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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Dr. Ronald Tarrel interviewd in MPR news story “Focus on concussions transforms high school football in Minnesota”

Tom Baker / For MPR News - image from MPR News Story

Tom Baker / For MPR News – image from MPR News Story

Dr. Ronald Tarrel, neurologist and concussion/TBI subspecialist, was a part of a story on MN Public Radio earlier this week regarding the policies, procedures, budgets and the impact of a state return-to-play concussion law passed three years ago. What are public high schools in Minnesota doing to keep kids who play football safe?

Listen to Dr. Tarrel and the MPR radio news story audio here:

http://www.mprnews.org/listen/?name=/minnesota/general/features/2014/09/30/concussion_20140930

As reported by reporter Trisha Volpe and published on the MPR website:

On a chilly mid-September evening, hundreds of fans filled the East Ridge High School football stadium in Woodbury to cheer for their team. The hum of the crowd reached a fever pitch as cheerleaders chanted for star players in rhythm with the marching band’s drums.

The opening kick-off between the Raptors and the Mahtomedi Zephyrs brought the crowd to its feet.

It’s a seasonal Minnesota ritual many decades old. But for the 25,000-plus high school students playing football this year, for their coaches on the sidelines and for their parents in the stands, the game is different from what it was even a few years ago. The reason? Concern over head injuries.

Hundreds of players have been pulled from games and practices, game rules have changed and parents have been involved more fully in what their teenage players are experiencing, a months-long MPR News and KARE 11 reporting project found. Using the state data practices law, the project queried more than 100 districts about their policies, their budgets and other matters related to high school football. It found rapid change in recent years but it also made clear some schools have taken more steps than others.

• In the three years since a state law required players suspected of suffering head injuries to be pulled from games and not allowed to return without medical clearance, schools have complied hundreds of times. But the law doesn’t require schools to keep track of those injuries. Some do and some don’t.

• Most schools survey football players’ cognitive abilities before the season by conducting baseline tests to compare memory, reaction time, speed and concentration before and after injury. Some schools don’t.

• Virtually all schools provide parents with detailed information about safety and head injuries. Some schools do more than others.

• The rules of the game have changed, allowing referees, for example, to impose greater penalties to punish behavior on the field known to lead to injury.

• Some schools have changed the way they hold practices, reducing the amount of contact between players, and coaches are finding ways to teach students to play differently. Next year, the Minnesota State High School League will require all schools to adopt some practice changes.

• Schools are using better equipment, although the amount of money spent on helmets in particular varies, as do policies about using reconditioned helmets.

Those findings are based on responses and follow up interviews involving 103 of Minnesota’s 333 school districts. Those districts include 139 high schools.

To be sure, medical experts point out injury can’t be eliminated in a sport that is inherently violent. Football participation in high school remains high, and many parents and coaches say the benefits of the work ethic and camaraderie players learn outweigh the risks, pointing out that student athletes can be injured playing any sport.

A student cannot return to play until all symptoms are gone and he or she receives written permission from a qualified medical provider. All 50 states have passed similar laws on concussions in sports for youth and high school players, according to the Centers for Disease Control. Read Minnesota’s Return-to-play law.

“Since we’ve had the return-to-play law, we’ve seen an explosion in people paying attention to concussions and we’re seeing more kids come in to make sure that their brains are working appropriately,” said Dr. Mark Gormley, a Pediatric Rehabilitation Specialist at Gillette Children’s Specialty Healthcare in St. Paul.

“I think that concussion management in high school in Minnesota has changed quite considerably over the past few years. I think it’s gotten a lot better and I think mainly it’s education and awareness,” Gormley said. “I think people are aware that when you have a concussion you are damaging the brain, and if you do that repetitively over a period of time you can cause permanent brain damage.”

Gormley, a youth concussion expert who examined the information school districts provided to MPR News, concluded that most schools are complying with the law.

But their responses show that school districts are complying in different ways.

