Neurology

Source: Wikipedia, the free encyclopedia.
This article is about the branch of medicine. For the scientific study of the nervous system, see Neuroscience. For the journal, see Neurology (journal).
"Neurological sciences" redirects here. For the journal, see Neurological Sciences (journal).

Neurology
MRI scan, lumbar puncture, electroencephalography
SpecialistNeurologist
GlossaryGlossary of medicine

Neurology (from

medicine dealing with the diagnosis and treatment of all categories of conditions and disease involving the nervous system, which comprises the brain, the spinal cord and the peripheral nerves.[1] Neurological practice relies heavily on the field of neuroscience, the scientific study of the nervous system
.

A neurologist is a

surgical specialty is neurosurgery.[2]

History

Main article:
History of neurology

The academic discipline began between the 15th and 16th centuries with the work and research of many neurologists such as

Duchenne de Boulogne, William A. Hammond, Jean-Martin Charcot, C. Miller Fisher and John Hughlings Jackson. Neo-Latin neurologia appeared in various texts from 1610 denoting an anatomical focus on the nerves (variably understood as vessels), and was most notably used by Willis, who preferred Greek νευρολογία.[4][5]

Training

Neurologist
Occupation
NamesPhysician, Medical Practitioner
Occupation type
M.B.B.S. (UK), D.M. (Doctorate of Medicine) (India), M.B. B.Ch. B.A.O. (Republic of Ireland)[6][7]
Fields of
employment
Hospitals, Clinics
Polish neurologist Edward Flatau greatly influenced the developing field of neurology. He published a human brain atlas in 1894 and wrote a fundamental book on migraines in 1912.
Jean-Martin Charcot is considered one of the fathers of neurology.[8]

Many neurologists also have additional training or interest in one area of neurology, such as stroke, epilepsy, headache, neuromuscular disorders, sleep medicine, pain management, or movement disorders.

In the United States and Canada, neurologists are physicians who have completed a postgraduate training period known as residency specializing in neurology after graduation from medical school. This additional training period typically lasts four years, with the first year devoted to training in internal medicine.[9] On average, neurologists complete a total of eight to ten years of training. This includes four years of medical school, four years of residency and an optional one to two years of fellowship.[10]

While neurologists may treat general neurologic conditions, some neurologists go on to receive additional training focusing on a particular subspecialty in the field of neurology. These training programs are called

pain medicine, sleep medicine, neurocritical care, vascular neurology (stroke),[11] behavioral neurology
, child neurology, headache, multiple sclerosis, neuroimaging, neurooncology, and neurorehabilitation.

In Germany, a compulsory year of psychiatry must be done to complete a residency of neurology.[12]

In the United Kingdom and Ireland, neurology is a subspecialty of general (internal) medicine. After five years of medical school and two years as a Foundation Trainee, an aspiring neurologist must pass the examination for

physiatry in the US) to specialise in neurological rehabilitation, which may include stroke medicine, as well as traumatic brain injuries.[citation needed
]

Physical examination

Main article: Neurological examination

During a neurological examination, the neurologist reviews the patient's health history with special attention to the patient's neurologic complaints. The patient then takes a neurological exam. Typically, the exam tests mental status, function of the cranial nerves (including vision), strength, coordination, reflexes, sensation and gait. This information helps the neurologist determine whether the problem exists in the nervous system and the clinical localization. Localization of the pathology is the key process by which neurologists develop their differential diagnosis. Further tests may be needed to confirm a diagnosis and ultimately guide therapy and appropriate management. Useful adjunct imaging studies in neurology include CT scanning and MRI. Other tests used to assess muscle and nerve function include nerve conduction studies and electromyography.

Clinical tasks

Neurologists examine patients who are referred to them by other physicians in both the

reflexes, coordination, and gait
.

In some instances, neurologists may order additional

evoked potentials are also commonly ordered.[14] Neurologists frequently perform lumbar punctures to assess characteristics of a patient's cerebrospinal fluid. Advances in genetic testing
have made genetic testing an important tool in the classification of inherited neuromuscular disease and diagnosis of many other neurogenetic diseases. The role of genetic influences on the development of acquired neurologic diseases is an active area of research.

Some of the commonly encountered conditions treated by neurologists include headaches,

head trauma, sleep disorders, neuromuscular diseases, and various infections and tumors of the nervous system. Neurologists are also asked to evaluate unresponsive patients on life support to confirm brain death
.

Treatment options vary depending on the neurological problem. They can include referring the patient to a

physiotherapist
, prescribing medications, or recommending a surgical procedure.

