Ellen Grass Memorial Lecture: Clinical Neurophysiology in the Treatment of Disease

ABSTRACT

Clinical neurophysiology has a long-standing history and value in the diagnosis of neurologic diseases. Because of their unique ability to assess physiology and function of the nervous system, electroencephalography (EEG), evoked potentials, electromyography (EMG), and polysomnography have long been used in the diagnostic evaluation of epilepsies, demyelinating disorders, neuromuscular disorders, sleep disorders, and other diseases affecting the central and peripheral nervous systems. The role of these tests and clinical neurophysiology in general has usually ended upon diagnosis. New applications of these trusted techniques are changing old perceptions. Continuous EEG monitoring has found new value in not only diagnosis but also in treatment of nonconvulsive seizures and status epilepticus. Visual evoked potentials have been shown to be a biomarker for assessment of demyelination and remyelination associated with treatment of multiple sclerosis. Various EMG techniques can be used to independently assess improvement or otherwise of many neuromuscular diseases. The use of these techniques in the treatment of various neurologic disorders is the next frontier for clinical neurophysiology.

KEY WORDS:

• Clinical neurophysiology
• continuous EEG monitoring (cEEG)
• electromyography (EMG)
• neuromuscular disorders
• visual evoked potentials (VEP)

ACKNOWLEDGMENTS

I would like to acknowledge the remarkable Neurodiagnostic Laboratories at Duke University Medical Center. Managers Emily Kale (Evoked Potentials and Neurophysiologic Intraoperative Monitoring), Zachary Canter (EEG and Epilepsy), and Emily Randolph (Sleep) and their staff provide exceptional care to patients every day and are vital colleagues. It is because of their dedication that studies like the ones discussed can be done and patient care advanced.

Disclosure: Dr. Husain reports the following: UCB Pharmaceuticals: research, consultation; Jazz Pharmaceuticals: consultation; Biogen Idec: consultation, research; Sage Therapeutics: consultation, research; Eisai Pharmaceuticals: consultation; Marinus Pharmaceuticals: consultation, research; Springer Publishers: royalties; Demos Medical Publishing: royalties; and Wolters Kluwer: editorship, royalties.