Clinical neurophysiology deals with researching and diagnosing nervous system disorders, including a range of conditions that affect the functioning of muscles (neuromuscular disease). Clinical neurophysiologists investigate the functioning of the brain, spinal cord, and limb muscles and nerves using computer, electronic, and magnetic techniques. They make diagnoses for conditions like epilepsy, Parkinson's disease, and motor neuron disease (MND).
They frequently collaborate closely with the department's technical staff, neurologists, and neurosurgeons. Most days are spent conducting clinics to electronically diagnose and monitor a variety of conditions. Clinical neurophysiologists may receive patient referrals from neurologists and neurosurgeons, but they also see patients in general medicine, pediatrics, and psychiatry. (1)
Definition and Overview
A neurologist's array of tools and tests, which includes clinical neurophysiology, can produce the most rewarding and occasionally unexpected outcomes when they are well coordinated. Clinical neurophysiology is essentially a technology platform that aids in the identification and care of people with neurological conditions. However, more fundamentally, this field is essential for recognizing the neurogenic abnormalities pattern as well as differentiating between myopathic and neuropathic causes of weakness.
Clinical neurophysiology is crucially useful in the diagnosis, localization, and staging of lesions and the progression or remission of neurological conditions. Electromyography (EMG) investigations may detect mild or inaccurate denervation alterations in the presence of neurogenic disorders through clinical evaluation. (2)
Neurologists that specialize in neurophysiology do not do surgeries. However, they engage in a range of approaches, such as:
● Intraoperative monitoring
Evoked potentials from neurosurgery and other nervous system operations are included in this procedure. Evoked potentials will be analyzed by a neurophysiologist to make sure that vital brain and nervous system functions are not harmed during surgery.
● Deep brain stimulation
In conditions like Parkinson's disease, deep brain stimulation aids in the brain's ability to control physical movement.
During an EEG, electrodes, which are tiny metal discs, are attached to various locations on the scalp. The brain's electrical signals will be monitored by these electrodes to look for irregularities.
Electrodes are applied to the skin of the arms, legs, and chest during an EMG test. These electrodes keep track of the electrical activity in the nerves and test how the muscles respond to this activity.
● Evoked potential tests
During this examination, the physician examines the speed at which nerves transmit information to the brain. The scalp will be covered with electrodes, after which the patient can choose to observe a visual pattern on a screen or experience brief electrical shocks in the arms or legs.
The neurological system of the body is tested and recorded throughout the procedures. The tests are designed to record rather than interfere with the body's normal electrical signals. (3,4)
If patients have any of the following symptoms or conditions, the doctor may recommend seeing a neurophysiologist for special tests and procedures:
- Serious headaches, weakness, dizziness, or vertigo
- Numbness, tingling, or trouble moving any part of the body
- Sleeping problems
It may be beneficial to seek help from a neurophysiologist if there are symptoms the doctor believes are due to a brain or nervous system problem, such as problems with memory, speech, decision-making, balance, coordination, or muscle control. A neurophysiologist may also be helpful if there is a brain or nervous system condition or disease that requires constant monitoring and special care, such as Parkinson's disease or multiple sclerosis. (5)
Risk and Side Effects
Appropriately selected patients for clinical neurophysiology procedures have no major risks or side effects, and these procedures are generally effective and safe. However, as with any medical procedure, there are some risks and side effects. The following can be listed as examples:
- Bruising or slight bleeding under the skin
- Device malfunction
- A feeling of pulling in muscles
- Speech or vision problems
- Loss of balance (6,7)
Post-Procedure and Follow-up
Patients are frequently monitored for a short time after a Clinical Neurophysiology procedure to ensure their rapid recovery. It is possible to monitor vital signs like heart rate and blood pressure.
Patients typically return to their regular activities right away after the operation. Procedures in clinical neurophysiology typically don't call for a lot of downtime. Some patients may have short-term discomfort or procedure-related adverse effects. This could include slight bruising, discomfort, or localized pain where the electrodes or needles were inserted. Within a few days, these symptoms normally go away on their own.
After the procedure, the recorded data will be analyzed by a clinical neurophysiologist or other healthcare professional. The outcomes will support the evaluation or diagnosis of the condition under investigation. Additional follow-up sessions or treatments can be suggested based on the results.
To detect or keep track of neurological conditions that might lead to emotional disturbance, clinical neurophysiology procedures are sometimes carried out. In order to deal with the possible effects of receiving a diagnosis or the continuous management of their condition, patients may find it helpful to get emotional support, therapy, or access to support groups.
It is crucial to speak with a medical expert with experience in clinical neurophysiology about the precise risks and probable negative effects related to any surgery. Based on the specific test carried out, the patient's medical background, and other pertinent criteria, they can offer comprehensive information.
It is significant to note that the entire procedure may differ according to the specific procedure, patient-specific features, and the intended use of the test. Patients who want individualized information and assistance about their specific situation, including specific post-procedure instructions or recommendations, should speak with a healthcare practitioner or neurophysiologist.
1- NHS. Clinical neurophysiology. (https://www.healthcareers.nhs.uk/explore-roles/doctors/roles-doctors/medicine/clinical-neurophysiology#)
2- BMJ Journals. Neurology and clinical neurophysiology: an artificial divide. (https://pn.bmj.com/content/21/4/274)
3,5- Healthgrades. Clinical Neurophysiologist: Your Expert in Nervous System Disorders.
4-WebMD. What is a Neurophysiologist? (https://www.webmd.com/a-to-z-guides/what-is-neurophysiologist)
6- Verywell Health. Electromyography (EMG). (https://www.verywellhealth.com/electromyography-7152418#toc-risks-and-contraindications)
7- American Association of Neurological Surgeons. Deep Brain Stimulation. (https://www.aans.org/en/Patients/Neurosurgical-Conditions-and-Treatments/Deep-Brain-Stimulation)