At Tennessee Valley Neurological Associates, our practice encompasses diagnosis and treatment of the following issues (as well as many other neurological disorders) in adults:

• Alzheimer's Disease (and other memory disorders)
• Parkinson's Disease
• Epilepsy
• Stroke
• Multiple Sclerosis
• Peripheral Neuropathies
• Migraines
• Dementia
• Vertigo and Dizziness
• Syncope 

The Brainstem Auditory Evoked Response (BAER) test measures responses in brain waves that are stimulated by a clicking sound to evaluate the central auditory pathways of the brainstem. The test is performed to help diagnose nervous system abnormalities, hearing losses, and to assess neurologic functions.

What to Expect

• You will be positioned on a reclining chair or bed and asked to relax and remain still.
• Electrodes will be placed on your scalp and on each earlobe.
• You will hear clicking noises or tone bursts through earphones, and the electrodes pick up the brain's response and record it on a graph.
• There is little, if any, discomfort.

How to Prepare

Please wash your hair the night before the test.

An electroencephalogram (EEG) is a test to detect abnormalities in the electrical activity of the brain.  At Tennessee Valley Neurological Associates, we are able to perform this test in our facility, as well as for our hospital patients.

An EEG is used to help diagnose the presence and type of seizure disorders, to look for causes of confusion, and to evaluate head injuries, tumors, infections, degenerative diseases, and metabolic disturbances that affect the brain. It is also used to evaluate sleep disorders and to investigate periods of unconsciousness.

What to Expect

1. In an EEG, electrodes (that look like flat metal discs) are placed on the scalp over multiple areas of the brain to record patterns and check for abnormalities in the tiny electrical impulses brain cells used to communicate.
2. A trained technician will guide you through the process as the test is performed.
3. The technician will apply between 16 and 25 electrodes with a sticky paste. These electrodes are connected to an amplifier and a computerized recording machine.
4. The recording machine converts the electrical signals into a series of wavy lines that are digitally recorded on the computer.

Please be aware that the following is also part of the exam:

• You will need to be able to lie on your back on a table for the test.
• You will need to lie still with your eyes closed because any movement can alter the results.
• You may be asked to do certain things during the recording, if indicated, such as breathe deeply and rapidly for several minutes, or look at a bright flickering light through closed eyes.
• This test causes no discomfort. While you may notice the feel of the electrodes on your skin, they only record activity and do not produce any sensation.

How to Prepare

1. Wash your hair the night before the test, omitting any oils, sprays, or conditioner that you may usually use in your hair.
2. Take all medications regularly, unless given other instructions by your physician.
3. Sometimes it is necessary to sleep during the test, so you may be asked to reduce your sleep time the night before the test.

Electromyography (EMG) and Nerve Conduction Studies(NCS) are ordered to learn more about the health of  the nerves that travel to and from your hands and feet (called peripheral nerves). These tests measure the speed of the nerve's conductivity and the electrical activity of the nerve to establish if a nerve is working properly. In the case of nerve injury or nerve entrapment, the test can often locate the exact site.

EMG and NCS are often done together to provide more complete information. More specifically:

• A NCS is used to detect and evaluate damage to the peripheral nervous system and to identify the location of abnormal sensations, such as numbness, tingling, or pain.
• An EMG is performed to aid in the diagnosis of conditions that damage muscle tissue, nerves, or the junctions between nerve and muscle (neuromuscular junctions), as well as to evaluate the cause of weakness, paralysis, involuntary muscle twitching, or other symptoms. (Problems in a muscle, the nerves supplying a muscle, the spinal cord, or the area of the brain that controls a muscle can all cause these kinds of symptoms.)

What To Expect

EMG: The muscles are assessed by inserting a tiny Teflon coated pin electrode into the muscle with the computer then recording the muscle potential. The sensation is similar to that of an injection that goes into the muscle as the pin electrode is inserted into the muscle. (That is if sensory awareness is not a problem.) It is important for the patient to lie still to reduce interference and to achieve accurate readings.

