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Neurology (from el, νεῦρον (neûron), "string, nerve" and the suffix -logia, "study of") is the branch of
medicine Medicine is the science and practice of caring for a patient, managing the diagnosis, prognosis, prevention, treatment, palliation of their injury or disease, and promoting their health. Medicine encompasses a variety of health care pr ...
dealing with the diagnosis and treatment of all categories of conditions and disease involving the brain, the spinal cord and the peripheral nerves. Neurological practice relies heavily on the field of
neuroscience Neuroscience is the science, scientific study of the nervous system (the brain, spinal cord, and peripheral nervous system), its functions and disorders. It is a Multidisciplinary approach, multidisciplinary science that combines physiology, an ...
, the scientific study of the
nervous system In biology, the nervous system is the highly complex part of an animal that coordinates its actions and sensory information by transmitting signals to and from different parts of its body. The nervous system detects environmental changes ...
. A neurologist is a physician specializing in neurology and trained to investigate, diagnose and treat neurological disorders. Neurologists treat a myriad of neurologic conditions, including stroke, seizures, movement disorders such as
Parkinson's disease Parkinson's disease (PD), or simply Parkinson's, is a long-term degenerative disorder of the central nervous system that mainly affects the motor system. The symptoms usually emerge slowly, and as the disease worsens, non-motor symptoms beco ...
, autoimmune neurologic disorders such as multiple sclerosis, headache disorders like migraine and
dementia Dementia is a disorder which manifests as a set of related symptoms, which usually surfaces when the brain is damaged by injury or disease. The symptoms involve progressive impairments in memory, thinking, and behavior, which negatively affe ...
s such as Alzheimer's disease. Neurologists may also be involved in
clinical research Clinical research is a branch of healthcare science that determines the safety and effectiveness ( efficacy) of medications, devices, diagnostic products and treatment regimens intended for human use. These may be used for prevention, treat ...
,
clinical trial Clinical trials are prospective biomedical or behavioral research studies on human participants designed to answer specific questions about biomedical or behavioral interventions, including new treatments (such as novel vaccines, drugs, diet ...
s, and basic or translational research. While neurology is a nonsurgical specialty, its corresponding surgical specialty is neurosurgery.


History

The academic discipline began between the 15th and 16th centuries with the work and research of many neurologists such as Thomas Willis, Robert Whytt,
Matthew Baillie Matthew Baillie FRS (27 October 1761 – 23 September 1823) was a British physician and pathologist, credited with first identifying transposition of the great vessels (TGV) and situs inversus. Early life and education He was born in the manse ...
, Charles Bell,
Moritz Heinrich Romberg Moritz Heinrich Romberg (11 November 1795 – 16 June 1873) was a German physician and neurologist, born in Meiningen, who published his classic textbook in sections between 1840 and 1846; Edward Henry Sieveking translated it into English in 185 ...
, Duchenne de Boulogne,
William A. Hammond William Alexander Hammond (28 August 1828 – 5 January 1900) was an American military physician and neurologist. During the American Civil War he was the eleventh Surgeon General of the United States Army (1862–1864) and the founder of the A ...
, Jean-Martin Charcot,
C. Miller Fisher Charles Miller Fisher (December 5, 1913, Waterloo, Ontario – April 14, 2012, Albany, New York) was a Canadian neurologist whose notable contributions include the first detailed descriptions of lacunar strokes, the identification of transient ...
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.


