Neurology (from Greek Ancient Greek is the historical stage in the development of the Greek language spanning the Archaic , Classical (c. 5th–4th centuries BC), and Hellenistic (c. 3rd century BC – 6th century AD) periods of ancient Greece and the ancient world. It is predated in the 2nd millennium BC by Mycenaean Greek. Its Hellenistic phase is known as Koine (& νεῦρον, neuron, "nerve"; and -λογία, -logia) is a medical specialty A specialty in medicine is a branch of medical science. After completing medical school, physicians or surgeons usually further their medical education in a specific specialty of medicine by completing a multiple year residency. Medical practitioners who engage in a medical specialty are known as medical specialists dealing with disorders of the nervous system A neurological disorder is a disorder of the body's nervous system. Structural, biochemical or electrical abnormalities in the brain or spinal cord, or in the nerves leading to or from them, can result in symptoms such as paralysis, muscle weakness, poor coordination, loss of sensation, seizures, confusion, pain and altered levels of consciousness. Specifically, it deals with the diagnosis and treatment of all categories of disease involving the central The central nervous system is the part of the nervous system that coordinates the activity of all parts of the bodies of bilaterian animals—that is, all multicellular animals except sponges and radially symmetric animals such as jellyfish. It contains the majority of the nervous system and consists of the brain and the spinal cord, as well as, peripheral The Peripheral Nervous System resides or extends outside the central nervous system (CNS), which consists of the brain and spinal cord. The main function of the PNS is to connect the CNS to the limbs and organs. Unlike the central nervous system, the PNS is not protected by bone or by the blood-brain barrier, leaving it exposed to toxins and, and autonomic nervous systems The autonomic nervous system is the part of the peripheral nervous system that acts as a control system functioning largely below the level of consciousness, and controls visceral functions. The ANS affects heart rate, digestion, respiration rate, salivation, perspiration, diameter of the pupils, micturition (urination), and sexual arousal, including their coverings, blood vessels, and all effector tissue, such as muscle.^[1] The corresponding surgical Surgery is a medical specialty that uses operative manual and instrumental techniques on a patient to investigate and/or treat a pathological condition such as disease or injury, to help improve bodily function or appearance, and sometimes for religious reasons. An act of performing surgery may be called a surgical procedure, operation, or simply specialty is neurosurgery Neurosurgery is the medical specialty concerned with the prevention, diagnosis, treatment and rehabilitation of disorders that affect the entire nervous system including the brain, spinal column, spinal cord, peripheral nerves, and extra-cranial cerbrovascular system. A neurologist is a physician A physician—also known as doctor of medicine, medical doctor, or simply doctor—practices the ancient profession of medicine, which is concerned with maintaining or restoring human health through the study, diagnosis, and treatment of disease or injury. This properly requires both a detailed knowledge of the academic disciplines underlying 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 research is a branch of medical science that determines the safety and effectiveness of medications, devices, diagnostic products and treatment regimens intended for human use. These may be used for prevention, treatment, diagnosis or for relieving symptoms of a disease, clinical trials Clinical Trials are conducted to allow safety and efficacy data to be collected for health interventions . These trials can take place only after satisfactory information has been gathered on the quality of the non-clinical safety, and Health Authority/Ethics Committee approval is granted in the country where the trial is taking place, as well as basic research Basic research or fundamental research is research carried out to increase understanding of fundamental principles. Many times the end results have no direct or immediate commercial benefits: basic research can be thought of as arising out of curiosity. However, in the long term it is the basis for many commercial products and applied research and translational research Translational research is another term for translative research and translational science, although it fails to disambiguate itself from forms of research that are not scientific , which are currently considered outside its scope. Translational research is a way of thinking about and conducting scientific research to make the results of research.

Field of work

A large number This is a list of major and frequently observed neurological disorders , symptoms (e.g., back pain), signs (e.g., aphasia) and syndromes (e.g., Aicardi syndrome) of Neurological disorders A neurological disorder is a disorder of the body's nervous system. Structural, biochemical or electrical abnormalities in the brain or spinal cord, or in the nerves leading to or from them, can result in symptoms such as paralysis, muscle weakness, poor coordination, loss of sensation, seizures, confusion, pain and altered levels of consciousness have been described. These can affect the central nervous system The central nervous system is the part of the nervous system that coordinates the activity of all parts of the bodies of bilaterian animals—that is, all multicellular animals except sponges and radially symmetric animals such as jellyfish. It contains the majority of the nervous system and consists of the brain and the spinal cord, as well as (brain The brain is the center of the nervous system in all vertebrate, and most invertebrate, animals. Some primitive animals such as jellyfish and starfish have a decentralized nervous system without a brain, while sponges lack any nervous system at all. In vertebrates, the brain is located in the head, protected by the skull and close to the primary and spinal cord The spinal cord is a long, thin, tubular bundle of nervous tissue and support cells that extends from the brain . The brain and spinal cord together make up the central nervous system. The spinal cord extends down to the space between the first and second lumbar vertebrae; it does not extend the entire length of the vertebral column. It is around 4), the peripheral nervous system The Peripheral Nervous System resides or extends outside the central nervous system (CNS), which consists of the brain and spinal cord. The main function of the PNS is to connect the CNS to the limbs and organs. Unlike the central nervous system, the PNS is not protected by bone or by the blood-brain barrier, leaving it exposed to toxins and, or the autonomic nervous system The autonomic nervous system is the part of the peripheral nervous system that acts as a control system functioning largely below the level of consciousness, and controls visceral functions. The ANS affects heart rate, digestion, respiration rate, salivation, perspiration, diameter of the pupils, micturition (urination), and sexual arousal.

