Author: DENT Neurologic Institute

Coping With Stress and the Unknown | Livestream Recap

In light of current events, Dr. Horatio Capote opened discussion on how to deal with anxiety and stress, and how working together, as a community, can benefit all of us.




Anxiety is a “perfectly normal emotion…it’s how we’re built, it’s probably a signal to our brains that something is up, something may need to be adjusted, or we may need to be careful about something.” Anxiety is an important and, given the circumstances, appropriate emotion to be having. Everyone experiences anxiety at some point in their lives. However, anxiety is not only an emotional response but a disorder. According to Dr. Capote, one may be suffering from an anxiety disorder if the anxiety persists for “about two weeks…not just a blip, but an ongoing issue…that it affects our function in some kind of way.” These may include interpersonal, occupational, and/or physiological functions. If you believe you have an anxiety disorder, it is essential to contact your doctor so they can help you.

The unknown is “extremely stressful…when we don’t know, we can’t predict, we’re figuring it out…that is tough on us.” A study conducted at Sloan Kettering Cancer Center in New York City and “what they discovered is that it was much more stressful to await the results of, say, a biopsy…await the results of some testing than to hear “Yes, you have cancer.” …because once you know, now you have a game plan…now you’re not up in the air trying to figure it out.” In this current situation, medical professionals are learning about the behavior of the virus and, and the unknown adds to the communal stress.


Community & Credible Sources


Dr. Capote builds off of his statement about communal stress, stating that community and connectedness are incredibly important during this pandemic. It is more than just physical connectedness; it is emotional and spiritual connectedness, a feeling that we are all in this together. “Our brains, our neocortex, our limbic systems, are built that way..different parts of our brain are built to respond to each other. So, we’re all connected…even if we’re not physically as connected lately as we would often like to be.” We must remember that we are all part of the human race, and we are all learning as much as possible to help each other.

To help ourselves and one another, we, as a community, must rely on credible sources for our information. Dr. Capote strongly recommends, for example, gathering information from the Centers for Disease Control. It is a trustworthy, scientific source that is more reliable than the “unusual information out there on the internet.”


How to Help Ourselves


Pandemics have existed throughout humanity, but now “we have technology that we all find out about things instantly. In the past, a pandemic could wipe out a country and then go on to the next country, and maybe take ten years to circle the globe. Everything is accelerated as a result of our new technologies.” So what do we do in the face of the unknown and compounding stress? First, we remember that we are all human beings connected. We must be kind, understanding, polite to each other. Secondly, we must take care of our bodies by getting adequate sleep and fueling our bodies with proper nutrition and exercise. “These things that keep our bodies intact and keep us going are important. We should not…skimp on this,” says Dr. Capote. Lastly, he also mentions that we should treat ourselves “within reason, within the bounds of normalcy…whatever it is for you.” All of these points are basic ideas of things that we can do to keep ourselves level-headed in the face of the current environment.


Q&A with Doctor Capote


Q: There’s a lot of parents who are homeschooling for the first time, and this can be very stressful for them. Are there any tips that you would give those parents on how to deal with this new routine they’re going through?

A: It is a challenge. I think it always pays to be honest and not make-believe you know stuff when you don’t. You can teach a lot to your kids by modeling…like “Hey, that’s a good question. I don’t know. Let’s learn together; let’s figure this out together. Let me show you how I’ve learned to seek out information,” and do some joint problem-solving. Make it a bit of an adventure. It is an opportunity to strengthen those ties with your kids. You know, you see them more frequently. Mind you, you know, everybody in close proximity for prolonged periods of time can get on each other’s nerves. So, you know, that’s understandable. But I think, you know, being honest, remembering that you are the parent, do not give the impression that you’re the buddy. You are the parent, and you have some leadership to exert and some delineation of what is right and wrong and things like that. But turn it into an adventure where both of you are sort of co-learners, and you’re still the guider and the leader because you have more experience on how to get questions answered, and of course, you do have a higher body of knowledge than the student. Then on top of it, it’s likely that after some amount of time, you’ll start kicking up memories of the information that you do know, and you start being able to retrieve that more easily. Like anything, it’s a, you know, it’s like a muscle; the more you use it, the better you get at it. So it’s a challenge, but I would invite you to reframe it as an adventure cognitively. By the way, it should give us great empathy for our teachers in the community. Teachers are out there. Some say probably not being rewarded as well as they ought or at least appreciated as much as they should be. So, you know, the next time you see a teacher just like we do with our veterans and thank them for their service. I think this will give us a much greater appreciation for that as well. I know I have a lot to owe to my teachers back from elementary school, but yes, my high school teachers. Shoutout to Christopher Columbus High School at Miami, Florida! They were terrific and have taught me great things that I remember to this day.


Q: Are there any tips that you have on how to discuss what’s going on with children?

A: Sure, sure. Again, you know, some honesty, some information. Try not to editorialize too much, you know, “Oh, this is because this that.” It’s just like, “Well, there’s this virus that has arisen and viruses, you know, they tend to change and mutate over time.” You see, it as an opportunity, right? And what’s a virus? Is it a bacteria? Is it more of a biochemical structure? Does it have life? What is it? So all those exciting opportunities to learn science are there depending on the age of the child, of course. But it’s something that’s out there. It can make people sick, and we’re dealing with it. We’re learning about it as we’re dealing with it at the same time, and we’re trying our best. Honestly, we are probably better equipped than we ever have been in the history of humanity. We have a lot of very bright people thinking about this thing. We have a lot of excellent technology, and so we’re putting all of these things to bear to answer these essential questions.


Q: Can CBD help with your anxiety?

