Infusion Therapy

What is “Infusion Therapy”?

• Infusions are medications that are administered via an IV.  These medications are dissolved in an IV bag, and delivered thru a peripheral vein or a central port.

When is infusion therapy used?

• Infusion medications are used to treat various illnesses, including Migraine Headaches, Multiple Sclerosis, Neuropathy, Myasthenia Gravis – to name a few.
• Speak with Dr. Athni about your treatment options, including infusion therapy.

Where are the infusions given?

• We have an Infusion Suite within our facility, with reclining lounge chairs for comfort and ease.
• Our infusion suite is available for infusions during normal business hours.

Who administers the infusions?

• We have 2 infusions nurses – Tracy and Lauren – who are certified in infusion nursing care.
• They will follow the medical directions prescribed by Dr. Athni, including any pre-infusion meds, post-infusion meds, as well as various medications used to treat any infusion related side effects.

VNS – Vagal Nerve Stimulation

What is Vagal Nerve Stimulation?

• Vagal Nerve Stimulation, or VNS, is a therapeutic option available for patients with uncontrolled seizures.
• The procedure is an “adjunct” to seizure medications, not a full replacement for medications.

What is involved with “VNS”?

• If you have a seizure disorder, which is hard to control with medications, then Dr. Athni will assess whether you might qualify for VNS.
• If you are deemed a good candidate for VNS, you will be referred to a local surgeon for VNS implantation.
• The surgeon will implant a small electrode in your neck, as well as a “power generator” in your left chest.
• You will then return to Dr. Athni for programming and management of your VNS.

How is VNS programmed?

• Approximately 1 week after your VNS surgery, Dr. Athni will connect a hand-held computer to your VNS.
• Using the hand-held computer, the VNS is digitally programmed, in an attempt to stop your seizures.
• The programming is done very slowly and methodically. It can take 6-8 weeks to complete the initial programming, requiring weekly visits to our office.
• Additional programming changes will be made beyond the 6-8 weeks as medically necessary.

DBS – Deep Brain Stimulation

What is Deep Brain Stimulation?

• Deep Brain Stimulation, or DBS, is a treatment option used for various types of Movement Disorders.
• The procedure has been very successfully used in patients with Parkinson’s Disease or Essential Tremors.
• The procedure is an “adjunct” to medications, not a full replacement for medications.

What is involved with DBS?

• Dr. Athni will assess you and determine whether you are a good candidate for DBS.
• If you medically qualify for the procedure, you will be referred to a Neurosurgeon for DBS implantation.
• You are fully awake during the surgical procedure.
• The Neurosurgeon will drill a small hole in your skull, and insert an “electrode” into your brain.
• The Neurosurgeon will also implant a “power generator” in your chest.
• You will then return to Dr. Athni for detailed “programming and management” of your DBS.

How is the DBS programmed?

• After you have the DBS inmplanted, Dr. Athni will connect your “generator” to a hand held computer.
• He will then program the leads in the brain to activate certain parts of the brain, in an attempt to reduce and control your movement disorder.
• The full programming may take 3-4 months.

Botox – Botulinum Toxin Injections

What is “Botox”?

• Botulinum toxin (B. toxin) is a “neuro toxin” which paralyzes any muscle it comes in contact with.
• When used as a medication, B. toxin is very powerful, and must be given by specially trained physicians.
• There are a few different companies which manufacture B. toxin, each under different brand names. The most common variety of B. toxin is “Botox”, manufactured by Allergan.

What is Botox used for?

• There are numerous diseases which are associated with “muscle spasms” or “stiffness”. For such conditions, B. toxin is an appropriate medication to “relax” those muscles.

What is the difference between “Cosmetic” and “Therapeutic” Botox?

• The drug is the same, but the use is vastly different.
• With Cosmetic Botox, the drug is injected into various muscles (typically the facial muscles) to eliminate wrinkles.
• Insurance does NOT pay for Cosmetic Botox.
• With Therapeutic Botox, the drug is injected into various muscles of the face, arms, legs, or back to alleviate a problem caused by a specific medical condition.
• Usually, insurance companies will pay for therapeutic Botox treatments.

How much does Botox cost?

• For Cosmetic Botox, it can cost around $13 to $15 per unit, and it is NOT covered by insurance plans.
  • A “typical” Cosmetic Botox session can involve injecting 30-100 units, depending on what we are trying to achieve.
• For Therapeutic Botox, if your insurance approves the treatment, your cost will typically be just your co-pay.
• Please speak with our financial / insurance department to get further information about your specific insurance plan.

Diagnostic Cardiovascular Ultrasound

Is the office “Accredited”?

• Our office Ultrasound Lab is accredited by the American College of Radiology (ACR).
• Such an accreditation implies that we meet a high standard of proficiency in performing these tests, by qualified and certified technicians.
• Our office is the only Neurology office in Middle Georgia to be fully accredited by the ACR.

What is an “Ultrasound”?

• An Ultrasound test is a non-invasive test used to visualize organs or blood flow inside the body.
• There are no needles involved.
• You will be fully awake and alert during the test.
• Ultrasound tests are NOT painful.

How is an ultrasound test performed?

• An “ultrasound probe” takes “real time” pictures of objects inside your body.
• The probe is moved on the surface of your skin, over the part of the body we are trying to visualize. The other end of the probe is connected to a computer.
• As the probe “sees” the objects inside your body, the computer records these images for later analysis.

Who performs the Ultrasound test?

• Any ultrasound examination done in our office is performed by a Board Certified Ultrasonographer.
• Our lead Ultrasonograher is Mike T, who has been performing ultrasound studies for over 15 years.

What is an Echocardiogram or Echo?

• An Echocardiogram, also called an “Echo”, is an ultrasound test of your heart. It visualizes the beating heart, the pumping blood, and the valves inside your heart.

What is a Carotid Doppler study?

• A Carotid Doppler study is to visualize the blood flow in the major blood vessels going to your brain, including the internal carotid arteries and the vertebral arteries.

Why is an Echo or Carotid Doppler study ordered?

• An Echo and Carotid Doppler tests are typically ordered as part of a “stroke work up”, looking for various causes for strokes.

EEG – Electrencephalogram

What is an Electroencephalogram (EEG)?

• An Electroencephalogram or EEG is a diagnostic test which examines the “brain waves”, using electrodes placed on the scalp. These electrodes are connected to a computer, which records your brain waves.

What is the difference between a “routine” and “ambulatory” EEG?

• Routine EEG
  • • A “routine” EEG is performed in the office, which takes approximately 30-45 minutes to perform.
    • This type of study only records your “brain waves” for about 20 minutes.
• Ambulatory EEG
  • • For an “ambulatory” EEG, the electrodes are connected to your scalp in the office, but we then send you home with these electrodes, along with a small hand-held computer.
    • This will record your brain waves for 3 or 4 full days, while you are leading a “normal life”.
    • Such EEGs are more accurate in that they are able to pick up abnormal brain waves while you are at work or while sleeping.
    • At the end of the 4 days, you will return the equipment to our office, which will then be analyzed and interpreted by Dr. Athni.
• Please discuss which type of EEG is appropriate for your situation

Which type of EEG is most ideal?

• Each type of EEG is used for different purposes.
• Which EEG is best for you will depend on your individual clinical situation.
• Dr. Athni will discuss these options with you during your office visit.

How is the EEG procedure performed?

• An EEG is a painless procedure, which involves attaching numerous electrodes to your scalp. These electrodes are connected to a computer, which will record your “brain waves’ during the duration of the study.
• These brain wave recordings are reviewed and interpreted by Dr. Athni.
• A certified EEG technician will attach the electrodes and perform the study, while being overseen by Dr. Athni.

Will an EEG always diagnose a seizure?

• A normal EEG does NOT mean there is “nothing wrong with you”.
• It also does NOT absolutely exclude a seizure or any other disease.
• The results of the EEG are used in conjunction with your clinical symptoms and other diagnostic tests, to make a final diagnosis and conclusion.

How do you prepare for the EEG test?

