Nearly three quarters of patients can effectively terminate a migraine attack with the use of medications known as triptans. In 60% of patients with epilepsy, freedom from seizures can be achieved using either one antiepileptic medication or a combination of such medications. Patients presenting to the emergency room within three hours of the onset of symptoms consistent with stroke (brain attack) may be able to benefit from the use of powerful clot-busters in an otherwise potentially devastating illness. Patients with Parkinson’s disease now have multiple medications at their disposal resulting in a significant improvement in their quality of life. For those who are diagnosed with multiple sclerosis, we now have several medications that have been proven to reduce attack frequency and therefore result in a better quality of life. Although we are not able to cure patients with Alzheimer’s disease, several medications are now available to ease the burden of the disease for both patients and caregivers.
In some cases, patients with epilepsy can be cured with surgical intervention. For patients with Parkinson’s disease, implantation of deep brain stimulators to control tremors and dyskinesias (involuntary abnormal movements) has immensely improved the quality of life of these patients. The key to the success of surgical procedures is the appropriate selection of patients for referral to a neurosurgical center
Neurological Tests
Technological advances have greatly enhanced our ability to accurately and correctly diagnose many neurological ailments. Nevertheless, the most crucial information is usually obtained during the initial visit with your physician. The patient interview and neurological examination that are performed during this initial visit will guide your doctor in deciding what examinations, if any, are needed.
Some investigations are performed in order to confirm a diagnostic impression. A confirmatory result then leads to discussions about therapeutic options. Other investigations are undertaken in order to exclude possible diagnostic etiologies. In this case, a normal study provides reassurance that potentially serious conditions are not being missed.
Introduction:
EEG is the name of a commonly performed investigation that detects abnormalities in the electrical activity of the brain. An EEG is not a ‘brain scan’. The EEG is a painless procedure.
How an EEG is performed:
Neurons (brain cells) communicate with each other via tiny electric currents. In an EEG, small flat metal discs (electrodes) are placed on the scalp in order to record the brain’s continuous electrical activity. These tiny electrical impulses are then transmitted via wires to a recording machine and the information is then displayed, as a series of wavy lines, on a computer screen or paper.
The test is performed by an EEG technician either at your physician’s office or in a hospital. The EEG technician will ask you to lie on your back on a bed or to sit in a reclining chair where a series of electrodes (usually around 20) will be applied to your scalp. The electrodes are held in place by way of a sticky paste. The electrodes only record activity and do not produce any sensations.
Introduction:
If you are suspected of having a muscle or nerve disorder, your physician may request that you undergo nerve conduction studies and electromyography. Although quite different data is obtained from each procedure, the information obtained from the two tests is complementary and assists your physician in reaching a diagnosis.
Who needs NCS/EMG studies?
These studies are performed in order to investigate a variety of complaints including:
- Numbness or tingling, especially in the arms or legs.
- Pain in the extremities, neck or back.
- Weakness that is thought to be due to disorders of peripheral nerves, the junction between muscles and nerves or muscles.
- Muscle cramps or involuntary twitching.
Several disorders of the nervous system can be investigated with the help of these tests:
- Radiculopathy (Such as in a herniated disc resulting in a pinched nerve in the neck or lower back)
- Carpal tunnel syndrome (compression of a nerve at the wrist)
- Low back pain
- Neck pain
- Neuropathy (such as with diabetic neuropathy)
- Neuropathic pain (such as with painful diabetic neuropathy or post-herpetic neuralgia)
- Myasthenia gravis (disorders of the neuromuscular junction)
- Myopathies (such as muscular dystrophies)
- Many other conditions
Where is the test performed?
This is an outpatient procedure. The test may be performed in your physician’s office or in a hospital.
What is Doppler Ultrasound?
Sound travels in waves. Ultrasound is sound that travels at a frequency that is beyond the hearing capacity of man. Using a handheld transducer placed on the skin, ultrasound waves penetrate the tissues and are reflected off the internal structures. The echoes produced are then captured by the transducer and a 2D image is projected upon a screen. Doppler ultrasound utilizes the same principles in order to image blood flow.
