I walk in a commercial district with this sign for a neurological health facility. The study of neurology encompasses many familiar diseases we have heard of, but did not know were classified as neurological e.g., alcoholism, bipolar disorder, carpal tunnel syndrome, etc. It is amazing how your brain can affect your body. At the Addison Athletic Club, I participate in an activity (on Zoom now) that is called Ageless Grace which is for seniors. It is designed to create new pathways in your brain. In one of the exercises (which we do seated), we move our right arm up and down in a straight line, our left arm in a circle and draw a triangle with our left foot. It doesn’t take long until your triangle looks like a circle or visa versa. It is meant to confuse and makes our brains and nervous system work harder. Let’s learn more about neurology.
According to Wikipedia, neurology — from Greek: νεῦρον (neûron), "string, nerve" and the suffix -logia, "study of" — is a branch of medicine dealing with disorders of the nervous system. 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.
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.
Significant overlap occurs between the fields of neurology and psychiatry, with the boundary between the two disciplines and the conditions they treat being somewhat nebulous.
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, Charles Bell, Moritz Heinrich Romberg, Duchenne de Boulogne, William A. Hammond, Jean-Martin Charcot 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.
Some neurological conditions and disorders
Alcoholism
Alcoholism is, broadly, any drinking of alcohol that results in significant mental or physical health problems. Alcoholism is not a recognized diagnostic entity. Predominant diagnostic classifications are alcohol use disorder or alcohol dependence.
Excessive alcohol use can damage all organ systems, but it particularly affects the brain, heart, liver, pancreas and immune system. Alcoholism can result in mental illness, delirium tremens, Wernicke–Korsakoff syndrome, irregular heartbeat, an impaired immune response, liver cirrhosis and increased cancer risk. Drinking during pregnancy can result in fetal alcohol spectrum disorders. Women are generally more sensitive than men to the harmful effects of alcohol, primarily due to their smaller body weight, lower capacity to metabolize alcohol and higher proportion of body fat. In a small number of individuals, prolonged, severe alcohol misuse ultimately leads to frank dementia.
The World Health Organization has estimated that as of 2016, there were 380 million people with alcoholism worldwide — 5.1% of the population over 15 years of age. As of 2015 in the United States, about 17 million or 7% of adults and 0.7 million or 2.8% of those age 12 to 17 years of age are affected. Alcoholism is most common among males and young adults. Geographically, it is least common in Africa (1.1% of the population) and has the highest rates in Eastern Europe (11%). Alcoholism directly resulted in 139,000 deaths in 2013, up from 112,000 deaths in 1990. A total of 3.3 million deaths or 5.9% of all deaths are believed to be due to alcohol. Alcoholism reduces a person's life expectancy by approximately ten years. Many terms, some insulting and others informal, have been used to refer to people affected by alcoholism; the expressions include tippler, drunkard, dipsomaniac and souse. In 1979, the World Health Organization discouraged the use of "alcoholism" due to its inexact meaning, preferring "alcohol dependence syndrome."
Alzheimer’s disease
Alzheimer's disease, also referred to simply as Alzheimer's, is a neurodegenerative disease that usually starts slowly and progressively worsens. It is the cause of 60–70% of cases of dementia. The most common early symptom is difficulty in remembering recent events. As the disease advances, symptoms can include problems with language, disorientation including easily getting lost, mood swings, loss of motivation, self-neglect and behavioral issues. As a person's condition declines, they often withdraw from family and society. Gradually, bodily functions are lost, ultimately leading to death. Although the speed of progression can vary, the typical life expectancy following diagnosis is three to nine years.
As of 2015, there were approximately 29.8 million people worldwide with AD with about 50 million of all forms of dementia as of 2020. It most often begins in people over 65 years of age, although up to 10% of cases are early-onset affecting those in their 30’s to mid 60's. It affects about 6% of people 65 years and older. In 2015, all forms of dementia resulted in about 1.9 million deaths. The disease is named after German psychiatrist and pathologist Alois Alzheimer, who first described it in 1906. Alzheimer's financial burden on society is large, on par with the costs of cancer and heart disease, costing $200 billion in the U.S. alone.
