Neurology Treatments In Israel

Prof. Boaz Weller
Director of the Neurology Department, Bnai Zion Medical Center
Prof. Boaz Weller
Prof. Weller is a graduate of the Technion Faculty of Medicine , Haifa, Israel and a practicing neurologist for over 30 years. Specializing in neuro-muscular disorders, including multiple sclerosis, neuropathy, myopathy, myasthenia, motor neuron disease ,epilepsy, parkinson’s and dementia. Prof. Weller is one of the key pioneers in Multiple Sclerosis (MS) research in Israel. His work has placed Israel’s MS treatment research onto the world stage and has ensured Israel is renowned as a world leader in MS treatment.

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In the neurological departments our experts treat all kinds of neurological disturbances. The doctors have different areas of expertise based upon research and extensive experience. At their disposal is the best equipment for both diagnosis and treatment.
Neurological departments have adjacent clinics and diagnostic laboratories which save the patients precious time performing tests connected with the diagnosis of various situations.
Two important medical services are active within the framework of this department: Centers for the diagnosis, treatment and follow up of Multiple Sclerosis Patients, and centers specializing in the field of Neurogeriatrics – neurological difficulties of elderly patients, including acute stroke patients who require urgent care until they are sent for rehabilitation.
The Neurology Clinics include assessment services and institutes for neuropsychological and neurophysiologic tests (EEG, EMG, VEP-BERA, TCD), and also Neuroimmunology and Neurogenetics laboratories.
Neurophysiological Tests

EMG - recording of the electrical activity of the muscle, in order to diagnose muscle diseases and changes in their functioning for various reasons.
Limitations in Performing the Test:
The test is not to be performed in patients who are receiving blood-thinning drugs (anti-coagulants). When the test is ordered to these patients, stopping the drugs temporarily for a few days before the test is performed is mandatory.
Test Procedure:

During the test patients are lying on their back. The treating doctor instructs to contract and relax the muscle (which will be checked at rest and at extended effort). Very fine disposable needles are inserted into the muscle. The number of tested sites (the muscles) depends on the reason for the referral. The test involves slight discomfort, which is generaly not long-lasting. Slight pain in the test area is possible for a few hours after the test. Duration of the test is about 30 minutes.
NCV - nerve conduction test performed in order to check the condition of peripheral nerves and any defects in them.

Test Procedure:

The treating doctor will attach electrodes over the muscle and/or the nerve to be tested. The number of stimulations given via the electrodes depends on the reason for the referral. The test is accompanied by a feeling of discomfort (usually painless) during the electrical stimulations. There is no risk in the test. There are no other side effects during this 30 minutes' test or afterward.

EEG – testing the electrical activity of the brain in order to estimate the electrical activity of the brain waves.

Test Procedure:

A technician places 20 electrodes on the surface of the patient's head, with the help of clear gel, which does not stain clothing. During the test the patient is instructed to close eyes (simply, or against a flashing light) and to breathe deeply. Full cooperation is required during this test in order to obtain a precise diagnosis. Electro encephalogram is sometimes done also during natural sleep, or under mild sedation.
VEP BERA – this test records the responses of sight and hearing nerves, in several conditions, including impaired balance and vertigo of all kinds.
Test Procedure:

Technically BERA is almost exactly as EEG. In cases of serious vision defects as a result of eye disease, it is recommended to carry out VEP in an eye clinic.

– A complete measurement of flow in the brain's blood vessels. Is carried out in order to evaluate speech functions, memory, attention, concentration and understanding in different situations e.g. stroke, depression, post head-trauma, age related situations and others.
The Neuro-immunology Laboratory

The neuro-immunology laboratory deals with specific tests for the diagnosis of autoimmune diseases of the nervous system.

The tests:

1. Oligoclonal immunoglobulin in cerebrospinal fluid for the identification of multiple sclerosis and brain inflammation
2. Transferring  beta-2 for the identification of leaking cerebrospinal fluid
3. Alpha-fetoprotein for the identification of birth defects in the nervous system, Hepatoma and pregnancy
4. Myelin basic protein and antibodies to myelin for the identification of the process of myelin destruction
5. Antibodies against MAG and galactocebroside for the identification of peripheral neuropathy
6. Antibodies against gangliodies: GM1, GD1a, GD1b, GQ1b for the identification of diseases of the peripheral nervous system
7. Antibodies to the acetylcholine receptor for the identification of myasthenia gravis
8. Antibodies to pre-neoplastic diseases Hu, Yo, Ri, Ma and to calcium channels for the identification of secondary phenomena of injuries to the nervous system and in a condition of malignant disease.
The Neurogenetics Laboratory

This laboratory enables the diagnosis of rare genetic diseases which affect the central nervous system and skeletal muscles' functions.
The tests:

