Clinical neurophysiology is a

medical Medicine is the science and Praxis (process), practice of caring for patients, managing the Medical diagnosis, diagnosis, prognosis, Preventive medicine, prevention, therapy, treatment, Palliative care, palliation of their injury or disease, ...

specialty that studies the central and peripheral nervous systems through the recording of bioelectrical activity, whether spontaneous or stimulated. It encompasses both research regarding the pathophysiology along with clinical methods used to diagnose diseases involving both central and peripheral nervous systems. Examinations in the clinical neurophysiology field are not limited to tests conducted in a laboratory. It is thought of as an extension of a neurologic consultation. Tests that are conducted are concerned with measuring the electrical functions of the

brain The brain is an organ (biology), organ that serves as the center of the nervous system in all vertebrate and most invertebrate animals. It consists of nervous tissue and is typically located in the head (cephalization), usually near organs for ...

spinal cord The spinal cord is a long, thin, tubular structure made up of nervous tissue that extends from the medulla oblongata in the lower brainstem to the lumbar region of the vertebral column (backbone) of vertebrate animals. The center of the spinal c ...

, and nerves in the limbs and muscles. It can give the precise definition of site, the type and degree of the lesion, along with revealing the abnormalities that are in question. Due to these abilities, clinical neurophysiology is used to mainly help diagnose diseases rather than treat them. In some countries it is a part of

neurology Neurology (from , "string, nerve" and the suffix wikt:-logia, -logia, "study of") is the branch of specialty (medicine) , medicine dealing with the diagnosis and treatment of all categories of conditions and disease involving the nervous syst ...

psychiatry Psychiatry is the medical specialty devoted to the diagnosis, treatment, and prevention of deleterious mental disorder, mental conditions. These include matters related to cognition, perceptions, Mood (psychology), mood, emotion, and behavior. ...

, for example the

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and

Germany Germany, officially the Federal Republic of Germany, is a country in Central Europe. It lies between the Baltic Sea and the North Sea to the north and the Alps to the south. Its sixteen States of Germany, constituent states have a total popu ...

. In other countries it is an autonomous specialty, such as

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, the

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Finland Finland, officially the Republic of Finland, is a Nordic country in Northern Europe. It borders Sweden to the northwest, Norway to the north, and Russia to the east, with the Gulf of Bothnia to the west and the Gulf of Finland to the south, ...

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and

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. Hospitals that have neurologists and neurosurgeons tend to house clinical neurophysiology departments. Usually these tend to be larger hospitals that are able to employ more specialized staff units. In hospitals that possess clinical neurophysiology facilities, the major diagnostic modalities employed include: *

Electromyography Electromyography (EMG) is a technique for evaluating and recording the electrical activity produced by skeletal muscles. EMG is performed using an instrument called an electromyograph to produce a record called an electromyogram. An electromyo ...

and nerve conduction studies: These diagnostic tests of the peripheral nervous system are especially useful in evaluating diseases of the muscles, nerves, and nerve roots. The basis of these tests is recording electrical activity of the muscles and the passage of electric signal along the nerves in the limbs. The disorders of nerve and muscle can either be acute (which means they rather come quickly), or have a slow developing nature. An online tool exists that allows for the interactive exploration of these neurophysiological methods and of the symptoms to which they can be related. *

Electroencephalography Electroencephalography (EEG) is a method to record an electrogram of the spontaneous electrical activity of the brain. The biosignal, bio signals detected by EEG have been shown to represent the postsynaptic potentials of pyramidal neurons in ...

: Diagnostic test of thalamocortical rhythms (brain waves), useful in evaluating

seizures A seizure is a sudden, brief disruption of brain activity caused by abnormal, excessive, or synchronous neuronal firing. Depending on the regions of the brain involved, seizures can lead to changes in movement, sensation, behavior, awareness, o ...

and various abnormalities of the

central nervous system The central nervous system (CNS) is the part of the nervous system consisting primarily of the brain, spinal cord and retina. The CNS is so named because the brain integrates the received information and coordinates and influences the activity o ...

. This is done by hooking up electrodes on the surface of the scalp to record currents from the

cerebral cortex The cerebral cortex, also known as the cerebral mantle, is the outer layer of neural tissue of the cerebrum of the brain in humans and other mammals. It is the largest site of Neuron, neural integration in the central nervous system, and plays ...

