Clinical Trials

Multiple Sclerosis Research:

PASSAGE – Safety Study in Patients With Multiple Sclerosis Treated Fingolimod or Other Approved Disease-modifying Therapies
This study is for patients with relapsing forms of MS, who are newly starting treatment with Gilenya (fingolimod) at the beginning of their trail participation. Participants are only asked to attend their normal office visits, from which anonymous medical information is taken to contribute to an ongoing safety analysis of this medication. Enrolled patients will have our office visits paid for by the study until 2022, but don’t wait, enrollment ends in November of 2017!
Learn more about PASSAGE

AbbVie M14-173 – A Multiple Dose Study of ABT-555 in Subjects With Relapsing Forms of Multiple Sclerosis
Patients who are currently not on treatment for their relapsing Multiple Sclerosis, or have been on a steady dose of an oral or injectable treatment for at least 3 months may be eligible for this trial. AbbVie Inc., a pharmaceutical company, has set out to see if their experimental treatment “ABT-555” is a safe and effective way to further fight the effects of this disease. The treatment is via 4 infusions, and participants would randomly receive one of three dose strengths or a placebo.
https://clinicaltrials.gov/ct2/show/NCT02601885?term=m14-173&rank=1

Dementia Research:

IDEAS – Imaging Dementia—Evidence for Amyloid Scanning Study
The purpose of this study is to assess the impact of amyloid PET scans, which are useful to diagnose Alzheimer’s disease and other types of dementia, on patient outcomes. Those eligible must be 65 years of age or older and have Medicare Part B or C as their primary insurance. The goal of the study is to find if amyloid PET scans will decrease uncertainty and increase confidence in the underlying cause of cognitive impairment or dementia, which could translate into earlier counseling and interventions in these domains and potentially lead to better outcomes. Amyloid PET scans have been approved by the FDA, but are expensive and currently not covered by insurance. This trial offers this scan at a tremendously reduced cost, or even for free depending on your secondary insurance plan!
Learn more about IDEAS

AWARE – A Study to Evaluate the Efficacy and Safety of ABBV-8E12 in Subjects With Early Alzheimer’s Disease
The purpose of the AWARE trial is to determine the efficacy and safety of an experimental treatment (ABBV-8E12) for patients with Alzheimer’s disease. For those who qualify to participate, ABBV-8E12 treatments would be administered through an IV infusion once a month for two years in our office. This study is testing three dose strengths compared to placebo, so participants have a 75% chance of receiving the treatment. Enrolled patients will have the medication and office visits paid for during the study, and will be generously compensated for their time!
Learn more about AWARE

Neurogenic Orthostatic Hypotension (NOH) Research:

RESTORE – Sustained Effect of Droxidopa in Symptomatic Neurogenic Orthostatic Hypotension
The purpose of this study is to evaluate the efficacy and safety of Northera (droxidopa) to treat neurogenic orthostatic hypotension (NOH). NOH symptoms include dizziness, light-headedness, or feelings that you may black out upon standing. This medication is for patients who also have Parkinson’s Disease (PD), Multiple System Atrophy (MSA), Pure Autonomic Failure (PAF), Non-Diabetic Autonomic Neuropathy (NDAN) or Dopamine Beta-Hydroxylase (DBH) deficiency. Northera has been approved by the FDA, and participants will receive medication and office appointments paid for during the study, as well as compensation for participation and travel expenses!
Learn More about RESTORE

To learn more about participating in one of these studies, please contact our Clinical Research Coordinator:
Lindsay Wenger
Lindsay@integratedneurologyservices.com
703-313-9111 ext. 107

 

Study sponsors: Our office is interested in further expansion and diversification of our clinical trials so that we can offer these opportunities to more of our patients. If you are currently recruiting sites for any clinical trial pertaining to a neurological condition that does not compete with our current trials, feel free to call or email Lindsay with information!