Training

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 Residency may refer to: * Domicile (law), the act of establishing or maintaining a residence in a given place ** Permanent residency, indefinite residence within a country despite not having citizenship * Residency (medicine), a stage of postgrad ...
specializing in neurology after graduation from medical school. This additional training period typically lasts five years, with the first year devoted to training in internal medicine. On average, neurologists complete a total of eight to ten years of training. This includes four years of medical school, five years of residency and an optional one to two years of fellowship. 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 fellowships, and are one to two years in duration. Subspecialties include brain injury medicine, clinical neurophysiology,
epilepsy Epilepsy is a group of non-communicable neurological disorders characterized by recurrent epileptic seizures. Epileptic seizures can vary from brief and nearly undetectable periods to long periods of vigorous shaking due to abnormal electrica ...
, neurodevelopmental disabilities, neuromuscular medicine,
pain medicine Pain management is an aspect of medicine and health care involving relief of pain (pain relief, analgesia, pain control) in various dimensions, from acute and simple to chronic and challenging. Most physicians and other health professional ...
, sleep medicine, neurocritical care, vascular neurology (stroke), 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. 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
Membership of the Royal College of Physicians Member may refer to: * Military jury, referred to as "Members" in military jargon * Element (mathematics), an object that belongs to a mathematical set * In object-oriented programming, a member of a class ** Field (computer science), entries ...
(or the Irish equivalent) and complete two years of core medical training before entering specialist training in neurology. 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 the
MRCPsych Member of the Royal College of Psychiatrists (MRCPsych) is a postnominal qualification awarded to physicians who have completed the prescribed training requirements and membership examinations mandated by the Royal College of Psychiatrists. MRCPsyc ...
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 at Queen Square, 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 traumatic brain injuries.


Physical 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.


Clinical tasks

Neurologists examine patients who are referred to them by other physicians in both the inpatient and
outpatient A patient is any recipient of health care services that are performed by healthcare professionals. The patient is most often ill or injured and in need of treatment by a physician, nurse, optometrist, dentist, veterinarian, or other health care ...
settings. Neurologists begin their interactions with patients by taking a comprehensive medical history, and then performing a physical examination focusing on evaluating the nervous system. Components of the neurological examination include assessment of the patient's cognitive function, cranial nerves, motor strength,
sensation Sensation (psychology) refers to the processing of the senses by the sensory system. Sensation or sensations may also refer to: In arts and entertainment In literature * Sensation (fiction), a fiction writing mode * Sensation novel, a Briti ...
, reflexes, coordination, and gait. In some instances, neurologists may order additional
diagnostic tests A medical test is a medical procedure performed to detect, diagnose, or monitor diseases, disease processes, susceptibility, or to determine a course of treatment. Medical tests such as, physical and visual exams, diagnostic imaging, genetic t ...
as part of the evaluation. Commonly employed tests in neurology include imaging studies such as computed axial tomography (CAT) scans, magnetic resonance imaging (MRI), and ultrasound of major blood vessels of the head and neck. Neurophysiologic studies, including electroencephalography (EEG), needle electromyography (EMG), nerve conduction studies (NCSs) and evoked potentials are also commonly ordered. Neurologists frequently perform lumbar punctures to assess characteristics of a patient's
cerebrospinal fluid Cerebrospinal fluid (CSF) is a clear, colorless body fluid found within the tissue that surrounds the brain and spinal cord of all vertebrates. CSF is produced by specialised ependymal cells in the choroid plexus of the ventricles of the ...
. 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,
radiculopathy Radiculopathy, also commonly referred to as pinched nerve, refers to a set of conditions in which one or more nerves are affected and do not work properly (a neuropathy). Radiculopathy can result in pain ( radicular pain), weakness, altered sen ...
, neuropathy, stroke,
dementia Dementia is a disorder which manifests as a set of related symptoms, which usually surfaces when the brain is damaged by injury or disease. The symptoms involve progressive impairments in memory, thinking, and behavior, which negatively affe ...
,
seizure An epileptic seizure, informally known as a seizure, is a period of symptoms due to abnormally excessive or synchronous neuronal activity in the brain. Outward effects vary from uncontrolled shaking movements involving much of the body with lo ...
s and
epilepsy Epilepsy is a group of non-communicable neurological disorders characterized by recurrent epileptic seizures. Epileptic seizures can vary from brief and nearly undetectable periods to long periods of vigorous shaking due to abnormal electrica ...
, Alzheimer's disease, attention deficit/hyperactivity disorder,
Parkinson's disease Parkinson's disease (PD), or simply Parkinson's, is a long-term degenerative disorder of the central nervous system that mainly affects the motor system. The symptoms usually emerge slowly, and as the disease worsens, non-motor symptoms beco ...
, Tourette's syndrome, multiple sclerosis, 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. Other neurologists specialize in the use of
electrodiagnostic medicine Electrodiagnosis (EDX) is a method of medical diagnosis that obtains information about diseases by passively recording the electrical activity of body parts (that is, their natural electrophysiology) or by measuring their response to external elec ...
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. The American Board of Electrodiagnostic Medicine certifies US physicians in
electrodiagnostic medicine Electrodiagnosis (EDX) is a method of medical diagnosis that obtains information about diseases by passively recording the electrical activity of body parts (that is, their natural electrophysiology) or by measuring their response to external elec ...
and certifies technologists in nerve-conduction studies. Sleep medicine is a subspecialty field in the US under several medical specialties including
anesthesiology Anesthesiology, anaesthesiology, or anaesthesia is the medical specialty concerned with the total perioperative care of patients before, during and after surgery. It encompasses anesthesia, intensive care medicine, critical emergency medicine, ...
, internal medicine, family medicine, and neurology. 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
neuroscience Neuroscience is the science, scientific study of the nervous system (the brain, spinal cord, and peripheral nervous system), its functions and disorders. It is a Multidisciplinary approach, multidisciplinary science that combines physiology, an ...
and neurology. Many neurologists work in academic training hospitals, where they conduct research as neuroscientists in addition to treating patients and teaching neurology to 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 neurosurgeon or an interventional 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 by neurologists. Some neurologists may develop an interest in particular subfields, such as stroke,
dementia Dementia is a disorder which manifests as a set of related symptoms, which usually surfaces when the brain is damaged by injury or disease. The symptoms involve progressive impairments in memory, thinking, and behavior, which negatively affe ...
, movement disorders,
neurointensive care Neurocritical care (or neurointensive care) is a medical field that treats life-threatening diseases of the nervous system and identifies, prevents, and treats secondary brain injury. History There have been many attempts to manage head inju ...
, headaches,
epilepsy Epilepsy is a group of non-communicable neurological disorders characterized by recurrent epileptic seizures. Epileptic seizures can vary from brief and nearly undetectable periods to long periods of vigorous shaking due to abnormal electrica ...
, sleep disorders, chronic pain management, multiple sclerosis, or neuromuscular diseases.