A: Yes. And this is from someone…I was initially a little bit skeptical, but it does turn out that CBD, which by the way, is extractable from both hemp as well as from cannabis, right, so it turns out that it has a beneficial effect on anxiety and probably sleep as well. We are proposing some studies on that soon. It’s just waiting for some FDA issues with the federal government to be able to do that. But, as you know, you can pretty much pick up CBD nowadays, I guess, at the corner store or the gas station or whatever. Mind you; there are products out there that our uber medical director, Director Laszlo Mutchler, actually went about purchasing CBDs from all these different places and had them laboratory analyzed. I found out that some of them only had 1% CBD in it, but they’re still calling it CBD and selling it out there. So that Latin phrase “caveat emptor” right “buyer beware,” that there’s different products thereof different qualities and, consequently, you would like to have something that is laboratory tested and certified actual CBD. I think over time we’ll see a lot more studies showing the efficacy of it. So double-blind placebo-controlled studies that will begin to show us its benefits on the, say, the sleep architecture and on the overall issue of curbing anxiety.


Q: Do you have any tips on how to talk to the elderly, whether it’s your parents, your grandparents, to make sure that they’re taking everything seriously without them feeling like you’re talking down to them or like they’re a child?

A: Sure. You know, as always, you speak genuinely to people. You start probably by saying, “Hey, the reason I’m having this conversation with you is because, you know, I love you, and I want you to do well. So whatever information I’m about to share with you is not it’s not coming from a bad place. It’s coming from a good place.” It’s my guess without knowing the particular situations. It’s hard to give specific advice. It may be hard to put things into context for some people. Some people have never experienced anything like this, and they’ve been around for a while. It may also be that older people, you know, they hear this information that they’re at a much higher risk and they’re anxious. They’re exceedingly concerned. I spoke to someone yesterday in a long-term care facility, and one of her neighbors had just passed away about four days ago. I don’t suspect anything, not from the virus. I think it was just her time. But yes, what happens, you know, another of your cohorts is gone, and you’re faced with your mortality. That’s scary, you know? When is it going to be my turn? And then on top of it, there’s this other new danger which threatens your life expectancy for sure, which is the coronavirus. So I can see it being very hard for people, you know, beyond their 60’s and 70’s to deal with things. But as always, we give honest information. We express our caring and our love, which is why we’re sharing knowledge, and we take it from them. So I think if you’re coming from the right place, if you’re not looking to be manipulative that, you know, shines through.


Q: Would you give that same advice to someone who is not following the guidelines that are in place? Is that kind of the same way you would talk to them? How would you reach out to someone who is not social distancing, not following the recommendations that are out there? How would you bring up that topic?

A: Well, I tend to try to use humor, so I would probably say something like, “Hey, I know you’re Superman and invincible, but listen. I’m worried about you. I mean, people are dying, and it’s best to take this thing seriously. I am! I am for myself and my family, and guess what? You’re part of my family, either immediate or the greater family of humanity. And for whatever reason, it just doesn’t look to me like you’re taking this as seriously as you should.”

There could be so many reasons for people who could be having some cognitive problems. People could be engaging in a lot of denial. I mean, we call these things “denial rationalization” we call these “defense mechanisms.”There’s a reason for that. We defend ourselves by utilizing these techniques. Now, there turns out to be a hierarchy of defense mechanisms. So, the most primitive defense mechanisms are denial. Even more primitive than that is the loss of contact with reality as hallucinations and things like. But the most sophisticated defense mechanisms are altruism and humor. So, people that are altruistic, they look out for others, they engage in philanthropy and caring for others and people that are funny. Those are the more sophisticated ego-coping mechanisms that we have.

And in the middle, there’s different ones, and interestingly enough, if you look at the development of the human being, you actually see that we tend to go through these different defense mechanisms as we mature. So little kids could probably spend a whole lot of time in denial and anger, and all kinds of stuff and then that comes that magical time in adolescence when everything seems funny and people just laughing up a storm no matter what. I know for me as a kid, I discovered Monty Python, and I thought that was hilarious. So you know you just see people going through all these stages. Unfortunately, some people seem to get stuck in a stage, or you have to help them move a little across those borders. Well, again, that’s the whole idea of connectedness in one way or another. So certainly, there are a lot of online communities that occur. There our faith communities that are meeting online.

I heard yesterday about a church that is basically operating almost like a drive-in theater. People are pulling up in their cars and listening to the sermon on a screen, and sometimes they honk the horn instead of “Amen,” but they’re connected. They’re connected even though they’re not that physically connected. There turns out to be online AA meetings and NA meetings, so people are engaging in the fellowship of sobriety that way. So I think we’ll see a lot more of that happening and, honestly, there can be great benefit to that as well. You can get a different sort of experience, but a connection on another level as well. We adopted telemedicine very quickly and, interestingly enough, I’ve noticed that and, you know, not to brag on myself, but I consider myself observant, and I think I listen to people and hear them out. But now, with telemedicine, I listen more attentively. I also have noticed that the people I’m connecting with, they’re better at describing things. They’re paying more attention to these details and telling me about it. So it may make us better communicators in the long run. It’s very interesting.

They say there are silver linings to everything. I see families get more connected, spending more time together, and I think it may enhance our communication skills because we’ve been so accustomed to texting a few words here and there or throwing out a…some message on Twitter and stuff like that. So this is an opportunity to engage in some of these uniquely human capabilities that we have. By the way, this is a little bit of an aside, but what the heck I’m the one talking so I could say whatever I want! One of my favorite things to remark on is a statement, you know, it’s not an exact quote, but basically, Sigmund Freud, the of the fathers of psychiatry was trained as a neurologist, so it’s always been part of the neurosciences. So, Dr. Freud just ran across this group of patients that were difficult to understand with the neurology he had been taught. So he developed this sort of, what he called the sort of artificial language of psychoanalysis to help describe what he was seeing. But he predicted one day we’ll know enough neuroanatomy, neurophysiology, and neuroscience in general, and my language will disappear. We won’t need these words that I’ve created. We will understand how it’s happening in the brain. So sure enough, the ventral tegmental area and the nucleus accumbens is kind of the reward center of the brain. That’s actually where, so to speak, sex, drugs, and rock and roll happen. So that would probably be the seat of the id of all of these impulses, of all of these urges. That would be where the id flows from. We know the anatomical location of that in the brain. And then the super-ego, that part that sort of holds down the id, the inhibitory part that he talked about turns out to be the prefrontal cortex. So in the prefrontal cortex, where the executive functions of the brain reside, we actually see these fibers that reach down into the ventral tegmental area and inhibit.

