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This article focuses on the institutional development of neurology in Germany up to the rise to power of the National Socialists and the radical sociopolitical changes after 1933. A wide range of scattered secondary literature was assessed and evaluated. Additionally, some original sources are literally quoted and interpreted according to the context. Since the end of the nineteenth century a complicated process of separation from internal medicine and psychiatry led to the formation of a self-conscious discipline of neurology. The first generation of German neurologists succeeded in founding the German Journal for Neurology ( 'Deutsche Zeitschrift für Nervenheilkunde') in 1890 and their own neurological association, the Society of German Neurologists ('Gesellschaft Deutscher Nervenärzte', GDN) in 1907. On an international scale, however, the institutional implementation of neurology with only a small number of chairs and few neurology departments remained more than modest. The ambitions for autonomy ended 2 years after the change of power in 1933. Regulatory interventions by the government and psychiatric interests led to the fusion of the GDN with the psychiatric specialist society, the new association being called the Society of German Neurologists and Psychiatrists ('Gesellschaft Deutscher Neurologen und Psychiater', GDNP) in 1935. In this group psychiatrists dominated the discourse. The expulsion, imprisonment and murder of physicians declared as non-Aryan or Jewish along with the forced consolidation ( 'Gleichschaltung') at the universities prompted profound changes in medical and academic life. It remains an ongoing challenge of neurological historical research to measure the impact of this upheaval on the few neurology departments in hospitals and private practices. [ABSTRACT FROM AUTHOR]

There are only a small number of studies dealing with the impact of eugenic theories and practices on the research of particular neurological diseases during the Third Reich. Thus, this contribution to the special issue on neurology in Germany between 1933 and 1945 focuses exemplarily on epilepsy research. By drawing on primary sources and secondary literature the article tries to reconstruct the scientific discourse of the time and consider the implications for patients. National socialistic ideology was based on eugenic thinking and the implementation of eugenic policies was a major political objective. An immediate effect of this policy was the passing of the Law for the Prevention of Genetically Diseased Offspring ( Gesetz zur Verhütung erbkranken Nachwuchses) in 1933. According to this law 'hereditary epilepsy' along with various other neurological and psychiatric disorders was regarded as a mandatory indication for forced sterilization. Subsequently, funding of epileptological research was generously increased and extended, e. g. at the German Research Institute (Deutsche Forschungsanstalt) in Munich and the Rheinische Provinzial-Institut in Bonn. The main focus was placed on idiopathic forms of the disease, which were a priori considered as hereditary. At the annual meetings of the Society of German Neurologists and Psychiatrists (Gesellschaft deutscher Neurologen und Psychiater), lectures and debates on epilepsy repeatedly constituted a key topic. Some participants opted for a broad interpretation of 'endogeneity' and thus favored an extension of the practice of sterilization but others advocated a more differentiated and restricted attitude. Several neurology researchers showed a penchant for self-mobilization in line with the doctrine of the new government. [ABSTRACT FROM AUTHOR]

The connection between systematic killing of the mentally ill and disabled, euphemistically called 'euthanasia' in the National Socialism ideology, and German brain research has been thoroughly investigated and in detail; however, the impact of this criminal nexus on the image and self-perception of German neurologists as well as the status of neurology as a medical discipline is still the subject of controversial debates. Between 1939 and 1945 the Kaiser Wilhelm Institute (KWI) in Berlin along with other research centres were insofar enmeshed in the 'euthanasia' program as brains of killed patients were dissected in the guise of 'concomitant research' in order to generate medical knowledge. Affected were mainly individuals suffering from oligophrenia, early childhood brain atrophy, cerebral palsy and epilepsy. According to current historical research, collegial networks were instrumental in receiving brains of killed patients. Furthermore, civil research units were supplemented by military ones at the KWI. These, too, were concerned with the collection of medical knowledge, for instance on injuries of the brain and spinal cord. The historical approach to consider the Nazi organizations and medicine as 'resources for each other' seems, therefore, at least in part applicable to neurology. [ABSTRACT FROM AUTHOR]

