UCSD Interventional Neurophysiology Services

Interventional Neurophysiology is a new academic program within the UCSD School of Medicine, with round the clock services offered to the UCSD Thornton and Hillcrest Hospitals.  Clinical oversight of the program is provided by Dr. Jeffrey Gertsch, Assistant Professor of Neurosciences.  Dr. Gertsch is a clinical Neurologist by training, and received fellowship training in surgical neurophysiology and epilepsy monitoring techniques. 

Interventional neurophysiology is a young and rapidly growing neurosciences subspecialty.  The goal of interventional neurophysiology is to provide rapid, real-time detection and clinical response for injuries to the nervous system.  Interrogation of major nervous system pathways (motor, sensory, auditory, global brain activity) by electrical stimulation and/or passive recording allows for sophisticated monitoring of the nervous system regardless of the patient's level of consciousness; a useful characteristic insofar as these techniques can be applied to the anesthetized or comatose patient who often cannot be evaluated in any other way (Reference: Xuguang Liu and Alan Forster.  Interventional Neurophysiology: A new frontier in investigation, treatment, and research.  Frontiers in Bioscience  2008; 13:1691-1697).  

Interventional Neurophysiology at the UCSD Medical Center is primarily divided into surgical neurophysiology and intensive care neurophysiology services: 

• Surgical Neurophysiology Services: The major interest in surgical neurophysiology is to prevent catastrophic complications in brain and spine surgeries (strokes, paraplegia, etc); however nervous tissue can be protected in many sites throughout the body.  Surgical neuro-physiological techniques can also provide unseen functional information about nervous pathways to actively assist in surgical resection, as in epilepsy and other brain surgeries.  
  • Kinney GA and Slimp JC. Intraoperative neurophysiological monitoring technology: recent advances and evolving uses. Expert Rev Med Devices  2007; 4:33-41. 
  • Sutter M, Eggspuehler A, Muller A, and Dvorak J. Multimodal intraoperative monitoring: an overview and proposal of methodology based on 1,017 cases. Eur Spine J 2007; Suppl 2:S153-161.

• Intensive Care Neurophysiology Services: ICU neurophysiology provides for the prognostic evaluation of the critically injured patients' nervous system, or surveillance against subtle seizures that may go unseen without continuous electroencephalographic monitoring of brainwave function
  • References: Hirsch LJ. Brain Monitoring: The Next Frontier of ICU Monitoring. J Clin Neurophysiol  2004; 21:305-306.
  • Carter BG and Butt W. Are somatosensory evoked potentials the best predictor of outcome after severe brain injury? A systematic review. Intensive Care Med 2005; 31:765-775. 

	Director Jeffrey Gertsch, MD Email:jgertsch@ucsd.edu Pager: 4019
	Staff:
	Shilpa Dayal, REEG, REPT Neurophysiology Specialist Pager: 8553
	Laurie Elliott Administrative Assistant

 

 

Services:

Surgical Neurophysiology Services Electromyography (EMG), live feed and evoked including cranial nerve coverage Somatosensory evoked potentials (SEP) Motor evoked potentials (MEP) Electroencephalography (EEG) and electrocorticography (ECoG) Auditory evoked potentials (BAEP) Wake craniotomy evaluations (language, motor, sensory, memory testing) and Wada tests Other specialized services as requested Intensive Care Neurophysiology Services Continuous electroencephalography (CEEG) Neurocritical care neurophysiological survey for comatose patients (SEP, MEP, EEG, BAEP) Electro-cerebral silence EEG