Sleep and Multiple Sclerosis

Psleepeople who have Multiple Sclerosis can face a number of challenges when it comes to restorative and restful sleep.  Studies have shown that sleep apnea is often under diagnosed among people with MS.  Click here to learn about common sleep problems in people with Multiple Sclerosis and click here for some helpful tips to improve your sleep quality.


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Meet our Movement Disorder & Parkinson’s Disease Subspecialists

We have 32 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 Parkinson’s Disease and other movement disorders.  However, two of our neurologists have developed a special interest in movement disorders, including Parkinson’s Disease.  They each continue to work with all types of neurological conditions and have additional interests as well.  Since it is Parkinson’s Disease Awareness Month, we’d like to highlight the providers who have developed a subspecialty within these conditions.  A link to each provider’s bio is included below.



Rob G. Jacoby, MD







Okeanis E. Vaou, MD

Medical Director, American Parkinson Disease Association of Minnesota





You can find bios for all of our doctors, Allied Health Professionals, and Neuropsychologists at our main bio page,


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Epilepsy and Seizure: Q & A with Dr. Gerald Dove

Dove_Gerald_webGerald Dove, MD is a Board Certified Neurologist with Noran Neurological Clinic.  He is additionally certified in Clinical Neurophysiology and Epilepsy.  He has undergone further training and certification, enabling him to perform EMG’s for both his own patients and for other providers’ patients when ordered, and is also trained to read and interpret electroncephalograms, or EEG’s.  In this Question and Answer session, Dr. Dove answers some common questions about epilepsy and seizure.



Q. What is Epilepsy? What is the difference between epilepsy and seizures?

A. A seizure is what happens when the brain has abnormal electrical activity leading to a sudden change in a person’s behavior or experience. On the other hand, the term Epilepsy is used to describe a condition where a person has a tendency for recurrent seizures, which cannot be easily fixed. I will try to illustrate with an example;  Low glucose (hypoglycemia) can cause seizures. If someone experiences a seizure due to low glucose, they do not necessarily have epilepsy. In this case the seizure occurred due to low glucose and if they avoid low glucose, they will never experience a seizure. On the other hand, someone with epilepsy will experience seizures, even if their glucose was normal or other provoking factors were eliminated.


Q. Is it possible to have seizures and not have epilepsy?

A. The answer is yes. The term epilepsy implies an innate tendency to experience seizures. Seizure, on the other hand, means a sudden change in a person’s behavior or experience due to abnormal electrical discharge in the brain. So if you experience a seizure (or multiple seizures), without having an innate tendency to have them, you don’t have epilepsy, despite the seizures. Situations that can lead to seizures that may not be due to epilepsy include alcohol withdrawal; illicit drug usage;  some prescribed medications some anti depressant medications, some antibiotics, some antipsychotic medications and some metabolic disorders including low glucose, low calcium, low magnesium. In these situations, the seizures are provoked or brought on by the change due to these factors. If these factors are eliminated, a seizure does not occur.


Q. What causes epilepsy?

A. There are many causes of epilepsy. Some kinds of epilepsy are genetic (or hereditary), but more commonly, epilepsy is acquired. In many cases (up to 50%), there is no identified cause.

The causes of epilepsy vary in different age groups. For patients who have epilepsy for the first time under age 25, this can be due to genetic factors, perinatal factors such as hypoxia at birth, metabolic disorders, brain infections such as meningitis and encephalitis, from febrile convulsions at an earlier age, and brain trauma.

For patients above age 50 who experience epilepsy for the first time, some of the more common causes include stroke, dementia, brain tumors, brain infections, and other inflammatory disorders.

Patients in the age range of 25-50 years tend to be the least likely to experience epilepsy for the first time. Though rarer in this age group, epilepsy can still occur due to the same causes in those who are less than 25 and older than 50 age groups. Other causes of epilepsy considered more common in this group would include brain toxicity from drugs and alcohol.


Q. How is epilepsy Diagnosed?

A. In order to diagnose epilepsy, you need to visit with a Neurologist or an Epileptologist. A neurologist is a doctor who specializes in treating disorders of the brain , spinal cord and nerves. An Epileptologist is a neurologist who specializes in epilepsy.

At the visit with the Neurologist or Epileptologist, the doctor will perform a history which would include questions about seizures, risk for epilepsy and family history. The doctor will also perform a neurologic examination and will request tests which include an EEG, a brain MRI and some blood tests. The diagnosis of epilepsy is made after information gathered through this means is analyzed.


Q. How is epilepsy treated?

A. There are a number of approaches to treating epilepsy. The first approach is by medications, also called anti epileptic drugs (AED). There are about 25 medications on the market for treatment of epilepsy. Some are effective for the different types of epilepsy, whereas others may have side effects that are not attractive in some populations, so the decision to choose a specific AED is dependent on various factors.

