Which conditions are most treatable?

[Yoyomama88]

Which conditions in neurology are the most treatable and make the greatest difference in patient's lives?

Also if there are certain illnesses that are not treatable currently, which diseases do you foresee major breakthroughs for in the near future?

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[typhoonegator]

Syphilis and B12 deficiency.

 

[Yoyomama88]

Oh c'mon haha. How about epilepsy, multiple sclerosis, stroke, migraine, myasthenia?...are patients screwed with the rest (dementia, brain tumors, trauma, genetic disorders etc)?

 

[typhoonegator]

Fine. Chiari I. Carpal tunnel. Treatable.

I will leave it up to you to decide whether putting a GBM patient on Temodar is more satisfying than putting an MS patient on Tecfidera. Your opinion there says much more about your interests than about QALYs.

If I had a keen understanding of where the next treatment breakthrough would come, my opinions would be reflected in my stock portfolio rather than on this forum.

 

[Yoyomama88]

So I have a question then, if you feel that most neurological problems are not treatable...Where do most neurologists gain fulfillment in their clinical work? The relationships they develop with their patients or simply making the diagnosis? (I could see things get fun when the DX is really hard to make, but most of it will be bread and butter type illness)

I love the brain, but at the end of the day... all you do is : 1) a history and a physical 2) give an rx (that has limited benefit), and 3) write up notes on patients. If you're not making a significant impact in their quality of life, then where's the satisfaction? I think acute stroke, status epilepticus and other neurologic emergencies are fascinating and the treatment provides immediate tangible benefits, but there's no way you can see only these types of patients in practice.

 

[Vader]

So I have a question then, if you feel that most neurological problems are not treatable...Where do most neurologists gain fulfillment in their clinical work? The relationships they develop with their patients or simply making the diagnosis? (I could see things get fun when the DX is really hard to make, but most of it will be bread and butter type illness)

I love the brain, but at the end of the day... all you do is : 1) a history and a physical 2) give an rx (that has limited benefit), and 3) write up notes on patients. If you're not making a significant impact in their quality of life, then where's the satisfaction? I think acute stroke, status epilepticus and other neurologic emergencies are fascinating and the treatment provides immediate tangible benefits, but there's no way you can see only these types of patients in practice.

Many and probably most common neurologic conditions are treatable (as mentioned above: stroke, migraine, epilepsy, Parkinson's, MS, etc). There are a handful that are reversible and even curable (i.e. brain infections, stroke in certain cases, vitamin deficiencies, Guillain-Barre syndrome, etc).

This is similar to most sub-fields of medicine that diagnose and treat chronic conditions (i.e. heart failure, renal failure, liver failure, etc.) and reversible/curable conditions (anemia, infections, etc).

Even when one cannot treat the underlying disease itself, one can still treat the patient. i.e. physical, occupational and speech therapy, supportive measures, education, community and social resources, psychosocial support, etc.

In being a physician, one has a much larger role than simply diagnosing and treating disease.

 

[postbacpremed87]

I think there is a lot of comfort in being able to put a name to the symptoms. Patients know what they have and can get their mind around treating it.

 

[oopsy]

I think acute stroke, status epilepticus and other neurologic emergencies are fascinating and the treatment provides immediate tangible benefits, but there's no way you can see only these types of patients in practice.

Sounds a lot like neurocritical care.

 

[Mattchiavelli]

Many and probably most common neurologic conditions are treatable (as mentioned above: stroke, migraine, epilepsy, Parkinson's, MS, etc). There are a handful that are reversible and even curable (i.e. brain infections, stroke in certain cases, vitamin deficiencies, Guillain-Barre syndrome, etc).

This is similar to most sub-fields of medicine that diagnose and treat chronic conditions (i.e. heart failure, renal failure, liver failure, etc.) and reversible/curable conditions (anemia, infections, etc).

Even when one cannot treat the underlying disease itself, one can still treat the patient. i.e. physical, occupational and speech therapy, supportive measures, education, community and social resources, psychosocial support, etc.

In being a physician, one has a much larger role than simply diagnosing and treating disease.

exactly- I really don't think contemporary medical practice is based around "cures" but more about outcomes like not being dead and/or quality of life type issues, of which some are a phenotypically disease-free state. Getting from 15 migraines a month to two that resolve in a few hours is a very big thing. Getting to no more migraines ever would be even better but not always achievable, and you have to decide if that makes you satisfied as a physician. Honestly if it doesn't, maybe medical practice isn't the best fit. The concept that surgery is "curative" nowadays is very dated, especially after you see a couple of ventral hernias that just won't quit.