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Electromyography (EMG) is an electrical test of the nerves and muscles. Neurologists use this test to aide in the diagnosis of a variety of disorders including neuropathy, radiculopathy, pinched nerves, spinal stenosis, carpal tunnel syndrome, myopathy, myostis, myasthenia gravis, and ALS. 

The test includes two parts. The first involves stimulation of various nerves with a small electrical impulse. The nerve impulse is measured in several ways including the size of the response and how fast the nerve is conducting the impulse. This portion of the study is often referred to as nerve conduction velocities, or “NCVs” – a common misnomer. Much more than velocity is measured. Only a trained neurologist should administer this test if optimal results are desired. 

The second portion of the test involves the use of a small needle to “listen” to the electrical activity of the muscles. This portion of the test is performed in two ways. The first is when the muscle is completely at rest. The second way is when the muscle is being “activated.” Accordingly, at times during the test, the examiner may ask the patient to “relax” or to contract a certain muscle, e.g. “curl your toes down” or “bend your arm toward your chest.”

Electroencephalography (EEG) is an electrical test of “brain waves” employed by neurologists in the diagnosis of seizures, epilepsy, dementia, and various states of confusion. The test involves the placement of an array of small, metal discs (electrodes) on the scalp surface. With the help of a computer, these electrodes then measure the electrical activity of the brain’s surface – a brain structure known as the cortex. Just as an EKG measures heart activity, EEG records brain activity as lines on paper or on a computer screen. The contour, shape, and frequency of these lines help the neurologist to interpret the recordings and their application to each individual patient. 

EEG is a non-invasive test during which there is essentially no risk. Patient’s should arrive with clean, dry hair and should avoid the use of significant hair products (gels, sprays, etc) prior to the study. Occasionally, the test results may be augmented by having the patient be “sleep-deprived.” When requested, a patient will be asked to obtain half of their usual amount of sleep on the night preceding the testing. Medications should be continued unchanged prior to the test unless specifically instructed otherwise. To prepare for the test, please avoid any hair pieces, hair spray or gel products, just clean dry hair. Also, avoid caffeinated products the day the test. 

Botox (botulinum toxin injections) is a biological medication that is injected into overactive muscles to weaken the muscle. Botox is an FDA-approved treatment in the management of chronic migraines, cervical dystonia (spasmodic torticollis), hemifacial spasm (uncontrollable clenching of one side of the face), blepharospasm (uncontrollable eye blinking), spasticity from stroke, and hyperhidrosis (excessive sweating). 

Botox is injected into specific muscles which are overactive, as determined by both the patient and the neurologist. Two or three days later, the muscles weaken slightly, thus facilitating the dexterity of a hand, improving walking, or decreasing pain, whichever the specific case may be. Botox is administered through a “standard size” needle for limb muscle injections. In the facial muscles and around the eyes, a very small needle is used. Occasionally, the neurologist may use an EMG machine to help target the injections into the most ideal portion of the muscle. 

Major side effects are very rare but could include swallowing difficulty, dry eyes, dry mouth, allergic reaction, and local pain - all of which are dependent on the site of location and the dose administered. Your neurologist will discuss these issues with you further and will take steps to avoid such reactions, including the use of small doses during the initiation of treatment.