Diagnostic Studies & Procedures

Diagnostic tests and procedures are vital tools that help our physicians confirm or rule out the presence of a neurological disorder or other medical condition. These include VER, SSEP, NCVEMG, EEG and BAER. Learn more about how these tests work and what results to expect.

Comprehensive and Thorough Consultations

Our providers and research team use a variety of diagnostic imaging techniques and chemical and metabolic analyses to detect, manage, and treat neurological disease.

Some procedures are performed in specialized settings, conducted to determine the presence of a particular disorder or abnormality. Many tests that were previously conducted in a hospital are now performed in our offices or at an outpatient testing facility, with little if any risk to the patient.

Diagnostic Services

Diagnostic tests and procedures are vital tools that help our physicians confirm or rule out the presence of a neurological disorder or other medical condition. These include VER, SSEP, NCVEMG, aEEG, EEG and BAER. Learn more about how these tests work and what results to expect.

Video ambulatory electroencephalography (AEEG) monitoring is a relatively recent technology that allows prolonged electroencephalographic (EEG) recording in the home setting.

Its ability to record continuously for up to 72 hours increases the chance of recording an ictal event or interictal epileptiform discharges (seizure activity). Initially the patient is seen in the office for application of the EEG electrodes. The patient will keep these electrodes on for up 72 hours, taking this device home with them. Some patients will require video monitoring. This will allow Dr. Shafer to visualize potential seizure activity on the video recording, comparing this to the electrical activity documented on the EEG waveforms. This data will allow for more specific neurological diagnosis.

Brain Stem Auditory Evoked Response (BAER)

BAER is a completely painless procedure, which usually takes between 30 and 45 minutes. You will be comfortably reclined as the technologist applies four electrodes; two on your scalp and one on the back of each ear lobe. You will be asked to remove any earrings, so we recommend that you do not wear any earrings to the appointment. You will then be given a set of earphones to wear which will be used to deliver a clicking sound. First, the left side will be stimulated with this sound, then the right side.

The auditory stimulus evokes a potential from the brain stem. This explains the name of the procedure. The potential that is evoked (which we see as a measurable wave form) provides the doctor with information as to how the brain stem is functioning physiologically.

Dr. Shafer will interpret the results and dictate the findings into his report, which we will expedite to your doctor. The technologist will not have information about the outcome.

No specific preparation is necessary. Please take any medication as you usually would – no changes are necessary.

It is best if anyone accompanying the person being tested wait in the lobby. Conversations with a third person during the test is not possible. Rest assure the patient is in caring, experienced hands and nothing during this test is unpleasant in any way.

Please visit the rest room adjacent to the waiting room upon your arrival at the office, before you are called back for the procedure.

Electroencephalogram (EEG)

The EEG is a painless procedure which records the physiological activity of the brain. The entire procedure take about an hour to an hour and 15 minutes. This procedure cannot be rushed – please allow adequate time in your schedule.

During the procedure, you will recline on a comfortable table while the technologist first applies 25 to 30 electrodes on your scalp. You will be asked to lay quietly with your eyes closed during the recording time. If appropriate, you will be asked to perform some deep breathing during a three to four-minute portion of the test. While your eyes remain closed, a strobe light will also flash at progressively faster frequencies, in five second intervals about ten times. Once this is completed, it is permissible and even encouraged for you to be very relaxed, possibly reaching a light stage of sleep.

In regards to preparation, it is best if you have eaten something prior to the test. If you have not eaten at least three hours or more prior to your appointment time, please arrange to have a snack before you arrive (I.E. fruit, crackers, etc…)

It is important to have a clean scalp free of hair spray, gel, mousse, and scalp oils. This assures good contact with electrodes which is essential to getting an accurate reading. Clean hair and scalp also make it possible to remove the electrode cream and electrodes without a trace.

No additional preparation is necessary. Please take any medication as you usually would – no changes are necessary.

It is best if anyone accompanying the patient remains in our lobby. During testing the patient must lay quietly; laughter, talking, or listening to conversation during the recording time will result in inaccurate and unusable data. Also, it is not possible for the technologist to speak with an observer or explain what is being done during the test. Rest assure that the patient is in caring, experienced hands and nothing during this test is unpleasant in any way.

Dr. Shafer will interpret the test results and discuss them with you at your next appointment. The technologist will not have information about the outcome.

Please visit the rest room adjacent to the waiting room upon your arrival at the office, before you are called back for the procedure.

