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Neurology (from Greek νεῦρον, neuron, "nerve" + the suffix -λογία, '-logia', "study of") is a medical specialty dealing with disorders of the nervous system. To be specific, it deals with the diagnosis and treatment of all categories of disease involving the central, peripheral, and autonomic nervous systems, including their coverings, blood vessels, and all effector tissue, such as muscle.^[1] The corresponding surgical specialty is neurosurgery. 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, and clinical trials, as well as basic research and translational research. Neurology, being a branch of medicine, differs from neuroscience, which is the scientific study of the nervous system in all its aspects.

Field of work[link]

A large number of neurological disorders have been described. These can affect the central nervous system (brain and spinal cord), the peripheral nervous system, or the autonomic nervous system.

Qualifications[link]

Jean-Martin Charcot is considered one of the fathers of neurology.^[2]

In the United States and Canada, neurologists are physicians who have completed postgraduate training in neurology after graduation from medical school. Neurologists complete, on average, at least 10–12 years of college education and clinical training. This training includes obtaining a four-year undergraduate degree, a medical degree (D.O. or M.D.), which comprises an additional four years of study, and then completing a three or four-year residency in neurology. The four-year residency consists of one year of internal medicine training followed by three years of training in neurology. One- and two-year fellowships are available following completion of the neurology residency, if desired.

Many neurologists also have additional subspecialty training (fellowships) after completing their residency in one area of neurology such as stroke or vascular neurology, interventional neurology, epilepsy, neuromuscular, neurorehabilitation, behavioral neurology, sleep medicine, pain management, neuroimmunology, clinical neurophysiology, or movement disorders.

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 (internal) medicine. After five to nine years of medical school and a year as a pre-registration house officer (or two years on the Foundation Programme), a neurologist must pass the examination for Membership of the Royal College of Physicians (or the Irish equivalent) before entering specialist training in neurology. A generation ago, some neurologists would have also spent a couple of years working in psychiatric units and obtain a Diploma in Psychological Medicine. However, this requirement has become uncommon, and, now that a basic psychiatric qualification takes three years to obtain, the requirement is no longer practical. A period of research is essential, and obtaining a higher degree aids career progression: Many found it was eased after an attachment to the Institute of Neurology at Queen Square in London. Some neurologists enter the field of rehabilitation medicine (known as physiatry in the US) to specialise in neurological rehabilitation, which may include stroke medicine as well as brain injuries.

Testing examinations[link]

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 mental status, function of the cranial nerves (including vision), strength, coordination, reflexes, and sensation. This information helps the neurologist determine whether the problem exists in the nervous system and the clinical localization. Localization of the pathology is the key process by which neurologists develop their differential diagnosis. Further tests may be needed to confirm a diagnosis and ultimately guide therapy and appropriate management.

Clinical tasks[link]

General caseload[link]

Neurologists are responsible for the diagnosis, treatment, and management of all the conditions mentioned above. When surgical intervention is required, the neurologist may refer the patient to a neurosurgeon. In some countries, additional legal responsibilities of a neurologist may include making a finding of brain death when it is suspected that a patient is deceased. Neurologists frequently care for people with hereditary (genetic) diseases when the major manifestations are neurological, as is frequently the case. Lumbar punctures are frequently performed by neurologists. Some neurologists may develop an interest in particular subfields, such as dementia, movement disorders, headaches, epilepsy, sleep disorders, chronic pain management, multiple sclerosis, or neuromuscular diseases.

Overlapping areas[link]

There is some overlap with other specialties, varying from country to country and even within a local geographic area. Acute head trauma is most often treated by neurosurgeons, whereas sequelae of head trauma may be treated by neurologists or specialists in rehabilitation medicine. Although stroke cases have been traditionally managed by internal medicine or hospitalists, the emergence of vascular neurology and interventional neurologists has created a demand for stroke specialists. The establishment of JCAHO 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 diseases are treated by infectious disease specialists. Most cases of headache are diagnosed and treated primarily by general practitioners, at least the less severe cases. Likewise, most cases of sciatica and other mechanical radiculopathies are treated by general practitioners, though they may be referred to neurologists or a surgeon (neurosurgeons or orthopedic surgeons). Sleep disorders are also treated by pulmonologists and psychiatrists. Cerebral palsy is initially treated by pediatricians, but care may be transferred to an adult neurologist after the patient reaches a certain age. 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 neuropsychologists are often called upon to evaluate brain-behavior relationships for the purpose of assisting with differential diagnosis, planning 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[link]

In some countries, e.g. USA and Germany, neurologists may specialize in clinical neurophysiology, the field responsible for EEG, nerve conduction studies, EMG and evoked potentials. In other countries, this is an autonomous specialty (e.g., United Kingdom, Sweden).

