Введение
Медицинская специальность
the journals
Clinical neurophysiology is a medical 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, spinal cord, 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 or psychiatry, for example the United States and Germany. In other countries it is an autonomous specialty, such as Spain, Portugal, Italy, the United Kingdom, Finland, Sweden and Norway. 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 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 that allows the interactive exploration of these neurophysiological methods and of symptoms to which they are related can be found here. Electroencephalography: Diagnostic test of thalamocortical rhythms (brain waves), useful in evaluating seizures and various abnormalities of the central nervous system. This is done by hooking up electrodes on the surface of the scalp to record currents from the cerebral cortex. 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: A type of sleep study employed to diagnose disorders associated with abnormal sleep behavior
Intraoperative monitoring, Intraoperative neurophysiologic monitoring:
Клиническая нейрофизиология – это медицинская специальность, изучающая центральную и периферическую нервные системы посредством регистрации биоэлектрической активности, как спонтанной, так и вызванной стимуляцией. Она включает в себя как исследования патофизиологии, так и клинические методы, используемые для диагностики заболеваний, поражающих центральную и периферическую нервные системы. Исследования в области клинической нейрофизиологии не ограничиваются лабораторными тестами и рассматриваются как расширение неврологической консультации. Проводимые тесты направлены на измерение электрической функции мозга, спинного мозга, нервов конечностей и мышц. Они позволяют точно определить локализацию, тип и степень поражения, а также выявить имеющиеся аномалии. Благодаря этим возможностям, клиническая нейрофизиология в основном используется для диагностики заболеваний, а не для их лечения. В некоторых странах, таких как США и Германия, она является частью неврологии или психиатрии. В других странах, например, в Испании, Португалии, Италии, Великобритании, Финляндии, Швеции и Норвегии, это самостоятельная специальность. Больницы, в которых работают неврологи и нейрохирурги, как правило, располагают отделениями клинической нейрофизиологии. Обычно это крупные больницы, способные нанять более специализированный персонал. В больницах, оснащенных клинической нейрофизиологической аппаратурой, основными методами диагностики являются:
the journals
Clinical neurophysiology is a medical 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, spinal cord, 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 or psychiatry, for example the United States and Germany. In other countries it is an autonomous specialty, such as Spain, Portugal, Italy, the United Kingdom, Finland, Sweden and Norway. 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 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 that allows the interactive exploration of these neurophysiological methods and of symptoms to which they are related can be found here. Electroencephalography: Diagnostic test of thalamocortical rhythms (brain waves), useful in evaluating seizures and various abnormalities of the central nervous system. This is done by hooking up electrodes on the surface of the scalp to record currents from the cerebral cortex. 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: A type of sleep study employed to diagnose disorders associated with abnormal sleep behavior
Intraoperative monitoring, Intraoperative neurophysiologic monitoring:
Электромиография и исследование нервной проводимости: Эти диагностические тесты периферической нервной системы особенно полезны для оценки заболеваний мышц, нервов и нервных корешков. В основе этих тестов лежит регистрация электрической активности мышц и скорости прохождения электрического сигнала по нервам конечностей. Заболевания нервов и мышц могут быть острыми (быстро развивающимися) или иметь медленное течение. Онлайн-инструмент для интерактивного изучения этих нейрофизиологических методов и связанных с ними симптомов можно найти здесь.
the journals
Clinical neurophysiology is a medical 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, spinal cord, 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 or psychiatry, for example the United States and Germany. In other countries it is an autonomous specialty, such as Spain, Portugal, Italy, the United Kingdom, Finland, Sweden and Norway. 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 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 that allows the interactive exploration of these neurophysiological methods and of symptoms to which they are related can be found here. Electroencephalography: Diagnostic test of thalamocortical rhythms (brain waves), useful in evaluating seizures and various abnormalities of the central nervous system. This is done by hooking up electrodes on the surface of the scalp to record currents from the cerebral cortex. 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: A type of sleep study employed to diagnose disorders associated with abnormal sleep behavior
Intraoperative monitoring, Intraoperative neurophysiologic monitoring:
Электроэнцефалография: Диагностический тест таламокортикальных ритмов (мозговых волн), полезный для оценки судорог и различных аномалий центральной нервной системы. Он проводится путем подключения электродов к поверхности кожи головы для регистрации токов коры головного мозга.
the journals
Clinical neurophysiology is a medical 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, spinal cord, 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 or psychiatry, for example the United States and Germany. In other countries it is an autonomous specialty, such as Spain, Portugal, Italy, the United Kingdom, Finland, Sweden and Norway. 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 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 that allows the interactive exploration of these neurophysiological methods and of symptoms to which they are related can be found here. Electroencephalography: Diagnostic test of thalamocortical rhythms (brain waves), useful in evaluating seizures and various abnormalities of the central nervous system. This is done by hooking up electrodes on the surface of the scalp to record currents from the cerebral cortex. 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: A type of sleep study employed to diagnose disorders associated with abnormal sleep behavior
Intraoperative monitoring, Intraoperative neurophysiologic monitoring:
Вызванные потенциалы: Диагностический тест, оценивающий специфические проводящие пути центральной и периферической нервной системы. Может включать зрительные, слуховые или соматосенсорные вызванные потенциалы. Они регистрируют электрические реакции мозга и спинного мозга на стимуляцию органов чувств.
