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Diagnostic Services

The CHOC Neuroscience Institute offers the full range of diagnostic services. The strength of our diagnostic services is our child-focused approach – from the small needles to collect blood for lab work to the small instrumentation for such diagnostic procedures as lumbar puncture. Parents and/or our child life specialists often stay with the child during these procedures. Our goal is to make the child as comfortable as possible during these tests.

Diagnostic procedures we offer at The CHOC Neuroscience Institute include:

• Computed tomography scan (CT scan) – This is a diagnostic imaging procedure that uses a combination of X-rays and computer technology to produce cross-sectional images (often called slices), both horizontally and vertically, of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat and organs. CT scans are more detailed than general X-rays. CT scans are often used to diagnose trauma, bleeding, stroke, masses or tumors, abnormal sinus drainage, sensorineural hearing loss, malformed bone or other tissues, brain abscess, cerebral atrophy (loss of brain tissue), cerebral edema (brain tissue swelling), and hydrocephalus (fluid collecting in the skull).

• EEG – An EEG, or electroencephalogram, is a recording of the electrical waves in the brain. It measures electrical impulses that are sent between nerve cells. This device is used to help diagnose the presence and type of seizure disorders, confusion, head injuries, brain tumors, infections, degenerative diseases and metabolic disturbances that affect the brain. It is used to evaluate sleep disorders and to investigate periods of unconsciousness. Abnormal EEG findings may indicate epilepsy, convulsion, any structural brain abnormality such as a brain tumor, brain infection, head injury, encephalitis (inflammation of the brain), hemorrhage (abnormal bleeding caused by a ruptured blood vessel), cerebral infarct (tissue that is dead because of a blockage of the blood supply), or a sleep disorder such as narcolepsy. An EEG uses small electrodes to measure the electrical activity within the brain. It does not deliver any electricity of its own. The technician uses a paste to attach 23 small electrodes to the person’s scalp. The electrodes carry information about the brain’s electrical activity to an amplifier. A special machine records the amplified brain waves, and produces a pattern of tracings called an electroencephalogram.

• MRI (magnetic resonance imaging) – This is a diagnostic test similar to a CT scan but which employs powerful magnets instead of X-rays to create precise pictures of body tissues using radio waves. These radio waves are not harmful to tissues, and the procedure is painless. However, it may require sedation because the child must remain absolutely still. MRI is especially useful in brain and neurological disorders because it can clearly show various types of nerve tissue. It provides clear pictures of the brain stem and posterior brain, which are difficult to view on a CT scan. It is also useful for the diagnosis of demyelinating disorders (disorders such as multiple sclerosis that cause destruction of the myelin sheath of the nerve) and can distinguish tumors or other lesions from normal tissues.

• Electrodiagnostic tests (i.e. electromyography [EMG] and nerve conduction velocity) – These studies evaluate and diagnose disorders of the muscles and motor neurons. During the nerve conduction studies, small electrical impulses are delivered to the arm or leg. During the EMG, a small needle is inserted into different muscles. The test takes ½ to 1-1/2 hours depending on the complexity of the problem and is usually very well tolerated. The impulses and needles are only slightly uncomfortable.

• Positron emission tomography (PET) scan – This computer-based imaging technique provides a picture of the brain’s activity rather than its structure by measuring levels of injected glucose that are labeled with a radioactive tracer.

• Arteriogram (also called angiogram) – This procedure provides a scan of arteries going to and through the brain.

• Spinal tap or lumbar puncture – Cerebrospinal fluid (CSF) surrounds the brain and spinal cord. A lumbar puncture, also called a spinal tap, is used to make an evaluation or diagnosis by examining this fluid. It is a useful diagnostic test for many neurological disorders, particularly infections and brain/spinal cord damage. The procedure is performed while the child lies on his side with legs curled up to the chest. A needle is placed between the small bones of the back to collect the fluid.

• Evoked potentials – These procedures record the brain’s electrical response to visual, auditory and sensory stimuli.

• Ultrasound (also called sonography) – This painless diagnostic imaging technique uses high-frequency sound waves and a computer to create images of blood vessels, tissues and organs. Ultrasounds are used to view internal organs as they function, and to assess blood flow through various vessels. In this test, the child lies down and lotion is spread over the area to be scanned. A probe is then rubbed over the area and a video image can be seen on a monitor.

