We offer a wide range of neurological procedures including:
Electroencephalography – EEG/VER
Electromyography – EMG/Nerve Conduction Studies
Trigger Point Injections
Deep Brain Stimulation
Dystonia and Botox Injections
Vagus Nerve Stimulation (VNS)
What is a Neurological Exam? The human nervous system is intricate and complex, an entire network of fibers that controls the entire body. Despite decades of research, it’s functioning is still quite mysterious. Sometimes our sophisticated laboratory tests do not provide enough information about how nerves are or are not functioning. The neurological exam is an inexpensive and noninvasive series of simple tests and questions that provide critical information about an individual’s nervous system. The neurological examination is divided into different areas, each one focuses on a separate part of the nervous system:
- Mental Status
- Cranial Nerves
- Motor System
- Sensory System
- Deep Tendon Reflexes
- Coordination and Cerebellum
The examination includes evaluation of:
- Diet and Exercise
During an electroencephalogram (EEG), electrodes are attached to the patient’s head and linked to a computer, where the electrical activity of the brain is measured. The computer records the electrical activity of the brain and then generates a digital or paper copy.
An EEG has several applications in neurology. The EEG is useful in diagnosing and classifying seizure disorders. It may also help to decide if an epilepsy patient is a candidate for surgery. During brain surgery, it is an important tool for intra-operative monitoring.
EMG/Nerve Conduction Studies
This test measures the electrical impulses produced by the nerves and the muscles. Nerve conduction study (NCS), measures how well and how fast a nerves can transmit an electrical signal. An electromyogram (EMG), evaluates the electrical activity of muscles at rest and during contraction.
This electrical activity measurement in muscles and nerves, can help establish the diagnosis for the peripheral nervous system diseases. These disorders include muscle tissue diseases such as myopathies and muscular dystrophies, peripheral nerve disorders such as neuropathies and radiculopathies and neuromuscular junction diseases such as Myasthenia Gravis. EMG and nerve conduction studies are often done together to give more complete information.
Trigger Point Injections
Dystonia is an involuntary contraction of muscles in a single region or may involve multiple muscles. Symptoms can be mild or severe and often interfere with the performance of many usual tasks. The effects of dystonia vary depending on the part(s) of the body affected and the contractions’ intensity. Here are some examples of focal dystonias:
- Blepharospasm: frequent blinking
- Cervical Dystonia: painful head twist and turn to one side
- Oromandibular Dystonia: difficulty chewing, eating, and speaking because of an inability to open or close the jaw
- Writer’s cramp or musician’s cramp: pain during a single repetitive motion
Many cases of dystonia have no obvious cause, but sometimes there is a neurological problem. The Neurologist will review each case and treat the patient accordingly. Dystonia treatment options include oral medications, Botulinum toxin injections and Deep Brain Stimulation.
Mild cases of dystonia may respond to oral medications. However, there has been great improvement in treatment options for dystonia because of successes with botulinum toxin injections (Botox). Botulinum toxin blocks the release of a chemical neuro-transmitter that causes muscle contraction. The injections weaken certain muscle fibers temporarily, which can decrease or eliminate dystonic contractions. Since the effects are temporary, injections need to occur approximately every three months. For more serious cases, Deep Brain Stimulation is considered.
Deep Brain Stimulation
Deep Brain Stimulation, also called DBS, provides treatment for patients whose motor functions are inhibited due to their neurological disorder. DBS helps these individuals regain control of their everyday movements and abilities. Parkinson’s disease, Essential Tremor, Dystonia and some types of obsessive-compulsive disorder can be treated through DBS.
How does Deep Brain Stimulation work?
There are three parts to the brain stimulation system. The first is a small pacemaker like device that is placed just under the skin near the collar bone. This device is called an implant pulse generator. A small flexible wire is attached to this device and then connected to leads which are placed by a neurosurgeon in the affected areas of the brain. Once the stimulation system is in place, small, electrical stimulations are sent from the implant pulse generator to the leads through the connection wire. A Neurologist makes adjustments to the pulse generator as needed for each individual patient, using a small hand-held computer device.
To treat Dystonia or Parkinson’s disease, bilateral leads are attached to the internal globus pallidus or subthalamic nucleus. For treatment of essential tremor, unilateral leads are attached to the ventro intermediate nucleus of the thalamus. Different areas of the brain would need to receive stimulations for the treatment of some forms of obsessive-compulsive disorder.
Patients suffering from neurological disorders have experienced remarkable results, allowing them greater control of their motor functions, expanded treatment options, and a more enjoyable life.
Botox Injections for the Treatment of Migraines
Chronic migraines can be a debilitating condition that causes intense pulsing and throbbing pain and affects about 12% of Americans. Migraines can significantly impact a patient’s quality of life. The FDA has approved Botox injections as effective in the prevention of migraines.
When Botox is used to treat chronic migraines, the patient receives multiple injections around the head and neck at intervals of about 12 weeks. These injections help to dull future headache symptoms because Botox blocks the release of a chemical neurotransmitter that triggers muscle contractions. The injections will temporarily weaken some muscle fibers, which may reduce or eliminate dystonic contractions. This treatment option applies to people with a history of chronic migraines that occur 15 or more days per month and last four hours or longer. Botox injections can also be used to treat some patients with Dystonia.
Botox injections are very effective and safe when administered by a well-trained neurologist with experience in this field. Our office will be happy to provide Dystonia patients with these interventions as necessary.
Memory testing, which includes cognitive tests, helps diagnose if a patient has a medical, psychiatric or neurological condition that contributes to thinking problems, and may help determine steps for the patient’s care. Taking cognitive tests to assess possible problems with their abilities to pay attention, learn, remember things and solve problems is becoming more common for older adults as a first step in the treatment and diagnostic process. Testing can assess possible dementia, including Alzheimer’s disease, or issues because of a stroke, neurodegenerative disease, head injuries or emotional or psychiatric conditions, including depression or bipolar disorder.
Vagus Nerve Stimulation (VNS)
VNS is a technique that is used to treat epilepsy. Medication can be used to control seizures in most people with epilepsy. Unfortunately, about 30% of people with epilepsy don’t respond well to anti-seizure medications. For some of these patients, surgery is used to remove the part of the brain that is causing the seizures. But, surgery may not be an option for others, and in those cases, VNS may be a good treatment choice. Under general anesthesia, the doctor implants a small pacemaker-like device under the skin in the upper chest. A tiny wire with an electrode on the end is then connected to the vagus nerve which is the longest nerve in the brain. The stimulator is computer programmed to send intermittent electrical impulses to the vagus nerve to stop or reduce the severity of seizures. Patients who undergo VNS continue to take anti-seizure medications.