We offer the comprehensive evaluation of following neurological
- 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.
- 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.
- 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
- 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.
- 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.
- 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
- 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.
- What Is An Overnight
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.
- 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.
- 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.
- 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.
- 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.
- 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
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
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
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,
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
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
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 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
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 persons ability to function in normal life roles,
and has eroded the pain sufferers self-esteem, well-being,
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.
Regional Pain Syndrome (Reflex Sympathetic Dystrophy- RSD)
3. Neuropathic Pain Syndromes
Herpes Zoster (Shingles)
Neuropathic feet pain
a. migraine headache
b. Tension headache
c. Cluster Headache
d. Mixed daily headache
6. Chronic back
a. Failed Back Surgery Syndrome
7. Chronic Abdominal and Pelvic Pain
a. Interstitial Cystitis
b. Chronic pancreatitis
9. Persistent Post Surgical Pain
10. Persistent chronic spasticity