Neurology

Neurology is a branch of medical science that is concerned with disorders and diseases of the nervous system. The term neurology comes from a combination of two words - "neuron" meaning nerve and "logia" meaning "the study of". Neurology deals with the diagnosis and treatment of all categories of conditions and disease involving the central and peripheral nervous systems (and their subdivisions, the autonomic and somatic nervous systems), including their coverings, blood vessels, and all effector tissue, such as muscle. Neurological practice relies heavily on the field of neuroscience, the scientific study of the nervous system.

What Neurologists treat

Neurologists treat a wide variety of conditions.

There are around a hundred billion neurons in the brain, capable of generating their own impulses and of receiving and transmitting impulses from neighbouring cells. Neurology involves the study of:

• The central nervous system, the peripheral nervous system and the autonomic nervous system.
• Structural and functional disorders of the nervous system ranging from birth defects through to degenerative diseases such as Parkinson's disease and Alzheimer's disease.

Neurologists are usually physicians but they may also refer their patients to surgeons specializing in neurology called neurosurgeons. Some examples of the diseases and disorders neurologists may treat include stroke, Alzheimer's disease, Parkinson's disease, multiple sclerosis, amyotropic lateral sclerosis, migraine, epilepsy, sleep disorders, pain, tremors, brain and spinal cord injury, peripheral nerve disease and brain tumors. Neurology also involves understanding and interpreting imaging and electrical studies. Examples of the imaging studies used include computed tomography (CT) scans and magnetic resonance imaging (MRI) scans. An electroencephalogram (EEG) can be used to assess the electrical activity of the brain in the diagnosis of conditions such as epilepsy. Neurologists also diagnose infections of the nervous system by analysing the cerebrospinal fluid (CSF), a clear fluid that surrounds the brain and spinal cord.

A neurologist is a physician specializing in neurology and trained to investigate, or diagnose and treat neurological disorders. Neurologists may also be involved in clinical research, clinical trials, and basic or translational research. While neurology is a nonsurgical specialty, its corresponding surgical specialty is neurosurgery.

Neurologists manage and treat neurological conditions, or problems with the nervous system. Symptoms that commonly require a neurologist include:

• coordination problems
• muscle weakness
• a change in sensation
• confusion
• dizziness

People who are having problems with their senses, such as touch, vision, or smell, may also need to see a neurologist. Problems with senses are sometimes caused by nervous system disorders.

Neurologists also see patients with:

• seizure disorders, such as epilepsy
• stroke
• multiple sclerosis
• neuromuscular disorders, such as myasthenia gravis
• infections of the nervous system, including encephalitis, meningitis, or brain abscesses
• neurodegenerative disorders, such as Lou Gehrig's disease and Alzheimer's disease
• spinal cord disorders, including inflammatory and autoimmune disorders
• headaches, such as cluster headaches, and migraine

Usual neurological procedures

During your first appointment with a neurologist, they'll likely perform a physical exam and a neurological exam. A neurological exam will test muscle strength, reflexes, and coordination.

Since different disorders can have similar symptoms, your neurologist may need more testing to make a diagnosis.

Neurologists may recommend a variety of procedures to help diagnose or treat a condition. These procedures may include:

Lumbar puncture

Your neurologist may use a lumbar puncture to test your spinal fluid. They may recommend the procedure if they believe your symptoms are caused by a problem in your nervous system that can be detected in your spinal fluid.

The procedure involves inserting a needle into the spine after numbing it and taking a sample of spinal fluid.

Tensilon test

This procedure can help your neurologist diagnose myasthenia gravis. In this test, your doctor injects you with a medicine called Tensilon. Then they observe how it affects your muscle movements.

Electromyography (EMG)

An EMG measures electrical activity between your brain or spinal cord to a peripheral nerve. This nerve is found in your arms and legs, and is responsible for muscle control during times of movement and rest.

EMGs can help your neurologist diagnose spinal cord disease as well as general muscle or nerve dysfunction.

During this test, your neurologist-technician inserts small electrodes into your muscles to help measure activity during periods of movement and rest. Such activity is recorded by a machine attached to the electrodes with a series of wires, which may be somewhat uncomfortable.

