Services

Neurological disorders

We offer the comprehensive evaluation of following neurological disorders.

ALS
Alzheimer's
Autism
Back Pain
Bell's Palsy
Coma
Cephalic Disorders
Cerebral Palsy
Charcot-Marie-Tooth Disease
Dementia
Epilepsy
Guillain-Barre Syndrome
Huntington's Disease
Hydrocephalus
Infectious Diseases
Lou Gehrig's Disease
Migraine
Movement Disorders
Multiple Sclerosis
Multisystem Atrophy
Myasthenia Gravis
Myopathies
Neurofibromatosis
Neuropathy
Parkinson's Disease
Seizure Disorders
Sleep Disorders
Stroke
Traumatic Brain
Injury
Tremor
Nervous System
Tumors
Vertigo

Diagnostic testing

EEG

  1. What is an EEG Test?
    An EEG, short for electroencephalogram, is a test which records the patterns of electrical changes both normal and abnormal, from the millions of nerve cells in the brain.


  2. What is the test for?
    It is used as an aid, but only an aid in diagnosing epilepsy, and other conditions. An EEG will not normally prove conclusively that you have, or don't have epilepsy. Your medical history and an eyewitness account of your seizures are still the most important factors in making a diagnosis.


  3. Who does the testing?
    A doctor or consultant will refer a patient for an EEG test. An EEG technician will carry out the test. A doctor who is a specialist in assessing EEG tests will report on the findings.


  4. What happens in an EEG test?
    The patient is asked to lie down. The technician explains what is going to happen and tries to ensure that the patient feels relaxed. The technician then places small discs, called electrodes on to the patient's head, either by attaching them with a glue-like substance to the scalp or by inserting them under a rubber cap placed on the patient's head. The electrodes are then connected by wires to the EEG machine, which is then switched on. The machine will only record what is already there - it will not cause anything to happen. The patient is asked to keep very still as movement can actually hide what is happening. The patient is then asked to do simple tasks e.g.

    (i) To open and close his/her eyes several times
    (ii) To take deep breaths for approximately three minutes
    (iii) To look at a flashing light called a stroboscope.


  5. Is the test painful?
    No. The cap on the head may be a little uncomfortable but the patient will not experience any pain during or as a consequence of the test. The EEG machine cannot 'read' minds or give an electric shock.


  6. How long does a test last?
    Approximately one hour is required for a routine EEG test. The hour allows time for the technician to explain the procedure, for the patient to feel reassured and for the technician to complete the recording. Some tests last longer than one hour.


  7. What does the EEG machine do?
    The EEG machine is really an amplifier. The electrical changes from the brain are very tiny indeed and the EEG machine magnifies them sufficiently to produce enough power to move pens up and down with each change. The movements are shown up as waves.
    (a) EEG recording of normal brain activity A normal recording showing reduction of rhythms on opening of eyes.

Sleep Study

  1. What Is An Overnight Sleep Study?

  2. An overnight sleep study is a diagnostic test that includes several types of measurements used to identify different sleep stages and classify various sleep disorders. Small sensors are connected to the head, face, chest and legs of the patient to monitor different brain and body activities including brain waves, eye movements, heart rate, respiration and muscle movements. This will not be painful or uncomfortable and is very safe.

  3. Can I Fall Asleep With All Those Wires On Me?
    Every effort is made to make the study as comfortable as possible. The sensor wires are gathered together to make it easy for the patient to roll over and change position The sensors can be disconnected very easily if the patient needs to go to the bathroom in the middle of the night.

  4. What Will Happen During My Study?
    While the patient is sleeping, various important body functions and data are monitored and recorded. The technician is monitoring the study throughout the duration of the study. If a respiratory or breathing problem is observed during sleep, the patient may be woken up to try a device that treats breathing problems. This device is a Continuous Positive Airway Pressure (CPAP) device and includes a small mask which fits around the nose.

  5. Should I Take My Regular Medication The Night Of My Study?
    Yes. The patient should not discontinue any prescription medication without consulting his/her doctor first. It is however important that the patient write down in the questionnaire that he/she is given before the study, any medication that he/she has been taking.

  6. Is There Anything In Particular That I Should Do On The Day Of My Study?
    It is important that the patient's hair is thoroughly dry and free of oils or sprays for the study. The patient should preferably not take any naps on the day of the study and should not take caffeinated beverages (including coffee, tea or soft drinks containing caffeine) 12 hours prior to the study. No alcoholic beverages should be consumed on the day of the study.

  7. What Happens After My Study?
    After a sleep study is finished, all the results will be compiled. Once the study has been interpreted, a report will be sent to the patient's referring physician. It will typically take 1-2 weeks before a full report is sent to the referring physician.