The article discusses the consequences for neurology as a discipline which resulted from neurologists' participation in the crimes committed under National Socialism (NS). Chronologically, the current literature distinguishes mainly four overlapping stages: (1) a first phase was characterized by legal persecution and 'denazification', which was also the time of the Nuremberg doctors' trial in which no neurologists were on trial. A detailed documentation of the trial for the German medical profession was published by Alexander Mitscherlich. (2) In the subsequent practice of wide amnestying and reintegration of former Nazi followers during the 1950s, neurologists were no exception as its elite continued in their positions. The year 1953 was the year of the Lisbon scandal, when chiefly Dutch representatives protested against the participation of Julius Hallervorden in the International Congress of Neurology. The newly founded societies, the German Society for Neurology (Deutsche Gesellschaft für Neurologie, DGN) and the German Society for Psychiatry and Neurology (Deutsche Gesellschaft für Psychiatrie und Neurologie, DGPN), unanimously supported their member. (3) The next period was characterized by a nascent criticism of the prevailing attitude of covering up the crimes committed by physicians during the Nazi period. The discovery of incriminating brain sections at various Max Planck Institutes brought neurology to the focus of the debate. (4) Since the 1980s and 1990s historians (of medicine) have been systematically examining medicine's Nazi past in a professional way, which resulted in a noticeable increase of knowledge. Additionally, a new generation of scholars provoked a change of mind insofar as they recognized medicine's responsibility for the crimes committed between 1933 and 1945. We expect that future historical research will further elucidate the history of neurology during the NS regime and have consequences for our current understanding of research ethics. [ABSTRACT FROM AUTHOR]

The care of elderly patients will continue to challenge the healthcare system over the next decades. As a rule geriatric patients suffer from multimorbidities with complex disease patterns, and the ability to cope with everyday life is severely reduced. Treatment is provided by a multiprofessional geriatric team, and the primary goal is improvement of functional status, quality of life in the social environment and autonomy by employing a holistic approach. In Germany geriatric care is provided by physicians from various medical specialties (e.g. general practitioners, internists, neurologists and psychiatrists). In the training for the subspecialty clinical geriatrics, these specialties enjoy equal rights. Recent efforts to establish a qualification as physician for internal medicine and geriatrics have initiated a discussion to make the suitability for qualification as a geriatrician dependent on the medical specialty. Geriatric patients benefit from multidisciplinary cooperation. Neurologists possess great expertise in the treatment of patients with dementia, depression, delirium, consequences of degenerative spinal cord diseases and vertebral bone fractures, stroke, Parkinson's syndrome, epileptic seizures, vertigo and dizziness, neuropathies, lesions of peripheral nerves and in the multimodal therapy of pain. To function in a position of responsibility in a geriatric department, neurologists need skills in general internal medicine. These are acquired either on a geriatric ward or during specialization as a neurologist by full time secondment to large neurological or interdisciplinary intensive care units. [ABSTRACT FROM AUTHOR]