• For the test, PLEASE do the following:
  • • go to bed at 1 AM, and get up at 5 AM
    • wash your hair in the morning
    • NO hair spray, NO gel, NO mouse, NO oil
    • DO NOT style your hair: NO braids, NO ponytails
    • Wear a button down shirt or blouse
    • NO perfumes or body lotions (you MAY wear deodorant
• The EEG tech will remind you about your appointment and answer any questions you may during the test.

When will you get the results of the test?

• After the completion of the test, Dr. Athni will review the recorded “brain waves” and put together an analysis or “report”.
• This will be reviewed with you on your next office visit.

eVOX – Quantitative EEG

What is it?

• eVox uses quantitative EEG technology along with various brain health biomarkers to aid in the diagnosis of cognitive disorders.

What is a Head Map?

• Computational EEG head maps are a visual representation of the difference in activity between a patient’s brain and a standardized database.

What are Brain Biomarkers?

• Objective metrics derived from computational EEG data provide insight into how the brain is functioning. Peak Alpha Frequency (PAF) reflects cognitive capacity and physiological aging3,4. Theta/Beta Ratio reflects inattention and is FDA cleared to aid in the diagnosis of various cognitive disorders.

What is an Event Related Potential (ERP)?

• ERPs measure brain processing speed and efficiency7. They are highly sensitive biomarkers that have been shown to reflect functional abnormalities even prior to symptom onset

What is a “Go-No-Go” Task?

• Performance during a go/no-go task reflects a patient’s ability to perform daily tasks effectively. Reaction time, reaction time variability, omission errors, and commission errors give insight to cognitive status and behavioral functioning

How do you prepare for the eVox test?

• For the test, PLEASE do the following:
  • wash your hair in the morning
  • NO hair spray, NO gel, NO mouse, NO oil
  • DO NOT style your hair: NO braids, NO ponytails
  • Wear a button down shirt or blouse
  • NO perfumes or body lotions (you MAY wear deodorant
• The tech will remind you about your appointment and answer any questions you may during the test.

When will you get the results of the test?

• After the completion of the test, Dr. Athni will review the recorded “brain waves” and the associated Brain Biomarkers, all of which will be put together in the form of a “report”.
• This will be reviewed with you on your next office visit.

NeuroTrax Test

What is a “NeuroTrax” Test?

• A NeuroTrax test is a computerized test to assess whether you have any cognitive impairment caused by your medical / neurological conditions.
• It is an office based NeuroPsychology test.

How is it performed?

• The test is performed on a computer, although you do NOT have to know how to use a computer to take this test.
• The test takes approximately 30-45 minutes to complete.

What will the results reveal?

• The results will tell us what type of cognitive impairment you may have.
• It will give is a “score” which can be tracked over time to look for any worsening or improvement.

How often is the NeuroTrax test performed?

• If abnormal, we typically repeat this test every 6 months to look for any changes.

Autonomic Nervous System test (ANS)

What is the “Autonomic Nervous System” (“ANS”) ?

• Your autonomic nervous system (ANS) is the part of your nervous system that functions to sustain your life by controlling your heart, lungs, digestive system, blood pressure, immune system, certain of your reflexes, fluid balance, pupil diameter, sweating, and sexual function.
• There are two parts (or branches) of your ANS: the sympathetic branch and the parasympathetic branch. Generally, the sympathetic branch is more in control when you are stressed, ill, or injured, while the parasympathetic branch is more in control when you are relaxing, sleeping, or recovering from an illness or injury.
• In fact, most illnesses and injuries cause or result from an imbalance between these two branches. An imbalance in your ANS can tell your doctor many things about how healthy you are, as well as what can be done to keep you as healthy as possible.

What is an ANS Test?

• We perform three (3) independent clinical ANS tests (or studies) designed to determine the ability of both branches of the autonomic nervous system (ANS) to respond to and relax from a challenge.
• The two branches that make up the ANS are the sympathetic and parasympathetic (SNS and PSNS, respectively).

What are the different components of the ANS test?

The ANS test consists of 3 components or challenges.

The challenges are:

• deep breathing to challenge the PSNS,
• valsalva to challenge the SNS, and
• standing from a seated position to challenge both systems

How long does it take?

• A study takes approximately 25 minutes to complete.

What results will be obtained from this test?

• The ANS test will tell us whether your sympathetic and parasympathetic nervous system are “in balance” or “out of balance”.
• These results will help guide Dr. Athni in formulating a treatment plan to try to bring the ANS back “in balance”.

How often is the ANS test performed?

• If your ANS test is “normal”, we will not have to repeat the study at any set interval.
• But, if it is abnormal, we will probably repeat the study in 4-6 months to see if our therapeutic intervention is resulting in any ANS improvement.

Consent – Who Can Accompany Patient Into Exam Room

• If you are being seen thru Worker’s Comp, we will only allow the patient in the exam room.  If a NCM or Adjustor wants to meet with Dr. Athni, they will need to schedule a separate appointment with the front office.
• If you are an adult and are being seen thru your private insurance or Medicare or Tricare, we will allow your spouse into the exam room.
• BUT, for anyone else, we will need a Medical Power-of-Attorney (Medical POA) or a Notorized letter stating the third-party is allowed to be involved in the patient’s care.  This would include friends or a parent of a patient or an adult child of a patient.
• This is a standard practice in Psychiatric offices.  Although we are not treating Psychiatric illnesses, many of our patients have cognitive issues.  To make sure decisions are being made in the best interest of the patient, we require such a POA.  Even if you do not have any issues which involve your cognitive abilities, we have one policy for all patients.
• We hope you understand the rationale for this policy.  We are merely trying to make sure unauthorized people (who may not have the patient’s best interest) are not involved in medical decisions.

Scheduling Appointments

• We are a “referral only” office.  We require a referral from your primary care physician.
• As soon as our office receives your referral, we will first verify your insurance benefits to make sure we are part of your insurance network. (Please look at “Insurance Networks” on the web site to see our network affiliation.)
• We request you forward a copy of your medical records prior to scheduling your initial appointment.  We will review your medical records before an appointment is given.  We reserve the right to NOT schedule an appointment – after reviewing your medical records, we may decide we will not be able to participate in your medical care.
• Our office staff will then contact you directly to schedule the initial appointment.
• We try to see patients within 2 weeks of receiving the referral.
• We normally see new patients Monday mornings or Thursday afternoons
• We will try to accommodate your personal / work schedule to minimize any inconvenience.
• If the appointment involves a Work-Comp issue, we must obtain a written approval from the WC adjuster prior to scheduling the appointment.
• We request ALL new patients to arrive at the office at least 1 hour BEFORE their scheduled appointment.
• This will ensure that all paperwork issues are completed before your scheduled appointment time. Otherwise, your consultation time will be delayed.

Medication Refills

What medications will be refilled?

• Our office will only refill those medications we have prescribed, AND only if you are an active patient in our practice.

How many refills will be prescribed?

• During your office visit, we will try to prescribe medications with enough refills to last you until your next office visit
• If you cancel your follow up appointment, we will NOT refill your medications until you are re-evaluated by Dr. Athni
• If you choose not to re-schedule your appointment, you should consider obtaining all further refills thru your primary care physician

How are refills processed??

• We normally refill medications during the office visit
• We send all medication refills thru eRx (electronic prescribing system)
• The eRx system minimizes human error, and reduces prescription filling time
• Once we send an eRx prescription, an eRx is typically processed and filled within 1 hour by most pharmacies

“Calling in” prescriptions

• To minimize errors, we will NOT “call in” a refill medications
• If your pharmacy does not accept electronic prescriptions, we will give you a hand-written prescription during your office visit for you to hand-carry

Narcotics Pain Medications and Controlled Medications

• Many pain medications are “controlled” and monitored by the DEA (Drug Enforcement Agency) to minimize fraud and abuse
• We will NOT prescribe or refill any controlled narcotic pain medications
• We WILL prescribed non-narcotic, controlled medications.
• These medications will ONLY prescribed and refilled during a face-to-face office visit

Auto Accident Evaluations

• If your medical issues are related to a recent motor vehicle accident, we will not wait for payment from your auto insurance or from your attorney.
• You will be responsible for full payment of any and all charges incurred at our office.
• You can file the claim with your auto-insurance company.
• We will NOT accept a delayed payment from “3rd party liability” benefits as a result of any auto accidents.
• We will NOT accept any “liens” or “promissory notes” from your attorney.

