TESTS WE DO

Reason for test: To look for epilepsy/seizures by listening to the waves the brain creates - epileptic activity looks different than regular brain wave activity.

How it's done:

• Using a cap or light gel/adhesive tiny electrodes that act as microphones to listen to brain waves are placed over the head in a specific pattern.
• A computer then analyzes waves coming from the brain to help determine any abnormalities.
• You may be asked to breathe faster (hyperventilate) or see strobe light flashes that are known to trigger seizures.

What to know before you come:

• Electrodes need to be placed on your head and placed through your hair; weaves, hairpieces and overall hairdos can get in the way of this.
• Since gel is used to attach the electrodes to the scalp you may want to shampoo your hair after the test.

Time factor: 30 minute EEG's take from some 45 minutes to 1 hour to perform including setup and removal of electrodes.

Fear Factor: Really none - just have to be able to sit through - often patients even fall asleep during the test - for children who have trouble sitting still this could be the biggest challenge.

Reason for the test: As with 30 minute EEG - looks for abnormal brain waves that could represent epilepsy - longer study so more brain waves can be studied.

ALL OTHER ISSUES SAME AS FOR 30 MINUTE EEG except for an additional 30 minutes needed for the extra testing time required.

Reason for the test:

• As with previous EEG's, again we are looking for abnormal brain waves that could be seizures.
• Ordered when there is a suspicion or concern for seizures and/or to clarify results of previous normal or abnormal EEG's.

How it's done:

• Just like the previous EEG's, only stronger adhesive is used so that you can keep the cap/electrodes on for 48 hours.
• You wear an EEG recording device and carry with you a video camera that syncs with the recording so that we can not only read your brainwaves, but compare with real time video of you during the record.

What to know before you come:

• Electrodes need to be placed on your head and placed through your hair; weaves, hairpieces and overall hairdos can get in the way of this.
• You must wear a cap for the duration of the test during the day and night and while you can bathe you cannot shower with the cap on your head.

Time Factor:

• Setting up the study in the office can take up to one hour while removal at the end of the study can take another 30 minutes.
• While we generally speak of a 48 hour (2 night) at home video EEG, at times the office will set patients up for as little as 24-hour or as long as 72-hour (3 night) EEG video ambulatory studies.

Fear Factor:

• No pain, just small electrodes placed over scalp that act like microphones to listen to your neurons.
• Being prepared to explain to others why you are wearing a cap.
• While you take a video camera with you that should be used as much as possible you can clearly limit the camera to areas that are reasonable for us to see - your privacy can always remain paramount.

Reason for the test:

• Excessive daytime sleepiness, snoring, insomnia, falling asleep easily during the day.
• Determine the integrity of your sleep to see if you might be able to benefit from possible intervention with a CPAP machine and mask (that may make it easier for you to sleep at night) or other intervention and solutions that may help you sleep better.
• Can also help determine if you have restless leg syndrome or any abnormal movement during sleep.

How it's done:

• You sleep overnight in our office arriving around 9pm and waking up before 6am with your sleep monitored by an all-night technician.
• Electrodes are hooked up to your head to measure brain waves and to also measure your breathing throughout the night.

What to know before you come:

• Bring a comfortable pair of pajamas - you will usually be up and able to leave by 6am but you may want to return to change clothes and shower before going to work the next day.
• Even despite sleeping in a lab, patients frequently experience better sleep in the lab than even at home.

Time Factor: Arrival at around 9pm the night of the study and generally out the door as early as 6am the following morning. Often patients sleep better in the lab than they have at home for some time.

Fear Factor:

• It can be uncomfortable to sleep in any bed or place that isn't home, but the beds and atmosphere is comfortable and someone is there overnight to watch over everything for your safety and well being.
• It can be uncomfortable sleeping with equipment attached to you but one can actually get used to all of this rather rapidly and sleep quite well regardless. Results for these studies can take up to 4 weeks due to the complex nature of the analysis of the study.

Reason for the test:

• If the first portion of your study shows evidence of possible sleep apnea, this test will be ordered to now quantify and see exactly how using a CPAP mask and machine can help you sleep comfortably and make sure you get oxygen throughout the entire night.
• The positive pressure of the machine and mask are able to gently overcome any resistance your own body may present to threaten your breathing during sleep.
• With proper settings and fitting of CPAP - you can sleep an entire night with better restful sleep than ever before.

How it's done:

• Just as with the PSG test above in house - you come in and are hooked up to electrodes to monitor brain wave and quality of sleep in addition to breathing.
• But now, in addition, you are fitted with a CPAP mask and machine that the technician will help adjust throughout the night to makes sure the settings help you overcome your blocked breathing.

What to know before you come: Just as with the PSG study - bring comfortable sleep wear, plan to be in by 9, out by 6am. If you enjoy reading, bring a book - we have cable tv to relax you.