Multiple Sclerosis (MS)

Integrated Neurology Services

Patients concerned with a diagnosis of MS often experience a number of emotions. In addition to feeling anxious and sometimes confused, people often wonder how a diagnosis of MS will affect their relationships, work, and everyday life.  With many decisions to make, including which treatment course is best for you, it is important to build a comfortable working relationship with your clinical team.

At Integrated Neurology Services, PLLC,  we follow the standards of NEDA, or No Evidence of Disease Activity. What this means is we define success of a therapy as the absence of new or enlarging lesions on MRI in addition to the absence of worsening disability as defined by the EDSS (Expanded Disability Status Scale). This approach leads to the possibility of earlier detection as well as a more accurate prognosis and is now viewed as the benchmark by which all Disease Modifying Therapy (DMT) is measured .

Why should you choose Integrated Neurology Services as your MS specialists?

  • We view MS as a controllable disease.
  • Academic level care in service. Dr. Fishman, a board certified Neurologist,  is well known for his skill, experience, and success in treating MS.  He has been at the forefront of MS treatment since 2005. The Infusion suites at Integrated Neurology Services were the first establishment to infuse Tysabri in the Metro D.C. area outside of a clinical trial.
  • Clinicians from Georgetown University Medical Center, Johns Hopkins Hospital, and the University of Virginia Health System frequently refer patients to Dr. Fishman for his expertise.
  • Our MS Center is a certified chapter of the Consortium of Multiple Sclerosis Centers
  • We have three convenient locations in the Metro DC area: Alexandria, Falls Church, and Lorton, Virginia.
  • Short wait times for new patient appointments. At Integrated Neurology Services, we aim to get you an appointment with one of our highly qualified clinicians in as short a time as possible.

What is Multiple Sclerosis (MS)?

MS is a disease of the central nervous system made up of the brain, spinal cord and optic nerves. Typically, the nerve pathways of the central nervous system are protected by a covering called the myelin sheath. This sheath acts as an insulator for the nerves and helps to increase the rate of conduction. In patients with MS, the myelin sheath is attacked by their own immune system. This leaves the nerves exposed and prone to further damage resulting in a disruption of flow of information traveling from the brain to the rest of the body.

Depending on the extent of the damage, symptoms of MS can include any combination of the following:

  • Numbness
  • Tingling
  • Muscle stiffness
  • Weakness
  • Balance issues
  • Vision issues
  • Fatigue
  • Bowel and/or bladder incontinence
  • Sexual difficulties

Origins of MS Treatment

Many doctors think of MS as a progressive disease with no effective treatment. It wasn’t until the advent of MRI’s 1980s that let us see the brain closely enough to develop effective therapies. Researchers tested different treatment regimens on patients with little success until the 1990s.

In 1993, the first treatment, Betaseron®, became available. Until 2007, it remained the only treatment option. Since that time, however, other treatments have been developed with additional promising drugs are on the horizon. Since that time we now have at our disposal:

3 oral medications:

2 infusible medications:

And 5 injectable medications:

At Integrated Neurology Services, we offer all treatment options in an attempt to manage most, if not all, of your overall symptoms. Our goal when developing a treatment strategy for our patients with MS is to manage patients’ symptoms while also attempting to stop any worsening progression of MS. We will tailor your treatment options to best suit your needs. While it is important to initiate treatments targeted towards the Multiple Sclerosis, it is also crucial to treat the patient as a whole.

Current MS Treatment Options

Disease Modifying Treatment (DMT)

For patients with relapsing-remitting MS, disease modifying treatment (DMT) can decrease the frequency and severity of relapses. DMT serves as the cornerstone for the management of MS. Currently, ten drugs have been approved for this purpose:

 

Medication Type Examples Method of Administration
Injectables Betaseron®
Avonex®
Rebif®
Extavia®
Copaxone®
Patients administer injectable medications themselves in the form of a shot under the skin or in a muscle. Depending on the medication type, doses may be given daily or weekly.
Intravenous Infusion Novantrone®
Tysabri®
These drugs are given at the clinic, often monthly or quarterly. (Learn more about our infusion suite.)
Oral Medications Gilenya®
Aubagio®
Tecfidera™
These medications are pills taken by mouth once or twice a day.