Pain management related services

Acute pain management

Acute pain is a term we use to refer to the pain that follows a surgical procedure or follows the onset of an otherwise suddenly painful condition (i.e., Trauma, Severe Migraine Headache, Pancreatitis, etc.).

Optimal care of the patient undergoing a surgical procedure includes effective pain management. Clinical studies continue to indicate that routine orders for intramuscular injections (IM) of narcotics fail to relieve pain in about half of postoperative patients. Unrelieved pain may result in shallow breathing, retained pulmonary secretions, and pneumonia. It may also trigger deleterious stress responses including increased pulse and blood pressure, impair the immune response and healing, promote breakdown of the tissues, and elicit negative emotional responses. Intramuscular injections of narcotics may result in uneven and unpredictable absorption from the muscle. Pain medication requirements vary for many reasons including age, fitness, personality type, normal pattern of pain medication use, liver function, and surgery performed. Pain is an individual, subjective experience; therefore, the pain medication to produce analgesia (pain relief) should be individualized.

Recognizing these facts we employ one of the most sophisticated acute pain care methods. The problem with effective pain control is not the medications, but the manner in which they are delivered. There have been two important advances in the field of pain management: 1. Intravenous Patient Controlled Analgesia (IV PCA) and 2. Epidural Analgesia. The pump can be used for IV PCA as well as for epidural techniques. It allows for a constant level of comfort as well as extra boosts of pain reliever that help patient to control pain during more strenuous portions of hospital recuperation.

A. What is Acute pain?

B. What is acute pain management?

C. Acute pain and surgical Recovery

D. Patient Controlled Analgesia (IV PCA)

E. Patient Controlled Epidural Analgesia (PC EA)

F. Regional Analgesia

G. Epidural Analgesia

H. Continuos Epidural Analgesia

I. Nerve Blocks

What is Acute Pain?

Acute pain is a term we use to refer to the pain that follows a surgical procedure or follows the onset of an otherwise suddenly painful condition (i.e., Trauma, Severe Migraine Headache, Pancreatitis, etc.). The treatment of such pain is called Acute Pain Management. The treatment of such pain is called Acute Pain Management.

What is Acute Pain Management?

Acute Pain Management is designed to substantially reduce postoperative pain. In some cases pain control following surgery is not just a matter of comfort - it is a matter of medical safety. If pain is not adequately controlled, patients may not be able to do the things required to get better such as taking deep breaths, getting out of bed, and walking. The object of acute pain control is to improve patient outcome as well as to improve comfort during the period of medical recuperation.

With the many techniques now available we can work with our patients to achieve the best in comfort and safety. Normally acute pain management is conducted in the hospital. However, on occasion, modified techniques can be provided for the patient at his or her home with the assistance of a sophisticated Home Care Medical Team.

In other situation some patients with chronic medical problems develop acute pain, for example, sickle cell crises and pancreatitis. In these situation pain acute pain management becomes equally important for the comfort of patient and proper recovery

Acute Pain and Surgical Recovery

Recovering from surgery can be very painful. Everyone understands that. Acute Pain Management is designed to specifically reduce this pain. But in some cases pain control is not just a matter of comfort - it is a matter of medical safety. If pain is not adequately controlled, you may not be able to do the things required to get better, such as getting out of bed, breathing deeply, assisting with physical therapy, etc.

These are things necessary for your recovery from surgery. By preventing you from fully taking part in your rehabilitation, pain can actually prevent you from getting better quickly. Worse yet, this same pain can lead directly to such inactivity that severe problems like pneumonia or embolism could occur. Intravenous Patient controlled analgesia (IV PCA) and patient controlled epidural analgesia (PCEA) and other techniques allow the patient to have some control over the pain, rather than having to wait for the nurse to bring the injection.

IV PCA (Intravenous Patient Controlled Analgesia)

IV PCA stands for intra-venous patient controlled analgesia. This is a mechanism developed to allow patients to deliver their own pain medicine. The medicine is delivered directly through an IV site. Pain relief is normally rapid. If your physician feel this would work well for you, you will be given a "button" connected to a small IV pump, which will deliver a small dose of pain medicine through your IV, when you push the button. The pump can also be programmed to provide a continuous basal infusion as well. With an IV PCA you may find that overall you actually need less pain medicine but experience better post-operative pain relief because you are able to get pain medication at the time you need it.

SubQ PCA (Subcutaneous Patient Controlled Analgesia)

SubQ PCA or subcutaneous patient controlled analgesia is a mechanism developed to allow patients to deliver their own pain medicine in the hospital or at home. Pain reliever is delivered directly through an implanted catheter directly under the skin. The catheter is connected to a small electronic pump, which will deliver a measured dose of pain medicine to you when you push the button. The pump can also be programmed to provide a continuous basal infusion as well. With an IV PCA you may find that overall you actually need less pain medicine but experience better post-operative pain relief because you are able to get pain medication at the time you need it.