They hold that thing down, and that would be the seat of the super-ego. Now interestingly enough, what I’ve just described is a little bit of a yin and yang. These opposing forces so in that counterbalance between the id and the super-ego arises, the ego, the self. One person might be a little bit heavier on the super-ego and that the personality arises a lot more on the regimented sort of obsessive side, and some person might be on the other side of that spectrum. So it’s that balance and friction and, I guess, yin and yang between those two things out of which can arise the personality. Another interesting thing, people’s sense of empathy, the seat of empathy turns out to be the amygdala. People, by the way, that get infectious yawning, turn out to be exceedingly empathic. But you can actually take pictures of people grimacing in pain and show them to someone under PET scanner, and you see the amygdala light right up. So we’re showing this deep that empathic connection, “Oh my God, that person is experiencing pain. It must be awful for them.” By the way, if you go to some maximum-security prison somewhere in America where people with antisocial personality disorder reside, you will see that that amygdala does not light up. That is how you could be a cold-blooded killer. You don’t have that. You don’t experience it, and nothing lights up in your brain, alright, I could kill you. So that’s another interesting phenomenon as well as we gain our knowledge of the brain and how it functions and how it makes us who we are. We’re figuring out a lot. I think that there are things beyond the physicality of the brain as well, you know, the whole spiritual perspective as well. So we’re not, at least in my estimation… we’re much more than just an interesting machine with lots of interesting parts that work together. We have sort of this ability to transcend all of that as well.


Q: Another question we have is for people who might be having, like you were saying, they obsess over something, or they’re empaths, they might be having panic attacks during this time. Whether it’s someone they know was going through something or if they find themselves obsessing over the news or if they have a cold and are obsessing over it themselves. So what are any tips you can give for someone who might be mid-panic attack?

A: Well, it’s important to understand that no one has ever died of a panic attack, although it feels that way. By the way, if you have frequent panic attacks, I would say more than two or three a week, it sort of, it may certainly be worthwhile to seek out some help with that. Now the panic attack and the whole sort of anxiety response is an important evolutionary phenomenon. We tend to focus sometimes on the emotional perspective of these things, but in fact, it’s very physical. There’s a part of the brain called the locus coeruleus, the little place that looks like a prune… ciruela coeruleus means prune. Anyway, the little place that looks like a prune secretes adrenaline, so in the face of a threat in the environment…boom! Adrenaline comes out. And what does adrenaline do? Well, it can make us hyperventilate, so we get lots of oxygen on board in case we need to fight or flee, in case we need to put them up or run away.


Because of this hyperventilation, that tends to make your ph in your blood change, you blow off CO2, and so your blood becomes more basic, and you can get tingly sensations in your fingertips and throughout. It cuts down circulation in the limbs, so if you get slashed, you won’t bleed out, and it shunts the blood to the major organs in the torso. It opens up your peripheral vision so you can spot danger coming at you from the sides more easily. It really prepares you for an emergency. If there were a bus coming at you down the street, you would want to have that system intact because it would prepare you to save yourself. The unfortunate thing is if this thing is happening all the time and for no reason at all, then it can become taxing. It can begin to have negative consequences on your body and your brain, and that’s when you would want to seek out some professional help with that. There are many ways to help, not only just medications, but certainly cognitive behavioral therapy is quite good, and oftentimes the simultaneous use of these different things can be synergistic. So one plus one equals three when you do things together like that. You may get much greater effects as well.



Q: So those are all the questions that we have. Is there anything else you want to add in? Maybe mention how people can call and make an appointment?

A: Absolutely. You are certainly welcome to seek us out. We are glad to help and to be of service. We have a great many different technologies that we utilize to help people, not just medications. We also have techniques like transcranial magnetic stimulation that turns out to be very good for treatment-resistant depression. We have electro-convulsive therapy. We have other medication treatments that are not exactly like taking a pill. We have a very, very good intravenous ketamine program. That one is actually quite impressive in that if you are a responder, you can see impressive and very rapid results from it. I’ve been impressed by it. I know I’ve said the same word like ten times. I’d be an awful author, but it’s been really exciting to see that happen. There are other treatments as well on the horizon. We are involved in a lot of research at the DENT. I believe I’m the principal investigator, I think in 27 different trials right now.

The DENT, in general, probably has close to 100 trials going on. We are America’s largest Neuroscience group. People come to us for help with researching new things, so we often have our ear to the ground for what’s up and coming. We may be able to get you into a trial for something new if you’ve tried all these different things, and nothing’s worked so far. We may be able to get you onboard for a new trial. So, a lot of aspects to the kind of work that we do at the DENT. We’re always glad to help in any way that we possibly can. If there’s something we don’t do quite often, our different providers, the doctors, and staff can reach out to other thought leaders throughout the country and find out more details. We’re proud to be from Buffalo. We love our community. We’re glad to help any way that we can. We’ve been here since 1963—some of the very first work that we did actually involved Parkinson’s disease.