Overlap with psychiatry[link]

Although mental illnesses are believed by some 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 that "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."^[3]. However, the view that mental illness is purely a physical illness reflects a school of thought known as epiphenomenalism, which argues that the mind has no causal effect at all, and is just the subjective experience of our brain at work. The most common view of mind and brain is school of thought known as property dualism. In other words, the mind is changes in the physical structure of the brain, and changes in the physical structure of the brain are the mind. The mind and brain can both be described and being based in the physical world, but explaining the mind, or mental illness, purely in physical terms, may not always be appropriate or useful.

Neurological diseases 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, there is not always a sharp distinction between neurology and psychiatry on a biological basis. The dominance of psychoanalytic theory in the first three quarters of the 20th century has since then been largely replaced by a focus on pharmacology. Despite the shift to a medical model, brain science has not advanced to the point where scientists or clinicians can point to readily discernible pathologic lesions or genetic abnormalities that in and of themselves serve as reliable or predictive biomarkers of a given mental disorder.

Cosmetic neurology[link]

The emerging field of cosmetic neurology highlights the potential of therapies to improve such things as workplace efficacy, attention in school, and overall happiness in personal lives.^[4] However, this field has also given rise to questions about neuroethics and the psychopharmacology of lifestyle drugs.

See also[link]

• List of neurologists

References[link]

1. ^ Acgme.org
2. ^ "Jean-Martin Charcot: The Father of Neurology". National Center for Biotechnology Information.
3. ^ Martin JBwow (May 2002). "The integration of neurology, psychiatry, and neuroscience in the 21st century". The American Journal of Psychiatry 159 (5): 695–704. DOI:10.1176/appi.ajp.159.5.695. PMID 11986119. http://www.ajp.psychiatryonline.org/cgi/content/full/159/5/695. 
4. ^ Hamilton, Roy. Looking at things in a different perspective created the idea of ethics of neural enhancement using noninvasive brain stimulation. Neurology January 10, 2011 vol. 76 no. 2 187-193. doi:10.1212/WNL.0b013e318205d50d

External links[link]

• American Academy of Neurology
• American Neurological Association
• European Federation of Neurological Societies
• European Journal of Neurology
• National Institute of Neurological Disorders and Stroke (NINDS)
• Neurology, official journal of the AAN
• World Congress of Neurology
• United Council for Neurologic Subspecialties

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Oliver Sacks
Sacks at the 2009 Brooklyn Book Festival
Born	(1933-07-09) 9 July 1933 (age 78) London, England
Years active	1966 – present
Known for	Popular books containing case studies of some of his patients
Profession	Physician
Specialism	Neurology

Oliver Wolf Sacks, CBE (born 9 July 1933, London, England), is a British neurologist, psychologist, writer, and amateur chemist who has spent the major portion of his career in the United States. He lives in New York City, and is professor of neurology and psychiatry at Columbia University, where he also holds the position of "Columbia Artist". He previously spent many years on the clinical faculty of Yeshiva University's Albert Einstein College of Medicine.

Sacks is the author of numerous bestselling books,^[1] including several collections of case studies of people with neurological disorders. His 1973 book Awakenings was adapted into an Academy Award-nominated film of the same name in 1990 starring Robin Williams and Robert De Niro.^[2] He, and his book Musicophilia: Tales of Music and the Brain, were the subject of "Musical Minds", an episode of the PBS series Nova.

Early life[link]

Sacks was the youngest of four children born to a North London Jewish couple: Samuel Sacks, a physician (died June 1990),^[3] and Muriel Elsie Landau, one of the first female surgeons in England.^[4] Sacks had a large extended family, and among his first cousins are Israeli statesman Abba Eban, writer and director Jonathan Lynn, and economist Robert Aumann.

When Sacks was six years old, he and his brother Michael were evacuated from London to escape the Blitz, retreating to a boarding school in the Midlands, where he remained until 1943.^[4] He attended St Paul's School in London. During his youth, he was a keen amateur chemist, as recalled in his memoir Uncle Tungsten.^[5] He also learned to share his parents' enthusiasm for medicine and entered The Queen's College, Oxford University in 1951,^[4] from which he received a Bachelor of Arts (BA) in physiology and biology in 1954.^[6] At the same institution, in 1958 he went on to incept as a Master of Arts (MA) and earn a BM BCh, thereby qualifying to practice medicine. He undertook residencies and fellowship work at Mt. Zion Hospital in San Francisco and at UCLA.^[7]

Career[link]

After converting his British qualifications to American recognition (i.e., an MD as opposed to BM BCh), Sacks moved to New York, where he has lived and practiced neurology since 1965.