Attention deficit hyperactivity disorder
Attention deficit hyperactivity disorder or ADHD is a neurodevelopmental disorder characterized by inattention or excessive activity and impulsivity, which are otherwise not appropriate for a person's age. Some individuals with ADHD also display difficulty regulating emotions or problems with executive function. For a diagnosis, the symptoms should appear before a person is 12 years old, be present for more than six months and cause problems in at least two settings — such as school, home, or recreational activities. In children, problems paying attention may result in poor school performance. Additionally, it is associated with other mental disorders and substance use disorders. Although it causes impairment, particularly in modern society, many people with ADHD can have sustained attention for tasks they find interesting or rewarding, known as hyperfocus.
Despite being the most commonly studied and diagnosed mental disorder in children and adolescents, the precise cause or causes are unknown in the majority of cases. Genetic factors are estimated to make up about 75% of the risk. Nicotine exposure during pregnancy may be an environmental risk. It does not appear to be related to the style of parenting or discipline. It affects about 5–7% of children when diagnosed via the DSM-IV criteria and 1–2% when diagnosed via the ICD-10 criteria. As of 2019, it was estimated to affect 84.7 million people globally. Rates are similar between countries and differences in rates depend mostly on how it is diagnosed. ADHD is diagnosed approximately two times more often in boys than in girls, although the disorder is often overlooked in girls because their symptoms are often less disruptive. About 30–50% of people diagnosed in childhood continue to have symptoms into adulthood and between 2–5% of adults have the condition. In adults, inner restlessness, rather than hyperactivity, may occur. Adults often develop coping skills which compensate for some or all of their impairments. The condition can be difficult to tell apart from other conditions, as well as from high levels of activity within the range of normal behavior.
Autism spectrum
The autism spectrum encompasses a range of neurodevelopmental conditions, including autism and Asperger syndrome, generally known as autism spectrum disorders or ASD. Individuals on the autism spectrum typically experience difficulties with social communication and interaction and may also exhibit restricted, repetitive patterns of behavior, interests or activities. Symptoms are typically recognized between one and two years of age in boys. However, many children are not diagnosed until they are older. It is also common for diagnosis to be received as an adolescent or as an adult. The term "spectrum" refers to the variation in the type and severity of symptoms. Those in the mild range are typically able to function independently, with some difficulties, while those with moderate to severe symptoms may require more substantial support in their daily lives. Long-term problems may include difficulties in daily living such as managing schedules, hypersensitivities, creating and keeping relationships and maintaining jobs.
An estimated 1% of the population or 62.2 million globally are on the autism spectrum as of 2015. In the United States it is estimated to affect more than 2% of children or about 1.5 million as of 2016. Males are diagnosed four times more often than females. The autism rights movement promotes the concept of neurodiversity, which views autism as a natural variation of the brain rather than a disorder to be cured.
Bipolar disorder
Bipolar disorder, previously known as manic depression, is a mental disorder characterized by periods of depression and periods of abnormally elevated mood that last from days to weeks each. If the elevated mood is severe or associated with psychosis, it is called mania; if it is less severe, it is called hypomania. During mania, an individual behaves or feels abnormally energetic, happy or irritable, and they often make impulsive decisions with little regard for the consequences. There is usually also a reduced need for sleep during manic phases. During periods of depression, the individual may experience crying and have a negative outlook on life and poor eye contact with others. The risk of suicide is high; over a period of 20 years, 6% of those with bipolar disorder died by suicide, while 30–40% engaged in self-harm. Other mental health issues, such as anxiety disorders and substance use disorders, are commonly associated with bipolar disorder.
Bipolar disorder occurs in approximately 1% of the global population. In the United States, about 3% are estimated to be affected at some point in their life; rates appear to be similar in females and males. The most common age at which symptoms begin is 20; an earlier onset in life is associated with a worse prognosis. Around a quarter to a third of people with bipolar disorder have financial, social or work-related problems due to the illness. Bipolar disorder is among the top 20 causes of disability worldwide and leads to substantial costs for society. Due to lifestyle choices and the side effects of medications, the risk of death from natural causes such as coronary heart disease in people with bipolar disorder is twice that of the general population.
