The XXI century discipline
Neurology when discovered, is undoubtedly one of the most extensive and exciting medical specialties. It is varied, treating complex patients with little prevalent pathologies, amazing clinical expressions, very urgent patients in the immediate management is basic, neurodegenerative diseases in which every day progress is being made, using complementary techniques such as doppler or electroneurodiagnósticas techniques know what happens to our sick, or resort to intervention to solve the problem.
Also in the last 15 years after the decade of the brain, we can treat most of our patients and get their disease and improve their quality of life. Both prevanlents and very disabling diseases such as migraine or other as devastating as stroke can act and improve the future of people.
Field of Neurology
Neurology is the most complex medical specialty that deals with the study of the operation and the diseases that affect the nervous system and muscles. In recent years it has experienced a breakthrough, being at the forefront of research. They described new entities and fortunately we can treat the vast majority of our patients. From improving the quality of life of many of them, to cure diseases, modify the immune system, raise the possibility of interventions, rate botulinum toxin or perform fibrinolysis in stroke to change the prognosis.
Early recognition of symptoms by patients and early diagnosis of the disease can change the lives of patients. For this reason it is essential that people know the most common symptoms of the disease and that doctors are able to make a proper diagnosis.
Currently many of the most common neurological diseases are subsidiaries of receiving a highly effective treatment, not only intended to improve symptoms but in many cases it is possible to modify the natural history of the disease.
Past, present and future of Neurology
Neurology from birth has been a discipline that has exceeded the classical concept of medical specialty. Although attendance remains the basis and possibly is the most rewarding part, birth conjunction with the neurosciences and their common and undivided growth opens a wide field of reflection and research.
A longitudinal view
Neuroscience is one of the youngest medical disciplines. His birth in the nineteenth century to the unity born of neuroscience and psychiatry. The relationship with the neurosciences has always been straightforward and has been instrumental in advancing both. The relationship with psychiatry suffered a conceptual separation, however in recent years, possibly because of the influence of basic neurosciences roads tend to cluster together. From years of phrenology to the present time they have been forged the basis of clinical neurology. Foundations that semiotics is a fundamental basis on which knowledge, additional tests and treatments are based.
Continuous neurology being a specialty where the gold standard in most diseases is clinical. This probably reflects how complex the nervous system. Perhaps for this reason, most technological advances are taking place in this field. As specialty is one of the most extensive and has evolved from a predominantly hospital discipline, to be irreplaceable in the treatment of ambulatory patients, improving the quality of life in emergencies with handling neurovascular disease, CNS infections, interconsult of complications neurological other disciplines, research with patient assessment and design studies.
Currently you might consider one of the most extensive specialties and subspecialties which there are possibly more special diagnostic and therapeutic management of patients.
If there is a defining characteristic of the neurologist in medical disciplines possibly the «detective» attitude of semiotics. In a structure as complex as the human brain and its relationship with the body and external environment, the classical clinical approach remains fundamental. The basis of our specialty is the history and examination, additional tests remain, in most cases, secondary.
The special ability to cope with the neurological disease is a crucial resource that is acquired during residency and accompanies us throughout our professional development. That an automatic way (praxical) will arise when evaluating patients. The face a neurological patient allows us to see how the human brain unique opportunity to our specialty, model base lesions neuroscience research works. It is undeniable that every day we find neurological patients that surprise us. It allows us to see with new eyes the world around us and opens an amazing field on our relationship with the world.
In the XXI century we are experiencing an exponential progress in the neurosciences. It originated in the early brain growth we have experienced that shows the human brain with the feeling that we are looking into it. From the functional techniques to locate different areas, nuclear medicine to «see» the amyloid, MRI high field to define more precisely the injury or analyze mediantes spectroscopy techniques, or interventional radiology that allows a sparsely interventionist way deal injuries of our patients. These advances require the neurologist to acquire a high-level technical skills with these procedures. Being able to indicate them, analyze, study their usefulness and even search the use or interest in the clinic of new technological advances.
It is undeniable that in recent years neuroscience has completely changed the therapeutic approach to the patient. The emergence of an extensive range of drugs to treat the vast majority of neurological diseases has led us down the path of therapeutic personalizations. This way, making the treatment as neurological patient is not an option, but an obligation. For most diseases have a large arsenal that allows us the right choice «a priori» to the patient profile. Clearly neurosciences is a preferential field of research in state and private institutions and certainly we will be witnessing the emergence of new therapeutic targets. A pending issue is neuroprotection. The neuron and glia cells are highly specialized and specific operating structures. This has hindered the development and evaluation of neuroprotective drugs. The idea is not to save neurons but saving functions. Possibly in this century we see the birth of these substances, although it seems a really complex field by the peculiarity of the structure of the brain.
Neuroscience has an unquestionable social dimension. Not only because of the disability that unfortunately accompanies our infirmities, but because neuroscience is beginning to be at the center of social and psychological research. For some researchers the only way to explain human behavior is to look at the brain. Thus, although perhaps with a simplistic approach, we neuroscientific explanations to addictions, to marketing and even neurothologic explanations. Another dimension is the growing legal. The legal implications that accompany the acts of our patients are higher than in other medical disciplines. From disqualify a patient with cognitive impairment, to assess the actions taken by a patient with a frontal syndrome or labor implications ascia a patient with epilepsy.
Santiago Ramon y Cajal told us that ontogeny is a reminder of the phylogeny. We see the development of the human brain the acquisition of a number of capabilities that reflect the social evolution. Special features of the human being will differ radically from other species, this difference estiva mainly in their cognitive abilities. Since language studies Chomsky, has advanced in the study of human evolution and this evolution, initially lost in anthropometric concepts, currently it is given from the hand of the neurosciences.
From phrenology we have seen a breakthrough in understanding the human brain. Leaving behind inadequate concepts about the external characteristics of the brain, and given hand lesional model have been defining features, Broca, Wernicke with language, frontal syndrome with Phineas Gage, boxes change in the pattern of food (syndrome gourmet) neuro-ophthalmological or complex disorders. In the last decade we can see the brain metabolism, this allows us to see which areas are activated during certain functions, discover how Wernicke’s area of reading is adjacent to but not the same spoken language, which areas are activated in migraine or cluster headache. This knowledge is not only theoretical but often form the basis for specific treatments. Noting patients with cluster headaches has been externally stimulate the dorsal hypothalamic area in refractory cases.
The XX and XXI century the social dimension is knowledge is basic. There is only one dissemination by the media of scientific advances, which were previously equity few. But looking for ways to apply this knowledge. This line has been vertebrate neuroscience as a new axis on which contact other disciplines. the neuroscientific explanation of such interesting aspects like food, marketing, economics, politics or humor is sought. These new lines of research that are based on classical disciplines are based on brain functioning, this field where the neurologist has extensive knowledge.
Neurology is a specialty different from the rest by treating a special structure that implies the definition of what we consider special in humans. This dimension makes it extremely complex, but also very attractive. It also opens a wide field in which develop, ranging from welfare aspects to neuroscience research.
Alcala de Henares, 22 June 2009. Residents First Congress of Neurology. CREN