We welcome the opportunity to help people in our community, and now with the espousal of telemedicine, we have actually been able to reach out. We do have people that come in from other regions and travel and come here to be seen, but now I think we will have the opportunity to expand our reach to different parts of the state and perhaps other states and help people without them having to be physically present all the time. So that’s maybe one of the silver linings of this whole thing. We’re really espousing the different new technologies and figuring out more ways that we can help people. So give us a call. We will try to help any way that we can, and hopefully we’ll all get through things together as part of the overall community, the sisterhood, and brotherhood of humanity


Q: And if someone’s provider is closed right now, they can always come to us, right? If someone’s doctor’s office is closed, but they really need to see, they can always come DENT?

A: Oh yeah. Sure, sure


Q: Do you have anything else you want to add in?

A: No. Listen, I wish you all well. Stay safe, take care of yourselves, and thanks for taking some of your valuable time and listening to me. I think together we’ll get through all of this and come out the better for it.





The content of this post is intended for general educational and informational purposes only; it does not constitute medical advice. Readers should always consult with a licensed healthcare professional for diagnosis and treatment.


To our dear friends in the Western New York community,

March 25, 2020


To our dear friends in the Western New York community,


Please know that your DENT team is here for you, and remains open for all essential office, diagnostic and treatment services, including injections, infusion, imaging, and counseling.

If you are scheduled for an in-office visit, rest assured that we follow CDC and other national and international expert guidelines for a safe environment.

If you exhibit symptoms of infection, including cough, fever, and shortness of breath, you should stay home, consult your primary care physician to address those symptoms, and schedule a telemedicine visit with your DENT provider to ensure that your care is uninterrupted.

Especially during times like this, your questions and concerns must be addressed efficiently. The best way to communicate with us is through our MyDentChart patient portal. A convenient tool for using the portal is a smartphone app called Healow.

Instructions for installing and using Healow can be found here.

Once installed, it is a simple way to send and receive messages, manage your appointment, and even conduct a “Tele-Visit” with your provider.

Although these are anxious times, we will get through this together. Your care matters and we vow to always be here for you.


Laszlo Mechtler, MD, Chief Medical Officer

Joseph Fritz, PhD, Chief Executive Officer



Tepezza™ Transformation – Rodney’s Journey

On January 21, 2020, the U.S. Food and Drug Administration (FDA) approved Tepezza™ (teprotumumab-trbw) for the treatment of adults with Thyroid Eye Disease. This is a rare condition where the muscles and fatty tissues behind the eye become inflamed, causing the eyes to be pushed forward and bulge outwards (proptosis).

The approval represents the first drug approved for the treatment of thyroid eye disease. DENT Neurologic Institute performed the first infusion in a private practice on February 12, 2020, on Rodney K.

Rodney has agreed to give progress updates for each infusion, and his hopes for the treatment. You can follow Rodney’s real-time progress below.


Infusion #1 –  February 12, 2020

“My expectation and hopes are that the bulging is reduced, that the vision is realigned properly, that the double vision is eliminated and that I will be able to see out of my left eye and to be able to read. Overall, I would like better sight out of my left eye. Icing on the cake would be if the shaking in my hands would go away, and all my symptoms will subside so I do not need the surgery. I would like to also not need to take the steroid. I would like to erase the embarrassment of face to face contact. There are times when I want to Photoshop my eyes. I think “is that what I really look like?” This drug is almost like a godsend. IF this drug is effective, if it works, it is almost like a miracle. It is so handy that we live close to a facility like DENT.”

Infusion #1


Infusion #2 – March 4, 2020

“The pressure and watering are better. I am hoping that the swelling and proptosis go a little bit down more. The double vision was reduced substantially. I feel like sometimes I still look a little pirate-like. The misalignment is not as pronounced as it was before [the first infusion]. I am just hoping for a little more improvement all the way around. If this drug was not approved, they were talking about surgeries. They said they would have to go in and shave the bone. It would have been really bad. This drug was approved at the perfect time.”

Infusion #2


The content of this post is intended for general educational and informational purposes only; it does not constitute medical advice. Readers should always consult with a licensed healthcare professional for diagnosis and treatment.


You talked, we listened! Phone Update

We understand that due to the amount of patients we have the privilege of taking care of that unfortunately that equates to high call volume for our patients to get through to us. In an effort to correct this issue, we have been diligently working on alternative options of communication for you!


Online Patient Portal

For all non-urgent medical communication such as prescription refills, check or cancel appointments, view testing results, or to message someone on your healthcare team we highly recommend utilizing your patient portal! Click here to enter your portal or if you don’t have an account yet, you can request it be activated there as well.


New Patient Scheduling

For anyone looking to schedule a consultation with one of our providers we now have the option to Pre-Register online so you don’t have to call! Visit our website at and click on the “Pre-Registration for New Patients” button, or click here. Once submitted, a patient experience expert will contact YOU within 1 business day to schedule. You can utilize this option at your convenience, let us call you so you don’t have to wait on hold!


Call Center Hours

Our phones will be closed from 12:30-1:15 pm beginning tomorrow, January 21st. This will allow our team to be at full productivity levels during all other times to provide better service to you and reduce your call wait time.

During this time frame, outside patients will still be able to press option 1 (716.250.2000) to schedule any diagnostic imaging testing such as MRI, CT and X-ray. We encourage patients to use the portal as stated above during this time or to pre-register if you’re a new patient.


We’re Hiring!

We are currently hiring patient experience representatives to grow our team to be able to provide better service to our community! To apply, please click here.

We want you to know that our patients are our #1 priority and providing high quality customer service is our goal. We take ownership that this has been an issue and we look forward to rectifying it.

Benign Paroxysmal Position Vertigo (BPPV) Case Study

Are You Experiencing Vertigo and Dizziness?
Don’t Wait Years to Get the Help You Need to Fix a Common Condition!

by Annette Pinder – Buffalo Healthy Living | Original article can be found here.