Cerebral palsy
Cerebral palsy or CP is a group of permanent movement disorders that appear in early childhood. Signs and symptoms vary among people and over time. Often, symptoms include poor coordination, stiff muscles, weak muscles and tremors. There may be problems with sensation, vision, hearing, swallowing and speaking. Often, babies with cerebral palsy do not roll over, sit, crawl or walk as early as other children of their age. Other symptoms include seizures and problems with thinking or reasoning, which each occur in about one-third of people with CP. While symptoms may get more noticeable over the first few years of life, underlying problems do not worsen over time.
Cerebral palsy is caused by abnormal development or damage to the parts of the brain that control movement, balance and posture. Most often, the problems occur during pregnancy; however, they may also occur during childbirth or shortly after birth. Often, the cause is unknown. Risk factors include preterm birth, being a twin, certain infections during pregnancy such as toxoplasmosis or rubella, exposure to methylmercury during pregnancy, a difficult delivery and head trauma during the first few years of life, among others. About 2% of cases are believed to be due to an inherited genetic cause. A number of sub-types are classified based on the specific problems present. For example, those with stiff muscles have spastic cerebral palsy, those with poor coordination in locomotion have ataxic cerebral palsy and those with writhing movements have dyskinetic cerebral palsy. Diagnosis is based on the child's development over time. Blood tests and medical imaging may be used to rule out other possible causes.
Down syndrome
Down syndrome or Down's syndrome, also known as trisomy 21, is a genetic disorder caused by the presence of all or part of a third copy of chromosome 21. It is usually associated with physical growth delays, mild to moderate intellectual disability and characteristic facial features. The average IQ of a young adult with Down syndrome is 50, equivalent to the mental ability of an eight- or nine-year-old child, but this can vary widely.
Down syndrome is one of the most common chromosome abnormalities in humans. It occurs in about 1 in 1,000 babies born each year. In 2015, Down syndrome was present in 5.4 million individuals globally and resulted in 27,000 deaths, down from 43,000 deaths in 1990. It is named after British doctor John Langdon Down, who fully described the syndrome in 1866. Some aspects of the condition were described earlier by French psychiatrist Jean-Étienne Dominique Esquirol in 1838 and French physician Édouard Séguin in 1844. The genetic cause of Down syndrome was discovered in 1959.
Epilepsy
Epilepsy is a group of neurological disorders characterized by recurrent epileptic seizures. Epileptic seizures are episodes that can vary from brief and nearly undetectable periods to long periods of vigorous shaking due to abnormal electrical activity in the brain. These episodes can result in physical injuries, either directly such as broken bones or through causing accidents. In epilepsy, seizures have a tendency to recur and have no immediate underlying cause. Isolated seizures that are provoked by a specific cause such as poisoning are not deemed to represent epilepsy. People with epilepsy may be treated differently in various areas of the world and experience varying degrees of social stigma due to their condition.
As of 2015, about 39 million people have epilepsy. Nearly 80% of cases occur in the developing world. In 2015, it resulted in 125,000 deaths, an increase from 112,000 in 1990. Epilepsy is more common in older people. In the developed world, onset of new cases occurs most frequently in babies and the elderly. In the developing world, onset is more common in older children and young adults due to differences in the frequency of the underlying causes. About 5–10% of people will have an unprovoked seizure by the age of 80, and the chance of experiencing a second seizure is between 40% and 50%. In many areas of the world, those with epilepsy either have restrictions placed on their ability to drive or are not permitted to drive until they are free of seizures for a specific length of time. The word epilepsy is from Ancient Greek ἐπιλαμβάνειν, “to seize, possess or afflict.”
Learning disability
Learning disability, learning disorder or learning difficulty (British English) is a condition in the brain that causes difficulties comprehending or processing information and can be caused by several different factors. Given the "difficulty learning in a typical manner," this does not exclude the ability to learn in a different manner. Therefore, some people can be more accurately described as having a "learning difference," thus avoiding any misconception of being disabled with a lack of ability to learn and possible negative stereotyping. In the United Kingdom, the term "learning disability" generally refers to an intellectual disability, while difficulties such as dyslexia and dyspraxia are usually referred to as "learning difficulties."
