Myasthenia Gravis – a Q&A with Adam Todd MD

todd_adam_web

Adam Todd MD is a Board Certified Neurologist with Noran Neurological Clinic.  As a certified electromyographer, he additionally performs EMGS for both his own patients and for other providers’ patients when ordered.  He has special interests in neuromuscular disorders, epilepsy, and stroke. In this Question and Answer session, Dr. Todd answers some common questions about Myasthenia Gravis.

 

 

 

Myasthenia Gravis

Question: What is myasthenia gravis?

Answer: Myasthenia gravis is an autoimmune disorder affecting the neuromuscular junction. As the name suggests, the neuromuscular junction is link between nerve and muscle. This link is established through chemical transmission. To move your muscles, a specific chemical neurotransmitter by the name of acetylcholine is secreted by the nerve. Acetylcholine clings to receptors on the muscle cell, stimulating them and resulting in muscle contraction. In myasthenia gravis, an antibody, a protein made by our own immune system blocks the receptors, effectively disconnecting the nerve from the muscle. This leads to weakness.

 

Question: What are the symptoms?

Answer: Premature fatigue, weakness, droopy eyelids and double vision are common presentations. Symptoms can be severe enough to cause weakness in muscles associated with breathing and swallowing. These symptoms are potentially life-threatening and require immediate medical attention.

 

Question: How is it diagnosed?

Answer: The diagnosis is based on a combination of clinical, laboratory and neurodiagnostic tests. When the clinical history is suggestive, a blood test is often obtained to look for antibodies specifically associated with myasthenia gravis. Electrodiagnostic testing is sometimes performed which can include nerve conduction studies and, less commonly, single fiber EMG. There is a close association between myasthenia gravis and tumors of the thymus gland. Therefore, a CT scan of the chest is often performed.

 

Question: How is it treated?

Answer: Myasthenia gravis is treated based on its severity. Milder symptoms may only require symptomatic treatment with an oral medicine called Mestinon (pyridostigmine). When generalized symptoms are present, daily steroids are often administered for a time. When long-term steroid use is anticipated, a steroid-sparing immunomodulating agent is used such as azathioprine, mycophenalate mofetil or cyclosporine . Some people can experience a “myasthenic crisis” which involves severe worsening of symptoms that is potentially life-threatening. This requires hospitalization and close medical monitoring. It is typically treated with either intravenous IVIG or plasmapheresis.

 

Question: What is the prognosis?  How does it affect a person’s life in the long run?

Answer: In the past, myasthenia gravis had a mortality rate as high 20-30%. With today’s medical knowledge and treatments, the prognosis is much better and most people can expect a normal life span. Some cases can go into remission with return of strength and can be safely taken off medications.

 

Thank you Dr. Todd for providing us with some great information!

To learn more about Dr. Adam Todd and how he works with his patients, visit his video bio at:

http://noranclinic.com/providers/todd_adam.html

If you have additional questions about myasthenia gravis and would like to schedule an appointment with a neurologist experienced in the management of your condition, please contact Noran Neurological Clinic at 612-879-1500.

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Dr. Burstein Interviewed on Fox 9 News regarding Guillain-Barre Syndrome in a young boy

KMSP-TV

 

If you missed the story last month, Dr. Burstein was interviewed for a news story that aired on Fox Channel 9 on November 13th regarding an 8-year old boy who was diagnosed with Guillain-Barre Syndrome, or GBS, shortly after receiving his flu shot last year.

From the KMSP Channel 9 website’s story:

MINNEAPOLIS (KMSP) –

It’s flu season and flu shots have the potential to keep people from getting sick, but in extremely rare cases, some people who get the shot can have a a frightening reaction. That’s exactly what happened to the McGowan family and 8-year-old Mason. They believe their saga started with a flu shot, though doctors will never know for sure.

Minneapolis Dr. Larry Burstein says about 2 out of every 100,000 kids develop Guillain-Barre, what the Mayo Clinic defines as “a rare disorder in which your body’s immune system attacks your nerves.”

…The Center for Disease Control says two thirds of the people who develop Guillain-Barre get it after being sick with a respiratory illness, others get it after the flu or other infections, and then on very rare occasions, after getting a vaccination. It’s most common in older adults. Experts say the benefits of getting a flu shot still outweigh the risks.

