what happens on first visit to neurologist

What Does A Neurologist Do On Your First Visit?

A neurologist is a medical expert responsible for the diagnosis and treatment of various nerve-related ailments. This includes disorders that affect the brain and the functionality of the nervous system. Although they are certified medical doctors, they do not perform any major surgical procedures. Then what does a neurologist do on your first visit? That is the main focus of discussion in this article.

Most of the patients visiting a neurologist are referrals from other medical institutions and you can also get the online medical second opinions . There are various tests that a neurologist does on you to get the right diagnosis. These tests are to determine whether your ailment is related to any nerve dysfunction. On the first neurologist appointment, you do not need any specific preparations. The interactions are generally cordial and simple medical procedures. The primary focus is usually on body reflexes, muscle strength, and sensory nerves coordination.

The initial encounter in the first visit to neurologist is usually an interaction session. It starts with introductions and brief interrogation of your medical history. After that, the neurologist will decide what route to take in your diagnosis. The procedures focus on the reaction of nerves to certain stimuli. After the analysis, the neurologist then concludes the report back to the referring doctor. Essentially that is what a neurologist does on your first visit.

Neurological testing is wide. Whereas some patients get their analysis over with physical examinations, others end up with laboratory tests. At the neurological clinic, the nerve specialist follows a medical procedure that involves the testing of nearly all the body faculties. Since the nervous system is the central body control, it takes time for a correct diagnosis to come out. Although most neurologists are private practitioners, they work with most insurance companies . When booking an appointment, try and get information about the billing methods of the neurologist. If their payment criterion is different, try and arrange for optional billing methods for your convenience. But most of the nerve experts use the local medical insurance payment methods.

When To See A Neurologist?

There is no definite cut time to see a neurologist. It is essential to seek neurological services when you experience one of these situations. Headaches and migraines are frequent in people . When they persist beyond the regular medication, seek further attention. The second is muscle numbness and chronic pain. Muscles react to nervous stimuli, and if you cannot respond appropriately, there is a problem. Poor or blurring of vision is another reason for neurological attention. It could be a case of multiple sclerosis developing. Amnesia, loss of memory, and confusing things could be a trigger for brain damage. Lastly is insomnia. When you suddenly start having difficulty in sleeping, seek neurological help.

Some people worry a lot about what to expect at a first visit to neurologist. After the initial diagnosis, a nerve specialist has a rough idea. But other tests may be necessary to corroborate the initial diagnosis. Laboratory tests of the blood and urine expose any infections in your system. Electromyography tests are where electrodes on your muscles detect the coordination between nerves and muscles.

Electroencephalograph is a test of the brain that recognizes the activities of the brain nerves. Electrodes on your scalp measure the magnetic actions of your brain’s electric impulses. Sometimes a biopsy is necessary. Neurologists observe a sample of your body tissue under a laboratory microscope for a diagnosis.

Electronic imaging is necessary, depending on the initial analysis. This test exposes any tumors, and poor aligning of the bones, nerves, tissues, and discs in the patient. A neurologist can also measure the effectiveness of the touch, sight, taste, and hearing senses. This measures the ability of the brain to respond to regular stimulation.

When you see a neurologist for back pain , a more serious test is necessary. The neurologist will perform the spinal tap procedure. It could mean severe damage to the spine, which controls all the nervous operations. He extracts some spinal fluid for checks. This procedure exposes any infection in the blood or injury of the spinal nerves or discs.

A neurologist serves a delicate balance in the therapy of a nervous patient. To help in your diagnosis in the initial visit, try answering the simple question. What does a neurologist do on your first visit? Have your medical history available with you when you visit. If possible, prepare your concerns, questions, and list them beforehand. It will help your first visit to yield more information aiding to a precise early diagnosis.

Doctor, author and fitness enthusiast, Ahmed Zayed, MD, is a surgery resident with a passion for helping people live a happy healthy life. He is the author of numerous health-related books and contributor to several medicine, health and wellbeing.

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Questions to Ask Your Neurologist at Your First Appointment

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By: Mathew Pulicken, MD

June 27, 2023

When it comes to your neurological health, seeking the expertise of a specialist is crucial. The Renown Institute for Neurosciences  provides comprehensive care for complex diseases affecting brain, spinal cord and peripheral nerves.

Let us help guide you through the appointment process to ensure a productive and informative first appointment.