Dr. Ron Tarrel, a neurologist with Noran Neurological Clinic in Minneapolis, also analyzed responses to the survey and recommended that districts follow more uniform practices. Tarrel noted that districts had different protocols for tracking injuries, for information parents and athletes get about risk and for equipment monitoring procedures.

“It’s not about pointing fingers,” Tarrel said. “It’s not about finding faults. It’s about accumulating data to continue to refine and put together the best law that gives you the best awareness, the best preventions, the best treatment, best outcome for their athletes.”

Like many Minnesota student athletes, Ben George of Ramsey, 14, is a two-sport kid. He plays football and hockey at the youth league level. But last fall, after receiving several hard football hits, then falling even harder on the ice during hockey practice, Ben had to stop playing – at least temporarily. After complaining of severe headaches, Ben was diagnosed with a concussion.

“My theory was that the two hits in football are what made him vulnerable to the fall when he was in hockey,” Ben’s mother Bridget George said.

Before Ben could return to play, he went through a structured rest and recovery process through Gillette. The program included brain exercises and cognitive testing. Since a concussion is not visible in the brain with modern medical technology, cognitive testing is the only way doctors can determine if the brain is healed.

“The first part of the process is resting the brain just like any other injury,” Gormley explained. “Once they are no longer having symptoms, we take them through a staged process of increasing their activity progressively until they can tolerate that activity and then we let them return to play.”

Ben eventually got better and seven months after his injury he was cleared to return to the game, but he will take part in only one sport when he attends Anoka High School next year.

“He made a choice between football and hockey, and he’s going with football,” Ben’s mother said. “I still have anxiety about it because it feels like once you have one, you’re vulnerable and maybe you stay that way. But I have to be confident that between some of that guidance and Ben’s own ability to monitor his symptoms, that we have a good plan.”

Earlier this month, the Minnesota Department of Health released its first compilation of injuries reported under the new law, an estimated 3,000 concussions among high school athletes in all sports. More than 40 percent involved football players, partly because more kids play football than other sports. The numbers were based on school districts that tracked and reported numbers to the state.

Those numbers are in line with what districts told MPR News. The 130-plus high schools that responded reported more than 1,800 football players were removed from practice or a game since the law was enacted. In very few cases did a player return to the same game, but many returned days or weeks later after receiving the required medical clearance.

Anoka-Hennepin, Minnesota’s largest school district, reported the highest number of players removed. Since 2011, 133 football players in the district’s five high schools were removed because of concerns about concussions. Not one returned to play in the same game.

In those same three years, South Washington County’s three high schools reported 126 players removed. Osseo’s three high schools reported 80 players removed. Eastview High School in the Rosemount-Apple Valley-Eagan School district reported 79 players taken out of the game because of concern about concussions.

Several sizable school districts outside the Twin Cities reported similar actions. Rochester reported 79 players removed at its three high schools since 2011. Mankato’s two high schools reported 68 players removed, and 62 players were taken out of practice or play in New Prague.

But not all schools have pulled players off the field. The Mountain Iron-Buhl school district, with 24 varsity players on the roster, reported no football-related concussions since 2011. South St. Paul also reported no players pulled from the game because of concern about concussions, and the New Ulm school district said the number of players removed from the game during that same time period due to concern about concussions was “unknown.”

“We really limit the contact we have during the week,” Mountain Iron-Buhl head coach Dan Zubich said. “All of our hitting is done Friday nights. We have been very lucky with head injuries. We watch the heads up concussion video the first day of practice and really stress the importance of shoulder down, head up tackling.”

While the numbers at some schools may seem high, concussion experts say that may be a function of closer monitoring as opposed to more kids getting hurt.

“If athletes and parents and coaches and healthcare providers and administrators are aware of the problem, they understand the symptoms and signs, they’re able to recognize them and maybe they’re compelled to refer to a healthcare provider because of the law, then we are seeing more folks, which is a good thing,” said Dr. Michael Stuart, an orthopedic surgeon and sports medicine expert at Mayo Clinic.

