Neuro Electrophysiology Unit

The Neuro Electrophysiology Unit is a part of the Centre for Neurosciences at Nanavati Max Super Speciality. It is one of the most comprehensive centres in Mumbai with well-equipped latest technology machinery and Senior experienced staff to carry out the diagnostic procedures and for interpretation of the Recorded data.

Services Provided:

The Neurophysiology Department offers variable tests to diagnose the neurological problems

• Electromyography and Nerve Conduction Study
• Facial Nerve Study
• Sympathetic Skin Response (For testing autonomic function )
• Pediatric Electromyography and Nerve Conduction Study
• EMG guided Botulinum toxin injections
• Evaluation of Birth /Adult brachial plexus injuries
• Specialized tests for Neuromuscular Junction Disorders(Decrement Study and Single Fiber EMG study)
• Evoked Potentials:
• Visual Evoked Response(VER) / BrainStem Auditory Evoked Response(BAER) / Somato Sensory Evoked Response(SSEP)
• Intraoperative Neuromonitoring (IONM)

• Routine EEGs and Video EEG (2 hours, 4 hours)
• Portable Bedside EEGs in ICUs.
• Sleep Deprivation EEG
• Neonatal EEGs

Introduction:

EMG/NCS is a combination of diagnostic procedures that is indicated for any neuromuscular disorder and helps the referring doctor to narrow the differential diagnosis by

• Localising the lesion
• Quantifying the problem (Mild /Moderate/Severe )
• Identifying the pathophysiology (Axonal, Demyelinating or Mixed)
• Any associated or underlying neuromuscular problem
• Assess prognosis especially in cases of nerve injuries

Why the test is done:

The referring doctor may recommend these tests to the patient if he/she shows signs or symptoms that may indicate a nerve or muscle disorder. These symptoms may include:

• Tingling in hands or feet
• Numbness
• Muscle weakness
• Muscle pain or cramps
• Traumatic Injuries

The clinical conditions where the test is mostly indicated:

• Peripheral Neuropathies
• Muscle diseases: Myopathies
• Diseases of Nerve and Muscle junction-Myasthenia Gravis
• Diseases of Motor neurons of the brain and spinal cord-Motor neuron disease
• Screening nerves in Diabetic patients of more than 5 years of history of Diabetes

Nerve conduction study (NCS) is always required along with Needle EMG

Nerve Conduction Study- (NCS)

• Do not apply lotion or cream over the skin and preferably wear loose clothes.
• Can be done very safely even in the newborn & pregnant women.
• The test would be contraindicated in patients with Pacemakers and in patients who are oral Anticoagulants (Warfarin)

Procedure: Some sticky pads will be placed on parts of your limbs will record the responses from your nerves. We stimulate nerves locally by giving bearable shocks in Milliamperes and may even cause slight movement of the muscle being stimulated.

Needle EMG examination

It is done by inserting fine disposable NEEDLE Electrodes into the muscles for a few seconds.

Procedure: The muscle activity is picked up by the needle electrodes and displayed on the monitor and over a loudspeaker and diagnosis is made on-line.

Repetitive Nerve Stimulation (Decrement Study)

Certain diseases where pathology at the nerve and muscle junction (the neuromuscular Junction) is suspected Special tests can evaluate these diseases.

• Repetitive Nerve Stimulation (Decrement Study or RNS test )
• Single Fiber EMG (SFEMG)

During this test, continuous current stimuli (6-7 taps) are given to a nerve to be tested. Kindly carry the medication along so that it can be taken as soon as the test is completed.

Evoked Potentials:

These are specialized tests, which involve three major tests that measure responses to Visual, Auditory and Electrical stimuli.

• Visual evoked Responses (VEP): Tests the Optic pathway
• Brainstem Auditory Evoked Potentials (BAEP): Tests the Auditory pathway.
• Somatosensory evoked potential (SSEP): Tests the Spinal cord function

Children will require sedation for the above test.

Intraoperative Neuromonitoring (IONM)

• This is a highly specialized technique offered at our centre.
• The nervous system can be monitored during the surgery.
• It is used for complex spinal surgeries and certain brain surgeries.

Electroencephalogram (EEG)

An EEG records the electrical activity that arises from the brain.

• Epilepsy or other seizure disorder
• Brain tumour
• Head injury
• Brain dysfunction that may have a variety of causes (encephalopathy)
• Encephalitis
• Stroke
• Dementia

• EEG – Both Sleep-deprived or routine
• Video EEG-( short and long term monitoring)
• Neonatal sleep EEG
• Dedicated Portable video EEG for ICU bedridden patients

Procedure: Several external electrodes are placed on your scalp. These records the electrical impulses generated from different centres or areas of your brain that are picked up by the electrodes and seen on the screen of the EEG machine. It is a painless and noninvasive test and can be done on children and adults safely.

Video EEG

Video EEG is an EEG performed along with a live Video recording. A Video picks up seizure activity when the patient is clinical experiencing a seizure and can add immense value to localization of a seizure.

• A Video EEG is typically done for long hours.
• Performed as an out-patient in our hospital
• The Neuroelectrophysiology department has well-trained staff
• Full time dedicated Neurophysiologists
• Neurologist attached to the hospital is involved in diagnosing EEG abnormalities
• 3 full times well experienced Senior Neurotechnologists.