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Electromyography & Nerve Conduction Study (EMG/NCS)

About the Tests:
Electromyography is a neurological test to help evaluate muscle and nerve function. There are two parts to this test. In all, you should be at our laboratory for approximately one hour.

Part I - The Nerve Conduction Study
During this portion, electrical impulses are employed to stimulate various nerves to determine how well they are working. A technician or technologist does the nerve conduction study. Prior to the test the skin over the area to be stimulated may be cleansed with alcohol and surface electrodes are applied. Please do not use lotion on your skin before the test. When your nerves are stimulated, you will experience a sharp sensation in the arm or leg being tested. Many people get used to the sensations to some degree as the testing continues.

Part II - The Electromyographic Examination
A small pin is inserted into various muscles by one of the neurologists for a detailed study of the activity of individual muscle fibers.

Electroencephalogram (EEG)

An EEG or electroencephalogram is a completely safe and painless procedure for recording the electrical activity produced by the brain. Patterns of the brain's electrical activity provide information about specific brain functions. This information is used to help identify a wide variety of neurological problems. The test usually takes 1 to 1½ hours to perform. Part of this time is spent in applying the electrodes. The actual recording time varies but usually lasts about 30 minutes.

Prior to the Test
1. So that our technicians can properly apply the electrodes to your scalp, please shampoo your hair the night before the test and do not use hair treatment products, such as hair spray, conditioners and hair dressing, or fix your hair in tight braids or corn rows.
2. Continue to take your prescription medicine unless specifically instructed by your physician to discontinue use. The technician needs to know what medicines you are taking, so if you take several medications you may want to bring a list of them to the test.
3. Unless you are instructed otherwise, you should eat normally. However, avoid coffee, tea, sodas, and other drinks and food that contain caffeine.
4. Please arrive a few minutes early for your test. The quality of the test will improve if you have a chance to relax for a few minutes beforehand.
5. A special cream is used to attach the electrodes to your scalp during this test. While the technician will clean most of this paste from your hair following the test, you may want to bring a scarf or wig with you as well.

During the Test
The most important things to do during the test are to relax and follow the technician's instructions. Please feel free to ask the technician questions at any time during the test.
1. We ask that all family and friends, except those who need to translate for the patient, wait in the reception area during the test. If you have to bring children with you, please bring a friend or family member to attend to the small children in the waiting while you are having your test.
2. While your doctor has given us information concerning your specific problem, the technician will also ask you for certain information that will be helpful to the physician who will interpret your test results.
3. The technician will then measure and mark the places on your scalp where the electrodes are to be applied. This is done with a special washable crayon.
4. Next, the technician will scrub each spot with a cleansing solution to ensure proper contact for the electrode. The electrodes will then be attached with a water soluble paste.
5. During the recording, you will be asked to lie down on an examination table. We will try to make you as comfortable as possible in order to help you relax.
6. The technician will ask you to open and close your eyes several times during the recording. You might also be asked to perform some special breathing and visual exercises that provide additional information.

After the Test
1. When the recording is complete, the technician will remove the electrodes and clean the paste from your scalp. A little residue might remain, although the technician will try to remove as much of the paste as possible. The residue will not harm your scalp and will wash away with shampoo.
2. Your physician will tell you how to obtain your test results.

Ambulatory EEG (Amb EEG)

An Ambulatory EEG (Amb EEG) is a safe, painless test, which will record the electrical activity produced by your brain. An Amb EEG uses a digital recording system to record brain activity for 24-72 hours while you go about your daily routine.

Before the test, recording electrodes will be attached to your scalp with an adhesive paste or air-dried adhesive. These will be covered with gauze and a net will help secure them. You may wish to bring a scarf or loose fitting hat to cover this wrapping while going home. You must not get the electrodes or recorder wet; therefore, you will not be able to shower or swim until the equipment is removed.

You should not scratch your head during the test. You also should not chew gum while the test is running.

You will be keeping a diary of things that you do and symptoms you experience during the test. If any symptoms occur you will push a button to note the recording.

It usually takes about an hour and a half to apply the electrodes and set up the equipment. A return appointment will be needed to remove the equipment. After the recorder and electrodes are removed the technologist will remove all of the adhesive from your scalp.

Preparation for the Test
1. Shampoo your hair the night before and do not use hair products such as hairspray or styling cream. Please remove all hairpieces prior to your appointment and do not fix your hair in tight braids or cornrows.
2. Continue taking any prescription medications unless specifically told otherwise by your physician.
3. Please wear a button down or zip front shirt since you will not be able to pull anything over your head once the electrodes are applied.

BOTOX

The following discussion is for general informational purposes only and is not meant to provide the reader with specific medical advice. Please consult with your personal physician, or with a neurologist, for specific advice, guidance and information regarding your particular circumstances.

DESCRIPTION
Botox, the best known form of Botulinum toxin, has been increasingly used in Neurology practice since its first approval by FDA in 1989. In addition to its popular role for cosmetic purpose, it has been used in multiple neurological conditions including: migraine; tension headache; tilted neck (torticollis or cervical dystonia); chronic neck and back pain; facial and eye lid twitches (facial and blepharospasms); limb spasticity after stroke, cerebral palsy, multiple sclerosis or spinal cord lesions; hyperhydrosis; temple-mandibular joint dysfunction (TMJ) and tremors.

Botox works by blocking the neurotransmitter release from nerve endings to muscle, allowing the muscle to relax. As a result, abnormal movements or muscle contractions are decreased.

Individual response to Botox treatment varies. Overall the treatment success rate is very high and majority of patients who receive this treatment are pleased with the benefit. But it is not a cure. On average, its effects last about 3 months and frequently repeat treatment is required.

TREATMENT
Botox treatment is not without side effects, but they are extremely rare and transient. After long term use of Botox, there is a slight chance developing resistance and the treatment appears less effective. The other widely used Botulinum Toxin is Myobloc, which is equally effective and it has special value in patients who developed resistance to Botox.

For torticollis, spasticity, and other dystonias, most insurances including Medicare cover the treatment. For other indications, it varies and frequently a pre-authorization from the insurance company is needed. This question can be addressed during consultation in our Botox Clinic.