Individuals with learning disabilities can face unique challenges that are often pervasive throughout the lifespan. Depending on the type and severity of the disability, interventions and current technologies may be used to help the individual learn strategies that will foster future success. Some interventions can be quite simplistic, while others are intricate and complex. Current technologies may require student training to be effective classroom supports. Teachers, parents and schools can create plans together that tailor intervention and accommodations to aid the individuals in successfully becoming independent learners. A multidisciplinary team frequently helps to design the intervention and to coordinate the execution of the intervention with teachers and parents. This team frequently includes school psychologists, special educators, speech therapists (pathologists), occupational therapists, psychologists, ESL teachers, literacy coaches and/or reading specialists.
Migraine
Migraine is a primary headache disorder characterized by recurrent headaches that are moderate to severe. Typically, episodes affect one side of the head, are pulsating in nature and last from a few hours to three days. Associated symptoms may include nausea, vomiting and sensitivity to light, sound or smell. The pain is generally made worse by physical activity, although regular exercise may have prophylactic effects. Up to one-third of people affected have aura: typically a short period of visual disturbance that signals that the headache will soon occur. Occasionally, aura can occur with little or no headache following, but not everyone has this symptom.
Globally, approximately 15% of people are affected by migraines. In the Global Burden of Disease Study of 2010, it was ranked as the third most prevalent disorder in the world. It most often starts at puberty and is worst during middle age. As of 2016, it is one of the most common causes of disability. An early description consistent with migraines is contained in the Ebers papyrus, written around 1500 BC in ancient Egypt. The word migraine is from the Greek ἡμικρᾱνίᾱ (hēmikrāníā), 'pain in half of the head', from ἡμι- (hēmi-), 'half', and κρᾱνίον (krāníon), 'skull.'
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, nonmotor symptoms become more common. The most obvious early symptoms are tremor, rigidity, slowness of movement and difficulty with walking. Cognitive and behavioral problems may also occur with depression, anxiety and apathy occurring in many people with PD. Parkinson's disease dementia becomes common in the advanced stages of the disease. Those with Parkinson's can also have problems with their sleep and sensory systems. The motor symptoms of the disease result from the death of cells in the substantia nigra, a region of the midbrain, leading to a dopamine deficit. The cause of this cell death is poorly understood, but involves the build-up of misfolded proteins into Lewy bodies in the neurons. Collectively, the main motor symptoms are also known as "parkinsonism" or a "parkinsonian syndrome."
The disease is named after English doctor James Parkinson, who published the first detailed description in “An Essay on the Shaking Palsy” in 1817. Public awareness campaigns include World Parkinson's Day on April 11 — the birthday of James Parkinson and the use of a red tulip as the symbol of the disease. People with PD who have increased the public's awareness of the condition include boxer Muhammad Ali, actor Michael J. Fox, Olympic cyclist Davis Phinney and actor Alan Alda.
Rabies
Rabies is a viral disease that causes inflammation of the brain in humans and other mammals. Early symptoms can include fever and tingling at the site of exposure. These symptoms are followed by one or more of the following symptoms: nausea, vomiting, violent movements, uncontrolled excitement, fear of water, an inability to move parts of the body, confusion and loss of consciousness. Once symptoms appear, the result is nearly always death. The time period between contracting the disease and the start of symptoms is usually one to three months but can vary from less than one week to more than one year. The time depends on the distance the virus must travel along peripheral nerves to reach the central nervous system.
Rabies causes about 56,000 deaths worldwide per year. More than 95% of human deaths from rabies occur in Africa and Asia. About 40% of deaths occur in children under the age of 15. Rabies is present in more than 150 countries and on all continents but Antarctica. More than 3 billion people live in regions of the world where rabies occurs.] A number of countries in the Asia-Pacific such as Australia, Japan and Singapore, as well as much of Western Europe, do not have rabies among dogs. Many Pacific islands do not have rabies at all. It is classified as a neglected tropical disease.
Stroke
A stroke is a medical condition in which poor blood flow to the brain causes cell death. There are two main types of stroke: ischemic, due to lack of blood flow and hemorrhagic, due to bleeding. Both cause parts of the brain to stop functioning properly. Signs and symptoms of a stroke may include an inability to move or feel on one side of the body, problems understanding or speaking, dizziness or loss of vision to one side. Signs and symptoms often appear soon after the stroke has occurred. If symptoms last less than one or two hours, the stroke is a transient ischemic attack or TIA, also called a mini-stroke. A hemorrhagic stroke may also be associated with a severe headache. The symptoms of a stroke can be permanent. Long-term complications may include pneumonia and loss of bladder control.
