Neurology

Physicians’ Clinic of Iowa’s fellowship trained neurologists treat a wide variety of neurological disorders, including those affecting the brain, spinal cord, nervous system, muscles, and neuromuscular junctions.

Our health team is committed to ensuring our patients, young and old, receive the best comprehensive neurological care. Your PCI neurologist works together with other physicians as part of a collaborative team in order to offer individualized treatment plans. 

What do PCI neurologists treat?

• Epilepsy & Seizure Disorders - About 1 in 26 people in the U.S. will develop a seizure disorder, however, a single seizure doesn't mean you have epilepsy. At least two unprovoked seizures are generally required for an epilepsy diagnosis. Epilepsy is a neurological disorder in which nerve cell activity in the brain becomes disrupted, causing seizures or periods of unusual behavior, sensations and sometimes loss of consciousness. Seizure symptoms can vary widely. Some people with epilepsy simply stare blankly for a few seconds during a seizure, while others repeatedly twitch their arms or legs.
   
• Headache Disorders - Headache is pain in any region of the head. Headaches may occur on one or both sides of the head, be isolated to a certain location, radiate across the head from one point, or have a vise-like quality. A headache may be a sharp pain, throbbing sensation or dull ache. Headaches may appear gradually or suddenly, and they may last less than an hour or for several days. Headaches are very common and can be caused by medications, eye strain, environmental factors, stress, sinus issues, etc. 
  
  Migraines are severe headaches usually accompanied by nausea, vomiting, and extreme sensitivity to light and sound. They can last several hours or several days, and usually affect your quality of life. Some migraines are preceded by sensory symptoms such as flashes of light, blind spots, or tingling in your arm or leg. Migraines are debilitating and frustrating, but medications, combined with self help and lifestyle changes, can make a difference. Physicians' Clinic of Iowa offers Botox injections for certain migraine sufferers. Use our Migraine Screening Tool to help you document your symptoms so you can talk with your doctor.
   
• Memory & Dementia Disorders - Dementia is not a disease. It is a broad term used to describe a decline in mental ability severe enough to interfere with every day life. Several diseases fall under this category. Alzheimer’s Disease is probably the most well-known of the memory disorders. It is an irreversible, progressive brain disorder that slowly destroys memory and thinking skills and, eventually, the ability to carry out the simplest tasks. In most people with Alzheimer’s, symptoms first appear in their mid-60s, however, some people have symptoms earlier in life.
   
• Movement Disorders - These neurological conditions that affect the speed, fluency, quality and ease of movement. There are many types of movement disorders. Some of the most common include Parkinson’s Disease, Tourette's, Huntington's Disease and cerebral palsy.

• Neuromuscular Disorders - Neuromuscular disorders affect the nerves that control your voluntary muscles. Voluntary muscles are the ones you can control, like in your arms and legs. Your nerve cells, also called neurons, send the messages that control these muscles. When the neurons become unhealthy or die, communication between your nervous system and muscles breaks down. As a result, your muscles weaken and waste away. The weakness can lead to twitching, cramps, aches and pains, and joint and movement problems. Sometimes it also affects heart function and your ability to breathe.
  Common neuromuscular disorders are multiple sclerosis, muscular dystrophies, myasthenia gravis and amyotrophic lateral sclerosis (ALS).

Botox® Treatments

Physicians' Clinic of Iowa Neurology providers offer Botox® treatments in Cedar Rapids for the following conditions:

• Dystonia
• Spasticity
• Blepharospasm
• Migraine headache
• Spasmodic torticollis
• Hyperhidrosis
• Muscle spasm secondary to multiple sclerosis or Parkinson’s disease

Request a referral from your primary care physician if you think Botox® therapy might be right for you. 

PCI Speciality Clinic - Waterloo

PCI Neurologists Renee Buchanan and Shereen Chang are available at PCI's Waterloo location
315 East San Marnan Drive, Waterloo, IA 50702

Call 319-234-2055 for an appointment.

