JLChulilla Expert in Clinical Neurophysiology

Specialist in
Clinical Neurophysiology

Dr. José Luís Chulilla Campanales

Sleep drive
Video-Electroencephalography
Electromyography
Evoked potentials

Clinical Neurophysiology is defined as a medical specialty that, fundamentally in basic neuroscience knowledge, has the objective of the functional exploration of the Central and Peripheral Nervous System, using highly specialized technology for diagnostic, prognostic and therapeutic orientation purposes.

Contact

Complete the application form
Cami del Reis 308, Bloque A, planta 3
07011 – Palma de Mallorca
Telephone: 971 905 202
Beltway, Exit 5B towards Valldemosa – Building next to MAPFRE.

Sleep is just as important as eating and drinking.

Sleep-wake rhythm keeps us mentally fit in the long run

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Dr. Jose Luis Chulilla haciendo un estudio a un paciente

“20 years of experience in Clinical Neurophysiology in Palma de Mallorca.”
This experience has allowed us to promote our medical departments in Palma with the aim of providing the best possible quality of care. The our consultations are technically and professionally organized to attend the most relevant neurophysiology clinical cases, with excellent patient care and treatment.

SLEEP UNIT

International Classification of Sleep Disorders
(Classification of Sleep Disorders or ICSD)

DYSOMNIAS
1. Intrinsic sleep disorders:

1. Psychophysiological insomnia
2. Idiopathic insomnia
3. Narcolepsy
4. Recurrent or idiopathic hypersomnia
5. Post-traumatic hypersomnia
6. Sleep apnea syndrome
7. Disorder of periodic movements of the legs
8. Restless legs syndrome

2. Extrinsic sleep disorders:

1. Inadequate sleep hygiene
2. Environmental sleep disorder
3. Altitude insomnia
4. Sleep disorder due to lack of adaptation
5. Association disorder in the establishment of sleep
6. Food allergy insomnia
7. Syndrome of nocturnal ingestion of food or drink
8. Sleep disorders secondary to the ingestion of alcohol, drugs or drugs

3. Circadian sleep rhythm disorders:

1. Rapid time zone change syndrome (transoceanic syndrome)
2. Sleep disorder in the night worker
3. Delayed sleep phase syndrome
4. Sleep phase advance syndrome
5. Sleep-wake cycle disorder other than 24 hours

PARASOMNIAS
1. Awakening disorders:

1. Confusional awakening
2. Sleepwalking
3. Night terrors

2. Sleep-wake transition disorders:

1. Rhythmic movement disorders
2. Speech disorders at night
3. Night cramps in the legs

3. Parasomnias commonly associated with REM sleep:

1. Nightmares
2. Sleep paralysis
3. Erections related to sleep disorders
4. Painful erections related to sleep
5. Cardiac arrhythmias related to REM sleep
6. REM sleep behavior disorders

4. Other parasomnias:

1. Night bruxism
2. Nocturnal enuresis
3. Paroxysmal nocturnal dystonia

SLEEP DISORDERS ASSOCIATED WITH MEDICAL OR PSYCHIATRIC PROCESSES
1. Associated with mental disorders:

1. Depression

2. Associated with neurological disorders:

1. Degenerative brain disorders
2. Parkinson’s disease
3. Deadly familial insomnia
4. Sleep-related epilepsy
5. Sleep-related headaches

3. Associated with other medical processes:

1. Sleeping sickness, African Trypanosomiasis
2. Nocturnal cardiac ischemia
3. Chronic obstructive lung disease
4. Sleep-related asthma
5. Sleep-related gastroesophageal reflux
6. Peptic ulcer disease
7. Fibrositis syndrome

We will carry out daytime polysomnographic studies and nighttime polysomnography (PSG) for the diagnostic study of:
Epilepsy.
Different sleep disorders, for example:
Dysomnias: intrinsic sleep disorders (insomnia and hypersomnia), extrinsic sleep disorders, and circadian rhythm disorders.
Parasomins: awakening disorders, sleep-wake transition disorders and parasomnia associated with REM sleep.
Sleep disorders associated with medical or psychiatric disorders.
In our sleep unit we will carry out diagnostic PSG studies for Obstructive Sleep Apnea-Hypopnea Syndrome (SAHS) and treatment, therapeutic trial with CPAP respirator.

