Adults Cerebral Musings Expert Blogs

Neurological Borderlands

In response to my attempts to discuss cognition and behaviour relating to a particular patient, whom I was presenting at a clinical case conference, a senior professor of neurology once said “I have little interest or belief in these modern supratentorial matters”. Although surprised and somewhat miffed, I took heart in the knowledge that I was not a stranger to this experience. The great father of cognitive and behavioural neurology, the legendary Norman Geschwind, is also reported to have had several similar experiences, when he set off on his journey exploring the brain, mind and cognition interface. Thanks to his brilliance, tenacity and the legions of pupils he managed to influence, the behavioural neurology interface that he gave life to is thriving today, in a way that he himself would have probably found unimaginable. Perhaps what surprised me most was that my own experience of rejection came almost three decades later, and the proponent was a neurologist somewhat junior to Norman Geschwind himself.Neurology is an academic specialty and one that has traditionally chosen to reside in ivory towers. Rather typical of this environment, many neurologists have been slow to accept and explore the rich interface that exists between their specialty and other aspects of medicine, science and indeed the humanities. However, both in the science and in the practice of medicine there exists many a rich example of such interfaces that occupy the borderlands of this great and noble specialty. In modern times the neuroscience arena has been revolutionised by advances in molecular and cellular understanding, neurogenetics, neuroimaging, neurophysiology, computational systems, neuropharmacology and other related areas of science and medicine.

Another quiet revolution has been taking place in neurology. Many centres world over have begun to develop clinical and research expertise in the interface between neurology and other areas of clinical medicine. Cognition and behaviour are now old examples of this interface that have advanced to becoming distinct specialties in their own right. Neuro-opthalmology, Neuro-radiology, Neuro-psychology and Neuro-rehabilitation are other examples of interface disciplines that have seen tremendous advances clinical, service development and research. Neuro-genetics, Neuro-epidemiology and Neuro-immunology are leading scientific disciplines today and have great prominence in academic institutions and specialist centres. Other emerging areas that are making progress, thanks to the efforts of individual clinician-academics, people of stature in different parts of the world, include Neuro-otology, Neuro-pulmonology, Neuro-cardiology, Neuro-gastroenterology, Neuro-urology, Neuro-oncology and Neuro-gynaecology etc. The momentum for such development has come mainly through interested clinician-academics in neurology and other branches of medicine, people with commitment, tenacity and foresight.

Significant contributions to these neurological borderlands have also begun to emerge in the research arena. A range of professionals from many scientific disciplines; biochemists, pathologists, microbiologists, pharmacologists, physicists and computational experts has begun to make inroads into neuroscience, often through major collaborative research programs. The humanities have not been left behind either with philosophers, psychologists, social scientists, behavioural scientists, linguists, nurses, health service professionals and many others taking part in interdisciplinary research at the neuroscience interface. However, despite these changes, the neurological borderlands remain largely ignored. The do not always form part of neurological curricula, nor do their proponents, laudable though their efforts, receive adequate attention as serious professionals in the neurological mainstream. Indeed, these specialists are often relegated to the very borderlands that they espouse and fail to find a befitting position within the rigid hierarchy of traditional academia, institutional or indeed that of learned societies.

In a world that is increasingly interdisciplinary, progress of any specialty is determined by its ability to incorporate and interface with the different disciplines that surround it: clinical, research and academic. The organisation and delivery of neurological services at the community level also demands a considerable interface between neurology and these borderlands, clinical, biological and psychosocial.  Such efforts must therefore transcend convention; beyond clinical work; beyond the biological sciences; beyond medicine and its specialties; to areas that appear peripheral but are nevertheless relevant. The neurological mainstream must develop an awareness and interest in these borderlands and make every effort to incorporate them in clinical, research and service development relevant to neurology. A failure to recognise this need to expand neurological horizons will only result in neurology failing to retain its rightful place under the sun, as the queen of medical specialties.

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