Our Clinical Programs
Progressive Neurology offers a wide variety of consultation and procedure-based services. As a group we provide expert diagnostic procedures both in our offices, as well as through our partnerships with Hackensack University Medical Center.
Services
EEG
We perform in-office routine EEG studies, multi-day ambulatory EEGs, as well as inpatient EEGs in our epilepsy monitoring units (EMUs). For select patients who require surgical evaluations and treatments for their epilepsy we also provide specialized EMU recordings partnered with our neurosurgical colleagues. Please see our Hackensack Epilepsy Center page for more details.
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We are able to provide short-term EEG monitoring to help in diagnosis and treatment of our patients.
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In some cases we are able to provide EEG hookup that is then brought to the patient's home for a period of time before being returned to our office.
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Through partnership with Hackensack University Hospital we are able to monitor and treat our patients in both the pediatric and adult epilepsy monitoring units (EMUs). EMU visits can also be used as part of surgical evaluations for patients that require neurosurgical treatments for their epilepsy.
EMG
Through our neuromuscular specialized doctors we provide EMG testing for a wide variety of neurologic concerns.
Sleep Studies
Sleep is a complicated function of the body. Most people spend about thirty percent of their lives sleeping. Sleep is primarily a function of the brain, however, several other organs function differently when we are sleeping. For example, muscle tone decreases during sleep, which can affect our breathing pattern. For this reason, studying sleep in a laboratory requires analysis of several systems and organs, including the brain, the eyes, the heart, the lungs and the muscles. A complete sleep study requires monitoring of all these systems, however, sometimes a simpler sleep study can be performed and may provide sufficient clinical information. The typical sleep study is performed in a specialized sleep laboratory where the patient spends the night. Sometimes, a follow-up test is performed during the day. Occasionally, sleep studies can be performed at home.
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A polysomnogram, or sleep study, consists of an overnight test performed at a specialized sleep laboratory. The study typically starts in the evening and ends in the morning. Several bodily functions are monitored to assess the quality of sleep and look for sleep disorders. Brain waves, or EEG, muscle tone and eye movements are monitored to determine the amount and quality of sleep. Breathing is monitored by measuring the air flowing in and out of the lungs and by measuring the movements of the chest and belly. Monitoring breathing patterns helps determine if the patient suffers from sleep apnea. Oxygen saturation is also measured to help determine if the patient is receiving enough oxygen. Finally, leg movements are measured to determine if the patient suffers from a movement disorder during sleep, such as periodic limb movement of sleep or other types of movements during sleep. Once the test is completed, the sleep technologist and physician review the study and interpret the results. A polysomnogram is very safe and is not associated with any significant risk, except for the discomfort caused by sleeping in a strange bedroom with multiple wires connected to the body.
Diagnostic Polysomnogram
A diagnostic polysomnogram consists of a sleep study as described above. The patient spends the night at the sleep lab and goes home in the morning, awaiting the interpretation of the study.
Positive Airway Pressure Titration
If the diagnostic sleep study reveals that the patient has obstructive sleep apnea, treatment with continuous positive airway pressure (CPAP) is sometimes recommended. In this case, a repeat sleep study is necessary to determine the level of air pressure needed. The patient comes back to the sleep laboratory for a second study during which CPAP is started and the degree of air pressure is gradually increased to achieve the best results possible. The sleep technologist monitors the breathing pattern and blood oxygen level to determine the level of air pressure at which the patient achieves normal breathing and oxygen levels. At the end of the CPAP titration study, the physician and staff of the sleep laboratory help the patient obtain a CPAP machine at home and prescribe the recommended air pressure.
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Occasionally, the diagnosis of sleep apnea and CPAP titration are performed in a single night. The study is called a split-night study. If the sleep technologist determines that the patient has definite obstructive sleep apnea, she/he may initiate CPAP titration and try to determine the best level of air pressure in the remaining time of the study. This usually spares the patient a second sleep study.