To read the full story online, visit Fox Channel 9 here: http://www.myfoxtwincities.com/story/27381691/family-forgoes-flu-shot-after-sons-guillain-barre

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Giving Tuesday!

Giving Tuesday Food Drive 2014

 

We all know about Thanksgiving, a wonderful time of year to remember and to be thankful for what we have. Then came Black Friday, and then Cyber Monday…now, after giving thanks for what we have ourselves and taking advantage of shopping deals, comes Giving Tuesday. This is the day to give back to others, a day to continue in the spirit of the season and share what we have. For some, this comes in the form of raising money or making a donation to a charity that is dear to us. It may be doing a small deed for a loved one or a stranger. It may be sharing our time in a way that helps someone else. For Noran, we have spent this time of year for the last several collecting food and housegold goods from among our providers and staff and donating them to local food shelves. This year, in honor or Giving Tuesday, we would like to kick off this event on Tuesday, December 2nd and will be collecting for the next two and half weeks. This year, we would also like to welcome donations from anyone who would like to participate in giving along side us! We will provide a donation box in both of our Minneapolis and Blaine lobbies from December 2nd through December 18th, and front desk staff at other locations can take donations at the front desk to be sent in along with our donations at the end of the collection period. If you have an appointment with us during this time frame, or are just conveniently close to one of our locations and would like to particpate, we are happy to accept your food donation along with our own internal donations, and will deliver them all together to local food shelves in December.

However you choose to do so, take advantage of Giving Tuesday and help someone if you can!
To view a printable PDF of the flyer for this event, click here: Giving Tuesday Food Drive 2014

For more information on Giving Tuesday, visit http://www.givingtuesday.org/ or watch this video from the #GivingTuesday website:

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Meet the Stroke Specialists of Noran Neurological Clinic

We have 34 adult and pediatric neurologists at Noran Neurological Clinic, and all are very experienced in treating patients with neurological disorders of all kinds. Furthermore, each of our providers is expertly trained in evaluating and treating patients with stroke. However, several of our neurologists have developed a special interest in stroke and work closely with the other specialists at Abbott Northwestern Hospital in post-stroke evaluations and treatment planning. They each continue to work with all types of neurological conditions and have additional interests as well. We’d like to introduce the providers who have developed a subspecialty within the area of stroke. A link to each provider’s bio is included below.

Dr. David P. Dorn, MD

http://www.noranclinic.com/providers/david_dorn.html

 

 

 

 

 

Tarrel_Ronald_webDr. Ronald M. Tarrel, DO

http://www.noranclinic.com/providers/ronald_tarrel.html

 

 

 

 

 

todd_adam_webDr. Adam J. Todd, MD

http://www.noranclinic.com/providers/todd_adam.html

 

 

 

 

 

 

You can find bios for all of our doctors, Allied Health Professionals, and Neuropsychologists at our main bio page, http://www.noranclinic.com/providers/neurologist_bios.html.

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Weekly trivia on Noran Clinic Facebook!

We are excited to be starting a weekly “Know Your Neurology” trivia on the Noran Neurological Clinic Facebook page! Check in weekly on Thursday anytime after 10:00 AM to see if you know the answer! Learn more about ways to keep your neurological system healthy, as well as facts about the conditions we treat every day as a comprehensive neurology practice. Be sure to post what you think the answer is, and we will post the correct answer the following Monday! (Also keep an eye out on our blog or facebook feed if you don’t know the answer, as we may have addressed the topic in a previous post.)

Plus, even better…the last Thursday of each month will be a trivia question with a bonus - be the first person to post the correct answer, and win a $5.00 gift card to Starbucks!

You do not need to be a patient or in any way connected to Noran Neurological Clinic to participate in our trivia, you just need to have “Liked” our clinic Facebook page in order to leave your answer in the comments section.

Thank you to everyone who participates, and good luck! Lets see how well you Know Your Neurology!

 

Trivia participants must be 18 years of age or older, and only one comment/guess is permitted per participant per bonus trivia on the last Thursday of each month. Winners will be announced in the comments section following the trivia, and will be contacted privately through Facebook messaging for information on receiving the indicated prize when applicable. Employees of Noran Neurological Clinic and its Centers are not eligible to receive a prize.

