Centres of Excellence

Introduction and  Department Highlights

With the increasing demand for special care in the area of neurological disorders, BLK Super Speciality Hospital has strengthened its Neurology Department under an able and dedicated team of professionals. Today, the department equipped with state of the art facilities for diagnosis and treatment of neurological disorders is capable of effectively handling any eventuality including stroke, epilepsy, movement disorders, neuromuscular disorders, demyelinating diseases, spinal disorders, dementia and neuropathies.

The neurosciences team in collaboration with CCM is geared to deal with emergencies in neurology including Thrombolysis in stroke. According to a study by the World Health Organization (WHO), released in 2009 brain stroke is the third largest killer in India after heart attack and cancer. The study points out that the incidence of stroke in India is around 130 per 100,000 people every year. It further says that about 20 percent of heart patients are susceptible to it. In fact, stroke is the most common cause of disability with more than 70 percent of stroke survivors remaining vocationally impaired and more than 30 percent requiring assistance with activities for daily living.

Studies also show that on an average, a person waits for 13 hours after experiencing the first symptoms of stroke before seeking medical care and Forty two percent patients wait for as long as 24 hours. Therefore, awareness on the issue is a must because it is critical to recognize the symptoms of stroke and seek immediate emergency attention. A brain stroke occurs when a blood vessel carrying oxygen and nutrients to the brain is blocked by a clot or bursts, causing the brain to starve. If deprived of oxygen for even a short period of time, the brain cells begin to die. Once this happens, the part of the body controlled by that section of the brain is affected, impairing language, motor skills or vision or causing paralysis.

The stroke unit at BLK Super Speciality Hospital has successfully treated many patients with almost complete recovery. Facilities exist for thrombolysis within window period, both IV and intra-arterial. Intra-arterial thrombolysis is possible at the site of arterial occlusions. With the facilities both in terms of equipment and knowledge base stroke patients are immediately attended to and treated with existing departmental protocols, thus salvaging life and limbs.

A well equipped electrophysiology lab is manned by qualified professionals, under the supervision of experienced neurologist. Besides EEG, NCV, EMG, RNS and evoked Potential studies, intra-operative SSEP monitoring as required during spinal surgeries is also possible at our tertiary care centre. The department is backed by an extremely competent and state-of-the-art radiology and interventional radiology department that provides around the clock neuroimaging facilities including CT scan, MRI and DSA.

The neurology department also offers botox (botulinum toxin) therapy used to treat dystonia—a neuromuscular disorder that produces involuntary muscle contractions, or spasm-that affects muscles that control movement in the eyes, neck, face, limbs, voice box, or the smooth muscle in the bladder. The goal of the therapy is to reduce muscle spasm and pain. Botulinum toxin has proven to be useful in the treatment of many forms of dystonia, including the following:

• Blepharospasm–forceful involuntary closure of the eyelids
• Strabismus–misalignment of the eyes
• Hemifacial Spasm–sudden contraction of the muscles on one side of the face
• Spasmodic torticollis, or cervical dystonia–muscle spasm in the neck that causes the head to turn to one side and sometimes forward or backward
• Oromandibular dystonia–continuous spasms of the face, jaw, neck, tongue, larynx, and in severe cases, the respiratory system
• Urinary retention–severe inability to urinate that requires catheterization
• Spasmodic dysphonia–spasm of the vocal cords that causes sudden disruption of speech
• Stuttering–repetitions of parts of words and whole words, long pauses, elongated sounds
• Voice tremor–quavering vocalization
• Limb spasticity (e.g., following stroke)

Services and Treatments Offered

Neurophysiology offers diagnostic services for evaluation of diseases of central Nerve us system and peripheral nervous system.

The diagnostic tests carried out are listed below:-

• Electroencephalography (EEG)
• Video EEG
• Bed side EEG monitoring
• Long term video EEG monitoring
• Electromyography (EMG)
• Nerve Conduction Studies (NCS)
• Repetitive Nerve Stimulation (RNST)
• Evoked potential
  • Visual Evoked Potential (VEP)
  • Brainstem Auditory Evoked Potential (BAER)
  • Somatosensory Evoked Potential (SSEP) 
     

Electroencephalography (EEG)
The electrical activity of brain is recorded by this test. The record is analysed for abnormalities in brain rhythm.

EEG is done in the following conditions:

• Epilepsy to confirm the diagnosis
• In spells of unconsciousness/ fainting - EEG is useful in differentiating these disorders from epilepsy
• Encephalitis (viral inflammation of brain e.g viral infections)
• Dementia
• Stroke
• Brain tumour
   

Details of Procedure

• The test is painless
• The patient lies on the bed quietly
• Electrodes (small metal discs) are placed on the head
• During the test the patient may be asked to open and close the eyes on a few occasions, may be asked to breathe rapidly for few minutes. The patient is encouraged to relax with eyes closed and encouraged to sleep
• The time required for preparation and actual recording may take approximately 40-60 minutes
• There are no side effects
   

Instructions

• Do not apply oil on the head
• Take a light meal, avoid fasting
• Take routine drugs
• Small children and uncooperative patients may be given sedative medicine
   

Electromyography (EMG)
The EMG test is used to evaluate the status of the muscles, nerves, roots and anterior horn cells. A number of neurological disorders present with weakness or atrophy (thinning) of muscles.

