Guide to Specialties - Neurophysiology

Background to the Specialty

Clinical Neurophysiology is a subspecialty of clinical neurology concerned with the diagnosis, monitoring and management of disease of the central and peripheral nervous systems (including muscle). In most cases clinical history and examination is extended by the use of electrical, magnetic and computing tools which emphasise the function of the excitable tissues as well as their location in pathways. There are four subsets of the specialty.

• Electreoencephalography and Magnetoencephalography are concerned with the recording of the electrical and magnetic activity of the brain. This has particular reference to the diagnosis and management of epilepsy, metabolic and infective brain disease. These may be combined with behavioural video recordings and for example may be used in presurgical assessment for the treatment of refractory seizures. 
• Evoked potentials document the electrical activity of peripheral and central nervous structures in response to an applied sensory stimulus which may be visual, auditory, tactile, electrical or cognitive. These are particularly applied in the diagnosis of multiple sclerosis, tumours of the cranial nerves and spinal disease but also have research applications in psychology. 
• Nerve conduction studies and electromyography study the function of cranial and peripheral nerves, spinal cord and muscle. This has relevance in the management of peripheral nerve trauma and entrapment, spinal nerve root injury and the full range of congenital and applied neuromuscular disease.
• Intraoperative monitoring is a growing area of the specialty where neurophysiological techniques can be used to monitor tissues undergoing manipulation during surgery. The main areas here are in treatment of brain tumours and spinal surgery.

Specialty Attractions

• Clinical Neurophysiology is an expanding specialty with currently a significant number of unfilled posts. Thus a Specialist Registrar completing the four year requirement for their CCST should have no difficulty progressing to a consultant post. 
• It is a specialty which combines true clinical expertise and patient contact with technical, analytical and manipulative skills. It serves many disciplines such as Neurology, Neurosurgery, Paediatrics, Orthopaedics and other medical and surgical specialties with specialist advice and particular interests can usually be developed with, for example, combined clinics in epilepsy or neuromuscular disease. 
• Departments of Clinical Neurophysiology are often within Regional Neuroscience centres with opportunities and facilities for collaborative research. 
• The provision of objective data in support of clinical opinion makes this specialty a frequent provider of medicolegal opinion.

Entry Qualifications

Entry to the specialty is normally at the Specialist Registrar grade, at which time candidates will have achieved the MRCP and completed their General Professional Training in Medicine. Prior experience in one or more of Neurology, Neurosurgery, Paediatrics, Psychiatry or Psychology is desirable. Previous research in basic or applied Neurosceinces is also a useful grounding for a career. It is usually not expected that a candidate for an SpR post would have had substantial prior training in Neurophysiological techniques.

Personal Qualities

• A patient-centred interest in clinical diagnosis and skills coupled with aptitude for technical and computing disciplines. 
• An interest in communicating their investigative conclusions to others - who will not understand the technical nature of the investigations. 
• An ability to work closely with a team of technical and medical colleagues. 
• An ability to be part of the wider team in contact with a patient where the end point of a consultation may not have a therapeutic element.

Duration of Training

4 years for single certification in Clinical Neurophysiology.

Since 2000, the option of dual certification in Neurology and Clinical Neurophysiology was reduced from 7 years to 6 years and 6 months.

Useful Links

For further information on the curriculum and training requirements Joint Committee on Higher Medical Training (JCHMT)

Links to Deaneries for local information and advice: Wessex Deanery