NEUROLOGY
Introduction:
Neurology is a medical science that deals with the diagnosis and treatment of all disorders regarding central and peripheral nervous systems, including their sub-divisions i.e autonomic and somatic nervous system along with their associated coverings, blood vessels, and all effector tissues such as muscles.
Neurology originated from a Latin word neurologia, dating back to 1675–85.
Neurologists are the physicians who are specialized in neurology to investigate, diagnose and treat neurological disorders. After completing graduation from medical school, neurologists do specialization for about three years. They also complete their internship and receive training in a neurology residency program.
Neurologists subspecialization:
In this modern era of medicines, the advent of new treatment and technologies has resulted in an increased number of specialities and subspecialties. The same aspect is true for neurology as well. A famous quote article demonstrated that 74% of neurologists will do a fellowship. This survey was done over 10 years and now has been increased to 78%. People plugged into specialists more as compared to a generalist, as there is a majority of residents now doing a fellowship, albeit in unequal numbers.
Physician experts are valued equally by the management skills of the neurologists and generally refer for the confirmation of diagnosis. But for better outcomes, people move towards the disorder specialists, especially for the treatment of Parkinson’s disease.
Therapeutic area (CNS):
The central nervous system is the major therapeutic area for neurology that consists of the brain and spinal cord and integrates the received information and coordinates and directs the activity of all parts of the body in all multicellulars. It possesses retina including optic nerve (cranial nerve ii) as well as olfactory nerves (cranial nerve i) and olfactory epithelium. The olfactory epithelium is only the part of the CNS that is in direct contact with the environment. Thus, it opens up for treatments.
CNS consists of white and grey matter. White matter contains axons and oligodendrocytes whereas grey matter contains neurons and unmyelinated fibres. They both contain different forms of glial cells that perform different functions like Bergmann glia act as scaffolding or neuroblasts to climb during neurogenesis, microglia, a specialized form of macrophage, involved in the immune system of bin and clearance of various metabolites from brain tissue. Whereas, astrocytes served for both clearance of metabolites and transport of fuel and required substances to neurons.
Another therapeutic area for neurology is the peripheral nervous system that contains neurons, axons and Schwann cells. It contains ganglia outside the brain and spinal cord. The peripheral nervous system connects the CNS to the limbs and organs, as it contains a large myelinated axon to the big toe.
Therapeutic indications concerned neurology:
There are several indications concerning neurology. Among them, coordination problems, muscle weakness, a change in sensation, confusion and dizziness are most common. People having problems with their senses, touch, coordination must concern a neurologist.
Neurologists are in concern to patients with seizure disorders such as epilepsy, stroke, multiple sclerosis, neuromuscular disorders such as myasthenia gravis, etc. Other therapeutic indications include infections of the nervous system like encephalitis, meningitis or brain abscesses.
Neurodegenerative disorders such as Lou Gehrig’s disease and Alzheimer’s disease also come under the neural therapeutic indications. Others are spinal cord disorders, including inflammatory and autoimmune disorder, headaches such as cluster headaches and migraine. These symptoms and indications need neurologists.
The drug used in neurology:
● Doxapram, CNS stimulant, used to treat airway obstruction and drug-induced respiratory depression
● Quetiapine, atypical antipsychotic, used in Alzheimer’s disease and dementia.
● For anxiety, there are several antianxiety drugs including diazepam, chlordiazepoxide, oxazepam, lorazepam, alprazolam, hydroxyzine, propranolol, etc.
● Trifluoperazine (phenothiazine) used to treat schizophrenia
● Methylphenidate used to treat ADD (attention deficit disorder) and narcolepsy (daytime sleep).
● Perphenazine (tranquillizer) used to treat bipolar disorder.
● divalproex, atypical antipsychotics, used to treat epilepsy along with the bipolar disorder.
● Valproic acid, also an atypical antipsychotic, used to treat convulsions, seizures and migraine.
● For depression, there are many antidepressant drugs like bupropion, mirtazapine, trazodone, venlafaxine, nefazodone, phenelzine, tranylcypromine, selegiline, isocarboxazid, amitriptyline, etc.
● For insomnia, several drugs are used such as methohexital, diazepam, alprazolam, temazepam, zolpidem, phenobarbital, nitrazepam, midazolam, etizolam, etc. modafinil, CNS stimulant, used to treat obstructive sleep apnea and shift work disorder.
● For Parkinson’s disease, many drugs are useful such as carbidopa-levodopa, benserazide, bromocriptine, ropinirole, pramipexole, selegiline, tolcapone, procyclidine, etc.
● For severe acute and chronic pain, some drugs like morphine, codeine, thebaine, papaverine and noscapine are used commonly.
● Caffeine, CNS stimulant, used to treat a severe headache.
Neurological procedures:
Neurologists may recommend to you a variety of procedures that help in the diagnosis and treatment of abnormal neurological conditions. These procedures are
Lumbar puncture:
It is used to test a patient’s spinal fluid. These procedures involve a needle inserted into the spine after numbering it and then a sample of spinal fluid is taken.
Tensilon test:
It helps neurologists to diagnose myasthenia gravis. Doctors used to inject patients with a medicine called tensilon then observe its effects on the patient’s muscle movements.
Electromyography (EMG):
It is used to diagnose spinal cord disease as well as general muscle or nerve dysfunction. In this procedure, doctors insert small electrodes into the patient’s muscles to measure the activity during periods of movement and rest. These electrodes are attached by a machine that measures such activity.
Electroencephalogram (EEG):
This procedure is used to measure the electrical activity in the brain with the help of applied electrodes in the scalp. It is widely used to diagnose inflammations, tumours, and injuries of the brain as well as seizures and psychiatric disorders. EEG does not cause any discomfort like EMG as the doctor places electrodes around the scalp, looking like small cups.
Other procedures:
To make an effective and correct diagnosis, a neurologist may use imaging tests such as computed tomography, or CT scan, magnetic resonance imaging or MRI scan and positron emission tomography, or PET scan.
