On the Novelty of Neurology

Welcome to our Neuroscience Society Blog, one of the most exciting features of our new website! Expect to see a variety of content, including discussions on neuroscience and advice and ideas about approaching university placements/projects/exams! To inaugurate this blog page, I will write a series of post highlighting some of the ways neuroscience plays a role in our lives. Each post will be a short commentary on how neuroscience has infiltrated a particular domain – from medicine, to psychology, philosophy and psychedelic drugs! Ultimately I hope to persuade you to explore more about this fascinating field… Almost everyone has some understanding of the term 'neuroscience'. Unlike with more obscure sounding disciplines such as 'rheumatology' or 'nephrology', most laypeople would be able to describe, at the very least, that neuroscience involves studying the brain. (And of course, we all know that the brain is by far the most intriguing organ!). Nevertheless, what once seemed a simple enough enquiry - "How does the brain work?" - created a rabbit hole, the bounds of which continue to expand. Other than its more obvious applications in medicine and molecular research, this 'simple' enquiry now stretches into the realms of social and behavioural sciences, linguistics and artificial intelligence, to name a few. Now, when someone states that they're a neuroscientist, it is just as likely that they're helping build a super-computer as they are researching drugs for Alzheimer's disease. Furthermore, the topic of the brain has sourced and fuelled countless philosophical discussions about mind, consciousness, reality, intelligence and beyond since the dawn of civilisation. So, not only does the concept of brain transcend scientific domains, but it transcends them temporally. A short commentary on clinical neuroscience Though examining the normally functioning brain is in itself plenty of food for thought, investigating and managing disorders of the nervous system is just as much a challenge. Neurologists and neurosurgeons specialise in treating these disorders, ranging from cerebrovascular events (e.g. stroke) to malignancies (e.g. glioblastomas) to neurodegeneration (e.g. Parkinson’s disease). As a medical student, my introduction to the tangible world of academic neuroscience came through neurology. From a year 10 work experience shadowing a stroke physician, to more recent rotations in neurology at university, the clinical cases in neurology have always struck me. In this first blog post, I will briefly discuss the uniqueness of clinical neuroscience amongst its fellow medical specialties. To me, what stands out in brain-related medical specialties is the inherent deficit of identity that often accompanies the problem. For example, let’s compare two patients with acute manifestations of coronary disease; one has a myocardial infarction (i.e. a heart attack) and the other a stroke. Both patients are treated successfully and are on the road to recovery- yet, the patient struck by the latter condition has suffered a global aphasia that renders him unable to comprehend and formulate any speech. The heart attack victim is able to talk with his family and carers; he is able to communicate how he is feeling and whether he feels any pain; he is able to reminisce and laugh; he is able to understand instructions and affection. On the other hand, the stroke victim has completely lost these faculties and cannot do any of those things. Even if through persistent language therapy he recovers, his toughest moments immediately after the event are completely isolating. Not only has he lost sense of himself, but others have too, and this would certainly affect his recovery. Despite the same aetiology, these conditions can affect an individual so differently, due to the mere location of ischaemia and the subsequent deficits. Of course, both problems are dreadful, but I know for sure which one I’d rather have… Additionally, there is a subtle, insidious stigma that is associated with neurological conditions which makes them so devastating. They give rise to symptoms that can perturb even observers who consider themselves wells of empathy. When someone suffers from a dermatological condition and may be bullied or vilified due to their visual appearance, the root of that stigma is somewhat clear to identify. And thus, for those looking from the outside, it is easy to isolate the factor that is causing the stigma. But what about when the attribute is hard to define? What about when it’s not a tangible characteristic that is being vilified? This is where I think neurological deficits condemn their bearers so cruelly. Many conditions curse patients with ‘invisible’ disabilities, implanted deep in things that make us really who we are. For example, consider one of the cardinal symptoms of Parkinson’s disease- a ‘mask-like’ appearance. The lack of facial control in many severe PD patients creates a Frankenstein-like stare that certainly isn’t approachable. If I was to walk past someone with such an expression, I would quite naturally recoil, or wonder what their problem was. Many carers - including family members - of people with dementia and PD, have a hard time trying to overlook the often scathing words and irrationality that these patients exhibit. Yet, imagine the pain of having no control over the things you say and do. And then imagine the despair of watching those around you inevitably resent who you’ve become because it’s simply too much to manage. This stigma from others isn’t limited to those with neurodegenerative conditions; in Louis Theroux’s excellent documentary - ‘A Different Brain’ - he explores the devastating effects of brain injury. In one family, tension is rife between a mother and her own son, due to the subtle personality changes the mother had after a traumatic brain injury. It was painful to see the desperation for love the mother felt, just beyond the aggressive exchanges she shared with her son. Though this lady retained her memories and most of her intellect, the damage to her brain changed her in such a subtle way that her son or partner could no longer love her like before. Another popular example which springs to mind is the character of Arthur Fleck from the 2019 film ‘Joker’. Aside from his undefined mental health condition, Arthur exhibits uncontrollable laughter (possibly some pseudobulbar affect) which initially appears as a trivial – almost hilarious – affliction. But in multiple scenes, Joaquin Phoenix brilliantly portrays how truly debilitating this is for Arthur, mostly due to how others react around him. (Anyway, I shouldn’t make this sound too much like a film review…) So, it’s that point – the change in ‘who someone is’ – after suffering from a neurological condition, that makes the field of neurology so devastatingly fascinating. The instances when a person can be restored to their ‘original’ selves seems such a liberating feeling that clinicians have the privilege of witnessing. Whether it be through slow but steady therapy, or a rapid emergency thrombectomy, clinicians of neuroscience have a duty to try and retain the essence of ‘person’ in the individuals they help. Otherwise- is there a point in treatment at all?

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