Neurophysiology

Provider of Nerve Conduction Study Tests to the NHS & Private Sectors

We are unique in that we are the only independent provider able to deliver the full range of Neurophysiology services outside specialist NHS hospitals.

We have seen over 80,000 patients from leading nationwide healthcare establishments both in the NHS and Private Sector. We are also an approved supplier to a number of Healthcare Insurance providers including BUPA.

Working side by side with our partners in the NHS we are able to ensure a smooth and seamless patient pathway to limit the stress caused to patients and ensure that the correct treatment plans can be quickly implemented.

neurophysiology

Provided on an outsourced basis for both one-off clinics and retained contracts, our fully flexible approach means we are able to supply a full patient booking and chaperoned clinic service through to supplying a leading consultant to deliver directly with the patient.

Integrating Seamlessly with Primary Care Trusts, NHS Foundation Trusts, NHS Acute Trusts and Independent Hospitals

Our business model has been designed to integrate seamlessly with Primary Care Trusts, NHS Foundation Trusts, NHS Acute Trusts and independent hospitals around the country, ensuring a textbook patient experience and a first-class service for the healthcare establishment itself.

Bespoke Healthcare only utilises the best UK–trained consultants and clinical physiologists in the neurophysiology sector, and we own the latest equipment giving us the freedom to hold clinics at any location best suited to the client.

Complex investigations usually undertaken in large tertiary centres can be delivered locally at any health centre, and our business model and service follows the guidelines recommended by the British Society for Clinical Neurophysiology (www.bscn.org.uk).

Bespoke Healthcare is fully registered with the Care Quality Commission (CQC), the independent regulator of health and adult social care in England. The CQC make sure health and social care services provide people with safe, effective, compassionate, high-quality care and where required, encourage care services to improve.

Small enough to care, large enough to heal

Greater Lancashire Private Hospital

Patient Information

You have been referred for an NCS/EMG test. This sheet gives you a brief outline of what to expect during the procedure.

What is an EMG/NCS test?

NCS testing is a measure of how well the nerves and muscles are working.  It involves stimulating a nerve at different points and recording a response.  The number of nerves and/or muscles tested will depend upon your presenting symptoms, the questions your consultant has asked us and the findings during the testing procedure.

What will happen during the test?

With the NCS testing, the physician places small surface electrodes onto your skin (of the leg/arm to be examined).  You will receive a small electrical impulses (on the leg/arm to be tested), so that the physician can evaluate the nerve.  The investigation is tolerated very well and some people who may have used TENS machine find experience to be quite similar. The test does not carry quantifiable side effects.

Many of the patients do not need EMG; some who do, it will require recording the signal from the muscle by using a very fine pin. This is a safe test which apart from some discomfort and at times minor bruising does not carry any major complications.

How do I prepare for the test?

No special preparation is required. You do not need to restrict your diet prior to your test. Also you do not need to omit your regular medication unless advised to do so by the referring physician.

  • It would be useful if you could wear loose clothing. For testing the hands/arms sleeves should be loose enough (half sleeves are good) to be pulled well above the elbow. For testing the legs the trousers should be loose enough to be pulled well above the knees. Some people wear or bring shorts with them to allow this.
  • Please do not apply moisturising cream for 24 hours prior to your appointment.
  • Should you have a pacemaker fitted, it is important that you inform us prior to your appointment by telephoning 01772 700629.
  • Please bring a list of any current medications.
  • Inform the consultant if you take blood-thinning medication such as Warfarin and bring the booklet with you.

How long will the test take?

Please allow between 30-60 minutes for the whole procedure.

Will I be informed of the test results at my appointment?

They will not be given to you on the day of the test, as the consultant needs to analyse the data afterwards. The results will be sent to your Consultant/GP within 1 week of your test.

Your information will only be shared with your referring clinician/GP.  It may also be anonymised for use in audit and research purposes.  If however you do not wish for this information to be shared, then please be aware this may impact upon your continuing care.

Can I return to work?

Absolutely, as there are no side effects and no restriction to return to work or usual activities.

You have been referred for an EEG test.  This sheet gives you a brief outline of what to expect during your test.

What is an EEG test?

EEG stands for ElectroEncephaloGram. It is a recording of the ‘brainwaves’ – the electrical activity of the brain. The many nerve cells that make up the brain produce continuous electrical activity when a person is awake, asleep or even in a coma. This can be recorded by placing around 20 small metal discs called electrodes, which are placed on the scalp using special paste.

What will happen during the test?

A routine EEG is a straightforward test and there are no effects during or after the test. The EEG is carried out either with you sitting up in a comfortable chair or lying on a couch. You will be asked you to open and close your eyes from time to time and changes in ‘brainwaves’ is recorded. During the test you may be asked to do deep breathing exercise (hyperventilation) for couple of minutes and towards the end of the test shown flashing lights at different flash frequencies (photic stimulation).  The test itself takes 20 minutes.  You can expect to be in the department for up to 1 hour.

Sleep Deprived EEG

In some cases it is useful to record the EEG whilst you sleep.  We make this decision with the doctor that refers you.  You will need to stay awake overnight and will be given the opportunity to sleep for one hour during the recording.  It is important you do not drive to your appointment as you will be very tired.  You can expect to be in the department for about 1.5 hours.

Melatonin Sleep EEG

If you have been referred for a Sleep EEG with Melatonin, please refer to the attached leaflet about Melatonin which is a naturally occurring drug which alters your body clock to help you sleep gently for a short period.  It will not knock you out and there are no side effects.  In this case you will need to have half your usual sleep overnight and will be given a tablet to take on your arrival in the department.  Please arrive half an hour early for your appointment.  You will not be able to drive home after your test so please ensure you have appropriate transport home.

