We have moved! We are now located at 105 New Town Rd, New Town TAS
Neurology consultations
About neurology consultations
Comprehensive Neurological Consultations
General neurology can be a bit like detective work. We see people with a wide range of symptoms. These include problems such as headaches, nerve pain, muscle weakness, vertigo, abnormal balance, memory difficulties, and language difficulties, as well as many others. We see people with a wide range of conditions such as headache disorders, Parkinson disease, Multiple Sclerosis, peripheral neuropathy, and myasthenia gravis. There are many less common neurological disorders as well.
As a result, we often need to have a comprehensive look at you as a whole person to help work out what is happening. Neurologists look after people with brain, spine, nerve and muscle conditions. We often work with a wider team of allied health practitioners, neurosurgeons, pain specialists and other medical practitioners to be able to help you function at your best.
Dedicated Care
Dr. Caroline Airey is dedicated to providing thorough and personalised care to people dealing with these complex neurological challenges. New patient consultations are typically booked for one hour, depending on the referral. Follow up consultations are booked for a minimum of thirty minutes.
Consultations and Procedures
It is preferable to see new patients face to face, to enable a detailed neurological examination. Telehealth consultations are available for follow up consultations, and in exceptional situations for new patients, although with an understanding that a face to face consultation would need to occur subsequently for examination purposes.
Our practice nurse or practice manager may contact you prior to the appointment. This may be to find out where previous tests have been done, or to find out what treatment you might have already tried in the past. If things have changed since you were first referred, please let us know. We would like to make sure that your consultations run as smoothly as possible.
Preparing for Consultations
It can be helpful to bring along a list of medications and any test results that have already been performed. If there are multiple symptoms over a long time period, it can be helpful to write these down, as well as questions you might have. We are happy for family or support people to attend consultations, as often they can provide additional valuable information as well as being a comforting presence.
If there are any other doctors or health professionals that you would like to be added to correspondence, we are happy to have their details.
Checklist
Checklist for Your Appointment
| Item | Status |
|---|---|
| Medicare Card | [ ] Bring |
| List of Current Medications | [ ] Bring |
| List of Allergies | [ ] Bring |
| Results of Previous Tests | [ ] Bring |
| List of Symptoms or Concerns | [ ] Bring |
Patient Involvement
Caroline encourages people to ask questions and thinks it is important that people are involved and understand their own healthcare. She is a firm believer that the best outcomes occur when a person, their family and health care team work together.
EEG
EEG service
We have expanded our neurophysiology services. We have added a highly qualified neurophysiologist to our team, Elisa Petrin. We now have an EEG service available, as well as expedited nerve conduction studies.
Nerve conduction studies and EMG
What are nerve conduction studies and EMG?
Nerve Conduction Studies
Nerve conduction studies are specialised tests designed to investigate and diagnose a spectrum of symptoms, including nerve pain, weakness, and changes in sensation. These tests play an important role in investigating a variety of conditions, such as carpal tunnel syndrome, ulnar neuropathy, peripheral neuropathy, and radiculopathy.
Electromyography (EMG)
EMG is another specialised test that assesses the electrical activity in muscles. The patterns that are seen can help determine the underlying causes of symptoms, such as nerve pain, weakness, and pins and needles. EMG involves a fine needle electrode being inserted into a muscle, with the electrical activity of the muscle then being recorded. It is important to note that no electric stimulus is involved in this part of the test. The only thing injected into the muscle is the electrode.
Test procedures
Test Procedures
Nerve conduction studies involve placing recording electrodes (similar to stickers) on the skin. A mild electric shock is then given to the nerve. The results are recorded on a computer. This can be uncomfortable, but generally, the stimulus is quite mild. On the other hand, EMG is not always necessary, depending on the reason for the referral.
Sometimes, your referring doctor may have referred you for a consultation and a test, or just for a test alone. Even if you have been referred for a test alone, we will sometimes ask you questions. We will examine you to make sure that we are answering the right questions with the testing.
Preparing for the Test
It is recommended to wear loose, comfortable clothes that can be easily rolled up above the knees or elbows, or to wear layers that can be removed. We have blankets available for privacy and comfort.
Take your usual painkiller medications on the day of the test. This also includes your usual medications. They won’t affect the results. If you are on blood thinners such as warfarin, dabigatran, enoxaparin or clopidogrel, it’s important to inform us beforehand. This is especially important for the EMG component. We will use the smallest possible needle to avoid excessive bruising and bleeding.
Avoid using moisturiser, creams or lotion on the arms or legs the day of the test if possible. The electrodes stick better to clean skin. We can manage this if you forget though.
If you are needle phobic, let us know. If you are sensitive to electric stimuli or shocks, inform us too. We can allow for a longer appointment time. This will help us make you feel as comfortable as possible.