Expected Payments

If you are a Work Injury or IME patient – No payment is required at time of office visit

• If you are being seen as an authorized Work Injury patient or as an authorized IME, you will NOT be asked to pay anything. All your bills will be handled through your Worker’s Compensation Insurance Company or your attorney.

What is your payment if you have Medicare?

• If Medicare is your primary insurance, then we expect 20 percent of your “Medicare allowable charges” and any deductible required for the calendar year.
• Per federal regulations, the Medicare deductible for calendar year 2022 is $226.

What is your payment if you have commercial (PPO or HMO) insurance?

• We will typically verify your insurance before you arrive at our office.
• If we are a “participating provider” for your insurance plan, then we will only collect the co-pay (either a set dollar amount or percentage).
• You may also be asked to pay any deductible that may not have been met for the calendar year.

What if we are NOT in your insurance network?

• If we are not in your insurance network, you may be asked to pay your bill in-full.
  Please discuss this with our office manager prior to your office visit.

What if you have NO insurance?

• If you are a NEW patient without a valid verifiable insurance, we will NOT be able to see you as a patient
• If you are an existing patient and have lost your insurance or we are no longer in your insurance network, then we expect full payment at the time of service.

Insurance Verification:

• We will verify your insurance PRIOR to your office visit.
• This verification will inform us of your insurance contract stipulations, including any co-pays you are required to pay.

WHEN to Pay:

• We expect payment at the time of service.

TYPE of Payment:

• Our office prefers cash or credit card (MC, Visa, Discover, and Amex).
• You may also pay On-Line thru this web site. We offer a Secure Payment process, powered by Pay-Pal.
• Due to the high number of “bounced checks”, we do NOT accept checks as a form of payment.

Filing Insurance Claims

What insurance claims do we file?

• We will file all Primary insurance claims.

How do we file insurance claims?

• If your insurance company is setup for electronic filing, we will file this claim electronically through our computer system.

When do we file the insurance claims?

• Typically, we file your claim within 7 days after the office visit.

NOTE: Although we may file your claim, it is quite common for insurance companies to “lose” and “not process” the claims. They commonly state that they did “not receive” our claims.

• Hence, it can sometimes take a few months for your claim to be processed properly.
• If we have not received payment within 45 days, we will re-file your claim.

Do we file Secondary insurance claims?

• Although we file all Primary insurance claims, we generally do NOT file Secondary insurance claims.
• Some insurance companies will transfer your claim automatically to the Secondary carrier, in which case it will get processed without any further intervention.
• Else, you will be required to submit the claim to your Secondary carrier after you receive the EOB (Explanation of Benefits) from your Primary insurance company.

Monthly Statements

When do we mail account statements?

• We mail account statements only AFTER the insurance has paid their portion.
• We will wait for payment from your insurance company before we send you a “Payment Due” bill. Sometimes, it may take up to 6 months (or longer) for us to receive the initial payment from your insurance company, so don’t be surprised if you receive a statement from us many months after services are rendered.
• If your insurance does not pay us anything, you will receive a bill for the full amount.
• We normally mail account statements once a month.

What if there is a zero balance?

• If your insurance company pays “in-full”, and there is NO balance due, you will NOT receive a statement.

What if there is a “balance due” on your account?

• If your insurance company only pays us a partial amount, and there is a remaining balance, we will send you a statement during the first week of the month following payment from the insurance company, and each month there-after until the balance is paid.

How many statements are mailed?

• You will receive a total of 3 statements from our office before sending your account over to a Collections Agency.

What if NO payment is made towards an open balance?

• If no payment is made towards your open balance after 3 monthly statements, your account will be sent to a local Collections Agency for further legal action.
• A separate “collections fee” will also be assessed above and beyond your open balance to cover the cost of the collections process.

Methods of Payment

• You may pay all or part of your open balance at any time. As long as there is an open balance, you will receive a monthly statement from our office. You may mail us your payment or stop by the office to pay.
• We accept cash, credit cards (Visa, MC, Discover, Amex), or debit cards.
• You may also pay on-line using our secure payment method powered by Pay-Pal.

On-Line Payment

• If you would like to pay a portion or all of your open balance, please use the form below.
• We use a Secure Payment process, powered by Pay-Pal. Please enter your Name and Birth Date so we can credit the correct account with your payment.
• After you click on the “Pay Now” button, you will be taken to a secure PayPal driven web site, where your payment will be processed.
• After the payment process, you will have a chance to enter any “comments or instructions” regarding your payment.

IME – Independent Medical Examination

WHAT is an IME?

• An Independent Medical Exam, commonly referred to as an “IME”, is a legal evaluation, usually requested by an insurance company, attorney, or some other involved 3rd party. These evaluations are strictly confidential, and the records are NOT released to any other requesting party.
• As an IME Physician, we fully understand that we are NOT developing any doctor-patient relationship. We will NOT prescribe any medications, and we will NOT make any formal treatment recommendations to the patient.
• Some diagnostic testing may be ordered to properly complete the IME, but these tests are scheduled and performed only with pre-approval from the insurance company or attorney.

HOW to schedule an IME:

• Independent Medical Examinations (IME) must be scheduled by the employer, attorney, or insurance company. Prior to scheduling the appointment, please call our office and talk with the office manager to discuss our IME financial policy. We typically request pre-payment for the IME.

WHEN are IMEs scheduled, and how long does it take?

• IMEs are scheduled at a mutually convenient time, and as quickly as possible.
• A typical IME can take 60 to 90 minutes with the patient. This is followed by an additional 3-4 hours of medical records review and case analysis.

What questions are answered during the IME?

• Typically, the IME-requesting party will ask a series of questions to be answered during the IME. All of these questions will be answered by Dr. Athni.
• If additional testing is necessary to properly answer these questions, we will recommend any necessary diagnostic tests. If approved, we will schedule and coordinate these diagnostic tests.
• Once the IME is completed, and if requested or necessary, Dr. Athni will call the IME-requesting party to discuss the case.

IME records are confidential:

• As noted above, we fully understand the legal implications of an IME, and hence we will release the report only to the IME-requesting party. These records are kept in strict confidence, and will NOT be released to anyone else.

Objectivity:

• All cases are handled objectively without being influenced by any outside party. Dr. Athni will “call it like he sees it”.
• For over 25 years, we have regularly seen patients referred by insurance companies (handling life insurance policies, disability insurance policies, workers compensation policies, etc), attorneys (representing both patients and employers), and directly from employers.

Oue experience with IMEs:

• Dr. Athni has been performing IMEs for over 25 years. On average, we complete 10 Independent Medical Evaluations per year.

Questions?

• If there are any questions or concerns regarding IMEs, please call our office and speak with our office manager. If they cannot answer your questions, then Dr. Athni will speak with you directly.

Records Review

• If an insurance company or attorney is involved in a legal case which requires a Neurological opinion, we will be happy to review the records and answer any pending questions.
• The Medical Records Review will be purely objective, regardless of who is requesting the Records Review.

• After the Records Review, Dr. Athni will be available to discuss the findings with the requesting attorney or insurance company.
• A report of the Records Review will be generated and faxed to the requesting party.
• Depending on the volume of the medical records, the review can take 1-2 weeks after receiving the medical records.

• We expect pre-payment for these services.
• The cost will be based on services requested, such as the volume of medical records, whether any imaging films need to be reviewed, and whether a telephone conference is also being requested.

• Please contact our office to discuss these fees.

Concussion Assessment

• Most people are familiar with football related concussions, but they are also quite common after work injuries.
• Concussions occur after a closed head injury, such as can occur after a fall or car accident or some other accident.  It is very important to have such head injuries evaluated quickly and aggressively, and as soon as possible after the accident.
• The symptoms associated with a concussion can be quite varied and unusual.
• Some diagnostic tests we perform in the evaluation of a concussion include: an MR brain, EEG, and Neurotrax test.
• Depending on the results of these tests, various treatment options will be discussed and recommended.

