Technology in neurology

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Continuing Medical Education

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University of Cape Town

Promising developments in clinical neurophysiology over the last 10 years have been largely eclipsed by the dramatic evolution of magnetic resonance imaging (MRI). One exception has been encephalography (video EEG) monitoring and, of course, research in clinical neurophysiology knows no bounds. Neurosurgery has had major developments and some of these areas have involved neurophysiological co-operation such as neurophysiological sampling and stimulation in extrapyramidal movement disorders, especially Parkinson's disease. Overall, as in the rest of medical technology, digitisation and computerisation have gradually replaced all analogue systems and as the industry matured, many proprietary systems have migrated to commercial standards, particularly versions of the Windows operating systems. This development in technology has had tangible benefits in overlap with office software, ease of handling large amounts of data and increasing confidence in improved reliability and manipulation of signals. However, this technological benefit is a double-edged sword and apart from the more familiar problems common to many small computer systems, digital systems are capable of distorting or hiding signals without the unwary operator being aware of this. An example would be suspicious looking 'sharp waves' (potentially epileptogenic) on the EEG, which are the result of a noisy (bad) signal unwittingly being filtered by innocuous sounding switches ('muscle filters'). Despite the advanced technology, basic principles of a clean source of signal are still essential. Neurophysiological studies have not been exclusive to neurology and with important developments in cardiology and anaesthetics, there is greater overlap in some of the technology underlying these fields. At the same time, there has been a move to train clinical technologists who are capable of moving between even more disparate fields such as renal (dialysis) to respiratory (lung functions) to neurology. Unfortunately, the numbers of clinical technologists' posts, and hence members, have dropped significantly and such developments may be more necessary than originally planned.The training centres for clinical technology have also been drastically reduced, further hampering new recruits.