neurology(redirected from clinical neurology)
Also found in: Dictionary, Thesaurus, Medical, Wikipedia.
a group of biomedical disciplines that study the structure and function of the healthy or pathological nervous system, as well as the principles of nervous system phylogeny and ontogeny. The theoretical bases of neurology include neurophysiology and such morphological disciplines as the anatomy, histology, embryology, and comparative anatomy of the nervous system. Neuropsychology is a division of neurology. Clinical neurology, which is the study of nervous diseases, is called neuropathology in the USSR. Neurosurgery deals with nervous system diseases whose treatment is mainly surgical. Mental diseases constitute a special group of central nervous system disorders; these are the subject of psychiatry.
In ancient times, physicians were to some extent familiar with the morphology of the nervous system: they recognized the difference between the brain and the spinal cord, they determined the relationship between nerves and the brain, and they described the brain meninges. In the 16th century, A. Vesalius studied the nervous system from the point of view of the interrelationship between form and function; such an approach has dominated the study of neurology to this day. The accumulation of anatomical data proceeded during the centuries that followed. During the 19th century, the development of microscopy led to the accurate description of the neuron, of the nerve pathways, and of the centers of the nervous system. Neurophysiology developed simultaneously with the histology and descriptive anatomy of the nervous system.
R. Boyle and F. Redi initiated exploration of the animal brain by performing brain ablation studies. The development of experimental neurology in the first half of the 19th century made it possible for F. J. Gall to advance the hypothesis of localization of brain function. Special centers that control motor and sensory functions were discovered in the brain and spinal cord. Disturbances in motor and sensory function, especially those that occur when half the spinal cord is severed, were described in 1849 by C. Brown-Séquard. Improvements in microscope technology and the development of methods for fixing cerebral tissues made it possible to study the microstructure of the brain.
In the second half of the 19th century, progress was made by J. F. Cohnheim and other researchers in studying the vascularization of the brain. At the same time, microscopic studies of brain structures were being carried out by other scientists, including the German anatomist and neurologist P. Flechsig and the French morphologist L. Ranvier. The phylogeny and ontogeny of the nervous system were also investigated during the second half of the 19th century. F. V. Ovsiannikov, V. A. Betz (Bets), N. M. Iakubovich, and V. M. Bekhterev made important contributions to the study of brain structures, including the discovery of Betz cells and Iakubovich’s and Bekhterev’s nuclei. At the turn of the 20th century, the physiological investigations of I. M. Sechenov, N. E. Vvedenskii, and C. Sherrington were especially significant to the development of neurology.
The 20th century has seen many important achievements in the field of neurology. Among these are the teachings of I. P. Pavlov on higher nervous activity, the explanation of the evolutionary genetics that define structure and function in the brain, and the inclusion of new data on the vertical levels of organization of brain activity into the older concepts about the horizontal levels of integration of nervous activity. Researchers in these areas include H. Magoun and G. Moruzzi in the USA, W. Pen-field and H. Jasper in Canada, and O. Sager, in the Socialist Republic of Rumania. J. Delgado in the USA and R. Hassler in the Federal Republic of Germany studied the functions of the brain by electrostimulation of the deep cerebral structures. Significant progress has also been made in understanding neuronal chemistry and the biochemical differences between the various structures of the central and peripheral nervous systems. The development of cybernetics as applied to neurology has occasioned attempts to create mathematical models that reflect morphological and physiological aspects of brain processes. The interrelationship of the brainstem and the subcortex received special consideration in these mathematical investigations. One potentially fruitful application of mathematical modeling methods to neurology is the possibility of representing cerebral reflex processes in the brain in the form of cybernetic diagrams.
The works of Pavlov’s school has exerted a singular influence on the development of neurology in the USSR. L. A. Orbeli developed the concept of the adaptotrophic function of the cerebellum and experimentally established the influence of the sympathetic nervous system on muscle contraction (the Orbeli-Ginetsinskii phenomenon). V. N. Chernigovskii significantly contributed to the study of interoception, and K. M. Bykov, to the study of the interrelation of the cerebral cortex and the internal organs.
