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Neurology is the branch of medicine concerned with the study and treatment of disorders of the nervous system.
The nervous system is a complex collection of nerves and specialized cells known as neurons that transmit signals between different parts of the body. It has two major divisions:
A medical doctor with specialized training in diagnosing, treating, and managing disorders of the nervous system.
In our center, we have adult neurologists who are seeing patients 17 years old and above and child neurologists who are seeing patients 16 and below.
What is a neurological exam?
A neurological exam, also called a neuro exam, is an evaluation of a person's nervous system that can be performed in the doctor's office. It may be performed with instruments, such as penlight, ophthalmoscope, reflex hammer, and tunning fork, and usually does not cause any pain to the patient. The extent of the exam depends on many factors, including the initial problem that the patient is experiencing, the age of the patient, and the condition of the patient.
What is done during a neurological exam?
The following is an overview of some of the areas that may be tested and evaluated during a neurological exam:
A medical specialty that studies the function of the central and peripheral nervous systems through the recording of bioelectrical activity. Tests that are conducted are concerned with measuring the electrical functions of the brain, spinal cord, and nerves in the limbs and muscles. It can give the precise definition of site, the type and degree of the lesion, along with revealing the abnormalities that are in question. Clinical neurophysiology is used to help diagnose diseases rather than treat them.
In ACPN, we offer these services to our patients:
1. Electroencephalogram (EEG)
An EEG is a test that records brain activity. During the procedure, electrodes consisting of small metal discs with thin wires are pasted onto the scalp. The electrodes detect tiny electrical charges that result from the activity of brain cells. The charges are amplified and appear as a graph on a computer screen. Patients are then exposed to a variety of external stimuli, such as bright or flashing lights or noises. The patient is asked to open and close his or her eyes, or to hyperventilate, i.e. breathe deeply for a few minutes. The electrodes transmit the resulting changes in brain wave patterns. Since movement and nervousness can change brain wave patterns, patients usually recline in a chair or on a bed during the test. This test can take one hour or more depending on the doctor's order. No pain is associated with EEG.
An EEG is one of the main diagnostic tests for epilepsy. It may also be helpful in diagnosing other brain disorders such as brain damage related to head injuries, inflammation of the brain, and metabolic and degenerative disorders. It is also used to confirm brain death in patients on life support. An EEG can't measure intelligence or detect mental illness.
2. Nerve Conduction Studies (NCS)/ electromyography (EMG)
Most of the time NCS and EMG are done together as they complement each other.
Nerve Conduction Studies include measurement of the speed of conduction of an electrical impulse through a nerve.
In this test, several flat metal disc electrodes are attached to the skin with tape or a paste. A shock-emitting electrode is placed directly over the nerve area, and a recording electrode is placed over the muscles controlled by that nerve. Several quick electrical pulses are given to the nerve, and the time it takes for the muscle to contract in response to the electrical pulse is recorded. The same nerves on the other side of the body may be studied for comparison. If the nerve is a sensation nerve then the signal would be traced in another point along its course.
NCS may take from 15 minutes to 1 hour or more, depending on how many nerves and muscles are studied. This study can determine if a nerve is functioning normally. This test is used to determine more about the functioning of peripheral nerves in the arms and legs. It can show if a nerve is pinched, and estimate the severity and site of the injury.
Muscles receive constant electrical signals from properly functioning nerves, and in turn they broadcast their own electrical signals. During an EMG, the electrical activity in muscles is measured. NCS is done by a technician with specialized training in neurophysiology, while EMG is performed by a neurologist who reads both parts and issue a report. In EMG, the neurologist places a very thin needle into few muscles, one after another, to record the electrical signals from the muscles under study. If a muscle is not receiving adequate impulses from its nerve, it broadcasts signals that indicate the muscle is malfunctioning. The results of EMG are often correlated with the results from the NCS. This test takes 15 to 30 minutes to complete, depending on how many areas are being studied.
3. Evoked Potentials
Evoked potential studies measure electrical activity in the brain in response to stimulation of sight, sound, or touch. Stimuli delivered to the brain through each of these senses evoke minute electrical signals. These signals travel along the nerves and in case of touch through the spinal cord to specific regions of the brain and are picked up by electrodes, amplified, and displayed for a doctor to interpret.
4. Sleep Studies
ACPN specializes in the evaluation of different sleep disorders including obstructive sleep apnea, insomnia, parasomnias and sleep-related movement disorders, such as restless legs syndrome, excessive sleepiness and narcolepsy.
A. Polysomnography (PSG) is a test done overnight while patient is asleep. It can be done in our center or in the patient’s house. The goal is to record brain and body activity that occurs during sleep so that sleep disorders can be diagnosed and treated.
During a sleep study, the following may be measured:
Eye movement, electrical currents of the brain, limb movement, breathing patterns, heart electrical activity, oxygen saturation in blood, body position, and snoring if any.
B. Continuous Positive Airway Pressure (CPAP) titration study determines the proper settings for CPAP therapy if the diagnosis of obstructive sleep apnea was made. The CPAP titration study is essentially the same as the polysomnogram with the addition of the CPAP therapy.
CPAP is a device used to treat obstructive sleep apnea, where repeated episodes of stoppage of airflow caused by collapse and closure of the airway at the level of the pharynx occur. The concept of CPAP is to increase the pressure of the air that you breathe during sleep. Then, the inspired air, under pressure, acts as a splint and holds the airway open. CPAP is an extremely effective method of treating sleep apnea. The CPAP device consists of a mask, usually put on nose, connected by tubing to a small air compressor that sits at the bedside. The tubing is long enough to allow you to move around or turn over in your bed. The machine does not breathe for you; it just changes the pressure of the air that you breathe. It keeps the airway open during the night by gently providing a constant stream of air through a mask you wear while you sleep.
The CPAP mask may cover only your nose or both your nose and mouth. Another option is to use nasal pillows, which fit in your nostrils. No matter what type of mask you use, it is important that it fits well and is comfortable. The mask must make a seal in order to keep your airway open through the night. A good mask seal will prevent air leaks and maintain the right level of air pressure.
Your sleep doctor will determine the amount of air pressure needed for CPAP to treat your sleep apnea.
C. Multiple sleep latency tests (MSLT) measure how long it takes to fall asleep.MSLT is a series of nap opportunities throughout the day. The test is most often used to determine if narcolepsy is present and provide a measure of sleepiness for patients experiencing excessive daytime sleepiness. This procedure is similar to PSG and is most often performed the day following a PSG. A technologist applies sensors and electrodes that will help determine sleep and wakefulness. Nap opportunities, total of 4 or 5 naps throughout the day, will be at two-hour intervals.
What are the common disorders/diseases related to neurology?
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