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It was the best of times; it was the worst of times. It was the age of wisdom, it was the age of foolishness. It was the epoch of belief; it was the epoch of incredulity; it was the season of light; it was the season of darkness. It was the spring of hope; it was the winter of despair. We had everything before us; we had nothing before us.
The introduction of Charles Dickens’ A Tale of Two Cities describes the state of medical affairs today as much as the tumultuous world of the French Revolution 200 years ago. On the one hand, advances in basic and clinical neuroscience are transforming our field. The following list includes topics unknown or in their infancy 30 years ago, when I was graduated from medical school, which are now central to the neurology research effort.
Topics unknown in 1969
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• CNS neurotransmitters (other than γ-amino-butyric acid, acetylcholine)
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• Receptors and mechanisms of receptor actions
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• Ion channels and membrane biophysics
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• Intercellular and intracellular communication
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• Cell death: necrosis, apoptosis
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• Nonsynaptic cell–cell interactions
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• Realistic computer modeling of neuronal networks
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• Biochemical and molecular genetics; cell biology
The last 10 years have also seen a great expansion in the following number of areas and topics considered appropriate for research support.1
Expanding areas of investigation in neurology1
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• Epidemiology
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• Experimental therapeutics
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• Disease prevention strategies
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• Quality of life issues
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• Behavioral/psychological issues
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• Health services research (quality assessment, cost-effectiveness, outcome research, decision analysis, and quality assessment)
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• Models for delivery of medical care (primary physician to neurologic center)
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• Ethics of clinical policies and research
As a specialty, we are riding a tidal wave of understanding fundamental mechanisms and advances in therapeutics that is simply unparalleled. The pace at which new information appears is rapid and far-reaching. The wonderful …
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