Sacks began consulting at chronic care facility Beth Abraham Hospital (now Beth Abraham Health Services), a member of CenterLight Health System in Bronx, NY, in 1966.^[8] At Beth Abraham, Sacks worked with a group of survivors of the 1920s sleeping sickness, encephalitis lethargica, who had been unable to move on their own for decades.^[8] These patients and his treatment of them were the basis of Sacks' book Awakenings.^[8]

Sacks served as an instructor and later clinical professor of neurology at the Albert Einstein College of Medicine from 1966 to 2007, and also held an appointment at the New York University School of Medicine from 1999 to 2007. In July 2007 he joined the faculty of Columbia University Medical Center as a professor of neurology and psychiatry.^[7] At the same time, he was appointed Columbia University's first "Columbia University Artist" at the University's Morningside campus, recognizing the role of his work in bridging the arts and sciences.

Since 1966 Sacks has served as a neurological consultant to various New York City nursing homes that are run by the Little Sisters of the Poor, and from 1966 to 1991, he was a consulting neurologist at Bronx Psychiatric Center.

Sacks' work at Beth Abraham helped provide the foundation on which the Institute for Music and Neurologic Function (IMNF) is built; Sacks is currently an honorary medical advisor.^[9] The Institute honored Sacks in 2000 with its first Music Has Power Award.^[10] The IMNF again bestowed a Music Has Power Award on Sacks in 2006 to commemorate "his 40 years at Beth Abraham and honor his outstanding contributions in support of music therapy and the effect of music on the human brain and mind".^[11]

Sacks remains a consultant neurologist to the Little Sisters of the Poor, and maintains a practice in New York City. He serves on the boards of the The Neurosciences Institute and the New York Botanical Garden.

Writing[link]

Beginning in 1970 Sacks wrote of his experience with neurological patients. His books have been translated into over 25 languages. In addition to his books, Sacks is a regular contributor to The New Yorker and The New York Review of Books, as well as other medical, scientific, and general publications.^[12][13][14] He was awarded the Lewis Thomas Prize for Writing about Science in 2001.^[15]

Sacks' work has been featured in a "broader range of media than those of any other contemporary medical author"^[16] and in 1990, The New York Times said he "has become a kind of poet laureate of contemporary medicine".^[17] His descriptions of people coping with and adapting to neurological conditions or injuries often illuminate the ways in which the normal brain deals with perception, memory and individuality.

Sacks considers that his literary style grows out of the tradition of 19th-century "clinical anecdotes," a literary style that included detailed narrative case histories. He also counts among his inspirations the case histories of the Russian neuropsychologist A. R. Luria.^[18]

Sacks describes his cases with a wealth of narrative detail, concentrating on the experiences of the patient (in the case of his A Leg to Stand On, the patient was himself). The patients he describes are often able to adapt to their situation in different ways despite the fact that their neurological conditions are usually considered incurable.^[19] His most famous book, Awakenings, upon which the 1990 feature film of the same name is based, describes his experiences using the new drug L-Dopa on Beth Abraham post-encephalitic patients.^[8] Awakenings was also the subject of the first documentary made (in 1974) for the British television series Discovery.

In his other books, he describes cases of Tourette syndrome and various effects of Parkinson's disease. The title article of The Man Who Mistook His Wife for a Hat is about a man with visual agnosia^[20] and was the subject of a 1986 opera by Michael Nyman. The title article of An Anthropologist on Mars, which won a Polk Award for magazine reporting, is about Temple Grandin, a professor with high-functioning autism. Seeing Voices, Sacks' 1989 book, covers a variety of topics in deaf studies.

In his book The Island of the Colorblind Sacks writes about an island where many people have achromatopsia (total colorblindness, very low visual acuity and high photophobia), and describes the Chamorro people of Guam, who have a high incidence of a neurodegenerative disease known as Lytico-Bodig disease (a devastating combination of ALS, dementia, and parkinsonism). Along with Paul Alan Cox, Sacks has published papers suggesting a possible environmental cause for the cluster, namely the toxin beta-methylamino L-alanine (BMAA) from the cycad nut accumulating by biomagnification in the flying fox bat.^[21][22]

Sacks has sometimes faced criticism in the medical and disability studies communities. During the 1970s and 1980s, his book and articles on the "Awakenings" patients were criticized or ignored by much of the medical establishment, on the grounds that his work was not based on the quantitative, double-blind study model. His account of abilities of autistic savants has been questioned by the researcher Makoto Yamaguchi,^[23] and Daniel Tammet shared this view. According to Yamaguchi, Sacks' mathematical explanations are also irrelevant.^[24] Arthur K. Shapiro—described as "the father of modern tic disorder research"^[25]—referring to Sacks' celebrity status and that his literary publications received greater publicity than Shapiro's medical publications, said he is "a much better writer than he is a clinician".^[26] Howard Kushner's A Cursing Brain?: The Histories of Tourette Syndrome, says Shapiro "contrasted his own careful clinical work with Sacks' idiosyncratic and anecdotal approach to a clinical investigation".^[27]

