See Marin IJ 8/25/18 article by Mark C. Volain - Marin schools focus on concussions as football participation declines

What does a concussion do to the brain?
A concussion occurs when the head hits or is hit by an object, or when the brain is jarred against the skull with sufficient force to cause temporary loss of function in the higher centers of the brain. The injured person may remain conscious or lose consciousness briefly and is disoriented for some minutes after the blow.

According to the Centers for Disease Control and Prevention, approximately 300,000 people sustain mild to moderate sports-related brain injuries each year. Most of them are young men between 16 and 25 years of age.

The risk of concussion from football is extremely high, especially at the high school level. Studies show that approximately one in five players suffer concussion or more serious brain injury during their brief high-school careers. The rate at the college level is approximately one in 20. Rates for hockey players are believed to be similar.

Concussion causes the brain to be jarred against the hard skull. This leads to inflammation, swelling and sometimes bleeding in the neurons and synapses in the brain. If untreated the brain pressure can rise and lead to fatal consequences. That’s why most common symptoms are confusion, headache, blurred vision, dizziness, cognitive problems, memory loss, mood swings and sleep disturbances. The injury to brain changes with the severity and recurrence of the impacts. Especially losing consciousness should be taken very seriously.

There have been a lot of studies recently linking head trauma like concussion to future issues like dementia and CTE. How have these studies impacted your practice, be it an increase is patients, less patients, more people looking for more info, people looking into preventative measures, etc.?
I have been seeing more high school and middle school students with soccer, basketball and football head traumas. The awareness of short and long term implications of head trauma are now well known by atheletes, parents and coaches. They all are looking for safer ways of playing sports. In adults, I see a lot of car accidents or bike accidents with head trauma or whiplash injuries to head and neck region. My patients with head injuries and postconcussion syndromes are exponentially increasing. The reason they all seek medical attention is the awareness and data on CTE and potential dementia.

What do you tell athletes who have suffered a head injury?
The atheletes who suffered a head injury should immediately stop playing their sport until they are evaluated by a professional. They should only go back to playing when all of their symptoms resolve. If they return earlier, their recovery will be delayed and they may be left with long term complications. On top if it, every additional head injury will cause further damage and delayed recovery. Therefore I recommend to be seen by a trained professional as soon as the injury occurs. Depending on the injury the atheletes may need brain scan, neuropsychological evaluation and treatment.

How do you feel about protocols that many schools have in place for dealing with head injuries and when they're able to return to both learning and competing athletically?
Many high schools and colleges now have initial impact or concussion evaluations before the students start playing their sports. I reviewed some and they are comprehensive. I feel strongly that this should be a country wide protocol in every school and concussion tests should be given annually to the students/athletes with no injuries and after every head injury. All atheletes, coaches and volunteering parents should take courses and get knowledgeable about the head injury protocols. The atheletes should only return to sports when they are fully recovered. The students should be allowed to home school and take their tests with accommodations till they fully recover.

Anything else you'd like to share in regards to athletics-based head injuries?
All athletes professional or school/college level should be given comprehensive courses regarding concussion. They should learn about signs and symptoms of concussion, post concussion syndrome and second impact syndrome. If they are aware of the symptoms then they will recognize them faster and take logical action themselves. It should be a mandatory training at schools to educate the students at every level. They should reach out to their primary care doctors with any questions if coaches or schools are not attentive to them.

We’ve all had mornings when it was tough to function because of a poor night’s sleep. But when those poor nights of sleep happen repeatedly, it can create serious health problems for us. Why sleep is so critical to good health is the theme of my newsletter this month.  

The information in this blog post will help you understand why sleep matters and how you can get the most benefit from your shuteye.

Please take a look at the video below, and if you have any questions or you want to know more about sleep and your health, please don’t hesitate to contact my office.

We are excited to share the new publication below. This study provides Class 1 evidence that for patients with migraine, gammaCore (non-invasive Vagus Nerve Stimulator) significantly increases the probability of having mild pain or being pain-free 2 hours post stimulation.
Follow the link below to review the published paper.
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Contact the Neurology Clinic of Marin for an appointment! 

