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Medical Treatments - Drexel Neurology

Neuropathic pain treatments. Drexel Neurology offered several treatments in Center City Philadelphia, listed below by type and disorder being treated.

Intravenous Infusions (IVs) for Complex Regional Pain Syndrome (CRPS, formerly RSD)

Ketamine

  1. Ketamine infusions are safe and efficacious for the management of refractory complex regional pain syndromes (CRPS). Ketamine has a very selective effect on relieving pain due to CRPS without causing prolonged sedation and respiratory depression. There is no problem with physical dependency, tolerance or constipation with ketamine.
  2. We offer an initial 3.5 hour infusion for ten days followed by two-day "boosters" every three months.
  3. Booster infusions have proven effective in patients with severe, multiple extremity, intractable, complex regional pain syndromes (CRPS). Ketamine booster infusions are likely to lead to fewer emergency room visits for these extremely difficult and serious cases of CRPS.
  4. The FDA-approved package insert supports the safety of ketamine: "[It] has a wide margin of safety; several instances of unintentional administration of overdoses of ketamine (up to ten times that usually required) have been followed by prolonged but complete recovery."

Intravenous Infusions (IVs) for Multiple Sclerosis (MS)

Natalizumab (Tysabri)

  1. Tysabri is an FDA-approved medication for adult patients with relapsing forms of multiple sclerosis (MS) to slow the worsening of physical disability and to decrease the number of flare-ups (relapses).
  2. Tysabri is an antibody, unlike other multiple sclerosis (MS) treatments. It is thought to inhibit white blood cells (T cells) from getting into the brain and attacking the myelin covering nerve fibers in the brain and spinal cord. This is believed to result in fewer of the brain lesions that cause MS symptoms.
  3. Infusions are once a month. They last an hour and there is a one hour observation period afterward.
  4. Because Tysabri increases the risk of progressive multifocal leukoencephalopathy (PML), a rare brain infection that can cause severe disability or death, Tysabri is generally recommended for patients that have not been helped enough by, or cannot tolerate, other treatments for MS.
  5. Tysabri does not cure multiple sclerosis (MS) and has not been studied for longer than two years or in patients with chronic progressive MS.

Intravenous Immune Globulin (IVIG)

  1. Immunoglobulins are antibody proteins that are secreted by the white blood cells called B-lymphocytes and by plasma cells in response to the presence of a substance (antigen) that provokes an immune response.
  2. Intravenous immunoglobulin G (IVIG) is a pooled human immunoglobulin G (IgG) that is presumed to modulate the immune system.
  3. There are some data that suggest that monthly administration of intravenous immunoglobulin G (IVIG) may be beneficial in reducing relapses and/or inflammatory lesions on MRI in some persons with relapsing-remitting MS.
  4. A meta-analysis of the various studies that have been done with intravenous immunoglobulin G (IVIG) concluded that it may be a valuable alternative for the treatment of relapsing-remitting MS (e.g., for those individuals who cannot or will not take one of the approved medications), but cannot presently be considered a first-line treatment.

Methylprednisolone (Solu-Medrol)

  1. Methylprednisolone is a synthetic corticosteroid. Steroids are hormones normally produced in the human body by the adrenal glands. They have a number of physiologic effects on different organ systems, but are most widely used for their anti-inflammatory actions.
  2. These steroids are different from the anabolic steroids used by athletes and others to enhance muscle development and strength.
  3. Steroids were among the first agents used to treat MS and remain the treatment of choice for managing acute exacerbations (relapses or attacks).
  4. A 3- to 5-day course of methylprednisolone can be used to treat any attack that is significantly affecting a person's ability to function at home or at work.
  5. Data from clinical studies suggest that "pulse" dosing provides maximum benefit with the fewest side effects for MS patients. The IV steroids may be followed by a 1- to 2-week tapering dose of oral steroids.

Intravenous Infusions (IVs) for Chronic Migraine

Anti-nauseants (metoclopramide and ondansetron)
Anti-nauseants have long been used for headaches. Emergency room treatment of headache most often uses anti-nauseants. These agents can also directly treat headache pain.

Magnesium Sulfate
Magnesium sulfate infusions are often helpful for migraine associated with neck pain and stiffness. It is well tolerated.

Dihydroergotamine (DHE)
Dihydroergotamine (DHE) is the gold standard for treating chronic migraine. DHE has a 10- to 14-hour half-life. You will need an EKG first because of the risk of vasospasm.

Valproate Sodium (Depacon)
Sodium valproate was approved in 1994 for oral use in the prophylaxis of migraines in the US. It was the first anticonvulsant molecule to be found useful in treating migraines in a prophylactic manner. After a time, an IV version of the valproate sodium was developed and has been used for treatment of seizures.

Levetiracetam (Keppra™)
This agent has a unique mechanism of action that blocks high-voltage calcium channels, another major activity of many neuronal stabilizing agents. Studies have supported its use in management of chronic migraine.

