[Neurology! Adieau? (Part 1)].
The neurological practice suffered considerable changes during the last twenty years. The recent therapeutic methods and the acceptance of the ideology of evidence based medicine, which is based on confidence in statistics, changed the reasoning of the neurologists. Therapy protocols intrude into the field of individual medicine, and doctors accept treatment schemes to alleviate responsibility of their decisions. In contrast with this, recent achievements in pharmacogenetics emphasize the importance of individual drug therapies. The protocol of intravenous cerebral thrombolysis does not require defining the origin of cerebral ischaemia in the acute stage, therefore, this procedure can be regarded as human experiment. According to the strict protocol thrombolysis might be indicated only in 1-8% of patients with cerebral ischaemia. According to the Cohrane database more trials are needed to clarify which patients are most likely to benefit from treatment. Because of the change in therapeutic principles transient ischaemic attack has been newly defined as "acute neurovascular syndrome". Multiplication of neurological subspecialties has been facilitated by the development of diagnostic tools and the discovery of effective new drugs. The specialization led to narrowing of interest and competency of clinicians. Several new neurological scientific societies were founded for the representation of specific disorders. In Hungary, between 1993 and 2000 nine scientific societies were grounded within the field of clinical neurology. These societies should be thankful to the pharmaceutical industries for their existence. In some European countries in 2007 only three neurological subspecialties were accepted, which are neurophysiology, neuro-rehabilitation and child-neurology. Neuro-radiology is in the hands of general radiologists, the specialization is not granted for neurologists. Because of the subspecialization the general professionalism of neurologists has diminished. Among young neurologists the propedeutic skills suffered most seriously. Subspecialisation of teachers also interferes with the practice oriented teaching of medical students and residents.
Szirmai
Imre
I
Semmelweis Egyetem, Neurológiai Klinika, Budapest. szirmaiimre@gmail.com
D002545:Brain Ischemia / Q000150:complications / Q000209:etiology; D002543:Cerebral Hemorrhage / Q000150:complications; D018849:Controlled Clinical Trials as Topic; D005060:Europe; D019317:Evidence-Based Medicine; D020445:Hospitalists / Q000193:education; D006801:Humans; D007362:Intensive Care Units; D002546:Ischemic Attack, Transient / Q000188:drug therapy; D008511:Medicine; D009462:Neurology / Q000193:education* / Q000639:trends*; D011871:Radiology; D016032:Randomized Controlled Trials as Topic; D020521:Stroke / Q000188:drug therapy* / Q000209:etiology / Q000601:surgery; D009626:Terminology as Topic; D015912:Thrombolytic Therapy / Q000379:methods; D014481:United States