Nerve Conduction Study and Electromyography (NCV/EMG)

NCV/EMG is an important diagnostic tool that can detect the cause of problems such as muscle weakness, numbness, spasms, paralysis, or pain. Nerve and muscle cells produce tiny amounts of electricity. The nerves send electrical signals to the muscles to the muscles, telling them when to relax and contract. Muscles produce tiny amounts of electricity when they move. If the nerves and/or muscles are affected by injury, disease, or compression, their electrical activity changes. During this diagnostic procedure, electrodes will record the activity of muscles and/or nerves. A computer records, prints, and stores the data. A monitor displays the data in a measurable wave form.

At VBNRI, a registered technologist will perform the portion of the test which looks at peripheral nerve function. The patient is lying down while the recording electrodes are placed on the skin over selected muscles. It is important to wash the skin well before the study and NOT apply and lotion before the procedure. For testing of the lower extremities, loose-fitting clothing such as gym shorts are highly recommended. A small electrical impulse is sent through the nerves being studied by means of hand held stimulation and the response is recorded. Tingling sensations of varying intensities are felt as the stimulation is done. Some describe it like the feeling of hitting your “funny bone.” Muscles, fingers, and/or toes may twitch slightly depending on the part of your body being studied. The stimulus is not enough to cause the limb to move significantly. It is necessary to reposition electrodes several times to study various nerves.

If necessary, another portion may be performed by the physician, who will analyze sounds and signals made by the muscles as he/she uses a small thin needle inserted into various muscles. The muscle is tested at rest and when contracting. Muscles to be tested are chosen by the physician.

The EMG/NCV helps your physician make an accurate diagnosis and to develop a care plan which will be most effective for you.

The SSEP is a procedure which records evoked potentials, or electrical signals generated by the nervous system in response to a stimulus. The entire procedure takes roughly about an hour to an hour and fifteen minutes. This procedure cannot be rushed – please allow adequate time in your schedule.

During this procedure, you will lay on a table while the technologist applies several electrodes. Depending on whether your upper extremities or lower extremities are tested, these will be applied to your scalp, mid cervical region at C5(neck), thoracolumbar region at T12 (mid back), ASIS – anterior superior iliac spine (top front of your hip bone), and your wrist or ankle. A very small electrical impulse will be used as the stimulus. Tingling sensations are usually described during this time. Muscle or digit twitching is to be expected. This impulse will travel along the peripheral nerve to the spinal cord, up the cord to the brain, and finally in the brain at the area called the primary somatosensory cortex. It is important to relax during this test as muscle tension will cause interference causing the testing to run longer. To help facilitate this, the technologist will provide you with a blanket if desired and dim the lights.

Preparation for the test includes no lotions or creams to be worn on the extremities being tested as well as clean, dry hair and scalp for ease of electrode placement. This assures good contact with the electrodes that are placed which is essential to getting an accurate reading.

No additional preparation is necessary. Please take any medication as you usually would – no changes are necessary.

It is best if anyone accompanying the patient remains in our lobby. During testing the patient must lay quietly; laughter, talking, or listening to conversation during the recording time will result in inaccurate and unusable data. Also, it is not possible for the technologist to speak with an observer or explain what is being done during the test. Rest assure that the patient is in caring, experienced hands and nothing during this test is unpleasant in any way.

Dr. Shafer will interpret the test results and discuss them with you at your next appointment. The technologist will not have information about the outcome.

Please visit the rest room adjacent to the waiting room upon your arrival at the office, before you are called back for the procedure

Visual Evoked Response or Visual Evoked Potential (VER)

The VER is a completely painless procedure that takes approximately 30 to 45 minutes to complete. Five electrodes will be applied to your scalp and you will watch a monitor that displays a moving checkerboard pattern. You will look at this screen with one eye at a time while the other eye is covered.

The visual stimulus evokes a response that we see as a measurable wave form. This provides the physician with information concerning how your brain is processing information that it receives by way of the optic nerve.

No specific preparation is necessary. Please take any medication as you usually would – no changes are necessary.

It is best if anyone accompanying the patient remains in our lobby. Any distraction that would cause the person being tested to look away from the screen would result in restarting the test. Rest assure that the patient is in caring, experienced hands and nothing during this test is unpleasant in any way.

Dr. Shafer will interpret the results and dictate the findings into his report, which we will expedite to your doctor or discuss with you at your next appointment. The technologist will not have information about the outcome.

Please visit the rest room adjacent to the waiting room upon your arrival at the office, before you are called back for the procedure.

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