Marin General Hospital has received the American Heart Association/American Stroke Association’s Get With The Guidelines®-Stroke Gold Plus Quality Achievement Award. The award recognizes the hospital’s commitment to ensuring stroke patients receive the most appropriate treatment according to nationally recognized, research-based guidelines based on the latest scientific evidence.

Marin General Hospital earned the award by meeting specific quality achievement measures for the diagnosis and treatment of stroke patients at a set level for a designated period. These measures include evaluation of the proper use of medications and other stroke treatments aligned with the most up-to-date, evidence-based guidelines with the goal of speeding recovery and reducing death and disability for stroke patients. Before discharge, patients should also receive education on managing their health, get a follow-up visit scheduled, as well as other care transition interventions.

​Dr. Ilkcan Cokgor has been the Stroke Director at Maring General Hospital and is proud to share this great news with you.

Held annually in more than 600 communities nationwide, Walk to End Alzheimer’s is the world’s largest event to raise awareness and funds for Alzheimer’s care, support and research.

Please join us! We invite you to enjoy heavy appetizers, refreshments and inspiring speakers while learning more about how you can support your local ALZ office and your community by getting involved in this important cause! 

I am hosting a table and volunteering at the kick-off event on Thursday, August 10th 5:30 - 7 pm at The Embassy Suites San Rafael, 101 McInnis Parkway.

​https://www.alz.org/walk/

KPIX-TV, CBS, Channel 5 - Saturday, June 3, 2017 @ 7:00-7:30pm
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“AMERICAN HEALTH FRONT!” has been produced by Medical Media Group since 2002. The program is dedicated to educating the public on healthcare technologies, providing our viewers with valuable information on the latest treatments and discoveries. Each half-hour program consists of news reports that introduce our audience to local health care specialists utilizing current techniques that are changing lives.

Marin Magazine conducted a 2015 survey that has resulted in this [415] Top Doctors list — top physicians practicing in San Francisco and Marin counties who received multiple independent recommendations from their peers. The list was rechecked again this year. The survey process started with a list of more than 4,000 licensed doctors across all specialties in both counties. All doctors on this list were both candidates and eligible voters in the peer-to-peer voting poll. Doctors were allowed to cast an unlimited number of votes across all specialties — they could vote for as many doctors as they wanted regardless of specific area of expertise — but they could only vote for the same doctor once.

http://www.marinmagazine.com/People-Places/415-Top-Doctors/

DR. ILKCAN COKGOR HAS BEEN PRACTICING IN MARIN COUNTY for over 16 years as a general neurologist and neuro-oncologist. In addition to her private practice, she consults to Marin General, Novato Community and Kentfield Rehab hospitals. She has a large number of patients suffering from migraines, Alzheimer disease, dementia, movement disorders, stroke, and spine disorders. She works with multiple sclerosis patients, as well as clients suffering from fibromyalgia, chronic fatigue syndrome and brain tumors. She does EMG and nerve conduction studies for nerve and muscle disorders and offers Botox for dystonia, spasticity and migraines. She is a patient advocate and speaker for many neurological disorders and treats pediatric neurology patients with head and sports related injuries. For continuity of care, Dr. Cokgor covers her own patients if they are admitted to the hospital. Her practice is open everyday and she has an efficient, bilingual staff to help patients fast and comprehensively. She accepts every kind of insurance.

Marin General Hospital is one of the main stroke centers in Marin county. We have a very aging population with stroke risk factors. We are diamond certified for our care of patients admitted to MGH. We take care of acute stroke patients by giving them TPA, admitting them for the full work up by doing MRI, echo and risk management. Then we refer them to rehab hospitals and follow up after their discharges till their fulll recovery. We have a close relationship with paramedic services, stroke awareness centers and provide all the information to our patients before they get discharged.

​Dr. Cokgor became the stroke director in MGH as of May 2017. She oversees ER, hospitalists, Neurologists, physical, occupational therapy and speech therapy services. She is responsible for the timeliness and the availability of offering every cutting edge therapy to our patients. When needed we transfer patients to university hospitals for thrombus retraction. We educate patients' families about care and symptoms. We have very trained nurses, doctors and therapists in MGH to provide all the needs for stroke patients and families.

Concussion is a direct impact by a blow or whiplash to the head, face and the neck. It can be a blow to the body that transmits to head too. In mild cases, symptoms resolve within 10 days. CT or MRI of brain are usually normal. If an injury is serious, the patients improve slowly over time. Torsional forces can delay the recovery.