YouTube Educational Videos

Dr. Athni has created educational videos hosted by YouTube, and have also been posted on this page for convenience.  The YouTube channel is called “NeuroEd – Neurology Education Made Easy.”

These videos are separated into various “playlists” – primarily based on “type of video” and suitable audience.  Each playlist is displayed separately on the various tabs on this page.

This list of videos will be slowly expanded over the next few weeks to months.  Subscribe to Dr. Athni’s Channel to view the latest videos.

If you have a specific topic that you want Dr. Athni to discuss, please let him know on your next office visit.

“The Brain Doc” – a Podcast series

Dr. Athni is in the process of creating a Podcast series entitled “The Brain Doc”. In the Podcast, Dr. Athni will interview various specialists, medical students, as well as discuss various medical topics.

You can find all the episodes on this website or on your favorite Podcast Player.

For Spotify, search “Brain Doc Athni”

For all other Podcast players, search “Brain Doc”.

If you find the podcast enjoyable and educational, please leave a positive review.  Thank you.

The Neuro Axis video-series (8 total videos) will teach you how to “localize the lesion” using a simple approach. Great tool for medical students and residents. If you follow the methodology in this video series, you will markedly improve your clinical neurology skills, improve your Shelf and Step scores. More importantly, you will be a “star” on rounds!

Introduction 00:00 — Disclaimer 00:17 — Start of video 00:56

Subscribe to my channel

«

Prev

1

/

1

Next

»

Neuro Axis: Overview

Neuro Axis: Muscle Disorder

Neuro Axis: NeuroMuscular Junction Dysfunction

Neuro Axis: Peripheral Nerve Disorders

Neuro Axis: Nerve Root Disorders

Neuro Axis: Spinal Cord Disorders

Neuro Axis: Brainstem Disorders

Neuro Axis: Subcortical & Cortical Disorders

«

Prev

1

/

1

Next

»

The Medical Student Success video-series aims to give you important tips and tricks to succeed in medical school.  During your clinical years, you have to not only get good grades, but you have to also learn how to be a successful clinician.  Watch these videos, and learn how to succeed in “the game” and learn how to be a “star” on rounds!

Introduction 00:00 — Disclaimer 00:17 — Start of video 00:56

How to assess progress

• You will be required to take a “Neurology Academic Quiz” on the first day of the rotation
• I do NOT expect you to “ace” this test.  Rather, it will assess your level of Neurology knowledge at the beginning of the rotation
• You will be required to take another “Quiz” at the end of the rotation
• Part of your “clinic” grade and assessment will be based on how you have progressed during your Neurology rotation
• These quizzes are NOT meant to be stressful.  Rather, they are meant to demonstrate your academic growth and help build your confidence in clinical Neurology
  

  ---

Teaching and Learning Process

• Many students and residents are “afraid” of neuroscience and Neurology.
• One of the best ways to learn Neurology is to understand the pathology and pathophysiology, instead of memorizing random facts
• To accomplish this, I use the Socratic method of teaching – so, be prepared to be challenged academically
• You will quickly realize, and hopefully appreciate, the importance of critical analysis and reasoning (remember CARS on the MCAT?)
• Come with an open mind, and you will quickly find that Neurology is a lot of fun.
• Don’t stress over this rotation.
• Bring your “A” game, and you will learn more than enough to earn an “A” on your shelf exam, while also becoming well prepared for the Neurology component of the Step 1 and Step 2 exams.

Rotation Expectations

• This is an out-patient rotation, with no call and no weekend responsibilities
• This is not a physically-challenging rotation (no sleep deprivation, no excessive walking, no after hours, etc)
• If you have a lecture commitment, just let me know, and you can break away for the lecture and return when you are done.
• We have a conference room where you can watch your lectures and grand rounds
• I will assign reading and “homework” during the rotation – you are an adult, so I expect you to keep up with these assignments
• Your typical workweek in the clinic will be around 30-35 hours
• Since this is not a very time-demanding rotation, I EXPECT you to read and learn Neurology when not in clinic
• There should be absolutely no excuses for not reading neuro related material during the rotation
• You will be working with Dr. Athni, directly – so please leave any “laziness” at home
• REMEMBER:  You will get out of this rotation what you put into it
  • This might be your only exposure to Neuro, so take advantage of the rotation.
  • The more you learn, the more you demonstrate an interest to learn, the more you ask, the more I will teach

Educational Resources

Some resources which might be helpful in your studying:

• Blueprints Neurology (5th edition, 2019) – most students feel this is the most inclusive “review” textbook
• Pre-Test Neurology
• U-World
• Online Med-Ed
• Case Files Neurology

SUGGESTION:

• During week 1 – Read Blueprints Neurology cover-to-cover, but don’t attempt to memorize all the details
• During week 2 – Re-read Blueprints Neurology, but in more detail, and focusing on the topics we discuss during the rotation
• During week 3 and 4 – Start doing sample test questions (Uworld, Pre-test, etc), while continuing to read Blueprints Neurology in detail.  Target-read the difficult topics.

This week-by-week plan is only a suggestion.  Over the past few years, students who have followed this plan have been greatly surprised and rewarded with their high achievement on the end-of-rotation Shelf Exam.

Technology

• Bring your laptop, tablet, iPad, or cell phone with internet browsing capability (we have wifi in the office)
• Please keep cell phone on “vibrate” mode
• DO NOT use your device to play games or “shop” or socialize with your friends while in clinic
• DO NOT use your cell phone or tablet in front of patients – this would be very rude, and a sign of dis-respect to the patient

Neuro Tools

• The only tool you would need would be a neuro hammer, but do not buy one.
• Most students & residents purchase the wrong type of hammer. I will show you which one to purchase.

Topics to study DURING the rotation

There are a handful of topics which are very common in Neurology, and which I feel are important for all young physicians to fully understand.

I would encourage you to study and try to understand the clinical relevance of these topics.  We will be discussing these topics at random times during the month.  The more you read about these topics, the more I can teach you during your clinical rotation.

• Side effects of common medications
• Different types of hydrocephalus
• Types of intra-cerebral bleeds
• Bell’s Palsy
• Common types of headaches
• Chronic pain vs. acute pain
• What are “scheduled” drugs
• Hallmark symptoms of Parkinson’s
• Parkinson’s vs. Parkinsonism vs. Synucleinopathy
• Seizures vs. Epilepsy
• How to treat status epilepticus
• Concussion vs. TBI vs. Closed Head Injury vs. Post-concussive Syndrome
• How to analyze CSF results
• Common types of peripheral neuropathy
• What is “AIDP” and “CIDP”, and the difference between these entities
• Stroke vs. TIA
• Acute and chronic management of cerebral ischemia (stroke)
• Myasthenia Gravis
• Multiple Sclerosis
• Aphasia vs. Dementia vs. Delirium

Time In Clinic

• Arrive at office around 7:45 am
• You should be able to leave office around 4:00 to 4:30 pm
• Monday’s are our “late days” – be prepared to stay till around 5:30 pm

Other Information

• Park at LEFT side of building, in covered parking area
• Enter thru side door – staff will have unlocked side door
• Consider bringing lunch – we have a kitchen with microwave and fridge
• Many eateries are within driving distance (Arby’s, Burger King, Fresh Market, Kroger’s, Starbucks, etc)
• Wear comfortable shoes
• DO NOT use your device to play games or “shop” or socialize with your friends while in clinic
• DO NOT use your cell phone or tablet in front of patients – this would be very rude, and a sign of dis-respect to the patient

Neurology Consultations

Out-patient, Office Consultations

• Dr. Athni is available for detailed Neurologic Consultations in our office.
• During your initial visit, we will do a detailed Neurologial history and physical exam.
• If a firm diagnosis can be made during the initial visit, we will set forth a treatment plan.
• If additional testing is necessary, we will delineate, schedule and follow thru with a diagnostic testing plan, after which a follow-up visit will be scheduled to discuss the results of the diagnostic tests.
• After the results are discussed, we will set forth a treatment plan as medically appropriate.
• Most diagnostic testing is done in “steps”, starting with the least invasive and slowly progressing to more invasive testing as the need arises.

