Services

We perform electromyography in our office for patients with suspected nerve disorders (neuropathy), muscle disorders (myopathy), nerve entrapments (pinched nerves) or spine disease. Our physicians have subspecialty training and additional board certification in electrodiagnostic testing. Testing usually involves recording nerve conduction responses from surface electrodes as well as inserting a small needle to record muscle responses. These tests are not performed in a standard manner, and testing is individualized to each patient depending on their symptoms. Therefore, this type of testing is best combined with neurologic consultation, and considered an extension of a more extensive neurologic evaluation.

Patient Instructions for Electromygraphy: You can expect the test to last up to 1 hour. The first part of the study is usually the nerve conduction test. This involves stimulating nerves using a tiny electric current, and recording the responses with surface electrodes on the outside of the skin. The electrical current causes tingling and some muscle twitches, but is not usually painful. The second part of the test is the needle examination. This involves inserting a tiny needle into some muscles in your arm or leg, and recording the electrical activity. Please take all of your medications as usual on the day of the test. Please do not put any kind of lotions on your skin on the morning of the test, as this can interfere with the recordings. You will be able to do normal activities after the test. Please wear gloves one hour before the test so that your hands are warm. Note to all Medicare patients: please note Medicare (and secondary insurance) will deny payment for the use of disposable needles during the test. The charge for this is $20.00, and will be expected at the time of service.

We perform electroencephalography (EEG) in our office. EEG is used to evaluate patient with spells or seizures. Sometimes we ask for patients to come for EEG first thing in the morning after keeping themselves awake the night before. This is called a sleep-deprived EEG and improves the sensitivity of the test. Studies are read by one of our physicians who has subspeciality training and board certification in electroencephalography.

Patient Instructions for EEG: Wash and dry your hair completely the morning of your appointment. Please refrain from using hairspray, styling gel or mousse. You may eat and take your usual medications normally before the test.

Patient Instructions for Sleep Deprived EEG: You must be sleep deprived from 6pm the night before the test. Avoid all stimulants, including caffeine, the night before the test. Wash and dry your hair completely the morning of your appointment. Please refrain from using hairspray, styling gel or mousse. You may eat breakfast and take your usual medications normally on the morning of the test. Sedation may be administered, unless otherwise instructed by your physician. Please have someone accompany you for the test to drive you home afterwards.

Dr. Ponce administers Botox (Botulinum Toxin) injections for patients with focal dystonia (hemifacial spasm, torticollis and writers’ cramp), muscle spasms-spasticity (post-stroke or multiple sclerosis, failed neck and back surgeries), and chronic migraine headaches.

Dr. Gennaro administers spinal nerve root blocks for relief of low back pain and sciatica. He also administers nerve blocks for relief of neuropathic pain from specific nerve injuries.

Dr. Gilson evaluates children for learning disabilities for several school systems.

Our physicians evaluate school and college students with minor sports related concussion and headache.

Dr Davis has fellowship training in sleep disorders, and he is available to evaluate patients with daytime sleepiness or other sleep problems, then determine the appropriate sleep laboratory testing that may be required to make a diagnosis, and finally arrange for the most appropriate treatment and follow-up. Our referring physicians find this approach more helpful than sending the patient directly to the sleep laboratory.

We interpret sleep studies (polysomnograms) performed in the the sleep laboratory at Monmouth Medical Center to evaluate patients with insomnia, restless legs syndrome, sleep apnea, narcolepsy REM sleep behavior disorder and other parasomnias.

Continuous video-EEG monitoring is sometimes necessary to determine whether spells of altered behavior and awareness is from epilepsy or some other disorder. Dr Mendelson is medical director of EEG and video-EEG monitoring at Monmouth Medical Center.

We refer some of our patients for lumbar puncture. This diagnostic test is performed by one of our physicians in the medical day stay unit at the hospital.

Patient Instructions for Lumbar Puncture: The procedure will usually be conducted in a hospital room in the medical day stay unit at the hospital. It normally takes about 20 minutes. You will be asked to sign a consent form. You will change into a gown. You will either lay on your side, or sit up on the side of the bed leaning forwards onto a pillow on a side table. Your spine will be cleaned with Betadine antiseptic. The physician will feel your spine, and then infiltrate local anesthetic into the spine at the appropriate level. You will feel a prick from the needle, and then the anesthetic burns a little at first. Then the physician will insert the spinal needle into this inter-space. Sometimes, as the needle enters the spinal canal, it “tickles” the nerve roots, and causes numbness or burning in one leg. If that happens, let the physician know right away so that the needle can be redirected. Once the needle is inserted into the spinal canal, the physician can collect the spinal fluid required for the research study. The commonest adverse effect from the procedure is a headache. There are several measures to help prevent this from occurring. After the procedure, you will be kept in bed for at least 2 hours. Even after you go home you should stay laying flat for the remainder of the day. You should just get up to eat or go the bathroom. You should drink plenty of fluids, preferably containing caffeine (like coke or ice tea), and keep hydrated. Hopefully you will feel fine by the next day. If you do have a headache, you should keep lying flat as much as possible for the next day or two, keep drinking plenty of fluids, and take Advil or Tylenol. The headache will usually resolve within 2-3 days. If you still have a severe headache more than 2-3 days after the procedure, you should contact your physician.

Our physicians hold teaching (clinical faculty) appointment at Drexel University College of Medicine. Medical students from Drexel come to our office for clinical rotations in neurology. We also teach medicine and orthopedic residents from the Monmouth Medical Center.

Patients with suspected Normal Pressure Hydrocephalus (NPH) are best evaluated using prolonged spinal fluid drainage via a lumbar catheter, with careful assessment of any resultant changes in cognition and gait and station, before it can be determined whether they would benefit from placement of a permanent ventriculoperitoneal shunt.

Established headache patients with severe breakthrough headache can now be sent directly to the hospital out-patient infusion center for intravenous medications avoiding an emergency room visit.