Of Pilots and Copilots: The Evolving Role of Artificial Intelligence in Clinical Neurophysiology

Artificial intelligence (AI) is revolutionizing clinical neurophysiology (CNP), particularly in its applications to electroencephalography (EEG), electromyography (EMG), and polysomnography (PSG). AI enhances diagnostic accuracy and efficiency while addressing interrater variability and the growing data volume. The evolution of AI tools, from early mimetic methods to advanced deep learning techniques, has significantly improved spike and seizure detection in EEG and facilitated whole EEG evaluations, reducing the workload on clinicians. In EMG, AI demonstrates promise in identifying motor unit abnormalities and analyzing audio signals, though challenges persist due to limited datasets and clinical context considerations. PSG scoring has seen substantial integration of AI, with systems achieving high accuracy through uncertainty estimation and selective manual review, but limitations remain in analyzing epileptic activity and classifying certain sleep stages. As a "co-pilot," AI augments human expertise by improving quality control, standardizing clinical trials, and enabling rapid data review, particularly for less experienced providers. Future AI advancements in CNP aim to shift from isolated data interpretation to providing clinical context, considering patient history, treatment options, and prognostic implications. While the potential of generative AI and "AI-omics" is transformative, the importance of thoughtful integration to augment rather than replace human expertise must be emphasized, ensuring that AI becomes a tool for collaboration and innovation in medicine.