NCS: The patient will be asked to lie on an examination table. Electrodes are placed on the skin over the nerve to be studied. These electrodes act as microphones to pick up any electrical signal that goes by them. An electrical stimulator is then placed on the skin near the electrodes and is used to create an electrical current strong enough to fully stimulate the nerve. A computer is used to record responses as various nerves are tested. This allows the physician to measure and calculate how fast the nerve is sending the impulses to the muscle.

• A majority of the time spent with the patient is setting up the studies and running the computer; a very small amount of the time involves electrical stimulation or use of the pin electrode.
• Discomfort during the tests should be minimal. The electrical stimulation of the nerve conduction study could be compared to a static electricity shock. The pin insertion could be compared to being pinched by someone's fingernails.
• No sedation is used during the test, as the patient needs to be awake to follow instructions during the exam.

How To Prepare

1. Please do not wear any lotion or perfume anywhere on the body.
2. Wear loose fitting clothes that can be raised to above the knee or above the elbow, depending on the limb that will be tested.
3. Take all medications regularly, unless given other instructions by your physician.

Following the Exam

• For some, there can be minor irritation at the pin insertion sites.  However,  there are no lasting effects from either the NCS or the EMG.
• The examining physician can give you an idea of any obvious abnormalities at the end of the test the same day. However, more detailed interpretation will be done once the results are factored into the patient's health history, symptoms, physical and neurological examinations, and the results of other tests to help establish a diagnosis.

Vagus nerve stimulation (VNS Therapy®) is designed to prevent seizures by sending regular, mild pulses of electrical energy to the brain via the vagus nerve, which is part of the autonomic nervous system that controls functions of the body that are not under voluntary control. These pulses are supplied by a device something like a pacemaker.

More details about the procedure may be found at the Epilepsy Foundation website.

Visual evoked responses (VER) evaluate the visual nervous system from the eye to the brain. The test is used to check for optic neuritis, optic tumors, retinal disorders and demyelinating diseases, such as multiple sclerosis.

What to Expect

• The test usually takes around 30 minutes.
• The head is measured and each electrode is attached with electrode paste and a piece of gauze.
• Three or more electrodes are attached to the patient's scalp. The patient is asked to stare at a pattern on a video screen. Each eye is tested separately. A patch is placed over the eye not being tested.
• After the test, the electrodes are removed with warm water and a washcloth. The patient's hair and skin remain intact. Normal washing of the hair will remove any leftover residue from the paste.

Preparing for the Test

1. You will need to be alert and well rested.
2. Bring any glasses or contact lenses you normally use.
3. Take all medications regularly, unless given other instructions by their physician.

After the Exam

The patient will learn the test results from either their neurologist or from a copy of the VER report sent to their referring physician.

The infusion services at TVNA is an alternative method of treatment when other forms of therapies are ineffective.  Our on-site Infusion therapy is used to administer medications or treatments directly into the bloodstream through an IV (intravenous) line. The goal of this therapy is to treat various neurological conditions more effectively and efficiently. Here are some key purposes for infusion therapy in neurology:

1. Multiple Sclerosis (MS) Treatment: Infusion therapy is often used for patients with MS to administer disease-modifying therapies (DMTs) like natalizumab (Tysabri) or ocrelizumab (Ocrevus), ublituximab (Briumivi). These medications help reduce the frequency of MS relapses and slow disease progression.
2. Migraine Management: Some patients with chronic migraines or severe acute migraines may receive infusions of medications like monoclonal antibodies (e.g., fremanezumab or eptinezumab), which help prevent or treat migraines.
3. Neuropathy and Pain Management: Infusions can be used for patients with chronic pain due to neuropathy, including treatments with corticosteroids or other medications to reduce inflammation or manage symptoms. Some of the medication we use to treat include Soliris, Ultomiris, Vyvgart, IVIG, Uplizna,
4. Autoimmune Neurological Disorders: For conditions like myasthenia gravis, Guillain-Barré syndrome, or vasculitis, infusion therapy may be used to administer immunoglobulin (IVIG) or plasmapheresis to modulate the immune system and reduce symptoms.
5. Severe Neurological Infections or Inflammatory Conditions: Infusion therapy may be used to administer immunosuppressive drugs in cases of infections or autoimmune-related neurological diseases.

