Medical specialty concerned with nervous system function and disorders. Clinical neurology began in the mid-19th century, when mapping of the functional areas of the brain first began and understanding of the causes of conditions such as epilepsy improved. The development of electroencephalography in the 1920s aided in the diagnosis of neurological disease, as did the development of computerized axial tomography in the 1970s and nuclear magnetic resonance imaging in the 1980s. In addition to dealing with physical disorders (e.g., tumours, trauma), neurology is unique among medical specialties in its intersection with psychiatry. Greater understanding of the brain chemistry of disorders such as schizophrenia and depression has led to a wide array of effective drugs that nevertheless work best in conjunction with psychotherapy. Side effects of drug or surgical therapy can be serious, and many nervous system disorders have no effective treatment.
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Neurology (from Greek νεῦρον, neuron, "nerve"; and -λογία, -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. Physicians who specialize in neurology are called neurologists, and are 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.
Major conditions include:
Neurologists complete, on average, 12 years of postsecondary 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 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.
Many neurologists also have additional subspecialty training (fellowships) after completing their residency in one area of neurology such as stroke, interventional neurology, epilepsy, neuromuscular, sleep medicine, pain management, neuroimmunology, clinical neurophysiology, or movement disorders.
In the United Kingdom and Ireland, neurology is a subspecialty of general (internal) medicine. After five or six years of medical school and a year as a pre-registration house officer (or two years on the new Foundation Programme) a would-be neurologist has to get enough training in internal medicine to 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 rehabiltation, which may include stroke medicine as well as brain injuries.
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.
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.
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).
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 VIJAY, 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 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.)
In Germany, a compulsory year of Psychiatry must be done to complete a residency of Neurology.
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