Probably the most important service we offer is the neurological evaluation, rendered either as a self-referred office visit or as an in-patient or out-patient consultation on the request of your referring or primary-care physician. During your evaluation, a detailed personal, past, family, and social history will be taken, followed by a comprehensive or detailed examination of all the important or relevant portions of your general physical or specific neurological systems, including (as necessary): your sensorium, cognition, special senses, speech and language function, coordination, sensory system, motor examination, stance and gait, and reflexes. After the examination, we may find it necessary to order or refer you for additional testing, such as laboratory blood work, an imaging study (MRI or CT scan), EEG, EP, or EMG/NCV. After each of your visits with us, we will prepare a detailed written record, which then becomes a part of your confidential medical file. When referred by another physician, a copy of this evaluation will be sent to him or her, and we can also provide you with a copy upon written request.
Patient instructions for neurological evaluations: Initial evaluations take much longer than follow-up or interval sessions. For initial office evaluations, you can expect to spend at least an hour with us, and you should also allow at least 15 minutes before your appointment to fill out any necessary paperwork. It is best to wear loose-fitting, comfortable and easily-removed clothing for any office visits with us, and we would suggest that the ladies not wear panty hose. Please be certain to bring with you a complete and accurate list of all your current medications and allergies, as well as any applicable insurance referral forms and insurance ID cards, as we must have a copy of all these things. You will be able to resume all your usual activities immediately after your neurological evaluation session with us.
The EEG was originally developed for clinical use in 1929 by Doctor Hans Berger in Europe. It is a study which measures the electrical activity of the brain and is especially sensitive and important for the diagnosis of seizure disorders and many other neurological conditions.
The brain is composed of billions of neurons (nerve cells) which function and communicate with each other and the rest of the body by transmitting electrical impulses which are mediated through various chemical and electrical processes in the brain. By carefully measuring this electrical activity over the surface of the head, neurologists use the EEG to gain important information about the physiology of the brain in health and disease.
During the EEG test, a specially-trained technologist will direct you to recline on a special (and very comfortable!) couch or bed and then painlessly apply a large number of electrodes (which will function as sensors) to your scalp using a small amount of special cream. This cream acts as a sort of "paste" as well as an electrical conductor enabling us to record the minute currents of electrical activity emanating from your brain.
While you are quietly reclining, the EEG technologist will be adjusting the equipment that performs this recording either on special graph paper or into a computer memory. The test is completely painless, and there is no radiation exposure or risk involved. During the EEG recording, you may be asked to "hyperventilate" (over-breathe) for a short time or watch a bright flashing strobe light for a few moments.
The entire examination usually takes anywhere from 45 minutes to 2 hours to complete. After the recording, the technologist easily and painlessly removes the electrodes, and the special paste is wiped clean with plain water. If you have received any sedation during the study, you may feel a little drowsy for the remainder of the day. The physician who ordered the EEG study will be sent a detailed report on the examination within 24 hours or less.
Patient instructions for EEG testing: In preparation for an EEG, you should wash your scalp and hair thoroughly the night before and not use any hair sprays, tonics or cosmetics on the day of the study. Often it is desirable to record an EEG while you are drowsy or asleep, as well as while awake. Therefore, you should get less than half your normal amount of sleep the night before your scheduled study, so that you will arrive a little "sleepy." You should not take any sleeping medications or stimulants the night before or on the appointment day unless you are specifically told to do so by your physician.
On the day of your EEG appointment, you should not eat or drink any caffeinated products (like cola, tea, coffee, chocolate, etc.), and you should eat only light meals at the usual times. Wear comfortable, loose-fitting clothing. You should also allow at least 15 minutes before your appointment time to fill out any necessary paperwork. A mature adult must accompany each EEG out-patient, since it may be necessary during the procedure to administer a mild sedative to induce drowsiness during the EEG recording. In that event, you would not be able to drive, operate any dangerous equipment, or take a bus or taxicab alone afterwards because you may well still be a little drowsy. Be sure to bring with you a complete list of all your current medications and your allergies, as well your insurance ID cards and any applicable referral forms provided by your referring or authorizing physician.
The body's nervous system uses electrical energy to convey messages smoothly along nerve fibers to and from the brain, analogous to the way copper wire conducts electricity from the wall switch to control a room's lighting. Motor nerve fibers terminate on muscle cells in a structure called the neuromuscular junction, which stimulates the muscle cell into a contraction. This muscle contraction produces movement of your joints. Injury or disease to the nerves or nerve fibers can impair this electrical transmission, and EMG/NCV testing is often used by your neurologist to help diagnose these ailments.
