ISPINE: NeuroDiagnostics

The eVox® system is an FDA 510(k) cleared medical device that measures brain function to aid doctors in the diagnosis of cognitive disorders.

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ISPINE: Top NeuroDiagnostics in Texas

The eVox®: Office-Based Solution.

EEG (Electro encephalo graphy) is monitoring method to record electrical activity of our brain. It is usually noninvasive, with the electrodes placed along the scalp, although invasive electrodes are also used sometimes such as in electrocorticography. EEG measures voltage fluctuations resulting from ionic current within the neurons of our brain. In medical terms, EEG means recording of the brain's spontaneous electrical activity over a period of time, as recorded from multiple electrodes placed on the scalp.

An event-related potential (ERP) is the measured brain response that is the direct result of a specific sensory, cognitive, or motor event. More formally, it is any stereotyped electrophysiological response to a stimulus. The study of the brain in this way provides a noninvasive means of evaluating brain functioning. To get the top electrophysiological monitoring in Texas come to ispine.

An evoked potential or evoked response is an electrical potential recorded from the nervous system of a human or other animal following presentation of a stimulus, as distinct from spontaneous potentials as detected by electroencephalography (EEG), electromyography (EMG), or other electrophysiologic recording method. Such potentials are useful for electrodiagnosis and monitoring.

Evoke Neuroscience, Inc. is the leading medical device company providing low cost brain electrophysiology equipment designed specifically to suit the needs of medical doctors and their patients. The eVox® system is an FDA 510(k) cleared medical device that measures brain function to aid doctors in the diagnosis of cognitive disorders. It collects 19-channel EEG and event-related potentials (ERP) data via a portable and automated 24-channel amplifier to offer objective, brainbased biomarkers that further assist in diagnosis of cognitive disorders. The physician may utilize these biomarkers to recognize early dementia conditions, identify the root cause of memory loss, and perform a differential diagnosis. By measuring brain function directly, physicians can enhance their clinical work-up beyond standard subjective patient questionnaires. The eVox System provides clinically actionable and objective biomarkers of brain health pertinent to conditions like Alzheimer’s disease, mild cognitive impairment, and other cognitive disorders.

VAT (Vestibular Autorotation Testing)

Electronystagmography (ENG) is a diagnostic test to record involuntary movements of the eye caused by a condition known as nystagmus. It can also be used to diagnose the cause of vertigo, dizziness or balance dysfunction by testing the vestibular system.

For most of the population, balance control occurs at an unconscious level. Signals from the inner ear continuously drive the eye muscles to coordinate eye movement with head movement. This coordination is necessary to have clear vision and balance. The communication between the ear and the eye is called the vestibuloocular reflex (VOR). When the VOR is functioning properly, eye speed and timing are equal and opposite to those of the head. But, if the speed or timing is off, even slightly, vision is distorted because of apparent motion of the visual field. The VAT® is an 18 second test of the high frequency horizontal and vertical VOR’s for diagnosis, treatment planning and monitoring of vestibular disease. The frequency tested ( 2 – 6 Hz) closely approximates normal head movements. For example, many patients complain of dizziness or loss of balance when they are walking, bending over or turning their head quickly. The VAT® quickly and comfortably monitors a patient’s head and eye motions to record what is happening in the vestibular portion of the inner ear. Testing with the VAT® often identifies problems not found with other vestibular tests, because the VAT® tests natural, faster motions and unlike other conventional vestibular tests, evaluates both the horizontal and vertical canals. Because the VAT® is sensitive to changes of the VOR and is easy to perform, it is often the first screening test a patient receives who complain of dizziness or balance problems. Patients do not object to repeated testing which makes the VAT® the ideal test to monitor ototoxic medication and vestibular rehabilitation.

Autonomic Nervous System Testing (ANS)

The autonomic nervous system (ANS) regulates physiologic processes, such as blood pressure, heart rate, body temperature, digestion, metabolism, fluid and electrolyte balance, sweating, urination, defecation, sexual response, and other processes. Regulation occurs without conscious control, i.e., autonomously. The ANS has two major divisions: the sympathetic and parasympathetic systems. Many organs are controlled primarily by either the sympathetic or parasympathetic system, although they may receive input from both; occasionally, functions are reciprocal (e.g., sympathetic input increases heart rate; parasympathetic decreases it).

