Healthcare Science Neurophysiology 2 and 3 (SPS222)

50 credits

Aim of this module

Electromyography and Nerve Conduction Studies and Evoked Potentials

This module will provide the trainee with detailed knowledge and understanding of electromyography, peripheral nerve conduction studies and evoked potentials, and their use in clinical assessment, diagnosis and management in various disease processes. They will have the ability to plan, prepare, perform and interpret peripheral nerve conduction studies and evoked potentials.

Paediatric EEG

This module will provide the trainee with detailed knowledge, understanding and the ability to perform resting and sleeping electroencephalograms (EEGs) and its use in the clinical assessment, diagnosis and management of children with neurological conditions. They will understand the pathophysiology, clinical presentation and electrocephalographic findings in paediatric epileptic syndromes and other clinical conditions.

EEG in the Intensive Care Setting

This module will provide the trainee with the knowledge, understanding and practical skills to record an electroencephalogram (EEG) in the intensive care setting. The trainee will appreciate the clinical use of the EEG and how it is used in patient management. The trainee will understand sources of errors, effects of sedation and non-pathological effects during EEG monitoring.

Sleep and Long term Monitoring

This module will provide the trainee with the detailed knowledge and understanding of the physiology of sleep and the practical skills required to record sleep parameters during polysomnography and multiple sleep latency recordings, as well as the clinical uses and management. It will also provide detailed understanding of the uses of long-term monitoring techniques, clinical uses and management in epileptic syndromes and sleep disorders.

Important information

The academic parts of this module will be detailed and communicated to you by your university. Please contact them if you have questions regarding this module and its assessments. The module titles in your MSc may not be exactly identical to the work-based modules shown in the e-portfolio. Your modules will be aligned, however, to ensure that your academic and work-based learning are complimentary.

Learning Outcomes

Electromyography and Nerve Conduction Studies and Evoked Potentials

1. Describe the anatomy and physiology of the peripheral nervous system.

2. Discuss and evaluate the types of electrodes, and their characteristics used in electromyography and nerve conduction studies and evoked potentials.

3. Describe the non-pathological sources of error and non-pathological effects on nerve conduction studies.

4. Describe the pathological changes in nerve conduction studies, clinical presentation and nerve conduction and electromyography changes in diseases of the peripheral nerves and skeletal muscle.

5. Describe the potentials associated with electromyography.

6 Critically evaluate the clinical uses of evoked potentials.

7. Describe the types and function of stimulators used in nerve conduction studies and evoked potentials (visual, auditory, somatosensory).

Paediatric EEG

8. Evaluate the design of a paediatric neurophysiology department.

9. Describe the normal resting and sleeping electroencephalogram of a paediatric patient.

10. Describe the pathophysiology, clinical presentation and electrocephalographic findings in paediatric epileptic syndromes.

11 Describe the pathophysiology, clinical presentation and electrocephalographic findings in paediatric conditions of the nervous system, paediatric metabolic manifestations on the central nervous system, and mental retardation syndromes and child psychiatry.

12. Critically appraise and discuss the clinical significance and interpretation of the paediatric electroencephalogram.

EEG in the Intensive Care Setting

13. Describe the anatomy and blood supply of the cerebral cortex and brainstem.

14. Describe the pathophysiology and management of the unconscious patient in the intensive care unit.

15. Critically appraise the techniques for the long-term monitoring of the electroencephalogram in patients on the intensive care unit.

16. Describe the effects that drugs and changes of other physiological variables have on the electroencephalogram.

17. Critically evaluate the clinical uses of the electroencephalogram in the unconscious patient.

Sleep and Long-term Monitoring

18. Describe the physiology of sleep and explain normal and abnormal sleep pattern.

19. Discuss and evaluate methods to assess excessive daytime sleepiness is assessed.

20. Critically evaluate the use of video telemetry and ambulatory recording in epileptic and non-epileptic seizure disorders.

21. Critically evaluate the clinical applications of ambulatory recordings in adult and childhood seizure disorders and disorders of sleep.