What to Expect at Your First Appointment at the Renown Institute for Neurosciences

Duration and Purpose: Your first appointment will last approximately one hour. This time allows the doctor to ask specific questions, do a thorough neurological exam and discuss your concerns.

Specialized Care: You will be matched with a provider who specializes in assessing and treating your specific ailment or condition. This tailored approach ensures that you receive care from an expert who has the specialized interest and expertise to address your needs effectively.

Initial Assessment: During your visit, you will first see a medical assistant who reviews your medication history and standard screening questions provided by your doctor. Following this portion of your appointment, the neurologist will ask specific and detailed questions about your condition and conduct a non-invasive neurological examination to evaluate your brain and nervous system functioning. This exam involves painless tests assessing your cognitive function and nerve operation, including tests for sensation, strength and coordination.

Treatment: After performing the neurological exam and addressing your questions, the neurologist will review the possible diagnosis and treatment plan, including any medication needs to help with your condition. Finally, your doctor may discuss the role of additional testing, including imaging studies ( CT / MRIs ), peripheral nerve testing ( EMG ) or brain wave testing ( EEG ), which will be scheduled for a later date.

Making the Most of Your Visit

To make your appointment as beneficial as possible, consider the following tips:

• Arrive Early: Plan to arrive at least 10 minutes early to fill out any necessary check-in items before your appointment's scheduled start time. This will ensure a smooth and timely visit.
• Bring Insurance Information: Have your insurance details readily available to facilitate the administrative process. This will help avoid any delays or confusion.
• Gather Medical Records: If you have received treatment or undergone tests with other healthcare providers relevant to your condition, bring along any medical records or test results. This information will assist your neurologist in gaining a comprehensive understanding of your medical history.
• The frequency, duration and severity of your symptoms.
• Share information about any medications or treatments you have tried for the condition and the outcomes.
• Prioritize questions to help the neurologist answer your most significant concerns during the initial visit.

Your first appointment with a doctor at the Renown Institute for Neurosciences is an opportunity to receive expert care and gain insights into the best method of treatment for your condition. By understanding what to expect and following the tips provided, you can maximize your visit and be on your way to achieving overall health and wellness.

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Prepare for Your First Appointment

Before your first appointment

• Please plan on two to four hours for your first appointment. 
• Review the following information and prepare your questions. You’ll find a checklist for what you need to do and bring to your visit.
• We make every attempt to collect your medical records before your first appointment so that the care team can review them ahead of time. If we cannot obtain them in time, we may need to reschedule your appointment.
• Stanford Medicine Cancer Center:  650-723-6469

On the day of your appointment

• Plan to arrive at least 90 minutes before your appointment time.
• If you need assistance when you arrive, please stop at the reception desk in the lobby. Our navigators will be happy to escort you to the clinic.

Your first appointment—meeting your care team

At your first appointment, you will meet the team who will take care of you throughout your treatment. Your care team will include four primary members:

• Your doctor, who may be a surgeon, neurologists, neuro surgeon, or interventional neuroradiologist, depending on the type of treatment you will receive
• Advanced practice provider (APP), who works with your doctor during diagnostic evaluation and treatment
• Multidisciplinary care coordinator (MCC), your main point of contact throughout your course of treatment
• Clinical administrative assistant (CAA), who helps with scheduling your appointments and managing your paperwork

You may have other doctors and care providers on your team, depending on the type of treatment you receive. You may not meet them at your first visit, however.

What to expect during your first appointment

During this visit, your doctor will discuss your medical history with you in detail, perform a physical examination, and discuss possible treatment options. Your doctor may send you for laboratory tests during your first appointment. You will not need to fast prior to the lab tests, unless your doctor notifies you otherwise. You may also need to have additional imaging done.

During your first visit, we will share some important information about your condition and your treatment options.

To help you remember everything we discuss, please bring a family member or friend. You may want to write down your questions so you can raise them with your doctors.

Please be prepared to take notes during your appointment.

Collecting your medical records

We collect your medical records before your appointment so that you have one less thing to worry about. We need to review your medical history so our doctors can better understand your current health, symptoms, and any previous tests or treatments. We will contact all non-Stanford hospitals, clinics, and imaging centers to ask for your records, including pathology slides, scans such as X-rays, and other reports.

