Clinical Neurophysiology 126 (2015) 1459–1461

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Clinical Neurophysiology journal homepage: www.elsevier.com/locate/clinph

Editorial

The prevalence of ‘Clinical Neurophysiology’ and related terms in the English literature: A specialty in transition

The relevance of a medical specialty is primarily determined by the ability of the professionals involved to improve the lives of their patients through both clinical care and scientific research. However, health care and research do not operate in a vacuum: funding for research and reimbursement for clinical care depend not only on their objective merits, but also on whether they are perceived as relevant and valuable by society at large. In recent years, Neurology and Neuroscience have reveled in an unprecedented amount of attention from the general public, probably in part due to numerous initiatives aimed at increasing awareness. In 1990, the ‘‘decade of the brain’’ was announced by the US Congress, stimulating a number of initiatives that enhanced public awareness of brain research (Jones and Mendell, 1999). Similarly, ‘‘Brain Awareness Week’’, a global campaign to increase public awareness of brain research is celebrated each year in a growing number of countries (Burton, 2007). More recently, the ‘‘ice bucket challenge’’ campaign went viral on the internet, sparking interest in amyotrophic lateral sclerosis and leading to a significant increase in donations for research (Carrì, 2014). To the casual observer, it seems that Clinical Neurophysiology has not been able to capture the public’s imagination in the same way. However, the cultural relevance of a specialty is difficult to quantify objectively. Google’s N-gram viewer (https://books.google.com/ngrams) enables users to measure the prevalence of a word or phrase in the entire literature of various languages up to 2008, including both scientific and lay books (Michel et al., 2011). We measured the prevalence of a number of phrases related to Clinical Neurophysiology from 1900 to 2008. This analysis is based on the assumption that a higher prevalence of a phrase in the literature indicates a higher awareness amongst the general public and therefore a greater cultural relevance. It should be noted that not all phrases could be included in this analysis because some have multiple meanings, of which only one pertains to Clinical Neurophysiology. Examples are ‘‘EP’’, ‘‘LP’’ and ‘‘MEG’’. For all phrases, the first 50 search results were checked to ensure that they were used as intended, i.e. in the context of Clinical Neurophysiology. This was the case for >95% of the search results of all phrases. In case of acronyms or words with multiple spelling variants (e.g., ‘‘single fibre’’ versus ‘‘single fiber’’), the option with the highest prevalence was selected. For acronyms, we also verified that the patterns in prevalence were similar to the full phrase (e.g., ‘‘EMG’’ had a pattern similar to ‘‘electromyography’’). Fig. 1a shows that, unsurprisingly, the words ‘‘Neurology’’ and ‘‘Neurosurgery’’ have become dramatically more prevalent in the

English language literature in recent years, although they appear to have stabilized since 1990. As expected, the prevalence of the words ‘‘Neurophysiology’’ and ‘‘Clinical Neurophysiology’’ has also increased in the twentieth century, but remains lower than ‘‘Neurology’’ and ‘‘Neurosurgery’’. Importantly, the prevalence of ‘‘Clinical Neurophysiology’’ has been in decline since the eighties of the previous century. We then quantified the prevalence of various diagnostic modalities commonly used in Neurology (Fig. 1b). Indeed, the classical clinical neurophysiological techniques, EEG, EMG and evoked potentials show a pattern highly similar to that of Clinical Neurophysiology: their prevalence peaked several decades ago. The word ‘‘EEG’’ reached its peak in the seventies, ‘‘EMG’’ in the eighties and ‘‘evoked potentials’’ in the nineties. Since then, these phrases show a gradual decline, although they appear to have stabilized somewhat in the most recent decade. This gradual decline becomes especially apparent when plotted against the continuing explosive growth of the word ‘‘MRI’’. Together, these data show that mention of Clinical Neurophysiology and its traditional techniques in the English literature has declined in recent decades. The exception is ‘‘ultrasound’’, but this technique is used by different specialties including Radiology, Obstetrics and Clinical Neurophysiology, and its importance for each of these specialties cannot be determined separately. Do these numbers predict a bleak future for Clinical Neurophysiology? Many will argue that our specialty has diversified tremendously and that the Clinical Neurophysiologist’s tool box now contains many more options than it did several decades ago. Fig. 1c shows the prevalence of a non-exhaustive selection of these techniques. Contact Heat Evoked Potentials (CHEPS), neuromonitoring, tilt-table testing and microneurography have all become extremely more common phrases in recent years, although their prevalence in absolute terms is still well below the popularity of EEG and EMG. The exception seems to be ‘‘single fibre EMG’’, which reached a peak in 1990 and has declined since. It could be argued that techniques are likely to be discussed more frequently in the literature when they are introduced and that it is to be expected that their prevalence declines as they become more commonplace and less novel. However, the continued rise in prevalence of MRI shows that this is not necessarily the case. Furthermore, this analysis is not an indicator of the clinical and scientific importance of Clinical Neurophysiology as a specialty. However, the correlation between the prevalence of certain

http://dx.doi.org/10.1016/j.clinph.2015.04.056 1388-2457/Ó 2015 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.

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Editorial / Clinical Neurophysiology 126 (2015) 1459–1461

Fig. 1. The prevalence of various phrases related to Clinical Neurophysiology in the English literature from 1900 to 2008. Data were smoothed for a period of five years. (a) The prevalence of Neurophysiology and Clinical Neurophysiology peaked several decades ago. (b) ‘‘EEG’’, ‘‘EMG’’ and ‘‘evoked potentials’’ show a pattern similar to Clinical Neurophysiology, whereas the prevalence of ‘‘MRI’’ has continued to rise. (c) Several newer neurophysiological techniques have become more prevalent but their absolute prevalence currently remains below that of EEG and EMG.

phrases in literature and their clinical application works in two directions: valuable techniques are expected to be mentioned more frequently in text books, and increased mention should raise awareness among the general public, leading to funding for clinical care and scientific research. Therefore, it would be naïve to believe that a specialty can continue to thrive if it does not generate a certain amount of discussion in the broader literature. In conclusion, our analysis paints a picture of a specialty not in decline but in transition: older techniques decline in popularity, as newer modalities appear. The continuous exploration and development of novel techniques is therefore vital if Clinical Neurophysiology is to remain relevant as a specialty.

Conflicts of interest None. References Burton A. Let’s talk about brains: International Brain Awareness Week. Lancet Neurol 2007;6:390–1. Carrì MT. Philanthropy: ice-bucket challenge should jolt funding. Nature 2014;515:343. Jones EG, Mendell LM. Assessing the decade of the brain. Science 1999;284:739. Michel J-B, Shen YK, Aiden AP, Veres A, Gray MKGoogle Books Team. Quantitative analysis of culture using millions of digitized books. Science 2011;331:176–82.

Editorial / Clinical Neurophysiology 126 (2015) 1459–1461



Martijn R. Tannemaat N. Ahmad Aziz 1 Leiden University Medical Center, Department of Neurology & Clinical Neurophysiology,

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K-05-Q, P.O. Box 9600, Albinusdreef 2, 2300 RC Leiden, The Netherlands ⇑ Corresponding author. Tel.: +31 71 526 2197; fax: +31 71 524 8253. E-mail addresses: [email protected] (M.R. Tannemaat), [email protected] (N.A. Aziz) Available online 17 April 2015

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Tel.: +31 71 526 2197; fax: +31 71 524 8253.

The prevalence of 'Clinical Neurophysiology' and related terms in the English literature: A specialty in transition.

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