Indicative Content

Nerve conduction studies and EMG and evoked potentials

  • The generation of neural, membrane, propagation, resting potentials and refractory periods
    • Saltatory conduction
      • F waves
      • H reflex
    • Compound nerve, muscle and sensory action potentials
  • Anatomy of the peripheral nerves
    • Brachial plexus
    • Median
    • Ulnar
    • Radial
    • Tibial
    • Sural and common peroneal nerve
  •  Recording and stimulus parameters used in the electromyogram and motor/sensory nerve conduction studies
    • Different types of needle electrodes
      • Concentric
      • Monopolar and single fibre
    • Electrode placement for nerve conduction studies (motor and sensory)
      • Median
      • Ulnar
      • Radial
      • Tibial
      • Sural and common peroneal nerve
  • Measure visual acuity; hearing threshold; sensory threshold Different types of electrodes used for recording evoked potentials
    • Surface
    • Gold foil
    • DTL needles
  •   Causes   of   errors   encountered  and  non-pathological    effects  in  the recording of conduction studies and evoked potentials and their elimination
  •   Nerve conduction studies
    • Errors in measurements and reproducibility of results
    • Limitation of motor conduction velocity measurements
    • Effect of age, gender, limb temperature
  •   Pathophysiological changes in nerve conduction studies
    • Axonal degeneration, demyelination, re-innervation
    • Block and slowed conduction
  •   The pathophysiology and clinical presentation and nerve conduction and electromyographic findings in the following conditions
    • Types of neuropathy
    • Axonal
    • Fibre-selective neuropathies
      • Large and small fibre neuropathies
    • Demyelinating diseases
    • Acute onset, hereditary, acquired, mononeuropathies
    • Entrapment neuropathies
      • Carpal tunnel syndrome
      • Ulnar nerve at the elbow
      • Tarsal tunnel
    • Radiculopathies
    • Traumatic nerve lesions
    • Myopathies
      • Inflammatory, endocrine, genetically determined myopathies
      • Plexus and root lesions
      • Neuromuscular junction disorders
      • Motor neurone disorders
  •   Potentials related to electromyography
    • Motor units
    • Insertion activity
    • End-plate noise
    • Fibrillations
    • Fasciculations
    • Positive sharp waves
    • Spontaneous repetitive activity
      • Myotonic discharges
      • Complex repetitive discharges
      • Neuromyotonia
    • Reinnervation
  •   Clinical uses of evoked potentials
  • Visual
  • Flash
    • Non-organic visual loss; cortical blindness
    • Pattern reversal visual evoked potentials
    • Optic nerve; demyelinating; systemic diseases
    • Chiasmal and retrochiasmal lesions
    • Optic tract and optic radiation disease
    • Occipital lesions
    • Non-organic visual loss
  • Auditory brainstem
    • Conduction hearing loss
    • Lesions of the acoustic nerve and brainstem lesions
    • Demyelination; ataxias; degenerative disorders
    • Prognostic value in coma
  • Somatosensory
    • Spinal cord; brainstem; trauma lesions
    • Tumours of the spinal cord
    • Giant SEPs
    • Central demyelination
    • Prognostic value in coma

EEG on the intensive care

  • Anatomy and blood supply to the cerebral cortex and brainstem
  • Management of the unconscious patient on the intensive care unit
    • Clinical neurological examination
    • Glasgow coma scale and outcome scale
    • General nursing, nursing procedures and techniques
  • Intensive care environment
    • Electrical safety; patient safety; infection control; sterile fields
    • Intensive care equipment
  •   The electroencephalogram in the unconscious patient  on  the  intensive care unit
  •    Electrode types used in the intensive care unit for the recording of the electroencephalogram; electrode placement used; artefact and interference identification and elimination
    • Main interference; respirators; infusion pumps
    • Electrical beds; renal dialysis equipment
    • Vital signs monitors
  •   Recording of other physiological variables
    • Electrocardiogram; pulse; respiration
    • Tremor; myoclonic jerks; eye movement
  • Drugs used for sedation on the intensive care unit and their effect on the electroencephalogram
  • Effect of other physiological variables and mechanism of effect on the electroencephalogram and evoked potentials
    • Blood pressure; heart rate; respiration rate; metabolic state
    • Liver and renal function
    • Electrolytes; temperature; raised intracranial pressure
  • Uses of the electroencephalogram in the unconscious patient (adult and children)
    • Anoxic brain damage; head injury; cerebral infarct; encephalitis and meningitis
    • Metabolic disease; multi-organ failure
    • Status – clinical and subclinical
    • Locked-in syndrome
    • Renal dialysis
    • Prediction of outcome
    • Prognostic value
    • Raised intracranial pressure
    • Brain death and irreversible cerebral damage
    • Status epilepticus
  • Technical requirements and instrumentation for the continuous monitoring of the electroencephalogram on the intensive care unit
  • Basic signal processing and interpretation
    • Fourier and amplitude analysis
    • Display, quality control and validation requirements
    • Artefact identification
    • Cerebral function monitor, analysing monitor
    • Compressed spectral array