If we are unable to obtain the appropriate records in time for your first appointment, we may ask you to help us obtain them. We also may need to reschedule your appointment until we obtain them. Depending on the facility, we may need you to sign and submit record release forms. Our goal is for you to have a productive first appointment with your doctor.

Stanford Health Library

For confidential help with your health care questions, contact the Stanford Health Library. Professional medical librarians and trained volunteers can help you access journals, books, e-books, databases, and videos to learn more about medical conditions, treatment options, and related issues.

• Main Library , 213 Quarry Road:   650-725-8400
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Published February 2022 Stanford Health Care © 2022

What Is a Neurologist and When Should You See One?

Neurological diseases and conditions can affect nearly every part of your body. Learn about neurologists, what they do and when to visit one.

This article is based on reporting that features expert sources.

What Is a Neurologist?

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A neurologist is a doctor who specializes in conditions that affect your brain, spinal cord and nervous system. Your nervous system controls all your body's functions – from processing memories to the beating of your heart. Neurologists focus on understanding and treating neurological problems, including headaches, sleep disorders and Alzheimer’s disease .

In this guide we explore what neurologists do and how they handle neurological issues. You'll learn the distinction between neurologists and other health care providers who work with disorders of the brain , such as neuroscientists and psychiatrists.

What Does a Neurologist Do?

Neurologists are medical doctors with specialized training in evaluating, treating and managing signs and symptoms related to the nervous system.

You could be referred to a neurologist for a number of symptoms, including:

• Headaches .
• Problems with focus or concentration.
• Cognition or memory issues.
• Numbness and tingling .
• Nerve pain, often described as burning or electric shock.
• Muscle weakness, spasms or twitching.
• Vision problems.
• Taste or smell disturbances.
• Imbalance when walking.

“In general, you're talking about something related to an issue that's involving the nervous system, meaning the brain, spinal cord, peripheral nerves or neuromuscular system,” says Dr. Vernon Williams, a board-certified sports neurologist, pain management specialist and founding director of the Center for Sports Neurology and Pain Medicine at Cedars-Sinai Kerlan-Jobe Institute in Los Angeles. “Neurologists are much more actively involved in not only ameliorating symptoms but reversing disease."

Neurological Problems

Common neurological conditions that neurologists diagnose, treat and manage include:

• Alzheimer’s disease or other forms of dementia.
• Headaches or migraines.
• Concussions.
• Brain or spinal cord injury.
• Brain, nerve or spine tumor .
• Nerve pain .
• Meningitis.
• Peripheral neuropathy .
• Epilepsy and seizures.
• Muscular dystrophies.
• Multiple sclerosis .
• Parkinson's disease .
• Amyotrophic lateral sclerosis  (ALS or Lou Gehrig’s disease).
• Infections of the nervous system, such as meningitis and encephalitis .

Neurologist vs. neuroscientist 

Neuroscientists are medical scientists who perform clinical research to better understand the body’s nervous system. They do not diagnose, treat or manage conditions directly with a patient population. Rather, they may perform clinical trials, study human activity and write academic research papers.

Neurologists, on the other hand, are medical doctors who work directly with patients to treat conditions affecting the nervous system.

Neurologist vs. neurosurgeon

“Most people think we’re surgeons,” says Dr. Elaine C. Jones, a neurologist and medical director of quality for Access TeleCare, a nationwide specialty telemedicine company. She is also a Fellow of the American Academy of Neurology.

Though there is a fair amount of overlap between neurologists and neurosurgeons, they’re not the same. The fields of neurosurgery and neurology are both made up of specialized doctors who diagnose and treat conditions of the brain, spine and nervous system.

Neurologists focus on treating and managing neurological disorders through medication, lifestyle modifications or other nonsurgical therapeutic interventions, whereas neurosurgeons undergo additional training in surgery to treat patients too. Neurosurgeons may treat conditions through nonsurgical or surgical interventions, such as brain surgery or spinal surgery to treat conditions like a brain tumor, aneurysm or herniated disc.

Neurologist vs. psychiatrist

“The difference between psychiatry and neurology is the most complex,” Jones says.

Both psychiatrists and neurologists work with conditions affecting the brain. Jones says that psychiatrists typically care for conditions that are less of a “structural issue” and more of a “chemical process” issue within the brain, such as anxiety or depression.

