, tingling, changes in sensation
• Weakness, heavy feeling of extremities
• Speech difficulty (garbled speech; slurred speech)
• Vision changes (Loss of vision in one eye, Decreased vision, Double vision)
• Sensation that the person or the room is moving (vertigo)
• Loss of balance
• Lack of coordination
• Gait changes, staggering
• Falling (caused by weakness in the legs)

Definition: A stroke is an interruption of the blood supply to any part of the brain. A stroke is sometimes called a “brain attack.”

Every 45 seconds, someone in the United States has a stroke. A stroke can happen when:

• A blood vessel carrying blood to the brain is blocked by a blood clot. This is called an ischemic stroke.
• A blood vessel breaks open, causing blood to leak into the brain. This is a hemorrhagic stroke.

Usually, a SUDDEN development of one or more of the following indicates a stroke:

• Weakness or paralysis of an arm, leg, side of the face, or any part of the body
• Numbness, tingling, decreased sensation
• Vision changes
• Slurred speech, inability to speak or understand speech, difficulty reading or writing
• Swallowing difficulties or drooling
• Loss of memory
• Vertigo (spinning sensation)
• Loss of balance or coordination
• Personality changes
• Mood changes (depression, apathy)
• Drowsiness, lethargy, or loss of consciousness
• Uncontrollable eye movements or eyelid drooping

If one or more of these symptoms is present for less than 24 hours, it may be a transient ischemic attack (TIA). A TIA is a temporary loss of brain function and a warning sign for a possible future stroke.

A stroke is a medical emergency. You must call 911 if someone has symptoms of a stroke

The goal of long-term treatment is to recover as much function as possible and prevent future strokes. Neurologist will examine you and order special tests to determine the cause of stroke and initiate appropriate treatment.

Alternative names:

Definition: Alzheimer’s disease (AD), one form of dementia, is a progressive, degenerative brain disease. It affects memory, thinking, and behavior.

Memory impairment is a necessary feature for the diagnosis of this or any type of dementia. Change in one of the following areas must also be present: language, decision-making ability, judgment, attention, and other areas of mental function and personality.

The rate of progression is different for each person. If AD develops rapidly, it is likely to continue to progress rapidly. If it has been slow to progress, it will likely continue on a slow course.

The first step in diagnosing Alzheimer’s disease is to establish that dementia is present. Then, the type of dementia should be clarified. A health care provider will take a history, do a physical exam (including a neurological exam), and perform a mental status examination.

Treatment

Unfortunately, there is no cure for AD. The goals in treating AD are to:

• Slow the progression of the disease.
• Manage behavior problems, confusion, and agitation.
• Modify the home environment.
• Support family members and other caregivers.

In addition, early testing of a vaccine against AD is underway.

Definition: Dementia is a loss of brain function. It is not a single disease. Instead, dementia refers to a group of illnesses that involve memory, behavior, learning, and communicating problems. The problems are progressive, which means they slowly get worse.

Causes, incidence, and risk factors: The two major causes of degenerative (non-reversible) dementia are Alzheimer’s disease and vascular dementia (loss of brain function due to a series of small strokes). Conditions that damage blood vessels or nerve structures of the brain can also lead to dementia. Treatable causes of dementia include normal pressure hydrocephalus, brain tumors, and dementia due to metabolic causes, thyroid conditions, low vitamin B12 levels, and infections.

Dementia may be diagnosed when a patient has two or more problems in brain function. Problems may involve language, memory, perception, emotional behavior or personality, and cognitive skills (such as calculation, abstract thinking, or judgment). Dementia usually first appears as forgetfulness. Other symptoms may only be seen during a medical exam or with cognitive tests.

Dementia usually occurs in older age. Dementia is rare in people under age 60. The risk for dementia increases as a person gets older.