clectroencephalography (EEG)

The electroencephalogram (EEG) is a measure of brain waves. It is a readily available test that provides
evidence of how the brain functions over time. The EEG is used in the evaluation of brain disorders. Most
commonly it is used to show the type and location of the activity in the brain during a seizure. It also is used to
evaluate people who are having problems associated with brain function. These problems might include confusion,
coma, tumors, long-term difficulties with thinking or memory, or weakening of specific parts of the body (such as
weakness associated with a stroke).

An EEG is also used to determine brain death. It may be used to prove that someone on life-support
equipment has no chance of recovery.

Scientists first captured and recorded brain waves in dogs in 1912. By the 1950s the EEG was used
commonly throughout the United States.

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Gery few risks are associated with an EEG. You may be asked not to take certain seizure or antidepressant
medications 1-2 days before you have an EEG. This may make you more prone to have a seizure, which is exactly
what the doctor would like to measure. During an EEG, the doctor may encourage the things that stimulate your
seizures, such as deep breathing or flashing lights, so that he or she can see what happens in your brain during
your seizures.



  

-You should be given instructions when the EEG is scheduled.

-If you routinely take seizure medication to prevent seizures, antidepressants, or stimulants, you may be asked to
stop taking these medications 1-2 days before the test.

-You may be told not to consume caffeine before the test.

-You should avoid using hair styling products (hairspray or gel) on the day of the exam.

- is prudent to have someone take you to the EEG location, especially if you have been asked to stop your seizure
medications.

-If you are having a sleep EEG, you may be asked to stay awake the night before the exam.

 

A standard noninvasive EEG takes about 1 hour. You will be positioned on a padded bed or table, or in a
comfortable chair. To measure the electrical activity in various parts of your brain, a nurse or EEG technician will
attach 16-20 electrodes to your scalp. Your brain generates electrical impulses that these electrodes will pick up.
To improve the conduction of these impulses to the electrodes, a gel will be applied to them. Then a temporary
glue will be used to attach them to your skin. No pain will be involved.

The electrodes only gather the impulses given off by your brain and do not transmit any stimulus to your
brain. The technician may tell you to breathe slowly or quickly and may use visual stimuli such as flashing lights to
see what happens in your brain when you see these things. The brain's electrical activity is recorded continuously
throughout the exam on special EEG paper.

°   During a specialized sleep EEG, you will be placed in a room that encourages relaxation and asked to fall
asleep while your brain's electrical activity is recorded. The sleep EEG will last about 2-3 hours.


 During a specialized ambulatory (moving from place to place, walking) EEG, the electrodes are
placed on your scalp and attached to a portable cassette recorder. You will be allowed to go home and resume
normal activities while the EEG continuously records. The ambulatory EEG typically lasts 24 hours.



After the test is complete, the technician will remove the electrodes. You will be instructed when to
resume any medications. You generally will be ready to go home immediately following the test. No recovery time
is required. Because you may be at risk for a seizure (especially if your medication has been withheld prior to the
EEG), you should have someone take you home, and you should not drive. You should avoid activities that may
harm you if a seizure occurs, until you have resumed your seizure medication for an adequate length of time.
These precautions do not necessarily apply to the person who was not on any seizure medication prior to the EEG.

 
   

Electromyography, or EMG, involves testing the electrical activity of muscles. Often, EMG testing is
performed with another test that measures the conducting function of nerves. This is called a nerve conduction
study. Because both tests are often performed at the same office visit and by the same personnel, the risks and
procedures generally apply to both tests.
 Muscular movement involves the action of muscles and nerves and needs an electrical current. This
electrical current is much weaker than the one in your household wiring.

some medical conditions the electrical activity of the muscles or nerves is not normal. Finding and
describing these electrical properties in the muscle or nerve may help your doctor diagnose your condition.

EMG may aid with the diagnosis of nerve compression or injury (such as carpal tunnel syndrome), nerve
root injury (such as sciatica), and with other problems of the muscles or nerves. Less common medical conditions
include amyotrophic lateral sclerosis, myasthenia gravis, and muscular dystrophy

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People usually have a small amount of discomfort during EMG testing because of pin insertion. Disposable
needles are used so there is no risk of infection.

During nerve conduction studies, small electrodes are taped to the skin or placed around fingers. You
typically experience a brief and mild shock, which may be a bit unpleasant. Most people find it only slightly
annoying.



  

No specific preparation is needed for the testing.

 

During EMG, small pins or needles are inserted into muscles to measure electrical activity. The needles
are different than needles used for injection of medications. They are small and solid, not hollow like hypodermic
needles. Because no medication is injected, discomfort is much less than with shots.

-You will be asked to contract your muscles by moving a small amount during the testing.