. * Evoked potentials: Diagnostic test evaluating specific tracts of the central and peripheral nervous system. May include visual, auditory, or somatosensory evoked potentials. These record the electrical responses of the brain and spinal cord to the stimulation of the senses. *

Polysomnography Polysomnography (PSG) is a multi-parameter type of sleep study and a diagnostic tool in sleep medicine. The test result is called a polysomnogram, also abbreviated PSG. The name is derived from Greek and Latin roots: the Greek πολύς ('' ...

: A type of sleep study employed to diagnose disorders associated with abnormal sleep behavior * Intraoperative monitoring, Intraoperative neurophysiologic monitoring:

In the United States

The pathway to becoming a clinical neurophysiologist in the U.S. includes completing an undergraduate degree, medical school, and postgraduate medical education, usually in neurology. Following the completion of an accredited residency program, clinicians may choose to enter a fellowship in Clinical Neurophysiology. Programs may expose their fellows to the broad spectrum of electrodiagnostic neurophysiologic studies, or may focus on a single area such as EEG or electrodiagnostic medicine. Clinical neurophysiology fellowships are generally 1–2 years in duration and may lead to board certification in one or more subspecialty areas.

In the United Kingdom

There are two healthcare professionals who typically perform neurophysiological investigations in the UK. These are medical staff trained in clinical neurophysiology, and clinical physiologists who undertake four years of practical training whilst undertaking an

honours degree Honours degree has various meanings in the context of different degrees and education systems. Most commonly it refers to a variant of the undergraduate bachelor's degree containing a larger volume of material or a higher standard of study, ...

. Physiologists perform the majority of EEGs, evoked potentials and a portion of the nerve conduction studies. They are then clinically reported either by the physiology staff or the medical staff. Their professional organisations are the British Society for Clinical Neurophysiology and the Association of Neurophysiological Scientists

Relationship to electrodiagnostic medicine

Electrodiagnostic medicine is a subset of clinical neurophysiology. Electrodiagnostic medicine focuses only on the

peripheral nervous system The peripheral nervous system (PNS) is one of two components that make up the nervous system of Bilateria, bilateral animals, with the other part being the central nervous system (CNS). The PNS consists of nerves and ganglia, which lie outside t ...

and not the

. Whereas a clinical neurophysiologist is trained to perform all the following studies EEG, intraoperative monitoring, nerve conduction studies, EMG and evoked potentials, and electrodiagnostic physician focuses mainly on nerve conduction studies, needle EMG, and evoked potentials. The American Board of Psychiatry and Neurology provides certification examination in clinical neurophysiology. The American Board of Electrodiagnostic Medicine provides certification in EDX medicines. The American Board of Clinical Neurophysiology certifies in electroencephalography (EEG), Evoked Potentials (EP), Polysomnography (PSG), Epilepsy Monitoring, and Neurologic Intraoperative Monitoring (NIOM).abcn.org In the US physicians typically specialize in EEG or EDX medicine but not both.

Neurophysiologists in hospitals

Hospitals that have neurologists and neurosurgeons tend to house clinical neurophysiology departments. Usually these tend to be larger hospitals that are able to employ more specialized staff units. Clinical neurophysiologists are responsible for analyzing and writing reports on tests that take place within the department. They must also interpret the results that they receive and convey this information to the doctor that referred the patient to the particular neurophysiologist. Many tests involve carrying out an EMG to read the evoked potential recordings. Nerve conduction recordings are extremely common as well.

References

External links

American Academy of Neurology

American Association of Neuromuscular & Electrodiagnostic Medicine

United Neurodiagnostic Professionals of America

Clinical Neurophysiology

from the

American Board of Psychiatry and Neurology The American Board of Psychiatry and Neurology, Inc. (ABPN) is a not-for-profit corporation founded in 1934 following conferences of committees appointed by the American Psychiatric Association, the American Neurological Association, and the t ...

Neuromuscular disease center, Washington University School of Medicine, St. Louis, MO

Cleveland Clinic Online Medical Reference

Tele EMG

EMG The Expert

Neurofisiologia Universidad de Montevideo

* ttps://web.archive.org/web/20021204092340/http://neurofisio.hn.org/index.phtml Perineuro, web de Neurofisiología Clínica
Hospital Universitario Central de Asturias, web del Servicio de Neurofisiología Clínica

Organizations

International Federation of Clinical Neurophysiology

American Academy of Clinical Neurophysiology

British Society for Clinical Neurophysiology

Norwegian Society for Clinical Neurophysiology

Dutch Society for Clinical Neurophysiology

Italian Society for Clinical Neurophysiology

Mexican Society for Clinical Neurophysiology

Sociedad Española de Neurofisiología Clínica

American Academy of Neurology

Czech Society for Clinical Neurophysiology
{{Authority control Neurophysiology