Clinical Neurophysiology

Clinical Neurophysiology Overview

The clinical neurophysiology laboratory provides extensive electrodiagnostic testing of the central and peripheral nervous system. All tests are performed by trained technicians or by physicians with subspecialty expertise. Tests performed in our laboratory include nerve conduction studies, needle electromyography (EMG), electroencephalography (EEG), ambulatory EEG, and evoked potentials (visual, auditory, and somatosensory), and Autonomic Testing.

 

 

 

 

 

 

To schedule nerve conduction studies, EMGs, EEGs, evoked potentials and autonomic testing:

  • Phone: (717) 531-3828, press option 1 (Neurology), then option 3 (Neurophysiology Lab)
  • Fax: (717) 531-4694

Neurologists

Manager:  B. Joy Zeager, Interim Lab Manager and Operations Director

Neurophysiology Technologists

  • Shannon Royer, Sr. Lead- EMG
  • Deb Zlatar, Sr. Lead - EEG
  • Franklin Baird Tech II, EEG & EMG
  • Jessica Berger, Tech Trainee- EEG
  • Colin Bonner, Tech I- EEG 
  • Marcia Hawthorne, Tech I - EEG
  • Janis Marinelli, Tech I - EEG & EMU
  • Colleen Newhard, Tech I - EMG
  • Cindy Nguyen, Tech I - EEG & EMU
  • Lindsey Welch, Tech I - EEG

 

Neurophysiology Staff

Laurie Chesnutt, MOA I - Front Desk Support

Hospital Admissions and Billing

While you are a patient at Penn State Hershey, we want to do everything possible to make your surgery and stay convenient and comfortable. If you are scheduled for admission to our hospital, you may want to review the following list of questions about our admissions and billing procedures before you arrive.

Patients are pre-admitted by their surgical coordinator at the outpatient clinic. The coordinator is responsible for obtaining your financial information and scheduling your admission time to Penn State Hershey. He or she can also answer any questions you have about insurance. Additionally, your physician may request some tests to be done before you are admitted. The surgical coordinator or your doctor’s office will arrange for an appointment to have the tests completed on an outpatient basis.

On the day you are scheduled for admission, you will check-in at the Admissions Office, located near the hospital’s main lobby. Patients should make plans for someone to drive them to Penn State Hershey. Parents must accompany patients who are younger than 18 years old. Once you have checked in, a patient services representative will show you to your room where you will be introduced to your nurse and given an admissions information packet. If you were admitted through the Emergency Department, you will be assigned a bed by the operating room. A patient services representative will contact you once you have been assigned your room.

Be prepared to provide your identification, insurance card and any necessary deductible or insurance copayment. If you are admitting a child, you will need to provide the hospital with written consent to provide your child with medical care. Guardians must bring legal proof of guardianship.

For insurance information, please click here.

What do I need to bring with me to the Admissions Office?

Where do I go the day of my surgery?

How am I admitted to the hospital?

Autonomic, Electromyography, Electroencephalogram, Epilepsy Monitoring, and Evoked Potential

Autonomic Testing-

Testing Preparation:

No food or drink for 3 hours prior to the test.  This includes caffeinated drinks such as tea, coffee, sodas, etc.

No beta blockers, antidepressants, antihistamines (for example metoprolol, propranolol, Effexor, Elavil, Buspar, Benadryl, Allegra, etc.) and over the counter cold and cough medications, for 24 hours prior to the test.  If you have questions about specific medications, be sure to check with your doctor as to whether they fall into these categories.

Skin should be clean with no lotions/creams applied to the skin prior to the testing.

Take a shower/bath on the day of the test is permitted but applications of the above should be avoided.

Do not wear compressive stockings on the day of the test.

Nerve Conduction Study (NCS)/Electromyography (EMG):

NCS/EMGs are performed to diagnose nerve and muscle disorders, and to distinguish one from the other. Examples include carpal tunnel syndrome, neuropathy, ALS, muscular dystrophies, myopathies, and myasthenia gravis.

The NCS is usually performed by a technologist. Electrodes are placed at various places on the body part being tested.  A stimulator is placed on the skin over the nerve that is being tested, and a series of brief electrical impulses is given in order to stimulate the nerve. These impulses will feel like small static electricity shocks. Waveforms are produced, which the doctor will later interpret.

The EMG is performed by a physician. Alcohol pads are used to clean the skin over the muscle being studied. A sterile, disposable needle is then inserted into the muscle, and the physician will ask you to either relax or contract that muscle.

Waveforms are produced, which the doctor will interpret, along with the NCS results, in order to reach a diagnosis. The NCS/EMG usually takes about 90 minutes to complete, but may last longer for more complex studies.

There are no risks with the NCS, although there may be a little discomfort from the electrical stimulation. The EMG may cause some small bruising at the sites where the needle was inserted. NCS/EMGs do not damage the underlying nerves or muscles, or worsen the condition for which you are being tested.

 

Electroencephalogram (EEG)

An EEG is a procedure that uses electrodes (small discs) attached to your scalp to detect electrical activity in your brain. 

 

Testing Preparation EEG:

Your test should last approximately 90 minutes. During your study, you will be asked to perform some deep breathing exercises, look at some flashing lights, and answer some questions.

  • Please have hair clean and dry.  You may wash your hair, but don't use any conditioners, or hair products. 
  • Avoid caffeine for at least six hours prior to testing.

Sleep Deprivation EEG:

This entails going to bed between 11:00 p.m. - 12:00 a.m. and awaking at 4:00 a.m. - 5:00 a.m. You should get no more than 6 total hours of sleep for the night.

Testing Preparation :

  •  Please have hair clean and dry.  You may wash your hair, but don't use any conditioners, or hair products. 
  • Avoid caffeine for at least twelve hours prior to testing.

 

Ambulatory EEG:

  • Please have hair clean and dry.  You may wash your hair, but don't use any conditioners, or hair products. 

 Electrodes will be glued to your head, and then you will go home with the electrodes attached. Depending on the physician's order, you will wear the electrodes for 24 or 48 hours. During that time, you will need to complete a diary of your activities. You will then return to the lab to have the electrodes removed.

 

Evoked Potentials:

The EP, also called an evoked response, is a recording of electrical activity from the brain, spinal nerves, or sensory receptors in response to specific external stimulation.  Electrodes are applied to the scalp and other areas of the body, a series of stimuli is introduced, and a computer records the neurological responses.  The response is plotted on a graph and interpreted by a physician who looks for particular waveforms and the time it takes them to occur.

Evoked potentials are helpful in evaluating a number of different neurological problems, including spinal cord injuries, and optic neuritis, and each type of EP looks at a different neurological pathway.  The three most common types of EPs are the brainstem auditory evoked response (BAER), the visual evoked response (VER), and the somatosensory evoked response (SER).

Auditory: The BAER assists in evaluating the auditory nerve pathways from the ears through the brainstem.  Electrodes are placed on the head, and earphones are placed over the ears.  The earphones deliver a series of clicks or tones to each ear separately.

Visual: VERs evaluate the visual nervous system from the eyes to the occipital (visual) cortex of the brain.  Electrodes are placed on the head, and the patient is asked to stare at a pattern on a  video screen while remaining fully alert.  Each eye is tested separately.

Somatosensory: SERs evaluate pathways from the nerves in the arms or legs, through the spinal cord, to the brainstem, or cerebral cortex. Electrodes are placed on the head and along the spinal cord, and a small electrical current is then applied to the skin overlying nerves on the arms or legs. The current creates a tingling sensation, bus is not painful. Each arm and leg is tested separately.