Overlapping areas

Some overlap also occurs 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 neuroradiology Endovascular therapy (EVT), also known as neurointerventional surgery (NIS), interventional neuroradiology (INR), endovascular neurosurgery, and interventional neurology is a medical subspecialty of radiology, neurosurgery, and neurology speciali ...
has created a demand for stroke specialists. The establishment of Joint 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 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. Likewise, most cases of sciatica are treated by general practitioners, though they may be referred to neurologists or surgeons (neurosurgeons or
orthopedic surgeons Orthopedic surgery or orthopedics ( alternatively spelt orthopaedics), is the branch of surgery concerned with conditions involving the musculoskeletal system. Orthopedic surgeons use both surgical and nonsurgical means to treat musculoskeletal ...
). Sleep disorders are also treated by pulmonologists and psychiatrists.
Cerebral palsy Cerebral palsy (CP) is a group of movement disorders that appear in early childhood. Signs and symptoms vary among people and over time, but include poor coordination, stiff muscles, weak muscles, and tremors. There may be problems with sens ...
is initially treated by pediatricians, but care may be transferred to an adult neurologist after the patient reaches a certain age.
Physical medicine and rehabilitation Physical medicine and rehabilitation, also known as physiatry, is a branch of medicine that aims to enhance and restore functional ability and quality of life to people with physical impairments or disabilities. This can include conditions s ...
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 in geriatric medicine. Clinical neuropsychologists are often called upon to
evaluate Evaluation is a systematic determination and assessment of a subject's merit, worth and significance, using criteria governed by a set of standards. It can assist an organization, program, design, project or any other intervention or initiative ...
brain- behavior relationships for the purpose of assisting with differential diagnosis, planning
rehabilitation Rehabilitation or Rehab may refer to: Health * Rehabilitation (neuropsychology), therapy to regain or improve neurocognitive function that has been lost or diminished * Rehabilitation (wildlife), treatment of injured wildlife so they can be retur ...
strategies, documenting cognitive strengths and weaknesses, and measuring change over time (e.g., for identifying abnormal aging or tracking the progression of a
dementia Dementia is a disorder which manifests as a set of related symptoms, which usually surfaces when the brain is damaged by injury or disease. The symptoms involve progressive impairments in memory, thinking, and behavior, which negatively affe ...
)