the journals
Clinical neurophysiology is a medical 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, spinal cord, 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 or psychiatry, for example the United States and Germany. In other countries it is an autonomous specialty, such as Spain, Portugal, Italy, the United Kingdom, Finland, Sweden and Norway. 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 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 that allows the interactive exploration of these neurophysiological methods and of symptoms to which they are related can be found here. Electroencephalography: Diagnostic test of thalamocortical rhythms (brain waves), useful in evaluating seizures and various abnormalities of the central nervous system. This is done by hooking up electrodes on the surface of the scalp to record currents from the cerebral cortex. 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: A type of sleep study employed to diagnose disorders associated with abnormal sleep behavior
Intraoperative monitoring, Intraoperative neurophysiologic monitoring:
Полисомнография: Исследование сна, используемое для диагностики расстройств, связанных с аномальным поведением во сне.
the journals
Clinical neurophysiology is a medical 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, spinal cord, 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 or psychiatry, for example the United States and Germany. In other countries it is an autonomous specialty, such as Spain, Portugal, Italy, the United Kingdom, Finland, Sweden and Norway. 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 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 that allows the interactive exploration of these neurophysiological methods and of symptoms to which they are related can be found here. Electroencephalography: Diagnostic test of thalamocortical rhythms (brain waves), useful in evaluating seizures and various abnormalities of the central nervous system. This is done by hooking up electrodes on the surface of the scalp to record currents from the cerebral cortex. 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: A type of sleep study employed to diagnose disorders associated with abnormal sleep behavior
Intraoperative monitoring, Intraoperative neurophysiologic monitoring:
Внутриоперационный мониторинг, Нейрофизиологический внутриоперационный мониторинг:
the journals
Clinical neurophysiology is a medical 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, spinal cord, 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 or psychiatry, for example the United States and Germany. In other countries it is an autonomous specialty, such as Spain, Portugal, Italy, the United Kingdom, Finland, Sweden and Norway. 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 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 that allows the interactive exploration of these neurophysiological methods and of symptoms to which they are related can be found here. Electroencephalography: Diagnostic test of thalamocortical rhythms (brain waves), useful in evaluating seizures and various abnormalities of the central nervous system. This is done by hooking up electrodes on the surface of the scalp to record currents from the cerebral cortex. 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: A type of sleep study employed to diagnose disorders associated with abnormal sleep behavior
Intraoperative monitoring, Intraoperative neurophysiologic monitoring:
В Соединенных Штатах
Путь к становлению клиническим нейрофизиологом в США включает получение степени бакалавра, окончание медицинского института и последипломное медицинское образование, как правило, по специальности неврология. После завершения аккредитованной программы резидентуры врачи могут выбрать прохождение интернатуры (fellowship) по клинической нейрофизиологии. Программы могут знакомить интернов с широким спектром электродиагностических нейрофизиологических исследований или фокусироваться на конкретной области, такой как ЭЭГ или электродиагностическая медицина. Интертуры по клинической нейрофизиологии обычно длятся 1–2 года и могут привести к получению сертификата специалиста в одной или нескольких подспециальностях.
В Соединенном Королевстве
В Великобритании нейрофизиологические исследования обычно проводят два типа специалистов в области здравоохранения. Это медицинские работники, прошедшие обучение в клинической нейрофизиологии, и клинические физиологи, которые получают высшее образование и одновременно проходят четырехлетнюю практическую подготовку. Физиологи выполняют большинство электроэнцефалограмм (ЭЭГ), вызванных потенциалов и часть исследований нервной проводимости. Клинические заключения по результатам этих исследований составляют либо физиологи, либо врачи. Их профессиональные организации – Британское общество клинической нейрофизиологии и Ассоциация нейрофизиологических ученых.
Связь с электродиагностической медициной
Электродиагностическая медицина является частью клинической нейрофизиологии. Электродиагностическая медицина фокусируется исключительно на периферической нервной системе, а не на центральной. В то время как клинический нейрофизиолог обучен проведению всех видов исследований, включая ЭЭГ, внутриоперационный мониторинг, исследования нервной проводимости, ЭМГ и вызванные потенциалы, врач-электродиагностик в основном специализируется на исследованиях нервной проводимости, игольной ЭМГ и вызванных потенциалах. Американский совет по психиатрии и неврологии проводит сертификационный экзамен по клинической нейрофизиологии. Американский совет по электродиагностической медицине предоставляет сертификацию в области электродиагностики (ЭДХ). Американский совет клинической нейрофизиологии сертифицирует специалистов по электроэнцефалографии (ЭЭГ), вызванным потенциалам (ВП), полисомнографии (ПСГ), мониторингу эпилепсии и неврологическому внутриоперационному мониторингу (НИОМ). В США врачи обычно специализируются либо на ЭЭГ, либо на ЭДХ, но редко сочетают обе специализации.
Нейрофизиологи в больницах
В больницах, где работают неврологи и нейрохирурги, как правило, располагаются отделения клинической нейрофизиологии. Обычно это крупные больницы, способные нанять более специализированный персонал. Клинические нейрофизиологи отвечают за анализ и написание отчетов по результатам исследований, проводимых в отделении. Им также необходимо интерпретировать полученные данные и передавать эту информацию врачу, направившему пациента к данному нейрофизиологу. Многие исследования включают проведение ЭМГ для регистрации вызванных потенциалов. Исследование нервной проводимости также проводится очень часто.