What to Expect at Your First Neurologist Appointment

If you or someone you love has symptoms of a nervous system (neurological) disorder, you may need to see a neurologist. This medical doctor can evaluate symptoms, perform a neurological exam, order diagnostic tests, and develop a treatment plan.

Hundreds of conditions can affect your nervous system, which includes your brain, spinal cord, and nerves. “Migraines, strokes, seizures, and nerve pain (neuropathy) are among the more common conditions we see,” says Rani Sarkis, MD, MSc, a neurologist with the Mass General Brigham Neuroscience Institute who cares for patients at Brigham and Women’s Hospital. Other common neurological disorders include dementia and memory disorders, Parkinson’s disease, and multiple sclerosis.

If you have signs of a neurological disorder, your primary care provider (PCP) may refer you to a neurologist. Here, Dr. Sarkis explains what to expect at your first neurologist appointment.

How can I prepare for my first neurologist appointment?

It’s natural to have concerns if you have neurological symptoms, such as pain, memory loss, or tremors. These actions can ensure you have a helpful, less stressful doctor visit.

• Dress comfortably: Your doctor tests your reflexes, muscle strength, balance, sensations, and more. “We need to be able to observe certain body responses during a physical examination,” says Dr. Sarkis. You may need to change into a medical exam gown. Dr. Sarkis also recommends wearing shoes that easily slip on and off. “We always check for sensation in the feet, which can help diagnose neuropathy.”
• Bring a family member or friend: Having an extra pair of ears can ensure you understand what the doctor says during the appointment. “If a patient is experiencing memory loss or seizures, it’s helpful to hear about the symptoms from someone else who has observed them,” says Dr. Sarkis.
• Gather your medical information: Electronic health records make it easier for your doctor to see your medical information. But it might not have information about appointments outside of the healthcare system. You may need to get imaging results on a disc to bring to the appointment, or ask the imaging center to send the results to your doctor. “Ideally, I like to review all of a patient’s information the day before the appointment,” says Dr. Sarkis. 
• Know your medications and supplements: Bring a list of every prescription and over-the-counter medication and supplement you take, including the dosage. “Sharing supplement information is very important,” says Dr. Sarkis. “Excessive amounts of certain vitamins can cause neurological symptoms, and some supplements interact with medications.”
• Allow enough time: Your first neurology appointment will take about 45 minutes. It may go longer if you’re getting cognitive tests. Most doctor offices recommend arriving at least 15 minutes early to allow enough time to complete important paperwork. 

What questions will my neurologist ask?

Your neurologist asks questions to better understand your symptoms, overall health, and the reason you’re seeking their expertise. Your provider may ask about:

• Family health history, such as whether close relatives have a history of dementia, stroke, seizures, or other neurological issues
• Lifestyle behaviors, including diet and nutrition, physical activity, alcohol and substance use, smoking, stress, and sleep 
• Personal medical history, including other medical conditions you have, previous surgeries or procedures, allergies, and medications and supplements
• Symptoms, including a timeline of when they first occurred, how often and when they occur (time of day), and what makes the symptoms better or worse

What takes place during a neurological exam?

Your neurologist performs a range of tests to see how different parts of your nervous system are working. These tests check for:

• Balance and coordination: Your provider may ask you to walk in a straight line or on your tiptoes, touch a finger to your nose with your eyes shut, or write your name.
• Cranial nerves: Your cranial nerves aid communication between your brain, head, neck, and torso. Your provider may test your vision, eye movements, and hearing. They may ask you to smile or stick out your tongue. 
• Memory and thinking: Your provider may ask you to tell them the date and where you are. Or you may repeat a series of words or draw certain shapes. 
• Movement and strength: To test muscle strength and flexibility, your provider may ask you to resist them as they push lightly against an extended limb.
• Physical health: Your provider checks your blood pressure, heart rate, and asks about your bladder and bowel control. These questions help assess the health of your autonomic nervous system. This system controls body processes like breathing and heart rate that happen without thought.
• Reflexes: Your provider may use a rubber hammer to lightly tap your knee and other tendons to see if they move and respond. This test assesses how well nerve signals travel between your spinal cord and muscles.
• Sensory nerves: This test checks your ability to sense pain, vibrations, temperatures, and other sensations. Your provider may ask you to describe what you feel as they touch different objects to your skin, such as a vibrating tuning fork, toothpick, and cotton ball.

Do I need other neurological tests?

Depending on the exam findings, your provider may order blood tests or additional neurological tests. These may include:

• Electroencephalogram (EEG) to check your brain’s electrical activity
• Imaging tests, such as an x-ray, MRI, CT scan, or ultrasound, to view your brain and spine, or muscles
• Muscle and nerve tests, such as electromyography (EMG) and nerve conduction study (NCS), to assess your muscles and the nerves that control them 
• Sleep study to check for restless legs syndrome and sleep apnea 

What questions should I ask my neurologist?

It’s helpful to bring a list of questions to your first neurology appointment to ensure you don’t forget to ask about something that’s important to you. You may want to ask your neurologist these questions: 

• What is causing this symptom or condition?
• What should I know about the tests you’re ordering?
• Is this condition hereditary?
• How will this condition affect my long-term health?
• Will this condition get better, worse, or stay the same over time?
• What are my treatment options?
• What are the treatment side effects?
• What can I do to lower my risk of more serious problems or complications?
• Should I avoid certain activities?
• When should I call your office or 9-1-1?

What happens after my first neurologist appointment?

Before you leave your doctor’s office, you should receive referrals to specialists like physical therapists or orders for imaging or other tests. 

“Your patient portal will have a summary of your visit and can be a good way to communicate with your care team about nonurgent matters,” says Dr. Sarkis. “My goal is for each patient to leave with a clear understanding of what’s next, whether that’s additional diagnostic tests or a personalized treatment plan.”