Consultant physicians working with patients - Royal College of ...

2 Specialties Clinical neurophysiologyClinical neurophysiologyDr Robin Kennett Consultant clinical neurophysiologistDr Rosalind Kandler Consultant clinical neurophysiologist1 Description of the specialtyClinical neurophysiology uses measurement of electricalactivity from the central and peripheral nervous systemto help in the diagnosis and management of a widerange of neurological conditions in all age groups. Mostconsultants work within neuroscience centres, althoughsome services are delivered in district general hospitals(DGHs), and all departments are supported byhealthcare scientists (HCS). The core investigations areelectroencephalography (EEG) and nerve conductionstudies (NCS) with electromyography (EMG), whichare mostly performed on outpatients and constitute thelargest part of clinical neurophysiology workload. EEGis used to investigate children and adults with epilepsy,the most common serious neurological condition, 1 andnerve conduction is required for the management ofperipheral nerve disorders such as entrapmentneuropathy (carpal tunnel syndrome, ulnar neuropathy,etc) and generalised peripheral neuropathy (eg diabeticneuropathy). Clinical neurophysiology is used toinvestigate a wide range of less common neurologicaldiseases, and most departments also perform long-termEEG monitoring to record episodic disorders(ambulatory EEG and video-telemetry), evokedpotentials for multiple sclerosis, and EMG forradiculopathy, muscle disease, myasthenia gravis andmotor neuron disease. Some departments offer highlyspecialised investigations that may not be available in allneuroscience centres, including EEG monitoring onintensive therapy unit (ITU) for coma, intracranial EEGandevokedpotentialrecordingduringneurosurgeryforepilepsy, brain tumours, Parkinson’s disease and spinalsurgery, polysomnography to investigate sleepdisorders, and evoked potentials for retinal disease andhearing loss.The scope of clinical neurophysiology brings it intocontact with many other specialties including neurologyand neurosurgery, paediatrics, rheumatology andorthopaedics, plastic surgery, ophthalmology, generalmedicine and general practice.2 Organisation of the service and patternsof referralNeurophysiology testing requires specialised recordingapparatus, an appropriate environment and trainedmedical and scientifc personnel. Consequently, servicesare hospital based and usually only available inneuroscience centres or larger DGHs. Smaller DGHsmay provide outpatient EEG and nerve conductionstudies, but patients needing more specialisedinvestigation or inpatient studies will be treated intertiary centres, on a hub-and-spoke model. DGHswithout clinical neurophysiology services are at adisadvantage for managing patients with acuteneurological conditions and further plans to strengthenneurology support to these hospitals 2 should includeprovision for neurophysiology. Sources of referral areusually from secondary or tertiary care but somedepartments allow limited direct access from primarycare.3 Working with patientsPatients referred for a neurophysiological opinion willusually be under the care of hospital consultants whowill explain the need for investigation. The results aresent to the referring physicians, but because of thecomplexity and technical nature of neurophysiologyreports, it is unusual for a copy being sent directly to thepatient. Where appropriate, the results may be discussedwith the patient by a consultant clinicalneurophysiologist: HCSs are not usually in a position toprovide a tailored clinical opinion or discuss furtherC○ Royal College of Physicians 2013 67