Suddenly, I was waking up dizzy every day. You know how sometimes when you’re on an elevator, and it dips suddenly, making your stomach flip? That’s what it felt like. I was moving up and down and sideways. I couldn’t get out of bed without feeling like I would fall, especially when I turned on my left side. Fortunately, I knew who to call.

Dr. Lixin Zhang is Director the Dizziness and Balance Center at Dent Neurologic Institute. His genuine concern for patients, extraordinary knowledge, and 90 percent success rate in helping patients with dizziness and balance issues makes him a hero to me. Fortunately, he made room for me in his schedule.

After reviewing my medications and possible stressors that might explain my dizziness, Dr. Zhang asked me to lie down. As he turned me to one side, the room started to flip as he exclaimed, “You really needed to come in!” He asked me to sit up, lie down, and turn a couple of times, and within seconds everything stopped. I was no longer dizzy. He said, “That’s it! It’s gone.” I was incredulous. Dr. Zhang said there is only a 15 percent chance that this will happen again, but if it does, I know where to go.

Dr. Zhang explained that what I experienced is called benign paroxysmal position vertigo (BPPV), the most common disorder of the inner ear’s vestibular system, and a vital part of maintaining balance. BPPV is benign, not life-threatening or progressive, and produces a sensation of spinning called vertigo that is both paroxysmal and positional, meaning it occurs suddenly with a change in head position.

Why does this happen? The vestibular organs in each ear include the utricle, saccule, and three semicircular canals. The semicircular canals detect rotational movement, are located at right angles to each other, and are filled with a fluid called endolymph. When the head rotates, endolymphatic fluid lags behind because of inertia, and exerts pressure against the cupula, the sensory receptor at the base of the canal. The receptor then sends impulses to the brain about the head’s movement.


vestibular organs in each ear


Dr. Zhang says BPPV occurs because of otoconia, tiny crystals of calcium carbonate that are a normal part of the inner ear’s anatomy. When the head is still, gravity causes the otoconia to clump and settle. When the head moves, the otoconia shift, stimulating the cupula to send false signals to the brain, producing vertigo and triggering nystagmus (involuntary eye movements). I was amazed when Dr. Zhang showed me a video of the episode of BPPV that I experienced, capturing those crazy involuntary eye movements. Visit to see how Dr. Zhang was able to fix my problem in seconds!

BPPV typically occurs on one side or the other, although in some cases it can occur on both sides. Symptoms include dizziness, lightheadedness, imbalance, difficulty concentrating, and nausea. Activities that bring on symptoms can vary, but are precipitated by changing the head’s position with respect to gravity. Most common movements include looking up or rolling over and getting out of bed. While the condition is not life-threatening, it can be very disruptive to a person’s work and social life, and pose a hazard due to an increased risk of falls.

According to Dr. Zhang, 2.4 percent of all people will experience the disorder at some point in their lifetimes. BPPV accounts for at least 20 percent of diagnoses made by physicians, and is the cause of approximately 50 percent of dizziness in older people. The good news is there is someone in Western New York who can stop BPPV in its tracks in 90 percent of all cases. If you have been suffering from any of the above symptoms, I urge you to make an appointment immediately with Dr. Zhang to get your life back by calling 716-250-2000 or visiting Learn more about BPPV at




The content of this post is intended for general educational and informational purposes only; it does not constitute medical advice. Readers should always consult with a licensed healthcare professional for diagnosis and treatment.


What is Rett Syndrome? | #OverpowerRett

Imagine the symptoms of autism, cerebral palsy, and epilepsy affecting one child who cannot speak. That is Rett syndrome.

Rett syndrome is a rare genetic neurological disorder that occurs almost exclusively in girls and leads to severe impairments, affecting nearly every aspect of the child’s life: their ability to speak, walk, eat, and even breathe easily.

The hallmark of Rett syndrome is near constant repetitive hand movements. Rett syndrome is usually recognized in children between 6 to 18 months as they begin to miss developmental milestones or lose abilities they had gained.

What causes Rett Syndrome?

The clinical features of Rett syndrome were first described in 1966 by Dr. Andreas Rett. Patients with these clinical features were subsequently given the designation of Rett syndrome in 1983 in recognition of Dr. Rett’s original report. Rett syndrome is still considered a clinical diagnosis based on specific developmental history and clinical criteria. These clinical criteria were last revised in 2010.

Rett syndrome is caused by mutations on the X chromosome on a gene called MECP2. There are more than 900 different mutations found on the MECP2 gene. Most of these mutations are found in eight different “hot spots.”

Rett syndrome is not a degenerative disorder with individuals living to middle age or beyond. It is not inherited. Rett syndrome occurs worldwide in 1 of every 10,000 female births, and is even more rare in boys.

Rett syndrome can present with a wide range of disability, ranging from mild to severe. The course and severity of Rett syndrome is defined by the location, type, and severity of the mutation and X-inactivation.


Symptoms for Rett Syndrome may not reveal themselves from six months until 18 months after an infant is born. One day your child is healthy and happy, grasping for things as babies do. The next day you notice they are experiencing:

  • Breathing difficulties
  • Cardiac Issues
  • Swallowing and digestive issues
  • Scoliosis
  • Seizures
  • Repetitive hand movements

These are just some of the symptoms of Rett Syndrome, a neurological disorder primarily affecting girls. Symptoms may be more severe in boys.

A mutated gene may be the cause of this disorder that affects all racial and ethnic groups around the world. That’s why it’s essential to know about Rett Syndrome Awareness Month in October.

Males with Rett

In 1999 it was reported that mutations in the MECP2 gene, located on the X chromosome, were associated with the clinical presentation of Rett syndrome. Since the ability to test the MECP2 gene has been available, there have been over 60 males reported with mutations in the MECP2 gene.

