From exact diagnosis to appropriate therapy

In 2001, what had been the joint medical society of neurology and psychiatry split into two respective societies. Neurology as a medical profession was for many years closely linked with psychiatry, and a majority of specialists in private practice were, through their training, qualified to practice in both fields. By the middle of the 1990s, analogous with other European countries, this development towards treating the specialisations separately was taken into account in training, and since then training in either neurology or psychiatry is possible.

History

Neurology, historically, begins in the second half of the nineteenth century. The first Austrian textbooks for neurology as a medical speciality, by Rosenthal and a little later Benedikt, date from around 1860. Neurology in Europe and in the United States has different roots.
In the German-speaking countries in particular, there is a close connection with internal medicine, and by tradition a link with psychiatry, which played an important role in the first neurological unit set up in Vienna in the previous century.

Basis

The basis of neurology was and remains neuroanatomy, which allows an exact localisation of dysfunction in the brain, spinal cord, peripheral nerves and muscles. Thus neurology is also closely linked to neuropathology, which constituted the comparative basis for clinical studies for many decades. That changed fundamentally in the middle of the last century with the development of electrophysiology, which enabled assessment of functions via electro-encephalography and later nerve conduction velocity tests, electromyography and evoked potentials

The spectrum was further augmented in the 1970s with the new insights and practical application of neuroimmunology and lastly, genetics. The introduction of imaging methods (ultrasound, computertomography, magnetic resonance tomography) had enormous practical effects on neurology, as did the methods of nuclear medicine, especially PET, which allowed, in addition to very exact localisation, the demonstration of functional processes and dysfunctions. This development is not yet complete and is being constantly improved and extended.

Neurology in Austria

Neurology has been accorded significantly greater importance in the health system in recent years. Until the mid 1970s, it had been restricted as a specialty to university clinics and specialised hospitals. In tertiary care hospitals of the time, only conciliar services were offered, which were required to serve both neurology and psychiatry. A neurological department was first integrated into a tertiary care hospital (Lainz) under Prof. Stacher in Vienna in 1976. This example was followed nationwide, and today a tertiary care hospital without a neurological department is barely conceivable. In recent years, medical training regulations to qualify as a general practioner have also required a two month internship in either neurology or psychiatry. Similar developments can also be observed in private practice, although this is not yet complete nationwide.

Neurological disease patterns

Neurological diseases are not uniform, but have a wide range of causes and present very different patterns of symptoms. From the many disease patterns of neurological illness, only a few can be cited here as examples. The numerically most common disease in neurology is circulatory disorders of the brain. Particularly in the treatment of “stroke”, numerous new initiatives have been undertaken in recent years. Studies have documented that early neurological intervention and the possibility of dissolving the vascular obliteration (lyse) offer improved outcomes. Therapies as complicated as these, and which also carry certain dangers, can only be carried out by specially trained neurologists working in specialised facilities. The concept of “stroke units” has established itself across Europe and is now also being adopted across Austria.

Alongside drug therapies, the emphasis is on early rehabilitation, neurological patient management and the over-all medical treatment of the patient. However this goes well beyond the acute phase and must include supplementary early rehabilitation. Additional neuro-rehabilitation centres are required here, and outpatient rehabilitation needs also to be given greater support.

Even more important than acute therapy and rehabilitation, is prevention. Neurology must succeed in arousing public awareness for “stroke patients” and of “the dangers of stroke”: this includes exercise, lifestyle, diet and, the most important factor, avoiding high blood pressure. The goal of these initiatives must be to prevent strokes. “Every stroke is a stroke too many.”

The list of neurological patterns of disease which in recent years, based on scientific research, have become more amenable to treatment could be continued indefinitely. Multiple sclerosis may be cited as a good example, in which neuroimmunological therapies have led to a decrease in the frequency of episodes and a reduction in their intensity. This achievement is based on a complex foundation of clinical experience, results from imaging (MRI) and many neuroimmunological groundwork studies. These positive developments have also brought further improvements in MS patient management. MS competence centres have been set up across Austria, which provide specialist treatment on one hand but also optimal care for patients by including members of other professional groups. Because of the age pyramid, the treatment of neurodegenerative diseases such as Parkinson’s is a growing necessity. Following the tremendous changes brought by the introduction of L-Dopa a few decades ago, there is now a whole range of substances or other treatment methods available to relieve symptoms of the illness.

Further examples of diseases which can be successfully treated include diseases of the spinal column, whereby an interdisciplinary approach, based on clinical investigation, can often offer better treatment of lesions of the spinal discs and nerve roots (herniated disc). Seizure disorders, polyneuropathy, muscle diseases and neurological intensive care are other important areas in treatment of disease in which neurology has set milestones in recent years. But it is particularly in the interdisciplinary area that neurology has set an important new course. Interdisciplinary links primarily with neurosurgery, orthopaedics and internal medicine can be observed. Neurooncology has traditionally had an interdisciplinary aspect, dealing as it does on the one hand with treatment of the primary brain tumour and on the other with treatment of the neurological effects of cancer. The introduction of a variety of specialist approaches and skills has brought improved outcomes for patients.