Editing Neurology (section)

==Clinical tasks==
{{More citations needed section|date=February 2015}}

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, [[Sensory nervous system|sensation]], [[reflexes]], [[Motor coordination|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]] (CAT) scans, [[magnetic resonance imaging]] (MRI), and [[ultrasound]] of major blood vessels of the head and neck. Neurophysiologic studies, including [[electroencephalography]] (EEG), needle [[electromyography]] (EMG), [[nerve conduction studies]] (NCSs) and [[evoked potentials]] are also commonly ordered.<ref>{{Cite web|title=Neurological Diagnostic Tests and Procedures Fact Sheet|url=https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Neurological-Diagnostic-Tests-and-Procedures-Fact|url-status=live|access-date=4 December 2021|archive-date=4 December 2021|archive-url=https://web.archive.org/web/20211204175121/https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Neurological-Diagnostic-Tests-and-Procedures-Fact}}</ref> Neurologists frequently perform [[lumbar puncture]]s 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.

===Neurotherapy===
{{Main|Neurotherapy}}
Neurotherapy involves systemic targeted delivery of an energy stimulus or chemical agents to a specific neurological zone in the body.<ref name="EEE Brain 2019" /><ref name="International Neuromodulation Society_2024" /><ref name="Val Danilov Origin Neurostimulation_2024" /> Some of the commonly encountered conditions treated by neurologists include headaches, [[radiculopathy]], [[neuropathy]], stroke, [[dementia]], [[seizure]]s and [[epilepsy]], [[Alzheimer's disease]], [[attention deficit/hyperactivity disorder]], [[Parkinson's disease]], [[Tourette's syndrome]], [[multiple sclerosis]], [[head trauma]], [[sleep disorder]]s, [[neuromuscular disease]]s, and various infections and tumors of the nervous system.<ref>LaFaver K, LaFrance WC, Price ME, Rosen PB, Rapaport M (2021). "Treatment of functional neurological disorder: current state, future directions, and a research agenda". ''CNS Spectrums''. 2021;26(6):607-613. doi:10.1017/S1092852920002138 </ref>  Neurologists are also asked to evaluate unresponsive patients on [[life support]] to confirm [[brain death]].<ref name="Wijdicks_Page_131">{{cite book |last1=Wijdicks |first1=Eelco F.M. |title=The Comatose Patient |date=2014 |publisher=Oxford University Press |location=Oxford |isbn=9780199331239 |page=131 |url=https://books.google.com/books?id=HpCtAwAAQBAJ&pg=PA131#v=onepage&q&f=false}}</ref>

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 neurophysiological monitoring|intraoperative monitoring]] to diagnose certain neurological disorders.<ref>{{cite web |url=http://www.acns.org/ |title=American Clinical Neurophysiology Society |publisher=Acns.org |access-date=30 March 2015 |archive-date=24 March 2015 |archive-url=https://web.archive.org/web/20150324151533/http://www.acns.org/ |url-status=live }}</ref> 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.<ref>{{cite web |url=http://www.abcn.org/ |title=American Board of Clinical Neurophysiology, Inc |publisher=Abcn.org |access-date=30 March 2015 |archive-date=22 March 2015 |archive-url=https://web.archive.org/web/20150322065435/http://www.abcn.org/ |url-status=live }}</ref> 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.<ref>{{cite web |url=http://www.abms.org/member-boards/specialty-subspecialty-certificates/ |title=Specialty and Subspecialty Certificates |publisher=Abms.org |access-date=30 March 2015 |archive-date=23 January 2020 |archive-url=https://web.archive.org/web/20200123231140/https://www.abms.org/member-boards/specialty-subspecialty-certificates/ |url-status=live }}</ref> 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 student]]s.

===General caseload===
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 neuroradiology|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 ([[genetics|genetic]]) diseases when the major manifestations are neurological, as is frequently the case. [[Lumbar puncture]]s 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.