1. Protein 14-3-3 in cerebrospinal fluid for the identification of Creutzfeldt-Jacob disease
2. TAU protein in cerebrospinal fluid for the identification of Alzheimer's disease
3. The faulty prion protein in urine for the identification of Creutzfeldt-Jacob disease
4. Mutation in the TAU protein (P301S) for the identification of dementia with Parkinsonism
5. Mutation in the glycogen branching enzyme (Y329S) for the identification of glycogen storage disease
6. Mutation in the aldehyde dehydrogenas enzyme (C682T) for the identification of Svegren-Larsen disease
7. Mutation in the transseritin protein (Y77S) for the identification of ameloid disease
8. Mutation in the prion protein (P102L) for the identification of Gerstman's disease
9. Mutation in the prion proteins (E200K, D178N) for the identification of genetic Creutzfeldt-Jacob disease
10. Mutation in the disperlin protein for the identification of muscular atrophy disease (Limb-Girdal)
11. Mutation in the CD45 protein for the identification of familial multiple sclerosis.

Multiple Sclerosis
The centres specializing in the diagnosis, treatment and follow up of patients with Multiple Sclerosis and provide the patient with the best up to date required care.
Multiple sclerosis is a chronic disease of demyelization of the central nervous system. That is, a disease in which the myelin sheath of the nerves in the brain and the spinal cord are injured at a number of foci (called "plaques"). These "plaques" are concentrated in the "white material" of the brain and the spinal cord, in particular surrounding the chambers of the brain and the visual nerves. The white material of the brain is all the area in which there is a high density of myelin-enveloped fibers; in the nature of things, since in these same areas there are few neurons (which are located in the "grey matter" in the brain covering), multiple sclerosis affects only the branching of the cells, and in most cases, therefore, does not cause severe cognitive damage as in Alzheimer's.
Multiple sclerosis is considered an inflammatory autoimmune disease in which the immune system attacks the myelin self proteins. Due to the injury in the myelin which acts as a protective envelope on all the nerves' fibers and as "insulating" material which enables the transfer of electrical signals, this results in disturbances in the transfer of electrical "messages" within the brain and the spinal cord, and defects/disturbances in the functioning of one or more nervous systems like the motoric system, perception, stability and coordination system, vision, sphincters, eye movement, etc.
Multiple sclerosis generally strikes people in their twenties and thirties. The disease is more common in people of European origin than in people of African or Far Eastern one. There is a connection between the disease and the geographical area in which the patient lived in the first years of his life. There is a higher frequency of the disease in women than in men.
The common symptoms (the clinical phenomena) of multiple sclerosis include sense disturbances ("pins and needles"), vision disturbances (blurring and double vision), limb weakness, instability and lack of coordination and disturbances in sphincter control.
Multiple sclerosis is a variable disease and its progression differs greatly from patient to patient. Not all patients hit with the disease will get to a stage of needing assistance in walking or paralysis. A significant number of patients do not suffer from disturbances in essential functions even many years after the onset of the disease and perhaps never will. The rest of the patients suffer from an acute disease (benign multiple sclerosis) or an advancing/progressive disease. In some of the patients the disease begins as an acute disease and then with time becomes progressive (secondary progressive).
Medicine today offers a range of drugs whose purpose is to ease the symptoms and slow the progress of damage in the central nervous system. Three preparations of Interferon-b (Evonax, Ravif, Betaferon) and Copaxone are more or less efficient in slowing the disease process, reducing the number of attacks and the damage to the white material in the brain. These preparations are given by injection only (1-3 injections per week) and it is recommended to start taking them with the start of clinical symptoms and following unequivocal diagnosis of multiple sclerosis.

Mitoxanatron: Administered in the case of worsening and rapidly progressing disease.
Steroids: are advised in acute cases or as a long-term treatment.
Immunosuppressive preparations: cyclophosphamide, methotrexate and Imuran are used in deteriorating conditions.

Other treatments: plasmapheresis (filtration of blood fluids).
Immunoglobulin preparation - administered intravenously.

There are many other treatments which are administered to ease the different symptoms which derive from the disease and one may consult with the treating doctor about these.
These clinics are intended for evaluation and treatment of age related memory disturbances and neurological disturbances. Within the framework of the clinic diagnoses for the evaluation of the source of memory disturbances are performed, including neurological tests, neuropsychological tests, blood tests and similar tests. Following the evaluation process, a detailed summary is sent to the patient and to his personal doctor, summarizing the findings. In accordance with the findings the patient receives the appropriate treatment and a follow-up program is recommended in order to efficiently estimate the treatment and its appropriateness for the patient. The clinic is in close contact with the family doctor, geriatric specialists, and services for dementia patients in the community.

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