Melomed Articles


14 February 2019 - Dr. Pearl  Thomas

Neurology - the face of the future


Among the medical disciplines, Neurology is usually considered the most arcane of fields and is often the most misunderstood.

The public often asks questions like, Doctor, do you do operations? and the answer is No. Colleagues in the medical fraternity will ask, I think the patient has a stroke. What do you think? and again, the answer is No. When you ask a neurologist, What do you do?, days later you may find yourself still the unwitting victim of an impromptu lecture, with the neurologist's passionate discourse about his/her field not waning in the least. Pardon my colleagues - after all, we love what we do.

I will not bore you with the answer of what neurologists do, but I will give you a glimpse in the unusual things that neurologists do, that make them very different from other specialists and hints at what the future of medicine may look like. 

Most people know that neurologists study the electrical activity of nerves all over the body. We look at muscles, the neuromuscular junction, nerves, spinal cord, brainstem and brain. We send little messages along the nerve and we track the course of these signals using electrodes. We look at spontaneous activity of muscles and brain cells. These components of the nervous system create a universe of their own, with constant chatter between neighbours and lots of traffic on the highways.

However, most people don't know that neurologists often interfere with the electrical activity of these components of the nervous system to make people better. 

At the most basic level, we inject local anaesthetic agents into subcutaneous tissue to paralyse nerves that propagate headache, or muscle paralysing agents like botulinum toxin into muscles that are overactive to diminish unwanted movements like blepharospasm, spasticity and dystonia. 

On a more complex level, neurologists use treatments and work closely with other disciplines to interfere with the electrical activity of the brain. 

The Cefaly device - http://www.cefaly.us/
The Cefaly device is a headband like device that sits across the forehead and uses transcutaneous electrical nerve stimulation (TENS) to stimulate the branches of the trigeminal nerve with the aim of, over time, diminishing the frequency and severity of migraine attacks. The results are not astonishing, but the device does work and allows some patients to reduce their requirement for medication to control their migraine attacks. 

Deep brain stimulation 
Patients with Parkinson's Disease can be offered a new lease on life with the implantation of a needle-like probe deep into the brain, where it emits regular electrical pulses. These pulses stimulate the discharge of critical neurotransmitters that are deficient in the brains of patients with Parkinson's Disease, which improves the symptoms of Parkinson's Disease dramatically, and significantly reduces the need for medication. Although the treatment is expensive, it is highly effective. 

Transcranial magnetic stimulation
Transcranial magnetic stimulation (TMS) is a noninvasive procedure that uses magnetic fields to stimulate nerve cells in the brain to improve symptoms of depression. TMS is typically used when other depression treatments havent been effective. During a TMS session, an electromagnetic coil is placed against your scalp near your forehead. The electromagnet painlessly delivers a magnetic pulse that stimulates nerve cells in the region of your brain involved in mood control and depression. And it may activate regions of the brain that have decreased activity in people with depression.

As medical science develops, so too will the frontier in Neurology broaden to offer patients new and effective treatments for problems that do not respond well to traditional therapies. As a neurologist, I am excited for what the future holds.  

Perhaps this will mean that Neurology will always remain the arcane speciality, as we now can alter human beings with carefully applied electrodes, but hopefully, the most inspiring message is that what we can do in the future will be limited only by what the collective human mind conceive.


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