Neurology Alert Departs From the Decade of the Brain to Enter the Century of the Brain

Decade of the Brain

This issue of Neurology Alert, janus-like, briefly reviews some of the remarkable discoveries and improvements of clinical neuroscience that have appeared during the Decade of the Brain. Also, it starts with great enthusiasm to ferret out the substance of new, ever more novel experiences and reports that may help neurologists and their patients during the forthcoming "Century of the Brain."

During the past 10 or more years, despite frustrating political and economical interference, neurologists have been rewarded with a substantial increase in many new, valuable laboratory tests, procedures, and concepts. New variations of magnetic resonant imaging (MRI) have improved that instrument’s diagnostic qualities as well as its increasing capability to quantify the dynamic changes that underlie the brain’s functional processes. Because of the increasing refinements of these and important other scientific tools, both basic and clinical neuroscientists are poised to identify important changes in understanding the fundamentals of many incompletely solved neurological disorders. To give an example of scientific promise about, Neurology Alert describes a remarkable example of the results of 10 such outcomes that a group of basic and clinical neuroscientists in 1992 predicted might be achieved within the remaining eight years of the Century of the Brain (see page 37). Many examples of farsightedness and ingenuity of other investigators also have been achieved since that time.

Until about 35-40 years ago, most clinical neurology depended on histories, physical signs, a limited number of electrophysiologic procedures, and relatively simple laboratory tests. Houndsfield’s demonstration in 1971 of the first commercial CAT scan initiated the capacity to define the static anatomy of the living brain. Reliable PET instruments appeared upon the scene in the early 1980s, thereby launching for the first time a machine capable of monitoring functional activity associated with specific human behavior. MRI was first invented and named as nuclear magnetic resonance (NMR) by Block and Purcell in 1946 and converted into medical MRI by Lauterbur in 1973. The ultimate step to clinical neurological use was developed in 1991. With successive technological advances, all three generations of MRI instruments have gradually not only mapped the brain, but the latter two, for the first time in history, have elevated psychology into a rich association with brain anatomy and the generative patterns that underlie behavioral functions.

Human health and behavior represent the functional product of an integrated biomachine, the brain, which generates and regulates its own selective, specific circuits and their many relationships with other bodily systems. The conscious as well as the automatic brain constantly regulates and mostly generates its immediate and more remote future, a chore that integrates its own instinctive and learned properties with those of other body organs. Despite this now widespread truism, until the early 1980s most clinical and even basic neurologists treated and investigated the nervous system by individually different scientific disciplines. Neurochemists, pharmacologists, physiologists, pathologists, anatomists, biological psychiatrists, mathematicians, and several other specialty groups often studied the brain independently. Much value emerged from those approaches. Nevertheless, single-goal investigations often failed because they lacked the understanding that other, interdigitating scientific modalities were required to understand the integrated nervous system. The change in approach started in 1966 when the farsighted Schmidt of MIT drew together leaders of the above disciplines and invited them to think together about the brain. The outcome of the interdependent discussions coined the term neuroscience,’ reflecting the biological integration of all the selective disciplines analyzing the functional brain and its appendages. The recent development of the cell-molecular-genetic discipline derives from this concept and completes present neuroscience integration.

Molecular genetics and molecular-cell biology are becoming the major tools of present medicine, including neuroscience. Functional brain imaging is, for the first time, providing not only images of human structural brain disease but also of the gross anatomy, chemistry, and pharmacology of the awake human brain and mind, both in sickness and in health. Clinical neurological research and even practice can best be understood and investigated by neurologists educated to diagnose patients, alleviate their sufferings, and meet the challenge of effectively conquering the underlying disorders. Early identification of neurological illnesses and the application of effective treatment represent the challenge to neurology in the forthcoming Century of the Brain. Cell/genetic neurological disorders are going to increase in frequency and neurologists will be the best group to identify their nature and treat them. Neurology Alert will continue to present mostly summaries that deal pragmatically with contemporary neurological diagnosis and treatment, but, when appropriate, we will discuss new discoveries that neurologists may wish to apply or explain to their patients.

A final note: even in today’s scientific, specialized approach to illness, more patients will come to neurologists with diseases of emotions than of the structural nervous system. Only we, as sensitive caregivers who understand the brain, know enough to distinguish psyche vs. soma as the basis of many nervous system complaints. Wise words by informed neurologists still can provide far more than a thousand laboratory tests in helping such individuals. Neurology Alert also has set a goal to provide its future readers with information about new neuropharmacologic agents that provide specific improvements in improving behavioral problems. Recommendations for further improvements always draw our attention.

With this issue, Neurology Alert is proud to add Thomas D. Bird, MD, as a contributor. Dr. Bird is Professor of Neurology at the University of Washington Medical School and a world expert in neurogenetics and how genes affect the nervous system. Along with his associates, Nancy B. Hanson, MS, and Roberta A. Pagon, MD, he has provided Neurology Alert with this first monthly Century Alert, an accompanying, informative table listing genetic neurological diseases with clinically available DNA-based genetic testing. This information is inserted in this issue for current subscribers. As a public service, it will be provided free to others who request it by calling Customer Service at 1-800-688-2421. Additions to the table as well as new discoveries in this important clinical field will be added to future monthly Alerts when appropriate. —fp