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I have been a neurologist for over 30 years. Although I remain committed to and mesmerised by the subject, I have doubts about some of the foundations upon which we practise.
Before coming into clinical neurology, I had spent 4 years in Leslie Iversen's laboratory in Cambridge. There, among others neurologists, psychiatrists, neurosurgeons and basic scientists, we studied and discussed widely the neurochemistry and pharmacology of diseases including Huntington's disease, schizophrenia, Alzheimer's disease, Parkinson's disease and gliomas. I naturally assumed that clinical neurologists would likewise be interested in all brain disorders. It was therefore a surprise to find neurologists at that time were not involved in the care of large swathes of brain disease, such as stroke (the most common acute brain disorder), dementia (the most common chronic brain disorder), brain tumours and head injury. They also had only limited participation in three other crucial clinical areas: acute neurology, neurological rehabilitation and psychiatry.
How much has changed?
Stroke medicine has been the shining beacon of progress. It is an emerging integrated subspecialty, shared between neurologists and elderly care physicians, each managing patients irrespective of their age and having a practice backed up by high quality large clinical trials.
By contrast, the management of other important neurological conditions has changed very little. …
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