Medical Services

At The CHOC Neuroscience Institute, we pride ourselves on the depth and breadth of medical and surgical services offered to young patients, which are accessed through several specialized clinics:

• Spasticity Clinic -- This is the only program of its kind in Orange County offering multispecialty evaluation for individuals from birth to age 17 with spasticity related to cerebral palsy or other neurological illness. Each child is evaluated by a team of neurosurgeons, orthopedic surgeons, pediatricians, social workers, occupational therapists, physical therapists and nutritionists.

• Spina Bifida Clinic -- Infants and children with spina bifida experience an array of symptoms that require the expertise of subspecialists in several fields. Our young patients especially benefit from a multidisciplinary team approach to care provided by neurosurgeons, urologists, orthopedic surgeons, physical therapists and social workers.

• Muscular Dystrophy Clinic -- This clinic is held in conjunction with the Muscular Dystrophy Association, and encompasses the 41 different diseases covered by the organization. The clinic, which is co-directed by an orthopedic surgeon and pediatric pulmonologist, focuses both on the treatment aspects of these conditions as well as coordinating all of the rehabilitation for our patients.

• Craniofacial Clinic -- Since the late 1960s, CHOC’s Craniofacial Clinic has been caring for children with cleft lip and/or palate, craniostenosis, and other genetic and congenital syndromes such as Crouzon’s disease, Apert syndrome and Velocardiofacial syndrome. The complexity of craniofacial disorders requires a team approach involving pediatric specialists in numerous fields including neurosurgery, genetics, anesthesiology, orthodontics, ophthalmology, otolaryngology, nursing, speech, psychology, audiology, social services and endocrinology. One of the many strengths of this clinic -- is that in one visit, your child can be seen by this team of specialists.

Innovation

The CHOC Neuroscience Institute is involved in several nationwide clinical trials and offers the access to latest in clinical and surgical interventions to help improve the quality of life for children with neurological disorders. Highlights include:

• Strata™ Valve – The CHOC Neuroscience Institute helped pioneer the use of Medtronic’s Strata Valve, a highly sophisticated medical device used to treat hydrocephalus (fluid accumulation in the brain). A sophisticated shunt, which is implanted under the patient’s skin, consists of three basic components: a catheter that is placed into the brain cavity where cerebrospinal fluid has accumulated; a valve that regulates the rate at which the fluid drains; and another catheter that takes the excess fluid into the abdomen, where it becomes reabsorbed by the body. The valve connects the two catheters and is controlled by the use of a magnet. CHOC was one of 20 medical centers in the United States to conduct clinical trials of the Strata Valve, and completed the highest number of implants in the study. Patients experienced an excellent success rate, and findings from this extensive effort contributed to the U.S. Food and Drug Administration approval of the device.


• Baclofen Infusion -- Since 1995, our surgeons have implanted close to __ baclofen pumps for treatment of spasticity and dystonia – making it one of the largest programs of its kind in the United States. The pump delivers a constant, low dose of the medication baclofen via catheter to the patient’s spinal cord and brain, allowing muscles to relax. The CHOC Neuroscience Institute studies young patients between the ages of 4 and 16 who have had a baclofen infusion pump implanted for severe spasticity. Through this study, we hope to determine if there are any complications associated with this treatment approach.


• Thalamic Stimulation for Cerebral Palsy -- Children with cerebral palsy have characteristic movement disorders including spasticity and dystonia. These patients may benefit from the delivery of electrical pulses to the thalamus, a cluster of nerves deep within the brain. The Institute hopes to help determine the benefits of thalamic stimulation in children with cerebral palsy.


• Vagal Nerve Stimulator™ (VNS) program -- One of the highlights of our seizure care is an active Vagal Nerve Stimulator™ (VNS) program, which is dramatically improving the quality of life for many young patients at CHOC. VNS is based on the findings that intermittent stimulation of the vagus nerve, which is located in the neck and projects to the brain, reduces seizures in certain patients. The VNS device resembles a pacemaker and is implanted under the skin in the upper left chest area. It delivers intermittent electric pulses 24 hours a day to the brain through a wire in the neck connected to the vagus nerve. When a patient senses the impending onset of a seizure, he or she can activate the device through a hand-held magnet to deliver an additional dose of stimulation.


• CYBON™ Image-Guided System -- When CHOC purchased the CYBON™ Suite in 2000, the hospital became the first Southern California healthcare provider to adopt the state-of-the-art surgical guidance system. Based on advanced, patented technologies, this system enables CHOC surgeons to visualize in 3-D the patient’s brain, and then synchronize this information with intraoperative data, such as images taken from the tip of the endoscope while the surgeon is operating. This new technology improves accuracy -- reducing the chances of injuring critical areas of the brain -- and allows for more minimally invasive procedures and smaller incisions.