In the case of many neurological symptoms and diseases, the situation does not require immediate care by a neurologist. For example, the examination and treatment of chronic headache such as tension headache and migraine is mainly implemented in basic health care. Similarly, a health centre or occupational health physician begins the clarifications of memory difficulties, tremor and numbness symptoms. When the diagnosis or further treatment requires input from a neurologist, the physician refers the patient to the local Neurology Outpatient Clinic.
The most important diagnostic tool a neurologist has is the patient’s account of his or her symptoms. In addition, the neurologist performs a clinical examination or examines muscle strength, sense of touch, reflexes and the operation of the cranial nerves by hands and by using a range of examination tools. If necessary, the neurologist uses various laboratory tests and imaging studies, measurements of nerve and muscle functioning (clinical neurophysiological examinations) and the expertise of other professionals such as therapists and neuropsychologists to assist in the diagnosis.
A diagnosis drawn up at the Neurology Outpatient Clinic and the nature of the symptoms or diagnosed disease is discussed with the patient. Next, treatment commences and further plans are drawn up. In most cases, the patient returns to the care of the referring physician at this point. However, in certain long-term neurological diseases, the patient stays in the care of the Neurology Outpatient Clinic for follow-up purposes so that the course of the disease and effectiveness and suitability of the treatment can be regularly assessed. In some cases, it is possible that despite extensive examinations, no references of a neurological disease are found that would explain the patient’s symptoms. However, as such, this is sometimes a notable result, because when a neurological disease has been ruled out, the significance of other (e.g. psychological) factors to the patient’s symptoms can be clarified.
The treatment of chronic neurological diseases is often related to long-term medication. Although a curative treatment for the disease might be missing, in most cases, medication is available that hinders the progress of the disease or alleviates its symptoms. For example, MS belongs to the first group and Alzheimer’s and Parkinson’s disease to the latter. In turn, the majority of patients suffering from epilepsy become completely seizure-free with regular antiepileptic medication.
Rehabilitation plays a key role in neurology: in many diseases, exercise that maintains physical and mental functioning alleviates symptoms, maintains working capacity or enables independent everyday life. A multidisciplinary team assesses the need for rehabilitation and implements it. In addition to a neurologist, the team includes a nurse, physiotherapist, occupational therapist, speech therapist, neuropsychologist and/or social worker, depending on the situation.