Paediatric EEG

  • Design of a paediatric neurophysiology department
    • Layout, accessibility, waiting areas, recording suites
    • Child–parent facilities
    • Staff areas, availability and departmental structure
    • Equipment specifications and availability
    • Normal resting electroencephalogram, normal variants and the sleeping electroencephalogram in paediatric patients
    • Infants in the first year of life; child and adolescence
  • Activation procedure their indications and contraindications
    • Hyperventilation, photic stimulation
    • Sleep deprivation and drug-induced sleep
  • Paediatric epileptic syndromes
    • Epileptic syndromes of infancy and early childhood
      • Infantile spasms (West syndrome, Blitz-Nick-salaam Krämpfe)
      • Febrile convulsions
      • Benign myoclonic epilepsy; severe myoclonic epilepsy in infancy
      • Lennox-Gaustaut syndrome
      • Epilepsy with myoclonic-astatic seizures
    • Epileptic syndromes of childhood
      • Childhood absence epilepsy
      • Epilepsy with myoclonic absences
      • Benign partial epilepsies in children
        • Benign childhood epilepsy with centro-temporal spikes Childhood epilepsy with occipital paroxysms
        • Benign epilepsy with affective symptoms
        • Benign partial epilepsy with extreme somatosensory evoked potentials
        • Atypical benign partial epilepsy
        • Other forms of benign partial epilepsies
      • Epilepsy with continuous spike and slow wave during slow sleep (CSWS or ESES)
      • Acquired epileptic aphasia (Laudau-Kleffner syndrome)
      • Chronic progressive epilepsia continua of childhood (Kojewnikov’s syndrome)
      • Epileptic syndromes of late childhood and adolescence
      • Juvenile absence; juvenile myoclonic epilepsy
      • Epilepsy with generalised tonic-clonic seizures on awakening
      • Primary reading; photosensitive epilesy
      • Progressive myoclonic epilepsies of childhood and adolescence
    • Paediatric conditions of the nervous system
    • Infection of the nervous system
      • Meningitis; encephalitis; Herpes simplex encephalitis
      • Tuberculous meningoencephalitis; cerebral thrombophlebitis
    • Cerebral malaria
      • Slow virus infections
      • Subacute sclerosing panenceohalitis
      • Human immunodeficiency virus infections and AIDS
      • Rasmussens’s syndrome; Reye syndrome
    • Brain tumours; cerebral palsy
      • Structural abnormalities
    • Paediatric metabolic conditions
    • Peroxisomal disorders
    • Lysosomal enzyme disorders and other leucodystophies
    • Neuronal ceriod lipofuscinosis
      • Amino acid disorders and organic acidurias
    • Paediatric metabolic manifestations on the central nervous system
    • Endocrine disorders
    • Disturbances of carbohydrate metabolism
    • Disturbances of electrolyte balance
    • Learning difficulties and child psychiatry
    • Down’s; Fragile X; Angelman’s; Rett’s; Tourett’s syndrome
    • Autism and related disorders
    • Developmental dysphasia; attention deficit hyperactivity disorder
    • Behavioural/ conduct disorders/problems; anorexia nervosa
    • Batten’s

Sleep and long-term monitoring

  • Clinical polysomnography
    • Electrode/Transducer placement
      • Electrooculogram
    • Submental muscle
    • Respiratory effort and movement
  • The electroencephalogram
  • Origin of the electroencephalogram
  • Characteristics of the normal awake EEG in adults and paediatrics including normal variants
  • Sleeping EEG in adults and Paediatrics
  • Vertex sharp waves, sleep spindles, K complexes and positive occipital sharp transients of sleep (POSTs)
  • Demonstrates an understanding of the normal  phenomena of sleep and  the different stages of sleep
  • Sleep stages
    • Stage I
    • Stage II
    • Stage III
    • Stage IV
    • Rapid eye movement (REM)
  • Sleep staging
    • Rechtschaffen and Kales
    • Hypnograms
    • Physiology of sleep and sleep disorders
  • Parasomnias
  • Insomnias
  • Hypersomnias
  • Assessment of excessive daytime sleepiness
  • Multisleep latency test (MSLT)
  • Maintenance of wakefulness test
  • Stanford sleepiness scale
  • Application of video-telemetry and Ambulatory Recording
  • Differential diagnosis
  • Differentiation between epileptic and non-epileptic attacks
  • Classification of seizures (in known epilepsy)
  • Focus localisation
  • Evaluating clinical symptoms
    • Seizure classification by clinical criteria
    • Hard to recognise seizures
    • Transitory cognitive impairment
  • Evaluating frequency of events
  • Detection of precipitating factors
  • Clinical utility of ambulatory recordings
  • Adult seizure disorders
  • Childhood seizure disorders
  • Evaluation of episodes of altered awareness or behaviour
  • Uses in sleep disorders
    • Hypersomnias
    • Parasomnias
    • Sleep apnoea
    • Periodic movements of sleep