About a fifth of the high schools that responded to the MPR News survey said they don’t track concussions among football players. That includes the schools in Minneapolis, the state’s third largest district. One district, Faribault, responded by saying, “We don’t write a policy for everything…we just try to do what’s right.”

Keeping track of that information is something medical professionals say is one of the most important things a school district can do because it can help identify trends and lead to safety improvement.

“I think someone needs to put together a uniform checklist, if that’s what it is, that every school can use,” said Tarrel. “People will know better what they’re looking for and better know how to respond to it.”

“It doesn’t take much to track,” Gormley said. “You can have your school manager track – how many kids had concussion symptoms, how many of them were resolved, when did they resolve.”

More info for parents and for doctors

Minnesota’s new law doesn’t require schools to report injuries to the state, but the Department of Health would like to expand its voluntary approach to get more experience collecting and interpreting the data.

The law does require school officials to provide information to athletes and parents about the risks of concussions. While the information and number of documents varied, all of the school districts that responded to the MPR News survey said they provide some type of concussion information to student athletes and their parents.

Some districts, including Centennial, Bemidji and Eden Prairie, even host mandatory safety and information meetings before the season begins.

In some districts doctors are getting more information, too, because of testing schools encourage. Because a concussion is not visible through any kind of brain scan, the only tool doctors have to determine whether an athlete has been injured and then healed is a test of cognitive abilities.

A baseline cognitive measurement assesses an athlete’s balance and brain function, learning and memory skills, ability to pay attention or concentrate and how quickly he or she thinks and solve problems. The athlete answers a series of questions, usually on a computer, and the results can be compared to a similar exam later if an athlete has a suspected concussion.

Most Minnesota school districts that responded to the MPR News survey offer baseline tests to football players before the season begins. But 17 districts reported they do not offer those tests, including big districts like Minneapolis, Eden Prairie and Roseville.

Changing the rules

Concern about head injuries has also affected the rules of the game itself and the way coaches conduct practices.

“We feel that football now is safer than it’s ever been,” said Kevin Merkle, associate director of the Minnesota State High School League, which governs interscholastic play across the state.

The kickoff run-up has been shortened to five yards to slow the play down and make impacts between players less forceful. For all kickoffs, including onside kicks, at least four players are now required to stand on either side of the kicker to balance the formation.

And when it comes to penalties, Merkle said the terms ‘targeting’ and ‘targeting a defenseless player’ have now been defined in the rulebook, and officials are being told to enforce targeting penalties more than they have in the past. Targeting a defenseless player used to be called ‘unnecessary roughness.’

“If kids are kicked out of the game because they launch and lead with their head, they can’t play the next game and that sends a strong message,” Merkle said.

The league hasn’t tracked how often those penalties are called, but Merkle said it may survey schools at the end of this season.

The league is also moving to reduce contact in practices. Starting next year, the league will limit to six the number of practices coaches can have in June and July in which players make contact with each other. Limiting contact means less opportunity for hits to the head.

The league is also looking at limiting the number of total practices in the summer and limiting the amount of contact during contact practices, Merkle said. The next step, he said, is changing practice guidelines for the August pre-season and the regular season as well.

Many states have gone a step further and passed laws that limit contact during football practice. In California, one of the most recent states to pass such a law, the measure limits practices with full-on tackling during the playing season and prohibits them during most of the off-season.

Merkle said most Minnesota football programs have already limited hits in practice on their own.

This is important because the rate of concussions is higher during practices than during games, said Dr. Grant Morrison, a physician at Fairview Sports Medicine in Eden Prairie. “If there were fewer contact-related practices, the sheer reduction in the number of possible injuries, it’s got to reduce the rate of concussions,” Morrison said.

Play low, keep heads up

Several districts say they’ve changed the way they practice. Calling safety his top priority, Stillwater head coach Beau LaBore said his teaching, coaching and practice techniques aim at keeping injuries down.

LaBore and coaches at other districts said they are teaching players to keep their heads up, to play low and to always have their feet underneath them, techniques known to lead to less violent contact during play. LaBore said his players are not allowed to use their helmets as weapons.

