neurology

 

(nʊrŏl'əjē, nyʊ–) , study of the morphology, physiology, and pathology of the human nervous system. As researchers, neurologists carry on investigative and experimental work in such areas as conductivity, embryology, and the metabolism of nervous tissue. As practicing physicians, neurologists diagnose and treat diseases that involve the nervous system. Since the brain, spine, and eye are integral part of the nervous system, the domain of neurology overlaps that of psychiatry, orthopedics and ophthalmology. Current research is directed toward spinal cord injuries, brain tumors, reattachment of severed limbs, and the treatment of conditions generated by repetitive motions. The recent discovery of growth factors opens the possibility of healing or regenerating tissues of the nervous system.

Neurology is a branch of medicine dealing with disorders of the nervous system. Medical professionals (such as Biomedical Doctors and Physicians) specializing in the field of neurology are called neurologists and are trained to diagnose, treat, and manage patients with neurological disorders. Most neurologists are trained to treat and diagnose adults with neurological disorders. Pediatric neurologists, nearly always a subspecialty of pediatrics, treat neurological disease in children. Neurologists may also be involved in clinical research, clinical trials, as well as basic research and translational research.

Field of work

Neurological disorders are disorders that affect the central nervous system (brain and spinal cord), the peripheral nervous system (peripheral nerves - cranial nerves included), or the autonomic nervous system.

Major conditions include:

• behavioral/cognitive syndromes
• headache disorders such as migraine, cluster headache and tension headache
• seizure disorders
• neurodegenerative disorders, including Alzheimer's disease, Parkinson's disease, and Amyotrophic Lateral Sclerosis (Lou Gehrig's disease).
• cerebrovascular disease, such as transient ischemic attack and stroke.
• sleep disorders
• cerebral palsy
• infections of the brain (encephalitis), brain meninges (meningitis), spinal cord (myelitis)
• infections of the peripheral nervous system, such as botulism
• neoplasms - tumors of the brain and its meninges (brain tumors), spinal cord tumors, tumors of the peripheral nerves (neuroma)
• movement disorders such as Parkinson's disease, Huntington's disease, hemiballismus, tic disorder, and Gilles de la Tourette syndrome
• demyelinating diseases of the central nervous system, such as multiple sclerosis, and of the peripheral nervous system, such as Guillain-Barré syndrome and chronic inflammatory demyelinating polyneuropathy (CIDP)
• spinal cord disorders - tumors, infections, trauma, malformations (e.g., myelocele, meningomyelocele, tethered cord)
• disorders of peripheral nerves, muscle (myopathy) and neuromuscular junctions
• traumatic injuries to the brain, spinal cord and peripheral nerves
• altered mental status, encephalopathy, stupor and coma
• speech and language disorders

Educational requirements

A neurologist's educational background and medical training varies with the country of training. Typically it includes a medical degree, and some years of postgraduate training, between 2-5 years. In the US, neurologists follow the standard pattern with an undergraduate degree, four years of medical school, a one-year internship and three years of specialized training. Many neurologists also have additional training or interest in one area of neurology such as stroke, epilepsy, neuromuscular, sleep medicine, pain management, or movement disorders.

Testing examinations

During a neurological examination, the neurologist reviews the patient's health history with special attention to the current condition. The patient then takes a neurological exam. Typically, the exam tests vision, strength, coordination, reflexes and sensation. This information helps the neurologist determine if the problem exists in the nervous system and the clinical localization. Localization of the pathology is the key process by which neurologist develop their differential diagnosis. Further tests may be needed to confirm a diagnosis and ultimately guide therapy and appropriate management.

Clinical tasks

General caseload

Neurologists are responsible for the diagnosis, treatment, and management of all the above conditions. When surgical intervention is required, the neurologist may refer the patient to a neurosurgeon, an interventional neuroradiologist, or a neurointerventionalist. In some countries, additional legal responsibilities of a neurologist may include making a finding of brain death when it is suspected that a patient is deceased. Neurologists frequently care for people with hereditary (genetic) diseases when the major manifestations are neurological, as is frequently the case. Lumbar punctures are frequently performed by neurologists. Other neurologists may develop an interest in particular subfields, such as dementia, movement disorders, headaches, epilepsy, sleep disorders, chronic pain management, multiple sclerosis or neuromuscular diseases.

Overlapping areas

There is some overlap with other specialties, varying from country to country and even within a local geographic area. Acute head trauma is most often treated by neurosurgeons, whereas sequela of head trauma may be treated by neurologists or specialists in rehabilitation medicine. Although stroke cases have been traditionally managed by internal medicine or hospitalists, the emergence of vascular neurology and endovascular neurosurgery as disciplines has created a demand for stroke specialists. The establishment of JCAHO stroke centers has increased the role of neurologists in stroke care in many primary as well as tertiary hospitals. Some cases of nervous system infectious diseases are treated by infectious disease specialists. Most cases of headache are diagnosed and treated primarily by general practitioners, at least the less severe cases. Similarly, most cases of sciatica and other mechanical radiculopathies are treated by general practitioners, though they may be referred to neurologists or a surgeon (neurosurgeons or orthopedic surgeons). Sleep disorders are also treated by pulmonologists. Cerebral palsy is initially treated by pediatricians, but care may be transferred to an adult neurologist after the patient reaches a certain age.

Clinical neuropsychologists are often called upon to evaluate brain-behavior relationships for the purpose of assisting with differential diagnosis, planning rehabilitation strategies, documenting cognitive strengths and weaknesses, and measuring change over time (e.g., for identifying abnormal aging or tracking the progression of a dementia).

Relationship to clinical neurophysiology

In some countries, e.g. USA and Germany, neurologists may specialize in clinical neurophysiology, the field responsible for EEG, nerve conduction studies, EMG and evoked potentials. In other countries, this is an autonomous specialty (e.g. United Kingdom, Sweden).

Overlap with psychiatry

Further information: Psychoneuroimmunology and Neuropsychiatry

Although many mental illnesses are believed to be neurological disorders affecting the central nervous system, traditionally they are classified separately, and treated by psychiatrists. In a 2002 review article in the American Journal of Psychiatry, Professor Joseph B. Martin, Dean of Harvard Medical School and a neurologist by training, wrote that 'the separation of the two categories is arbitrary, often influenced by beliefs rather than proven scientific observations. And the fact that the brain and mind are one makes the separation artificial anyway.' (Martin JB. The integration of neurology, psychiatry and neuroscience in the 21st century. Am J Psychiatry 2002; 159:695-704)

There are strong indications that neuro-chemical mechanisms play an important role in the development of, for instance, bipolar disorder and schizophrenia. As well, 'neurological' diseases often have 'psychiatric' manifestations, such as post-stroke depression, depression and dementia associated with Parkinson's disease, mood and cognitive dysfunctions in Alzheimer's disease, to name a few. Hence, there is no sharp distinction between neurology and psychiatry on a biological basis - this distinction has mainly practical reasons and strong historical roots (such as the dominance of Freud's psychoanalytic theory in psychiatric thinking in the first three quarters of the 20th century - which has since then been largely replaced by the focus on neurosciences - aided by the tremendous advances in genetics and neuroimaging recently.)

External links

• European Federation of Neurological Societies
• European Journal of Neurology
• National Institute of Neurological Disorders and Stroke (NINDS)
• On Line Neurology Journal Club (via JournalReview.org)
• Fast-MAG The Field Administration of Stroke Therapy – Magnesium Phase 3 Clinical Trial
• Journal of The American Stroke Association
• Therapeutic Guidelines - Neurology
• Revista de neurologia (Spanish) (English)

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