Many unknowns in neurology?

[SxRx]

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Hello everyone,

I'm an M1 and am currently taking neuroscience. I have a question about the field in general from what I've observed in my neuro class.
We were learning about how the basal ganglia and cerebellum get involved in motor coordination. However, when I asked the professor, "So, the initial motor signal from the motor cortex goes to the basal ganglia, processed there, and comes back to the cortex. Then, the signal goes down to the brainstem and some of the signal goes to the cerebellum via pontocerebellar pathway. Exactly how are all these things interlinked to produce a movement?" She is a very nice and knowledgeable professor. But, she told me that things are not very clear yet exactly how they all interact. To me, this type of functional question seems very rudimentary part of neurology that I expected people to have answers.

My observation from conversations like this is that there are much more unknowns in the field of neurology than say cardiology or gastroenterology (I could be wrong....but, just my observation).

If this is true, can this be a bit frustrating not knowing in more details about how things work in the neuro system as a physician?

Thanks.

 

[HarveyCushing]

Hello everyone,

I'm an M1 and am currently taking neuroscience. I have a question about the field in general from what I've observed in my neuro class.
We were learning about how the basal ganglia and cerebellum get involved in motor coordination. However, when I asked the professor, "So, the initial motor signal from the motor cortex goes to the basal ganglia, processed there, and comes back to the cortex. Then, the signal goes down to the brainstem and some of the signal goes to the cerebellum via pontocerebellar pathway. Exactly how are all these things interlinked to produce a movement?" She is a very nice and knowledgeable professor. But, she told me that things are not very clear yet exactly how they all interact. To me, this type of functional question seems very rudimentary part of neurology that I expected people to have answers.

My observation from conversations like this is that there are much more unknowns in the field of neurology than say cardiology or gastroenterology (I could be wrong....but, just my observation).

If this is true, can this be a bit frustrating not knowing in more details about how things work in the neuro system as a physician?

Thanks.

I think that is why many are drawn to neurology, myself included, because of the many unknowns. Neurology (the brain in general) is the last frontier within medicine. As you yourself learned, there is a lot that we don't know within this field. There are many questions that still need to be asked within neurology. Some might get frustrated by this. Others might really like this aspect as the field is always evolving and changing. Talk to some of your neurology attendings that have been practicing +15-20yrs and ask them about the changes they have seen since they began. I think the next 5-10yrs will show more knowledge, treatment therapies...etc. than any previous time period in the field.

 

[Nerdoscience]

1) Didn't you answer your own question to the professor? What exactly do you want to know?
2) We do know exact pathways, but these are simplifications of a system where different cells have different functions, functions are done in probabilistic centers, not necessarily discrete structures, there is a degree of adaptability, and signaling is as much about modulating other signals as it is about creating something new.
3) Do we know what each nerve of the enteric nervous system does? Do we know the exact mechanism of takotsubo cardiomyopathy causing apical hypokinesis and ballooning in the setting of adrenergic overload? I beg to differ with your thought that we understand the body other than the brain all that well. It's not a simple machine. It's far more interlinked and complicated than that.

 

[McGillGrad]

You're only a MS1 and your teacher was allowing you to save face by simplifying it for you because you are not far enough along in medical school to appreciate the complexities of the system.

There are many areas that need further research in neurology, but it is more nuanced than you imagine.

 

[Enkidu]

"So, the initial motor signal from the motor cortex goes to the basal ganglia, processed there, and comes back to the cortex. Then, the signal goes down to the brainstem and some of the signal goes to the cerebellum via pontocerebellar pathway. Exactly how are all these things interlinked to produce a movement?"

What kind of an answer were you looking for? Did you want to know how many synapses are involved, what neurotransmitters are used, or what? Did you want her to draw the relevant networks and describe them with differential equations?

To be honest, it kind of sounds like you're having a conceptual problem understanding what the nervous system does, rather than neuroscience being filled with unknowns.

In any case, medical school only goes a certain depth with these things. If you want to understand it better, the circuits of the basal ganglia and cerebellum are among the best studied, so there are definitely resources out there.

 

[Vader]

The brain and nervous system are immensely more complicated than the heart or GI tract. It is exactly this complexity that intrigues neurologists and neuroscientists. As you can already sense, we understand relatively little about how neural systems work to produce behavioral phenomena, but this is a current area of intensive investigation.

Very little if any systems neuroscience is taught in medical school unfortunately, mainly because our understanding is so fresh (much of the work was done in the last decade or two).

That being said, neurologists actually need only a rudimentary understanding of basic neuroscience to practice clinical neurology (as it is practiced currently). Most important is knowledge of neuroanatomy for the purpose of localization. Once localized, the question becomes what disease entities could cause the lesion (i.e. differential diagnosis) and treatment is directed toward the particular disease.

One thing I find particularly appealing is that the neurologist is able to query the nervous system through the neurological examination to localize the lesion and monitor disease progression. Thus, even without a good understanding of how the system works, neurologists are able to detect where, and many times what the lesion is, simply by history and physical examination alone.

 

[PhakeDoc]

The thing that appeals to me most about neurology, coming from a basic science perspective, is that nearly every patient/condition is an "experiment" in the making. You steer the rudder of interest within the realm of neurology/neuroscience, and you can find an interesting problem nearly with every patient (ok, except for perhaps low back pain), generally with ramifications from both the science and clinical aspect. That to me is what'll keep me coming back "tomorrow."

You can use the "frustration" either as a limitation or an impetus to find out more.

Would you really want to work in a field that had all the answers and all you did was go through an algorithm without any thought about what was going on?

 

[pep45]

Great discussion!! I feel the same way as many of you... Neurology is fascinating already and I am looking forward to see where the field has taken off to in 20 years!!

 

[tibuan]

I've been thinking of having this career. Awesome discussion. Neurology is one of the best medical stems you can have.
indianapolis surgical oncologist

 

[HarveyCushing]

I've been thinking of having this career. Awesome discussion. Neurology is one of the best medical stems you can have.
indianapolis surgical oncologist

Huh??? 😕

 

[PhakeDoc]

Huh??? 😕

Make that x2. 😱