Background: The number of sick leaves due to job strain is increasing. Objective: This study's scope is to examine working conditions of neurologists in hospitals in regard to job strain and job satisfaction. Methods: This study is part of the iCEPT-Study. The iCEPT-Study was conducted as a web based survey among physicians ( n = 7090) in German hospitals. The focus was on working conditions regarding job strain. Job strain was measured by a questionnaire consisting of items and scales from the short version of the Effort-Reward-Imbalance (ERI) questionnaire and the short questionnaire for working analysis (KFZA). By calculation ratios of distinct scales according to validated stress models a conclusion could be drawn as to whether or not job strain was present. Results: The total number of n = 354 neurologists were analyzed. The response rate was at 18.2 %. Job strain was encountered by 52.0 % (95 %-KI: 46.7|57.2) of all neurologists and no significant gender difference was present. However, resident neurologists were significantly more often exposed to job strain than attending neurologists (OR = 2.9; 95 %-KI: 1.6-4.7; p < 0.001). Regarding job satisfaction, 59.6 % (95 %-KI: 54.5-64.7) of all respondents stated to be satisfied with their job. Significantly more men were satisfied than women (OR = 1.5; 95 %-KI: 1.0-2.4; p < 0.05). Putting the focus on different occupational positions revealed that significantly more attendings were satisfied with their job than residents (OR = 2.9; 95 %-KI: 1.7-4.8; p < 0.001). Conclusion: The results of this study showed high prevalence of job strain among neurologists in German hospitals. Keeping the negative implications of mental and physical health in mind, the working conditions of neurologists must be improved. As shown in this study, a possible way to do so is to increase job control in order to decrease a major stressor at work. [ABSTRACT FROM AUTHOR]

Summary: The still continuing accelerated development of neurology in Germany is described in this article by a contemporary witness who was active in this field from 1965 to 2005. The personal experiences of the author are obviously only reflected over these 40 years so that the glorious antecedents in the period up to 1933, the era in which our predecessors were the world leaders in neurology, is not sufficiently covered. This dominance was lost by the anti-Semitism during the era of National Socialism and the sequelae of World War II. As a result of the war, German neurologists became effectively isolated and their participation in international congresses was forbidden so that a gradual reestablishment of alignment only became possible after 1960. In this brief description no attempt at completeness has been made and only subjectivity and brevity have been considered. An attempt is made to retrospectively convey what essentially happened. An exact dating of advances over the period was sometimes difficult. The readership will have the opportunity to share the surprise of the author on how meagre the neurological knowledge and diagnostic methods were 50 years ago, how rapidly the subsequent development happened, how rapidly things became obvious which 20 years ago nobody was aware of and despite the progress how pleased we were to find ourselves at the most recent state of error and probably still find ourselves nowadays. In particular, how powerless and untested the therapeutic efforts were at that time. The progress can only be measured by a comparison between then, 50 years ago and the present. A projection of the future based on these experiences is not attempted but it seems to be certain that many conceptions, diagnostic advances and therapy options are still undiscovered and that further exciting times can be expected. [ABSTRACT FROM AUTHOR]

Background: Decompressive hemicraniectomy reduces mortality in patients with space-occupying MCA infarction. Quality of life in surviving patients is discussed controversially. We assessed attitudes of neurologists and nurses providing care to this patient group towards decompressive hemicraniectomy. Methods: A postal questionnaire on attitudes and opinions on prognosis and quality of life after decompressive hemicraniectomy was returned by 280 neurologists and 166 nurses from tertiary care centers throughout Germany. Results: In both groups of professionals, estimates of the probability of survival after decompressive hemicraniectomy and the resulting degree of disability were consistent with results of clinical outcomes studies. Only 9% of the nurses and 33% of the physicians assumed that the majority of survivors achieve an acceptable quality of life; 58% of physicians and 32% of nurses would suggest decompressive hemicraniectomy to their nearest relative. Under the assumption of an uncertain outcome, 61% of physicians and 22% of nurses would agree to decompressive hemicraniectomy. In both professional groups, agreement for surgery increases when scenarios with a more favorable outcome were proposed [modified Rankin Scale (mRS) 2-5)]. If an outcome of 4 on the mRS is proposed, indicating moderately severe disability, only a minority favored decompressive hemicraniectomy (25% of doctors and 8% of nurses). Conclusions: Despite a realistic assessment of prognosis after decompressive hemicraniectomy, a majority of respondents estimated the quality of life of survivors as unsatisfactory. Nurses had a more pessimistic attitude towards decompressive hemicraniectomy. The majority of respondents consider an outcome of 4 on the mRS as unacceptable. [ABSTRACT FROM AUTHOR]