Diagnostic Testing

Your physician may refer you to one of our neurologists for diagnosis, consultation and/or ongoing treatment for neurological disorders.

Electroencephalogram (EEG)

An electroencephalogram (EEG) is a test that detects electrical activity in your brain using small, metal discs (electrodes) attached to your scalp. Your brain cells communicate via electrical impulses and are active all the time, even when you’re asleep. This activity shows up as wavy lines on an EEG recording.

An EEG is one of the main diagnostic tests for epilepsy. An EEG can also play a role in diagnosing other brain disorders.

How should you prepare for an EEG?

• Come with clean, dry hair
• Do not use hair spray, conditioners, hair creams/sprays. (Hair products can make it harder for the sticky patches that hold the electrodes to adhere to your scalp.)
• Dress comfortably – do not wear a turtleneck
• Do not drink any alcohol or caffeinated drinks on the test day – coffee, tea, cola drinks, mountain dew, etc…
• Take medications as usual unless your doctor directs you to do otherwise.
• Eat normal meals before testing’

Results

Our doctors, who are trained to analyze EEGs, will interpret the recording and give you the results. Please note that the EEG technician is unable to give results during/after an EEG. The doctor must first interpret the results.

Risks

EEGs are safe and painless. Sometimes seizures are intentionally triggered in people with epilepsy during the test, but appropriate medical care is provided if needed.

What should you expect?

During the test, you’ll feel little or no discomfort. The electrodes don’t transmit any sensations. They just record your brain waves.

To start off, our technician will measure your head and mark your scalp with a special pencil to indicate where to attach the electrodes. Those spots on your scalp might be scrubbed with a gritty cream to improve the quality of the recording.

Next, they will attach discs (electrodes) to your scalp using a special adhesive. Sometimes, an elastic cap fitted with electrodes is used instead. The electrodes are connected with wires to an instrument that amplifies the brain waves and records them on computer equipment.

Once the electrodes are in place, an EEG typically takes up to 60 minutes.

You will be asked relax in a comfortable position with your eyes closed during the test. At various times, the technician might ask you to open and close your eyes, perform a few simple calculations, read a paragraph, look at a picture, breathe deeply for a few minutes, or look at a flashing light.

After the test, the technician removes the electrodes, and you should be ready to drive home (unless instructed not to drive by your physician).

We recommend not making plans directly after the test as most people want to wash out the cream used during the test from their hair/scalp. Many people also bring a hat for after the test

EEG Instructions

Ambulatory EEG

What’s the test like?

An ambulatory EEG test makes a recording of your brain’s activity over a number of hours or days.

• EEG wires are placed on your scalp, like in a routine EEG, then attached to a special recorder that is slightly larger than a portable cassette player.
• You can wear the recorder on your waist, with the wires running either under your shirt or outside of it.
• The electrodes on your head are covered with a cap or gauze dressing.
• During the test, you can go about your normal routine for up to 24- 72 hours.
• During the test, keep a diary of what you do during the day and if you’ve had any seizures or other symptoms. This will help the doctor identify the cause of activity on the recording. For instance, the electrodes may make your head itchy, and if you scratch it, that may appear as abnormal activity on the EEG.
• Because the electrodes must stay on your head longer than for a regular EEG, the technologist will probably use a special glue called “collodion” to keep them in place. After the test, acetone (like nail polish removal) or a similar solution is used to remove the glue at the end of the test.

Why do I need one?

The brain’s electrical activity fluctuates from second to second, but routine EEGs provide only a 20- to 40-minute sample of this activity. If epilepsy waves occur in your brain only once every 3 or 4 hours, or if they only happen at certain times of day, a regular EEG might not record them.

To record seizure activity, a longer EEG recording with times that you are both awake and asleep may be needed. When this test is done at home, it’s called an ambulatory EEG.

An ambulatory EEG may be done if you continue to have seizures after trying various seizure medications. The testing can either confirm the diagnosis of epilepsy or find that epilepsy waves are not causing the seizures. Ambulatory EEG monitoring is generally done at a specialized epilepsy center.

Electromyogram (EMG)/Nerve Conduction Study (NCS)

What is an EMG/NCS Test?
Electromyography (EMG) and Nerve Conduction Studies (NCS) are tests used to view and send electrical signals. During an EMG, a needle is inserted directly into a muscle, which records the electrical activity in that muscle. The signals from this test can tell us about the extent of muscle injuries as well as their location. Nerve Conductions Studies (NCS) are very similar and they cause your arm/leg to jump via signals from an electrode placed on your skin. EMG/NCS testing may result in some discomfort, but is usually well tolerated.

How to prepare for your EMG /NCS test:
• Eat your normal meal on the day of the test and continue any medication you are taking unless otherwise instructed.
• If possible, take a shower or bath before your exam in order to remove oils from your skin.
• Do not apply creams/ lotions/ oils on hands, arms, legs and feet.
• Remove all jewelry (rings or bracelets) and wristwatch.
• Please wear loose clothing around the part of the body we are testing so that we can roll the clothing up. Otherwise, we will have you wear a gown.
• The test will not affect your ability to drive, so there is no need to have someone drive you to and from the test unless this is what you usually do for transportation.

What are the risks of EMG /NCS testing?
EMG is a low risk procedure, and complications are rare. There is a small risk of bleeding and infection where the needle electrode is inserted.

What do I expect after an EMG/NCS test?
You may experience some muscle soreness and temporary minor bruising where the need electrode is inserted into your muscle. This is normal, and the bruising should fade in several days. If it persists, contact your primary care doctor.

EMG Instructions

Carotid Ultrasound

A Carotid (kuh-ROT-id) ultrasound is a safe, painless procedure that uses sound waves to examine the blood flow through the carotid arteries.

Your two carotid arteries are located on each side of your neck. They deliver blood from your heart to your brain. Carotid ultrasound tests for blocked or narrowed carotid arteries, which can increase the risk of stroke. The results can help your doctor determine a treatment to lower your stroke risk.

How you prepare

You can take the following steps to prepare for your appointment:

• Wear a comfortable shirt with no collar or an open collar.
• Don’t wear a necklace or dangling earrings.

What you can expect

Our technician (sonographer) Ruth conducts the test with a small, hand-held device called a transducer. The transducer emits sound waves and records the echo as the waves bounce off tissues, organs and blood cells.

A computer translates the echoed sound waves into a live-action image on a monitor. The radiologist may use a Doppler ultrasound, which shows blood flowing through the arteries. In a Doppler ultrasound, the rate of blood flow is translated into a graph.

A carotid ultrasound usually takes about 30 minutes. You’ll likely lie on your back during the ultrasound. The ultrasound technician (sonographer) may position your head to better access the side of your neck.

The sonographer will apply a warm gel to your skin above the site of each carotid artery. The gel helps transmit the ultrasound waves back and forth. The sonographer then gently presses the transducer against the side of your neck. You shouldn’t feel any discomfort during the procedure. If you do, tell the sonographer.