By delivering medications directly into the bloodstream, infusion therapy can often provide more immediate and controlled effects compared to oral medications. It also allows higher doses of certain treatments, which might be more effective for specific neurological conditions.

Our experienced staff provides a safe, comfortable, and convenient environment for your treatment. We have an in-house medical billing department that assists with insurance concerns and facilitate pre-certifications. Our goal is to help our customers with any medical, personal, or insurance concern.

Understanding Stroke: What You Need to Know

A stroke is a medical emergency that occurs when there is a problem with the blood flow to the brain. This can cause brain cells to be deprived of oxygen and nutrients, leading to potential brain damage or even death. It's crucial to recognize the signs of a stroke and get medical help immediately.

Types of Strokes

1. Ischemic Stroke:
   • This is the most common type of stroke, occurring when a blood clot or other blockage blocks a blood vessel in the brain, restricting blood flow.
2. Hemorrhagic Stroke:
   • This type of stroke occurs when a blood vessel in the brain bursts, causing bleeding in or around the brain.
3. Transient Ischemic Attack (TIA):
   • Often called a "mini-stroke," a TIA occurs when the blood flow to the brain is temporarily blocked. Symptoms usually resolve within minutes to hours but should be treated as a medical emergency because they can indicate an increased risk of a full stroke.

Signs and Symptoms of Stroke: Act FAST

It's essential to recognize the warning signs of a stroke early. Use the FAST method to check for signs:

• Face: Ask the person to smile. Does one side of their face droop or look uneven?
• Arms: Ask the person to raise both arms. Does one arm drift downward or feel weak?
• Speech: Ask the person to repeat a simple sentence. Is their speech slurred or difficult to understand?
• Time: If any of these symptoms are present, call emergency services right away. Time is critical in treating a stroke.

Risk Factors for Stroke

Certain factors can increase your risk of having a stroke, including:

• High blood pressure (Hypertension)
• Heart disease or irregular heartbeat (e.g., atrial fibrillation)
• Diabetes
• Smoking
• High cholesterol
• Obesity
• Physical inactivity
• Family history of stroke
• Age: The risk increases with age, especially after 55
• Gender: Women may have a higher risk due to pregnancy, birth control, and menopause

Preventing a Stroke

While you can't change all of the risk factors (such as age or family history), there are steps you can take to reduce your risk:

• Control your blood pressure: Regular monitoring and management through medication or lifestyle changes.
• Eat a healthy diet: Focus on fruits, vegetables, whole grains, lean proteins, and low-fat dairy.
• Exercise regularly: Aim for at least 30 minutes of moderate activity most days of the week.
• Quit smoking: Smoking increases stroke risk and damage to blood vessels.
• Limit alcohol: Drinking in moderation (if at all) is key to reducing stroke risk.
• Manage stress: Practice stress-reducing techniques like meditation or deep breathing.

Treatment Options for Stroke

Treatment for stroke depends on the type and timing of the stroke:

• Ischemic Stroke: Medications like tissue plasminogen activator (tPA) may be used to dissolve clots if administered within a few hours of symptom onset.
• Hemorrhagic Stroke: Surgical intervention may be needed to stop the bleeding and relieve pressure on the brain.
• Rehabilitation: After a stroke, rehabilitation (e.g., physical, occupational, and speech therapy) can help you recover lost abilities and improve your quality of life.

Recovery and Rehabilitation

Recovery after a stroke can vary depending on the severity of the stroke and the timely intervention. Rehabilitation programs are designed to help patients regain strength, mobility, speech, and cognitive skills. It's important to have a dedicated support system in place, which may include healthcare providers, family, and friends.

If You or a Loved One Has Had a Stroke

If you or a loved one has experienced a stroke, we offer specialized services for stroke recovery and management. Our clinic provides:

• Post-stroke rehabilitation: Including physical, speech, and occupational therapy
• Neurological evaluations: To monitor recovery and prevent future strokes
• Chronic stroke management: Ongoing care and lifestyle advice to reduce the risk of another stroke

Core Cognitive Assessment at Our Neurology Clinic

Cognitive assessments are used to evaluate how well an individual is thinking, remembering, and processing information. These assessments are critical in diagnosing and monitoring various neurological conditions that affect cognitive function, such as Alzheimer’s disease, dementia, traumatic brain injury, and other cognitive disorders.