Electromyography (EMG) records the electrical activity in the muscle cells directly. This test can help determine the cause or extent of muscle weakness, spasm, pain, inflammation, or paralysis in the limbs, spinal area, or even the face. An electrode - actually a small thin needle - is gently inserted into the muscle being studied. The muscle's electrical activity is then recorded during needle insertion or movement, at rest, and also with muscular contraction. A special computerized amplifier increases these signals allowing them to be accurately analyzed. The results may be displayed on an oscilloscope, computer screen, or printed out on paper for visual study. Often, loudspeakers are used so the sounds produced by these electrical signals can also be analyzed.
After the first muscle is tested, the electrode may then be inserted into other muscles. The total testing time may range from just a few minutes to more than an hour, depending on how many muscle areas need to be examined. The electrode insertion into the muscles is a little bit uncomfortable, but most patients (even children) can tolerate this slight discomfort quite reasonably. After the exam, the muscles that were tested may feel a little sore or reddened for a day or so.
Most often, a nerve conduction velocity (NCV) test will accompany an EMG, and this is why we consider these examinations together. The NCV test evaluates the status of the peripheral nerve fibers by recording how well small electrical impulses travel through the fiber. The peripheral nerves transmit information from the spinal cord to the muscles and in the reverse direction back to the spinal cord from the sensory receptors in the skin. There are many disorders that can slow or reduce the strength of these signals, and that is what the NCV test can show.
A stimulating electrode applies a small impulse over the surface of a nerve and other recording electrodes are placed on your skin to measure these electrical signals as the impulses travel along the nerve fiber. During each stimulation, you will feel a little "tingle," but this is not harmful. As in the case of the EMG exam, the results are recorded by a computerized amplifier and displayed on a screen or printed on paper for detailed analysis by the neurologist. Each single nerve test takes just a few minutes, so the total study time for the entire examination depends on how many nerves must be recorded. The physician who ordered the EMG/NCV study will be sent a detailed report on the examination within 24 hours or less.
Patient instructions for EMG/NCV testing: In preparation for an EMG/NCV test, you should bathe or shower the night or morning before the test so that the skin areas are clean. You should not apply any lotions or oils to your skin, as these can interfere with the recording of the electrical impulses. You should eat your normal meals and take all your regular medications on schedule prior to the test. You should also allow at least 15 minutes before your appointment to fill out any necessary paperwork. It is best to wear loose-fitting, comfortable and easily-removed clothing for any office visits with us, and we would suggest that the ladies not wear panty hose. Please be certain to bring with you a complete and accurate list of all your current medications and allergies, as well as any applicable insurance referral forms and insurance ID cards, as we must have a copy of all these things. You will be able to resume all your usual activities immediately after your EMG/NCV test with us.
The nervous system contains many billions of nerve fibers and tracts that, like telephone cables, carry electrical information in the form of impulses, to and from the brain. Illness or injury to the nervous system can adversely affect how well and accurately these transmissions occur.
Evoked potential (EP) tests check the condition of some of these important nerve fiber pathways. This computerized technique can aid the neurologist in diagnosing these disorders by helping to pinpoint the site and nature of nerve damage. There are three different types of EPs performed, depending on the nerve pathway under consideration: visual, auditory, and somatosensory. Each test involves a mild stimulus (visual, sound, or skin sensation) to cause the respective nerve cells to react and send a message to the central nervous system. These impulses, called "evoked" responses, can then be measured, displayed and analyzed by the sensitive EP equipment. Any patient may need just one, two, or all three types of EP testing, depending on the clinical situation. EP tests may also be used to monitor coma patients, monitor patients during surgical procedures, and test hearing in infants or others whose hearing cannot be tested in standard ways.
A visual evoked potential (VEP) test evaluates pathways behind the eyes having to do with the transmission of visual signals back to the brain. Electrodes are painlessly attached to a few key points on the scalp, and the patient is asked to gaze at a video screen that displays (usually) a reversing checkerboard pattern for a few minutes. Each eye is studied separately. VEP tests may help find the cause or determine the nature of certain vision, optic nerve, or other brain disorders (especially multiple sclerosis). The whole examination, which is totally painless and risk-free, generally takes well less than an hour to complete. The physician who ordered the VEP study will be sent a detailed report on the examination within 24 hours or less.
An auditory evoked potential (AEP) test, also sometimes called a brainstem auditory evoked response (BAER) test, evaluates the nerve pathways from the inner ears to the brain. In this case, electrodes are painlessly attached to the outside of each ear and to several other keys spots on the scalp. Earphones are then placed in or on the ears, and the patient just relaxes while listening to some repetitive "clicking" noises through the earphones. The EP machine can then "track" those signals as they travel through various portions of the brain. This examination, which may be used to help uncover the cause of hearing and balance problems, as well as dizziness or vertigo, generally takes about an hour and is totally painless and without any risk. The physician who ordered the AEP study will be sent a detailed report on the examination within 24 hours or less.