In-patient, Hospital Consultations

• We are affiliated with the Piedmont Hospital Health System
• For in-patient evaluations, we expect you to be admitted by a Hospitalist, your Internist or your Family Practitioner
• If a neurological problem arises which cannot be handled by your admitting physician, he or she will call the Neuro-Hospitalist for a formal hospital consultation

Infusion Therapy

What is “Infusion Therapy”?

• Infusions are medications that are administered via an IV.  These medications are dissolved in an IV bag, and delivered thru a peripheral vein or a central port.

When is infusion therapy used?

• Infusion medications are used to treat various illnesses, including Migraine Headaches, Multiple Sclerosis, Neuropathy, Myasthenia Gravis – to name a few.
• Speak with Dr. Athni about your treatment options, including infusion therapy.

Where are the infusions given?

• We have an Infusion Suite within our facility, with reclining lounge chairs for comfort and ease.
• Our infusion suite is available for infusions during normal business hours.

Who administers the infusions?

• We have 2 infusions nurses – Tracy and Lauren – who are certified in infusion nursing care.
• They will follow the medical directions prescribed by Dr. Athni, including any pre-infusion meds, post-infusion meds, as well as various medications used to treat any infusion related side effects.

VNS – Vagal Nerve Stimulation

What is Vagal Nerve Stimulation?

• Vagal Nerve Stimulation, or VNS, is a therapeutic option available for patients with uncontrolled seizures.
• The procedure is an “adjunct” to seizure medications, not a full replacement for medications.

What is involved with “VNS”?

• If you have a seizure disorder, which is hard to control with medications, then Dr. Athni will assess whether you might qualify for VNS.
• If you are deemed a good candidate for VNS, you will be referred to a local surgeon for VNS implantation.
• The surgeon will implant a small electrode in your neck, as well as a “power generator” in your left chest.
• You will then return to Dr. Athni for programming and management of your VNS.

How is VNS programmed?

• Approximately 1 week after your VNS surgery, Dr. Athni will connect a hand-held computer to your VNS.
• Using the hand-held computer, the VNS is digitally programmed, in an attempt to stop your seizures.
• The programming is done very slowly and methodically. It can take 6-8 weeks to complete the initial programming, requiring weekly visits to our office.
• Additional programming changes will be made beyond the 6-8 weeks as medically necessary.

DBS – Deep Brain Stimulation

What is Deep Brain Stimulation?

• Deep Brain Stimulation, or DBS, is a treatment option used for various types of Movement Disorders.
• The procedure has been very successfully used in patients with Parkinson’s Disease or Essential Tremors.
• The procedure is an “adjunct” to medications, not a full replacement for medications.

What is involved with DBS?

• Dr. Athni will assess you and determine whether you are a good candidate for DBS.
• If you medically qualify for the procedure, you will be referred to a Neurosurgeon for DBS implantation.
• You are fully awake during the surgical procedure.
• The Neurosurgeon will drill a small hole in your skull, and insert an “electrode” into your brain.
• The Neurosurgeon will also implant a “power generator” in your chest.
• You will then return to Dr. Athni for detailed “programming and management” of your DBS.

How is the DBS programmed?

• After you have the DBS inmplanted, Dr. Athni will connect your “generator” to a hand held computer.
• He will then program the leads in the brain to activate certain parts of the brain, in an attempt to reduce and control your movement disorder.
• The full programming may take 3-4 months.

Botox – Botulinum Toxin Injections

What is “Botox”?

• Botulinum toxin (B. toxin) is a “neuro toxin” which paralyzes any muscle it comes in contact with.
• When used as a medication, B. toxin is very powerful, and must be given by specially trained physicians.
• There are a few different companies which manufacture B. toxin, each under different brand names. The most common variety of B. toxin is “Botox”, manufactured by Allergan.

What is Botox used for?

• There are numerous diseases which are associated with “muscle spasms” or “stiffness”. For such conditions, B. toxin is an appropriate medication to “relax” those muscles.

What is the difference between “Cosmetic” and “Therapeutic” Botox?

• The drug is the same, but the use is vastly different.
• With Cosmetic Botox, the drug is injected into various muscles (typically the facial muscles) to eliminate wrinkles.
• Insurance does NOT pay for Cosmetic Botox.
• With Therapeutic Botox, the drug is injected into various muscles of the face, arms, legs, or back to alleviate a problem caused by a specific medical condition.
• Usually, insurance companies will pay for therapeutic Botox treatments.

How much does Botox cost?

• For Cosmetic Botox, it can cost around $13 to $15 per unit, and it is NOT covered by insurance plans.
  • A “typical” Cosmetic Botox session can involve injecting 30-100 units, depending on what we are trying to achieve.
• For Therapeutic Botox, if your insurance approves the treatment, your cost will typically be just your co-pay.
• Please speak with our financial / insurance department to get further information about your specific insurance plan.

Diagnostic Cardiovascular Ultrasound

Is the office “Accredited”?

• Our office Ultrasound Lab is accredited by the American College of Radiology (ACR).
• Such an accreditation implies that we meet a high standard of proficiency in performing these tests, by qualified and certified technicians.
• Our office is the only Neurology office in Middle Georgia to be fully accredited by the ACR.

What is an “Ultrasound”?

• An Ultrasound test is a non-invasive test used to visualize organs or blood flow inside the body.
• There are no needles involved.
• You will be fully awake and alert during the test.
• Ultrasound tests are NOT painful.

How is an ultrasound test performed?

• An “ultrasound probe” takes “real time” pictures of objects inside your body.
• The probe is moved on the surface of your skin, over the part of the body we are trying to visualize. The other end of the probe is connected to a computer.
• As the probe “sees” the objects inside your body, the computer records these images for later analysis.

Who performs the Ultrasound test?

• Any ultrasound examination done in our office is performed by a Board Certified Ultrasonographer.
• Our lead Ultrasonograher is Mike T, who has been performing ultrasound studies for over 15 years.

What is an Echocardiogram or Echo?

• An Echocardiogram, also called an “Echo”, is an ultrasound test of your heart. It visualizes the beating heart, the pumping blood, and the valves inside your heart.

What is a Carotid Doppler study?

• A Carotid Doppler study is to visualize the blood flow in the major blood vessels going to your brain, including the internal carotid arteries and the vertebral arteries.

Why is an Echo or Carotid Doppler study ordered?

• An Echo and Carotid Doppler tests are typically ordered as part of a “stroke work up”, looking for various causes for strokes.

EEG – Electrencephalogram

What is an Electroencephalogram (EEG)?

• An Electroencephalogram or EEG is a diagnostic test which examines the “brain waves”, using electrodes placed on the scalp. These electrodes are connected to a computer, which records your brain waves.

What is the difference between a “routine” and “ambulatory” EEG?

• Routine EEG
  • • A “routine” EEG is performed in the office, which takes approximately 30-45 minutes to perform.
    • This type of study only records your “brain waves” for about 20 minutes.
• Ambulatory EEG
  • • For an “ambulatory” EEG, the electrodes are connected to your scalp in the office, but we then send you home with these electrodes, along with a small hand-held computer.
    • This will record your brain waves for 3 or 4 full days, while you are leading a “normal life”.
    • Such EEGs are more accurate in that they are able to pick up abnormal brain waves while you are at work or while sleeping.
    • At the end of the 4 days, you will return the equipment to our office, which will then be analyzed and interpreted by Dr. Athni.
• Please discuss which type of EEG is appropriate for your situation

Which type of EEG is most ideal?

• Each type of EEG is used for different purposes.
• Which EEG is best for you will depend on your individual clinical situation.
• Dr. Athni will discuss these options with you during your office visit.

How is the EEG procedure performed?

• An EEG is a painless procedure, which involves attaching numerous electrodes to your scalp. These electrodes are connected to a computer, which will record your “brain waves’ during the duration of the study.
• These brain wave recordings are reviewed and interpreted by Dr. Athni.
• A certified EEG technician will attach the electrodes and perform the study, while being overseen by Dr. Athni.