In 2013, approximately 6.9 million people had an ischemic stroke and 3.4 million people had a hemorrhagic stroke. In 2015, there were about 42.4 million people who had previously had a stroke and were still alive. Between 1990 and 2010 the number of strokes which occurred each year decreased by approximately 10% in the developed world and increased by 10% in the developing world. In 2015, stroke was the second most frequent cause of death after coronary artery disease, accounting for 6.3 million deaths or 11% of the total, About 3.0 million deaths resulted from ischemic stroke while 3.3 million deaths resulted from hemorrhagic stroke. About half of people who have had a stroke live less than one year. Overall, two thirds of strokes occurred in those over 65 years old.
Tourette syndrome
Tourette syndrome or Tourette's syndrome — abbreviated as TS or Tourette's — is a common neurodevelopmental disorder that begins in childhood or adolescence. It is characterized by multiple movement (motor) tics and at least one vocal (phonic) tic. Common tics are blinking, coughing, throat clearing, sniffin, and facial movements. These are typically preceded by an unwanted urge or sensation in the affected muscles, can sometimes be suppressed temporarily and characteristically change in location, strength and frequency. Tourette's is at the more severe end of a spectrum of tic disorders. The tics often go unnoticed by casual observers.
Tourette syndrome was named by French neurologist Jean-Martin Charcot for his intern, Georges Gilles de la Tourette, who published in 1885 an account of nine patients with a "convulsive tic disorder." While the exact cause is unknown, it is believed to involve a combination of genetic and environmental factors. The mechanism appears to involve dysfunction in neural circuits between the basal ganglia and related structures in the brain.
Training
Many neurologists also have additional training or interest in one area of neurology, such as stroke, epilepsy, neuromuscular, sleep medicine, pain management or movement disorders.
In the United States and Canada, neurologists are physicians having completed postgraduate training in neurology after graduation from medical school. Neurologists complete, on average, about 8 years of medical college education and clinical training, which includes obtaining a four-year undergraduate degree, a medical degree (DO or MD), which comprises an additional four years of study, then completing one year of basic clinical training and four years of residency. The four-year residency consists of one year of internal medicine internship training followed by three years of training in neurology.
Some neurologists receive additional subspecialty training focusing on a particular area of the fields. These training programs are called fellowships, and are one to two years in duration. Subspecialties include brain injury medicine, clinical neurophysiology, epilepsy, hospice and palliative medicine, neurodevelopmental disabilities, neuromuscular medicine, pain medicine, sleep medicine, neurocritical care, vascular neurology (stroke), behavioral neurology, child neurology, headache, multiple sclerosis, neuroimaging 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 or 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 or the Irish equivalent and complete two years of core medical training before entering specialist training in neurology.
Clinical tasks
Neurologists examine patients who are referred to them by other physicians in both the inpatient and outpatient 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, reflexes, coordination and gait.
In some instances, neurologists may order additional diagnostic tests as part of the evaluation. Commonly employed tests in neurology include imaging studies such as computed axial tomography or CAT scans, magnetic resonance imaging or MRI and ultrasound of major blood vessels of the head and neck. Neurophysiologic studies, including electroencephalography or EEG, needle electromyography or EMG, nerve conduction studies or NCSs and evoked potentials are also commonly ordered. Neurologists frequently perform lumbar punctures to assess characteristics of a patient's cerebrospinal fluid. 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, neuropathy, stroke, dementia, seizures and epilepsy, Alzheimer's disease, attention deficit/hyperactivity disorder, Parkinson's disease, 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 studies — needle EMG and NCSs. In the U.S., 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 U.S. physicians in general clinical neurophysiology, epilepsy and intraoperative monitoring. The American Board of Electrodiagnostic Medicine certifies U.S. physicians in electrodiagnostic medicine and certifies technologists in nerve-conduction studies. Sleep medicine is a subspecialty field in the U.S. 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 — 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 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.
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