The sympathetic nervous system is catabolic and activates fight-or-flight responses. Thus, sympathetic output increases heart rate and contractility, bronchodilation, hepatic glycogenolysis and glucose release, BMR (basal metabolism rate), and muscular strength; it also causes sweaty palms. Less immediately-life-preserving functions (e.g., digestion, renal filtration) are decreased.

The parasympathetic nervous system is anabolic; it conserves and restores. Gastrointestinal secretions and motility (including evacuation) are stimulated, heart rate is slowed, and blood pressure decreases.

Disorders of the ANS can affect any system of the body; they can originate in the peripheral or central nervous system and may be primary or secondary to other disorders. Symptoms suggesting autonomic dysfunction include orthostatic hypotension, heat intolerance, nausea, constipation, urinary retention or incontinence, nocturia, impotence, and dry mucous membranes. If a patient has symptoms suggesting autonomic dysfunction, cardiovagal, adrenergic, and sudomotor tests are usually done to help determine severity and distribution of the dysfunction.

Autonomic Regulation is the body’s ability to maintain homeostasis (stability and balance) during internal and external stimuli. Autonomic Regulation is always functioning, and we are often unaware of the important tasks it is performing. When the nerves that control Autonomic Regulation are damaged, Autonomic Dysfunction can develop. Autonomic Dysfunction can be temporary or chronic. Diabetes and Parkinson’s disease are two examples of chronic conditions that can lead to Autonomic Dysfunction. VitalScan ANS+ tests Autonomic Regulation through a combination of Heart Rate Variability (HRV) Assessment and Cardiac Autonomic Reflex Tests (CARTs).

Cardiovagal innervation testing evaluates heart rate response to deep breathing and to the Valsalva maneuver, via electrocardiogram rhythm strip. If the ANS is intact, heart rate varies with these maneuvers; the ratio of longest to shortest RR interval (Valsalva ratio) should be 1.4 or greater.

Vasomotor adrenergic innervation testing evaluates response of beat-to-beat blood pressure to the head-up tilt and Valsalva maneuver. The head-up tilt shifts blood to dependent parts, causing reflex responses. The Valsalva maneuver increases intrathoracic pressure and reduces venous return, causing blood pressure changes and reflex vasoconstriction. In both tests, the pattern of responses is an index of adrenergic function.

Autonomic nervous system (ANS) testing, including parasympathetic function (cardiovagal innervation), sympathetic adrenergic function (vasomotor adrenergic innervation).

This tool is used to evaluate symptoms of vasomotor instability for any of the following:

  • Diagnose the presence of autonomic neuropathy in a patient with signs or symptoms suggesting a progressive autonomic neuropathy, including: Diabetic neuropathy, Amyloid neuropathy, Sjogren’s syndrome, Idiopathic neuropathy, Pure autonomic failure, Multiple system dystrophy.
  • Evaluate the severity and distribution of a diagnosed progressive autonomic neuropathy;
  • Differentiate the diagnosis between certain complicated variants of syncope from other causes of loss of consciousness;
  • Evaluate inadequate response to beta blockade in vasodepressor syncope;
  • Evaluate distressing symptoms in the patient with a clinical picture suspicious for distal small fiber neuropathy in order to diagnose the condition;
  • Differentiate the cause of postural tachycardia syndrome;
  • Evaluate change in type, distribution or severity of autonomic deficits in patients with autonomic failure;
  • Evaluate the response to treatment in patients with autonomic failure who demonstrate a change in clinical exam;
  • Diagnose axonal neuropathy or suspected autonomic neuropathy in the symptomatic patient;
  • Evaluate and diagnose sympathetically maintained pain, as in reflex sympathetic dystrophy or causalgia; or
  • Evaluate and treat patients with recurrent unexplained syncope to demonstrate autonomic failure.

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