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Multiple sleep latency test, or MSLT, also referred to as a "nap test," measures our tendency to fall asleep during the day. It is usually performed after an overnight sleep study. The patient stays in the sleep laboratory until late afternoon and is asked to try to nap either four or five times. The sleep technologist ensures that the room is dark and quiet and the patient is given 20 minutes to try to fall asleep. After 20 minutes, lights are turned on in the room regardless if the patient had fallen asleep or not. After a break, the process is repeated and the patient is asked to take another nap. The naps are then analyzed to assess whether the patient had actually fallen asleep or not, and which sleep stages were reached. In general, most people are not able to fall asleep four or five times during the day, unless they are severely sleep deprived, or suffer from a sleep disorder that causes excessive sleepiness.
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Maintenance of wakefulness test or MWT is the opposite of the multiple sleep latency test. It measures our ability to stay awake when given the opportunity to fall asleep. It is usually performed after an overnight sleep study. The patient stays in the sleep laboratory until late afternoon and is given four opportunities to fall asleep. The sleep technologist ensures that the room is quiet and leaves a dim light on. The patient is asked to sit in bed and stay awake. Unlike MSLT, the patient is supposed to make an effort to avoid falling asleep. The study is then analyzed to assess if the patient was able to stay awake or not.
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With the advancement of technology, we are now able to perform a sleep study while the patient is at home. The study is similar to a regular polysomnogram, sometimes using a smaller number of electrodes. The study can be set up in the sleep laboratory or the doctor's office. In some cases, the technologist will go to the patient's home and set up the study. Once the study is completed, the information collected is then analyzed by the sleep technologist and the physician to determine if the patient has a sleep disorder or not. The main advantage of an ambulatory sleep study is that it is performed in the comfort of the patient's own home and bed, and replicates the natural circumstances of the patient's nightly sleep. The major problem with it is that the information recorded is not monitored continuously throughout the night and is only reviewed next day, once the study is completed.
Cognitive Testing
Cognitive function is a very vague term that describes various functions of the brain called higher cortical function. These include attention and concentration, speech and language, memory, executive function, spacial function and other more complex functions of the brain that define our character, temper and personality. In general, it is very difficult to evaluate all these functions in an office or laboratory setting because the brain is a very complex organ and higher cortical functions are the most complicated functions of the brain. They truly are what makes us what we are.
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Computer-based cognitive testing consists of a series of tests performed on a regular computer to assess various higher cortical functions, such as attention and concentration, short and long-term memory, various language functions, such as speech and comprehension, executive function and others. All the tests are given on a computer screen, similar to any home computer and the test is designed to be very easy even to people with no computer experience. It is almost like an easy video game. At Progressive Neurology, we perform one of the standardized computer-based tests, called MindStreams®. The program offers several various tests that assess different cognitive functions. The physician usually selects which test is appropriate based on the patient's condition. For example, patients suspected of having attention deficit disorder will be given a different set of tests than those suspected of having Alzheimer's disease. The test can be used by children and adults and the results are provided based on the patient's age.
Cognitive testing is sometimes used to help support the suspected diagnosis of certain conditions, such as attention deficit disorder (ADD) or attention deficit hyperactivity disorder (ADHD), mild cognitive impairment (MCI) or conditions causing dementia, such as Alzheimer's disease. The test can also be very useful in monitoring treatment. For example, once a patient is diagnosed with a certain condition and treatment is started, a follow up test after several weeks may help determine if the treatment is actually working or not. If the patient performed better at the follow-up test, that would indicate that the treatment might be working. Finally, cognitive testing sometimes helps assess the progression of the disease. For example, in patients with early dementia or mild cognitive impairment, follow up testing several months later or a year later may help determine if the condition is getting worse or not. If you have additional questions about cognitive testing in general, and computer-based cognitive testing specifically, please contact us.
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Occasionally, the diagnosis of sleep apnea and CPAP titration are performed in a single night. The study is called a split-night study. If the sleep technologist determines that the patient has definite obstructive sleep apnea, she/he may initiate CPAP titration and try to determine the best level of air pressure in the remaining time of the study. This usually spares the patient a second sleep study.