“It’s a good thing that we have improved the way we coach the game, the way that we equip our players to play the game and ultimately ensure that the proper techniques and skills are being used to keep football as safe as it can be,” LaBore said.

Eagan High School head coach Rick Sutton told MPR News’ The Daily Circuit program in August, “It’s extremely important that we as coaches do a great job of teaching proper technique, that we make sure that our players are keeping their head out of the game.”

Mayo Clinic’s Stuart offered advice to parents. “Make sure that your child is learning the rules of the game, make sure that their behavior on the field is safe and that they’re using proper blocking and tackling techniques, that they strengthen their neck muscles and use the entire approach for safety,” Stuart said.

The role equipment does and doesn’t play

On a fall afternoon in 1974 Craig Stroup, now 56 and living in Golden Valley, would play his first and last high school football game. He was 16, playing defense for Hopkins High School. Stroup tackled an opponent, a hit he would remember 40 years later.

“The left side of my head hit his knee,” Stroup said.

He made his way to the sideline and collapsed, remaining in a coma for six weeks with a brain hemorrhage.

Stroup sued a football helmet company, claiming the helmet he wore should have absorbed the impact, according to Steve Stroup, Craig’s brother.

But the injury was life changing. Craig Stroup will always need assistance and has virtually no short-term memory.

“I totally understand football and why kids enjoy doing it, but (a head injury) really can change things, the whole dynamics of the family, and it can affect you for a lifetime,” Steve Stroup said.

Helmet designs have changed significantly since Stroup was injured.

They are key to preventing skull fractures, but the scientific community has debated whether they can prevent concussions as well.

The National Operating Committee on Standards for Sports Athletic Equipment (NOCSAE) sets standards for all kinds of athletic equipment. At the high school level in Minnesota, if a football helmet doesn’t have the NOCSAE stamp of approval it doesn’t get used. NOCSAE is currently working on a new helmet standard that measures some of the forces known to lead to concussion.

NOCSAE’s Executive Director Mike Oliver said equipment has come a long way in keeping players safer on the field.

“The technology has changed,” Oliver said. “Some of the material science has changed. You can make shells thinner, but just as strong. There are variable density foams now that you didn’t have back in the day.”

Most experts agree that keeping football helmets in good condition, reconditioning them every year and making sure they fit properly, is very important. Reconditioning includes the inspection, cleaning, sanitizing and repair or restoration of the helmet to make sure it performs as it did when it was new.

Twenty school districts that responded to the MPR News survey have an actual policy to recondition helmets. Another 58 school districts said they have a procedure to evaluate the condition of helmets at the end of each season. Some recondition every year, others do it every few years. Most work with their individual helmet vendors to inspect and recondition.

In addition, all school districts that responded told MPR News that they purchase new helmets which are, in general, replaced every 10 years.

Some districts use football helmets rated highest by a controversial Virginia Tech star rating system that suggests a reduction in the risk of concussion based on the model of helmet a player chooses. But most experts say helmets can’t reduce the risk or prevent concussions at all. They say helmets can protect the skull, but there is little – at least today – that can be done to keep the brain from hitting the inside of the skull, which results in concussions.

While equipment is important, it may not be the most important.

“It really starts with research to understand who’s at risk, how concussions occur and then we take that information and look into strategies for prevention,” Mayo Clinic’s Stuart said. “The important thing is to make sure that we have the athlete’s best interest in mind… focus more on conditioning, speed, agility, skill development…Will there be concussions? Of course. But this is not about elimination. This is about reduction of risk.”

You can read the full original online article, including additional video, audio, images, and links, here: http://www.mprnews.org/story/2014/09/30/high-school-concussions-transform-high-school-football-in-minnesota

 

 

 

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The 2014 American Diabetes Association Expo is coming up Oct. 11th

ADA expo 10.11.14

We are happy to share some great information from the American Diabetes Association about the upcoming Walk to Stop Diabetes and Diabetes Expo!