===Overlapping areas===
Some overlap also occurs with other specialties, varying from country to country and even within a local geographic area. Acute [[traumatic brain injury|head trauma]] is most often treated by neurosurgeons, whereas [[sequelae]] of head trauma may be treated by neurologists or [[Physical medicine and rehabilitation|specialists in rehabilitation medicine]]. Although stroke cases have been traditionally managed by internal medicine or hospitalists, the emergence of vascular neurology and [[interventional neuroradiology]] has created a demand for stroke specialists. The establishment of [[Joint Commission]]-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 disease]]s are treated by infectious disease specialists. Most cases of headache are diagnosed and treated primarily by [[general practitioner]]s, at least the less severe cases. Likewise, most cases of [[sciatica]] are treated by general practitioners, though they may be referred to neurologists or  surgeons (neurosurgeons or [[Orthopedic surgery|orthopedic surgeons]]). [[Sleep disorders]] are also treated by [[Pulmonology|pulmonologists]] and [[psychiatrists]]. [[Cerebral palsy]] is initially treated by [[Pediatrics|pediatricians]], but care may be transferred to an adult neurologist after the patient reaches a certain age. [[Physical medicine and rehabilitation]] physicians may treat patients with neuromuscular diseases with electrodiagnostic studies (needle EMG and nerve-conduction studies) and other diagnostic tools. 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 neuropsychology|Clinical neuropsychologists]] are often called upon to [[Neuropsychological assessment|evaluate]] brain-[[Human behavior|behavior]] relationships for the purpose of assisting with [[differential diagnosis]], planning [[Physical medicine and rehabilitation|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 such as the United States and Germany, [[neurologists]] may subspecialize in [[clinical neurophysiology]], the field responsible for EEG and [[Intraoperative neurophysiological monitoring|intraoperative monitoring]], or in electrodiagnostic medicine [[nerve conduction study|nerve conduction studies]], EMG, and [[evoked potentials]]. In other countries, this is an autonomous [[Specialty (medicine)|specialty]] (e.g., United Kingdom, Sweden, Spain).

===Overlap with psychiatry===
{{Further|Psychoneuroimmunology|Neuropsychiatry}}

In the past, prior to the advent of more advanced diagnostic techniques such as [[MRI]] some neurologists have considered psychiatry and neurology to overlap. Although [[mental illness]]es are believed by many{{Weasel inline|date=November 2024}} 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, "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".<ref name="pmid11986119">{{cite journal
|author=Martin JB
|title=The integration of neurology, psychiatry, and neuroscience in the 21st century
|journal=The American Journal of Psychiatry
|volume=159
|issue=5
|pages=695–704
|date=May 2002
|pmid=11986119
|doi=10.1176/appi.ajp.159.5.695
}}</ref>

[[Neurological disorders]] 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, the sharp distinction between neurology and psychiatry is not always on a biological basis. The dominance of [[psychoanalysis|psychoanalytic theory]] in the first three-quarters of the 20th century has since then been largely replaced by a focus on pharmacology.<ref>{{Cite journal|last=Kandel|first=Eric R.|date=1998|title=A New Intellectual Framework for Psychiatry|url=http://psychiatryonline.org/doi/abs/10.1176/ajp.155.4.457|journal=American Journal of Psychiatry|language=en|volume=155|issue=4|pages=457–469|doi=10.1176/ajp.155.4.457|pmid=9545989|issn=0002-953X|access-date=9 June 2021|archive-date=17 January 2023|archive-url=https://web.archive.org/web/20230117144615/https://ajp.psychiatryonline.org/doi/full/10.1176/ajp.155.4.457|url-status=live|url-access=subscription}}</ref> Despite the shift to a medical [[Conceptual model|model]], brain science has not advanced to a point where scientists or [[clinicians]] can point to readily discernible pathological lesions or genetic abnormalities that in and of themselves serve as reliable or predictive [[biomarkers]] of a given mental disorder.