The life of a clinical physiologist…
…from EEGs to epilepsy surgery
Hi everyone, my name is Danielle1 and I’m a Clinical Scientist in Neurophysiology2. I know it’s a bit of a mouthful but technically that’s our title (sometimes also Clinical Physiologist, Neurophysiological Scientist or previously, EEG Technician…) We’re the ones you go to see for your EEG3 and we do everything from taking your history, to applying all those electrodes to your head and messing up your hair, to analysing your brain waves and writing the report that is sent to your doctor.
One of my most hated questions is “so do you just stick electrodes on peoples’ heads all day then?” (believe it or not, I’ve been asked this several times…). Well, the answer is no. As well as seeing you in clinic, maybe after your first seizure or to monitor progress on a particular medication, we see lots of patients on the wards including intensive care. As well as epilepsy, EEGs give us a lot of valuable information to diagnose and assist in the treatment of many conditions including managing brain injuries and coma. We also do long term monitoring such as ambulatory EEG and video telemetry, where the electrodes stay in place for up to a week to gain a more in-depth understanding of your brain activity and seizure patterns. Having an EEG recording at the time of your seizure is the gold standard and gives us the best chance of managing your condition, and this is what we aim to capture during these long term EEG recordings. Sometimes it’s also useful to see your brain activity during sleep, as some types of epilepsy occur only during sleep and epileptic discharges (the abnormalities we see in the recording that might indicate predisposition to seizures) may reveal themselves while you are falling asleep or while you’re asleep.
As well as EEGs, we perform a range of other diagnostic investigations on the nervous system. These include nerve conduction studies for conditions such as carpal tunnel syndrome2 or diabetic neuropathy2, and evoked potentials for disorders of the visual, auditory or somatosensory pathways2.
Our job is actually very varied and to me, combines a perfect mix of patient contact with science - this is one of the main reasons I entered the profession. Many of us have entered the world of Clinical Neurophysiology via different routes – I initially did a degree in Neuroscience and then completed the NHS Graduate Scientist Training Programme (STP)4, which combined three years of practical training with a Master’s degree in Clinical Science. There is also the option to go directly into Neurophysiology as an undergraduate, completing the Practitioner Training Programme (PTP)5.
As well as performing a range of different investigations, we see patients of all ages (from newborns to the elderly) and have to develop a broad knowledge of a range of neurological conditions. Communication and interpersonal skills are crucial, as we often have to describe quite difficult concepts (such as how our investigations work) to our patients, some of whom will have associated cognitive2 or developmental co-morbidities2. We also often work within a multi-disciplinary team of Physiologists2, Consultant Neurophysiologists2, Epilepsy Nurses2, and sometimes other related services such as Psychology2, Imaging2 and Neurosurgery2, so have to communicate the relevant parts of our work to each profession. The job can be very unpredictable, and no two days are the same – we always have to be ready to respond rapidly to a request to see a critically ill patient or someone experiencing seizures at that given time. Sometimes we might spend the whole day in clinic or seeing patients on the wards and other days we’ll mostly be sitting at the computer analysing EEG recordings and writing reports. Working in Neurophysiology means you have to be able to adapt, both to each patient and to the changing demands of each day.
As you can imagine, applying approximately 30 electrodes to a 3 year-olds’ head can also be very challenging, so we have to be flexible, innovative and inventive in the way we approach our task (sometimes this involves watching Frozen6 AGAIN or having to pretend that the electrodes give you superhero powers!). Empathy is key, as it is in all healthcare professions, and you have to be able to listen to your patients and make them feel at ease. I feel that we often act as the bridge between the patient and their Consultant, so we might get asked those questions that patients don’t quite feel they can ask their Consultant. There is lots of scope for progression and opportunities to get involved in research, service development and even leadership and management. I have been luckily enough to move into the field of epilepsy surgery (which I find so fascinating!) – this process involves intracranials2 or invasive recordings, where electrodes are actually placed within your brain and not just on the scalp. This helps us to more accurately identify the origin of seizures and assess whether it might be possible to do brain surgery to resect this area of tissue or disrupt the epilepsy network in an attempt to treat your seizures. I know that this can seem like a very scary concept at first, but it really can work! I hope this post has given you a little more understanding of Clinical Neurophysiology and the part we play in your epilepsy diagnosis and management. I guess I’ll just finish off with my main tips for having your EEG:
Firstly and most importantly, PLEASE wash your hair before you come to see us!
Try not to be worried or self-conscious about having your EEG done, the most important thing to us and the quality of the recording is that you RELAX! (And believe me, we really don’t care what you look like with all those electrodes on your head or while you’re doing your deep breathing!)
As I mentioned, we see patients of all ages and abilities and we are used to adapting to this. Please don’t worry or underestimate our ability, especially with children – we’ve got this!
Please feel free to ask us any questions during your EEG appointment, I promise they won’t be silly, and we’ll always do our best to answer them.
If you’re interested in a career in Clinical Neurophysiology, more information can be found here: www.ansuk.org/careers
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