Medical specialty dealing with disorders of the nervous system
This article is about the branch of medicine. For the scientific study of the nervous system, seeNeuroscience. For the journal, seeNeurology (journal).
M.D. orD.O. (US),M.B.B.S. (UK), D.M. (Doctorate of Medicine) (India), M.B. B.Ch. B.A.O. (Republic of Ireland)[9][10]
Fields of employment
Hospitals, Clinics
Polish neurologistEdward 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.[11]
In the United States and Canada, neurologists are physicians who have completed a postgraduate training period known asresidency specializing in neurology after graduation frommedical school. This additional training period typically lasts four years, with the first year devoted to training ininternal medicine.[12] 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.[13]
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 calledfellowships, and are one to three years in duration. Subspecialties in the United States include brain injury medicine,clinical neurophysiology,epilepsy, neurodevelopmental disabilities,neuromuscular medicine,pain medicine,sleep medicine, neurocritical care, vascular neurology (stroke),[14]behavioral neurology, headache, neuroimmunology[15] and infectious disease,movement disorders, neuroimaging, neurooncology, and neurorehabilitation.[16]
In Germany, a compulsory year of psychiatry must be done to complete a residency of neurology.[17]
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 forMembership of the Royal College of Physicians (or the Irish equivalent) and complete two years of core medical training before entering specialist training in neurology.[18] Up to the 1960s, some intending to become neurologists would also spend two years working in psychiatric units before obtaining a diploma in psychological medicine. However, that was uncommon and, now that theMRCPsych takes three years to obtain, would no longer be practical. A period of research is essential, and obtaining a higher degree aids career progression. Many found it was eased after an attachment to the Institute of Neurology atQueen Square, London. Some neurologists enter the field of rehabilitation medicine (known asphysiatry in the US) to specialise in neurological rehabilitation, which may include stroke medicine, as well as traumatic brain injuries.[citation needed]
During aneurological 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 thecranial 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.
In some instances, neurologists may order additionaldiagnostic tests as part of the evaluation. Commonly employed tests in neurology include imaging studies such ascomputed axial tomography (CAT) scans,magnetic resonance imaging (MRI), andultrasound of major blood vessels of the head and neck. Neurophysiologic studies, includingelectroencephalography (EEG), needleelectromyography (EMG),nerve conduction studies (NCSs) andevoked potentials are also commonly ordered.[19] Neurologists frequently performlumbar punctures to assess characteristics of a patient'scerebrospinal fluid. Advances ingenetic 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.
Treatment options vary depending on the neurological problem. They can include referring the patient to aphysiotherapist, 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 andintraoperative monitoring to diagnose certain neurological disorders.[22] Other neurologists specialize in the use ofelectrodiagnostic 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.[23] The American Board of Electrodiagnostic Medicine certifies US physicians inelectrodiagnostic medicine and certifies technologists in nerve-conduction studies. Sleep medicine is a subspecialty field in the US under several medical specialties includinganesthesiology,internal medicine,family medicine, and neurology.[24] 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 betweenneuroscience and neurology. Many neurologists work in academic training hospitals, where they conduct research as neuroscientists in addition to treating patients and teaching neurology tomedical students.
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 aneurosurgeon or aninterventional neuroradiologist. In some countries, additional legal responsibilities of a neurologist may include making a finding of brain death when it is suspected that a patient has died. 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 byneurologists. Some neurologists may develop an interest in particular subfields, such as stroke,dementia,movement disorders,neurointensive care, headaches,epilepsy,sleep disorders, chronicpain management,multiple sclerosis, orneuromuscular diseases.
Some overlap also occurs with other specialties, varying from country to country and even within a local geographic area. Acutehead trauma is most often treated by neurosurgeons, whereassequelae of head trauma may be treated by neurologists orspecialists in rehabilitation medicine. Although stroke cases have been traditionally managed by internal medicine or hospitalists, the emergence of vascular neurology andinterventional neuroradiology has created a demand for stroke specialists. The establishment ofJoint Commission-certified stroke centers has increased the role of neurologists in stroke care in many primary, as well as tertiary, hospitals. Some cases of nervous systeminfectious diseases are treated by infectious disease specialists. Most cases of headache are diagnosed and treated primarily bygeneral practitioners, at least the less severe cases. Likewise, most cases ofsciatica are treated by general practitioners, though they may be referred to neurologists or surgeons (neurosurgeons ororthopedic surgeons).Sleep disorders are also treated bypulmonologists andpsychiatrists.Cerebral palsy is initially treated bypediatricians, but care may be transferred to an adult neurologist after the patient reaches a certain age.Physical medicine and rehabilitation physicians may treat patients with neuromuscular diseases with electrodiagnostic studies (needle EMG and nerve-conduction studies) and other diagnostic tools. In the United Kingdom and other countries, many of the conditions encountered by older patients such as movement disorders, including Parkinson's disease, stroke, dementia, or gait disorders, are managed predominantly by specialists ingeriatric medicine.
In the past, prior to the advent of more advanced diagnostic techniques such asMRI some neurologists have considered psychiatry and neurology to overlap. Althoughmental illnesses are believed by many[weasel words] to be neurological disorders affecting the central nervous system, traditionally they are classified separately, and treated bypsychiatrists. In a 2002 review article in theAmerican Journal of Psychiatry, Professor Joseph B. Martin, Dean ofHarvard 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".[25]
Neurological disorders often havepsychiatric manifestations, such as post-stroke depression, depression anddementia associated withParkinson's disease, mood and cognitive dysfunctions in Alzheimer's disease, andHuntington disease, to name a few. Hence, the sharp distinction between neurology and psychiatry is not always on a biological basis. The dominance ofpsychoanalytic theory in the first three-quarters of the 20th century has since then been largely replaced by a focus on pharmacology.[26] Despite the shift to a medicalmodel, brain science has not advanced to a point where scientists orclinicians can point to readily discernible pathological lesions or genetic abnormalities that in and of themselves serve as reliable or predictivebiomarkers of a given mental disorder.
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.[27] However, this field has also given rise to questions aboutneuroethics.
^abVal Danilov I (2023). "The Origin of Natural Neurostimulation: A Narrative Review of Noninvasive Brain Stimulation Techniques."OBM Neurobiology 2024; 8(4): 260;https://doi:10.21926/obm.neurobiol.2404260.
^"Neurological Disorders".Johns Hopkins Department of Neurology. 24 February 2020.Archived from the original on 15 September 2021. Retrieved15 September 2021.
^LaFaver K, LaFrance WC, Price ME, Rosen PB, Rapaport M (2021). "Treatment of functional neurological disorder: current state, future directions, and a research agenda".CNS Spectrums. 2021;26(6):607-613. doi:10.1017/S1092852920002138
^Martin JB (May 2002). "The integration of neurology, psychiatry, and neuroscience in the 21st century".The American Journal of Psychiatry.159 (5):695–704.doi:10.1176/appi.ajp.159.5.695.PMID11986119.