This trivia is in no way sponsored, endorsed, supported, or organized by Facebook. The recipient of the information provided by you is not Facebook, but Noran Neurological Clinic, PA. By participating in this promotion, you release Facebook from any and all liability in connection with Noran Neurological Clinic’s trivia.

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Noran Clinic Epilepsy Specialists interviewed for a Pioneer Press Special Epilepsy Issue

Earlier this year, The Pioneer Press, in collaboration with the Epilepsy Foundation of Minnesota, published a special “Celebrating 60 Years” feature edition about Epilepsy in celebration of the 60th anniversary of the founding of the Epilepsy Foundation. The neurologists at Noran Clinic who specialize in epilepsy and seizure as part of their practice were asked to answer several questions about Epilepsy, medications, and SUDEP.

See our doctors’ questions and answers below. To read the full feature, including the Q&A with Noran Clinic doctors on pages 4 and 5, you can view it here:

PIONEER PRESS & EPILEPSY FOUNDATION SPECIAL SECTION

 

Q: What is Epilepsy? (Gerald Dove, MD) 

Epilepsy is used to describe a condition in which a person has a tendency for recurrent seizures.  A seizure is what happens when the brain has abnormal uncontrolled electrical activity. Having a seizure does not necessarily imply epilepsy. This is due to the fact that some seizures can occur due to provoking factors, even in persons with no tendency to continue to have seizures. Such examples of situations where seizures occur, due to provoking factors, but are not epilepsy, are seizures that occur due to alcohol withdrawal and hypoglycemia. In these instances, when these situations or provoking situations are avoided, seizures never occur or recur. On the other hand, someone with epilepsy can have seizures, even when these situations are avoided.

There are many causes of Epilepsy, some inherited or genetic and others acquired, such as brain trauma, brain tumors, strokes, or brain infections.

Dr. Gerald Dove

Dr. Gerald Dove

 

 

 

 

 

 

Q: When should someone seek a specialist for epilepsy? (Tacjana Friday, MD)

An epileptologist is a neurologist who specializes in the treatment of seizures and epilepsy, and has acquired expertise in seizures and seizure disorders, anticonvulsants, and advanced treatment options such as epilepsy surgery.  An epileptologist is mainly consulted when a patient has poorly controlled epilepsy requiring more complex medical management, requires further evaluation with an EEG (electroencephalogram) to help characterize their spells or seizures, and/or to discuss other treatment options.

Dr. Tacjana Friday

Dr. Tacjana Friday

 

  

 

 

 

 

Q: Will I be on anti-epileptic medication for the rest of my life? (Syed Shahkhan, MD)

Most people with well-controlled seizures would like to stop taking their seizure medicines. In some cases, this can be done with the supervision of your doctor. You have the best chance of remaining seizure-free without medication if:

  • You had few seizures before you started taking seizure medicine
  • Your seizures were easily controlled with one type of medicine
  • You have normal results on a neurological examination
  • You have a normal EEG

Children with symptomatic epilepsy (epilepsy due to a known cause like brain injury, infections, tumor, and brain mal formation), adolescent onset, and a longer time to achieve seizure control are associated with a worse prognosis. In adults, factors such as a longer duration of epilepsy, an abnormal neurologic examination, an abnormal EEG, and certain epilepsy syndromes are known to increase the risk of recurrence. Even in patients with a favorable prognosis, however, the risk of relapse can be as high as 20% to 25%. Most doctors will consider tapering the dosage and discontinuing your seizure medicines after a seizure-free period of 2 to 4 years.

A decision about whether to stop taking seizure medicines should only be made after a long conversation with your neurologist, weighing all the risks. Are the possible results of another seizure (like injury or loss of your driver’s license) more acceptable than the continued effects of your medication?

Dr. Syed Shahkhan

Dr. Syed Shahkhan

 

 

 

 

 

 

Q: A stat is out about how seniors will be the largest population with seizures in the next 5 years.  Does a physician have any tips or special concerns a senior might need to know about having epilepsy? (Rupert Exconde, MD)

Epilepsy frequently affects the elderly. Relative to younger populations, the over-65 age group has a higher prevalence of epilepsy.