More sustained has been the critique of his political and ethical positions. Although many characterize Sacks as a "compassionate" writer and doctor,^[28][29][30] others feel that he exploits his subjects.^[31] Sacks was called "the man who mistook his patients for a literary career" by British academic and disability-rights activist Tom Shakespeare,^[32] and one critic called his work "a high-brow freak show".^[33] Such criticism was echoed by a Sacks-like caricature played by Bill Murray in the film The Royal Tenenbaums.^[34] Sacks himself has stated "I would hope that a reading of what I write shows respect and appreciation, not any wish to expose or exhibit for the thrill... but it's a delicate business."^[35]

Honors[link]

Since 1996 Sacks has been a member of The American Academy of Arts and Letters (Literature).^[36] In 1999 he became a Fellow of the New York Academy of Sciences.^[37] Also in 1999, he became an Honorary Fellow at The Queen's College, Oxford.^[38] In 2002 he became Fellow of the American Academy of Arts and Sciences (Class IV—Humanities and Arts, Section 4—Literature)^[39] and he was awarded the 2001 Lewis Thomas Prize by Rockefeller University.^[40]

Sacks has been awarded honorary doctorates from the College of Staten Island (1991),^[6] Tufts University (1991),^[41] New York Medical College (1991),^[6] Georgetown University (1992),^[42] Medical College of Pennsylvania (1992),^[6] Bard College (1992),^[43] Queen's University (Ontario) (2001),^[44] Gallaudet University (2005),^[45] University of Oxford (2005),^[46] Pontificia Universidad Católica del Perú (2006),^[47] and Cold Spring Harbor Laboratory (2008).

Oxford University awarded him an honorary Doctor of Civil Law degree in June 2005.^[48]

Sacks received the position "Columbia Artist" from Columbia University in 2007, a post that was created specifically for him. In this capacity he gains unconstrained access to the University, regardless of department or discipline.^[49]

Sacks was appointed Commander of the Order of the British Empire (CBE) in the 2008 Queen's Birthday Honours.^[50]

84928 Oliversacks, a 2 miles (3.2 km)-diameter main-belt minor planet discovered in 2003, was named in his honor.^[51]

In February 2010 Sacks was named to the Freedom From Religion Foundation's Honorary Board of distinguished achievers.^[52]

Personal life[link]

For his entire life Sacks has had a condition known as prosopagnosia or face blindness.^[53] In a December 2010 interview Sacks discussed how he had also lost his stereoscopic vision the previous year due to a malignant tumor in his right eye. He now has no remaining vision in his right eye.^[54] His loss of stereo vision was recounted in his book The Mind's Eye, published in October 2010.^[55] Sacks discussed his struggles with prosopagnosia in an interview by Leslie Stahl on the March 18, 2012 episode of 60 Minutes.

Sacks has never married or lived with anyone and says that he is celibate.^[56] In a December 2001 interview he stated that he had not had a relationship in many years and has described his own shyness as "a disease".^[57] Sacks swims almost every day and has done so for decades. He discussed his work and his personal health issues in the June 28, 2011 BBC documentary Imagine.^[54]

Publications[link]

As main author[link]

• Migraine (1970)
• Awakenings (1973)
• A Leg to Stand On (1984) (Sacks's own experience, after an accident, of losing the awareness of one of his legs)
• The Man Who Mistook His Wife for a Hat (1985)
• Seeing Voices: A Journey Into the World of the Deaf (1989) Online access
• An Anthropologist on Mars (1995)
• The Island of the Colorblind (1997) (total congenital color blindness in an island society, Guam disease)
• Uncle Tungsten: Memories of a Chemical Boyhood (2001)
• Oaxaca Journal (2002)
• Musicophilia: Tales of Music and the Brain (2007)
• The Mind's Eye (2010)

As contributor[link]

• A Man Without Words (1991) (foreword)

References[link]

External links[link]

Wikimedia Commons has media related to: Oliver Sacks

Wikiquote has a collection of quotations related to: Oliver Sacks

• Oliver Sacks' official website
• Oliver Sacks at Columbia University
• Oliver Sacks article archive at The New York Review of Books
• Oliver Sacks at TED Conferences
• Oliver Sacks on Charlie Rose
• Works by or about Oliver Sacks in libraries (WorldCat catalog)
• Oliver Sacks collected news and commentary at The New York Times
• Oliver Sacks on CNN in January 2011
• Oliver Sacks on Science Friday, National Public Radio