Post concussion syndrome symptoms are headaches, dizziness, imbalance, memory problems and mood swings. The pathophysiology involves many disrupted pathways in the brain either causing nerves to be functionally compromised or die at severe cases.

Second impact syndrome means a second head injury between 24 hours and 10 days after the first one. It can cause massive brain swelling leading to death or severe disability. It is common in young patients and boxers.

​Traumatic brain injury (TBI) is a consequence of concussion and can occur after bicycle accidents, skateboard accidents, MVAs, falls and sport injuries. Patients with repeated TBIs are at risk of chronic traumatic encephalopathy ( CTE). There are 4 stages of CTE. First stage includes headaches, inattention and concentration problems. Second stage includes impulsive behavior, depression and short term memory loss. Third stage includes executive dysfunction with severe cognitive decline. Fourth stage includes dementia. MRI of brain shows atrophy by then.

Treatment of concussion is to stop any activity for 10 days and see a neurologist. Patients need a full exam, rest and sleep. Imaging may or may not be necessary. The patients should then start some limited exercise like walking, cycling or swimming. If they have recurrence of their symptoms they should stop immediately. There is no diagnostic blood test available yet to diagnose these patients. The patients, coaches and families should have a understanding of these syndromes before pushing athletes back to the fields.

Tension headaches are the most common type of headaches. Chronic Tension Headaches (CTH) mean constant tension headaches more than 15 days per month for at least 3 months. The CTH last hours to days and are constant. They can be episodic or chronic. They involve both sides of the head and they are pressing or tightening kind of pain that change in intensity from mild to severe. Unlike migraines, they are not accompanied by other symptoms such as nausea and light sensitivity. CTH mostly affect working people with jobs in front of a computer and students who carry heavy backpacks.

The cause of CTH is unknown but both peripheral and central pain mechanisms play a role. The peripheral sensitization causes local tissue damage, producing pain and causing substances to be released. Prolonged peripheral sensitization leads to central sensitization which means that the pain radiates all around the original tissue. The main symptoms of CTH are tenderness and dull pain over frontal, neck muscles and chewing muscles. It hurts when a patient moves the neck up and down or sideways. It causes stiff neck muscles and postural abnormalities.

​The diagnosis includes eliminating other neck and brain causes contributing to pain syndrome first. Treatment is muscle relaxors, anti-inflammatory medications like Advil or Motrin and physical therapy. Physical therapist can evaluate the muscles, pain and pressure over the neck muscles. She can give isometric manual exercises, massage trigger points and mobilize joints. The best treatment is combination of physical therapy and massage. Botox is another option if all modalities fail.

Dear patients, friends, and colleagues,

This is my first ever blog and I am excited to share news with you on a regular basis on my new website. To start with I want to emphasize what I actually specialize on. I do both outpatient and inpatient Neurology which require different skills. Hospital patients get admitted mostly due to a stroke, head injury, brain infections and spinal cord problems. If patient develops severe pain in the neck or back or severe headache they get admitted for work up and treatment. If they develop sudden onset of weakness, numbness, speech difficulty and balance problems they get admitted to rule out a stroke.

I treat every kind of neurological disorder in my clinic. I am a general neurologist with a long experience on migraines, dementia, multiple sclerosis and back and neck pain. I see young and old patients with concussion, brain injuries and bleeds. I am subspecialized in neuro-oncology which means I treat brain and spinal cord tumors but luckily these tumors are rare. I offer Botox injections for neck spasms, back torsion, migraines, TMJ problems and grinding. I also treat stroke related spasticity patients with Botox. I do EEG to work up seizure patients. I do EMG and nerve conduction studies for nerve and muscle disorders. Long experience with migraines, demantia , movement disorders like Parkinson's disease. 

As you see I cover almost every part of Neurology. As I am very up to date with advances in Neurology and get qualified every year for new technology and medications I feel confident to help every kind of neurology patient. I will go into details and update you about the new discoveries and treatment options for different neurological disorders in my blog as time goes on.

​Please feel free to contact me through my contact web form with your questions, feedback and your own experiences. My staff and I hope to give you the best, comprehensive care possible in Marin county.