The clinical presentation of epilepsy in the elderly may be quite different from what is typically seen in younger people. In addition, common illnesses of older people can be easily mistaken for epileptic seizures, and vice versa. The elderly are more likely to present with nonspecific symptoms, such as altered mental status, memory lapses, episodes of confusion and loss of consciousness.  Because of the atypical presentation, the diagnosis is usually delayed by several months even in the care of an experienced neurologist.

It is important to recognize that freedom from seizures can be achieved in the vast majority of elderly epileptic patients. However, the morbidity associated with epilepsy is substantial, so once a successful treatment regimen has been established, lifelong treatment may be important for selected individuals.

Dr. Rupert Exconde

Dr. Rupert Exconde

 

 

 

 

 

 

Q: What is SUDEP and what do I need to know about it? (Rupert Exconde, MD)

SUDEP (sudden unexpected death in epilepsy) is the leading cause of epilepsy-related deaths. It accounts for close to 20% of deaths in individuals who suffer from epilepsy. It is diagnosed if death occurred while the patient is in a reasonable state of health, death happened during normal and benign circumstances, death was not the direct result of a seizure or status epilepticus (prolonged seizure) and an obvious medical cause of death could not be determined at autopsy.

Known risk factors for SUDEP include: young age (25 to 35), male gender, developmental delay, use of alcohol and recreational drugs, uncontrolled generalized convulsive seizures, night time seizures, concurrent use of multiple anti-seizure medications, subtherapeutic anticonvulsant levels, and treatment other than medication (surgery, vagus nerve stimulator, ketogenic diet).

The goal for decreasing the risk for SUDEP is optimal seizure management. Adherence with medication intake is essential. Avoidance of alcohol, illicit drugs, seizure-provoking situations, and high-risk situations (e.g., driving, swimming) are of paramount importance.

Dr. Rupert Exconde

Dr. Rupert Exconde

 

 

 

 

 

 

Q: Thoughts on medical marijuana as an epilepsy therapy? (Beth Staab, MD)

Medical marijuana is a hot topic in the national media and the medical community.  With it’s recent legalization in Colorado the medical community is now more aggressively looking into potential therapeutic options for marijuana-including its use in epilepsy.

Currently, there is only a small controlled clinical trial that was performed in 1980 showing its potential effectiveness in humans.  There are case reports of medical marijuana being effective for medically intractable epilepsy in children.  In animal studies, there is a suggestion that tetrahydrocannabinol (THC-the active ingredient in marijuana) can control seizures not responsive to other therapies.

Before marijuana becomes a mainstream therapy for medically intractable epilepsy, we need more clinical trials to determine dose and administration method but there is hope that this may be able to be added to the armamentarium that neurologists have to treat seizures.

Dr. Beth Staab

Dr. Beth Staab

 

 

 

 

 

 

If you have additional questions about epilepsy or seizure and would like to schedule an appointment with a neurologist experienced in the management of this condition, please contact Noran Neurological Clinic at 612-879-1500.

 

 

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I’ve Never Had an MRI Before…

Allergic to MRIs SomeEcard

 

Remember being told to stay still as a child, and it suddenly seemed like the hardest thing in the world to do?

It is not often that this is asked of us in day to day life as adults, but it is one of several important things to remember when having an MRI done at your imaging center.  For some people, just feeling nervous about having a test done in a strange machine might cause difficulty with finding a comfortable position and relaxing enough to be still for 15 to 45 minutes.  Knowing what to expect and how an MRI works may help put you at ease and make this important scan seem to fly by.

What Does an MRI Machine Look Like?

There are several different types of MRI available now.  Many people still think of the older bullet-style MRI machines from many years ago, but new technology has allowed for very high quality MRI’s to be more open, and shorter “tubes” that closely resemble donuts, or CT scanners.  Here are a few images of the type of MRI used at the Minnesota Diagnostic Center – Siemens Magnetom Espree Wide Bore scanner.

MRI large man on espreeespree side view

MRI woman in espreeAs you can see, this machine is spacious enough to accommodate most individuals; it also allows a person to go in feet first for lower body scans, and in some cases a person’s head may remain outside of the machine.