A few of these males had a clinical picture consistent with the clinical criteria for Rett syndrome; however, most of these males presented with a different clinical presentation. Most males with mutations in MECP2 gene present with an earlier onset of symptoms, typically with significant problems beginning at or shortly after birth.

The determination of Rett syndrome is still based on clinical criteria and the clinical presentation. Over 95% of females with classic Rett syndrome will have a mutation in the MECP2 gene. Mutations in the MECP2 gene by themselves are not sufficient to make a diagnosis of Rett syndrome. Patients with mutations in the MECP2 gene that do not meet the clinical criteria for Rett syndrome are given the designation of MECP2-related disorders.

How can you help?

Having a loved one with Rett Syndrome can be difficult. They often have behavioral problems and extreme levels of anxiety because they can hear and understand us, but cannot respond or move well on their own. Here are ways you can help someone you know who has Rett Syndrome:

Socialize. Kids must spend time with their peers, but when they can’t talk, it makes things difficult. Try teaching them yes and no with the direction they move their eyes, or even giving them a choice board so they can point to their answers. Taking a trip to the movie theater with friends is also a good idea because speaking will be minimal from both ends.

Be active. Again, this is something that can be hard when a child has trouble moving on their own. But, if you can help them on a short walk, go for a swim, or even ride horses, it can help with both physical and mental strength. Plus, it’s something the whole family can enjoy together.

Keep learning and be mindful.  There is constant research happening with Rett Syndrome. Hopefully, someday, a cure or better treatment will be discovered. The more you learn and are aware of what is truly going on in your child’s mind and body, the better you can react in ways that will make them feel comfortable.

5 Things You Might Not Know About Rett Syndrome

  1. The mutation is random. One of the most frustrating things about studying the gene mutation is that it occurs with conception, and other family members may not experience it.
  2. Sufferers can outgrow it. Many live satisfying lives well past middle age and into their later years.
  3. Babies seem healthy until it appears. Unlike other kinds of disorders, Rett Syndrome babies seem entirely normal until symptoms appear between six and 18 months after a female child is born.
  4. Varied symptoms. Rett Syndrome symptoms can include scoliosis, irregular breathing during the day, and sleep disturbances at night.
  5. Love and support make a difference. People impacted by Rett Syndrome can improve immeasurably with the love, understanding, and support of their family and friends.

To learn more or donate to Rett Syndrome, visit these organizations:


The content of this post is intended for general educational and informational purposes only; it does not constitute medical advice. Readers should always consult with a licensed healthcare professional for diagnosis and treatment.


World Stroke Day

If you or someone you know wants to make an appointment at the DENT Stroke Clinic, call 716-250-2000 or click here for more information.

World Stroke Day 2019 is October 29. The world stroke campaign’s goal is to raise awareness of stroke symptoms and the leading causes of strokes.

One in four people will have a stroke in their lifetime. Most strokes are preventable with a few simple steps. Here are the top tips that help to reduce the risk of stroke.

Control high blood pressure

Half of all strokes are associated with hypertension. Knowing your blood pressure and controlling it with lifestyle changes or medication will reduce your risk of stroke.

Exercise 5 times per week

Over a third of all strokes happen to people who do not get enough exercise. 20-30 minutes of moderate exercise five times per week will reduce your stroke risk.

Eat a healthy balanced diet

Almost a quarter of all strokes are connected to poor nutrition. Eating a diet that is high in fresh fruits and vegetables, and reducing consumption of processed food will reduce your risk of stroke.

Reduce your cholesterol

More than 1 in 4 strokes are linked to high levels of “bad” LDL cholesterol. Eating low saturated fats, avoiding processed food, and exercise will help to reduce your risk. If you are unable to maintain a healthy cholesterol level with lifestyle changes, your doctor may advise medication to help.

Maintain a healthy weight

Being overweight or obese was found in almost 1 in 5 strokes. Maintaining a healthy Body Mass Index (BMI) or Hip to Waist Ratio will help you reduce your risk.

Stop smoking and avoid smoky environments

Almost 1 in 10 strokes were associated with smoking. Stopping smoking will reduce your risk of stroke and the risks of people who live around you. Getting help to quit increases your chances of success.

Reduce your alcohol intake

Over 1M strokes each year were linked to excessive alcohol consumption. If you drink, keep it a limit of 1-2 units of alcohol a day.

Identify and treat atrial fibrillation

People with AP are 5x more likely to have a stroke than the general population. If you are over 50, talk to your doctor about AF screening. If you have AF, talk about treatments that will reduce your risk.

Manage diabetes

If you have diabetes, you are at a higher risk of stroke. Diabetes and stroke also share several risk factors, including diet and exercise. If you have diabetes, talk to your doctor about how to reduce your stroke risk.

Manage stress and depression

Almost 1 in 6 strokes are linked to mental well-being. Managing stress, depression, anger, and anxiety are all critical to reducing stroke risk.

Recognize signs FAST

F.A.S.T. is a way to recognize signs of a stroke.

FACE (has their mouth drooped?)

ARMS (can they lift both arms?)


TIME (time is critical!)

Why choose DENT?

There are about 1.5 Million strokes in the US each year. Nearly half of these are severe, requiring immediate hospitalization and often aggressive intervention. On the other hand, approximately 750,000 strokes occur with only passing symptoms. These mild strokes or Transient Ischemic Attacks (TIAs) are alarming, but often result in little or no deficit.

TIAs are critically vital warning signs of a potential devastating stroke. TIA symptoms must not be ignored. The Dent Mild Stroke/TIA clinic is run by experts in stroke neurology that have fine-tuned the diagnosis and treatment of this disease, resulting in a significantly reduction in the risk of a recurrent stroke.

Learn more about our comprehensive stroke center here.

