Acupuncture is a procedure that uses fine needles placed at different points on your body, ears, or head. The needles may be connected to an electric stimulator to strengthen the effect. Usually the needles are left in place for about 30 minutes, which completes one treatment. 4-8 treatments comprise 1 course. A patient may need one or more course(s) depending on the nature, complexity, chronicity, and severity of the disease.
NCS is a procedure that one or more of your nerves are electrically stimulated and the response of the nerve recorded by a machine. The latencies, amplitudes, and nerve conduction velocities are determined and compared to normal values.
EMG is a procedure that a special needle will be inserted inside one or more of your muscles. You will be asked to relax or contract the muscle and the responses will be recorded. You will hear some sound during the procedure as well.
After analyzing the data from NCS and EMG, a neurologist can diagnose some of the diseases such as carpal tunnel syndrome, lumbar or cervical radiculopathy, peripheral neuropathy, ALS, etc.
EEG is a test for electric activities of the brain. It is especially important for the evaluation and management of epilepsy or seizure disorders. It can also provide information for neurologists when evaluating a patient for other disorders such as dizziness and passing out, headaches, change of mental status, brain tumor, encephalopathy, non-epileptic or psychogenic seizures, etc.
It is a noninvasive test, recorded from metal electrodes placed on the scalp by an EEG tech. The total recording time is usually about 30 minutes. During the recording, the patient is usually asked to perform hyperventilation (breathing hard) for 3 minutes, and given flashing lights for a short period of time, see if those will bring up any seizure activities. Patient is also asked to sleep for 10-15 minutes if he/she can. After patient finishes the test, he/she can go home without any restrictions.
BOTOX INJECTIONS FOR CHRONIC MIGRAINES
Botox injection is indicated for the prophylaxis of chronic migraine headaches (HA) (> 15 days per month with HA, each HA lasting > 4 hours per day). The study showed Botox injection to those patients can decrease the HA frequency and severity. Side effect or adverse events from Botox injections are rare if the procedure is performed correctly.
During the procedure, typically 31 sites will be injected with Botox with 30G (very small) needles. Patient may have mild local bleeding from the injection, but usually it stops quickly.
After the procedure, patient typically starts to feel less frequent and less severe HA in the second or third week. The effect usually will last for 3 months. Then patient is due for the next Botox injection.
SPHENOPALATINE GANGLION (SPG) BLOCK
SPG is composed of a lot of nerve cells, innervated by a branch of the trigeminal nerve, located in the back part of the nasopharyngeal cavity. Blockade of SPG with anesthetic medication (e.g. Marcaine) can help to control headaches or trigeminal neuropathic pain.
This is an office procedure performed with Tx360 device, which has a soft catheter to deliver the anesthetic to the SPG. It is safe, easy to use, and can be completed within a minute without significant adverse events. The pain relief usually starts within 10-15 min after the procedrue, and lasts 24-48 hours. It can be used for acute treatment for migraine or trigeminal neuralgia, or preventive treatment if performed repeatedly (average 2 times per week) for several weeks. It has demonstrated significant efficacy in clinical trials. Most insurance companies cover this procedure without any problems.
TRIGGER POINT INJECTION (TPI)
Steriod (usually depomedrol) and local anesthetics (usually lidocaine) will be injected at the site(s) where you have pain or tenderness. There will be significant relief of pain in the neck, back, shoulder and some other areas for several weeks.
Most patients do not have any complications, althought there may be some tenderness and aches during the first 1-2 days right after the procedure.
LUMBAR PUNCTURE (LP)
LP is a procedure where a spinal needle is placed into your spinal canal and cerebrospinal fluid (CSF) is collected for diagnosis or treatment. You are asked to lay on your side in a fetal position. LP usually helps neurologists diagnose some diseases such as multiple sclerosis (MS), meningitis, encephalitis, etc.
Before the procedure, your back will be cleaned thoroughly (sterilized) first. Then local anesthetics (usually lidocain) will be injected at the LP site. Then LP begins.
After the procedure, you should lay flat for 30-60 minutes after the LP to prevent headache. If you have a headache which is worse when sitting or standing up, lay down and drink lots of fluid. If your headache persists, call your doctor or go to the nearest emergency room.
Now, this procedure is perfomed in a hospital under an X-ray machine most of the time due to the convenience and accuracy.