That means that neurologists work to address physiological dysfunctions in the brain, whereas psychiatrists address mental health disorders .

“But there is a lot of overlap, especially when you come to diagnoses like dementia,” Jones says. “We do collaborate a lot with our colleagues, both internal medicine and pediatrics, and certainly neurosurgery and psychiatry.”

What to Expect at Your First Neurologist Visit

When visiting a neurologist, there are generally two processes – an emergency or inpatient situation versus an outpatient setting.

Inpatient visit

Some neurological signs and symptoms may require more emergent care.

“In an emergency situation, a patient will come into the ER if they have anything that seems to be affecting the nervous system,” Jones says.

For example, that could mean the patient had a stroke or seizure, or they’re experiencing weakness, numbness, trouble walking or speaking, or visual changes.

Jones practiced for about 17 years as a solo practice neurologist in Rhode Island, but now she works in teleneurology for a nationwide company that covers the emergency room. When she’s on call, she could receive a call from an emergency department in any of the 26 states where she’s licensed to practice.

“We’ll assist with the local emergency room team on figuring out what needs to be done,” she says.

That may mean prescribing medication, making a diagnosis or referring the patient to another specialist within the hospital.

Outpatient visit

Outpatient visits are typically less pressing, and the patient is sometimes referred by their primary care physician.

• Comprehensive history.

Physical examination

• Review of findings.
• Treatment plan.

Comprehensive history

Taking the patient’s comprehensive history includes a review of symptoms, discussing medical history and social history.

First, Williams says they’re asking questions about symptoms, such as:

• How did your symptoms start?
• When did they start?
• Are there any clear patterns or characteristics to the symptoms?
• How is it affecting your daily function or quality of life?

Next, Williams says your doctor will review your medical history, asking questions like:

• Do you have any other conditions or diagnoses that may predispose you to certain kinds of neurologic conditions?
• What medications are you taking?

He adds that neurologists will sometimes do a “review of systems,” where they ask questions about other body parts or systems unrelated to the brain or nervous system that may be causing symptoms. Lastly, Williams says they’ll take a comprehensive social history, with questions that may include:

• Do you smoke?
• Do you drink alcohol?
• Have you used drugs?
• Do you exercise?
• How’s your sleep?

Your neurologist will focus the physical examination on the nervous system. This can include examining your:

• Vision, hearing and speech.
• Muscle strength, which includes assessing muscle tone or stiffness.
• Motor function, including balance and coordination.
• Mental health, which could entail memory and cognitive function assessments.
• Sensory function, such as temperature sensitivity and pain tolerance.

Depending on the outcome of the comprehensive history and physical examination, your doctor may order further neurological tests. If you’re lucky, your doctor may offer those in-house.

“In my particular practice, I try to do as much as possible in real time when the person is with me and as much as possible in the office so that we can really improve continuity of care,” Williams says.

Testing may include blood work and laboratory testing. It could also involve electrodiagnostic testing, which tests the nerves and how they’re sending signals throughout the body. It could also involve electrical testing of the brain. Looking at brainwave activity could involve imaging like MRIs, CAT scans, PET scans or functional imaging, Williams says.

Here are some common neurological tests:

• Electroencephalography, or EEG. This measures electrical activity of the brain and detects brain wave abnormalities.
• Electromyography, or EMG. This assesses muscle function and nerve cells that control them and is often used when someone is experiencing symptoms like tingling, numbness or weakness.
• MRI, or magnetic resonance imaging. This medical imaging technique can create detailed images of the brain and spinal cord. The test could detect abnormalities like tumors or structural issues.
• CT scan, or a computed tomography scan. CT scans use X-rays to create cross-sectional images of the brain, blood vessels and soft tissues.
• Biopsy. This procedure is done to remove a piece of tissue from a muscle, nerve or brain for further testing or analysis.
• Genetic testing. This may be used to identify genetic mutations associated with neurological conditions, like Huntington's disease.

Review of findings

Your doctor will review their patient’s symptoms, physical examination, test results and any other relevant information that was discussed during their appointment, Williams says.

Treatment plan

Your neurologist will then map out a “curated, personalized, individualized approach to their care, to their treatment or intervention,” Williams says.