Find out more about stroke risk factors and prevention at


The content of this post is intended for general educational and informational purposes only; it does not constitute medical advice. Readers should always consult with a licensed healthcare professional for diagnosis and treatment.


Suicide Prevention and Mental Health Awareness

Mental Health Promotion and Suicide Prevention Livestream Recap with Dr. Horacio Capote, Director of the DENT Psychiatry Clinic.

Talking about Mental Health and Suicide Prevention is very important. A million people a year died by suicide.

“There are a lot of myths to discuss and a lot of questions that you may have, so hopefully we will be able to cover a lot of these topics,” says Dr. Capote.

Myth: you can make someone suicidal by bringing up the topic

“This is completely false,” stats Dr. Capote. “In fact, many people are eager to discuss it, share it, and have an outlet.”

If you have suspicion that someone might have suicidal thoughts, it does not hurt to ask. You’re not going to do anybody any harm by asking. Instead, it shows that you are empathetic and that you care.

Myth: there is nothing you can do

“The data shows us that everyone is completely conflicted about suicide, all the way to the end,” explains Dr. Capote.

There are many places to intervene, and several things you can do. The first thing is to have curiosity to reach out and be willing to be part of the solution.

Recognize the warning signs:

Someone might show warning signs for suicide if they:

  • Suddenly are obsessed about death (talking about it, writing about it, etc.)
  • Have a change in personality
  • Have a change in behavior

“These are signs that something is going on that is worth identifying, and there are more major signs of trouble,” says Dr. Capote.

These significant signs of trouble are:

  • A family history of suicide
  • If that individual has attempted suicide before
  • If that individual has a mental illness

“People with schizophrenia and many other mental illnesses have a much higher risk for suicide compared to the general population,” explains Dr. Capote.

Treatment Options

“Sometimes, we tend to get a little pessimistic about treatment,” says Dr. Capote.

It is important to note that there are many many types of treatment, not just medication treatment. There are many forms of psychotherapy (psychodynamic psychotherapy, supportive psychotherapy), cognitive-behavioral therapy, dialectical behavioral therapy, and lifestyle management.

Lifestyle management include how you eat and exercise. Active people feel engaged and empowered. The Meditteranean diet is good for the brain.

“The Meditteranean diet is probably just a fancy way of saying ‘eat colorful foods,'” Dr. Capote jokes. “If it is colorful, not bleached, and not processed, you know it has a lot of antioxidants that are helpful and protect your brain.”

Why choose DENT Neurologic Institute

There are a variety of treatments, and DENT Neurologic Institute, fortunately, has all of them available.

“To my knowledge, DENT is perhaps one of the few places that may offer these various treatments in one location,” says Dr. Capote. “We are the only free-standing outpatient institute in the country that offers electroconvulsive therapy.”

If you or someone you know wants to become a patient at DENT, call us at 716-250-2000. Click here to learn more about our Psychiatry Center.

If you are in crisis, please call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255) or contact the Crisis Text Line by texting TALK to 741741.


The content of this post is intended for general educational and informational purposes only; it does not constitute medical advice. Readers should always consult with a licensed healthcare professional for diagnosis and treatment.


Spasticity Clinic Livestream Recap

On September 13th, we went Live ith Dr. Bennett Myers, Co-Director of DENT’s new Spasticity Clinic. Spasticity is, unfortunately, a prevalent problem that we see at DENT Neurologic Institute.

What is Spasticity?

In its broadest terms, spasticity refers to abnormal muscle contraction that is produced by an injury to the brain and spinal cord. Often, it can be confused with muscle spasm.

All of us have had muscle spasms in our neck, back, or arms. Muscle spasm also refers to a kind of abnormal muscle contraction. It is fundamentally different than spasticity.

The difference is not always evident to most people.

“Neurologists who are skilled in diagnosis and assessing patients can usually pick [the differences] up quite readily,” explains Dr. Myers. “There needs to be some sort of injury to the brain or spinal cord to produce spasticity.”

Most Common Causes + Diagnosis

The most common causes of spasticity that we often see are diseases of the central nervous system, like Multiple Sclerosis, Cerebral Palsy, or brain tumors. Spasticity is not a disease in itself; it’s more of a symptom of a lot of different types of conditions.

Most patients who show up to the Spasticity Clinic already have a diagnosis for whatever is wrong with their central nervous system that is reducing the spasticity.

“Since most patients who come to the clinic already have a diagnosis, our focus at the DENT Spasticity Clinic is focusing on management of the spasticity,” explains Dr. Myers.

Why do you need to manage spasticity?

Not all spasticity needs management.

“Some patients will have some weakness in their legs,” explains Dr. Myers, “and the spasticity is helpful to them. It helps keep them upright and enables them to walk.”

If you over treat the spasticity, you can take someone who can walk and treat the spasticity, and now their legs are weaker, and they are unable to walk.

“We always have to be very clear as to what we are trying to accomplish when treating the spasticity,” says Dr. Myers. When treating someone with spasticity, the specialists at DENT first identify what the cause is. Next, they figure out if the spasticity is causing problems for the patient and what those problems are.


What is the goal of treatment?

Spasticity can be quite painful. Relieving pain for patients could be a goal of treatment. Sometimes, spasticity is not helpful, and it can interfere, which is more common in the arms and the hands.

“For example, people [who] have had strokes. Maybe they are not paralyzed. There is a weakness, but they have some movement. The muscles become very spastic from the injuries to the brain, and the spasticity interferes with function,” says Dr. Myers. “So, our goal of treatment in that individual may be to improve function.”

Those who have more severe spasticity, it is not only painful, but it can be hard for them to care for themselves. “If a patient has severe spasticity of their arm, so their arm is curled up very tight, you can imagine it is hard t get a shirt on and off,” says Dr. Myers. “A goal of treatment for that individual may be to relieve the spasticity to make it easier for the patient to get dressed.”