Lacosamide (Vimpat)
Lacosamide (Vimpat) is a newly FDA-approved medication for the treatment of seizures. It has been shown to be effective for chronic migraine also.

Methocarbamol (Robaxin)
Methocarbamol (Robaxin) is an older muscle relaxant preparation with an uncertain pharmacologic mechanism(s) of action, it is one of the very few available in an IV form. It is helpful in chronic migraine especially if the migraine is accompanied by neck pain and spasm.

Ketoralac (Toradol)
Ketoralac (Toradol) is a potent intramuscular or IV anti-inflammatory medication that is helpful for relieving pain and inflammation.

Methylprednisolone (SoluMedrol)
Methylprednisolone (SoluMedrol) is an IV corticosteroid useful in reducing the inflammation associated with chronic migraine.

Chronic Inflammatory Demyelinating Polyneuropathy (CIDP)

Chronic Inflammatory Demyelinating Polyneuropathy (CIDP) is characterized by progressive weakness and impaired sensory function in the legs and arms. It is caused by damage to the myelin sheath (the fatty covering that wraps around and protects nerve fibers) of the peripheral nerves. It often presents with symptoms that include tingling or numbness (beginning in the toes and fingers), weakness of the arms and legs, fatigue, and abnormal sensations.

Intravenous Immune Globulin (IVIG)

  1. Intravenous immunoglobulin G (IVIG) therapy is effective and can be used even as a first-line therapy.
  2. Immunoglobulins are antibody proteins that are secreted by the white blood cells called B-lymphocytes and by plasma cells in response to the presence of a substance (antigen) that provokes an immune response.
  3. Intravenous immunoglobulin G (IVIG) is a pooled human immunoglobulin G (IgG) that is presumed to modulate the immune system.

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BOTOX® Injection for Chronic Migraine

  1. BOTOX® is approved by the FDA to prevent headaches in adults with chronic migraine who have 15 or more days each month with headache lasting four or more hours each day in people 18 years or older.
  2. BOTOX® received FDA approval for treatment of chronic migraine based on efficacy and safety demonstrated in two well-controlled clinical trials.
  3. Multiple injections are placed at sites around the head and upper neck.
  4. Relief might last three to four months.

BOTOX® Injection for Dystonia

Dystonia is involuntary movements and prolonged muscle contraction, resulting in twisting body motions and abnormal posture. These movements may involve the entire body, or only an isolated area. Symptoms may even be "task specific," such as writer's cramp. Dystonia can be inherited, occur sporadically without any genetic pattern, or be associated with medications or diseases.

  1. Results from a key clinical study showed that after receiving BOTOX® treatment, the vast majority of people with cervical dystonia had improved head posture, neck pain that was less intense and happened less often, and an improved ability to function in certain daily activities.
  2. Stop or greatly reduce neck pain and muscle spasms.
  3. Reduce intensity and frequency of pain.
  4. Improve your ability to perform certain daily activities.

BOTOX® Injection for Spasticity

Spasticity is a state of increased tone of a muscle (and an increase in the deep tendon reflexes). For example, with spasticity of the arms there is an increase in tone of the leg muscles so they feel tight and rigid.

  1. BOTOX® is approved by the FDA to treat increased muscle stiffness in elbow, wrist, and finger muscles in people 18 years and older with upper limb spasticity.
  2. BOTOX® received FDA approval for the treatment of upper limb spasticity based on efficacy and safety demonstrated in three well-controlled clinical trials.

Botulinum Toxin Clinic

The Botulinum toxin injection clinic is located at Drexel Neurology Associates at 219 N. Broad Street in Center City Philadelphia. The clinic is held every week and is run by Dr. Venkatesh who serves as the principal injector.

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Steroid Injection at the Wrist for Carpal Tunnel Syndrome (CTS)

Carpal Tunnel Syndrome (CTS) results from pressure on the median nerve as it travels through the carpal tunnel. Patients commonly experience pain, tingling and weakness in the thumb, index and middle fingers.

  1. Carpal tunnel steroid injection at the wrist is used to treat the symptoms of carpal tunnel syndrome by injecting a steroid solution into the bursa surrounding the median nerve.
  2. Injected corticosteroids appear effective in reducing subjective symptoms for 1-3 months when compared to placebo. While short-term relief of symptoms after injection appears superior to relief patients experience after carpal tunnel release surgery, the advantage is lost over the course of a year.

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Balance Treatment: Balance-Based Torso-Weighting (BBTW) for Multiple Sclerosis (MS), Parkinson's Disease, Stroke, Cerebellar Disorders, and Cerebral Palsy

  1. Balance-based torso-weighting is an evaluation and treatment system consisting of an assessment procedure that in turn results in a custom weighted patient garment. A therapist assesses an individual's balance to find problem areas. Once the balance dysfunction is identified, small non-obtrusive weights are strategically placed on the torso (trunk) to improve balance control. Patients frequently report improvement during their first visit.

To make an appointment with a Philadelphia-area neurologist, please call 215-762-6915.

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