I've been referred to a Neurologist...now what should I expect?

Should I Consult a Neurologist?

A partial answer to the question requires an appreciation of:

(1) A definition of neurological diseases and disorders.

(2) The qualifications of a neurologist to diagnose and treat these diseases.


Neurological diseases and disorders are organic or physical conditions of the brain and the spinal cord (central nervous system) as well as the peripheral nerves and muscles (peripheral nervous system). These comprise around 10% of diseases that come to medical attention. Some examples of neurological diseases include: strokes, epilepsy, brain tumors, Alzheimer’s disease, Parkinson’s disease, multiple sclerosis, head injuries, migraine and other headaches. In addition, many medical disorders arising outside of the nervous system such as diabetes, high blood pressure, as well as kidney and liver diseases can affect the nervous system.

Neurology is a term encompassing the above disorders and neurologists are medical specialists with postgraduate training and skills in neurology. After graduation from medical school and gaining a broad education in medicine as a whole, doctors pursuing a career in neurology usually take up positions for three or more years as trainees in academic hospital departments of neurology. Most large hospitals and medical schools have departments of neurology and many, particularly those engaged in medical research, have supervised training programmes for neurological trainees.  On completion of this specialised education, young trainees will seek formal certification confirming their competence. This involves passing rigorous written and oral examinations. In America, the successful candidates are “Board Certified” and in other countries, such as those of the Commonwealth, the equivalent terms may be a “Fellow” or a “Member” of a specialist society.

Neurologists are not surgeons and should not be confused with neurosurgeons. Although the borders of neurology and psychiatry overlap, neurologists are not experts in psychiatric diseases and are not qualified or inclined to evaluate people who have a predominately psychiatric disorder.

Keeping the above in mind, let us get back to the original question of should I see a neurologist?


Usually the patients are referred to neurologists by their family doctors or various medical specialists. These doctors can recognise or suspect that their patients have neurological diseases and may want confirmation of their diagnosis or help with diagnosis and management.  Insurance companies and other organisations, always with the patient’s consent, may also request a neurological opinion. Although in some localities patients may refer themselves to neurologists directly, many neurologists prefer that their patients are referred to them by other medical doctors. At first glance, this extra step before seeing a neurologist may appear an unnecessary impediment, but on the whole it more likely results in an appropriate consultation for both the patient and the doctors involved.  Thus, most commonly, the answer to should I see a neurologist?” is if my doctor thinks that I should. This does not preclude the patient’s right to request a neurological opinion without their doctor recommending it. In most instances their doctor will agree with this request, and in many localities medical ethics ban a doctor for declining such a request.

Once I make an appointment to see a neurologist, what should I expect?


The typical first neurological consultation takes around one hour. The first part is a dialog with the neurologist regarding the history of the patient’s relevant symptoms as well as a review of their other medical background. Then the neurologist will do a selective general physical examination and a detailed examination of the nervous system or neurological examination. The aims of this process are to establish whether there is a neurological disorder and if so what part of the nervous system is involved. The localisation of the disorder, for example in the spinal cord, helps limit the number of possible causes. The possible causes are the differential diagnosis. Usually, the neurologist will pick the most likely cause as the diagnosis but keep the differential diagnosis in mind.

Once the above is completed the neurologist will sometimes arrange tests to help confirm the diagnosis and to explore selective parts of the differential diagnosis. Other times, tests may not be necessary and the diagnosis can be confirmed by specific treatments that help the disease in question. For example if the diagnosis is migraine or Parkinson’s disease, a good response treatment may confirm the diagnosis and tests may not be necessary.  Occasionally, despite all of the above, the diagnosis remains uncertain, but may reveal itself in time. Here the diagnosis is made by clinical observation or follow-up neurological consultations. At completion of the consultation, the patient should expect a thorough explanation from the neurologist, in plain or non-medical terms. Further follow-up appointments are then arranged depending upon the diagnosis and response to treatment.

What are tests that may be ordered by a neurologist?

 
Magnetic resonant (MR) or computerised tomographic (CT) imaging visualise the brain and spinal cord and are the diagnostic tests choice for many diseases such as tumors, stroke, and multiple sclerosis.

Electroencephalography (EEG) records the brain’s electrical activity and is useful for the diagnosis of epilepsy.

Nerve conductions tests and electromyography (EMG) are means of recording the electrical activity of peripheral nerves and muscles, which are useful in the diagnosis of diseases primarily affecting these structures.

Lumbar puncture (LP) is a means of sampling the spinal fluid that bathes the nervous system and is useful for suspected infections and inflammatory neurological disorders.

For more detailed information an excellent and authoritative source is the American Academy of Neurology web site:  

http://patients.aan.com/disorders/

Dr. William Wallis

Neurologist
11 Waimea Lane,
Remuera, Auckland, 1050
New Zealand