How do I prepare for the test?

There is no special preparation needed beforehand and you should continue with any anti-epilepsy treatment or other drugs which you have been prescribed unless your doctor tells you otherwise. Make sure you have clean, dry hair, free of hair products.  You may like to bring a hat as your hair will be sticky after the test until washed.   If you are having a sleep test, please ensure you do not drink tea, coffee or stimulants prior to the test.

Note: If you have any current skin conditions affecting the scalp, please could you contact the office on 01772 700629.

Please ensure that your hair is clean and free from any sticky hair products.

Will I be informed of the test results at my appointment?

The results will be sent to your Consultant/GP within 1 week of your test.  They will not be given to you on the day of the test, as the consultant needs to analyse the data.

Your information will only be shared with your referring clinician/GP.  It may also be anonymised for use in audit and research purposes.  If however you do not wish for this information to be shared, then please be aware this may impact upon your continuing care pathway.

Are there any side effects?

No, absolutely not. You will be tired if you have had a sleep/melatonin EEG.

Can I return to work?

Absolutely, as there are no side effects and no restriction to return to work.

What is a Sleep Deprived EEG Test?

You may have already had a standard waking EEG. Sleep deprivation may help in two ways.

Firstly, the tiredness may result in brain waves on the EEG which are not usually seen. Secondly, you may fall asleep during the EEG and this may reveal new information that would otherwise have been unseen. If you are being investigated for seizures, there is a slightly increased risk of you having a seizure when you are sleep deprived.

Preparing for your Test

  • Stay awake throughout the whole of the night before your test.
  • Have a good breakfast.
  • Have clean hair that is free from hair-spray or gel.
  • Wear comfortable loose clothing that you are happy to sleep in.
  • Continue with any medication you are currently taking. It is helpful to bring a list of your medications with you.
  • If you would usually drive to your appointment, please make alternative arrangements. It is not safe for the patient or anyone who stayed up with them, to drive after sleep deprivation.

About the Procedure

Electrodes are attached to your scalp using special sticky paste and then your brainwaves are recorded. During the recording we may ask you to:

  • attempt a short period of deep breathing
  • watch a flashing light.

You will be asked to give your written consent to these procedures before the test starts. This is to confirm you understand there is a very small risk (less than 0.1%) of the procedure causing you to have a seizure. Having a seizure could result in the loss of your driving licence. You may, of course, decline this part of the test. Video images will be recorded at the same time as the EEG activity to help with your diagnosis.

Please allow up to 1 hour 30 mins for this test.

What to Expect Afterwards

Once the test is finished, we remove the discs from your head. You may find a small amount of paste left in your hair and this is easily washed out with shampoo. You may wish to bring a hat or cap to wear.

Getting your Results/Follow-up

The specialist Physiologist performing your test will not be able to give you a result immediately after the test is completed. The results need to be analysed by a Consultant Neurophysiologist. A final report will be issued to your referring clinician.

What is an Ambulatory EEG Test?

What is an ambulatory EEG recording? This records the activity of the brain over several hours,

i.e. 24 hours or overnight. If you are having attacks or symptoms of some sort every day, or at

night, it may be very helpful to record one, in order to know what type of treatment may be of most benefit to you.

Preparing for your Test

Please ensure your hair is clean and free from products or gels of any kind. Continue with any medication you are currently taking. It is helpful to bring a list of your medications with you.

About the Procedure

You will attend the Department twice. Once for electrode connection and recorder attachment/setup, and the second for disconnection.  Please allow up to 1 hour for each visit.

Small discs are placed on the scalp, which has first been prepared by rubbing with a cotton bud dipped in a skin preparation gel. This is to ensure a good contact is made between your skin and the electrode. The discs are held in place with paste and a special kind of glue called Collodion.

During the recording the leads from the discs are connected to a recorder. This is a small box that can be attached to a belt or placed in a rucksack or shoulder bag. It is advisable to wear clothing that does not need to be removed over the head. When attached, the electrodes will be visible on your head, particularly at the front. You may wish to bring a hat or other head covering to put on. The recorder is carried around with you for the duration of the recording. At night it should be removed from the belt and placed in a position such that you/your child cannot get the leads wrapped around the neck. During the recording, you are able to move about freely and continue with most daily activities. However, we do ask you NOT to get the recorder or electrodes wet, e.g. by washing your hair or taking a shower. While recording, we will ask you or a carer to keep a diary of your activities (e.g. when you have meals, take medication, go to sleep etc.) and any symptoms or attacks. This is vital in allowing us to correctly interpret the recording; without it, it may not be possible to report on the recording.

What to Expect Afterwards

The Collodion glue will be removed with a special solution, which leaves the hair looking greasy. We will remove as much of the collodion as possible, but you may find that a small amount will be left in your hair. You need to wash your hair to remove any residual glue; we recommend that you do this as soon as possible after the electrodes are removed. It may take more than one wash for the collodion to be completely removed.  In a very small number of patients, there may be an allergic skin reaction. If you are sensitive to cosmetics, lotions or Micropore tape, please contact the Department before attending for your test.

Getting your Results/Follow-up

The specialist Physiologist performing your test will not be able to give you a result immediately after the test is completed. The results need to be analysed by a Consultant Neurophysiologist. A final report will be issued to your referring clinician.