Some Common Disorders are

• Muscular dystrophy
• Myopathy
• Neuropathy
• Carpal tunnel syndrome
• Nerve injuries
• Cervical/lumbar radiculopathy
• Motor neuron diseases
   

The EMG may be done either alone or in combination with nerve conduction studies (NCS) depending on the neurological disorder. Common symptoms of muscle involvement:

• Difficulty in climbing stairs
• Difficulty in getting up from sitting/squatting position
• Difficulty in performing movements like buttoning, breaking chapatis, mixing food, combing hair
• Raising hands above the head
   

Details of Procedure

• A thin disposable EMG needle is inserted into the muscle to be examined. Depending on the type of disease one or more muscles may be required to be tested
• You may experience mild pain during the procedure
• There is no risk of transmitting the infection since disposable needles are used and they are destroyed after use
• You can have your regular food and medication on the day of the test
• You should wear loose clothes so that the test can be easily done
   

Nerve Conduction Studies  (NCS)

• Nerve conduction studies are used to evaluate the function of the nerves
• There are mainly two types of nerves - motor and sensory. The nerve conduction studies are specially designed to perform motor nerve conduction and sensory nerve conduction
   

Nerve conduction studies is recommend for following diseases

• Neuropathy in patients with diabetes mellitus
• Connective tissue diseases
• Injury to the nerves
• Carpal tunnel syndrome /Tarsal tunnel syndrome
• Cervical/lumbar disc prolapse
• Intake of drugs, which may affect the nerves. (drugs taken for treatment of tuberculosis/ cancer)
• Guillain Barre Syndrome (GBS)
• Hereditary Neuropathy
• Myasthenia
• Symptoms of nerve involvement:
• Tingling, numbness of hands/feet
• Burning sensation/pain in the hands and feet
• Decreased sensation in arms/legs
• Weakness /thinning of arms and legs
   

Details of Procedure

• Test usually takes 20-30minutes
• Metal disc plates (electrodes) are placed on the skin over nerves
• and muscles and mild electrical stimulation is given and the response is recorded
• Usually two nerves in upper limbs and two nerves in lower
• Limbs are tested. It may be necessary to test more nerves depending on the neurological disease
   

Instructions

• Wear loose clothes, which will allow easy examination
• Fasting not required
• For children who are uncooperative sedation may be required
• There is no after effect following the test
   

Repetitive Nerve Stimulation(RNST)
Repetitive nerve stimulation tests are a special type of nerve conduction study. Rather than a single electric shock, a brief series of shocks is applied to a motor nerve and responses are recorded from a muscle supplied by that nerve. The study is generally performed before and after brief exercise of the muscle. Serial response amplitudes are recorded. Repetitive nerve stimulation is useful for evaluating myasthenia gravis and other disorders of neuromuscular transmission.

Evoked Potential (EP)
Evoked potential (EP) is the electrical response recorded from brain, spinal cord or peripheral nerve evoked by various external stimuli, such as visual, auditory or somatosensory stimulation. The recording electrodes are placed over the scalp, neck or spine which varies depending on the type of stimulus modality to be tested. The evoked potential provides valuable information about the functional status and diseases affecting vision, hearing and sensory pathways.

Visual Evoked Potential (VEP)
VEP provides information regarding conduction in visual pathway from the retina to brain (occipital cortex). VEP is recommended for following diseases:

Impairment of vision due to

• Multiple Sclerosis
• Optic Neuritis
• Tumours of the brain (pituitary tumours)
• Head injuries
• Drugs which may cause visual impairment
• In children with mental retardation/ delayed development to assess visual status
   

Details of Procedure

• The test is performed in dark room
• Each eye is tested separately
• The patient is asked to focus on a point on the monitor, which shows checkerboard pattern
• Small metals plates (electrodes) are applied to the head, which record the electrical potential
• The procedure usually take approximately 30 minutes
   

Instructions
Hair should be washed, dried, with no oil, gel, spray etc
If the patient is using spectacles or contact lenses than he/she should wear them at the time of examination
For children who are uncooperative sedation may be required

Brainstem Auditory Evoked Potential (BAER)
This test examines the integrity of auditory pathway through the brainstem. The sound enters ear canal and stimulates auditory nerve. The electrical impulse travels from auditory nerve through the brainstem to auditory cortex. During testing, the patient hears the repetitive click sound through the earphone.

BAER is recommended for following diseases:

• Hearing problem
• Dizziness/ Vertigo
• Multiple Sclerosis
• Tumours of the Brainstem
• Head Injuries
• Delayed development in children
• Jaundice in children
   

Details of Procedure

• The stimulus is provided using headphone in one ear followed by second ear
• The electrical response is recorded by small metal plates (electrodes)
• The test is not painful 
   

Instructions

• Hair should be washed, dried, with no oil, gel, spray etc
• For children who are uncooperative sedation may be required
• The procedure usually takes approximately 30 minutes
   

Somatosensory Evoked Potential (SSEP)
This test examines the sensory system from the peripheral nerve to the sensory cortex of brain. Weak electrical stimuli are applied to the peripheral nerve, for example median or ulnar nerve for upper extremity study and tibial nerve for lower extremity study.

SSEP is recommended for following diseases

• Numbness/weakness of arm or leg
• Diseases of the spinal cord
• Multiple Sclerosis
   

Details of Procedure

• The electrical stimulation is applied to nerve in the arm or the leg
• The response is recorded from the neck and the head by electrodes placed over the surface
• Mild pain is experienced when electrical stimulation is applied
   

Instructions

• Should wear loose clothes, which will allow easy examination
• Fasting not required
• For children who are uncooperative sedation may be required
• There is no after effect following the test