There is tension in neurology between sub-specialism and generalism, something discussed in this issue through a geographically based metaphor. Bas Bloem and colleagues make the specialist’s case that complexity within neurology’s subspecialties leads to islands of expertise, and the need to build bridges between these islands (page 532). Steve Lewis puts the generalist perspective that there should be a mainland of general neurology as a safe haven for patients, avoiding the need for island hopping (page 530).

Most general neurologists manage the initial presentations of neurological disorders but might involve subspecialists if problems persist. Almost all neurologists manage some patients with epilepsy. For women with epilepsy there are additional dimensions to consider including risks of teratogenicity, the impact on contraception and the managing of medication during pregnancy. Emily …