Will an EEG always diagnose a seizure?

• A normal EEG does NOT mean there is “nothing wrong with you”.
• It also does NOT absolutely exclude a seizure or any other disease.
• The results of the EEG are used in conjunction with your clinical symptoms and other diagnostic tests, to make a final diagnosis and conclusion.

How do you prepare for the EEG test?

• For the test, PLEASE do the following:
  • • go to bed at 1 AM, and get up at 5 AM
    • wash your hair in the morning
    • NO hair spray, NO gel, NO mouse, NO oil
    • DO NOT style your hair: NO braids, NO ponytails
    • Wear a button down shirt or blouse
    • NO perfumes or body lotions (you MAY wear deodorant
• The EEG tech will remind you about your appointment and answer any questions you may during the test.

When will you get the results of the test?

• After the completion of the test, Dr. Athni will review the recorded “brain waves” and put together an analysis or “report”.
• This will be reviewed with you on your next office visit.

eVOX – Quantitative EEG

What is it?

• eVox uses quantitative EEG technology along with various brain health biomarkers to aid in the diagnosis of cognitive disorders.

What is a Head Map?

• Computational EEG head maps are a visual representation of the difference in activity between a patient’s brain and a standardized database.

What are Brain Biomarkers?

• Objective metrics derived from computational EEG data provide insight into how the brain is functioning. Peak Alpha Frequency (PAF) reflects cognitive capacity and physiological aging3,4. Theta/Beta Ratio reflects inattention and is FDA cleared to aid in the diagnosis of various cognitive disorders.

What is an Event Related Potential (ERP)?

• ERPs measure brain processing speed and efficiency7. They are highly sensitive biomarkers that have been shown to reflect functional abnormalities even prior to symptom onset

What is a “Go-No-Go” Task?

• Performance during a go/no-go task reflects a patient’s ability to perform daily tasks effectively. Reaction time, reaction time variability, omission errors, and commission errors give insight to cognitive status and behavioral functioning

How do you prepare for the eVox test?

• For the test, PLEASE do the following:
  • wash your hair in the morning
  • NO hair spray, NO gel, NO mouse, NO oil
  • DO NOT style your hair: NO braids, NO ponytails
  • Wear a button down shirt or blouse
  • NO perfumes or body lotions (you MAY wear deodorant
• The tech will remind you about your appointment and answer any questions you may during the test.

When will you get the results of the test?

• After the completion of the test, Dr. Athni will review the recorded “brain waves” and the associated Brain Biomarkers, all of which will be put together in the form of a “report”.
• This will be reviewed with you on your next office visit.

NeuroTrax Test

What is a “NeuroTrax” Test?

• A NeuroTrax test is a computerized test to assess whether you have any cognitive impairment caused by your medical / neurological conditions.
• It is an office based NeuroPsychology test.

How is it performed?

• The test is performed on a computer, although you do NOT have to know how to use a computer to take this test.
• The test takes approximately 30-45 minutes to complete.

What will the results reveal?

• The results will tell us what type of cognitive impairment you may have.
• It will give is a “score” which can be tracked over time to look for any worsening or improvement.

How often is the NeuroTrax test performed?

• If abnormal, we typically repeat this test every 6 months to look for any changes.

Autonomic Nervous System test (ANS)

What is the “Autonomic Nervous System” (“ANS”) ?

• Your autonomic nervous system (ANS) is the part of your nervous system that functions to sustain your life by controlling your heart, lungs, digestive system, blood pressure, immune system, certain of your reflexes, fluid balance, pupil diameter, sweating, and sexual function.
• There are two parts (or branches) of your ANS: the sympathetic branch and the parasympathetic branch. Generally, the sympathetic branch is more in control when you are stressed, ill, or injured, while the parasympathetic branch is more in control when you are relaxing, sleeping, or recovering from an illness or injury.
• In fact, most illnesses and injuries cause or result from an imbalance between these two branches. An imbalance in your ANS can tell your doctor many things about how healthy you are, as well as what can be done to keep you as healthy as possible.

What is an ANS Test?

• We perform three (3) independent clinical ANS tests (or studies) designed to determine the ability of both branches of the autonomic nervous system (ANS) to respond to and relax from a challenge.
• The two branches that make up the ANS are the sympathetic and parasympathetic (SNS and PSNS, respectively).

What are the different components of the ANS test?

The ANS test consists of 3 components or challenges.

The challenges are:

• deep breathing to challenge the PSNS,
• valsalva to challenge the SNS, and
• standing from a seated position to challenge both systems

How long does it take?

• A study takes approximately 25 minutes to complete.

What results will be obtained from this test?

• The ANS test will tell us whether your sympathetic and parasympathetic nervous system are “in balance” or “out of balance”.
• These results will help guide Dr. Athni in formulating a treatment plan to try to bring the ANS back “in balance”.

How often is the ANS test performed?

• If your ANS test is “normal”, we will not have to repeat the study at any set interval.
• But, if it is abnormal, we will probably repeat the study in 4-6 months to see if our therapeutic intervention is resulting in any ANS improvement.

Consent – Who Can Accompany Patient Into Exam Room

• If you are being seen thru Worker’s Comp, we will only allow the patient in the exam room.  If a NCM or Adjustor wants to meet with Dr. Athni, they will need to schedule a separate appointment with the front office.
• If you are an adult and are being seen thru your private insurance or Medicare or Tricare, we will allow your spouse into the exam room.
• BUT, for anyone else, we will need a Medical Power-of-Attorney (Medical POA) or a Notorized letter stating the third-party is allowed to be involved in the patient’s care.  This would include friends or a parent of a patient or an adult child of a patient.
• This is a standard practice in Psychiatric offices.  Although we are not treating Psychiatric illnesses, many of our patients have cognitive issues.  To make sure decisions are being made in the best interest of the patient, we require such a POA.  Even if you do not have any issues which involve your cognitive abilities, we have one policy for all patients.
• We hope you understand the rationale for this policy.  We are merely trying to make sure unauthorized people (who may not have the patient’s best interest) are not involved in medical decisions.

Scheduling Appointments

• We are a “referral only” office.  We require a referral from your primary care physician.
• As soon as our office receives your referral, we will first verify your insurance benefits to make sure we are part of your insurance network. (Please look at “Insurance Networks” on the web site to see our network affiliation.)
• We request you forward a copy of your medical records prior to scheduling your initial appointment.  We will review your medical records before an appointment is given.  We reserve the right to NOT schedule an appointment – after reviewing your medical records, we may decide we will not be able to participate in your medical care.
• Our office staff will then contact you directly to schedule the initial appointment.
• We try to see patients within 2 weeks of receiving the referral.
• We normally see new patients Monday mornings or Thursday afternoons
• We will try to accommodate your personal / work schedule to minimize any inconvenience.
• If the appointment involves a Work-Comp issue, we must obtain a written approval from the WC adjuster prior to scheduling the appointment.
• We request ALL new patients to arrive at the office at least 1 hour BEFORE their scheduled appointment.
• This will ensure that all paperwork issues are completed before your scheduled appointment time. Otherwise, your consultation time will be delayed.

Medication Refills

What medications will be refilled?

• Our office will only refill those medications we have prescribed, AND only if you are an active patient in our practice.

How many refills will be prescribed?

• During your office visit, we will try to prescribe medications with enough refills to last you until your next office visit
• If you cancel your follow up appointment, we will NOT refill your medications until you are re-evaluated by Dr. Athni
• If you choose not to re-schedule your appointment, you should consider obtaining all further refills thru your primary care physician

How are refills processed??