Qualifications

In the United States and Canada, neurologists are physicians who have completed postgraduate training in neurology after graduation from medical school A medical school is a tertiary educational institution—or part of such an institution—that teaches medicine. In addition to a medical degree program, some medical schools offer programs leading to a Master's Degree, Doctor of Philosophy (PhD), Bachelor/Doctor of Medicine (MBBS, BMed, MDCM, MD, MBChB, etc), Doctor of Osteopathic Medicine (DO-. 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 Sleep medicine is a medical specialty or subspecialty devoted to the diagnosis and therapy of sleep disturbances and disorders. From the middle of the 20th century, research has provided increasing knowledge and answered many questions about sleep-wake functioning. The rapidly evolving field has become a recognized medical subspecialty in some, 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 Membership of the Royal Colleges of Physicians (MRCP is a postgraduate medical diploma. The examinations are run by the Federation of the Medical Royal Colleges of the United Kingdom (UK) – the Royal College of Physicians of London, the Royal College of Physicians of Edinburgh, and the Royal College of Physicians and Surgeons of Glasgow. The (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 Physical medicine and rehabilitation , or physiatry (pronounced /fɪ.zi.ˈæ.tri/ or /fɪ.ˈzaɪ.ə.tri/), is a branch of medicine which aims to enhance and restore functional ability and quality of life to those with physical impairments or disabilities. A physician who has completed training in this field is referred to as a physiatrist. In in the US) to specialise in neurological rehabilitation, which may include stroke medicine as well as brain injuries.

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 Cranial nerves are nerves that emerge directly from the brain stem, in contrast to spinal nerves which emerge from segments of the spinal cord (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.

Many symptoms that may occur would involve: tension, sleep loss, headaches and anger.

