Q: What is an EEG? A: An EEG is also known as an electroencephalogram. This is a test where wires and electrodes are temporarily pasted to your head/scalp to monitor your brain wave activity. EEG's are routinely used to evaluate patients who have seizures, convulsions, blackout spells, spells of unusual behavior, or confusion/memory loss. It is a painless, non-invasive test which evaluates your brain waves, much like an ECG evaluates your heart's electrical activity.
Q: What is a NCS (Nerve Conduction Study)? A: An NCS is an electrical test of your nerves in your face, arms, and legs. It is used to help evaluate symptoms such as numbness, tingling, pins/needles sensations, burning pain, and sharp/shooting pains of the hands, feet, or face. The test uses electrodes placed on the skin overlying the nerves. A very tiny electrical current is then passed through the nerve to assess its function. There is minimal discomfort due to a feeling of a tiny electrical shock, but most patients tolerate this without much difficulty.
Q: What is an EMG? A: An EMG is also known as an electromyogram. This is a test where muscle and nerve function are evaluated using a very thin needle. There is no electrical stimulation or "shock" as in NCS's. However, a very thin, sterile needle is inserted into various muscles of the arm, leg, and paraspinal areas to determine if they are functioning normally. A microscopic microphone is located in the tip of the needle, which listens to muscle activity. Healthy muscles give of a healthy sound, however, unhealthy muscles give off abnormal sounds. Depending on which muscles sound unhealthy, an EMG may determine which nerves in the neck or back are irritated or injured. This is often seen in radiculopathies, otherwise known as "pinched nerves." Various muscle disorders and neurodegenerative disorders are also evaluated with EMG.
Q: Who performs the NCS and EMG studies? A: At Northlake Neurology, Drs. Jung and Robles personally perform all the NCS and EMG testing. Furthermore, Dr. Jung is specifically fellowship trained in neurophysiology and is board-certified in clinical neurophysiology. The actual performance and interpretation of NCS and EMG studies require specialized training during the years of residency and fellowship training. These tests should only be interpreted by experienced neurologists or physiatrists (physicians trained in rehabilitative medicine), because they require a high degree of skill, clinical knowledge of neuroanatomy, and the ability to treat potential, but rare, complications. Some NCS tests may be performed by a technician under the supervision of a physician trained in neurodiagnostic medicine, but never should these tests be interpreted by a technician or computer.
Q: Why do some doctors' offices perform NCS and EMG studies if they are not neurologists or physiatrists? A: There are "mobile electrodiagnostic units" (mobile EDX units) that contract with offices to perform these tests, but they are not recognized by the major governing bodies of neurophysiology and electrodiagnostic medicine. These mobile EDX units often consist of an unsupervised technician who utilizes a "one-size-fits-all" arm or leg brace and hand-held device that generates nerve conduction data of questionable accuracy. Furthermore, the great majority of these tests are then interpreted by a central computer located in another state...not by a specially trained physician. Medicare/Medicaid and most major insurance carriers have now denied any coverage of such testing with hand-held devices.
Other offices contract a physical therapist to perform NCS and EMG studies in their offices. North Carolina Medical Laws do not prohibit physical therapists form performing these studies. However, therapists are NOT allowed to provide or make a diagnosis. Unfortunately, some offices have these physical therapists give interpretations that a physician simply "signs off" on as agreeing with the therapist's interpretation. So, there is no diagnosis, but simply an interpretation rendered only by the performing physical therapist. This is like having an x-ray, then having the x-ray technician give an interpretation of the x-ray results. Would you want medical decisions being made based on test results not rendered by a physician trained in that kind of testing?!
Q: Is it safe to have NCS and EMG testing done by one of these "mobile EDX units"? A: The American Academy of Neurology has several guidelines and position statements regarding the safety of NCS/EMG testing by mobile EDX units. Please click here to access this information. The American Association of Neuromuscular and Electrodiagnostic Medicine also has an EMG/NCS Position Statement.
Q: How do I know if I have migraines? A: Do you get nauseated with your migraines? Do you have sensitivity to bright lights during your headaches? Do you have to stop what you are doing when you get a headache? If you answered "yes" to 2 of these 3 questions, there is a >90% chance that you have migraines.* If so, you should ask your doctor for a referral to a neurologist. (*The ID Migraine Validation Study, Neurology 2003; 61: 375-382)
Q: How do I know if I had a seizure? A: If you have ever blacked out and cannot remember what happened, or had uncontrollable jerking/twitching with or without the loss of consciousness, you may have had a seizure. Only your doctor can determine if you really had a seizure. If so, your doctor may refer you to a neurologist or you may wish to call our office for an appointment.
Q: Do the doctors at Northlake Neurology speak English that I can understand? A: Yes. Both Drs. Jung and Robles speak perfect English without any foreign accent.
Q: Do I need a referral to see Drs. Jung and Robles? A: No. All self referrals are welcomed.
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