What Does an MRI Sound Like?

If you know someone who has had an MRI, you may have heard that they can be pretty loud – lots of knocking and humming.  Although new scanners have recently come on the scene that claim to be mostly silent, they are not yet widespread.  Most imaging facilities, like MDC, provide headphones and music, and even allow you to bring your own CD to listen to, blocking out a good part of the MRI sounds.  To listen to an MRI without the headphones or music, check out this video below…just a couple of minutes here and there gives you the idea.

Although it may seem pretty obnoxious sounding, for many people it is still monotonous enough to put them to sleep!

Am I All Alone In There?

Once you are on the MRI table and the appropriate body part to be scanned is in the machine, your MRI technologist will leave the immediate room and go to the MRI control room next door.  There is a window so that your technologist can see everything that is going on with you in the machine, as well as a two way intercom so that you can talk to her and she can talk to you.  In addition, there is an “emergency” or “panic” button in the machine that you can press at any time if you feel you cannot complete the test, and the technologist will have you off of the table within seconds.

Why Is It So Important to Stay Still?

Although MRI machines work quickly and are able to take a number of pictures in a short amount of time, it is not quick enough to avoid blurring if you are moving during the scan.  Moving the body part being scanned may cause unclear pictures, which then need to be re-taken.  Having to take important images more than once means a longer time in the MRI Machine, and moving too much to retake them all may mean that the quality is not as clear as your doctor and the radiologist would like to see in order to make an accurate diagnosis and the best possible treatment plan.

How Does an MRI work? How Is It Different than an X-Ray or CT?

The primary difference between how an MRI works versus an X-Ray or CT is that it uses a magnetic field instead of x-ray beams. An x-ray uses a small amount of radiation from one direction, whereas a CT uses multiple x-ray beams (radiation) while x-ray detectors rotate around you for more detail. An MRI, on the other hand, does not use any ionizing radiation. Instead, it creates a strong magnetic field around your body that causes the hydrogen protons in your body to align. The MRI then sends out radio waves that “knock” the hydrogen protons out of alignment, and as they re-align in the magnetic field, they send out their own electric signals. These are picked up by the MRI computer that converts them into detailed images. For a great visual explanation, check out this brief video by the National Institute of Biomedical Imaging and Bioengineering (a branch of the National Institutes of Health):

MRI’s are better at imaging organs and soft tissues (like those in the brain and along the spinal cord), along with abnormalities in these tissues, than CT’s.

Because there is no radiation used, there is no inherent risk by having MRI’s done. However, since it is a huge magnet, any metals on or in the patient can present their own risks – anything from pace makers and stents to some types of tattoo inks and piercings may not be completely MRI safe, and staff should be made aware before the scan appointment. In some cases, a contrast dye is used to better highlight areas of abnormal tissues. As with all injections, there is always the risk of allergic reaction in some people.

Any Other Tips?

For more information on how to prepare for your MRI scan and what to expect from MDC staff before and at the time of your test, visit the Minnesota Diagnostic Center website page Prepare for Your Magnetic Resonance Imaging (MRI)

Although you have likely already reviewed MRI Safety questions at the time that your MRI scan was scheduled, protocols are in place to ensure that nothing is missed, and you will be asked many of the same questions again upon check in.  It is not uncommon that a person remembers something they may need to let the MRI staff know about that they didn’t realize was important the first time around.  Arrive early enough to review this paperwork, and remember that the staff is asking you these questions again for your own safety and to ensure the best image quality for your doctor.  You can always ask staff about the importance of the MRI screening process if you wonder why.

You can also feel free to call with any questions you might have and speak to one of the MDC and Noran Clinic staff at 612.879.1000, during regular business hours (8 am – 4 pm).

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Noran Clinic and neurologist Dr. Susan Evans featured in MN Monthly

Evans_Susan_web

Last year, MN Monthly featured a specialty healthcare section and explored some of the top specialty centers in Minnesota. Noran Neurological Clinic and neurologist Dr. Susan Evans were featured as the Minnesota neurology clinic. If you did not see it last year when it was published in the May, 2013 edition of MN Monthly, you can read it here!

