Neurological Diagnosis and Treatment for Learning Disabilities

    (415) 561-6755 | 350 Sansome Street, Suite 680, San Francisco, CA 94104

  At Bright Minds Institute Each Child is Unique  
 
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We help families

Treatment from age 2

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Tests we may prescribe for your child


After your first visit

After a thorough neurological evaluation, Dr. Fernando Miranda may recommend further testing. Based on the outcome of his initial evaluation there are several assessments that may be prescribed.

DEEP Assessment

BMI image is an EEG or electroencephalogram. It is much more specific than a traditional EEG using thirty two electrodes. The DEEP Assessment measures objectively the correlation between the brain function and the electrical activity of the neural tissue: at rest, through the circadian rhythm and during specific tasks. It may measure dysfunction, mild deviations from normal or definite abnormalities in the maturational process. Evoked responses (ERP) use stimuli in the visual and auditory domains to show objective links between perceptive-cognitive deficits and electrical maturational or structural damage to the brain.

BMI image Evoked responses may be altered by changes in the individual's psychological state, underlining the importance of differentiating between focused attention and non specific alertness. DEEP also offers an objective follow up to the improvement in the functional connectivity achieved when the right method is used in the treatment of a dysfunctional state.

The test takes place at our clinic and lasts between two and a half to three and a half hours. Up to approximately one hour of this time is used for placing the electrodes. During set up your child may participate in activities that distract him/her while encouraging him/her to "sit still" such as reading, playing video games, talking to/playing with staff and parents, or watching a DVD.

Your child's hair will have some residual gel (used for conductivity of electrodes) left in it after the test and your child will most likely need to take a bath/shower that evening.

We digitally analyze your child's DEEP Assessment data after the procedure and provide you with results the next day.

(See Details about the EEG process or learn about the history of EEGs.)

MRI

BMI image or Magnetic Resonance Imaging is a non-invasive procedure that allows us to look at the physical structure of the brain. The MRI rules out any possible structural abnormalities. The test takes between 45 and 60 minutes. If the child is apprehensive about enclosed spaces, a mild sedative may be prescribed. In some cases, outpatient anesthesia may be used. An "open MRI" is not an option as it is not specific enough for our purposes. Dr. Miranda strongly encourages the MRI be performed at a facility where the staff is familiar with the specificities of the examination, and where a Neuroradiologist is available for reading of the study.

MRI spectroscopy

is similar in patient experience to an MRI. It frequently takes place after the traditional MRI and lasts for approximately 15 additional minutes. Using a computer, technologists are able to measure specific neurotransmitter amounts in various areas of the brain. The outcome of this exam may help Dr. Miranda to make an accurate diagnosis. The findings often provide evidence to support the need for a specific pharmacologic intervention.

DTI (Diffusion Tensor Imaging)

is another form of MRI. The actual test follows the traditional MRI, and again takes an additional 15 minutes. The reading of the test is quite involved and requires a specialized technique and physics, all of which are not available but in major Medical Centers. Using the water absorption quality of myelin (sheath that surrounds nerve cells), the test is capable of detecting established and new pathways that have been formed in the brain. As new pathways are evidence of learning, this test is anatomical and physiological evidence of rewiring the brain through learning. DTI can be used as pre- and post measures to test the effectiveness of a particular pharmacologic agent, or specific tutorial and behavioral program or therapy.


Costs vary depending on services provided. We can help people from:

$395 - Medical records review, including MRI analysis, EEG data and reports, relevant prior history. (Up to 1" of reports.) Materials, fee and completed BMI intake packet required before or day of your child's first visit.

$695 - First visit. Full one hour initial clinical evaluation or initial phone/Skype consultation. Account setup.

$3,995 - P300 DEEP Assessment. Brain activity mapping and cross-function scan; digital analyses and comparison with our proprietary, Harvard Medical School/Children's Hospital Boston-developed BEAM (Brain Electrical Activity Mapping) database. Serves as baseline against improvements in future DEEP test results.

$3,395 - Follow-up DEEP Assessment. Repeat of your original test protocol. Recommended one year after initial diagnosis to quantitatively assess progress. More often for difficult cases. Especially recommended upon or after onset of adolescence.

$195 - Follow-up appointments and consultations. Per 15 minutes. (One hour = $780.) Includes in person, phone/Skype or email consultations of a medical nature involving any of our neurologists.

$5,085 - Everything. Full one hour initial clinical evaluation or initial phone/skype consultation with records review (including MRI analysis) plus our custom P300 DEEP Assessment brain scan and comparison with our proprietary, Harvard Medical School/Children's Hospital Boston-developed BEAM (Brain Electrical Activity Mapping) database. Add $195 per additional 15 minutes of follow-up. Initial DEEP follow-ups are usually 45 minutes to one hour for results follow-up and consultation with recommendations.

We require one follow-up visit or consultation per quarter, or once every four months, to follow up your child's status and progress properly, especially if s/he is using neuropharmacological therapies. These visits are usually 15 to 30 minutes in length unless you have extensive questions or if an unusual situation has occurred.

All services are prepaid before or on the day of your appointment. We require a 25% deposit for patients receiving our signature DEEP Assessment two weeks prior to date of service to reserve an appointment.



How are people referred to Bright Minds Institute?

People are referred to the Bright Minds Institute in many ways, including by their physicians, mental health professionals, family members, friends, or by learning about us through lectures, Dr. Miranda's television appearances, and the Internet. You can refer yourself or someone you love to the clinic.


What if I don't have a doctor to refer me?

People who are self-referred first speak to one of our Intake Coordinators to make sure we are the appropriate place for help. A phone consultation with one of our professionals is recommended before an evaluation or brain scans are scheduled.


Tests we likely will not prescribe for your child


MEG scan

A magnetoencephalography scan is a metabolic functional test. Unlike electrical tests such as the DEEP EEG, the test involves a 1.5-2.0 second delay to measure activity. Since the brain reacts in the range of 300 milliseconds, this is not useful to study fast brain activity. Using magnets like an MRI, MEG requires absolute stillness in a patient. However, since it is a brain functionality test, sedating a child to stay still alters the whole thing. The test is not useful in diagnosing children for our purposes.

MEG is primarily useful with adults, and mainly to study one part of the brain at a time, particularly areas used for reading. Unlike the DEEP EEG, it cannot look at cross-function between different areas of the brain at the same time.

VEEG

Video EEG simply records a video of your child at all hours, particularly during sleep, while he/she is also wired up to an EEG machine. Technicians can then compare behavior with EEG data. VEEG is useful for separating "hysterical" (for whatever reason) individuals from those with true epilepsy or other disorders.

fMRI

Functional MRI. No children can undergo this test. Individuals must readily think of specifics as directed by a technician. So again, this is not child appropriate.

 
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