Neurology

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Neurology is a branch of medicine dealing with disorders of the nervous system. 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. Pediatric neurologists, nearly always a subspecialty of pediatrics, treat neurological disease in children. Neurologists are also involved in clinical research, clinical trials, as well as basic research and translational research.

Contents

[edit] Field of work

Neurological disorders are disorders that affect the central nervous system (brain, brainstem and cerebellum), the peripheral nervous system (peripheral nerves - cranial nerves included), or the autonomic nervous system (parts of which are located in both central and peripheral nervous system). Neurologists also diagnose and treat some conditions in the musculoskeletal system.

Major conditions include:

[edit] 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, often 3-5 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 or movement disorders.

[edit] 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 is in the nervous system. Further tests may be needed to confirm a diagnosis or find a specific treatment.

[edit] Clinical tasks

[edit] 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 movement disorders, headaches, epilepsy, sleep disorders, multiple sclerosis or neuromuscular diseases.

The core neurological diseases that are the primary domain of neurologists are:

  • demyelinating diseases of the central nervous system.
  • the epilepsies
  • headache and migraine
  • movement disorders
  • polyneuropathies
  • spinal cord disorders
  • genetic diseases with a primarily neurologic manifestation

[edit] Overlapping areas

There is some overlap with other specialties, varying from country to country and even within a local geographic area. Most stroke patients are seen only by specialists in internal medicine. Whether stroke patients should be seen primarily by neurologists is contested. Acute head trauma is most often treated by neurosurgeons, whereas sequela of head trauma may be treated by neurologists or specialists in rehabilitation medicine. 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.

[edit] 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).

[edit] Overlap with psychiatry

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.)

[edit] See also

[edit] External links



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Neurobiology | Cognitive Neuroscience | Computational Neuroscience | Neural Engineering | Neuroanatomy | Neurochemistry | Neuroimaging | Neurolinguistics | Neurology | Neuropharmacology | Neurophysiology | Neuropsychology | Psychopharmacology | Systems Neuroscience
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Neurology

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