They see patients the second and fourth Wednesday of every month. Services offered are:

• General neurology
• New patient consults
• Follow-up care

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The neurologists and care team at Physicians’ Clinic of Iowa use leading testing procedures to get the most accurate information for your neurological care. These tests help to treat a wide range or neurological disorders and diseases, from headaches to movement disorders (Parkinson’s disease) and neuromuscular diseases (multiple sclerosis or ALS).  Neurological testing is minimally invasive and can help determine the next steps in your treatment. 

EEG Testing (Electroencephalography)

What is Electroencephalography?

An electroencephalogram (EEG) is a neurological test to measure the electrical activity of the brain. Your doctor may order this test to check for seizures or other neurological disorders, such as stroke, encephalitis, sleep disorders, or dementia. During your test, small metal disks (electrodes) will be adhered to your scalp with paste, and will record electrical activity for approximately 25 minutes. The test is completely painless, and takes approximately 60 minutes from start to finish.

Before Your Test

Prepare for your test as instructed. Wash and dry your hair and scalp with no hair styling products. Scalp and hair should be clean and free of excess oil. Take all medications, unless specifically told not to do so. Eat as usual, but NO caffeine. You may be asked to sleep during the EEG. To help you do this you may be told to stay up all or part of the night before the test.

• 18 months—5 years: Stay up one hour later and get up one hour earlier than normal. Schedule EEG in the afternoon. Parents should bring special blankets, binkies or bottles to help.
• 6—12 years: Stay up until 11pm and and wake up at 6am. Afternoon testing is best.
• 13 years—Adult: Limit sleep to 5 hours only (Midnight - 5 am preferably.)
• FOR ALL PATIENTS: NO NAPS or CAT NAPS!

Let the Technologist know

For your safety and for the success of your test, tell the technologist:

• What medications you take
• About any seizures you may have had in the past

You may also be asked questions about your overall health, such as diet and exercise and other practices that can affect neurological health.

During your test

Your EEG Test will take approximately one hour. You will lie down on an exam table in a softly lighted room. The technologist will measure certain points on your head. He or she will use a special pencil to mark the spots where electrodes will be placed on your scalp. Your scalp will be rubbed with a mild abrasive and electrodes will be attached. You will then be asked to do any of the following:

• Relax, and open and close your eyes.
• Breathe rapidly and deeply (hyperventilate) for a few minutes.
• Sense a flashing light through your closed eyes.
• Relax and go to sleep - remaining as still as you can.
• It is important that you avoid talking during the testing.

After Your Test

When your EEG Test is done, all of the electrodes will be removed. At home, wash your hair to remove any remaining glue or paste. You can get right back to your normal routine. If you stopped taking any medications before the test, ask your neurologist when you can start taking them again. Your doctor will let you know when your test results are ready and will schedule a time to go over them with you!

EMG/NCV Testing (Electromyography and Nerve Conduction Studies)

What is EMG/NCV testing?

Electromyography (EMG) is a neurological test that checks the health of the muscles and the nerves that control the muscles. EMG is most often used when people have symptoms of weakness, and examination shows impaired muscle strength. It can help to tell the difference between muscle weakness caused by injury of a nerve attached to a muscle and weakness due to a neurologic disorder.

A Nerve Conduction Velocity test (NCV) is usually performed along with an EMG. It shows how fast electrical signals move through a nerve and is used to diagnose nerve damage or destruction.

How long does the testing take?

Testing takes about 30 minutes on average.

How are the tests performed?

EMG
Your neurologist, with assistance from a technician, will insert a very thin needle electrode through the skin into the muscle. This needle is similar to an acupuncture needle and much skinnier than the needles used to give injections. The electrode on the needle picks up the electrical activity given off by your muscles. This activity appears on a nearby monitor, and may be heard through a speaker. After placement of the electrodes, you may be asked to contract the muscle. For example, bending your arm. The electrical activity seen on the monitor provides information about your muscle’s ability to respond when the nerves to your muscles are stimulated.