ELECTROMYOGRAPHIC STUDIES, EVOCATED POTENTIALS AND ELECTRORRETINOGRAM

It is a diagnostic examination that is used to evaluate the correct functioning and electrical activity of the muscles and the motor neurons that control them.

Conventional electromyography (EMG), electroneurography (ENG) and reflex studies (F / H) studies: diagnostic studies of diseases of the central and peripheral nervous system: degenerative diseases of the 2nd motor neuron, peripheral neuropathies (CTS), polyneuropathies (PNP), radiculopathies cervical and lumbo-sacral, B and LS brachial plexopathies, myopathic processes, etc.

Electromyography (EMG): Conventional / insertion EMG, EMG is a diagnostic examination that is used to evaluate the correct functioning and electrical activity of the muscles and the motor neurons that control it.
Electroneurography or nerve conduction study (ENG): it is a study of the conduction of nerve fibers (motor, sensory and mixed), with which the integrity and function of the peripheral nerves of the body is evaluated.

Special EMG studies such as repetitive nerve stimulation (ER) and single fiber (JITTER / SFEMG), for the diagnosis of neuromuscular transmission disorders (Myasthenia Gravis).

EMG-S tremor records used in the differential diagnosis of parkinsonian tremor vs essential tremor vs action tremor.

EMG studies of the sympathetic nervous system, cutaneous sympathetic response SSR for the diagnosis of diseases such as diabetic PNP polyneuropathies.

Quantitative EMG studies (EMG-Q / MULTI-MUP) and turns-amplitude for the diagnosis of myopathic processes.

Blink-Reflex (BR) blink reflex for the electrophysiological study of the trigeminal-facial pathway, the diagnostic study of peripheral facial neuropathies.

It is a study of nerve fiber conduction (motor, sensory and mixed), evaluating the integrity and function of the body’s peripheral nerves.

Auditory Brainstem Evoked Potentials (PEATC):
Used for objective assessment of hearing ability. They are brain responses to auditory stimulation, they allow to study the auditory pathway along the brain stem. The main clinical indications for PEATC are: assessment of the integrity of the retro-cochlear auditory pathway and serve as an objective method of assessing hearing loss.

Visual Evoked Potentials (PEV):
They inform about the optic pathways and are especially useful in evaluating the optic nerve.
PEV-Pattern: used to assess the conduction of the visual pathway from the optic nerve to the occipital cerebral cortex, with the alternating pattern-checkerboard technique, the potentials are usually obtained by stimulation with a monitor where a formed chessboard is presented by black and white squares. They are the evoked potential with greater sensitivity in multiple sclerosis, they also have important utility in ischemic optic neuropathy and other optic nerve injuries. PEV-Flash: they are evoked by stimulation, flashes of a flash, evaluating the persistence, not of the visual pathway.

Somatosensory Evoked Potentials (PESS):
Used to assess somatosensory conduction through the posterior spinal cords.
Stimulation of a mixed nerve trunk, median or posterior tibial nerve is used. They are used to assess the conduction of thick sensory fibers in peripheral nerve lesions, in segments that cannot be explored using conventional EMG techniques: Guillain-Barré syndrome, PNP polyneuropathies, multineuropathies and mononeuropathies, distal axonopathies, brachial plexopathies, radiculopathies and melopathies due to spondyloarthrosis, focal thalamic and brain stem lesions, myclonia, multiple sclerosis, and other demyelinating diseases.

