Neurological Investigations

What is an EEG?

EEG is short for "electroencephalogram." An EEG is a test that measures electrical activity in the brain and records brain wave patterns. Some brain conditions can affect a person's brain wave patterns.

Why Might My Child Need an EEG?

A Pediatric Neurologist might order an EEG to diagnose or get more information about:

• Seizures - provides information about your child's seizures
• Episodes of passing out or fainting
• Brain tumor, injury, or disease
• Sleep problems or memory problems
• Before brain surgery

How to Prepare for an EEG

• The night before, wash hair with shampoo only. Don't use conditioner, cream, or gel
• Avoid caffeine for 8 to 12 hours before the EEG
• Follow doctor's instructions about taking medicines
• For "sleep-deprived EEG," your child may need to stay awake late and rise early

What Happens During the Test?

• A technologist applies small electrodes on the scalp using paste
• Wires from electrodes are connected to a computer that records brain waves
• Your child will lie on a bed or sit in a chair
• Medicine may be given to help sleepy children
• A routine EEG takes about 1 hour
• Some EEGs can last several hours or overnight

Types of EEG

• Video EEG: A camera records your child along with brain activity
• Ambulatory EEG: Your child goes home with a portable recorder that tracks brain activity for a few days

Important: The EEG does not hurt. It only records the electricity your brain makes — it does not do anything to your brain, and it cannot read thoughts or feelings.

What is the BERA Test?

BERA is a safe and painless hearing test that checks how the hearing nerves and brain respond to sounds. It helps in early detection of hearing loss, especially in babies and young children.

Why is BERA Done?

BERA may be needed if:

• Baby fails a newborn hearing test (like OAE)
• Child is too young or uncooperative for other hearing tests
• Child has neurological or developmental concerns
• Parents are worried about child's hearing
• Family history of hearing loss
• Infections before or after birth
• Premature birth or low birth weight
• Severe jaundice at birth

How to Prepare Your Child

• Child should be calm or asleep during the test
• Doctor may advise sedation — follow food & sleep instructions carefully
• Keep the child awake beforehand so they may sleep during the test

What Happens During the Test?

• Soft earphones are placed in ears
• Small sensor stickers (electrodes) on forehead & near ears
• Clicking sounds are played
• Electrodes measure brain's response
• Duration: approximately 1 hour (longer if baby wakes up)
• You can stay with your child during the test

Important: Early testing = Better hearing outcomes. If advised, don't delay the BERA test.

What is an NCV Test?

The Nerve Conduction Velocity (NCV) test measures how well and how fast your child's nerves conduct electrical signals. It helps to assess whether there is any nerve damage, weakness, or other related issues.

Why is the NCV Test Done?

• To check for nerve damage or weakness
• To assess muscle problems such as weakness, numbness, or tingling
• To evaluate neurological disorders affecting muscles and nerves
• To help diagnose conditions like GBS, Carpal Tunnel Syndrome, Peripheral Neuropathy

How is the Test Done?

• Electrodes (small patches) will be placed on the skin
• Mild electrical pulses will be applied to assess nerve impulse speed
• The test is quick, usually lasting 30 to 60 minutes
• There may be mild tingling or discomfort, but it is not painful

How to Prepare

• No special preparation is needed (no fasting)
• Avoid creams, lotions, or oils on your child's skin on the day of the test
• Inform the doctor about any medications
• Let the doctor know about any implants, pacemakers, or other medical devices

What is a VEP Test?

VEP (Visual Evoked Potential) is a safe and painless test. It checks how well the eyes and brain work together. The test records the brain's response to light or patterns shown on a screen.

Why is it Done?

A Pediatric Neurologist may recommend a VEP test if:

• Your child has poor vision not explained by routine eye tests
• There are concerns about the optic nerve
• The child has developmental delay, squint, or suspected brain/nerve problems
• To check for optic neuritis, multiple sclerosis, brain injury, or lazy eye

Before the Test

• Wash child's hair the night before; avoid oil, gel, clips
• Normal food and drink are allowed
• Bring your child's glasses if they use them
• Carry previous reports (MRI, eye exam, EEG)
• Small children may be given a mild sedative to help them sleep

During the Test

• Child sits in front of a screen with patterns or flashing lights
• Small stickers (electrodes) placed gently on the scalp
• Child only needs to look at the screen quietly
• Test duration: 20-30 minutes
• The test is completely painless
• Parents are often allowed to stay inside

What is a CT Scan?