Treatments included in a personalized care plan will vary depending on your specific diagnosis, severity of symptoms and individual needs. However, common treatments that may be prescribed as part of a neurological care plan may include:

• Medications. Medications are frequently used to manage symptoms, such as anticonvulsants for epilepsy and seizures.
• Physical therapy , which can help improve strength, mobility and coordination for some neurological conditions.
• Occupational therapy, which can be beneficial for conditions that affect motor skills or activities of daily living .
• Speech therapy, which may be used for patients with speech, language or swallowing conditions.
• Surgical interventions. For example, you may be referred to a neurosurgeon to have a tumor removed or to repair damaged nerves.
• Lifestyle modifications, which could mean dietary modifications or exercise recommendations.
• Mental health therapy or group counseling , as some neurological conditions can have a significant psychological impact.

How Should I Prepare for My First Neurologist Appointment?

To ensure you get the most out of your first visit, preparing ahead of your neurologist appointment is key. Here are some steps to help you prepare for your first appointment:

• Send over a copy of your medical records.

Make a list of symptoms.

Bring a list of medications and supplements., write down a list of questions., bring a friend or family member., send a copy of your medical records..

Your doctor will want a full picture of your medical history. The best way to ensure your neurologist has the complete picture is to make sure all of your medical records have been sent to your doctor's office ahead of time. Not only will this give the full picture, but it can help avoid duplicate testing and speed up the process of getting a diagnosis.

This includes gathering any past test results, imaging scans like CT scans or MRIs, surgeries and major illnesses. Even something that seems insignificant to your visit may provide valuable information to your neurologist.

You should write down any symptoms you're experiencing, even if they seem minor or unrelated. Your neurologist will want to know additional details like when your symptoms started, their frequency and duration and if you've noticed any triggers or patterns.

A list of any and all medications, vitamins and supplements you're taking will help ensure nothing is missed. Be sure to include dosage and frequency as well.

Your neurologist needs to know what you're taking for two reasons: They could be contributing to or causing your symptoms, or they could interact with some neurological medications.

Doctor's appointments go quickly, and writing down your questions in advance of the appointment can help ensure no questions are left unanswered. Your questions likely vary greatly depending on your individual symptoms or diagnosis, but examples may include:

• Are there any major red flags with my condition I should be aware of?
• What are potential side effects of my treatment and/or medication?
• What can I do to monitor my condition at home?
• How often should I follow up with you?
• What can I expect at my next appointment?

A visit to the neurologist can be overwhelming – particularly if you're facing a neurological illness that is associated with cognitive issues. Having a loved one with you to take notes and be your advocate during the appointment can be helpful logistically to keep information organized. Receiving a diagnosis for a neurological disorder can also be a lot to process, so having a loved one available may provide emotional support.

Neurology Specialties

There are a range of subspecialty areas in the field of neurology, such as:

• Pediatric neurology.
• Geriatric neurology.
• Sports neurology.
• Nerve specialist.
• Sleep medicine.
• Specializing in particular disorders, like epilepsy, headaches/migraines or multiple sclerosis.

Williams is a practicing neurologist who subspecialized in sports neurology, “which is a relatively new subspecialty in neurology that’s involved in evaluating and treating injuries that can occur to the nervous system through participation in sports.” He often sees concussions or head injuries, but he also sees spinal cord injuries or peripheral nerve injuries. “In addition to treating injuries, sports neurologists will often assist people with other neurologic conditions in improving their function,” Williams says. “For instance, we know people who have Alzheimer’s disease and Parkinson’s will benefit greatly from exercise and from physical activity that really improves their symptoms and prolongs deterioration.”

The U.S. News Health team delivers accurate information about health, nutrition and fitness, as well as in-depth medical condition guides. All of our stories rely on multiple, independent sources and experts in the field, such as medical doctors and licensed nutritionists. To learn more about how we keep our content accurate and trustworthy, read our  editorial guidelines .

Jones is a neurologist and medical director of quality for Access TeleCare, a nationwide specialty telemedicine company. She is also a Fellow of the American Academy of Neurology.

Williams is a board-certified neurologist, pain management specialist and founding director of the Center for Sports Neurology and Pain Medicine at Cedars-Sinai Kerlan-Jobe Institute in Los Angeles.

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What Does a Neurologist Do on Your First Visit? Preparing for Your Appointment

January 24, 2024 | Brain and Spine Specialists

As we step into a new year, prioritizing health becomes a key resolution for many. Visiting a neurologist for the first time can be a part of this journey. This blog aims to demystify the process and help you prepare effectively for your appointment.