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 Neurosurgery is the medical specialty concerned with the prevention, diagnosis, treatment and rehabilitation of disorders that affect the entire nervous system including the brain, spinal column, spinal cord, peripheral nerves, and extra-cranial cerbrovascular system. In some countries, additional legal responsibilities of a neurologist may include making a finding of brain death Brain death is a legal indicator of death in the USA that refers to the irreversible end of all brain activity due to total necrosis of the cerebral neurons following loss of blood flow and oxygenation. Brain-stem death (not whole brain death) is taken to be the significant indicator of death. The significant point is that the brain is no longer when it is suspected that a patient A patient is any person who receives medical attention, care, or treatment. The person is most often ill or injured and in need of treatment by a physician or other health care professional, although one who is visiting a physician for a routine check-up may also be viewed as a patient is deceased Death is the termination of the biological functions that define a living organism. The word refers both to a particular process and to the condition that results thereby. The nature of the latter has been for millennia a central concern of the world's religious traditions and of philosophical enquiry. Belief in some kind of afterlife or rebirth. Neurologists frequently care for people with hereditary (genetic A gene is a unit of heredity in a living organism. It is normally a stretch of DNA that codes for a type of protein or for an RNA chain that has a function in the organism. All living things depend on genes, as they specify all proteins and functional RNA chains. Genes hold the information to build and maintain an organism's cells and pass genetic) diseases when the major manifestations are neurological, as is frequently the case. Lumbar punctures In medicine, a lumbar puncture is a diagnostic and at times therapeutic procedure that is performed in order to collect a sample of cerebrospinal fluid (CSF) for biochemical, microbiological, and cytological analysis, or very rarely as a treatment ("therapeutic lumbar puncture") to relieve increased intracranial pressure are frequently performed by neurologists Neurology 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. Some neurologists may develop an interest in particular subfields, such as dementia Dementia is a serious loss of cognitive ability in a previously unimpaired person, beyond what might be expected from normal aging. It may be static, the result of a unique global brain injury, or progressive, resulting in long-term decline due to damage or disease in the body. Although dementia is far more common in the geriatric population, it, movement disorders Personality disorder · Impulse control disorder · Factitious disorder (Munchausen syndrome), headaches A headache or cephalgia is pain anywhere in the region of the head or neck. It can be a symptom of a number of different conditions of the head and neck. The brain tissue itself is not sensitive to pain because it lacks pain receptors. Rather, the pain is caused by disturbance of the pain-sensitive structures around the brain. Several areas of the, epilepsy Epilepsy (from the Ancient Greek ἐπιληψία — "to seize") is a common chronic neurological disorder characterized by recurrent unprovoked seizures. These seizures are transient signs and/or symptoms of abnormal, excessive or synchronous neuronal activity in the brain. About 50 million people worldwide have epilepsy, with almost 9, sleep disorders A sleep disorder is a medical disorder of the sleep patterns of a person or animal. Some sleep disorders are serious enough to interfere with normal physical, mental and emotional functioning. A test commonly ordered for some sleep disorders is the polysomnography, chronic pain Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage. It is the feeling common to such experiences as stubbing a toe, burning a finger, putting iodine on a cut, and bumping the "funny bone" management, multiple sclerosis Multiple sclerosis is a disease in which the fatty myelin sheaths around the axons of the brain and spinal cord are damaged, leading to demyelination and scarring as well as a broad spectrum of signs and symptoms. Disease onset usually occurs in young adults, and it is more common in females. It has a prevalence that ranges between 2 and 150 per 10 or neuromuscular A neuromuscular junction is the synapse or junction of the axon terminal of a motoneuron with the motor end plate, the highly-excitable region of muscle fiber plasma membrane responsible for initiation of action potentials across the muscle's surface, ultimately causing the muscle to contract. In vertebrates, the signal passes through the 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 Traumatic brain injury occurs when an external force traumatically injures the brain. TBI can be classified based on severity, mechanism (closed or penetrating head injury), or other features (e.g. occurring in a specific location or over a widespread area). Head injury usually refers to TBI, but is a broader category because it can involve damage is most often treated by neurosurgeons Neurosurgery is the medical specialty concerned with the prevention, diagnosis, treatment and rehabilitation of disorders that affect the entire nervous system including the brain, spinal column, spinal cord, peripheral nerves, and extra-cranial cerbrovascular system, whereas sequelae A sequela, is a pathological condition resulting from a disease, injury, or other trauma of head trauma may be treated by neurologists or specialists in rehabilitation medicine Physical medicine and rehabilitation , or physiatry (pronounced /fɪ.zi.ˈæ.tri/ or /fɪ.ˈzaɪ.ə.tri/), is a branch of medicine which aims to enhance and restore functional ability and quality of life to those with physical impairments or disabilities. A physician who has completed training in this field is referred to as a physiatrist. In. 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 An infectious disease is a clinically evident illness resulting from the presence of pathogenic microbial agents, including pathogenic viruses, pathogenic bacteria, fungi, protozoa, multicellular parasites, and aberrant proteins known as prions. These pathogens are able to cause disease in animals and/or plants. Infectious pathologies are also are treated by infectious disease specialists. Most cases of headache A headache or cephalgia is pain anywhere in the region of the head or neck. It can be a symptom of a number of different conditions of the head and neck. The brain tissue itself is not sensitive to pain because it lacks pain receptors. Rather, the pain is caused by disturbance of the pain-sensitive structures around the brain. Several areas of the are diagnosed and treated primarily by general practitioners A general practitioner or GP is a medical practitioner who provides primary care and specializes in nothing and sees everything. A general practitioner treats acute and chronic illnesses and provides preventive care and health education for all ages and both sexes. They have particular skills in treating people with multiple health issues and, at least the less severe cases. Similarly, most cases of sciatica Sciatica is a set of symptoms including pain that may be caused by general compression and/or irritation of one of five spinal nerve roots that give rise to each sciatic nerve, or by compression or irritation of the left or right or both sciatic nerves. The pain is felt in the lower back, buttock, and/or various parts of the leg and foot. In and other mechanical radiculopathies are treated by general practitioners, though they may be referred to neurologists or a surgeon (neurosurgeons or orthopedic surgeons Orthopedic surgery or orthopedics (orthopaedic doctors above the rank of SHO/FY2 are also called orthopods) is the branch of surgery concerned with conditions involving the musculoskeletal system. Orthopedic surgeons use both surgical and nonsurgical means to treat musculoskeletal trauma, sports injuries, degenerative diseases, infections, tumors,). Sleep disorders A sleep disorder is a medical disorder of the sleep patterns of a person or animal. Some sleep disorders are serious enough to interfere with normal physical, mental and emotional functioning. A test commonly ordered for some sleep disorders is the polysomnography 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.^[2]

There are strong indications^{[citation needed]} 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 and Huntington 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

• List of neurologists

References

1. ^ Acgme.org
2. ^ 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. PMID 11986119. http://www.ajp.psychiatryonline.org/cgi/content/full/159/5/695.

External links

• American Academy of Neurology
• American Neurological Association
• European Federation of Neurological Societies
• European Journal of Neurology
• National Institute of Neurological Disorders and Stroke (NINDS)
• Neurology, official journal of the AAN
• Therapeutic Guidelines – Neurology
• United Council for Neurologic Subspecialties
• NeurologyExam.com - Free neurology exam videos, templates, links, & recommended tools.
• Neurological Institute of New York

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