In general, patients should bring their doctor's referral letter as well as any relevant additional information (list of medications), test results and scans (films and reports).

Please wear loose fitting clothing for ease of clinical examination or nerve conduction studies.

Please take your regular medications as prescribed on the day of the consultation, test or procedure.

You will be asked to fill in two forms on medical history and new patient information, which can be downloaded below.

For all tests and procedures, please try to minimise the application of moisturisers or makeup for both nerve conduction studies as well as for botulinum toxin injection. This will ensure the best results.


Nerve conduction studies/EMG

Nerve conduction studies and EMG (electromyography) measure the function of the peripheral nervous system.

Nerves work by conducting electricity, thus nerve conduction studies use very small electrical pulses to test how well the nerve is working. EMG is used to directly measure nerve and muscle damage by recording muscle contraction through a fine needle inserted into the muscle.

The symptoms of peripheral nerve diseases can include numbness, weakness and pain. Nerve conduction studies help in diagnosing diseases of peripheral nerves. Commonly, these diseases can include nerve compression syndromes such as carpal tunnel syndrome, ulnar neuropathy as well as radiculopathies (nerve root compression) such as sciatica.

Other nerve diseases include peripheral neuropathy from diabetes or nerve inflammation/damage. Muscle diseases may also be diagnosed using nerve conduction studies as well as EMG. The most common symptom of muscle disease is weakness.

The test is generally not uncomfortable. Your doctor will write a referral which describes the area to be studied based on your symptoms.

The test will be personally performed by Dr Wardman.


Botulinum Toxin injections

Controlled amounts of botulinum toxin is injected into muscles (with EMG guidance) or under the skin using a fine needle.

Botulinum toxin is commonly used in movement disorders: dystonia, spasm, spasticity. More recently, there is evidence that botulinum toxin may reduce the frequency of chronic migraine headache.

Botulinum toxin is also used to treat excess sweating of the armpits or hands.

In movement disorders, Botulinum toxin primarily works by weakening the muscle(s) that it has been injected into. This weakness is not permanent and the muscle will generally recover after 3-4 months (sometimes sooner). Thus a repeat injection is required at this time to continue treating the condition.

In chronic migraine headache, the mechanism of action is not well defined but it involves feedback between peripheral sensation and central migraine generation pathways.

In excess sweating disorders, botulinum toxin weakens the small sweat gland muscles and thereby reducing the production of sweat.


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