Understanding the Role of a Neurologist

A neurologist is a medical specialist focusing on diagnosing and managing disorders of the brain, spinal cord, and nerves. These experts handle a variety of conditions, including epilepsy , multiple sclerosis , Parkinson’s disease , stroke , and more . Neurological health is a crucial aspect of overall well-being, as it affects numerous facets of life. Early and accurate diagnosis, followed by effective management of neurological conditions, is vital. It not only addresses immediate health concerns but also plays a significant role in maintaining long-term quality of life. Visiting a neurologist, therefore, is an important step towards ensuring comprehensive health care.

Preparing for Your Neurology Appointment

Preparation is key to a successful neurology appointment. Being well-prepared can ensure that your neurologist has all the necessary information to make an accurate diagnosis and develop an effective treatment plan.

Gathering Your Medical Records

Before your appointment, gather all relevant medical records, test results, and a list of current medications. This includes any previous neurological evaluations, MRI or CT scan results, and blood work. Having these documents at hand allows the neurologist to gain a comprehensive understanding of your medical history. It’s also important to include records of treatments or medications you’ve tried in the past, as this information can be crucial in determining the best course of action for your condition.

Making a Symptom Diary

Maintaining a symptom diary is an invaluable tool for both you and your neurologist. In this diary, record the nature of your symptoms, their frequency, intensity, and any potential triggers or alleviating factors. Also, note any patterns or changes in your symptoms over time. This detailed account can provide critical insights into the nature of your neurological issues, helping your neurologist to make a more precise diagnosis and tailor your treatment accordingly.

What to Expect During Your First Neurologist Appointment

A first-time visit to a neurologist, especially at a referral-based practice like Brain & Spine, can be an important step in addressing your neurological health. Understanding what to expect, starting from obtaining a referral to the appointment itself, can make the process smoother.

Starting with a Referral at Brain & Spine

Before scheduling your first appointment at Brain & Spine, which operates primarily on a referral-only basis, you’ll need to obtain a referral from your primary care physician. This is a standard procedure at Brain & Spine to ensure that patients receive specialized care in a coordinated manner. Your primary care physician will evaluate your symptoms and, if they deem it necessary, will refer you to a neurologist at Brain & Spine. This referral not only helps in streamlining your care but also ensures that the neurologist has a comprehensive understanding of your medical background right from the first visit.

The Initial Consultation

The initial consultation is a critical component of your visit. Here, the neurologist will engage in a detailed discussion about your medical history. This includes understanding any symptoms you’ve been experiencing, reviewing past medical records, and discussing any previous treatments or diagnostic tests you’ve undergone. This conversation is pivotal for the neurologist to form an initial understanding of your neurological health and to identify potential areas that require further examination or testing.

Comprehensive Neurological Examination

Following your initial consultation, you will undergo a comprehensive neurological examination. This examination includes various assessments such as tests for muscle strength, reflexes, coordination, sensation, balance, and mental function. These tests are essential for detecting any neurological abnormalities and guiding further diagnostic procedures.

Embracing Your Neurological Health

Embarking on your neurological health journey with Brain & Spine is a proactive step towards better health. Their team of specialists is dedicated to providing comprehensive care, from initial consultations to detailed follow-up appointments. By being well-prepared and engaging actively with your neurologist, you’re setting a strong foundation for effective management of your neurological condition. Remember, at Brain & Spine, your neurological health is a priority, and their tailored approach to treatment and care is designed to support you every step of the way on this important journey.

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How To Prepare For Your First Neurologist Visit.

If your primary care physician refers you to a  Neurologist , here’s what you  can  expect. During your  first appointment , a  Neurologist will  likely ask you to participate in a physical exam and neurological exam. Neurological exams  are  tests that measure muscle strength, sensation, reflexes, and coordination.

Your First Visit to Dr. Eddie Patton’s Office

Neurological disorders such as muscle diseases, peripheral neuropathy, dementia, ataxia, dystonia, Parkinson’s disease and Multiple Sclerosis bring with them a host of potential symptoms affecting movement, daily activities and mental status, and no two cases are the same. One way to feel more in control is to become informed about your disease and to take an active role in your healthcare, which includes preparing for your neurologist visit.