F-ERG with flash: they assess the electrophysiological function of the photo-receptors and the outer layers of the retina, especially the peripheral retina. It is of great interest in retinitis pigmentosa and other retinopathies.
ERG-P with pattern-pattern: informs the state of retinal ganglion cells and can identify macular alterations that simulate optic neuropathies.

Guided EMG recordings for treatment with botulinum toxin, Botox, in dystonia and spasticity of the extremities and prevention of excessive sweating to alleviate autonomic disorders.

Tremor EMG records used in the differential diagnosis of parkinsonian tremor vs essential tremor vs action tremor.

JITTER / SFEMG single fiber EMG for DG of pre and post-synaptic disorders of neuromuscular transmission, eg Myasthenia Gravis and Eaton Lambert SDR.

Quantitative EMG-EMG-Q / MULTI-MUP and turns-amplitude studies for the diagnosis of myopathic processes.

Blink-Reflex BR blink reflex for electrophysiological study of the trigeminal-facial pathway, diagnostic study of peripheral facial neuropathies.

EMG studies of the sympathetic nervous system, cutaneous sympathetic response SSR for the diagnosis of diseases such as diabetic PNP polyneuropathies.

RSC sympathetic-cutaneous response, somato-sympathetic reflex for DG study of peripheral fine fiber neuropathies (diabetic and uremic).

For the study of parasympathetic cholinergic fibers, cardiovagal responses, assesses heart rate variation with deep breathing, postural changes and the Valsalva maneuver (QRS dipole). Applications: diabetes DM central autonomic pictures, Shy Drager syndrome

VIDEO ELECTRO ENPHALOGRAPHY V-EEG

The electroencephalogram EEG is the graphic image of the recording of electrical activity in the brain over time.
The main indication for V-EE is Epilepsy, a diagnostic study of the irritative brain bioelectric activity, critical and inter-critical, ruling out slow and expressive EEG foci of initiation, assessing in turn the possible electro-clinical correlation, also in pre-surgical evaluation of epilepsy. It is useful to know possible lesions such as the distribution and nature of epileptiform graph elements, being essential for the diagnosis, classification and prognosis of epilepsies.
Baseline V-EEG recordings are performed while awake and with partial sleep deprivation (to obtain better performance) in adult, neonatal and infant patients.
Waking basal V-EEG video.
V-EEG video with partial sleep deprivation.

The prolonged Video-EEG / LTM monitoring of wakefulness and sleep is a diagnostic examination of Clinical Neurophysiology that consists of the simultaneous recording of the patient’s symptoms (video) and the activity of electroencephalography (EEG) during a variable period of time. It allows to document clinical episodes, for example epileptic seizures, and to analyze the V-EEG recording of wakefulness and critical and intercritical NREM / REM sleep.
The indications for V-EEG / LTM monitoring in EPILEPSY are:
Differential diagnosis between epileptic and non-epileptic seizures.
Detection, characterization and quantification of the type of seizure and type of epilepsy.
Assessment of triggers.
Determination of the circadian pattern of the seizure, and the influence of drugs on
changes in the pattern of seizures and behavior.
Document epileptiform patterns and assessment during NREM / REM sleep
of the disruption of sleep architecture in cognitive epilepsies (pediatrics). Pre-surgical evaluation of candidates for epilepsy surgery.

Consultations and Facilities

Our medical centers are located at C / Bisbe Campins 4 and Cami dels Reis 308, Palma.
In them we have equipment in accordance with European regulations, I use in reference hospitals, with renewed and updated programs

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Interdisciplinary collaboration

We work in a close interdisciplinary relationship with the Neurology department of Dr. Nobbe, at the Palmaclinic center in Palma, for the medical evaluation and correct study of neurological patients.

We also carry out interdisciplinary collaboration with other medical specialties such as Traumatology, Neurosurgery, Rheumatology, Internal Medicine, Psychiatry, etc. For more information you can fill out the contact form.