A somatosensory evoked potential (SSEP or SEP) test assesses the sensory pathways from the nerves in the arms or legs, through the spinal cord, and to the brain. Electrodes are painlessly placed on the scalp, the extremities, and along the outside of the spine. A small current is then applied to the skin near nerves on the arms or legs as each extremity is tested separately. The applied current causes a sensation of tingling but is not particularly painful. The test can take between 45 and 90 minutes, depending upon how many areas need to be examined. There are no significant health risks or side effects to this procedure. The physician who ordered the SSEP study will be sent a detailed report on the examination within 24 hours or less.
Patient instructions for all EP testing: In preparation for an EP test, out-patients should bathe or shower the night or morning before the test so that the skin areas are clean. You should not apply any lotions or oils to your scalp or skin, as these can interfere with the recording of the electrical impulses. You should eat your normal meals and take all your regular medications on schedule prior to the test. Be sure to bring any required prescription eyeglasses or contact lenses if you are having a visual evoked potential (VEP) test performed, since you'll need to be able to focus clearly on the video screen. You should also allow at least 15 minutes before your appointment to fill out any necessary paperwork. It is best to wear loose-fitting, comfortable and easily-removed clothing for any office visits with us, and we would suggest that the ladies not wear panty hose. Please be certain to bring with you a complete and accurate list of all your current medications and allergies, as well as any applicable insurance referral forms and insurance ID cards, as we must have a copy of all these things. You will be able to resume all your usual activities immediately after your EP testing with us.
A lumbar puncture (LP), sometimes also called a spinal tap, is a procedure where a sample of spinal fluid is withdrawn from a small space located near the base of the spine, or "tail bone," for diagnostic or therapeutic purposes.
The spinal fluid, technically known as cerebrospinal fluid (CSF), is made up mostly of water but contains various other nutrients and other natural cells and chemical substances important for maintenance of normal nervous system function. The CSF is constantly being produced and re-absorbed by the brain and circulates through and around the entire brain and spinal cord.
By analyzing the components of this CSF, the neurologist can often determine a great deal of information about the brain's chemistry in both health and disease. An LP may be very important to help study many different disorders of the nervous system, including: infections, inflammations, bleeding in the brain and spinal cord, degenerative diseases, certain types of cancers, demyelinating diseases (such as multiple sclerosis), and hydrocephalus ("water on the brain"). While most LPs are performed for diagnostic purposes, a spinal tap may also be needed to administer certain chemicals or drugs into the nervous system or to relieve certain conditions where there is a build-up of too much CSF or CSF pressure.
LPs may be performed either in the neurologist's office or in the out-patient department of a hospital or medical clinic. You will be asked either to lie curled up on your side or to sit up with your back facing the neurologist. This positioning is important to open up the spaces between your vertebrae, making it easy to insert a thin needle into the lumbar fluid sack which connects with the rest of the CSF compartment. Before inserting this needle, the neurologist will clean your lower back with a sterile wash solution and then numb the area with a local anesthetic so that the needle insertion is not painful.
Once the CSF sample is obtained, the needle is withdrawn and a small bandage or band-aid is applied to the puncture site. There should not be any significant bleeding. Generally, you will then be asked to lie still for about 15 minutes, which allows the puncture site to "seal." The small amount of CSF that is removed is usually replaced by the body naturally within about an hour.
You will then be instructed to drink plenty of fluids and to remain flat (at home) for the remainder of the day, avoiding any significant exertion or prolonged periods of standing or sitting up. Many neurologists feel that these rest measures reduce the likelihood of a "post-LP headache" the next day. However, a small number of patients (probably less than 1%) will nevertheless develop such a post-LP headache the next day even if they are careful to take these steps. If the headache does occur, it is usually relieved by continuing to stay flat at bed rest for a longer period and with over-the-counter analgesics.
The most common complication of this procedure is the post-LP headache, but that occurs only very uncommonly - probably in less than 1% of patients. Since this test does involve a needle puncture, even more rare complications can be temporary backache (while the puncture site is healing) or bleeding or infection at the site. Though very rare, these problems can all be effectively managed with no long-term ill effects. Despite "old wives' tales" to the contrary, modern LPs do NOT cause paralysis.
Patient instructions for LPs: No special advance preparation is really necessary for an out-patient lumbar puncture. You should eat your normal meals and take all your regular medications on schedule prior to the test. It is best to wear loose-fitting, comfortable and easily-removed clothing, and we would suggest that the ladies not wear panty hose. You should also allow at least 15 minutes before your appointment to fill out any necessary paperwork. You must come accompanied by a responsible adult who can drive you home after the procedure and be with you for the remainder of the day at home. Please also be certain to bring with you a complete and accurate list of all your current medications and allergies, as well as any applicable insurance referral forms and insurance ID cards, as we must have a copy of all these things.