• We normally refill medications during the office visit
• We send all medication refills thru eRx (electronic prescribing system)
• The eRx system minimizes human error, and reduces prescription filling time
• Once we send an eRx prescription, an eRx is typically processed and filled within 1 hour by most pharmacies

“Calling in” prescriptions

• To minimize errors, we will NOT “call in” a refill medications
• If your pharmacy does not accept electronic prescriptions, we will give you a hand-written prescription during your office visit for you to hand-carry

Narcotics Pain Medications and Controlled Medications

• Many pain medications are “controlled” and monitored by the DEA (Drug Enforcement Agency) to minimize fraud and abuse
• We will NOT prescribe or refill any controlled narcotic pain medications
• We WILL prescribed non-narcotic, controlled medications.
• These medications will ONLY prescribed and refilled during a face-to-face office visit

Auto Accident Evaluations

• If your medical issues are related to a recent motor vehicle accident, we will not wait for payment from your auto insurance or from your attorney.
• You will be responsible for full payment of any and all charges incurred at our office.
• You can file the claim with your auto-insurance company.
• We will NOT accept a delayed payment from “3rd party liability” benefits as a result of any auto accidents.
• We will NOT accept any “liens” or “promissory notes” from your attorney.

Expected Payments

If you are a Work Injury or IME patient – No payment is required at time of office visit

• If you are being seen as an authorized Work Injury patient or as an authorized IME, you will NOT be asked to pay anything. All your bills will be handled through your Worker’s Compensation Insurance Company or your attorney.

What is your payment if you have Medicare?

• If Medicare is your primary insurance, then we expect 20 percent of your “Medicare allowable charges” and any deductible required for the calendar year.
• Per federal regulations, the Medicare deductible for calendar year 2022 is $226.

What is your payment if you have commercial (PPO or HMO) insurance?

• We will typically verify your insurance before you arrive at our office.
• If we are a “participating provider” for your insurance plan, then we will only collect the co-pay (either a set dollar amount or percentage).
• You may also be asked to pay any deductible that may not have been met for the calendar year.

What if we are NOT in your insurance network?

• If we are not in your insurance network, you may be asked to pay your bill in-full.
  Please discuss this with our office manager prior to your office visit.

What if you have NO insurance?

• If you are a NEW patient without a valid verifiable insurance, we will NOT be able to see you as a patient
• If you are an existing patient and have lost your insurance or we are no longer in your insurance network, then we expect full payment at the time of service.

Insurance Verification:

• We will verify your insurance PRIOR to your office visit.
• This verification will inform us of your insurance contract stipulations, including any co-pays you are required to pay.

WHEN to Pay:

• We expect payment at the time of service.

TYPE of Payment:

• Our office prefers cash or credit card (MC, Visa, Discover, and Amex).
• You may also pay On-Line thru this web site. We offer a Secure Payment process, powered by Pay-Pal.
• Due to the high number of “bounced checks”, we do NOT accept checks as a form of payment.

Filing Insurance Claims

What insurance claims do we file?

• We will file all Primary insurance claims.

How do we file insurance claims?

• If your insurance company is setup for electronic filing, we will file this claim electronically through our computer system.

When do we file the insurance claims?

• Typically, we file your claim within 7 days after the office visit.

NOTE: Although we may file your claim, it is quite common for insurance companies to “lose” and “not process” the claims. They commonly state that they did “not receive” our claims.

• Hence, it can sometimes take a few months for your claim to be processed properly.
• If we have not received payment within 45 days, we will re-file your claim.

Do we file Secondary insurance claims?

• Although we file all Primary insurance claims, we generally do NOT file Secondary insurance claims.
• Some insurance companies will transfer your claim automatically to the Secondary carrier, in which case it will get processed without any further intervention.
• Else, you will be required to submit the claim to your Secondary carrier after you receive the EOB (Explanation of Benefits) from your Primary insurance company.

Monthly Statements

When do we mail account statements?

• We mail account statements only AFTER the insurance has paid their portion.
• We will wait for payment from your insurance company before we send you a “Payment Due” bill. Sometimes, it may take up to 6 months (or longer) for us to receive the initial payment from your insurance company, so don’t be surprised if you receive a statement from us many months after services are rendered.
• If your insurance does not pay us anything, you will receive a bill for the full amount.
• We normally mail account statements once a month.

What if there is a zero balance?

• If your insurance company pays “in-full”, and there is NO balance due, you will NOT receive a statement.

What if there is a “balance due” on your account?

• If your insurance company only pays us a partial amount, and there is a remaining balance, we will send you a statement during the first week of the month following payment from the insurance company, and each month there-after until the balance is paid.

How many statements are mailed?

• You will receive a total of 3 statements from our office before sending your account over to a Collections Agency.

What if NO payment is made towards an open balance?

• If no payment is made towards your open balance after 3 monthly statements, your account will be sent to a local Collections Agency for further legal action.
• A separate “collections fee” will also be assessed above and beyond your open balance to cover the cost of the collections process.

Methods of Payment

• You may pay all or part of your open balance at any time. As long as there is an open balance, you will receive a monthly statement from our office. You may mail us your payment or stop by the office to pay.
• We accept cash, credit cards (Visa, MC, Discover, Amex), or debit cards.
• You may also pay on-line using our secure payment method powered by Pay-Pal.

On-Line Payment

• If you would like to pay a portion or all of your open balance, please use the form below.
• We use a Secure Payment process, powered by Pay-Pal. Please enter your Name and Birth Date so we can credit the correct account with your payment.
• After you click on the “Pay Now” button, you will be taken to a secure PayPal driven web site, where your payment will be processed.
• After the payment process, you will have a chance to enter any “comments or instructions” regarding your payment.

IME – Independent Medical Examination

WHAT is an IME?

• An Independent Medical Exam, commonly referred to as an “IME”, is a legal evaluation, usually requested by an insurance company, attorney, or some other involved 3rd party. These evaluations are strictly confidential, and the records are NOT released to any other requesting party.
• As an IME Physician, we fully understand that we are NOT developing any doctor-patient relationship. We will NOT prescribe any medications, and we will NOT make any formal treatment recommendations to the patient.
• Some diagnostic testing may be ordered to properly complete the IME, but these tests are scheduled and performed only with pre-approval from the insurance company or attorney.

HOW to schedule an IME:

• Independent Medical Examinations (IME) must be scheduled by the employer, attorney, or insurance company. Prior to scheduling the appointment, please call our office and talk with the office manager to discuss our IME financial policy. We typically request pre-payment for the IME.

WHEN are IMEs scheduled, and how long does it take?

• IMEs are scheduled at a mutually convenient time, and as quickly as possible.
• A typical IME can take 60 to 90 minutes with the patient. This is followed by an additional 3-4 hours of medical records review and case analysis.

What questions are answered during the IME?

• Typically, the IME-requesting party will ask a series of questions to be answered during the IME. All of these questions will be answered by Dr. Athni.
• If additional testing is necessary to properly answer these questions, we will recommend any necessary diagnostic tests. If approved, we will schedule and coordinate these diagnostic tests.
• Once the IME is completed, and if requested or necessary, Dr. Athni will call the IME-requesting party to discuss the case.

IME records are confidential:

• As noted above, we fully understand the legal implications of an IME, and hence we will release the report only to the IME-requesting party. These records are kept in strict confidence, and will NOT be released to anyone else.

Objectivity:

• All cases are handled objectively without being influenced by any outside party. Dr. Athni will “call it like he sees it”.
• For over 25 years, we have regularly seen patients referred by insurance companies (handling life insurance policies, disability insurance policies, workers compensation policies, etc), attorneys (representing both patients and employers), and directly from employers.

Oue experience with IMEs:

• Dr. Athni has been performing IMEs for over 25 years. On average, we complete 10 Independent Medical Evaluations per year.

Questions?

• If there are any questions or concerns regarding IMEs, please call our office and speak with our office manager. If they cannot answer your questions, then Dr. Athni will speak with you directly.

Records Review

• If an insurance company or attorney is involved in a legal case which requires a Neurological opinion, we will be happy to review the records and answer any pending questions.
• The Medical Records Review will be purely objective, regardless of who is requesting the Records Review.

• After the Records Review, Dr. Athni will be available to discuss the findings with the requesting attorney or insurance company.
• A report of the Records Review will be generated and faxed to the requesting party.
• Depending on the volume of the medical records, the review can take 1-2 weeks after receiving the medical records.

• We expect pre-payment for these services.
• The cost will be based on services requested, such as the volume of medical records, whether any imaging films need to be reviewed, and whether a telephone conference is also being requested.