A CT scan (Computed Tomography) is a type of imaging test that uses special X-rays to take detailed pictures of the inside of the body. It creates cross-sectional and 3D images that help doctors see organs, bones, and tissues clearly.

Why is it Done?

A Pediatric Neurologist may recommend a CT scan to check for:

• Injuries or trauma
• Swelling, infection, or tumors
• Blood clots or bleeding

Does it Involve Radiation?

Yes, CT scans use a small amount of X-ray radiation. While the amount is low and generally safe, doctors recommend CT only when truly necessary, especially in children.

How to Prepare

• Tell the doctor about all medications, allergies (especially to contrast dye), and any implants
• Give light food unless instructed to keep child fasting
• Dress child in comfortable, metal-free clothes
• Remove all jewelry, watches, glasses, hair clips
• For young or restless children, sedation may be recommended

What Happens During the Scan?

• Child lies on a narrow table that slides into the scanner
• If contrast is needed, it will be given via an IV line
• The technologist operates from another room but can see and talk to your child
• Child will be asked to stay still
• The machine makes whirring or clicking sounds but does not touch or hurt
• The scan takes about 5 to 15 minutes

What Is an MRI?

MRI stands for Magnetic Resonance Imaging. It's a safe, painless test that uses a strong magnet (not radiation) to take detailed pictures of the inside of the body.

Doctors use MRI scans to look at the brain and spine, organs, heart and blood vessels, bones and joints.

How to Prepare Your Child

• Inform doctor about any medicines, allergies, and implants or metal objects in child's body
• Tell doctor about tattoos, piercings, or permanent makeup
• Let your child know the machine makes loud noises but won't hurt
• Explain they'll need to lie still and may hear music or wear earplugs
• If your child gets anxious, talk to doctor beforehand — medicine can be given to help relax

What to Bring / Leave at Home

• Bring: list of medications, comfort item if allowed, previous medical records
• Leave: jewelry, hair clips, metal zippers, watches, glasses, electronics

What Happens During the MRI

• Child will wear a hospital gown
• If contrast dye is needed, it will be given through a small IV
• Child lies on a table that slides into the scanner
• The technologist can see and talk to your child at all times
• The scan usually takes 20 to 60 minutes
• The test is painless, but staying still is very important

After the MRI

Your child can usually go home right away. If calming medicine was given, someone will need to stay with them and help them rest.

What Are Neurometabolic Tests?

Neurometabolic tests help find rare inherited conditions where the body cannot properly break down certain nutrients or chemicals. These conditions can affect brain growth, cause seizures, developmental delay, or even coma.

Early diagnosis is important — some conditions are treatable with diet or medications.

Why Are These Tests Done?

Doctors may suggest neurometabolic testing if your child has:

• Developmental delay or loss of previously gained skills
• Seizures that are difficult to control
• Poor muscle tone (hypotonia), stiffness, or abnormal movements
• Behavioral concerns or autism with other warning signs
• Unexplained vomiting, drowsiness, or unconsciousness
• Enlarged or small head size
• Family history of similar illness
• MRI/EEG suggestive of metabolic disorder

Key Tests

• TMS (Tandem Mass Spectrometry): Detects over 30+ metabolic disorders from a small blood sample
• GCMS (Gas Chromatography-Mass Spectrometry): Analyzes urine for abnormal organic acids
• Other tests: Lactate, ammonia, blood sugar, plasma amino acids, enzyme and genetic tests

Reports may take 1-3 weeks. Results may help start special diet, vitamins, or medication.

What is Genetic Testing?

Genetic testing is a medical test that looks at a child's DNA to find changes (mutations) that might explain certain health conditions. It helps doctors understand if a genetic disorder is present and how it might affect your child's health or development.

Why is Genetic Testing Recommended?

Doctors may suggest genetic testing if a child has:

• Developmental delay (slow in sitting, walking, talking)
• Intellectual disability or learning difficulties
• Autism spectrum disorder (ASD)
• Seizures or epilepsy
• Unexplained muscle weakness or movement disorders
• Multiple birth defects or unusual physical features
• Family history of genetic conditions

Types of Genetic Tests

• Karyotyping: Looks at chromosomes for abnormalities
• Chromosomal Microarray: Detects small missing or extra pieces of chromosomes
• Single Gene Tests: Tests for specific genetic conditions
• Whole Exome/Genome Sequencing: Comprehensive analysis of all genes

What to Expect

• Usually requires a simple blood sample
• Results may take 2-8 weeks depending on the test
• Genetic counseling is recommended before and after testing
• Results can help guide treatment and inform family planning