Neurosciences (or clinical neurosciences) refers to the branch of medicine that focuses on the nervous system. The nervous system is made of two parts:
- The central nervous system (CNS) consists of your brain and spinal cord.
- The peripheral nervous system consists of all your nerves, including the autonomic nervous system, outside of the brain and spinal cord, including those in your arms, legs, and trunk of the body.
Together, your brain and spinal cord serve as the main "processing center" for the entire nervous system, and control all the functions of your body.
A number of different medical conditions can affect the nervous system, including:
- Blood vessel disorders in the brain, including arteriovenous malformations and cerebral aneurysms
- Tumors, benign and malignant (cancer)
- Degenerative diseases, including Alzheimer disease and Parkinson disease
- Disorders of the pituitary gland
- Headaches, including migraines
- Head injuries such as concussions and brain trauma
- Movement disorders, such as tremors and Parkinson disease
- Demyelinating diseases such as multiple sclerosis
- Neuro-ophthalmologic diseases, which are vision problems that result from damage to the optic nerve or its connections to the brain
- Peripheral nerve diseases (neuropathy), which affect the nerves that carry information to and from the brain and spinal cord
- Mental disorders, such as schizophrenia
- Spine disorders
- Infections, such as meningitis
DIAGNOSIS AND TESTING
Neurologists and other neuroscience specialists use special tests and imaging techniques to see how the nerves and brain are working.
In addition to blood and urine tests, tests done to diagnose nervous system diseases may include:
- Computed tomography (CT scan)
- Lumbar puncture (spinal tap) to check for infection of the spinal cord and brain, or to measure the pressure of the cerebro-spinal fluid (CSF)
- Magnetic resonance imaging (MRI) or magnetic resonance angiography (MRA)
- Electroencephalography (EEG) to look at brain activity
- Electromyography (EMG) to test nerve and muscle function
- Electronystagmography (ENG) to check for abnormal eye movements, which can be a sign of a brain disorder
- Evoked potentials (or evoked response), which looks at how the brain responds to sounds, sight, and touch
- Magnetoencephalography (MEG)
- Myelogram of the spine to diagnose nerve injury
- Nerve conduction velocity (NCV) test
- Neurocognitive testing (neuropsychological testing)
- Polysomnogram to see how the brain reacts during sleep
- Single photon emission computed tomography (SPECT) and positron emission tomography (PET) scan to look at brain metabolic activity
- Biopsy of the brain, nerve, skin, or muscle to determine if there's a problem with the nervous system
Neuroradiology is a branch of neuroscience medicine that focuses on diagnosing and treating nervous system problems.
Interventional neuroradiology involves inserting tiny, flexible tubes called catheters into blood vessels leading to the brain. This allows the doctor to treat blood vessel disorders that can affect the nervous system, such as stroke.
Interventional neuroradiology treatments include:
- Balloon angioplasty and stenting of carotid or vertebral artery
- Endovascular embolization and coiling to treat cerebral aneurysms
- Intra-arterial therapy for stroke
- Radiation oncology of the brain and spine
- Needle biopsies, spine and soft tissues
- Kyphoplasty and vertebroplasty to treat vertebral fractures
Open or traditional neurosurgery may be needed in some cases to treat problems in the brain and surrounding structures. This is more invasive surgery that requires the surgeon to make an opening, called a craniotomy, in the skull.
Microsurgery allows the surgeon to work on very small structures in the brain using a microscope and very small, precise instruments.
Stereotactic radiosurgery may be needed for certain types of nervous system disorders. This is a form of radiation therapy that focuses high-powered x-rays on a small area of the body, thereby avoiding damage to surrounding brain tissue.
Treatment of nervous system-related diseases or disorders may also include:
- Medicines, possibly given by a drug pumps (such as those used for people with severe muscle spasms)
- Deep brain stimulation
- Spinal cord stimulation
- Rehabilitation/physical therapy after brain injury or stroke
- Spinal surgery
WHO IS INVOLVED
The neurosciences medical team is often made up of health care providers from many different specialties. This may include:
- Neurologist: a doctor who has received extra training in the treatment of brain and nervous system disorders
- Vascular surgeon: a doctor who has received extra training in the surgical treatment of blood vessel disorders
- Neurosurgeon: a doctor who has received extra training in brain and spine surgery
- Neuropsychologist: a doctor specially trained in administering and interpreting tests of the cognitive function of the brain
- Pain physician: a doctor who received training in treating complex pain with procedures and medicines
- Psychiatrist: a doctor who treats brain-behavioral disease with drugs
- Psychologist: a doctor who treat brain-behavioral conditions with talk therapy
- Radiologist: a doctor who received extra training in interpreting medical images and in performing different procedures using imaging technology specifically for treating brain and nervous system disorders
- Nurse practitioners (NPs)
- Physician assistants (PAs)
- Nutritionists or dietitians
- Primary care doctors
- Physical therapists, who help with mobility, strength, balance, and flexibility
- Occupational therapists, who help keep people functioning well in the home and at work
- Speech-language therapists, who help with speech, language, and understanding
This list is not all-inclusive.
Brazier MAB. The emergence of electrophysiology as an aid to neurology. In: Aminoff MJ, ed. Aminoff's Electrodiagnosis in Clinical Neurology. 6th ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 1.
Daroff RB, Jankovic J, Mazziotta JC, Pomeroy SL. Diagnosis of neurological disease. In: Daroff RB, Jankovic J, Mazziotta JC, Pomeroy SL, eds. Bradley's Neurology in Clinical Practice. 7th ed. Philadelphia, PA: Elsevier; 2016:chap 1.
Daroff RB, Jankovic J, Mazziotta JC, Pomeroy SL. Laboratory investigations in diagnosis and management of neurological disease. In: Daroff RB, Jankovic J, Mazziotta JC, Pomeroy SL, eds. Bradley's Neurology in Clinical Practice. 7th ed. Philadelphia, PA: Elsevier; 2016:chap 33.
Daroff RB, Jankovic J, Mazziotta JC, Pomeroy SL. Management of neurological disease. In: Daroff RB, Jankovic J, Mazziotta JC, Pomeroy SK, eds. Bradley's Neurology in Clinical Practice. 7th ed. Philadelphia, PA: Elsevier; 2016:chap 53.
Meyer PT, Rijntjes M, Hellwig S, Klöppel S, Weiller C. Functional neuroimaging: functional magnetic resonance imaging, positron emission tomography, and single-photon emission computed tomography. In: Daroff RB, Jankovic J, Mazziotta JC, Pomeroy SL, eds. Bradley's Neurology in Clinical Practice. 7th ed. Philadelphia, PA: Elsevier; 2016:chap 41.