Brain surgery is another option for treating some kinds of epilepsy, when AED medications are not effective. This is not for everyone.

Diets including the Ketogenic diet, modified Adkin’s diet and Adkin’s diet have been proven to be of added benefit, when medications alone have not been effective in controlling seizures.

There are also devices such as the Vagus Nerve Stimulator (VNS), Deep Brain Stimulator and the RNS neurostimulator that help reduce seizures, in conjunction with AED.


Q. Many people think of seizure and imagine a loss of consciousness and uncontrollable, violent body movements. Is this common, and are there other types of epileptic seizures that can happen? What do they look like?

A. This question can be best answered by remembering the basic premise, that “a seizure is what happens when the brain has abnormal electrical activity”. Building from our knowledge that the brain has multiple, varied, protean functions, it is not difficult to imagine that abnormal electrical activity in different parts of the brain will have different manifestations. Some seizures occur when this abnormal electrical activity is generalized . These are called generalized epileptic seizures. There are other seizures that occur when this electrical activity is limited to a small (or focal) part of the brain . These are called focal (or partial) epileptic seizures. As you can imagine the manifestations will be very different in these situations. Thus it follows that there are different manifestations of seizures.

Some of the manifestations of generalized epileptic seizures include absence seizures (or the so called ‘petit mal’ seizures). These manifest as a brief staring episode, without any other manifestation. Myoclonic seizures are another example of generalized seizures which manifest as a brief jerk of an arm, leg or whole body without loss of consciousness. We are all aware of ‘grand mal’ seizures (better called generalized tonic clonic seizures), which manifests as loss of consciousness and uncontrollable violent body movements. Other seizure types in this broad category of generalized epileptic seizures include tonic seizures (where there is sudden brief increased muscle tone), atonic seizures (where there is loss of muscle tone, sometimes with falls) and clonic seizures.

Focal epileptic seizures have varied manifestations , depending on the part of the brain that is involved. These can range in severity from brief subjective experiences without loss of awareness or responsiveness (also called simple partial seizure or ‘aura’) to more those associated with loss of consciousness (also called complex partial seizure). Sometimes the focal epileptic seizure can progress to a generalized tonic clonic seizure. Some manifestations of focal epileptic seizures can include smell sensation, visual hallucination, hearing a noise, ‘déjà vu’ feeling or some other manifestation.


Q. Does it hurt to have a seizure?

A. There are different types of seizure manifestations. Minor or small seizures such as simple partial seizures or absence (‘petit mal’) seizures do not cause any pain. On the other hand, there can be effects of generalized tonic clonic seizures (also called “ Grand Mal Seizures’) that can be painful. These effects can be simplistically divided into direct effects of the seizure and indirect effects of the seizure. Direct effects that are associated with pain include biting the tongue, a dislocation of the shoulder, a rib fracture, vertebrae fracture, muscle aches or headaches. Indirect effects occur as a result of a fall during a seizure and these can include a skin laceration or a skull fracture.


Q. Are there certain triggers that a person with epilepsy should be certain to avoid?

A. There are some triggers for epilepsy. Some of these triggers are specific to different types of epilepsy. Thus, it is important that you identify the kind of epilepsy you have, and then you can be educated about which triggers to avoid. In general, situations such as alcohol withdrawal, alcohol intoxication, hypoglycemia (low glucose), illicit or some prescribed drug intoxication or use, sleep deprivation, and hormonal changes such as menstrual cycle can trigger seizures in some patients with epilepsy.

Beyond these more ‘general’ triggers, there are also some more specific triggers for certain defined epilepsy types. I must stress that these don’t apply to the overwhelming majority of patients with epilepsy. These types of epilepsy which are relatively rare, the so called ‘reflex epilepsies’, can have specific triggers, such as strobe or flashing lights, hot water, reading a book, and specific foods, such as milk, etc. It is again, important to note these are very rare and don’t apply to most patients with epilepsy.


Q. What should I do if I or someone I love may be experiencing seizures?

A. First and foremost, don’t panic. Look for a neurology clinic or epilepsy clinic in your area. Call and make an appointment to see a neurologist or epileptologist. A neurologist is a doctor that specializes in treating diseases of the brain, spinal cord and nerves. An epileptologist is a neurologist, that specializes in epilepsy. Obviously, it is preferred that you see an epileptologist, but there may be situations where none is available where you live, so you can see a neurologist. Most neurologists have some expertise in managing epilepsy.


Q. Are there conditions that are often related to or often occur alongside epilepsy?

A. Yes there are. These conditions can be simplistically divided into two groups; those conditions that can cause epilepsy to occur with epilepsy, and those that can be caused by epilepsy or the treatment of epilepsy.

Some conditions or disorders that can cause epilepsy include some genetic or hereditary disorders, brain tumors, brain infections, strokes, and dementia. The second group of conditions include depression, other mood disorders, memory loss, reduced fertility, and osteoporosis.