Preparing for Your Neurologist Appointment

Choosing a specialist like Dr. Patton to supervise your overall healthcare is essential. An open relationship can be a powerful factor in maintaining your physical and emotional well-being for the long term. To have a productive appointment with Dr. Patton please fill out a medical intake questionnaire and during your  make sure your questions are answered. Good communications will assist with the appropriate health and medication regiments so you can feel and function better despite your current condition.

New patients will need to complete a medical intake questionnaire, which is available to download in advance. The questionnaire will ask for details on your health history, the condition you are being referred for, and any other conditions for which you are being treated. New patient consults are approximately 45-60 minutes and will include a thorough neurological exam. Follow up exams will take approximately 30-45 minutes. Parkinson patients are seen again in three to six months.

Only you know what is going on in your body on a day-to-day basis. Some things may be minor and some may progress over time. Your role is to provide your doctor information about your health, health history, medications and symptoms, and to report any specific changes in your condition since your last medical appointment.

Take control of your condition by being an active participant in your healthcare.

Receiving or awaiting a diagnosis of a potentially debilitating movement disorder can bring about a sense of unease and uncertainty. Despite many patients that feel overwhelmed and lost control over their life it are those who, this is a time to be active in your care. By focusing on care provisions you will out pace those who may want to ignore their diagnosis and put off seeking care. Dr. Patton will do his best to inform, direct, and track your care with you on your care journey.

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Preparing for Your Neurologist Appointment

Take control of your condition by being an active participant in your healthcare, by karen hales, neurology solutions contributing writer.

Receiving or awaiting a diagnosis of a potentially debilitating movement disorder can bring about a sense of unease and uncertainty. Many patients may become overwhelmed and feel they have lost control over their life. Some may want to ignore their diagnosis and put off seeking care.

Neurological disorders such as ataxia, dystonia, Parkinson’s disease and Multiple Sclerosis bring with them a host of potential symptoms affecting movement, daily activities and mental status, and no two cases are the same. One way to feel more in control is to become informed about your disease and to take an active role in your healthcare, which includes preparing for your neurologist visit.

Choosing a specialist to supervise your overall healthcare is essential. An open relationship with your physician can be a powerful factor in maintaining your physical and emotional well-being for the long term. This article is to assist you in having productive appointments with your neurologist to make sure your questions are answered and you can feel and function better despite your condition.

New patients of Neurology Solutions Movement Disorders Center will be asked to complete a medical intake questionnaire , which is available to download in advance. The questionnaire will ask for details on your health history, the condition you are being referred for, and any other conditions for which you are being treated. New patient consults are approximately 45-60 minutes and will include a thorough neurological exam. Follow up exams will take approximately 30-45 minutes. Parkinson patients are seen again in three to six months. Call Neurology Solutions at 512-865-6310 to make an appointment.

Only you know what is going on in your body on a day-to-day basis. Some things may be minor and some may progress over time. Your role is to provide your doctor information about your health, health history, medications and symptoms, and to report any specific changes in your condition since your last medical appointment.

Before Your Appointment

• Prepare to arrive a little early for your scheduled appointment to provide time to fill out any necessary paperwork and so you can gather your thoughts before you meet with the doctor.
• Bring the name and address of your primary care physician so he can receive a copy of the medical report following your visit. Have your insurance card and doctor’s referral form with you. Bring a record of medical test results and reports related to the condition.
• Have a list of all medications and dosages, including supplements, you are taking, as some medications can interact poorly with others.
• Since some conditions may have a genetic component, find out your family medical history specifically related to walking or coordination problems of family members, including grandparents, parents, aunts and uncles, siblings and cousins.
• Keeping a log or journal of your symptoms to refer to is a helpful tool in tracking your condition’s progression and to better determine what treatments or medications are working.
• Be specific in describing your symptoms and how they affect your daily living activities, including estimated periods of time when the symptoms became apparent or worsening. Select the top three symptoms or problems that are most severe to discuss during your appointment.
• Be prepared to answer: What other medical conditions do you have? Have you had an adverse reaction to any medications? How and when did symptoms of your condition come on? How have your symptoms changed since that time? What activities does your condition make difficult to do? What makes your symptoms worse? What makes your symptoms better?
• If you have recently started a new medication or therapy regimen, be prepared to discuss any side effects or results of the treatment. Have a list of three or four key questions you would like to discuss with your neurologist so you don’t leave the appointment with additional worries.
• If you think you will have difficulty remembering or understanding your doctor’s instructions, bring along a loved one or friend to your appointment to take notes and help ask questions.

