Neurology is a branch of medicine dealing with disorders of the nervous system. Physicians specializing in the field of neurology are called neurologists and are trained to diagnose, treat, and manage patients with neurological disorders. Most neurologists are trained to treat and diagnose adults with neurological disorders. Pediatric neurologists, nearly always a subspecialty of pediatrics, treat neurological disease in children. Neurologists may also be involved in clinical research, clinical trials, as well as basic research and translational research.
Field of work
Neurological disorders are disorders that affect the central nervous system (brain and spinal cord), the peripheral nervous system (peripheral nerves - cranial nerves included), or the autonomic nervous system (parts of which are located in both central and peripheral nervous system). Neurologists also diagnose and treat some conditions in the musculoskeletal system.
Major conditions include:
ˇ headache disorders such as migraine, cluster headache and tension headache
ˇ epilepsy and seizure disorders
ˇ neurodegenerative disorders, including Alzheimer's disease, Parkinson's disease, and Amyotrophic Lateral Sclerosis (Lou Gehrig's disease).
ˇ cerebrovascular disease, such as transient ischemic attack and stroke.
ˇ sleep disorders
ˇ cerebral palsy
ˇ infections of the brain (encephalitis), brain meninges (meningitis), spinal cord (myelitis)
ˇ infections of the peripheral nervous system, such as botulism
ˇ neoplasms - tumors of the brain and its meninges (brain tumors), spinal cord tumors, tumors of the peripheral nerves (neuroma)
ˇ movement disorders such as Parkinson's disease, Huntington's disease, hemiballismus, tic disorder, and Gilles de la Tourette syndrome
ˇ demyelinating diseases of the central nervous system, such as multiple sclerosis, and of the peripheral nervous system, such as Guillain-Barré syndrome and chronic inflammatory demyelinating polyneuropathy (CIDP)
ˇ spinal cord disorders - tumors, infections, trauma, malformations (e.g., myelocele, meningomyelocele, tethered cord)
ˇ disorders of peripheral nerves, muscle (myopathy) and neuromuscular junctions
ˇ traumatic injuries to the brain, spinal cord and peripheral nerves
ˇ altered mental status, encephalopathy, stupor and coma
ˇ Speech and language disorders
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 vision, strength, coordination, reflexes and sensation. This information helps the neurologist determine if the problem is in the nervous system. Further tests may be needed to confirm a diagnosis or find a specific treatment.
Introduction:
It is a degenerative disorder of the central nervous system that affects the control muscles, and so many affect movement, speech and posture. Parkinson’s disease belongs to a group of condition called movement disorder.
Symptoms
Parkinson’s disease affects movement typical other symptoms include disorders of mood, behavior thinking, and sensation. Individual patient’s symptoms may be quite dissimilar, progression is also distinctly individual.
Diagnosis
Usually Doctors look for shuffling of feet and lack of swing in the arms. Doctors may sometimes request brain scan for laboratory tests in order to rule out the other diseases.
Treatment
Parkinson’s disease is a chronic disorder that requires broad-based management including patient and family education support group services, general wellness maintenance, exercise and nutrition. At present there is no cure for Pd, but medication or surgery can provide relief from the symptoms.
Medical therapy
The most widely used form of treatment is L-dopa in various forms.
Using dopamine agonists
Using MOA-B incubators
Surgical Management
Movement disorder central patient are evaluated fro surgery as follows. First a neurologist with expertise in movement disorder evaluates the patient. These can be Potential surgical candidates then are evaluated by neurosurgeon, who determines whether the patient is indeed a surgical candidates and decides which procedure would benefit the patient most.Close collaboration between the neurologist and the neurosurgeon aids the decision making process, minimizing patient confusion and stress.
Until recently, surgery for movement disorder involved predominantly destructive lessening of abnormally hyperactive deep brain.
Neuroablative Procedures
During neuroablation, a specific deep brain target is destroyed by thermoregulation.
i) Ventrolateral thalamotomy
VL thalamotomy was the most frequently performed procedure for movement disorder in the pre-lovadopa era because tremor responds best to thalamotomy and can be monitored more easily in the operating room than gait abnormalities, rigity and aleivargia.
Indication for thalamotomy
Thalomotomy is indicated in patient with PD who are disabled by medically refractory tremor. Rest tremor alone is rarely disabling and bradykinesisa and rigiding can reduce descteriry irrespective of tremor.
ii) Pallidotomy
Indications
Pallidotomy improve the symptoms of PD including rigiding bradykinesisa and gait abnormalities, as well as the long term complication of L-Dopa therapy.
iii) Deep Brain Stimulation
Deep brain stimulation (DBS) was first used in the 1970 for the treatment of chronic pain, but over last 15 year DBS has reemerged as one of the most effective treatment for advanced movement disorders.
Advantages
The main advantages of DBS are reversibility and adjustability. Because the DBS lead left in place, physicians have ongoing access to the target site allowing them to adjust stimulation parameters in response to changes in the patient condition.
Speech therapies
The most widely practiced treatment for the speech disorder associated with parleiusor disease.
Physiotherapy
Regular physical exercise and /or therapy including in forms such as yoga and dance can be beneficial to the patient for maintaining and improving mobility.