Continuous Wave Doppler Ultrasound allows your physician to listen to the sound of blood flowing through your vessels. A change in pitch can then provide an estimate of the degree of narrowing in the blood vessel.
Color Doppler Ultrasound utilizes two technologies simultaneously. In addition to the standard images that are obtained, Doppler sounds are converted into colors that are superimposed upon the image of the blood vessel representing the speed (velocity) of blood flow through the vessel under study.
Duplex Doppler Ultrasound also utilizes two technologies simultaneously. With standard techniques, an image of the blood vessels and neighbouring organs is produced. Additionally, the Doppler sounds are converted into a graph that records the speed and direction of flow in the blood vessel under study.
Introduction:
Evoked Potentials are also referred to as evoked responses. In these tests, the brain’s response to various stimuli is recorded. The three commonly performed types of evoked responses are:
- Visual evoked potentials (VEP). During this procedure a light stimulus is presented to the patient.
- Brainstem auditory evoked potentials (BAEP). During this procedure a sound stimulus is presented to the patient.
- Somatosensory evoked potentials (SSEP). During this procedure an electric impulse is presented to the patient. There are two common varieties of this test:
Upper extremity (SSEP)
Lower extremity (SSEP)
Where the test is performed:
These are outpatient procedures. They can be performed in your physician’s office or in a hospital.
Who performs these tests?
Evoked potential (EP) studies are performed by specially trained neurophysiology technologists.
What is a CT scan?
A CT scan is an imaging procedure that utilizes X-rays in order to provide pictures of the internal structures of the human body. This is a painless procedure. The images produced are cross-sectional in nature. Each 2-D imaging slice resembles what you would see if for example you took an apple and sliced it in half across the middle and then looked at the cut surface. If you did this starting at the top of the apple and worked down to the bottom you would have a series of slices that represent the entire structure. With the aid of a computer, 3-D images can be reconstructed from these 2-D slices.
Why is a CT scan performed?
A neurologist will usually request a CT of the brain or spinal cord. At times, a CT of the sinuses or chest may also be requested. CT scans aid in the diagnosis of many conditions including: herniated discs; mass lesions such as tumors; infections of the brain, meninges or spinal cord..
What is an MRI?
Magnetic Resonance Imaging (MRI) is a diagnostic procedure that utilizes a large, strong magnet in order to produce a picture (image) of the internal structures of the human body such as the brain and spinal cord. Magnetic Resonance Angiography (MRA) uses the same technology in order to produce an image of the arteries whereas Magnetic Resonance Venography (MRV) produces images of the veins. The MRI machine is housed in a special room that provides protection for its powerful magnet.
Are there any risks?
The MRI is a safe and painless procedure. There are no documented risks. The safety of this procedure during pregnancy is unknown although there is no documented evidence of any risk. It is still preferable, if at all possible, not to perform an MRI during the first trimester.
What is a lumbar puncture?
A lumbar puncture is also referred to as a spinal tap. It is a diagnostic procedure that is performed in order to obtain a sample of CSF which is then sent for testing. CSF (cerebrospinal fluid) is a clear, colorless fluid that surrounds the brain and spinal cord. At times an LP is a therapeutic procedure involving the administration of medication into the CSF.
Who performs a lumbar puncture?
An LP is performed by qualified physicians from various specialties who are skilled in this procedure.
Where is a lumbar puncture performed?
Although an LP is often performed acutely in a hospital setting (emergency room, intensive care unit or general ward), it is also frequently performed on an out patient basis either in your physician’s office or as a same day procedure in a hospital.
What is Angiography?
Literally speaking, ‘angiography’ translates to ‘imaging of blood vessels.’ Four major blood vessels provide the blood supply of the brain. These are the right and left carotid arteries and the right and left vertebral arteries.
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