Table 2

Managing investigations for neurology patients

InvestigationsImpact/suggestion for neurology service
Testing of respiratory functionAs of 7 July 2020, The Thoracic Society of Australia and New Zealand and Australian and New Zealand Society of Respiratory Sciences suggest all pulmonary function testing can be performed in patients who are afebrile, have no symptoms of a viral illness and staff can perform it with appropriate personal protective equipment. There is a concern that spirometry creates the potential for droplet formation and aerolisation.26
Nerve Conduction Studies and EMGConsider limiting testing to those patients in whom the test will make a considerable and immediate impact on management, for example, in cases where there is clinical suspicion of acute inflammatory neuropathies, neuromuscular junction disorders, vasculitis and/or myositis. Typical presentations of GBS or myasthenia may not require routine neurophysiology testing prior to initiating treatment.27
EEG testing
  • Consider changing from cup or disc electrodes to needle electrodes which have their own limitations but can be applied rapidly.

  • Brief, reduced montages that screen for generalised status epilepticus with video recording are recommended by Gelisse et al

  • Hyperventilation is discouraged

  • PPE measures as per institution guidelines24

ImagingThe Royal Australian and New Zealand College of Radiologists has listed advice regarding reintroduction of services as restrictions ease.25 As specialists who request these investigations, we must take in to consideration the risk posed to patients from attending hospital and also the likely reduction in availability of these services.
  • EEG, electroencephalography; EMG, electromyography; GBS, Guillain-Barre syndrome; PPE, personal protective equipment.