Oftentimes, a neurologist will order a nerve conduction velocity (NCV) study in conjunction with an EMG. While an EMG measures muscle activity, an NCV assesses the ability of your nerves to send the necessary signals that control these muscles. If your neurologist recommends both tests, you'll likely do the EMG first.

During an NCV test, electrodes are taped over the same muscles that you had EMG electrodes in previously. Two sets of electrodes are used here - one sends small pulses in an effort to stimulate your nerves, while the other set measures the results.

In all, the average EMG/NCV combination test may take about an hour or longer to complete. You'll want to avoid any stimulants, such as caffeine and nicotine, several hours before your test, or else these substances may alter your results.

Your neurologist may also ask that you don't take any blood-thinning medications or nonsteroidal anti-inflammatory drugs (NSAIDs) for 24 hours ahead of the EMG.

Electroencephalogram (EEG)

With electrodes applied to your scalp, an EEG measures electrical activity in the brain. It's used to help diagnose conditions of the brain, including inflammation, tumors, and injuries, as well as seizures and psychiatric disorders.

Unlike an EMG, an EEG doesn't usually cause any discomfort. Before the test, a technician places electrodes around the scalp that look like small cups. As small charges in the brain are measured through the electrodes, the technician will create changes in the environment to measure brain signals, such as different lighting or noises.

Like an EMG, you'll need to avoid stimulants the day prior to the test. You can also expect the EEG to take an hour. Sometimes the test is done while you're sleeping.

Other tests

Neurologists may use other types of tests, as well. Although they may not perform the test, they may order it, review it, and interpret the results.

To make a diagnosis, a neurologist may use imaging tests such as:

• computed tomography, or CT scan
• magnetic resonance imaging, or MRI scan
• positron emission tomography, or PET scan

Other diagnostic procedures include sleep studies and angiography. Angiography determines blockages in the blood vessels going to the brain.

Your neurologist may help you manage your symptoms and neurological disorder alone, or with your primary care physician and other specialists.

Brain and Neurological Conditions

The brain is by far the most complex and fascinating organ of the body. Although some may try to argue, it is the organ most worthy of a lifetime of study. The brain can be contrasted with the heart, which undoubtedly plays a key supportive role. There remains much to be known about the brain. Although tremendous strides are made each year, the study of the brain remains in its infancy. This black box is intimidating for many medical students, but has also been the source of fascination for the world's greatest scientists, writers, and philosophers.

Due to the complexity of the nervous system, there are hundreds of different neurological conditions, affecting billions of people worldwide. They are the leading cause of disability and account for a significant percentage of global deaths. The nervous system is vital in keeping the body alive and functioning. Everything we do depends on the messages that our nerves transmit between our brain, spinal cord and the rest of our body. The brain is our most complex organ, enclosed inside a protective skull. It controls everything that happens in the body, including vital functions like breathing and heartbeat. Without the brain, the body would not be able to function. The brain is connected to the spinal cord via the brain stem. The brain and spinal cord are enclosed in a triple membrane and are surrounded by a protective fluid called cerebrospinal fluid (CSF). One of the main functions of the CSF is to protect the brain and regulate the pressure inside the skull, acting as a shock absorber. It also carries nutrients to the nervous system and removes nerve waste.

Together, the brain and spinal cord make up the central nervous system. The spinal cord extends the nerve fibres from the brain. Messages, or nerve impulses, travel from the brain along the spinal cord and control the activities of the body, such as movement of the arms and legs, sensory functions like touch and temperature, and things we don't think about that go on in the background, like the function of our organs. This is achieved via the second main division of the nervous system, the peripheral nervous system. The peripheral nervous system is the network of nerves outside the central nervous system. Sensory and motor nerves branch out from the spinal cord between the vertebrae, carrying messages between the central nervous system and our bones, muscles, skin and other organs. An injury to a peripheral nerve can result in loss of feeling or movement. Disorders of the neuromuscular system, where nerves and muscles interact, include motor neuron disease, muscular dystrophy and multiple sclerosis.

Treatment options

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 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 and certifies technologists in nerve-conduction studies. Sleep medicine is a subspecialty field in the US under several medical specialties including anesthesiology, 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 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 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. 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 or 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, movement disorders, neurointensive care, headaches, epilepsy, sleep disorders, chronic pain management, multiple sclerosis, or neuromuscular diseases.

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