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• A world in which neurologists and clinical neurophysiologists work well side by side for the benefit of patients
  Abena D Osei-Lah
  Published on: 26 July 2021

• Published on: 26 July 2021

  A world in which neurologists and clinical neurophysiologists work well side by side for the benefit of patients

  • Abena D Osei-Lah, Consultant Clinical Neurophysiologist University Hospitals Dorset NHS Trust

  I read your article (Neurology and clinical neurophysiology: an artificial divide. Kieran MC. Pract Neurol 2021;21:274-275) with interest.
  Clinical neurophysiology is primarily a diagnostic specialty concerned with recording electrical activity from the nervous system to aid the diagnosis, classification and management of neurological disease (clinical neurophysiology curriculum: www.jrcptb.org.uk/specialties/c;inical-neurophysiology). One of the attractions of the specialty is precisely this: the breadth of the specialty and the interaction with a wide variety of specialties. Although nerve conduction studies (NCS) and electromyography (EMG) form a big part of our work, most clinical neurophysiologists, at least in the UK do a lot more. We record and report electroencephalography (EEG) studies including long term recordings and video EEG telemetry, a variety of evoked potential studies (EPs), electroretinography (ERG) studies and sleep studies, among others. The specialty is about more than NCS and EMG. Even within the area of NCS/ EMG, although a proportion of our referrals are from neurology teams, we frequently see patients referred by orthopaedic, oncology and rheumatology teams.
  I suppose there could be a world in which neurologists perform NCS / EMG as well as EPs, EEGs, sleep studies on all their patients; hand surgeons and shoulder specialists perform NCS /EMG on their patients...

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  I read your article (Neurology and clinical neurophysiology: an artificial divide. Kieran MC. Pract Neurol 2021;21:274-275) with interest.
  Clinical neurophysiology is primarily a diagnostic specialty concerned with recording electrical activity from the nervous system to aid the diagnosis, classification and management of neurological disease (clinical neurophysiology curriculum: www.jrcptb.org.uk/specialties/c;inical-neurophysiology). One of the attractions of the specialty is precisely this: the breadth of the specialty and the interaction with a wide variety of specialties. Although nerve conduction studies (NCS) and electromyography (EMG) form a big part of our work, most clinical neurophysiologists, at least in the UK do a lot more. We record and report electroencephalography (EEG) studies including long term recordings and video EEG telemetry, a variety of evoked potential studies (EPs), electroretinography (ERG) studies and sleep studies, among others. The specialty is about more than NCS and EMG. Even within the area of NCS/ EMG, although a proportion of our referrals are from neurology teams, we frequently see patients referred by orthopaedic, oncology and rheumatology teams.
  I suppose there could be a world in which neurologists perform NCS / EMG as well as EPs, EEGs, sleep studies on all their patients; hand surgeons and shoulder specialists perform NCS /EMG on their patients with entrapment neuropathies and brachial plexopathies; hip surgeons assess electrodiagnostically their patients with leg weakness following hip replacement; ophthalmologists record and report electroretinographies in patients with possible degenerative retinal diseases and paediatricians record and report EEGs in children presenting with episodes likely to be seizures.
  I agree that neurophysiological investigations are extensions of the clinical assessments of patients and the findings should always be interpreted within the clinical context. Clinical neurophysiologists should receive rigorous training, not only in the technical aspects of the specialty but also in the clinical areas (neurology, adult and paediatric epilepsy, ophthalmology, psychiatry etc. as well as in the art of communication with the different referring specialties). The clinical neurophysiologists and the referring clinicians need to work together and communicate clearly about the needs of the patients and the clinical and electrophysiological findings. It is in the patients’ best interests that we work together in functioning multidisciplinary teams.
  I think modern medicine has a place for well-trained neurologists and competent and enthusiastic clinical neurophysiologists (and our clinical physiologist colleagues) to work side by side to deliver a quality service to our patients.

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  Conflict of Interest:
  I am a practising consultant clinical neurophysiologist

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