We offer management of spasticity with novel medications such as botulinum toxin (Botox, Myobloc, Dysport), and intrathecal baclofen (ITB). All evaluation and treatment is done onsite; however, we work closely with local physical and occupational therapists.
Deep Brain Stimulation
We are one of a few sites in California with special expertise in the management of patients who have had deep brain stimulation for Parkinson’s disease, tremor, or other neurological conditions. Our team is specially trained to recognize the subtle yet critical symptoms that allow us to carefully titrate medication and stimulation parameters to optimize the outcome for patients with complex and challenging movement disorders.
Botulinum Toxin (Botox)
Ours was one of the first programs in the country to offer this novel therapeutic approach to the management of dystonia, spasticity, and other movement disorders. Dr. Sutton trained in this technique during his fellowship in 1989, before it was approved by the FDA, and assisted in research that eventually led to its approval by the FDA for cervical dystonia.
Botox and a related medication, Myobloc, are also helpful for treating the symptoms of many other neurological disorders, including excessive saliva production, excessive sweating, hemifacial spasm, eyelid spasms, and back pain.
Neurophysiology testing is done in our neurophysiology laboratory, by Dr. Sutton. Neurophysiology tests may include nerve conduction studies (NVC), electromyographic studies (EMG), electroencephalography (EEG), or all three, depending on the nature of your problem. Nerve conduction studies are helpful in evaluating back and neck pain and monitoring the objective severity of diabetic polyneuropathy. EEG has proven to be helpful in complex neurological presentations, improving the accuracy of diagnosis in suspected degenerative conditions such as Alzheimer’s disease, Lewy body dementia, and Parkinson’s disease with dementia. In addition, it can be helpful in monitoring the effects of centrally acting neuropsychiatric medications. Neurophysiologic abnormalities are common in conditions not previously thought to affect the peripheral nervous system; up to 50% of patients with Parkinson’s disease will have neuropathy when examined with formal nerve conduction testing. Each neurophysiology evaluation usually takes about an hour. We will provide you will additional information on what to expect prior to and at the time of these procedures should they be required.
Neuropsychology evaluations are also performed in our office. The goal of these evaluations is to understand how the structure and function of the brain relate to specific neurological and psychological processes and behaviors. This includes understanding patients’ cognitive and emotional strengths and weaknesses, including how their cognitive and psychological abilities are associated with various neurological conditions, such as strokes, head injuries, and dementia.
At PNMG, these evaluations are conducted by Dr. Steven Rogers, Dr. Kathleen Tingus, and their team members. Dr. Rogers and Dr. Tingus are both nationally recognized and widely published fellowship-trained clinical neuropsychologists.
The neuropsychology evaluation takes about 3 hours and involves a clinical interview and completion of standardized neuropsychology measures (e.g., tests examining attention, language, memory, psychological functioning, etc.). Prior to this evaluation, patients will be sent a medical questionnaire to complete at home and bring to their first visit. After the evaluation is complete, analysis of the findings and preparation of a comprehensive report will be conducted by the neuropsychological team. Because of the complexity of this evaluation, it can take two to three weeks for the final report to be prepared. This report will provide patients and the PNMG team diagnostic conclusions and treatment recommendations.
Although we do not offer imaging within our practice, we work closely with local imaging centers in Ventura County, both in clinical care as well as in clinical research. We will arrange for imaging when necessary, whether magnetic resonance imaging (MRI), computerized axial tomography (CT), poitron emission tomography (PET) or dopamine transporter scans. We can also provide important insight into the clinical significance of any findings and arrange for further diagnostic studies if, and when, appropriate.