Neurology in 10-20 years?

[GatsbysBatman]

What are you 90%, 50%, & 10% confident will change or continue in neurology in the next decade or two?

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[dodobirddh]

These are the changes that I foresee...

1. Artificial Intelligence will play an important role in neurology in the next couple of decades.
PubMed article on AI shaping future of neurology
2. Point of care apps will boom
Differential diagnosis generator app
3. Genetics will play a huge role in therapeutics

 

[scoopdaboop]

These are the changes that I foresee...

1. Artificial Intelligence will play an important role in neurology in the next couple of decades.
PubMed article on AI shaping future of neurology
2. Point of care apps will boom
Differential diagnosis generator app
3. Genetics will play a huge role in therapeutics

Idk about genetics. That was also being formulated in psych, but not really much evidence.

 

[Thama]

It will probably look a lot like it does today, but with some new drugs. Maybe we will have an AD drug that works but I'm not holding my breath. More likely, we will have some ASO-based gene therapies for some genetic diseases (HD and SCAs are high on the list). We will all be even more overwhelmed than we are now trying to care for aging-related diseases in a rapidly aging population.

 

[Aldertonghen]

It will probably look a lot like it does today, but with some new drugs. Maybe we will have an AD drug that works but I'm not holding my breath. More likely, we will have some ASO-based gene therapies for some genetic diseases (HD and SCAs are high on the list). We will all be even more overwhelmed than we are now trying to care for aging-related diseases in a rapidly aging population.

What are your thoughts on the future of DBS? Do you think indications will expand and possibly include things like psych conditions, pain (there’s research on them now but no definitive proof I think)? And about VNS/RNS in epilepsy? Any new neuromodulation technologies not used yet but are promising?

 

[deathmerchant]

What are you 90%, 50%, & 10% confident will change or continue in neurology in the next decade or two?

I think Neuro will continue to be a high burnout speciality. Midlevels will be seen practicing independently everywhere and in everyspeciality. Reimbursements will increase to a certain point over the next 5-10 years and then they will plateau and start going down.

We will definitely have some new treatment options, but nothing groundbreaking. Unless there are breakthroughs in ND disorders like ALS or Alzheimers. Neuro-oncology will definitely progress with Oncology in general. We will probably have portable CTs/MRIs- hopefully in the offices and ERs. That would make life much easier. Everybody will be getting a genetic panel to diagnose and chose the right meds for them. Gene therapy will be available to many.
We will likely be dealing with a lot of 90+ year olds with higher expectations.

I think DBS or VNS, in their current state, will expand little bit, but not much more than what they are now. Although I do believe that they are the gateway towards Neuromodulation in general and I think Adavanced Neuromodulation could be game changing in the future for things like Epilepsy, spinal cord injury etc. May be even AD.

Also, if for some reason US becomes a socialized healthcare system, physician salaries will go down all over IMO, but Neuro will become more sought after, maybe one of the most- which is what happens in other socialized medicine countries.

 

[Captain_Falcon]

What About socialized medicine would make neuro specifically more sought after?

 

[confused_doc]

What About socialized medicine would make neuro specifically more sought after?

People tend to choose things they find interesting rather than makes them money. The subject matter of neurology tends to be quite interesting compared to a lot of medical specialties when you remove money out of the equation.

 

[deathmerchant]

What About socialized medicine would make neuro specifically more sought after?

Like confused_doc mentioned above, neuro is one of the more fascinating fields and people in most other countries appreciate that more. US healthcare is skewed heavily towards procedural/high reimbursement or lifestyle specialities. Enormous student loans are a factor too.
Neuro (or IM- because in most countries Neuro is a fellowship after IM residency) is still not the Most sought after, but definitely in top 5-10% in many countries.
Its the same with Pediatrics- Its very competitive and sought after and respected in most countries. Not so much here in the US.

 

[Captain_Falcon]

Ahh I just kinda misunderstood the premise - I misread, thinking the statement was "under socialized medicine Neuro will make more $$$ or won't get cut as much as others effectively having it make more $$$" -- I totally agree that Neuro is the best (I'm applying this cycle), and if it got paid a bit more it would be more competitive

 

[Thama]

What are your thoughts on the future of DBS? Do you think indications will expand and possibly include things like psych conditions, pain (there’s research on them now but no definitive proof I think)? And about VNS/RNS in epilepsy? Any new neuromodulation technologies not used yet but are promising?

I'm not the one to talk about VNS or RNS in epilepsy - not my field.

Re: DBS, in the near future I think we'll see advances in a few key areas: closed-loop systems and automated programming, connectivity-based target selection and outcomes prediction, and expansion of disease indications.

I think people have been a little overeager on the expansion of disease indications compared to what DBS actually is and can do. Historically, we think of DBS creating a simulated lesion in an overactive circuit, and the diseases that it has successfully treated are essentially overactive "circuitopathies" in some sense. In trying to apply DBS to diseases that don't really behave this way (e.g. Alzheimers), the results have been extremely poor. As we still don't understand circuit-level mechanisms very well in most Axis 1 psychiatric disorders, I think successful treatment of those is still a long way off. In OCD, we do have that circuit-level understanding with a few rational targets within the basal ganglia, so we've achieved some limited success (enough to get humanitarian device exemptions). But for things like depression, we're stuck trying to treat a symptom that may be a result of a totally unknown number of underlying disease processes, and no real evidence for whether there is a single neuroanatomical region where a simulated lesion would create the desired effect. It's very much cart before the horse, scientifically speaking.

That brings up the other part - other new neuromodulation techniologies. TCMS/TCDS are becoming quite widely used in psychiatric fields, and I would be more optimistic about this direction in psychiatric disease than DBS. Non-invasive lesioning (historically gamma knife, more recently focused ultrasound) is becoming very popular for treatment of tremor and occasionally Parkinson disease, but more due to unethical marketing approaches than due to effectiveness. The other thing that is likely to affect DBS is the development of subcutaneous levodopa pumps - this is certain to be on the market within the next 1-2 years and may be a more desirable option than DBS for a large percentage of those currently getting DBS.

 

[voxveritatisetlucis]

What About socialized medicine would make neuro specifically more sought after?

Why do you think socialized medicine is on the horizon though? California couldn’t even pass Calcare (universal health coverage) with supermajorities in both houses and the governorship. At the end of the day, raising taxes is still a huge liability on both sides of the aisle

 

[Captain_Falcon]

Why do you think socialized medicine is on the horizon though? California couldn’t even pass Calcare (universal health coverage) with supermajorities in both houses and the governorship. At the end of the day, raising taxes is still a huge liability on both sides of the aisle

Never said it is