Time Factor: Arrival at around 9pm the night of the study and generally out the door as early as 6am the following morning. Often patients sleep better in the lab than they have at home for some time.

Fear Factor:

• In addition to the above concerns with PSG - sleeping away from home and electrodes when sleeping - this also involves sleeping with mask with air throughout the study.
• The air is there to help you breath when its difficult and should not only be comfortable but make breathing easier during sleep.
• Results for these studies can take up to 4 weeks due to the complex nature of the analysis of the study.

This is a combination of the above Polysomnography (PSG) and CPAP studies combined in one night -all info as above.

Results for these studies can take up to 4 weeks due to the complex nature of the analysis of the study.

Some insurance companies insist on running a modified home sleep study prior to allowing a more thorough in office full sleep study.

These studies involve taking home with you a very modified sleep study device with far fewer electrodes that measure your breathing, pulse and basic sleep activity.

This is a very simple and simplified version of the normal in-house overnight study, but if this study shows evidence of sleep apnea we can then proceed to obtain an in-house study.

This home study is done in your own bed and you will be showed how to attach the leads and use the equipment prior to the study - you then return the equipment the next day after your study for analysis.

Reason for test: To get a very basic screening to see if there are any obvious abnormalities with patients breathing and lungs when challenged that could be leading to breathing difficulties during sleep.

How it's done:

• Patient are asked to forcefully breath into a tube as strongly as they can for one full breath and then breath in also forcefully.
• Patients are then asked to do some basic exercise - walking back and forth for example, and the test is repeated.

What to know before you come: If you have a known pulmonary condition or already have a pulmonologist you likely have already had a similar test and make sure to make your provider and technician aware.

Time factor: This test should take from 10-15 minutes to complete.

Fear Factor: Really none - just make sure you are able to comfortably breath during the test.

Reason for the test:

• To look for abnormality in muscle and/or nerve and to assist in making the proper diagnosis and then to add proper treatment intervention.
• Helps to determine the existence of, nature of and exact location of nerve or muscle injury.
• Examples for such testing would be to help in diagnosis and treatment of neuropathies, carpal tunnel, foot drop, pinched nerves (radiculopathy) or muscle diseases (myopathy, muscular dystrophy) just to name a small number of reasons to perform such testing.

How it's done:

• Studies are done focused on the arms/neck or legs/low back or both.
• Electrodes are placed over the skin and weak impulses are applied (generally that you can barely feel) that help measure speed of nerve.
• The muscle part of the examination uses a small probe that serves as a microphone in muscle - this is an acupuncture type very thin probe that slips under the skin to listen for abnormality in muscle.

What to know before you come: Make sure you make the doctor and technician aware if for any reason you may be pregnant, have an electronic devices of any type implanted such as a pacemaker or defibrillator or any type of implant that could possibly be affected by electrical current.

Time Factor:

• The nerve conduction velocity (NCV) portion of the test can take between 15-30 minutes for an upper or lower study.
• The muscle portion of the study can take between 5-15 minutes for an upper or lower study.
• Combined studies done on the same day may be less than the time for each individually as time is often saved on setup and the upper and lower portions of the test are very similar.

Fear factor:

• There is a small amount of electrical signal that can for some cause some mild discomfort during the nerve conduction portion of the test.
• The technician is very sensitive to every patient's various sensitivity to this portion of the test and will do everything possible to cater to each patient's unique level of sensitivity to this portion of the test and will do everything possible to cater to each patient's unique level of sensitivity or discomfort they may experience on any portion of the test.
• The muscle portion of the test can also be uncomfortable for some, but we are careful to work with each patient and to minimize any discomfort and to obtain information as accurately and rapidly as possible.
• Many patients experience little to no discomfort.
• The only reason we do any of these tests to begin with is when there is an important need to make a diagnosis with plans that depend on these test results.

Brainstem Auditory Evoked Response (BAER) Studies

Reason for the test: To help determine if there is an central abnormality in the brainstem auditory and/or vestibular system (from the vestibular-cochlear nerve through the brainstem) to assist in the diagnosis of various balance, vertigo or tinnitus (abnormal sounds such as ringing in the ear) disorders.

How it's done: Electrodes are connected to the head (just to listen to brainwaves) and patients wear a headphone that plays a series of sounds that are then detected as brainwaves by the attached electrodes.

What to know before you come:

• Electrodes need to be placed on your head and placed through your hair; weaves, hairpieces and overall hairdos can get in the way of this.
• Since gel is used to attach the electrodes to the scalp you may want to shampoo your hair after the test.

Time Factor: The test can take from 15 to 30 minutes.

Fear Factor: Really none - there is truly no pain or discomfort overall.

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Visual Evoked Response (VER) Studies

Reason for the test:

• To help determine if there is an central abnormality in the visual evoked response system to assist in the diagnosis of optic nerve dysfunction.
• Generally, very sensitive in the diagnosis of optic neuritis and ultimately multiple sclerosis.