Some neurologists specialize in certain parts of the nervous system or in specific procedures. For example, clinical neurophysiologists specialize in the use of EEG and intraoperative monitoring to diagnose certain neurological disorders.[15] Other neurologists specialize in the use of electrodiagnostic medicine studies – needle EMG and NCSs. In the US, physicians do not typically specialize in all the aspects of clinical neurophysiology – i.e. sleep, EEG, EMG, and NCSs. The American Board of Clinical Neurophysiology certifies US physicians in general clinical neurophysiology, epilepsy, and intraoperative monitoring.[16] The American Board of Electrodiagnostic Medicine certifies US physicians in electrodiagnostic medicine and certifies technologists in nerve-conduction studies. Sleep medicine is a subspecialty field in the US under several medical specialties including anesthesiology, internal medicine, family medicine, and neurology.[17] Neurosurgery is a distinct specialty that involves a different training path and emphasizes the surgical treatment of neurological disorders.

Also, many nonmedical doctors, those with doctoral degrees (usually PhDs) in subjects such as biology and chemistry, study and research the nervous system. Working in laboratories in universities, hospitals, and private companies, these neuroscientists perform clinical and laboratory experiments and tests to learn more about the nervous system and find cures or new treatments for diseases and disorders.

A great deal of overlap occurs between

medical students
.

General caseload

Neurologists are responsible for the diagnosis, treatment, and management of all the conditions mentioned above. When surgical or endovascular intervention is required, the neurologist may refer the patient to a

neuromuscular
diseases.

Overlapping areas

Some overlap also occurs with other specialties, varying from country to country and even within a local geographic area. Acute

geriatric medicine
.

aging or tracking the progression of a dementia
)

Relationship to clinical neurophysiology

In some countries such as the United States and Germany,

specialty
(e.g., United Kingdom, Sweden, Spain).

Overlap with psychiatry

Further information: Psychoneuroimmunology and Neuropsychiatry

In the past, prior to the advent of more advanced diagnostic techniques such as

American Journal of Psychiatry, Professor Joseph B. Martin, Dean of Harvard Medical School and a neurologist by training, wrote, "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".[18]

biomarkers
of a given mental disorder.

Neurological enhancement

The emerging field of neurological enhancement highlights the potential of therapies to improve such things as workplace efficacy, attention in school, and overall happiness in personal lives.[20] However, this field has also given rise to questions about neuroethics.

See also

References

  1. ^ ACGME (1 July 2016). "ACGME Program Requirements for Graduate Medical Education in Neurology" (PDF). www.acgme.org. Archived from the original (PDF) on 13 January 2017. Retrieved 10 January 2017.
  2. ^ a b "Working with Your Doctor". American Academy of Neurology. Archived from the original on 2 August 2014. Retrieved 28 October 2012.
  3. ^ "Neurological Disorders". Johns Hopkins Department of Neurology. 24 February 2020. Archived from the original on 15 September 2021. Retrieved 15 September 2021.
  4. PMID 33837748
    .
  5. PMID 33837768
    .
  6. ^ "Medical Practitioners Act, 1927". Irishstatutebook.ie. 28 May 1927. Archived from the original on 30 December 2013. Retrieved 30 March 2015.
  7. ^ "Medical Council – Medical Council". Medicalcouncil.ie. 15 February 2010. Archived from the original on 25 November 2015. Retrieved 30 March 2015.
  8. PMID 20739583
    .
  9. ^ "Length of Residencies". Washington University Medical School. Archived from the original on 16 October 2021. Retrieved 15 September 2021.
  10. ^ "Neurologist Profile" (PDF). Education Portal. Archived (PDF) from the original on 24 February 2017. Retrieved 23 February 2017.
  11. ^ "ABMS Guide to Medical Specialties" (PDF). American Board of Medical Specialties. Archived from the original (PDF) on 23 September 2020. Retrieved 26 November 2012.
  12. PMID 24297784
    .
  13. ^ Tuarez, Jaimar (28 October 2020). ""How long does it take to become a neurologist in the UK?"". neurotray.com. Archived from the original on 4 December 2021. Retrieved 4 December 2021.
  14. ^ "Neurological Diagnostic Tests and Procedures Fact Sheet". Archived from the original on 4 December 2021. Retrieved 4 December 2021.
  15. ^ "American Clinical Neurophysiology Society". Acns.org. Archived from the original on 24 March 2015. Retrieved 30 March 2015.
  16. ^ "American Board of Clinical Neurophysiology, Inc". Abcn.org. Archived from the original on 22 March 2015. Retrieved 30 March 2015.
  17. ^ "Specialty and Subspecialty Certificates". Abms.org. Archived from the original on 23 January 2020. Retrieved 30 March 2015.
  18. PMID 11986119
    .
  19. PMID 9545989. Archived
    from the original on 17 January 2023. Retrieved 9 June 2021.
  20. PMID 21220723
    .
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