Meet Dr. Krikor Tufenkjian
Krikor Tufenkjian, MD, is a neurologist at Drexel Neurosciences Institute. He cares for patients in the general neurology and neuromuscular clinic where he performs and interprets Nerve Conduction Studies (NCS)/Electromyogram (EMG). He also interprets electroencephalogram (EEG) tests. In addition to his clinical work, Dr. Tufenkjian is a faculty member in the Department of Neurology at Drexel University College of Medicine.
Can you tell me a little bit about your life before medicine and what drew you to the profession?
I come from Syria where the education system is a little different. Typically by high school, you have already decided what you want to do and where you'll be going to school. I always enjoyed science and wanted to find a way to use that in a tangible way to benefit society. I knew I wanted the rewarding effect of helping others on a daily basis, so medicine seemed like a natural fit. I enrolled in medical school right after high school.
What brought you to the United States?
I wanted to get the best training possible and at an innovative level that was not available back home, so as I was finishing school I planned to train abroad. I completed my neurology residency training at Case Western Reserve University in Cleveland. Afterwards, I did an additional year of training in epilepsy and EEG interpretation there, followed by another year of subspecialty training in EMG and neuromuscular medicine at the Lahey Clinic in Burlington, Massachusetts.
What are some of the common conditions you treat?
Generally speaking, patients come to see me with nerve and muscle conditions that cause loss of sensation, tingling, pain and weakness. In the electrodiagnostic lab (sometimes called the EMG lab), we evaluate people with conditions like carpal tunnel syndrome, ulnar nerve entrapment, nerve root injuries, peripheral neuropathies, muscle disease and many other disorders. In the EEG lab, we evaluate patients who have seizures and epilepsy.
What role does electricity play in the brain and the body?
The role of electricity is not something we think about too often, but we would not exist without the small electrical currents that carry signals in the brain, nerves and muscles fibers. Electricity plays a big role in the communication between cells, carrying signals down the nerves and generating contraction in the muscles.
Electrical activity in the brain can be recorded through EEG technology, which is an essential step in studying conditions that cause seizures. Electrical activity in the nerves and muscles is recorded in the electrodiagnostic lab to determine the location and cause of nerve and muscle injuries.
What are some signs that could indicate a neuromuscular condition?
The most common symptoms are numbness, tingling, pain, weakness and losing muscle mass. Of course, everyone can get numbness and tingling now and then, such as when you sit in an awkward position and your leg goes to sleep. In those situations, a nerve is being temporarily compressed and that is why you get these symptoms, but once you change position and remove the pressure off the nerve, the symptoms go away. When there is more significant nerve injury coming from a different mechanism like inflammation of the nerves, the symptoms can persist and worsen over time.
When there is muscle disease the patient can get very weak. For example, they notice having trouble getting up from a chair, climbing up and down steps, or just holding their arms up for any length of time.
In some cases double vision, difficulty swallowing and changes to the voice can be signs of a neuromuscular condition.
What treatment options do you provide?
Many of the acquired conditions we treat are caused by autoimmunity, which means the damage is being caused by the body's immune system. For those conditions, the treatments typically involve calming down the immune system. For example, in myasthenia gravis the immune system produces abnormal antibodies that block the signal between the nerve fibers and the muscle fibers. This causes the patient to become weak because the signals from the nerves are not reaching the muscle fibers to generate a contraction. Treatments aim at lowering the amount of antibodies and/or stopping their production. This typically involves corticosteroids, intravenous immunoglobulin (IVIG), plasma exchange and other modalities. Sometimes the problem can be much simpler, like a slight compression of the nerve and we may recommend a brace or surgical decompression.
What causes carpal tunnel syndrome?
The basic underlying problem is usually overuse of the hand. The median nerve carries the sensation from the first three fingers and supplies the muscles in the base of the thumb. This nerve has to cross through a part of the wrist called the carpal tunnel to reach the hand. This tunnel lies between the wrist bones and a thick fibrous tissue forming the roof. Repetitive hand use can cause swelling and increased pressure in this tunnel. This in turn presses the nerve leading to numbness, tingling, pain and in severe cases, hand weakness.
How can you prevent and/or treat carpal tunnel syndrome?
Avoiding repetitive hand use helps to prevent this. If the symptoms have already developed then it can still be useful to modify and decrease hand use. Oftentimes this is not practical, especially when manual work is part of someone's job. There are specialized wrist braces that help treat this. These are designed to prevent bending of the wrist which takes some of the pressure off the nerve. These braces are usually helpful, and we recommend that the patient wear those at least at night and as long as possible during daytime. Sometimes decompressive surgery is needed to help with the symptoms and to prevent more permanent nerve injury from developing over time.
What do you like most about working at Drexel?
The support staff here is tremendous. I'm fairly new to Drexel, and being new can present some challenges. Everyone at Drexel has been so helpful, efficient and a pleasure to work with.
There's also great collaboration here between the primary care physicians and the specialists in neurology. This is by far one of the most energetic groups of neurologists I've worked with. We cover many different subspecialties within neurology, which helps us give patients the most comprehensive care possible.
Krikor Tufenkjian, MD
neuromuscular disease, electromyography (EMG), electroencephalography (EEG)
MD – University of Aleppo
Drexel Neurosciences Institute
The Arnold T. Berman, MD Building
219 N. Broad Street, 7th Floor
Philadelphia, PA 19107
The information on these pages is provided for general information only and should not be used for diagnosis or treatment, or as a substitute for consultation with a physician or health care professional. If you have specific questions or concerns about your health, you should consult your health care professional.
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