 

Recommended Websites:

Virtual MS Center

For US healthcare professionals only

https://www.tysabrihcp.com/en_us/home/resources/rms-videos/tys-1007905-fishman.html

https://www.tysabrihcp.com/en_us/home/resources/rms-videos/tys-1009858-fishman.html

https://www.tysabrihcp.com/en_us/home/resources/rms-videos/tys-1007998-fishman.html

https://www.tysabrihcp.com/en_us/home/resources/rms-videos/tys-us-0066-fishman.html

Treatments

Sleep Apnea

Treatments for sleep apnea include CPAP or Bi-level titrations as well as individualized treatment education and follow up. Other treatments for sleep apnea including surgery and oral appliances are also available.

Insomnia

We provide both cognitive behavioral therapy as well as pharmacologic therapy for the treatment of insomnia.

Narcolepsy

We have extensive experience in providing both pharmacologic and behavioral treatment to patients with narcolepsy.

Restless Leg Syndrome

Treatments for Restless Leg Syndrome including vitamin supplementation and pharmacological therapy are available.

Other Sleep Related Disorders

Behavioral and pharmacologic therapies are available for the treatment of disruptive sleep events such as confusional arousals, sleepwalking, sleep terrors and REM behavior disorder. We also provide therapy for circadian rhythm disorders, sleep related movement disorders, sleep related epilepsy and sleep related headaches.

When applicable, all treatment modalities that we provide are available for both the adult and pediatric population.

Diagnostic testing

Polysomnogram (PSG)

Lab-PSGLab-PSGA polysomnogram monitors a person’s sleep habits overnight in a sleep lab. The sleep technologist will position tiny painless sensors to different points on the patient’s body to record brain waves, respiratory flow, blood oxygen level, muscle activity, heart rhythm, body position and other body functions during sleep.
During a sleep study, the technologist is in constant video and audio contact with the patient, providing a safe, supportive environment with minimal anxiety.
Treatments for sleep and breathing disorders such as sleep apnea, including the administration of positive airway pressure (PAP) and nocturnal oxygen, are frequently initiated during a PSG.

PAP Titration Study

Lab-CPAPLab-CPAPA positive airway pressure (PAP) titration study is performed on someone who has already been diagnosed with sleep apnea or a sleep related breathing disorder by a PSG.
In addition to all the sensors used in a PSG, the sleep technologist will help the patient to find a comfortable mask that best fits his or her face. When connected to a small flow generator, the mask allows air to gently blow into the back of the patient’s throat to maintain an open upper airway so that the patient can breathe normally. The air flow pressure is gradually increased during the night, in order to find the right level of air pressure that will prevent the collapse of the patient’s upper airway. This will eliminate loud snoring and maintain an adequate blood oxygen level.

Nap Studies – Multiple Sleep Latency Test (MSLT) & Maintenance of Wakefulness Test (MWT)

Lab-MSLT-MWTLab-MSLT-MWTBoth nap studies are done during the daytime. MSLT is used to see how quickly a person falls asleep in quiet situations during the day. This test is the standard way to objectively measure an individual’s level of daytime sleepiness and is used to diagnose hypersomnias such as narcolepsy. The study is always preceded by an overnight PSG in the lab. It consists of a series of daytime naps in which the patient’s sleep is monitored, with similar sensors as those used in a PSG.
In contrast, the MWT is used to measure how alert a person is during the day and it shows whether or not the individual is able to stay awake for a defined period of time. This is an indicator of how well a person is able to function and remain alert in quiet times of inactivity. Unlike the MSLT, MWT is not preceded by an overnight PSG. It consists of a series of sleep trials during which the sleep technologist will monitor the patient’s ability to resist the urge to fall asleep.

