Neurophysiologist

What is a neurophysiologist?

A neurophysiologist is a healthcare provider who has expertise in assessing how your nervous system is functioning, especially its electrical activity. They perform tests and diagnose neurological conditions.

Your nervous system (brain, spinal cord and nerves) is your body’s command center. It controls everything you think, feel and do — from moving your arm to the beating of your heart.

What’s the difference between a neurophysiologist and a neurologist?

A neurophysiologist is a specialist in the field of neurology.

A neurologist is a medical doctor who has training in all aspects of your nervous system, including its general anatomy and function and the conditions that affect it. A neurophysiologist is a neurologist who has specialized knowledge specifically on the function of your nervous system. They perform tests and interpret the results to do so.

A neurophysiologist often doesn’t recommend treatment for neurological conditions, but a neurologist does.

What does a neurophysiologist do?

A neurophysiologist assesses and diagnoses conditions that affect the function of your body’s nervous system. They mainly do this by performing and analyzing a variety of tests that record your nervous system’s electrical activity.

There are two main types of neurophysiologists: surgical neurophysiologists and clinical neurophysiologists. They each have specific roles and responsibilities.

Some neurophysiologists mainly work in research.

Surgical neurophysiologists

A surgical neurophysiologist is part of the surgical team. They work closely with the anesthesiologist or nurse anesthetist, surgeons (like neurosurgeons) and other providers.

During surgery, a neurophysiologist tests and monitors your nervous system. Depending on the type of surgery, this monitoring assists your surgeons in avoiding or reducing complications like paralysis, hearing loss or stroke.

Surgical neurophysiology is also called intraoperative neurophysiology monitoring (IONM).

Some common surgeries that involve a neurophysiologist include:

• Spinal surgery.
• Certain types of brain surgery.
• Certain ear, nose and throat (ENT) procedures.
• Peripheral nerve
• Vascular surgeries, like carotid endarterectomies and thoracic-abdominal aortic aneurysms (TAAA).

Surgical neurophysiologists use several different testing and monitoring systems during surgery, a few of which include:

• SSEP (somatosensory evoked potentials): This test records the response of your brain, nerves or spinal cord to electrical stimulation of a peripheral nerve. Surgical neurophysiologists commonly use it during spine surgery and in some brain and peripheral nerve surgeries.
• TCeMEP (transcranial electrical motor evoked potentials): This test records the response of your spinal cord or limb muscles to an electrical stimulus applied to the motor cortex of your brain. Surgical neurophysiologists commonly use it during spine surgery.
• BSEP (brainstem auditory evoked potentials): This test records the response of your brainstem to an auditory stimulus — usually a clicking sound delivered through earphones. Surgical neurophysiologists use it to monitor brainstem function and to help preserve hearing in acoustic neuroma and brainstem tumor surgeries.
• EEG (electroencephalogram): This test records spontaneous brain activity. Surgical neurophysiologists use it to monitor the function and “health” of your cerebral cortex to avoid injuries caused by ischemia (reduced blood flow) during carotid endarterectomies and aneurysm clippings.

Clinical neurophysiologists

Clinical neurophysiologists work closely with neurologists and neurosurgeons. They perform tests to assess the function of your nervous system and diagnose certain neurological and neuromuscular conditions. They may perform these tests in an outpatient setting or as part of your stay in a hospital, depending on your situation.

Tests that clinical neurophysiologists use include:

• EMG (electromyography): This is a diagnostic test that evaluates the health and function of your skeletal muscles and the nerves that control them. It can help diagnose several conditions, including peripheral neuropathy, carpal tunnel syndrome, muscular dystrophy and amyotrophic lateral sclerosis (ALS).
• Nerve conduction study (NCS): This is a diagnostic test that evaluates the function of your peripheral nerves. An NCS can help detect the presence and extent of peripheral nerve damage. Neurophysiologists often perform EMGs and NCSs together.
• Electroencephalogram (EEG): This test involves sticking electrodes on the surface of your scalp to record electrical activity from your cerebral cortex. Clinical neurophysiologists use it to evaluate seizures and various abnormalities of the central nervous system.
• Evoked potential test: Evoked potential tests measure the electrical activity in areas of your brain and spinal cord in response to certain stimuli. They record how quickly and completely nerve signals reach your brain. There are several kinds, including brainstem auditory evoked response (BAER), visual evoked potential (VEP) and somatosensory evoked potential (SEP).
• Sleep study (polysomnography): This is a diagnostic test that tracks and records how multiple body systems work while you’re asleep. Clinical neurophysiologists use it to diagnose sleep disorders.

Does a neurophysiologist go to medical school?

Yes, a neurophysiologist is a medical doctor. They go to medical school.

How do you become a neurophysiologist?

To become a clinical neurophysiologist, a person must complete:

• Four years of premedical education at a college or university, resulting in a bachelor’s degree.
• Four years of medical school, resulting in a Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO) degree.
• One year of internship in general internal medicine.
• Up to four years of residency (depending on the program) in a neurology program.

Some people choose to do a fellowship program after residency to subspecialize in a specific area of neurophysiology. Fellowships can focus on epilepsy, neuromuscular diseases, sleep disorders and more.

A note from Cleveland Clinic

A neurophysiologist may be a part of your healthcare team if your healthcare provider suspects you have a neurological condition, or you’ve been diagnosed with one. They’re experts in their field and have up-to-date knowledge on tests that can assess your nervous system’s function. Don’t hesitate to ask your neurophysiologist questions. They’re available to help you.