P. K. Anokhin facilitated the investigation of the integrative activity of the brain by introducing his theory of functional systems. E. A. Asratian experimentally induced various lesions in the brain in order to study the high degree of cerebral plasticity; these investigations were important in establishing a theory to explain the recovery of neurologic functions and to elucidate the compensatory processes that occur in response to a neurologic injury. N. A. Bernshtein formulated the principles of the organization of motor functions. The investigation of the cytoarchitectonics of the brain has been continued by the German neurologists K. Brodmann, S. Vogt, and O. Vogt and by several Soviet neurologists, including S. A. Sarkisov and I. N. Filimonov. B. N. Klosovskii has continued the study of vascular structure in the brain.
The electrode implants and stereotoxic operations performed by Bekhterev and other scientists who employ microelectrode techniques have uncovered new data on the functional significance of various regions of the brain. The use of these methods has contributed to the development of the doctrine of localization of function in the central nervous system and has opened up the possibility of directing mental processes during pathological states.
Major scientific centers where neurology is studied in the USSR include the Institute of Brain Research and the Institute of Neurology of the Academy of Medical Sciences of the USSR and the Institute of Higher Nervous Activity and Neurophysiology of the Academy of Sciences of the USSR (Moscow); the Institute of Experimental Medicine of the Academy of Medical Sciences of the USSR and the V. M. Bekhterev Psychoneurological Institute (Leningrad); the Institute of Psychiatry and Neurology (Kharkov); the Institute of Neurology, Neurosurgery, and Physiotherapy (Minsk); and the Institute of Experimental and Clinical Neurology (Tbilisi). Problems of neurology are discussed in several publications, including Zhurnal nevropatologii i psikhiatrii im. S. S. Korsakova (S. S. Korsakov Journal of Neuropathology and Psychiatry; published since 1901), Klinicheskaia meditsina (Clinical Medicine; published since 1920), and Voprosy neirokhirurgii (Problems of Neurosurgery; published since 1937).
Abroad, the important research centers in neurology include the Neurological Institute of Columbia-Presbyterian Medical Center in New York City and the National Institute of Neurological Diseases and Stroke in Bethesda, Md., in the USA; the National Hospitals for Nervous Diseases in Great Britain; the Max Planck Institute in the Federal Republic of Germany; the Montreal Neurological Institute; the Psychoneurological Institute in the Polish People’s Republic; the Institute of Neurology in the Socialist Republic of Rumania; and the Center for Neurology, Psychiatry, and Neurosurgery in the People’s Republic of Bulgaria. Neurological research is covered in the following general medical and specialized journals: Neurology (published in Minneapolis, Minn., since 1951), Archives of Neurology (published in Chicago, III., since 1919), Journal of Nervous and Mental Diseases (published in Baltimore, Md., since 1874), Brain (published in London since 1878), Nervenartz (published in Berlin since 1928), Revue neurologique (published in Paris since 1893), European Neurology (published in Basel since 1968), and Journal of the Neurological Sciences (published in Amsterdam since 1964). The World Federation of Neurology unites neurologists of various countries. International congresses on neurology have been held since 1897.
REFERENCESSharko, Zh. M. Bolezni nervnoi sistemy: Lektsii. . . . St. Petersburg, 1876.
Kozhevnikov, A. Ia. Nervnye bolezni i psikhiatriia. Moscow, .
Bekhterev, V. M. Obshchaia diagnostika boleznei nervnoi sistemy, parts 1–2. St. Petersburg, 1911–15.
Kurs nervnykh boleznei, 3rd ed. Edited by G. I. Rossolimo. Moscow-Leningrad, 1930.
Astvatsaturov, M. I. Uchebnik nervnykh boleznei, 8th ed. Moscow-Leningrad, 1939.
Sepp, E. K., M. B. Tsuker, and E. V. Shmidt. Nervnye bolezni, 5th ed. Moscow, 1954.
Mnogotomnoe rukovodstvo po nevrologii, vols. 1–8. Moscow, 1955–63.
Arkhangel’skii, G. V. Istoriia nevrologii ot istokov do XX veka. Leningrad, 1965. (Contains a bibliography.)
Krol’, M. B., and E. A. Fedorova. Osnovnye nevropatologicheskie sindromy. Moscow, 1966.
Oppenhein, H. Lehrbuch der Nervenkrankheiten, parts 1–2. Berlin, 1923.
Holmes, G. Introduction to Clinical Neurology. Edinburgh, 1946.
L. O. BADALIAN