A Neurologist is a medical doctor specialising in the diagnosis, treatment and management of disorders of the brain, spinal cord, peripheral nerves and muscles. A GP refers a person to a neurologist for a specialist opinion, if the person's symptoms are suggestive of a neurological problem.
Neurologists are generally asked to see people who have symptoms that might relate to the nervous system. Their initial role is to identify which part of the nervous system is affected and to determine the nature of the dysfunction. During a neurological examination the neurologist reviews the person's medical history with special attention to the current complaints. The neurologist will review the person's cognitive function, vision, hearing, balance, strength, co-ordination, reflexes and sensation. This is achieved by interviewing the person, and by performing a specific examination designed to test the functioning of the nervous system.
If an abnormality in the neurological examination is suspected, it may be necessary to conduct further tests to diagnose a neurological problem. These include magnetic resonance imaging (MRI) scanning of the brain and/or spinal cord. MS plaques are easily identified using MRI scanning and often the scans may need to be repeated over time to confirm a diagnosis.
Spinal fluid analysis is often undertaken by performing a lumbar puncture. A sample of spinal fluid is withdrawn and examined in the laboratory for evidence of inflammation associated with MS. In approximately 80 per cent of people with MS, the spinal fluid contains oligoclonal bands (OCBs). These bands, which are composed of antibodies directed at parts of the nervous system, indicate that there is a degree of inflammation within the central nervous system, and are useful in the work up of possible MS. Less commonly electrical testing may also be performed, including visual evoked responses (VERs), which measure the length of time it takes for an electrical signal to travel from the eyes to the back of the brain. VERs are often prolonged in MS patients.
Once a diagnosis of MS is confirmed the Neurologist will outline the therapeutic options which will vary according to each patient. They may also refer the patient to other services such as physiotherapy, occupational therapy, psychology, urology etc depending on the particular needs in each case. The Neurologist will generally see MS patients at least once per year for monitoring of the condition. They may request follow up MRI scans over time.
Useful Links and Resources
You can find a series of interviews with Neurologists about their work and various aspects of MS, carried out by Shift.MS as part of their MS Reporters project
These websites have some useful information on preparing for an appointment with your Neurologist:
MS Ireland is aware of serious deficits in neurology services in Ireland. Did you know that:
- Ireland exceeds the recommended ratio of Consultant Neurologists per head of population in every hospital group
- In MS Ireland’s recent My MS My Needs survey, 44% of people with MS waited more than six months for their last Neurologist appointment
A report by the Neurological Alliance of Ireland (NAI) gives more detail and facts and figures on under-resourcing and under-staffing in Ireland’s neurology centres. You can access the report here