Relationship to clinical neurophysiology

In some countries such as the United States and Germany, neurologists may subspecialize in clinical neurophysiology, the field responsible for EEG and intraoperative monitoring, or in electrodiagnostic medicine nerve conduction studies, EMG, and evoked potentials. In other countries, this is an autonomous specialty (e.g., United Kingdom, Sweden, Spain).


Overlap with psychiatry

In the past, prior to the advent of more advanced diagnostic techniques such as MRI some neurologists have considered psychiatry and neurologic to overlap. Although mental illnesses are believed by many 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 Harvard Medical School (HMS) is the graduate medical school of Harvard University and is located in the Longwood Medical Area of Boston, Massachusetts. Founded in 1782, HMS is one of the oldest medical schools in the United States and is cons ...
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". Neurological disorders often have psychiatric manifestations, such as post-stroke depression, depression and
dementia Dementia is a disorder which manifests as a set of related symptoms, which usually surfaces when the brain is damaged by injury or disease. The symptoms involve progressive impairments in memory, thinking, and behavior, which negatively affe ...
associated with
Parkinson's disease Parkinson's disease (PD), or simply Parkinson's, is a long-term degenerative disorder of the central nervous system that mainly affects the motor system. The symptoms usually emerge slowly, and as the disease worsens, non-motor symptoms beco ...
, mood and cognitive dysfunctions in Alzheimer's disease, and Huntington disease, to name a few. Hence, the sharp distinction between neurology and psychiatry is not always on a biological basis. The dominance of psychoanalytic theory in the first three-quarters of the 20th century has since then been largely replaced by a focus on pharmacology. Despite the shift to a medical model, brain science has not advanced to a point where scientists or clinicians can point to readily discernible pathological lesions or genetic abnormalities that in and of themselves serve as reliable or predictive 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. However, this field has also given rise to questions about neuroethics and the
psychopharmacology Psychopharmacology (from Greek grc, ψῡχή, psȳkhē, breath, life, soul, label=none; grc, φάρμακον, pharmakon, drug, label=none; and grc, -λογία, -logia, label=none) is the scientific study of the effects drugs have on mo ...
of
lifestyle drugs Lifestyle drug is an imprecise term commonly applied to medications which treat non–life-threatening and non-painful conditions such as baldness, wrinkles, erectile dysfunction, or acne, which the speaker perceives as either not medical problems ...
can have negative and positive effects on neurology because different types of drugs can depend on people and their lives heyanne l.dorsey


See also

* American Board of Psychiatry and Neurology * American Osteopathic Board of Neurology and Psychiatry * ''
Developmental Neurorehabilitation ''Developmental Neurorehabilitiation'' is a peer-reviewed medical journal which covers research into recovery and rehabilitation in children with brain injury and neurological disorders. The editors of Developmental Neurorehabilitation' arRussel ...
'' *
List of neurologists This is a list of neurologists and neurosurgeons, with their year of birth and death and nationality. This list compiles the names of neurologists and neurosurgeons with a corresponding Wikipedia biographical article, and is not necessarily a refle ...
* List of women neuroscientists * Neuroepigenetics *
Neurohospitalist Neurohospitalist is a term used for physicians interested in inpatient neurological care. It is an emerging subspecialty of neurology Neurology (from el, νεῦρον (neûron), "string, nerve" and the suffix -logia, "study of") is the bra ...
, a physician interested in inpatient neurological care


References

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