Neurology (from
Greek ,
neuron, "nerve"; and ,
-logia) is a
medical specialty dealing with disorders of the nervous system. Specifically, it deals with the diagnosis and treatment of all categories of disease involving the
central,
peripheral, and
autonomic nervous systems, including their coverings, blood vessels, and all effector tissue, such as muscle. The corresponding
surgical specialty is
neurosurgery. A
neurologist is a
physician who specializes in neurology, and is trained to investigate, or diagnose and treat neurological disorders. Pediatric neurologists treat neurological disease in children. Neurologists may also be involved in
clinical research,
clinical trials, as well as
basic research and
translational research. In the United Kingdom, contributions to the field of neurology stem from various professions; saliently, several biomedical research scientists are choosing to specialize in the technical/laboratory aspects of one of neurology's subdisciplines.
Field of work
Neurological disorders are disorders that can affect the
central nervous system (
brain and
spinal cord), the
peripheral nervous system, or the
autonomic nervous system.
Conditions can include but are not limited to:
Educational requirements
In the United States and Canada, neurologists are physicians who have completed postgraduate training in neurology after graduation from
medical school. Neurologists complete, on average, at least 12 years of college education and clinical training. This training includes obtaining a four-year undergraduate degree, a medical degree, which is an additional four years, and then completing a three or four-year residency in neurology. The four-year residency consists of one year of internal medicine training followed by three years of training in neurology. One and two year fellowships are available following completion of the neurology residency if desired.
Many neurologists also have additional subspecialty training (fellowships) after completing their residency in one area of neurology such as stroke or vascular neurology,
interventional neurology, epilepsy, neuromuscular, neurorehabilitation, behavioral neurology,
sleep medicine, pain management, neuroimmunology, clinical neurophysiology, or movement disorders.
In Germany, a compulsory year of psychiatry must be done to complete a residency of neurology.
In the United Kingdom and Ireland, neurology is a subspecialty of general (internal) medicine. After five to nine years of medical school and a year as a pre-registration house officer (or two years on the Foundation Programme) a neurologist must pass the examination for
Membership of the Royal College of Physicians (or the Irish equivalent) before entering specialist training in neurology. A generation ago some neurologists would also spend a couple of years working in psychiatric units and obtain a Diploma in Psychological Medicine, but that became uncommon and now that a basic psychiatric qualification takes three years to obtain it is no longer 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 at Queen Square in London. Some neurologists enter the field of rehabilitation medicine (known as
physiatry in the US) to specialise in neurological rehabilitation, which may include stroke medicine as well as brain injuries.
In India, a candidate aspiring to be a neurologist must complete a three year residency in Medicine, followed by a three year fellowship course in neurology at a teaching hospital recognized by the
Medical Council of India or the
National Board of Examinations. At the end of the course an examination is held and a degree of DM(Neurology) or DNB(Neurology) is awarded. The course can only be done by those who are in possession of an MD(Medicine) or a DNB(Medicine) degree. However, some institutions offer a five year integrated course leading to the award of the DM in neurology, which can be taken directly after completion of the M.B.B.S degree.
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 mental status, function of the
cranial nerves (including 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 neurologists 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. 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. Some 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
sequelae 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
interventional neurologists has created a demand for stroke specialists. The establishment of
JCAHO certified 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. 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 in
geriatric medicine.
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
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.There are strong indications that neurochemical mechanisms play an important role in the development of, for instance,
bipolar disorder and
schizophrenia. Also, "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 reasoning and strong historical roots (such as the dominance of
Freud's
psychoanalytic theory 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.)
See also