NCV
Patches called surface electrodes, similar to those used for ECG, are placed on the skin over nerves at various locations. Each patch gives off a very mild electrical impulse, which stimulates the nerve. The nerve’s resulting electrical activity is recorded by the other electrodes. The distance between electrodes and the time it takes for electrical impulses to travel between electrodes are used to determine the speed of the nerve signals.

How will the tests feel?

For the EMG test, you may feel some pain or discomfort when the needles are inserted, but most people are able to complete the test without significant difficulty. Afterward, the muscle may feel tender or bruised for a few days.

For the NCV test, the impulse may feel like an electric shock. Depending on how strong the stimulus is, you will feel it to varying degrees, and it may be uncomfortable. You should feel no pain once the test is finished.

What should I know before testing?

You should avoid using any creams or lotions on the day of the test.

Podcasts

Neurology Physician Andrew Peterson, MD FAASM specializes in pediatric epilepsy, neurology, and sleep medicine and talks with Expert Hour at WMT Radio about his work. He talks about the differences between adult neurology and pediatric neurology, sleep apnea, and epilepsy.  

Health Library

• Neurology Center - This health information page is dedicated to tools and resources for neurology patients. You’ll find information on neurology symptoms, diseases and conditions, plus tests and treatments—including animations and videos.

Recommended Websites

• Neurological Disorders & Stroke -  This site provides in-depth information on all types of neurology conditions, treatment, and research. Many support organizations are also listed for each neurological disorder. 
• mychronicmigraine.com - This site provides general information about chronic migraine symptoms and treatments.
• botoxchronicmigraine.com - Patient stories from those receiving Botox treatments for chronic migraine.

Botox® Injections for Severe Migraine 

"After several confusing years of vertigo and being bounced from specialist to specialist in Dallas, TX, I moved to Cedar Rapids, with the goal of getting better and being closer to family for help on really bad days. Dr. Robert Struthers at PCI Neurology diagnosed my vertigo as being caused by chronic migraine or MAV (Migraine-Associated Vertigo). We tried all the usual migraine preventatives, but nothing worked. My migraines changed to more classic migraine symptoms, headache nausea, visual disturbances, including holes in my vision, which are not fun… Especially when driving. I have a movement disorder affecting my neck and was receiving Botox® for that. My insurance won’t allow more than one area to be treated with Botox® at a time, so it was a hard decision for me to give Botox® a try for migraine, because of the trade off.

Migraine with vertigo was making life impossible. Socializing was a nightmare, as I couldn’t filter light and sound, was sick to my stomach a great deal of the time and my typical response to being asked, even to dinner with a friend, was “not today, but keep asking me, I appreciate being included.” I would isolate, which in turn left me extremely depressed. You can’t plan with frequent migraine with vertigo… For anything. It simply doesn’t allow you to be present for your own life. I wouldn’t know from day to day if I could even walk when I woke up, or if vertigo would send me falling to the floor and crawling to the restroom. Life was without hope, my future looked quite void of me, because I no longer trusted my body and brain (with good reason).

I decided to give up my dystonia treatment so I could begin Botox® for migraine. Now, Dr. Renee Buchanan gives me approximately 40 Botox® injections every 90 days. She follows an FDA-approved map showing where and how much to inject. I’ve had two rounds and it has greatly reduced the frequency and length of the migraines. If I do get a migraine, they don’t last for so many days that I have to go to hospital for rescue IV treatments.

I'm not symptom free and doubt I ever will be, but this treatment has greatly improved my quality of life. It’s a very effective treatment I highly recommend. Thank you to Dr. Buchanan and staff!"

