Neurophysiology & Intraoperative Neurophysiological Monitoring (IONM)

During this test for epilepsy, your doctor places electrode sensors on your scalp or brain surface to monitor your brain’s electrical activity.

We also offer:

• Video EEG Monitoring: We simultaneously record your brain’s electrical activity with an EEG and video. Comparisons between the two records can help doctors pinpoint the origins of seizures and the seizure type. We also offer high-density EEG, which utilizes more than 100 electrode sensors to more accurately pinpoint the seizure focus.
• Ambulatory EEG Monitoring: A small portable device monitors brain and seizure activity as you go about daily life outside the hospital. This method enables your doctor to observe brain activity over a longer period of time.

An EMG measures the electrical activity of muscles. Nerve conduction studies measure electrical signals among nerves. Performed jointly, these tests aid the diagnosis of neurological conditions such as amyotrophic lateral sclerosis (ALS), muscular dystrophy, myasthenia gravis and neuropathy. MUSC has the only accredited EMG lab in South Carolina.

An EP test measures how the brain responds to specific types of sensory input such as sound, light, and sensation. The test detects damaged areas, or lesions, in the brain, and aids the diagnosis of multiple sclerosis, brain, and spinal tumors, and vision, and hearing problems.

Intraoperative neurophysiological monitoring (IONM) provides real-time assessment and feedback of the patients' neurological function to surgeons that perform a wide variety of operative procedures. IONM serves as an immediate alarm to the surgical team to identify decline of neurologic function, in order to prevent permanent neurological impairment. Moreover, the IONM team serves as an advocate for the patient’s safety throughout surgical procedures.

Commonly monitored surgical procedures include adult and pediatric neurosurgery, orthopedic spine, cardiac, pain management, neurovascular, and ear, nose and throat specialties. The value of IONM has consistently been investigated and reported to enhance optimal patient care and surgical outcomes. MUSC is proud to have an IONM team on-site to ensure positive patient outcomes.

This imaging test is performed in conjunction with an electroencephalogram (EEG) to reveal how your brain uses glucose, a sugar. A low-level radioactive drug, or tracer, given with the glucose shows areas of the brain with high levels of chemical activity. PET scans can aid the diagnosis of epilepsy, Alzheimer’s disease, Parkinson’s disease, Huntington’s disease, and stroke.

This noninvasive ultrasound procedure checks for abnormal blood flow within the major arteries of the brain. Your doctor may use TCD (also called an intracranial cerebrovascular exam) during surgery to monitor blood flow within the brain.

This is an ultrasound of the arteries located in the neck. An ultrasound transducer is used to scan each side of the neck to examine the carotid arteries. Carotid Dopplers are performed for the following indications:

• Cerebrovascular Accident (CVA)
• Transient Ischemic Attack (TIA)
• Carotid dissection
• Subclavian steal
• Known stenosis

Your doctor may perform this test before you undergo surgery for epilepsy. The Wada test, also known as the intracarotid sodium amobarbital procedure (ISAP), helps establish where certain functions, such as language, and memory, are localized in the brain.

MUSC Health has a carefully selected team of highly educated and skilled IONM specialists, who are dedicated to patient care and research. Each team member has accreditation through the national board of neurodiagnostic credentialing (ABRET) and holds a CNIM credential. The diversity and background of each team member provides IONM advancements in technology and monitoring techniques for multiple disciplines of surgery. The MUSC Health IONM team works directly with surgeons, the EEG department, neurologists, and technical equipment specialists to tailor and implement a plan for patient-specific needs.

The team communicates effectively to monitor the following:

• Cortical perfusion detection for vascular surgeries (EEG)
• Electromyography (EMG) to detect nerve root irritation in the face and spine
• Stimulation of specific nerve roots for identification during surgery as well as optimal pedicle screw placement (tEMG)
• Cranial nerve monitoring (sp/tEMG), lateral spread response (LSR) for facial nerve
• Recurrent laryngeal nerve (RLN) and laryngeal adductor reflex (LAR) monitoring (EMG, MEP)
• Facial nerve mapping for parotid tumor removal
• Brainstem auditory evoked potentials (BAERs/ABR) for preservation of hearing
• Sensory function via dermatomal and peripheral nerve stimulation via Somatosensory Evoked Potentials (DSSEP, SSEP)
  
  • Determination of motor versus sensory cortex of the brain via central sulcus identification
  • Dorsal Column Mapping (DCM) to identify a safe entry zone for removal of spinal cord tumors
  • Optimal Dorsal Root Ganglion (DRG) and Spinal Cord Stimulation SCS placement procedures for chronic pain
• Patient motor function via functional cortical and subcortical mapping, transcranial, transabdominal, corticobulbar and direct cortical motor evoked potentials (TcMEP, TaMEP, coMEP, and dcMEP, respectively)
• Language, speech, and comprehension through brain mapping and evaluation with Neuromapper technology
• Microelectrode recording (MER) for mapping in deep brain stimulator (DBS) placement
• Pre-operative Motor and Speech mapping via Transcranial Magnetic Stimulation (TMS) with Nextstim