Patient Care at Neurology Office


Neurologists are physicians who deal with the central and peripheral nervous system. Specifically, that includes the brain, the brainstem, the spinal cord, the nerves and nerve twigs, as well as the muscles that are supplied by those nerves and nerve twigs. In addition, neurologists focus on assessing how the nervous system is working and finding the precise process when the nervous system is not working well.

Neurologists routinely care for a wide variety of medical processes, including such things as stroke, seizure, memory loss, confusion, disorientation. Under this heading would also be the diagnosis of Alzheimer’s disease.

In addition, the very common processes of neck and back pain, whiplash, spinal cord injuries and muscle disorders are routinely treated by neurologic specialists. In addition, such things as carpal tunnel syndrome, numbness, tingling, and distortion of sensation in the arms and legs, hands and feet are common problems that are dealt with by neurologic specialists.  Also, neurologists are uniquely skilled in the diagnosis and treatment of one of the most common disorders, that being headache. While there are a wide variety of headaches, both general headache, neck related headache, and “migraine” are common processes that are treated by neurologists.

Additional disorders such as Parkinson’s disease, Multiple Sclerosis, dizziness, lightheadedness, and gait and balance issues are often addressed by neurologists.

I was initially surprised years ago when patients would come to the office and state “I didn’t know what to expect when I saw a neurologist”. It’s a little bit daunting when you see a specialist for the first time, particularly one that deals with the nervous system.

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Diagnostic and Clinical Assessments

The clinical evaluation and the history is the most essential aspect of any neurologic exam. However, when the neurologic exam, including the history and physical is not enough, diagnostic testing may be required. At the Neurology Office, we offer a comprehensive array of diagnostic testing.

This test is a very common one, that tests how well the nerves are performing. It is commonly used when someone has nerve twig damage, such as carpal tunnel syndrome, diabetic neuropathy, or to illuminate a process when there may be numbness, tingling or sensory distortions. The nerve conduction velocity study is routinely performed by a Board Certified technician, and includes preparing the involved extremity, applying a small pulse of electricity, and measuring the conduction from Point A to Point B. Measuring the size of the current as well as the speed of the current provides valuable information in determining how the nerve is functioning.

This test is performed in combination with the nerve conduction study, and is performed at the same time. This is performed by the neurologist, and involves measuring how the nerve supplies the muscle with information. This process involves taking a sterilized recording electrode, and monitoring the information from inside the muscle. This includes a series of small little pinpricks, in the affected limb. Often this test is done in a bilateral fashion to compare one side to the other. While this is somewhat uncomfortable, it is not particularly painful, and is performed very quickly.

In many abnormal neurologic conditions, the electrical activity of the muscles and/or the nerves is abnormal. Finding the type of abnormality, the location, and the pattern can often be helpful in providing information that allows your doctor to diagnose your illness.

This test is performed in the office, and is not at all painful. This is a test to measure brainwave activity, very similar to how an echocardiogram measures electrical activity of the heart. This is performed by a certified technician, and interpreted by the neurologist. The process involves taking sterilized recording electrodes, and placing them on the outside of the head. This is done with tape or very mild glue, and is not at all invasive. This test is done while the patient is awake; in addition, drowsy states are monitored, and if possible a sleep state is recorded as well. The time for this test is approximately anywhere from 20 minutes to 1 hour. If the test is not conclusive, or if there are suspicious findings, additional testing including a 24-hour or 48-hour recording may be required. If this is the case, video monitoring in combination with the recording may be performed. Finding the pattern of electrical activity, particularly if there are abnormalities, can lead to the appropriate diagnosis and treatment. The neurologist at Neurology Office will review the results with you, and explain the pertinent findings, and outline the appropriate treatment regimen after the test is interpreted.

MRI stands for magnetic resonance imaging. This is not an x-ray, but rather a magnetic scan and focuses on the body soft tissue rather than bony structures. There are many fine centers in Southwest Florida that perform MR imaging studies. Dr. Kandel is approved to read at a number of these, and will refer you to the most appropriate center for you. Whether it be short-bore, open, stand-up, or now with the latest technology 3.0 Tesla, indicating the highest magnetic strength, Dr. Kandel has access to the latest technology of MR imaging scanning.

Most MRI scans take between 12 and 40 minutes, depending on what part of the body is studied and how many scans need to be performed. Usually there is a loud booming sound, which can be partially relieved by wearing earplugs (supplied by the MRI centers), or by having headphones with music playing (also provided by the MRI centers).

It is essential that you inform Dr. Kandel when he orders the test as well as the MRI technicians if there are any implanted devices in your body such as pacemakers, stimulators, artificial valves, and aneurysm clips. There are a number of other devices which are relatively contraindicated for MRI scanning, but is essential the technicians doing the scan as well as Dr. Kandel are absolutely aware of any reason not to perform an MRI.