There are two types of tests that can be performed. A polysomnogram (PSG) or Multiple Sleep Latency Test (MSLT). A PSG entails wearing headgear that monitors snoring, respiratory effort, and position of body. It can be performed at home (ambulatory PSG) or in an office setting (overnight PSG). An overnight PSG is more accurate than an ambulatory PSG as it allows for monitoring of limb movement and electrical activity of the brain. A MSLT is always conducted in a sleep lab and entails monitoring the patient has they make four separate attempts to fall asleep. It is particularly useful for diagnosing narcolepsy. These tests are performed in a sleep lab.

This test uses small electrodes applied to the scalp by a technician. The patient is asked to perform various activities such as hyperventilate and attempt to sleep while the electrodes passively measure the brain’s electrical activity. This test is often performed when seizures are suspected. This test is performed in a neurophysiology lab at the hospital.

This test is almost always performed in conjunction with the nerve conduction study (NCS). During this test, a very thin needle is pushed into selected muscles of interest to listen to the muscle’s electrical activity. This test provides indirect evidence for injury of nerve roots leaving the spinal column or to make a diagnosis of a systemic muscle disease (myopathy). This test is performed at the neurology office.

A nerve conduction study (NCS) involves a series of small electrical shocks administered to nerves traveling in the upper or lower limbs. This is particularly helpful to localize sites where a peripheral nerve has been compressed as it travels across a joint. This test is performed at the neurology office.

Evoked potentials (EP’s) involve a series of small electrical shocks delivered to the ankle or wrist while electrodes applied to the hair measure the brain’s electrical activity. This is a helpful test when there is a concern for injury of the spinal cord. This test is performed in a neurophysiology lab at the hospital.

A carotid duplex is a test performed using a probe held to the neck which emits painless ultrasound waves. Using information gleaned from the ultrasound, the structure of the carotid arteries along with the pattern of blood flow within the carotid arteries can be visualized. Sometimes ultrasound is also used to look at the blood flow of the arteries in the skull and this test is called a trans-cranial Doppler (TCD). This test is performed in a vascular lab at the hospital.

A lumbar puncture (LP) is also known as a ‘spinal tap’. The brain and spinal cord float in cerebrospinal fluid (CSF). The CSF contains waste products and can be helpful to analyze when a disease involves the central nervous system. This CSF is collected in the low back so as to avoid injuring the brain and spinal cord in the process of collecting the fluid. The entire procedure takes less than 30 minutes to perform. This test is performed in the outpatient surgery wing of the hospital.

A small dose of a medicine called Tensilon is administered to a patient suspected of having Myasthenia Gravis. While this short-acting medication is active, a NCS is performed to confirm electrically the diagnosis of Myasthenia Gravis. This test is performed in the neurology office.

Intra-operative Monitoring (IOM) is performed in the operating room (OR). While a patient undergoes surgery on the brain or spinal cord, various electrical tests (EP’s, EMG, EEG) are performed continuously to ensure the nervous system remains uninjured.

Neurocognitive Evaluation:

This involves a neurologist administering a battery of standardized questions which test various regions of the brain. This test takes place in the neurology office.

IME:

An Independent Medical Evaluation (IME) involves a thorough review of management for a particular condition followed by a neurological examination. A summary of the conditions, both active and resolved, is created along with a list of recommended treatments. This is a single visit that occurs in the neurology office.

Botulinum Injection:

Botulinum toxin is a protein that when injected into a muscle can weaken the muscle temporarily for a period of up to 12 weeks. It is used by neurologists to treat chronic migraines, torticollis, writer’s cramp, or post-stroke spasticity. This procedure takes place in the neurology office.

Qutenza Patch Application:

Qutenza is a high concentration patch of 8% Capsaicin. Capsaicin is a naturally occurring compound found in chili peppers that inactivates pain fibers when applied topically. Qutenza is a patch that is applied in the doctor’s office for one hour and then removed. It then starts providing relief of post-herpetic neuralgic pain within the next 14 days. This pain relief lasts up to 3 months.