Diagnostic Capabilities

Full electromyography and nerve conduction study laboratory (clinical neurophysiology) with technical support, resident and postgraduate fellow participation. The combined EMG/NCV/Autonomic Laboratory performs 2,000 tests per year aiding the neuromuscular specialists in diagnosing disease and evaluating therapeutic efficacy for nerve and muscle diseases.

Electromyography/nerve conduction study testing:
This standard testing involves the application of small shocks and pinpricks to a patient's nerves and muscles on an outpatient or inpatient basis to determine the diagnosis of a variety of conditions affecting the nerve, neuromuscular junction, or muscle. In addition, these studies can help rule out diseases of the brain and spinal cord when used in tandem with imaging studies such as CT scanning, PET scanning, and MRI.

Evoked potential testing:
Small shocks applied to a variety of nerves with surface recording electrodes placed on the scalp and neck, the application of small flashing lights to a patient with surface scalp recording, and testing of inner ear and brainstem function via audio replay can help aid the physicians in diagnosing a variety of conditions affecting the peripheral nerve, brain, and spinal cord.

Quantitative muscle testing (QMT):
As part of our Amyotrophic Lateral Sclerosis Center, quantitative muscle testing can be performed serially to document any ongoing strengthening or weakening- aiding our patients and physicians in understanding of the progression of their disease, as well as therapeutic effectiveness.

Autonomic Laboratory Diagnostics:
A full battery of testing for small nerves involved in peripheral neuropathy, particularly diabetes, can be tested via QSART (Quantitative Sudomotor Axon Reflex Testing). In addition, tests of cardiac and peripheral blood vessel function, depending upon an intact autonomic nervous system, are readily testable in our laboratory via tilt table analysis, Valsalva maneuver testing and heart rate response to a deep breathing stimulus.

Quantitative Sensory Testing (QST):
Threshold to heat and cold stimuli, and vibratory stimuli can act as an adjunct to standard EMG/NCS testing in determining the progression of peripheral nerve disease and treatment effectiveness.

Neuropathology:
Our neurosurgeons perform nerve and muscle biopsies on selected patients to help determine the diagnosis of a variety of unusual neuromuscular disorders with onsite neuropathological analysis.

Inpatient neurological care, both in a critical care and non-critical care setting, is available for those patients with acute neuromuscular conditions. Intensive care physicians, nurses, and support staff are available 24 hours per day.

Transfers/Referrals:
(412) 359-8066 or (412) 359-8850

With one phone call, a referring physician may transfer the care of a neuromuscular patient to Allegheny General Hospital. All arrangements can be made for intrahospital transfers through the One Call Center at (412) 359-8066. Referrals for outpatient evaluation may be made at (412) 359-8850 for Drs. Rana and Small.

Treatments

Major associated treatments of neuromuscular diseases, both acute and chronic:

Corticosteroids:
Corticosteroid use is generally accepted to help improve strength in patients with chronic inflammatory demyelinating polyneuropathy (CIDP), myasthenia gravis, and variety of other neuromuscular conditions. Although many side effects are expected with chronic high dose use, the use of these drugs has greatly improved the quality of care and life of patients with many neuromuscular diseases.

Intravenous immunoglobulin (IVIG):
The use of pooled IgG (antibodies) from a variety of blood donors is standard therapy for patients with Guillain-Barré syndrome (acute inflammatory demyelinating polyneuropathy), chronic inflammatory demyelinating polyneuropathy (CIDP), myasthenia gravis, and other associated nerve, neuromuscular junction, and muscular diseases. This relatively safe alternative to corticosteroids can be used in combination with other agents and is available at the Allegheny General Hospital Neuromuscular Center on both an outpatient and inpatient basis.

Plasmapheresis:
This dialysis-like treatment is reserved for patients with acute decompensations in serious neuromuscular diseases resulting in severe paralysis, swallowing problems, and breathing problems including the Guillain-Barré syndrome, chronic inflammatory demyelinating polyneuropathy, and myasthenia gravis, among others. Plasmapheresis at Allegheny General Hospital is supported by the Central Blood Bank of Allegheny County whose nurses provide onsite care on both clinic and outpatients

Immunosuppressive therapy:
The use of a variety of immunosuppressive drugs such as methotrexate, mycophenolate, azathioprine, cyclophosphamide, rituximab, as well as others, are reserved for patients with chronic neuromuscular conditions to prevent the necessity of long-term steroid use, with its attendant complications. In addition, the favorable side effect profile of these drugs and efficacy in numerous disorders allows the Neuromuscular Center to treat patients with the most modern therapies, maximizing efficacy and minimizing side effects.