Procedures Done In Our Office

Botulinum Toxin Injections:

Botox – Dysport – Myobloc – Xeomin

Injection with botulinum toxin can relieve pain and muscle spasms associated with a variety of medical conditions. Treatment can block the nerve signals that make muscles contract, making the targeted muscles relax.

What conditions do we treat?

• Chronic Migraine 
• Post stroke spasticity
• Dystonias
• Blepharospasm / Hemi-facial Spasm

What should I expect during Botox treatment?

Your doctor will discuss your botox injections and answer any questions you have. We use small needles similar to acupuncture needles to minimize your discomfort during the injections. Your treatment will generally only take about 30 minutes or less, and when your session is complete, you will be able to drive and return to your day to day activities.

Your Botox therapy starts with two treatments spaced 3 months apart. After two treatments, you’ll know how well Botox works for you. If you decide to continue the therapy, you’ll receive a treatment every 3 months to maintain your results.

Routine EEG and Ambulatory EEG

What is an EEG?

An EEG, or electroencephalogram, is a test that gives your doctor information about the brain’s activity. This painless test is conducted with electrodes placed on the scalp.

What’s the difference between EEG routine and EEG ambulatory?

Routine and ambulatory EEG both involve having electrodes placed on your head. However, while a routine EEG takes place at our office and takes up to an hour, an EEG ambulatory can take 24 hours or more at your home.

For the ambulatory procedure, the technician attaches the electrodes as with the routine EEG, then covers them with a cap or layers of gauze. Instead of being connected to an EEG machine, the electrodes go to a portable recorder. This is a small box you wear across your waist or shoulder.

While wearing the ambulatory EEG, you continue with your day as much as possible, recording what you do and how you feel. If you have a seizure, you or a caregiver should press an event button on the recorder when the seizure begins.

Ambulatory EEG:

An ambulatory EEG may be done if you continue to have seizures after trying various seizure medications. The testing can either confirm the diagnosis of epilepsy or find that epilepsy waves are not causing the seizures. Ambulatory EEG monitoring is generally done at a specialized epilepsy center.

What’s the test like?

An ambulatory EEG test makes a recording of your brain’s activity over a number of hours or days.

• EEG wires are placed on your scalp, like in a routine EEG, then attached to a special recorder that is slightly larger than a portable cassette player.
• You can wear the recorder on your waist, with the wires running either under your shirt or outside of it.
• The electrodes on your head are covered with a cap or gauze dressing.
• During the test, you can go about your normal routine for up to 24- 72 hours.
• During the test, keep a diary of what you do during the day and if you’ve had any seizures or other symptoms. This will help the doctor identify the cause of activity on the recording. For instance, the electrodes may make your head itchy, and if you scratch it, that may appear as abnormal activity on the EEG.
• Because the electrodes must stay on your head longer than for a regular EEG, the technologist will probably use a special glue called “collodion” to keep them in place. After the test, acetone (like nail polish removal) or a similar solution is used to remove the glue at the end of the test.

How is it performed?

• The study will be performed lying down
• An EEG technician prepares small spots (the size of a pencil eraser) on your head by scrubbing the areas with a cotton swab and a sensitive skin cleansing product.
• About 27 electrode discs the size of a pencil eraser are placed onto your head and held in place with a tacky conductive cream or they may be glued in place.
• Your brain waves are typically recorded for 20-40 minutes after the leads are placed.
• The electrodes are removed at the end of the test and you may leave.
• Hair will be damp after the clean- up process (you may bring a scarf or cap with you)
• You may have some skin irritation after the study.
• You should follow up with your referring physician for results.

EEG instructions

• Wash and dry your hair the night before your EEG. Do not use conditioners, hair creams, sprays or gels. Hair products can make it harder for the electrodes to adhere to your scalp.
• Please remove hair extensions, weaves and toupees before coming for the procedure.
• You may eat, drink and take prescribed medications as usual.  If you have excessive coughing, sneezing or running a fever, please reschedule your appointment.
• Please do not allow sleep on the way to the office. The test is most useful if it contains drowsiness and sleep.
• Report to the office no more than five minutes before your appointment. As a reminder our technicians do see patients after our business hours in which case please knock on the door or call the technician if you have an issues.
• Go to the bathroom before you get your study.

If your physician instructs you to have a SLEEP DEPRIVED EEG please follow the instructions below:

•  Limit sleep to no more than 4 hours the night before your test
•  Do not use caffeine or any other stimulants to stay awake (ex. Soda, coffee, tea)
•  Please do not nap in the car or while waiting for the EEG.

Electromyography (EMG) and/or Nerve Conduction

Electromyography refers to the measurement of tiny electrical potentials which are generated by muscles. Abnormality of these electrical potentials can indicate certain types of disorders of either nerve or muscle and may be very helpful in identifying the type of neuromuscular disorder which you may have. However, it requires the use of a very small, sterile recording electrode placed within the muscle in order to obtain this information. The physician performing the study will do everything to minimize any discomfort. The overwhelming majority of patients tolerate this study well and no premedication is necessary.

Nerve conduction studies refer to tests in which small, painless and safe electric currents are applied to nerves over the skin. The responses of the nerves are then recorded by using surface electrodes placed over various parts of the limbs. Although a minor discomfort may be experienced, this procedure is entirely without risk and is well tolerated. The information from this study may be very informative in certain disorders affecting the peripheral nervous system such as:

•   Carpal tunnel syndrome
•   Muscular dystrophy
•   Myasthenia gravis
•   Nerve complications
•   Peripheral neuropathy
•   Pinched nerves
•   Guillain-Barré syndrome
•   Amyotrophic lateral sclerosis (ALS or Lou Gehrig’s disease)

The electromyographic and nerve conduction studies which will be performed are done by a highly trained neurologist who has had extensive experience in this field. No testing above and beyond that needed to obtain the necessary information will be done. The neurologist who performs the test will be happy to discuss the general nature of the test.

Following the examination, a complete report will be written and sent to your physician with the results. Your referring physician will be responsible for any additional testing and /or treatment based upon the results of the test. However, this test may be obtained in conjunction with a neurologic consultation at the time of the test.

Sleep Medicine

Sleep medicine is the medical subspecialty focused on optimizing sleep health and diagnosing and treating sleep disorders and other sleep-related concerns. Sleep disorders are common, 50 to 70 million Americans are estimated to suffer from chronic sleep issues.

If left untreated, they can have significant long-term consequences, such as increased risk of heart disease, stroke, type 2 diabetes, obesity, depression, and injuries. Dr Curatalo works closely with sleep clinics to coordinate sleep studies, CPAP machines and other sleep devices.

Stroke

The NIH states that each year, about 795000 people in the United States have strokes, and of these incidents, 137000 of the people die. Symptoms of stroke include trouble walking, speaking, and understanding, as well as paralysis or numbness of the face, arm, or leg.

Early treatment with medications like tPA (clot buster) can minimize brain damage. Other treatments focus on limiting complications and preventing additional strokes.

VNS Vagus Nerve / DBS Deep Brain Stimulation Programming

Vagus Nerve Stimulation (VNS) is a treatment that uses an implanted device to send electrical pulses to the brain through the vagus nerve. The goal of VNS is to reduce abnormal electrical activity in the brain and the frequency of seizures. VNS is used to treat conditions such as epilepsy and depression.

Deep Brain Stimulation (DBS) is a surgical procedure that uses electrical stimulation to treat movement disorders and other neurological conditions.