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Neuropathy


 

Neuropathy refers to dysfunction of the peripheral nerve. It often presents with progressive pain and/or numbness. The EMG study shows decreased amplitude in the SNAPs (sensory nerve action potentials). This form of neuropathy is usually due to a toxic-metabolic insult such as chemotherapy, diabetes or chronic alcohol use. Sometimes it is the result of connective tissue diseases such as lupus, polyarteritis nodosa or Sjogren’s syndrome. All of these conditions have to be screened for in any evaluation. Sometimes no cause is found and treatment is symptomatic.

There is another very common neuropathic condition seen almost exclusively in the elderly, and it present with progressive imbalance. It is called CIDP (chronic immune demyelinating polyneuropathy) and is an autoimmune condition where there is a loss of myelin in the peripheral nerve. Myelin is the fatty tissue which surrounds every nerve and which enhances conduction. When it is damaged, conduction of electricity in the nerve is slowed. More importantly, different frequencies travel at different velocities (dispersion), the message from the nerve is scrambled, and the brain is no longer sure where the limb is in space. The result is an imbalance. This is a serious condition since it can result in falling, yet it is often highly treatable with intravenous immunoglobulin (ivIg). The EMG signature is slowing of nerve conduction.

CIDP is not usually associated with monoclonal proteins but sometimes it is. These must be screened for with a blood test known as immune protein electrophoresis since a monoclonal spike in the blood could represent a more malignant underlying condition such as multiple myeloma or lymphoma. If the spike is of the IgG type, then a bone marrow aspiration is mandatory. Usually, this is negative for malignancy and most of these neuropathies are treatable. If it is IgM then it is usually benign but is usually less responsive to ivIg.

Michael Hutchinson, MD, PhD

Dr. Hutchinson is a board-certified neurologist and senior faculty at the Icahn School of Medicine, Mount Sinai, Manhattan. His clinical interests include headaches, dementia, concussion, traumatic brain injury (TBI), Parkinson's Disease, multiple sclerosis, epilepsy, anxiety and REM sleep disorders.  He has an extensive scientific background and brings a science-based approach to solving clinical problems.

During residency at the University of Washington, Hutchinson used his knowledge of chaos theory to propose a new way of treating status epilepticus, the most lethal form of epilepsy. The treatment proved successful and is now standard-of-care in the US. Hutchinson later did a sabbatical at Queen Square, London, where Ian McDonald was pioneering the use of beta interferon as the first treatment for multiple sclerosis.

 

After residency training, Hutchinson underwent a neuroimaging fellowship in Los Angeles.

 

After arriving at NYU in 1994, Hutchinson pioneered the use of cholinesterase inhibitors as a treatment for the dementia of Parkinson's disease. At the time this was considered forbidden because it might make the patient physically worse, but Hutchinson argued that this premise was ill-conceived. Today, cholineserase inhibitors are standard-of-care in Parkinson dementia. Hutchinson later developed a new way of treating acute relapses in multiple sclerosis, which puts the patient in charge, and which has yielded impressive long-term results.

 

During his time at NYU, Hutchinson made early contributions to functional MRI, discovering that regional brain activations during cognitive tasks are accompanied by widespread deactivations.  In structural imaging, Hutchinson combined physics, neuropathology, and image processing to develop a robust MRI biomarker for Parkinson's disease.

 

In addition to certification in neurology, Hutchinson is certified in neuroimaging (MRI and CT of the brain and spine), which combines neuroanatomy, neuropathology and neurophysiology, fields which form the unique base of clinical neurology.

 

Dr. Hutchinson holds a PhD in molecular physics and is inventor of spatial sensitivity encoding for MRI - sometimes referred to as parallel MRI - which is now the acknowledged standard for clinical MRI. He is currently exploring a possible extension of this to ultrafast imaging.

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Michael Hutchinson, MD, PhD

Dr. Hutchinson is a board-certified neurologist and senior faculty at the Icahn School of Medicine, Mount Sinai, Manhattan. His clinical interests include headaches, dementia, concussion, traumatic brain injury (TBI), Parkinson's Disease, multiple sclerosis, epilepsy, anxiety and REM sleep disorders.  He has an extensive scientific background and brings a science-based approach to solving clinical problems.

During residency at the University of Washington, Hutchinson used his knowledge of chaos theory to propose a new way of treating status epilepticus, the most lethal form of epilepsy. The treatment proved successful and is now standard-of-care in the US. Hutchinson later did a sabbatical at Queen Square, London, where Ian McDonald was pioneering the use of beta interferon as the first treatment for multiple sclerosis.

 

After residency training, Hutchinson underwent a neuroimaging fellowship in Los Angeles.

 

After arriving at NYU in 1994, Hutchinson pioneered the use of cholinesterase inhibitors as a treatment for the dementia of Parkinson's disease. At the time this was considered forbidden because it might make the patient physically worse, but Hutchinson argued that this premise was ill-conceived. Today, cholineserase inhibitors are standard-of-care in Parkinson dementia. Hutchinson later developed a new way of treating acute relapses in multiple sclerosis, which puts the patient in charge, and which has yielded impressive long-term results.

 

During his time at NYU, Hutchinson made early contributions to functional MRI, discovering that regional brain activations during cognitive tasks are accompanied by widespread deactivations.  In structural imaging, Hutchinson combined physics, neuropathology, and image processing to develop a robust MRI biomarker for Parkinson's disease.

 

In addition to certification in neurology, Hutchinson is certified in neuroimaging (MRI and CT of the brain and spine), which combines neuroanatomy, neuropathology and neurophysiology, fields which form the unique base of clinical neurology.

 

Dr. Hutchinson holds a PhD in molecular physics and is inventor of spatial sensitivity encoding for MRI - sometimes referred to as parallel MRI - which is now the acknowledged standard for clinical MRI. He is currently exploring a possible extension of this to ultrafast imaging.


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    "Finding Dr. Hutchinson has saved my life from migraines that I have suffered from all my life. I love him! I highly recommend him to anyone who needs a neurologist."

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Michael Hutchinson, MD
35 35th St.
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New York, NY 10016