Neurology through the years: A dramatic improvement in diagnosis and treatment
James McCarthy, MD, has been a practicing neurologist on Cape Cod for 45 years. That gives him a good perspective on the changes that have occurred in his field of practice - and they are substantial. Now practicing at Neurologists of Cape Cod in Hyannis, he said things that we take for granted today, like advances in diagnostics, didn’t even exist in 1973, when he first began practicing medicine.
“The changes are amazing,” he said. “When I started off in 1973, there were no scans - no CAT scans, no MRI scans. All diagnosis had to be done clinically.”
The availability of advanced imaging means that neurologists can now not only locate the part of the brain in which the disease process is located, but also what the actual disease process is. This is critical information that informs decisions on treatment. For example, when people had a stroke before scans were available, doctors didn’t know whether it was a hemmorhagic stroke, due to a burst blood vessel, or whether it was an ischemic stroke, due to a bloodclot.
The distinction is important because the treatment of each cause is the exact opposite. For a stroke that is due to a clot, doctors want to dissolve the clot with “clot-busting medications.” But if the stroke is due to a hemmorage, the goal is to encourage the blood to clot and stop the bleeding. Prior to this imaging capability, physicians were forced to make an eduated guess and begin treatment, often with less than desirable results.
Scans also allow neurologists to conduct electrical studies of the nervous system to see whether the neurological problem is in the central nervous system or the peripheral nervous system. Each follows a different disease process that can now be defined.
The second big advancement in neurology is in the available treatments, according to Dr. McCarthy.
“It used to be that neurology was a diagnostic specialty,” he said. “We didn’t have many treatments. People would come in for a consultation and we would say you have Parkinson’s disease or you have multiple sclerosis or you had a stroke, and send them back to the primary care physician. Now we have good treatments.”
One example is the treatment of seizures. For decades there were only two medications that could be used: Dilantin and Phenobarbitol. In the mid-1970s, Tegretol came out and, in the 80s, Depakote arrived on the scene. In the 90s, at least 10 new medications were approved by the FDA and each has its own particular benefits.
“We’ve made tremendous progress with multiple sclerosis, as well,” Dr. McCarthy said. “There was virtually no treatment for MS until 1993, when they started these injections of medications that have helped alter the disease process. But in the last five years, we now have 11 different oral medications we can give.”
There were no medications to treat Parkinson’s disease until 1967 when L-dopa came out. Now there are many medications that have been extremely helpful in managing the disease.
Even though treatments have remained elusive for diseases like malignant brain tumors and Alzheimer’s disease, diagnosis has become possible, which offers patients the gift of knowledge so they can plan ahead.
“Basically the diagnosis of neurological disease has had a complete revolution in the last 50 years,” Dr. McCarthy said.