-With nerve conduction studies, small electrodes will be taped to your skin or placed around your fingers. You
typically will experience a mild and brief tingling or shock, which may be a bit unpleasant.

-The person who administers the test will explain the procedure. Often muscle activity is monitored through a
speaker during the test, which may make a popping or soft roaring noise. The EMG technician will be looking at an
oscilloscope, which looks like a small TG set during the procedure.

-Testing may take 30-60 minutes.



If you are having this test in a doctor͛s office, you will be sent home following the procedure without any
restriction of activities. Some people may have minor aches and pains from the testing.
Î

 
 

Îatecholamines are small molecules made by nerve tissue (including the brain) and the adrenal
gland.The major catecholamines are dopamine, norepinephrine, and epinephrine. These substances
break down into other compounds, which leave your body through your urine.

A urine test can be done to measure the level of catecholamines in your body.

Îatecholamines can also be measured with a blood test.

 !



-For this test, you must urinate into a special bag or container every time you use the bathroom for 24-
hour period.

-On day 1, urinate over the toilet into the container or bag when you wake up in the morning. Îlose the
container tightly. Keep it in the refrigerator or a cool place during the collection period.

-Urinate into the special container every time you use the bathroom for the next 24 hours.

-On day 2, urinate into the container in the morning again when you wake up.

-Label the container with your name, the date, the time of completion, and return it as instructed.

"
 


-Thoroughly wash the area around the urethra (the hole where urine flows out). Open a urine collection
bag (a plastic bag with an adhesive paper on one end).

-For males, place the entire penis in the bag and attach the adhesive to the skin.

-For females, place the bag over the two folds of skin on either side of the vagina (labia). Put a diaper on
the baby (over the bag).

-Îheck the infant frequently, and change the bag after the infant has urinated. Empty the urine from the
bag into the container provided by your doctor.

-Because lively infants can cause the bag to move, this procedure may take a couple of attempts. You
may need extra collection bags.

-When finished, label the container and return it as instructed.

 
!


-Acute stress and vigorous exercise may affect the test results.

-Foods that can increase urinary catecholamines include coffee, tea, bananas, chocolate, cocoa, citrus
fruits, and vanilla. Avoid these foods for several days prior to the test.
-Îertain drugs can also affect test results. Your health care provider may tell you to stop taking certain
medicines before the test. Never stop taking medicine without first talking to your doctor.

!  

 



 

 


Acetaminophen (Tylenol)

Aminophylline

Îaffeine

Îhloral hydrate

Îlonidine

Disulfiram

Erythromycin

Insulin

Levodopa

Lithium

Methenamine

Methyldopa

Nicotinic acid (large doses)

Nitroglycerin

Quinidine

Tetracyclines

Drugs that can decrease catecholamine measurements include:

Îlonidine

Disulfiram

Guanethidine

Imipramine

MAO inhibitors

Phenothiazines
0eserpine

Salicylates

 !
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The test involves only normal urination, and there is no discomfort.

#!



The test is usually done to diagnose an adrenal gland tumor called pheochromocytoma. It may
also be used to diagnose neuroblastoma. Urine catecholamine levels are increased in most persons with
neuroblastoma.

The urine test for catecholamines may also be used to monitor those who are receiving
treatment for these conditions.

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-All of the catecholamines are broken down into inactive substances that appear in the urine:

-Dopamine becomes Homovanillic acid (HGA)

-Norepinephrine becomes normetanephrine and vanillylmandelic acid (GMA)

-Epinephrine becomes metanephrine and GMA

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-Dopamine: 65 - 400 micrograms (mcg)/24 hours

-Epinephrine: 0.5 - 20 mcg/24 hours

-Metanephrine: 24 - 96 mcg/24 hours (some laboratories give the range as 140 - 785 mcg/24-hours)

-Norepinephrine: 15 - 80 mcg/24 hours

-Normetanephrine: 75 - 375 mcg/24 hours

-Total urine catecholamines: 14 - 110 mcg/24 hours

-GMA: 2 ʹ 7 milligrams (mg)/24 hours

#
 
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-Elevated levels of urinary catecholamines may indicate:

-Acute anxiety
-Ganglioblastoma (very rare)

-Ganglioneuroma (very rare)

-Neuroblastoma (rare)

-Pheochromocytoma (rare)

-Severe stress

-Additional conditions under which the test may be performed:

-Multiple endocrine neoplasia (MEN) II

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There are no risks.

Î

 


Several foods and drugs, as well as physical activity and stress, can affect the accuracy of this test.

 
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Dopamine-urine test; Epinephrine-urine test; Adrenalin-urine test; Ganillylmandelic acid (GMA); Urine
metanephrine; Normetanephrine; Norepinephrine-urine test; Urine catecholamines; GMA; HGA;
Metanephrine; Homovanillic acid (HGA)