How it's done: Electrodes are connected to the head (just to listen to brainwaves) and patients look at a checkerboard pattern of LEDs that are watched by the patient and that are then detected as brainwaves by the attached electrodes.

What to know before you come:

• Electrodes need to be placed on your head and placed through your hair; weaves, hairpieces and overall hairdos can get in the way of this.
• Since gel is used to attach the electrodes to the scalp you may want to shampoo your hair after the test.

Time Factor: The test can take from 15 to 30 minutes.

Fear Factor: Really none - there is truly no pain or discomfort overall.

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Somatosensory Evoked Potential Studies (Upper or Lower Extremities)

Reason for the test:

• To help determine if there is an central abnormality in the somatosensory evoked response system to assist in the diagnosis of nerve slowing from the upper or lower extremities through the more central levels of the nervous system near the spinal cord and into the brain.
• Generally very sensitive in the diagnosis of nerve conduction deficits and useful in diagnoses of radiculopathy (pinched nerves) and multiple sclerosis (MS).

How it's done:

• Electrodes are connected to the head to listen to brainwaves.
• Patients receive a very small impulse that is then detected as brainwaves by the attached electrodes.

What to know before you come:

• Electrodes need to be placed on your head and placed through your hair; weaves, hairpieces and overall hairdos can get in the way of this.
• Since gel is used to attach the electrodes to the scalp you may want to shampoo your hair after the test.

Time Factor: The test can take from 15 to 30 minutes.

Fear Factor: Really none - there is truly no pain or discomfort overall.

Reason for the test:

• Computerized-based in-office neuropsychiatric testing helps us test for various domains and overall cognitive performance in situations when memory is called into question for post-traumatic injuries, stroke, dementia, children with poor school performance.
• To help assess in not only cognition, but attention in situations such as attention deficit disorder and attention deficit with hyperactivity disorder (ADD/ADHD).
• Very useful for assessing patients who are using controlled substances such as narcotics or benzodiazepines to help assess safety and adequate cognition/attention.

How it's done:

• Patients sit in front of a computer faced with a battery of questions that they attempt to answer to help determine their overall cognitive ability.
• These tests are tailored to educational level and also available in multiple languages.

What to know before you come: Familiarity with a basic computer keyboard is helpful but not mandatory.

Time Factor: The test generally takes about 45 minutes to complete.

Fear Factor: None.

Reason for the test: To investigate symptoms of dizziness, vertigo, or imbalance by assessing the inner ear and central motor functions related to balance. It helps determine if these symptoms are caused by an inner ear disorder or a problem in the brain.

How it's done:

• Patients sits an a chair and wears a pair of goggles over their eyes that have a video camera that is able to closely watch the movement of each eye.
• The patient is put through a number of moves that may bring out their symptoms and the movement of the eye is recorded and is then able to help determine the exact basis for their symptoms.

What to know before you come:

• This is an important test to help determine the basis of the symptoms you have been experiencing and to help us both localize and then eventually fix the problem.
• This test may cause some of these very symptoms in the course of helping to diagnose these problems that you have been experiencing - the technician will do all they can to make this test as tolerable as possible.

Time Factor: The test generally takes about 30-40 minutes to complete.

Fear Factor:

• Depending on whether or not you experience a great deal of vertigo all the time you may find this test to be challenging as this can trigger those very symptoms you are having trouble with.
• The test is very limited in time, may not bother you at all, and is very important in helping us find the basis of your symptoms and enabling us to formulate a plan on fixing the problems with imbalance, vertigo and dizziness you have been experiencing.
• You may become nauseous during the test but the technician will do all they can go slow and work to enable you to complete the test.

Reason for the test: To rule out any possible stenosis (narrowing), arteriovenous malformation (AVM), or aneurysm limiting blood flow to the brain from the carotid artery system.

How it's done: Patients generally lie down and have an ultrasound probe listen for the flow of the carotid artery system in the neck.

What to know before you come: You will be asked to lie down. To use the ultrasound probe for this test, the technician will need access to your neck, and there will be ultrasound gel that will feel cold and touch your neck via the probe.

Time Factor: The test generally takes about 15-20 minutes to complete.

Fear Factor: None.

Reason for the test: To rule out any possible stenosis (narrowing), arteriovenous malformation (AVM), or aneurysm limiting blood flow within the brain's arterial system.

How it's done: Patients generally lie down and have an ultrasound probe listen for the flow of the artery system of the brain.

What to know before you come: You will be asked to lie down. To use the ultrasound probe for this test, the technician will need access the sides of your scalp, and there will be ultrasound gel that will feel cold and touch the sides of your head via the probe.

Time Factor: The test generally takes about 20-30 minutes to complete.

Fear Factor: None.