Q. Are there any other questions about epilepsy and seizures you often hear from people?

A. What restrictions do I have when I have epilepsy?

-          Do not drive for 3 months after a seizure that is associated with loss of consciousness or loss of motor control

-          Do not climb heights unattended

-          Do not climb a ladder more than 2 feet in height unattended.

-          Do not swim unattended

-          Do not lift weights, such as in bench pressing, unattended


Is Epilepsy infectious or contagious?



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

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

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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Parkinson’s Awareness Month

The Michael J. Fox Foundation shares this striking infographic about Parkinson's Disease

The Michael J. Fox Foundation shares this striking infographic about Parkinson’s Disease


Parkinson’s disease (PD) is a degenerative brain disorder that causes impairment in motor functions, typically experienced as shaking or tremors, stiffness in the body and/or limbs, slowness of movement, and trouble with balance and falling.  In support of Parkinson’s Awareness Month, we are inviting you to educate yourself about this disease and explore ways to help beat Parkinson’s.

For those who are living in Minnesota and looking for local resources, there are two wonderful organizations to get in contact with – the American Parkinson Disease Association (APDA) and the Minnesota Chapter of the National Parkinson Foundation (NPF).  They both can provide detailed information about the disease and how to handle common associated symptoms and problems; an opportunity to post questions to doctors in an anonymous forum; and information on local events for those with Parkinson’s, their care partners, and anyone interested in getting involved.



The American Parkinson Disease Association Minnesota Chapter can be reached at 1-888-302-7762, or by visiting the website:





The National Parkinson Foundation – MN can be reached at the PD Helpline, 1-800-473-4636, or by visiting the website:


Check in to our facebook page throughout the month of April to get insight into this neurodegenerative disease and find ways to participate in the Parkinson’s community in your area.


If you have questions about a possible diagnosis of Parkinson’s or other movement disorder, or are seeking treatment, please contact Noran Neurological Clinic at 612-879-1500 to schedule an appointment with a neurologist experienced in the diagnosis and management of this disease.


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Meet our doctors for National Multiple Sclerosis Education and Awareness Month

We have 32 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 identifying and managing patients with multiple sclerosis and other autoimmune disorders.  However, several of our neurologists have developed a special interest in multiple sclerosis over years of education and practice.  They each continue to work with all types of neurological conditions and have additional interests as well.  Since it is Multiple Sclerosis Awareness Month, we’d like to highlight some of our providers who have developed a subspecialty in MS.  A link to each provider’s bio is included below.




Dr. David P. Dorn MD








Dr. Susan L. Evans MD








Dr. Rob G. Jacoby MD








Dr. Soren A. Ryberg MD








Dr. Michael P. Sethna MD, PhD








Dr. Syed M. Shahkhan MD





You can find bios for all of our doctors, Allied Health Professionals, and Neuropsychologists at our main bio page,


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New Headband device approved by FDA to assist in migraine management

According to an article posted on MedPage Today by John Gever, this is a brand new FDA approved preventative treatment, using TENS technology:

“A headband delivering electrical nerve stimulation can prevent onset of migraine headaches and can be marketed for that purpose in the U.S., the FDA said Tuesday.

Called Cefaly, the Belgian-made device is the first to win FDA approval for migraine prevention and is also the first transcutaneous electrical nerve stimulation (TENS) system OK’d for any type of pain prevention, as opposed to acute treatment, the agency said.”

Read the full article here: FDA Approves Headband Device for Migraine

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An interesting history of Multiple Sclerosis from the National MS Society

old book spines

Although Multiple Sclerosis wasn’t first recognized as a specific disease until the 1870′s in England and the United States, neurological symptoms that were likely evidence of MS have been documented for far longer.  The National MS Society provides a great history of the study of MS symptoms, the identification of MS as its own disease, and the many treatments doctors provided over the decades before our current therapies were developed.  Check it out in this printable PDF file:


You can find this, and other educational and helpful information on understanding MS at the National Multiple Sclerosis Society website here:


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New blood test could potentially predict Alzheimer’s Disease before symptoms develop

(CNN) — “In a first-of-its-kind study, researchers have developed a blood test for Alzheimer’s disease that predicts with astonishing accuracy whether a healthy person will develop the disease.

Though much work still needs to be done, it is hoped the test will someday be available in doctors’ offices, since the only methods for predicting Alzheimer’s right now, such as PET scans and spinal taps, are expensive, impractical, often unreliable and sometimes risky.

‘This is a potential game-changer,’ said Dr. Howard Federoff, senior author of the report and a neurologist at Georgetown University Medical Center. ‘My level of enthusiasm is very high.’

The study was published in Nature Medicine.”

