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cases, the electrode contacts used for recording

can be subsequently used to perform

micro-thermocoagulation procedures that can

avoid major resection (therapeutically

interventional neurophysiology).

Multimodal evoked potentials (VEP, ERG, BAEP,

SEP, MEP, LEP, AEP, etc.) are employed in the

diagnosis of the causes of sensory and motor

disturbances, for instance in multiple sclerosis,

in coma prognosis and in investigation of

ophthalmic and auditory disease, while

multimodal event-related potentials (ERPs),

being long latency evoked potentials, reflect

cognitive processing and therefore allow the

recording of brain responses during tasks

involving different types of memory, problem

solving, decision making, etc.

Intraoperative monitoring of brain, spinal cord

and nerve function during surgery is improving

the safety of these procedures and, indeed, is

becoming mandatory medico-legally. The

monitoring of ICU patients is becoming more

widespread and standard.

Optimising neurological care during emergency

and intensive care treatment has become a

priority through all age groups. In particular,

neonatal brain monitoring with long-term EEG is

already a standard in most European tertiary level

centres in neonatal intensive care. Brain

monitoring is also a key component of paediatric

and adult intensive cares, as well as an

increasingly used method in the emergency

medicine of neurologically compromised patients.

EEG, together with other measures such as

polysomnography, is the only way to accurately

measure sleep stages and is the backbone of

the diagnostic investigation of sleep disorders.

In addition, electromyography, quantitative

motor unit studies, nerve conduction studies,

and reflexes (spinal, brainstem, transcortical)

are standard extensions of the neurologic

examination to diagnose patients with anterior

Clinical neurophysiology

THE IFCN-EC, CO-ORDINATED BY PROFESSOR WALTER PAULUS, OUTLINES

THE CHAPTER’S POSITION PAPER

C

linical neurophysiology (as defined by the International

Federation of Clinical Neurophysiology) is ‘a medical specialty,

or sub-specialty, concerned with function and dysfunction of the

nervous system, caused by disorders of the brain, spinal cord, peripheral

nerve and muscle, using physiological and imaging techniques to

measure nervous system activity. When interpreted in relation to the

clinical presentation of patients, data from these techniques can either

diagnose or assist in the diagnosis of neurological or psychiatric

conditions and quantify, monitor, and follow progression of such

conditions. Clinical neurophysiology also encompasses physiological

methods for therapy of neurological and psychiatric disorders.’

Research in clinical neurophysiology

Clinical neurophysiology encompasses a broad array of methods to study

the peripheral and central nervous system, and targets virtually all

diseases in neurology and psychiatry. Clinical neurophysiology bridges

basic neuroscience closely with clinical neuroscience. It is a typical

translational part of brain research. Investigation of human brain function

is possible from single cell recordings during epilepsy surgery or deep

brain stimulation to recording activity of large-scale brain networks during

electroencephalography (EEG), magnetoencephalography (MEG),

single-photon emission computed tomography (SPECT), positron

emission tomography (PET) or functional magnetic resonance imaging

(fMRI). These investigations are often combined with psychophysical and

neuropsychological investigations.

Methods

Multichannel recording of brain electrical (EEG) and magnetic activity

(MEG) is a necessary adjunct to the diagnosis of epilepsy and delineation

of its type and frequency, and in the analysis of wake/sleep conditions

and reduced states of consciousness. Refinement with modern source

analysis methods will allow improved precision, in particular in conjunction

with multimodal imaging. The introduction of ambulatory recording of EEG

and video now means that patients can be recorded over days at home,

improving yield and the patient experience. In cognitive neuroscience, EEG

and MEG are the only real-time recording techniques presently available,

are thus often essential for data acquisition and are complementary to

functional imaging (the neurophysiological signals have a time

discrimination thousands of times higher than techniques based on blood

flow/metabolism). Though EEG has been considered a clinical tool, over

the last decade or so it has moved beyond this to also be frequently used

in neuroscience laboratories.

Subdural and intracerebral EEG recordings are techniques that are

currently indispensable in defining surgical targets during the pre-surgical

assessment of pharmaco-resistant epilepsy. In an increasing number of

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THE HUMAN BRAIN