May 2013 MN Monthly Specialists article

 

For more from Minnesota Monthly, you can visit their website at http://www.minnesotamonthly.com/

To read more about Dr. Evans, you can visit her biography page and video bio here: http://www.noranclinic.com/providers/susan_evans.html

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Thank your Physician Assistant this week!

Noran logo PAWeek

 

Did you know that this week is National Physician Assistant Week? It is a time to celebrate the great work PA’s do in the medical field and thank them for their wonderful patient care!

Among our providers at Noran Clinic, we have a team of Allied Health Professionals, which includes both Physicians’ Assistants and Nurse Practitioners who work in conjunction with your neurologist to provide the best care possible. If you would like to learn more about how PA’s and other AHP’s work with your doctors, visit one of our other blog posts: What is an Allied Health Professional and how do they participate in my care?

Thank you to Stephanie Brakel PA-C, Tammy Mehlhaus PA-C, Jessica Nelson PA-C, and Deborah Osgood PA-C – Noran Neurological Clinic wouldn’t be the same without you!

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A Q&A with Pediatric Neurologist Dr. Steve Janousek

Dr. Steven JanousekSteven Janousek, MD is a Board Certified Neurologist with Noran Neurological Clinic. He is additionally qualified in Pediatric Neurology. He has undergone further training and certification, enabling him to read and interpret electroncephalograms, or EEG’s, for both his own patients and for other providers’ patients when ordered, and also has special interests in Epilepsy and Neonatal Neurology. In this Question and Answer session which Dr. Janousek originally completed for Minnesota Monthly, we get to know Dr. Janousek and his practice a little better!

 

 

Question: What is the research finding or treatment in your field that has you most excited about practicing medicine in 2015 and the years to come?

Answer: Devices which interface with the human nervous system are being developed. One of the earliest useful examples of this was cochlear implantation. This technology has allowed some deaf people to hear. I hope that during my lifetime I will see such interfaces successfully applied to other systems; perhaps someday allowing the blind to see or restoring the ability to walk following a spinal cord injury. Of course, these are at this point  dreams for the future.  But such advances seem to be theoretically possible.

 

Question: How has your field of practice changed since you graduated medical school and what changes do you see on the horizon?

Answer: I began practice in the pre-internet era. If I had a question about a rare medical condition, I would spend a weekend in a medical library going through lists of journals, ordering articles- oftentimes from overseas- and perhaps getting an answer to my questions by mail in two to three weeks. Currently, the same investigation can take place in such a brief period of time that I can often give patients an answer to our questions while they are in the office.

 

Question: What should a patient keep in mind when visiting a physician in order to obtain the best outcome?

Answer: I find the most successful and rewarding office visits with my patients to occur when we work together on a treatment program. I can recommend therapies and treatments for patients, but unless those plans are modified to fit the specific constraints of a particular individual’s situation it may not be possible to fully implement the recommendations. In addition, the outcome is obviously better when a patient has a full understanding of the rationale for my recommendations. I believe that time spent educating someone about their particular condition and about treatment options is time well spent.

 

Question: What is a piece of information about your field of practice that you wish all patients knew in order to promote their health?

Answer: In this day, we have many medications that can treat many previously untreatable conditions. However, I wish patients had a greater appreciation for the fact that medication management for various conditions, while very helpful, in many cases is not the only answer. Various therapies, oftentimes requiring additional time and effort from the patient, may be necessary for a better overall outcome.

 

Question: What would you like your patients to know about your job that you feel they don’t?

Answer: I cannot imagine that my patients have any idea how incredibly educational and rewarding I find my career in medicine to be. As physicians we are privy to situations involving humanity that very few people have access to. A career in medicine is truly a lifelong lesson in understanding who we are and what it means to be human.

 

Thank you Dr. Janousek!

 

To learn more about Dr. Steven Janousek and how he works with his patients, you can watch a video featuring Dr. Janousek from the Child Neurology Foundation on his bio page:

http://www.noranclinic.com/providers/steven_janousek.html

If you have additional questions about pediatric neurology or would like to schedule your child for an appointment with a pediatric neurologist, please contact Noran Neurological Clinic at 612-879-1500.

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