I am a current neurology resident, and here are my predictions for the changes which will ocurr in neurology in my career.
1) There will be newer and more effective treatments for neuroimmunological diseases. Diseases such as autoimmune demyelinating polyneuropathy, multiple sclerosis, and myasthenia will be categorized, subcategorized, and studied extensively. New monoclonal antibody infusion treatments will have specific targets for maximal efficacy with less side effects. The prognosis of "malignant" multiple sclerosis may improve somewhat, although some cases will still be resistant.
There may an increase in the early diagnosis of benign multiple sclerosis and unnecessary aggressive treatment in these patients could be an unfortunate side effect.
2)
The treatment of acute stroke will go the way of cardiology, and tissue plasminogen activator and thrombectomy will become commonplace even at non-academic centers. Current multimodal MRI techniques for determining which patients will benefit from intervention will prove unreliable, but doctors will continue to treat acute stroke very aggressively with a modest clinical benefit and an astronomically increased cost.
3) Advances in neuroimaging will assist in the diagnosis of neurological disorders in ways that I am unable to predict. New forms of functional neuroimaging or spectroscopy may play a role.
4) neurointerventional radiology will continue to grow, and intraarterial procedures will be performed where neurosurgical proceedures were previously performed. Perhaps even brain biopsy will be performed via catheter based proceedures.
5) The number of drugs used to treat migraine will increase tremendously without clinical benefit
6) The treatment of partial onset epilepsy with surgery/radioablation will increase in frequency along with the use of magnetoencephalography
7) Intraoperative monitoring will continue to grow and may gain a role in acute stroke.
8) We will continue to see advancements in the understanding of neurdegenerative and genetic disorders, and many etiologies will be defined explicitly. Clinical entities previously thought to be homogeneous will be broken down into distinct categories. Most of these conditions will remain without highly effective treatments, although a smaller number of metabolic conditions will become highly treatable. Prenatal diagnosis and genetic counseling will become commonplace. Specifically, I suspect that several decades from now, gene chip microarray analysis for a myriad of common and uncommon human diseases will be done routinely.
9) For the most part, there will be no highly effective treatments for the most common forms of dementia
10) New chemotherapy regimens will significantly improve the prognosis of certain brain cancers with a previously poor prognosis such as high grade glioma. Open surgical debulking/resection may even become unnecessary.
11) In general, neurologists in particular and physicians in general will in many cases fail to meet the ridiculously high expectations of patients.