Home Sleep Study

Home-PSG-StudyA home sleep test involves the use of a portable monitoring device that is worn while sleeping. The patient would come to our clinic and be instructed on how to put on the device by our sleep technologist. After the night is over, the portable monitoring device is returned to our clinic and its recorded data will be promptly interpreted.
Home sleep study has the benefits of sleeping in one’s own bed and not have the nightly routine interrupted. However, home sleep study is only applicable for a selected group of patients and only used to diagnose obstructive sleep apnea. Furthermore, it is only conducted as part of a comprehensive sleep evaluation performed by our medical director.

Clinical Consultation

Sleep medicine consultation is a critical part of our services. We are committed to providing comprehensive evaluation, diagnosis and treatment to patients with obstructive sleep apnea (OSA), insomnia, narcolepsy, circadian rhythm disorders, restless legs syndrome (RLS) and other sleep disorders. We also welcome pediatric consultation for sleep disorders. For your convenience we have a Patient Referral Form which can be downloaded or obtained from our office.

Spasticity / Contracture

What is spasticity?

Spasticity is defined as an involuntary, velocity-dependent, increased resistance to stretch. This definition means that the amount of resistance to stretching is partly determined by the speed with which a spastic muscle is stretched, and manifests as pain, tightness, or posturing

What is a contracture?

Fixed resistance to passive stretching of a joint due to shortening or wasting (atrophy) of muscle fibers, tendons, or the development of scar tissue (fibrosis) of the joints.

Causes of Spasticity

The most common causes of spasticity are lack of oxygen to the brain before, during, or after birth (cerebral palsy); physical trauma (brain or spinal cord injury); blockage of or bleeding from a blood vessel in the brain (stroke); and multiple sclerosis (MS). When the damage that causes the eventual spasticity first occurs, the muscles are usually flaccid before they become spastic. Spasticity may not be present all the time—it may be related to a trigger, or stimulus, such as pain, pressure sores, a urinary tract infection, ingrown toenails, tight clothing, or constipation.

Our Approach

Spasticity and contractures are symptoms commonly experienced in many different diseases that can affect the nervous system. Therefore, the treatments have to be tailored specifically for each individual patient depending on their underlying ailment, their level of independence, their individual goals, and care setting.

The initial assessment and treatment is dependent on the severity of the spasticity, which limbs are affected, the amount of tendon shortening, and any joint abnormalities. Generalized therapy includes treatment with oral medications, or with implantable devices that deliver medicine directly into the spinal canal. Isolated therapy includes injections, particularly with botulism toxin and tendon stretching.

Occasionally, patients with severe spasticity or contractures will have difficulty making further progress with no operative treatments. For these patients surgery can be very helpful.

Surgery can be a very powerful tool to “unlock” the functional potential within a patient that is being overpowered by spasticity or contractures.

This program applies a team approach to treating spasticity and contractures. The combination of dedicated physical/occupational therapists, neurologists, orthopedic/neurological surgeons, and orthotic specialists, all with different but complimentary skills and experiences, ensures the best possible outcome.

Dr. Simon Fishman

Dr. Simon Fishman is board certified by the American Board Of Neurology and Psychiatry and the American Board of Neuromuscular and Electrodiagnostic Medicine. He has extensive experience with movement disorders, neuromuscular disease, rehabilitative neurology, stroke, degenerative neurological disorders, and therapeutic use of Botox and Baclofen.
Dr. Fishman has been practicing general neurology, since July 2000, in Northern Virginia with admitting privileges at Inova Fairfax and Alexandria Hospitals and Mount Vernon Hospital.

More about Dr. Fishman »

Additional Resources

Infusion Suite

Our spacious, relaxing infusion suite, features wall-to-wall windows and is staffed by the highest quality infusion nurses. We offer an array of infusion therapy options at Integrated Neurology Services. If you have questions about an IV treatment–ask us!