To see the full article on the CNN website: CNN Article Alzheimer’s Blood Test


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Sleep Tips: Quiet your mind and get some sleep!

For many people, the hardest part about getting quality, restful sleep is just getting started.  You’re in bed, the lights are turned off, and now suddenly it seems your brain is turned ON.  In some cases, anxiety can play a role in racing thoughts throughout the day, including at night.  However, for others it has little to do with anxiety and more to do with making sure you are preparing yourself for sleep, and that your bedroom is the best place possible to get sleep.  Here are some tips to keep in mind when you are fighting a racing mind at bedtime, or anytime you aren’t getting the sleep you need:

  1. Recognize that SLEEP is IMPORTANT.  You can read just how important in the article by Noran Clinic’s board-certified neurologist and sleep specialist, Eric Hernandez MD PhD, “Sleep is an essential part of life
  2. Keep electronic devices out of the bedroom.  This includes computers, cell phones, tablets, TV’s…anything with a screen.  Exposure to lit up electronic devices at night can be not only mentally stimulating, but the light actually impacts the way your body works, fooling it into acting as if it is still daytime and feeling like it should be awake.  Put away the device at least 30 minutes prior to when you want to be sleeping, but earlier is better.
  3. Don’t drink caffeine after lunch.  Caffeine has a half-life of 5-6 hours for most people.  This means that if you drink two cups of coffee at 3pm, by 8pm your body will still feel like it has just had one cup of coffee.  In another 5-6 hours, around 1am, you will still have half a cup of coffee’s worth of caffeine in your system.  If you think that drinking coffee right before bedtime, or in the middle of the night, might keep you up – remember that half of the caffeine you take in during the day will be in your system for another 5 hours at least!  If you drink caffeinated beverages, make sure you are drinking it early enough in the day that you get the boost but still have enough time for it to be mostly out of your system by bedtime.
  4. Don’t use tobacco or alcohol as sleeping aids.  You may think it will help you sleep because you feel relaxed or drowsy shortly after smoking or drinking, but certain chemicals in tobacco are actually linked to wakefulness, and alcohol causes sleep to be lighter and less restorative.  Both substances tend to lead to earlier waking (sleeping for fewer hours), and higher rates of insomnia.
  5. Keep a schedule. It can be tempting to stay up late or sleep in on the weekends, but maintaining too much of a difference in sleep and wake times can make it difficult to fall asleep when you really need to during your regular week.  Keep your bedtime and wake up schedule to within 1-2 hours of the same times every day, even on the weekends.
  6. Create an optimal sleeping environment.  Have a comfortable mattress, pillow, and blankets, and keep your bedroom temperature cool at night – what is comfortable varies person to person, but some studies suggest between 65 – 72 degrees F.  Getting too warm or too cold at night can disrupt sleep.
  7. Write down your worries or to do list earlier in the day. When your mind is regularly cycling through things you feel you need to remember at night, it can help put your mind at ease to know it is all written down somewhere for the next day so that you do not need to worry about it in bed.
  8. Still can’t sleep? Don’t stay in bed!  If you can’t sleep, don’t stay awake in bed trying to will yourself to sleep.  The bed is for sleeping, so if you aren’t, get up and do something quiet or boring somewhere else until you feel like sleeping.  Here are some ideas from the American Academy of Sleep Medicine on what to do, or not do, if you find yourself in this spot: Can’t sleep?  Do this, not that!


If you feel you have tried it all and you are still regularly losing sleep to bouts of insomnia, particularly if it is impacting your day to day life, it may be time to talk to a doctor.  To schedule an appointment with a board-certified sleep neurologist at Noran Clinic Sleep Center, call 612-879-1500.


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Make 2014 the year you make a difference for those with MS

Consider registering for a Walk MS event in your area!  This year’s National MS Society’s Walk MS takes place on Sunday, May 4th in 17 different cities in Minnesota.  Help raise funds for critical research and programs that support people living with Multiple Sclerosis!

As a participant, you can choose to walk either a 1.5 or 6.5 mile route.  There is no registration fee or minimum donation required, but fundraising is encouraged.  Prefer cheering to walking?  There are lots of opportunities to volunteer the morning of the walk instead, from helping with set up and registration to celebrating at the finish line.

Looking for something a little more challenging?  The National MS Society also hosts a Challenge Walk MS, which is a 2-day 50k on September 20-21 this year.  If you feel like revving up to do some major miles in support of those with Multiple Sclerosis, or want to volunteer to help motivate those who are doing the walking, registration is open!  The event page even includes tips for training so you can start preparing now.

Are you more of a cyclist?  Prefer to fundraise in the mud?  There are also opportunities for Bike MS and Muckfest MS during the year!

For more information on how you can participate in such fun, meaningful events, and to check out other opportunities to fundraise for Multiple Sclerosis, visit the National MS Society’s Get Involved page at:

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