• Please contact our office to discuss these fees.

Concussion Assessment

• Most people are familiar with football related concussions, but they are also quite common after work injuries.
• Concussions occur after a closed head injury, such as can occur after a fall or car accident or some other accident.  It is very important to have such head injuries evaluated quickly and aggressively, and as soon as possible after the accident.
• The symptoms associated with a concussion can be quite varied and unusual.
• Some diagnostic tests we perform in the evaluation of a concussion include: an MR brain, EEG, and Neurotrax test.
• Depending on the results of these tests, various treatment options will be discussed and recommended.

YouTube Educational Videos

Dr. Athni has created educational videos hosted by YouTube, and have also been posted on this page for convenience.  The YouTube channel is called “NeuroEd – Neurology Education Made Easy.”

These videos are separated into various “playlists” – primarily based on “type of video” and suitable audience.  Each playlist is displayed separately on the various tabs on this page.

This list of videos will be slowly expanded over the next few weeks to months.  Subscribe to Dr. Athni’s Channel to view the latest videos.

If you have a specific topic that you want Dr. Athni to discuss, please let him know on your next office visit.

“The Brain Doc” – a Podcast series

Dr. Athni is in the process of creating a Podcast series entitled “The Brain Doc”. In the Podcast, Dr. Athni will interview various specialists, medical students, as well as discuss various medical topics.

You can find all the episodes on this website or on your favorite Podcast Player.

For Spotify, search “Brain Doc Athni”

For all other Podcast players, search “Brain Doc”.

If you find the podcast enjoyable and educational, please leave a positive review.  Thank you.

The Neuro Axis video-series (8 total videos) will teach you how to “localize the lesion” using a simple approach. Great tool for medical students and residents. If you follow the methodology in this video series, you will markedly improve your clinical neurology skills, improve your Shelf and Step scores. More importantly, you will be a “star” on rounds!

Introduction 00:00 — Disclaimer 00:17 — Start of video 00:56

Subscribe to my channel

«

Prev

1

/

1

Next

»

Neuro Axis: Overview

Neuro Axis: Muscle Disorder

Neuro Axis: NeuroMuscular Junction Dysfunction

Neuro Axis: Peripheral Nerve Disorders

Neuro Axis: Nerve Root Disorders

Neuro Axis: Spinal Cord Disorders

Neuro Axis: Brainstem Disorders

Neuro Axis: Subcortical & Cortical Disorders

«

Prev

1

/

1

Next

»

The Medical Student Success video-series aims to give you important tips and tricks to succeed in medical school.  During your clinical years, you have to not only get good grades, but you have to also learn how to be a successful clinician.  Watch these videos, and learn how to succeed in “the game” and learn how to be a “star” on rounds!

Introduction 00:00 — Disclaimer 00:17 — Start of video 00:56

How to assess progress

• You will be required to take a “Neurology Academic Quiz” on the first day of the rotation
• I do NOT expect you to “ace” this test.  Rather, it will assess your level of Neurology knowledge at the beginning of the rotation
• You will be required to take another “Quiz” at the end of the rotation
• Part of your “clinic” grade and assessment will be based on how you have progressed during your Neurology rotation
• These quizzes are NOT meant to be stressful.  Rather, they are meant to demonstrate your academic growth and help build your confidence in clinical Neurology
  

  ---

Teaching and Learning Process

• Many students and residents are “afraid” of neuroscience and Neurology.
• One of the best ways to learn Neurology is to understand the pathology and pathophysiology, instead of memorizing random facts
• To accomplish this, I use the Socratic method of teaching – so, be prepared to be challenged academically
• You will quickly realize, and hopefully appreciate, the importance of critical analysis and reasoning (remember CARS on the MCAT?)
• Come with an open mind, and you will quickly find that Neurology is a lot of fun.
• Don’t stress over this rotation.
• Bring your “A” game, and you will learn more than enough to earn an “A” on your shelf exam, while also becoming well prepared for the Neurology component of the Step 1 and Step 2 exams.

Rotation Expectations

• This is an out-patient rotation, with no call and no weekend responsibilities
• This is not a physically-challenging rotation (no sleep deprivation, no excessive walking, no after hours, etc)
• If you have a lecture commitment, just let me know, and you can break away for the lecture and return when you are done.
• We have a conference room where you can watch your lectures and grand rounds
• I will assign reading and “homework” during the rotation – you are an adult, so I expect you to keep up with these assignments
• Your typical workweek in the clinic will be around 30-35 hours
• Since this is not a very time-demanding rotation, I EXPECT you to read and learn Neurology when not in clinic
• There should be absolutely no excuses for not reading neuro related material during the rotation
• You will be working with Dr. Athni, directly – so please leave any “laziness” at home
• REMEMBER:  You will get out of this rotation what you put into it
  • This might be your only exposure to Neuro, so take advantage of the rotation.
  • The more you learn, the more you demonstrate an interest to learn, the more you ask, the more I will teach

Educational Resources

Some resources which might be helpful in your studying:

• Blueprints Neurology (5th edition, 2019) – most students feel this is the most inclusive “review” textbook
• Pre-Test Neurology
• U-World
• Online Med-Ed
• Case Files Neurology

SUGGESTION:

• During week 1 – Read Blueprints Neurology cover-to-cover, but don’t attempt to memorize all the details
• During week 2 – Re-read Blueprints Neurology, but in more detail, and focusing on the topics we discuss during the rotation
• During week 3 and 4 – Start doing sample test questions (Uworld, Pre-test, etc), while continuing to read Blueprints Neurology in detail.  Target-read the difficult topics.

This week-by-week plan is only a suggestion.  Over the past few years, students who have followed this plan have been greatly surprised and rewarded with their high achievement on the end-of-rotation Shelf Exam.

Technology

• Bring your laptop, tablet, iPad, or cell phone with internet browsing capability (we have wifi in the office)
• Please keep cell phone on “vibrate” mode
• DO NOT use your device to play games or “shop” or socialize with your friends while in clinic
• DO NOT use your cell phone or tablet in front of patients – this would be very rude, and a sign of dis-respect to the patient

Neuro Tools

• The only tool you would need would be a neuro hammer, but do not buy one.
• Most students & residents purchase the wrong type of hammer. I will show you which one to purchase.

Topics to study DURING the rotation

There are a handful of topics which are very common in Neurology, and which I feel are important for all young physicians to fully understand.

I would encourage you to study and try to understand the clinical relevance of these topics.  We will be discussing these topics at random times during the month.  The more you read about these topics, the more I can teach you during your clinical rotation.

• Side effects of common medications
• Different types of hydrocephalus
• Types of intra-cerebral bleeds
• Bell’s Palsy
• Common types of headaches
• Chronic pain vs. acute pain
• What are “scheduled” drugs
• Hallmark symptoms of Parkinson’s
• Parkinson’s vs. Parkinsonism vs. Synucleinopathy
• Seizures vs. Epilepsy
• How to treat status epilepticus
• Concussion vs. TBI vs. Closed Head Injury vs. Post-concussive Syndrome
• How to analyze CSF results
• Common types of peripheral neuropathy
• What is “AIDP” and “CIDP”, and the difference between these entities
• Stroke vs. TIA
• Acute and chronic management of cerebral ischemia (stroke)
• Myasthenia Gravis
• Multiple Sclerosis
• Aphasia vs. Dementia vs. Delirium

Time In Clinic

• Arrive at office around 7:45 am
• You should be able to leave office around 4:00 to 4:30 pm
• Monday’s are our “late days” – be prepared to stay till around 5:30 pm

Other Information

• Park at LEFT side of building, in covered parking area
• Enter thru side door – staff will have unlocked side door
• Consider bringing lunch – we have a kitchen with microwave and fridge
• Many eateries are within driving distance (Arby’s, Burger King, Fresh Market, Kroger’s, Starbucks, etc)
• Wear comfortable shoes
• DO NOT use your device to play games or “shop” or socialize with your friends while in clinic
• DO NOT use your cell phone or tablet in front of patients – this would be very rude, and a sign of dis-respect to the patient