Starting January 2017, some insurance companies will require patients to seek intravenous treatment outside of a hospital setting due to high costs. Integrated Neurology Services is happy to provide above-quality care for patients seeking  IV therapy. If you are looking for a new IV clinic, please contact us at 703-313-9111.

What is The Infusion Suite?

The Infusion Suite is an outpatient medical office that provides infusion services in a convenient and personal setting. The Infusion Suite is supervised by our highly qualified trained medical team who coordinates care with doctors and pharmacies, performs pre-authorizations, and anything else that is required to provide treatment.

All our infusion centers are equipped with reclining chairs, state of the art infusion pumps, televisions, and wireless internet. Patients also have access to refrigerators and microwaves.

Infusion Therapies

Clinical Monitoring

  • Prior to receiving IV treatment, all patients are evaluated by our clinical team for proper medication dosing and interactions with outstanding conditions.
  • All nurses are trained to monitor vitals and to observe for potential side effects.
  • Lab services are available if requested by referring physician.

All major insurances are accepted.
Weekend hours are offered two weekends a month.

Call now to schedule!

 

IV FAQ

Read through some commonly asked questions about our infusion suite service. If you have any other questions please feel free to ask us!

What is an infusion?

An infusion is a method of delivery for medications and fluids through a vein.

Who administers my infusion treatment?

An RN administers the treatment.

Where can I go for my infusions?

Hospitals, private infusion clinics, and at home. These all have varying costs and pros/cons such as level of comfort, privacy, safety, etc.

Will my doctor be at my infusion?

An INS MD will be in the building M-Th, 0800-4:30, so if your infusion is taking place during this time, there will be a doctor in the building. Keep in mind that it may not be your prescribing doctor and if you would like to see a physician, it is best to schedule an appointment with them. If your prescribing MD is not an INS physician, then they will not be present for your infusions.

How long will it take to receive my infusion?

It depends on what drug/therapy is being infused and how well the patient tolerates it.

Can I bring anyone to my appointment?

Yes, but depending on how busy the infusion suite is, they may or may not be able to sit with you during your treatment. They are always welcome to wait in our waiting room, however. It is always recommended to have someone else drive you to and from your first few appointments until you know how well you tolerate your treatment.

What can I expect at my appointment?

You can expect to come into the office and check-in with the front desk. They will verify your insurance info, collect a co-pay if indicated and verify that all of your paperwork is completed/up-to-date. You will then be taken back to the infusion suite when the nurse is ready to begin your infusion. The RN will start with an assessment to include checking your vitals, reviewing your current medications,  and noting any changes since your previous appointment or establishing a baseline if you are a new patient. The RN will also provide teaching about your infusion for new patients. The RN will then start your IV and administer any premeds as ordered, then start the infusion of your medication. Vitals will be checked periodically during the infusion, and once your infusion is complete. You will be observed for 30 minutes after your infusion during which time a saline flush will be administered. After one more set of vitals are taken, you will be discharged with verbal or written instructions as appropriate providing that there haven’t been any complications or reactions. You will also be scheduled for your next infusion before you leave the infusion suite.

What should I wear to my infusion?

You can wear anything you would like, but we recommend comfortable clothing and request that you wear clothing that allows easy access to arms so that we can start your IV without complication. Avoid sleeves that are too tight as they may restrict the flow of your IV. If you have a mediport, you will want to wear a button-up shirt or a shirt with a v-neck or lower neckline so that we can easily access your port.

What can I do during my appointment?

During your appointment, you may watch one of our TV’s, utilize our free WiFi to enjoy on your own device (cell phone, laptop, tablet), read, sleep, color, etc. Please do remember that our infusion suite is a shared space so we kindly request that you limit cell phone calls to short, essential calls (coordinating rides or urgent matters only), and please use headphones for music/movies/games etc. (We have a few loaner pairs in case you forget yours). We also provide earplugs at all of our infusion suites for those that prefer a quiet environment. We also have pillows and blankets on hand for comfort, but feel free to bring your own if you wish.