What is a contraction or contracture?

We often treat spasticity to prevent contracture formation, which is scarring at the joints.

“An example of this is if I took my arm, put it in a sling, and leave it there for three months. Later, if I took the sling off, I might not be able to move my arm at all,” says Dr. Myers. “Why is that? Neurologically I am fine, but the problem here is that the joints have stiffened up so severely and scarred down that now they do not move anymore.”

Someone who has had the issue after any type of injury to the brain or spinal cord will eventually have their joints tighten up and scar. The mentioned injury can be a painful situation. Often, preventing contracture formation is a goal when treating spasticity.

Steps take to diminish spasticity

We don’t treat spasticity for the sake of it. We want to relieve pain, improve function, prevent contracture formation, and make our patients’ lives better in some way.

The treatment plan depends on how much of the body is involved and how bad the spasticity is.

“Let’s take someone who has mild to moderate degree of spasticity, for example. The first thing we try is physical therapy, occupational therapy, stretching, and regular exercise,” Dr. Myers explains. “We will see if we can get an adequate handle on the spasticity without resorting to any medication.”

The treatment suggestions mentioned by Dr. Myers do not have any side effects. Our first form of treatment is trying to manage spasticity without an invasive or medication approach. “When we can be successful in that rate, usually everybody is quite happy,” says Dr. Myers.

“Often, that is not enough, and we need to be more interventional,” Dr. Myers adds in.

Interventional Treatments

The next step will often be medication. There are several medications that we commonly use that relieve spasticity. These usually work best in people where the spasticity is relatively widespread, or is severe.

Most medicines that help with spasticity have the same side effect: sleepiness.

“If I am making them semi-comatose where they’re sleeping 20 hours as a side effect, I am not doing them any favors,” says Dr. Myers. “That is often our limitation to using medication. If it is a high enough dose, I can relieve an awful lot of spasticity. However, if someone is sleeping all the time, then I haven’t improved their quality of life, which is the whole goal of why I am treating the spasticity.”

Why choose DENT?

The DENT Neurologic Institute is among the largest, most comprehensive neurology practices in the United States. We are focused on providing superior clinical care, advanced diagnostic services, clinical research, and education.

The breadth and scope of our clinical expertise has allowed the creation of our specialty clinics. Every clinic has the same mission: to provide a disease-specific approach to treatment. This unique and integrated model has strengthened our standards of care, quality measurement, outcomes, and participation in clinical research.

To make an appointment, please call 716-250-2000. More information about our new Spasticity Clinic will be released soon.


The content of this post is intended for general educational and informational purposes only; it does not constitute medical advice. Readers should always consult with a licensed healthcare professional for diagnosis and treatment.


Reasons to see a Spine Specialist | DENT Spine Center

Spine Specialist in Buffalo, NY | Neck pain and back pain can range from being an irritation to being debilitating. No matter the pain level or the injuries and conditions you may have, the DENT Spine Center has more treatment options now than ever before. 

Dr. Thomas Pfiffner, DENT’s Spine Specialist, can diagnose the cause of your pain and counsel a wide range of remedies. Dr. Pfiffner brings over 20 years of experience as a chiropractor to DENT.

In this blog post, we will highlight why you should consider seeing our Spine Specialist.


#1 – Team Access

Our team specializes in spine disorders, neuroradiology, chronic pain management, physiatry, and physical medicine and rehabilitation. On top of that, the DENT Spine Center, UB Neuro and Buffalo Rehab group are all conveniently located in one spot. 


#2 – Non-surgical Treatment

Every back and neck pain patient is unique, and our team can help determine a diagnosis outside of surgery. Surgery may seem like the obvious and only option if your neck and back pain is severe enough. However, a spine specialist can ease your neck pain or back pain in non-surgical manners. 


#3 – Are You Suffering From Debilitating Pain?

It might be time to call a Spine Specialist if your neck and spine problems are causing you to miss work or day-to-day activities. Signs or symptoms to see a Spine Specialist may include back or neck pain that :

  • Does not get better, or worsens
  • Produces numbness, tingling or weakness
  • Makes fine motor skills and/or general movement hard

Having one or more of these conditions that affect your activities can sometimes make you feel hopeless. The DENT Spine Center is focused on getting the right treatment plan for you.


#4 – Learning about the cause

What is really causing the problem? Are there any changes I can make to improve the pain? What treatment options will lead to normalcy? A spine specialist can answer all of these questions, plus more.


Why choose DENT?

Specializing in the brain and spine, patient-centered care is our primary focus at the DENT Spine Center. With on-site collaboration between DENT, Buffalo Rehab, Bennett Rehab and University at Buffalo Neurosurgery, we provide unparalleled coordination and expertise to manage the most complex spine conditions. Our full-service imaging with onsite neuroimaging and general radiology experts are from DENT and Western New York Imaging. 

DENT provides ongoing research and development on the region’s most sophisticated MRI. This brings state of the art diagnostic capabilities to our patients, while simultaneously delivering an experience that elevates patient comfort.


Expanded Imaging Services

DENT has recently expanded our Imaging Services at the new Spine Center on George Karl Boulevard, near Wehrle and Transit. In addition to MRI and Ultrasound services, DENT is seeing the return of CT, and is venturing in X-Ray for the first time.

X-rays are available for pediatric and adult patients.

CT will be available from newborns to adults. Our new scanner has software to limit radiation exposure to our pediatric patients.




Our Spine Specialist and team is ready and excited to take care of you. To learn more, click here or call 716-250-2000 to make an appointment – help is one phone call away.


The content of this post is intended for general educational and informational purposes only; it does not constitute medical advice. Readers should always consult with a licensed healthcare professional for diagnosis and treatment.


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