What is a Cognitive Assessment?

A Cognitive Assessment is a series of tests designed to measure different aspects of brain function, including memory, attention, language, problem-solving skills, and other cognitive abilities. The results help healthcare providers understand how the brain is functioning and can guide decisions about treatment, care planning, and interventions.

Why is a Cognitive Assessment Important?

Cognitive testing helps identify changes in brain function that may be due to neurological conditions. Early detection of cognitive decline allows for timely intervention, which may improve outcomes and quality of life. Cognitive assessments are particularly useful for:

• Diagnosing cognitive disorders: Such as Alzheimer's disease, other forms of dementia, and Parkinson's disease.
• Assessing brain function after trauma: For individuals recovering from head injuries or concussions.
• Monitoring progression of neurological conditions: Tracking cognitive changes over time to adjust care plans.
• Evaluating effects of treatments or medications: Understanding how treatments may be influencing cognitive health.

What Does a Cognitive Assessment Include?

The Core Cognitive Assessment typically includes the following components:

1. Memory Testing:
   • Measures short-term and long-term memory, including the ability to recall words, numbers, and events.
2. Attention and Concentration:
   • Tests the ability to focus and maintain attention over a period of time, including tasks that require mental effort and concentration.
3. Language Skills:
   • Assesses speaking, comprehension, and reading abilities. This can involve naming objects, following directions, and understanding language.
4. Executive Function:
   • Evaluates higher-level cognitive skills such as planning, problem-solving, decision-making, and reasoning.
5. Visuospatial Skills:
   • Tests the ability to understand spatial relationships and recognize objects or faces.
6. Processing Speed:
   • Measures how quickly and accurately you can perform cognitive tasks, such as recognizing patterns or solving problems.
7. Mood and Psychological Assessment:
   • In some cases, a cognitive assessment may also evaluate mood and mental health, as depression or anxiety can impact cognitive function.

How is the Assessment Conducted?

The cognitive assessment is typically administered by a trained neuropsychologist or neurologist. It can be done through paper-and-pencil tests, computerized assessments, or both. The assessment is non-invasive and may take anywhere from 30 minutes to 2 hours, depending on the complexity and scope of the evaluation.

Some tests may include:

• Standardized questionnaires and surveys
• Problem-solving tasks
• Memory exercises
• Verbal and non-verbal assessments

Who Should Consider a Cognitive Assessment?

A cognitive assessment is recommended for individuals who may be experiencing any of the following:

• Memory problems or difficulty recalling recent events.
• Changes in thinking abilities: Difficulty concentrating, planning, or completing tasks.
• Mood or personality changes: Increased irritability, confusion, or withdrawal.
• History of neurological conditions: Conditions such as Alzheimer’s, Parkinson’s, or stroke.
• Traumatic brain injury: Following concussions or other head injuries.

Additionally, cognitive assessments are important for elderly individuals to monitor age-related cognitive decline and differentiate it from more serious neurological conditions.

What Happens After the Assessment?

After the cognitive assessment, the results will be reviewed with you, and your healthcare provider will discuss the findings. Based on the results, the following may occur:

• Diagnosis: If a cognitive disorder is identified, the appropriate diagnosis will be made.
• Treatment Recommendations: The Neurologist will discuss treatment options, which may include medication, therapy, or lifestyle changes.
• Follow-up Plan: If no major cognitive issues are found, periodic follow-up assessments may be recommended to track cognitive health over time.
• Referrals: In some cases, you may be referred to other specialist or therapist for additional evaluation or treatment.

How to Schedule a Cognitive Assessment

If you or a loved one are experiencing any cognitive concerns, a core cognitive assessment may be helpful. Please contact our office to schedule an appointment with one of our experienced neurologists or neuropsychologists. Early detection of cognitive issues can lead to better management and improved outcomes.