Will I be allowed to eat during my infusion?

You may eat during your infusion, but we do request that you avoid bringing in odoriferous foods as the infusion suite is a shared space and we want to be sensitive to other patients that may not feel well. We do have a refrigerator and a microwave on site and we are more than happy to heat up your food for you or keep it chilled until you are ready to consume it.

 

If you have any other questions, feel free to contact us!

 

For US healthcare professionals only click here

 

 

Integrated Sleep Services

At Integrated Sleep Services, we have specialized sleep clinics and labs that provide all the required services needed to diagnose, treat and support patients with sleep disorders. These integrated services enable us to offer patients and referring physicians greater convenience, valuable information and better outcomes.

Clinical consultation

Sleep medicine consultation is a critical part of our services. We are committed to providing comprehensive evaluation, diagnosis and treatment to patients with obstructive sleep apnea (OSA), insomnia, narcolepsy, circadian rhythm disorders, restless legs syndrome (RLS) and other sleep disorders. We also welcome pediatric consultation for sleep disorders. For your convenience we have a Patient Referral Form which can be downloaded or obtained from our office.

Diagnostic testing

We provide a variety of diagnostic sleep test services, including PSG, PAP Titration Study, Nap Studies, and Home Sleep Study. Read More

Treatments

We provide treatments for all kinds of sleep disorders, including Sleep Apnea, Insomnia, Narcolepsy, Restless Leg Syndrome, and other sleep-related disorders. Read More

Obstructive Sleep Apnea (OSA)

OSA is the most common category of sleep-disordered breathing affecting at least 18 million Americans. OSA occurs when a person stops breathing continually during restorative sleep. Breathing is stalled because of the airway collapses and prevents air from getting to the lungs. The pauses in breathing causes decrease in oxygen levels and awakenings to clear the throat. Disrupted sleep can results in sleepiness and fatigue during the day, as well as increase your likelihood of a stroke or heart attack.

OSA is completely treatable and reversible.

What are symptoms of OSA?

  • Apnea (Gasping while asleep)
  • Daytime sleepiness.
  • Morning Headaches.
  • Snoring
  • Depression
  • Memory/Concentration Difficulties
  • Nocturia (getting up at night to urinate)
  • Decreased energy
  • Decreased libido
  • Shortness of breath
  • Uncontrolled blood pressure at early age

Who is at risk for Sleep Apnea?

  • Men older than 45, women older than 50.
  • 10% above ideal body weight.
  • Neck size greater than 17 inches.
  • People with diabetes, high blood pressure, heart disease, or nocturia (frequent urination at night)
  • Those with family history of OSA
  • Snorers

Importance of Sleep

Lack of restful sleep can have negative effects on all aspects of life, such as increased rates of accidents, decreased quality of life, difficulty concentrating, and increased rates of depression. Sleep problems can also increase the risk of heart disease, stroke, hypertension, and death.

What is a Home Sleep Test?

A home sleep test involves the use of a portable monitoring device that is worn while sleeping. New guidelines by The American Academy of Sleep Medicine states that home sleep tests can help detect obstructive sleep apnea (OSA) in selected adults.

For Your Sleep Study

  • Please arrive on time to your appointment, since it can take up to 30 minutes for the equipment to be hooked-up.
  • Wear a shirt that you plan to sleep in: t-shirt or tank top.
  • We suggest you bring either a button down or zippered top to put on after you have been hooked-up.
  • Must make an appointment for the next morning to un-hook the equipment. Must be prior to 1 pm.
  • There is a $10 per hour charge for all un-hook appointments scheduled after 1 pm.
  • There is a $100 refundable deposit fee for the equipment. Please bring either a check or credit card to your appointment. The fee will only be taken in the case of broken or lost equipment.

Please download, print and sign the Sleep Study Cancellation Agreement below.

Sleep Study Cancellation Agreement

The following links take you to physician-monitored patient education provided by healthcommunities.com