-- A. Wixcel, Cedar Rapids, IA

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Outreach Clinic

•   Buchanan County Health Center
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•   Crossing Rivers Health, Prairie du Chien
•   Eastern Iowa Sleep Center, Belle Plaine
•   Jones Regional Medical Center
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Tracy Alshouse, PA-C Vijay Aluri, MD, RhMSUS Amber Arthurs, ARNP, NP-C Heidi Barnhart, PA-C Aubrey Barton, PA-C Jennifer Botsford, ARNP, FNP-C Michael Brooks, MD, FACP, FACR J. Renee Buchanan, MD, MA Rasa Buntinas, MD Gina Burke, OTR/L, CHT Rikka Burroughs, ARNP, NP-C, CUNP Ann Camblin, DPT, MPT Carrie Campbell, ARNP, AGACNP-BC Kevin Carpenter, MD, FACS Kenneth Cearlock, MD Shereen Chang, MD Bogdan Cherascu, MD Peter Chimenti, MD Lisa Coester, MD, FAAOS Brandey Cordes, MS, FAAA Ryan Dempewolf, MD, FACS Rodney Dempewolf, DPM Michelle Dole, DPM Christopher Donahue, PA-C Kevin Eck, MD, FAAOS Scott Ekroth, MD Daniel Fabiano, MD, FAAOS Melissa Fagan, ARNP, FNP-BC William Fusselman, MD Amy Ganske, ARNP, FNP-BC Scott Geisler, MD Melanie Giesler-Spellman, DO, FAOCO Justin Gilbert, MD Kelsey Grimm, PA-C M. Tory Haefner, DPT, CLT Lesley Haro, ARNP, FNP-C Kimberly Harris, ARNP, FNP-C David Hart, MD, FAAOS Craig Haverman, PTA, ATC/L Jennifer Herting, PT, MPT MaryAnn Heying, PTA, COTA/L Gregory Hill, MD, FAAOS Logan Hoxie, MD, FACS James Huber, DO Gregory Janda, MD Melissa Janssen, ARNP, FNP-BC Bharat Jenigiri, MD Angie Jenkins, MA, CCC-A David Jerkins, MD Robert Keating, MD, FACS Cheryl Koester, MA, CCC-A Laurence Krain, MD Jared Kray, DO Jeffrey Krivit, MD, FACS Meiying Kuo, MD, FACS, FASSH Cassandra Lange, MD, FAAOS David Lawrence, MD, FACS Brendan Leiran, PA-C James Levett, MD, FACS Paul Lottes, MD Ryan McBride, DPM Jill Miller, ARNP, FNP-BC Steven Mindrup, MD Cynthia Morrison, ARNP, FNP-C Sandeep Munjal, MD Ritu Munjal, MD, CCD Jeffrey Nassif, MD, FAAOS Jeffrey Nielsen, MD, FACS Clifford Novak, MD, FAAOS Andrew Nowell, MD, FACS Kerri Nowell, MD, FACS James Pape, MD, FAAOS Peter Pardubsky, MD, FAAOS, FASSH Erica Pasterski, ARNP, FNP-C Ann Paulsen, OTR/L, CHT Thomas Paynter, MD. FAAOS Gina Perri, MD Andrew Peterson, MD, FAASM Fred Pilcher, MD, FAAOS Jennie Pint, MA, CCC/SLP Charles Pruchno, MD Annette Qualben, ARNP, FNP-C Megan Raddatz, ARNP, NP-C Jeffrey Ralston, MD Melanie Ramsey, ARNP, FNP-BC Patti Recker, PA-C Erin Reisner, OTR/L, MOT Paul Renz, MD, FACS Teri Rexroth, ORT/L, MOT, CLT Thomas Richardson, MD Jonathan Rippentrop, MD Thomas Rogers, DO David Rubsam, MPT, OCS Heidi Sandersfeld, PA-C Lori Schumann, ARNP-C Harinder Singh, MD Robert Struthers, MD Erin Swailes, ARNP, FNP-C Kyle Switzer, DO Michael Telisak, MD, FACS Lesley Vancura, ARNP, FNP-BC Steven Wahle, MD, FACS Garry Weide, DO, FACOS Matthew White, MD, FAAOS Jason Willer, MPT

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