Justin Stentis our head neurophysiology technician.
He performs a wide range of diagnostic tests of the nervous system under the supervision of our neurologists, who analyse the results and report back to the referring practitioners.
Justin has been practicing since 2004, has a background in nursing and holds a Diploma of Clinical Neurophysiology Technology (RMIT). He is an active member of the Association of Neurophysiological Technologists of Australia.
Medical practitioners may use our referral request, which can be faxed or emailed to our rooms, or handed to the patient to make those arrangements.
Katrina Vardanega has been trained as our support technician, and has been performing quality EEGs since 1998. She has recently completed the Epilepsy Action Australia Certificate in Epilepsy Management.
Katrina also handles queries from patients regarding their medications, symptoms or management, and liaises between the patient and neurologists regarding their concerns.
Kath Wood has recently returned to our practice to perform EEGs. She has a background in nursing and holds a Certificate in Neurophysiology. She has 35 years experience in performing EEGs and has a special interest in paediatric EEGs.
Nerve Conduction Studies (NCS) and Electromyography (EMG)
Evoked Potentials (EP) - Somatosensory, Vestibular, Brainstem and Vestibular
Neurophysiology tests measure the function or electrical activity of the nervous system (brain, spinal cord, peripheral nerves and muscles). Our neurologists analyse the results and report back to the referring practitioners. These tests help doctors make a diagnosis and then develop an appropriate treatment plan. The tests only record information, and have no side effects.
Different appointment times are allocated to the various tests, so it is important for us to know for which test your doctor is referring you. Special care may be needed with young children or developmentally disabled people, so please advise us when you make the appointment. When both a consultation and a test are required, every effort is made to arrange these appointments for the same day.
Take your regular medication on the day of the test. Hairspray, gel and skin lotion should be avoided if possible. Bring your glasses or contacts with you if you are having Visual testing.
All tests are covered by Medicare unless you have a worker’s compensation or third party insurance claim, for which you will require written approval from the insurance company. If you are unable to keep your appointment please let the staff know and an alternative appointment will be arranged.
Nerve Conduction Studies & Electromyography
Nerve Conduction Studies (NCS)
This test measures electrical signals in the nerves mostly in the arms or legs, by giving small electrical pulses to the skin over the nerve. This sensation can be slightly uncomfortable but generally not painful, and it is similar to a brief static electricity shock commonly experienced in everyday life. You will be talked through the test step by step and warned when to expect the pulse.
Occasionally it may be necessary to insert a very small sterile needle under the skin to record a signal if it cannot easily be obtained from the surface electrode. Which nerves are tested depends upon the particular clinical problem.
Sometimes further information is needed about the electrical activity inside one or several muscles which can give additional useful information about their nerve supply. This situation requires electromyography (EMG).
Damage to a muscle or its nerve of supply alters the electrical signal inside that muscle, and being aware of such changes may help diagnose the problem.
The neurologist uses a disposable thin sterile needle and sterile technique to prepare the skin. The needle simply records information from the muscle and nothing is administered via the needle.
The EMG is analysed initially with the muscle at rest, and the patient is then asked to move the limb in a graded way by the neurologist. The number of muscles tested depends on the clinical problem. The needle used is very fine, but some discomfort may be felt as the needle punctures the skin and also when the muscle is moved.
There is constant communication between the patient, neurologist and technician and the procedure is usually very well tolerated. It is important to notify the staff if you are on blood thinning medication e.g. Aspirin or Warfarin.
This study records the electrical activity of the brain from metal discs (electrodes) applied to the skin of the scalp. It takes about 45-60 minutes. It is best to have your hair clean and dry without spray or gel.
You will sit in a chair with discs held on by a cap which is tied under your chin and the skin under each disc is rubbed to make a good electrical contact. For most of the test you relax in the chair with your eyes shut. It is important that your head be kept as still as possible. The usual recording time is 20 minutes. The entire process takes about 45 to 60 minutes.
You will be asked to open and shut your eyes at some stage, as well as take deep breaths for between 3 and 5 minutes. This task may make you feel lightheaded, but the feeling goes when you breathe normally again. Near the end of the recording, a bright light may be flashed in your eyes at different speeds, and with the eyes open and shut. Any gel left in your hair will dry and brush or wash out easily.
A sleep deprived EEG may be requested. Special instructions are required from our staff for this test.
We perform EEGs on children, from new born babies. The appointments take up to two hours and may be videoed (if you give your consent). The studies are reported by Dr Deepak Gill, head of the Epilepsy Unit at Westmead Children’s Hospital. Special instructions are required for paediatric EEGs.
Evoked potentials are electrical signals generated by the brain and recorded from discs on the scalp after a stimulus is applied.
The stimulus may be visual (VEP - visual evoked potentials), sound (BAEP - brainstem auditory evoked potentials and VEMP - vestibular evoked myogenic potentials), sensation from the limbs (SSEP - somatosensory evoked potentials) or face (TEP -trigeminal evoked potentials).
The tests are generally well tolerated but can take an hour or more.
Discs may be applied to the scalp, neck and back, and the shoulder regions to record the electrical signals in the brain, spinal cord, leg and shoulder nerves. A fine sterile needle may be inserted under the skin along the course of the nerve to make it easier to record the responses.
The stimulus comes from pads applied over the nerve at the wrist or ankle. The electrical stimulus is just strong enough to cause a slight twitch in the hand or foot muscles, and as it repeats, it causes a pulsing sensation that is not uncomfortable. You will be reclined and relaxed.
Please bring your glasses or contact lenses. Discs will be applied to your scalp with paste to record the brain activity. You will be asked to sit relaxed in a chair whilst looking at a centrally situated spot on a TV screen which displays an alternating checkerboard pattern.
This test requires you to concentrate on looking at the target spot while several runs are recorded - you will be given short rests between each run.
BRAINSTEM AUDITORY (BAEP)
This test also has discs applied on the scalp to record brain activity. The stimulus is a click coming from a pair of headphones.
You will be asked to indicate when you can first hear the click as its intensity is gradually increased, which is known as the click threshold. Thereafter, the click intensity is increased to the required test level, and it is repeated rapidly while you sit relaxed.
It is not uncomfortable, and you do not have to concentrate when the test is running.
VESTIBULAR EVOKED (VEMP)
This test is very similar to the BAEP (see above) in its performance.
There are two principal differences. Firstly, the click intensity for the test is standard, and you will not be asked to detect the click threshold.
Secondly, discs will be applied to the muscles on the front of your neck, and during the test you will be asked to contract these muscles by turning your head against resistance.