Regional Analgesia

In regional analgesia, only a specific area of the body is targeted for pain relief. This type of pain control involves placing a needle near nerves supplying the area of the body to be operated on and injecting a pain reliever directly into this area. The needle placement can usually be done under sedation or after our patient is asleep in the operating room. There are several advantages to regional analgesia. It provides pain control at the surgical sight without as much sedation after surgery. Many areas of the body are suitable for regional analgesia. Examples of some of these include surgery on the hand (e.g. reconstruction), surgery on the foot (e.g. bunionectomy), surgery on the leg (e.g. total knee replacement), surgery on the shoulder (e.g. rotator cuff repair), abdominal surgery (e.g. exploratory laparotomy), and lung surgery (e.g. thoracotomy). Another instance in which regional analgesia is very commonly employed and preferred is with labor and delivery and also following cesarean sections.

Types of Regional Analgesia

There are several different types of regional analgesia available. Some of these include:

Epidural Analgesia

Epidural analgesia involves delivery of anesthetic medication on nerves within the epidural space in the vertebral column. We place a small tube or catheter within this space and this allows us to continuously give medication as required for comfort throughout the surgical recovery and beyond. Frequently the patient can be given control over this dosing mechanism just as with the IV PCA. This technique is called patient controlled epidural analgesia or PCEA. This type of pain control is particularly well suited for major lower extremity procedures like a total hip or knee replacement, certain abdominal or pelvic surgeries and is especially useful after chest surgery.

Continuous Epidural Analgesia

Continuous epidural analgesia is a term that refers to any epidural with medication designed to reduce pain but not provide total lack of sensation to the affected body area. This category would include the walking epidural discussed above but also includes such things as standard labor epidurals. Depending on the medication used, the patient may experience some mild, moderate, or even significant leg weakness while the epidural is in effect. If weakness is anticipated or expected, you will be asked to remain in bed during the course of your epidural administration.

Nerve Blocks

There are a large variety of specific nerve blocks that we can use to ensure your comfort postoperatively. They are too numerous for discussion here. Each of these techniques has advantages and disadvantages. Your anesthesiologist will discuss these with you as well as covering various anesthetic options for your particular surgery. If there are specific medical concerns associated in your case with conservative, intravenous, or regional pain management, those will be explained to you as well.

Chronic pain management

Chronic pain is pain that persists far beyond the expected recovery time. Chronic pain syndrome is a condition in which chronic pain has substantially interfered with a person’s ability to function in normal life roles, and has eroded the pain sufferer’s self-esteem, well-being, and relationships.

Treatment of chronic pain is more challenging as compared to acute pain management. Successful therapy depends on a multidimensional assessment of the pain problem that goes beyond the physiologic cause and includes the contributing factors and barriers. Contributing factors are those things which do not cause the pain in-and-of themselves, but which may amplify the pain or perpetuate it. Examples include poor posture in the chronic neck pain patient, or dietary factors in the migraine patient. Also, insomnia, anxiety and depression may contribute to an amplified pain experience. An intercurrent illness such as bronchitis with persistent cough may be a contributing factor in a patient with recent rib fracture pain. Barriers make pain assessment harder, prevent successful application of a useful treatment, or block the recovery process. Examples should include language or cultural barriers, chemical dependency, chaotic psychosocial lifestyle, insurance non-coverage. A history of physical, emotional or sexual abuse can act as a barrier because patients with such a history may adapt poorly to a new physical injury. Medical illness can also act as a barrier: The patient with peptic ulcer disease may not be able to utilize non-steroidal anti-inflammatory drugs, which would otherwise have helped the pain problem.

We evaluate and treat chronic pain by employing multidisciplinary approach. We offer treatment to following chronic pain disorders.

1. Myofascial Pain Syndrome

a. Fibromyalgia

2. Complex Regional Pain Syndrome (Reflex Sympathetic Dystrophy- RSD)

3. Neuropathic Pain Syndromes
a. Acute Herpes Zoster (Shingles)

Post Herpetic Neuralgia
b. Trigeminal Neuralgia
c. Neuropathic feet pain

4. Cancer Pain

5. Headache- Chronic
a. migraine headache
b. Tension headache
c. Cluster Headache
d. Mixed daily headache

6. Chronic back pain
a. Failed Back Surgery Syndrome

7. Chronic Abdominal and Pelvic Pain
a. Interstitial Cystitis
b. Chronic pancreatitis

8. Chronic Facial Pain

9. Persistent Post Surgical Pain

10. Persistent chronic spasticity