Checklist for your nerve conduction study/EMG
Checklist for Your Nerve Conduction Study/EMG
- Wear Loose, Comfortable Clothing
- Choose outfits that can be easily rolled up above the knees or elbows.
- Avoid Using Moisturiser or Creams
- Refrain from applying any products on the skin the day of the test for better electrode adhesion.
- Inform Us if You’re Taking Blood Thinners
- Let us know if you’re on medications like warfarin, dabigatran, enoxaparin, or clopidogrel.
- Take Your Usual Medications
- Don’t forget your regular medications, especially pain relief, as they won’t affect the test results.
Botulinum toxin (“Botox”)
About Botulinum toxin treatment
Conditions Treated with Botulinum Toxin
Botulinum toxin injection, also known as “Botox,” is a treatment option provided at our practice. It is widely utilised to treat people with chronic migraines, who have not had improvement with standard preventative treatments.
The treatment is also effective in managing various other neurological conditions.
These include:
- Hemifacial spasm
- Blepharospasm
- Cervical dystonia
- Spasticity
- Axillary hyperhidrosis (a condition characterized by severe abnormal sweating)
Administration of Botulinum Toxin
The administration of Botulinum toxin for neurological conditions is performed differently for different conditions.
There are a relatively large number of injection sites for chronic migraine and axillary hyperhidrosis, for instance, but relatively few for other conditions.
In migraine treatment, the dose of toxin per injection is quite small. A very fine gauge needle is used. This minimises discomfort.
While injections can be uncomfortable, the procedure itself is usually quick.
If you have a fear of needles or other concerns, it is good to discuss this in advance. There may be strategies we can use to help.
How often do I need to have treatment?
How often do I need to have Botox treatment?
For most conditions, Botulinum toxin will need to be given every three months. Like most treatments, it is not always effective for everyone. It is generally well tolerated and safe. Occasionally, there can be side-effects. These are usually annoying but not serious.
For conditions such as cervical dystonia, or hemifacial spasm, a low dose is often used to begin with. This approach is used in case of sensitivity to the drug. Sometimes it can take several treatments to find the optimal dose and injection sites that controls the symptoms.
Other conditions such as chronic migraine, have a standardised protocol for treatment, although some adjustments can be made. If there hasn’t been a response by the end of six months, we usually don’t continue.
Some people are able to stretch out the time between Botox treatments. However, many people find the effect wears off before they are due for their next treatment.
How much does Botulinum toxin cost?
How much does Botulinum toxin cost?
There are three fees that are usually charged for PBS qualifying treatment:
consultation fee (usually associated with an 116 item number), a
procedure fee (this is for the procedure i.e. doing the injections) and a
pharmacy co-payment for the medication itself. This is what you would pay if you were picking up the medication from a pharmacy yourself.
We use an e-pharmacy, EPIC, to deliver Botox to the practice in advance. EPIC will send an invoice to your email address after treatment. Another pharmacy might send it if it is another product. This should usually be for an amount of $31.60 or $7.70. Sometimes these invoices can go to your junk mail. It is worth checking this from time to time. Preferably, add the pharmacy as a safe sender.
There is a Medicare rebate available for the administration of Botulinum toxin for the following neurological conditions and the cost of the Botox drug itself is subsidised by the PBS for these conditions:
- Hemifacial spasm
- Blepharospasm
- Cervical dystonia
- Spasticity
- Chronic migraine
- Axillary hyperhidrosis (a condition characterized by severe abnormal sweating)
For these medical conditions, this means that the cost of the Botulinum toxin drug itself is mainly covered by the PBS. A co-payment is payable just like any normal prescription you would have dispensed from a pharmacy. This is $31.60 or $7.70 if you are concession card holder. If you spend above a particular threshold on medications, this will reduce.
Non-PBS Indications
We can use Botulinum toxin for other conditions that do not currently have a PBS item number. In this case Botulinum toxin is used on a private prescription. The most common condition is bruxism (grinding/clenching the jaw muscles). In this case, we can provide an estimated out-of-pocket cost, which is based on the estimated dose given, and which Botulinum toxin product is injected (Botox, Dysport, or Xeomin).
We will provide details of costs before any treatment is given. Sometimes this will be an approximate range as the exact dose may not be known before a consultation.
Migraine and Hyperhidrosis
For chronic migraine patients, there must be 12 weeks or 84 days between treatments to be eligible for a Medicare rebate. There are other eligibility criteria for people with chronic migraine to be able to access treatment. As a result, it is unusual for Botox to be injected on a first consultation, unless continuing established treatment from another provider.
Axillary hyperhidrosis treatment must occur not earlier than every 16 weeks (4 months), otherwise it is not eligible for a medicare rebate.