The neurologists at the Taylor Medical Group periodically may offer you the opportunity of participating in a clinical trial. All clinical trials in which TMG participates are FDA-approved investigations of a product or pharmaceutical that is believed to be safe and effective to treat or manage a particular neurological disorder or symptom. Your participation in any trial is ALWAYS strictly voluntary on your part, and your decision to participate or not to participate will never in any way prevent us from continuing your neurological care with the same personal attention and concern we render all our patients.
Pharmaceutical and biomedical companies sponsor clinical trials in cooperation with respected doctors or medical groups that have exemplary reputations and demonstrated commitments to clinical and intellectual excellence. Clinical trials are very important in establishing the effectiveness of a particular therapy for widespread use before being offered to the general public as the standard of care. This is how medical knowledge is advanced and the way that novel and more efficacious treatments are proven. By participating in a clinical trial, you would not only be helping to advance important medical science, but you might also gain the opportunity to receive a new treatment (generally free of charge) before it becomes available to the general public.
If a particular clinical trial is applicable to your personal situation, you will be provided with extremely detailed information about the known benefits and risks of participation, and you will be given the opportunity to have all your questions and concerns addressed before you make your decision about participating. You should also know that once you enter a trial, your neurologist might terminate your involvement at any time if we consider that there is a possibility of any harm at all to you, or if new information becomes available indicating that an alternative treatment would be more beneficial for your condition. In addition to our safety monitoring, you would always have the right at any time to withdraw yourself from the trial with or without reason.
Some of the research and clinical trials in which Taylor Medical Group and/or its neurologists have participated include:
- A double-blind placebo-controlled trial of three dosages of an investigational drug for the treatment of patients with painful diabetic neuropathy.
- A double-blind parallel placebo-controlled single dose study of a new agent for the treatment of migraine with or without aura.
- A randomized double-blind placebo-controlled parallel group evaluation of an oral 5-HT1B/1D receptor agonist in the treatment of transformed migraine.
- Evaluation of the safety of three doses of a benzoquinone derivative in patients with probable Alzheimer's disease.
- Comparison of three dose levels 5-HT1D nasal spray in acute treatment of a single migraine attack in adolescent migraineurs.
- Comparison of two dose levels of a 5-HT1D-like receptor agonist and two dose levels of a 5-HT1 receptor agonist for the acute treatment of migraine.
- Evaluation of the safety, tolerability, and efficacy of a 5-HT1 serotonin agonist (10 mg and 5 mg) for the acute treatment of migraine.
- A double-blind placebo-controlled parallel group study of oral doses of ropinirole for six months in the treatment of early Parkinsonian patients not previously treated with L-Dopa.
- Evaluation of a novel agent in the treatment of patients with cognitive impairment associated with dementia of the Alzheimer 's type (GDS stage 3/4).
- A double-blind placebo-controlled six-month extension study to evaluate the long-term efficacy and safety of ropinirole in early Parkinsonian patients not receiving dopaminergic therapy.
- Safety and efficacy of long-term use of a novel agent in the treatment of patients with cognitive impairment associated with Alzheimer's dementia.
- A long-term open label safety study of a 5-HT1B/1D agent orally in migraine patients.
- A double-blind placebo-controlled trial to evaluate the safety and efficacy of valproic acid extended-release tablets in migraine prophylaxis.
- A multi-center double-blind parallel group randomized study to compare the efficacy of 20 mg and 40 mg of an investigational drug with placebo, and the safety of an investigational drug with placebo, and a miscellaneous CNS agent in the acute treatment of migraine headache.
- Evaluation of the safety and efficacy of an NSAID for the prevention of Alzheimer's disease in patients at risk.
- Comparison of the analgesic effect of two OTC medications and placebo in subjects with episodic tension-type headaches.
- Evaluation and efficacy and safety of an OTC analgesic (1,000 mg) for the treatment of pain associated with migraine headaches.
- Pilot study to evaluate the methodology used to compare an NSAID and an OTC analgesic or matching placebo to treat minor arthritis pain in sufferers who use OTC analgesics.
- Comparison of the efficacy of a stratified treatment regimen for acute migraine attacks with that of standard care, such as stepped care or staged care.
- Comparison of an NSAID (1,200 mg), 5-HT1D (25 mg), and placebo in subjects with moderate or severe acute migraine headache.
- Comparison of single doses (200 mg, 400 mg, and 600 mg) of an NSAID and placebo in the acute treatment of migraine headache pain.
- Comparison of the efficacy and safety of an NSAID, a narcotic analgesic, and placebo in subjects with episodic tension-type headaches.
- Evaluation of the efficacy of wearing a magnetic shoe insert versus placebo in treating painful diabetic neuropathy.
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