Welcome to Neurology Associates of Fredericksburg

Electromyography/Nerve Conduction Velocities (EMG/NCV's) These are among the most important tests to study pinched nerves, diseases affecting the nerves in the limbs, and muscle diseases; problems which may produce numbness, tingling, pain and weakness in the limbs. During NCV's, mild electrical stimulation is applied to nerves over the limbs and their impulses recorded. During EMG, a single, small, Teflon-coated, needle-shaped electrode is placed in the muscles just under the skin and the muscles' own electrical activity is recorded. The patient may experience mild transient discomfort during the procedure. A patient should not use lotions or oils on the skin on the day of the test, otherwise no preparation is necessary and the patient can drive home immediately afterward.

Electroencephalogram (EEG) is used to diagnose and evaluate neurologic diseases, such as seizures and epilepsy, and symtoms such as memory loss, dizziness, confusion, fainting, and a variety of other problems. The test measures the electrical activity of the brain waves, by painlessly pasting about 26 small electrodes over the head, and recording the brain's activity. This is done in our office, and then analyzed by our neurologists, at Neurology Associates of Fredericksburg. Additionally, for more complicated cases, a digital EEG device can be worn home, which continuously records from 24 to 72 hours of your brain activity(7 to 25,000 screens) to later be both visually and digitally analyzed. This can also include video recording.

Evoked Potential Testing records the brain's response to visual, auditory, and limb stimuli. Visual evoked potentials test the visual pathways between the retina (eye) and the brain by presenting alternating checkerboard patterns. Brainstem auditory evoked potentials test the pathways between the ear and the brain by using headhones over the ears. Somatosensory Evoked Potentials test the pathways through the limbs and spine to the brain by stimulating nerves with small electrical pulses, usually felt as tingling sensations.

Muscle biopsy and sural nerve biopsy: These are sometimes necessary to arrive at a definite diagnosis in diseases affecting the muscles or the nerves in the limbs (myopathies, peripheral neuropathies), respectively. These are both brief outpatient procedures done early in the morning after an overnight fast. They are performed under local anethesia and IV sedation in an outpatient surgery facility. The patient can walk and use the limb but is advised to "take it easy" and rest for two days after either of these procedures. The patient will need someone to drive him/her to and from the procedure.

Skin biopsy: This procedure is occasionally necessary to diagnose certain diseases producing numbnes, tingling or pain in the hands and feet (small fiber neuropathies). A small "button" of skin is removed from the calf and from the thigh under local anesthesia. This is a very simple procedure done in our office. It does not require fasting or special preparation and the patient can drive home immediately afterward.

Injections of this medicine are done in our office to treat certain conditions causing uncontrolled contractions or abnormal postures of the face, neck, or limbs (dystonias, blepharospasm, Meige syndrome, hemifacial spasm, spasticity). Sometimes EMG guidance is necessary to reach deep muscles. No preparation is necessary and the patient can drive home immediately afterward.

DBS is a medical device (much like a cardiac pacemaker) implanted for control of abnormal movements such as tremor, Parkinson's disease symptoms, and also dystonia.

The complex neurostimulator is placed beneath the skin of the chest, and wire leads are implanted in the center of the brain by a skilled neurosurgeon. Electrical stimulation is then sent directly to targeted areas in the basal ganglia (the motor control "switchboard" centers).

Your neurologist at Neurology Associates of Fredericksburg will wirelessly program and adjust this device to achieve a reduction of some abnormal movements for improved function.

Transcranial Doppler (TCD) is a non-invasive ultrasound test used to evaluate blood flow patterns in brain arteries. During the procedure, a small ultrasound probe is placed either over the temples, the base of the neck, and above the eye to evaluate blood flow velocities. Current uses of TCD include:

• Detection of cerebral vasospasm following brain hemorrhage (stroke)
• Diagnosis of intracranial arterial stenosis (blockage)
• Evaluation of adequate cerebral blood flow patterns and vasomotor reserve in the face of extra-cranial (carotid) stenosis
• Detection of stroke risk in sickle cell anemia
• Detection of Cerebral Emboli (mobile blood clots)
• Detection of a Patent Foramen Ovale (PFO) with contrast ("bubble TCD")