Seeing a neurologist
What are neurologists?
A neurologist is a medical doctor (MD) who has gone through medical school (4 years) and then a 4-year residency program in neurology. Neurology itself is the study of the whole nervous system, it's diseases, and how to treat them. Neurologists are an excellent choice for evidence-based, professionally integrated, medical care for a concussion.
There are a few sub-specialties in neurology which are the best for treating concussions. The best subspecialty for a concussion would be sports neurology followed by headache neurology. Sports neurologists are somewhat rare, but most major cities will have a headache neurologist. If you are looking for a specialist, these doctors/doctors offices will advertise themselves as having these specialists, or you can ask a local neurologist.
What will a neurologist do?
When you go to a neurologist appointment, you can expect them to run some sensory, motor, and psychological tests (these are measured on standardized scales) to establish the severity of symptoms. Depending on how long it has been since the concussion the neurologist will recommend different treatment and rehabilitation regimes. For this rehabilitation, they may recommend a short rest period, but often they will start the patient on a low-intensity non-contact exercise and physical therapy.
Who will a neurologist work with?
For patient’s rehabilitation, a neurologist will most often recommend a concussion patient to a physiotherapist and/or a physiatrist. In rarer cases, they may recommend patients to a nutritionist, psychologist, endocrinologist, and/or occupational therapist. Particularly helpful are physiotherapists who do vestibular therapy.
What other treatments/rehabilitation would a neurologist recommend?
Most neurologists will recommend some combination of rest, physical therapy, psychological therapy, and occupational therapy. Your neurologist will recommend treatments that have evidence-based positive results and have been verified as safe. However, many alternative therapies/treatments are being proposed which offering various degrees of evidence.
I spoke with Dr. Josh Kamins (MD) from UCLA Brain Sports about what he would recommend regarding looking into alternative treatments. He said that any patient looking into alternative treatments should ask themselves three questions.
Could the treatment itself cause more harm?
Does it take away energy from other activities that would help the patient more?
Is it financially doable?
If you are OK with the answers to all three of these questions, then you may want to look into different types of treatments.
What if you aren’t satisfied with your neurologist?
If you think that your neurologist isn’t helping enough or exploring all your options, Dr. Kamins recommends that you first search out another neurologist, hopefully, one who has one of the specialties listed above (headache neurology or sports neurology). Also important to keep in mind is that research into concussions and the number of treatments for concussions has expanded massively in the past 15 years, so many doctors are not versed in the current research or the newest treatment. This does not mean that the new treatment doesn’t work, but just that it's new and relatively untested or not thoroughly researched.