 

“I am pleased to share with you some NEW and exciting features of the 2014 American Diabetes Association EXPO. This year we will be introducing the Grand Tasting Area. The Grand Tasting Area is a multi-layered world class sampling of appealing diabetes-friendly foods created and served by Novo Nordisk Diabetes Education Program Celebrity Chefs: Chef Tiffany Derry, Chef Rory Schepisi, Chef Doreen Colondres, and Chef Dana Herbert. Each chef will be paired with a Novo Nordisk Diabetes Educator delivering an educational message surrounding healthy eating and meal planning. Healthy eating does not have to be boring but vibrant, full of life and flavor! Groups will be admitted into the Grand Taste area every 15 minutes from 11:00 am – 1:30 pm.
Stop by the Delta Dentals booth this year, to learn more about oral health and diabetes. Research shows that there is an increased prevalence of gum disease among those with diabetes. If you have diabetes you could be at risk for developing serious gum disease and other oral health complications. Get more information and learn about important preventative techniques to keep your mouth healthy!
Follow The American Diabetes Association on Facebook at https://www.facebook.com/ADA.Minnesota, , on Twitter @diabetesMN, or our blog at diabetesmn.com.
If you haven’t registered this year for the 2014 Minneapolis Diabetes EXPO it isn’t too late. Pre-registered participants will be allowed early admittance into the Diabetes EXPO along with access to a portion of the show floor before the doors for the EXPO open to the general public. In addition pre-registered participants will be entered in a drawing to win a meet and greet in the Grand Tasting Area with CelebrityChefs .Visit www.diabetes.org/expominneapolis for more information about the EXPO and to register.
Don’t forget to visit the EXPO website to download your pass to ride any Metro Transit Bus or Light Rail the day of the EXPO and check out the charter buses coming to the EXPO from around the state.
Have you ever wished that there was a day to celebrate all of your hard work to live well with diabetes? Did you know there is? At the Step Out: Walk to Stop Diabetes we celebrate everyone living with diabetes because YOU are the reason we walk to help raise funds to find the cause and cure of this “silent disease”. Red Striders are children and adults who have type 1, type 2 or gestational diabetes. Join Team Red Twin Cities! Team Red is the friends and family team for striders that are not already on another team. Register at: www.diabetes.org/teamredmn or check for a walk site near you at www.diabetes.org/walk. Walks in Minnesota will take place on September 27 – Twin Cities and October 4 – Stillwater, Brainerd and Mankato.”

 

 

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MN Monthly Best Doctors 2014

best-doctors-feature-illustration-phil-wrigglesworth

Noran Clinic is happy to announce all our Pediatric Neurologists were listed as Best Doctors for 2014 by Minnesota Monthly!

They are Steven Janousek MD, Lawrence Burstein MD, and Abigail Boetticher MD.

In March, Professional Research Services contacted more than 10,000 licensed doctors in the 11-county metro area, as well as Olmsted County. Respondents were to name up to three doctors (other than themselves) in each specialty category. Physicians who received the highest number of votes are reflected by specialty in the Best Doctors list.   Please see the attached link for the full article, list and a Q&A, that includes answers from Noran Clinic’s Dr Janousek.

http://www.minnesotamonthly.com/media/Minnesota-Monthly/October-2014/Best-Minnesota-Doctors-2014/

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Ground breaking ceremony for the new Lake Elmo/Woodbury location!

Our providers, administration, and partners at the Davis Group were excited to celebrate breaking ground on the site of Noran Clinic’s new Lake Elmo/Woodbury clinic, estimated to be opening July 2015!

elmo

Our Lake Elmo address will be 8515 Eagle Point Blvd.

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Dr. Vaou interviewed about Parkinson’s Disease on KSTP

Although actor Robin Williams’ death was a result of depression, attention has also been brought to Parkinson’s Disease in light of learning of Williams’ diagnosis. In a brief interview to share more about this diagnosis and its relationship to depression, Dr. Vaou was interviewed live by Ellen McNamara on August 15th 2014.  Watch the clip above, or visit the original on the KSTP website through this link:

http://kstp.mn/7ka30

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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