Many neurological conditions require lifestyle changes. Many neurological medications are started or changed gradually according to instructions provided during your appointment. Let your neurologist know if you are unclear on the instructions and the information you are given. Often, a nurse or other staff member can spend more time with you if needed.

After Your Appointment

Make appointments for any follow-up tests, therapies or other medical orders immediately. Make sure your primary care physician receives a copy of your neurologist’s report. There may be a list of recommendations to discuss with your doctor.

Begin taking any medication prescriptions immediately, and report any troubling side effects to your neurologist as soon as they appear.

You should be reassessed every six months or with any sudden decline in mobility or change in behavior to best manage your condition. A variety of resources and healthcare organizations are available to help expand your understanding of your condition and provide support and programs to help you stay active and maintain a high quality of life.

To learn more about maximizing your visit with your neurologist, see the Parkinson’s Disease Foundation’s Checkup Checklist .

Stay informed by frequenting Neurology Solutions’ blog , or join Neurology Solutions Movement Disorders Center’s e-mail list to stay up to date on the latest in treatments, how to manage stress and maintain quality of life while battling illness, and tips for staying healthy.

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Five Questions to Ask Your Neurologist

You've waited weeks to see your neurologist. When you arrive, she conducts a physical examination and asks about your symptoms since the last visit, all of which is vital. But when you or a family member has a chronic or life-threatening neurologic condition—such as Parkinson's disease (PD), Alzheimer's disease (AD), multiple sclerosis (MS), or a brain tumor—the concerns that keep you up at night might not make it into those discussions. Maybe you're concerned about your job, but you can't seem to find the right opportunity to bring it up.

In the last issue of Neurology Now , we discussed five tests or treatments that you might not need . Here, neurologists choose five questions they think patients should ask to get the best possible care.

Should I Get a Second Opinion?

Bruce H. Cohen, M.D., Fellow of the American Academy of Neurology (AAN) and director of pediatric neurology Akron Children's Hospital, treats adults and children who have brain tumors. He recommends asking your neurologist if you should get a second opinion.

"Brain tumor treatment, especially if the tumor recurs, may differ depending on the medical center and the equipment available," Dr. Cohen says. "Ask your doctor if there are different ways to treat your tumor and whether technology better suited to treat it might be available elsewhere." Most medical centers can't afford all the different radiation therapy machines used to treat brain cancer, he says—nor provide all types of experimental chemotherapy, including gene therapy or vaccine therapy. "For example, a proton beam accelerator, which is used in patients who require very precise treatment of their brain cancer, is found at only a few centers across the United States," Dr. Cohen notes.

When Dr. Cohen recommends a specific treatment, he informs his patients which therapy is available at his hospital and whether treatment differs elsewhere. He often offers his first and second choice of treatment options and provides patients the opportunity to get a second opinion if additional options are offered at other facilities.

That's exactly what he did in 1994 after diagnosing a young child who had what appeared to be a slow-growing malignant brain tumor . Although he had recommended chemotherapy to the mother, he also referred her to another expert whom he respected but thought might disagree with him. Indeed, that second neurologist recommended radiation therapy; later, a third neurologist recommended a watch-and-wait approach. The family returned to Dr. Cohen after opting for the third option of cautious observation. And the child, now an adult, has been returning to Dr. Cohen once a year...for the past 19 years.

Most of the time, doctors welcome questions such as this. If for some reason your doctor is offended, you can always seek out another opinion or contact a patient advocacy group.

Should I Start Making Plans to Change My Home or Job?

Make it a point to let your neurologist know where you live and what you do for a living, and ask whether you should anticipate changes over the course of your illness that would require adjustments. Caregivers should be involved in these discussions as well; in the case of many neurologic conditions, the patient may not have the insight to recognize when he or she is having cognitive difficulties. "Often, we get so caught up responding to what patients are dealing with in the present that we forget to help them anticipate and plan for the future," says Janis Miyasaki, M.D., associate professor and associate clinical director of the Movement Disorders Centre at the University of Toronto.

"Young doctors whom I train are often baffled when I ask them, 'Does this person live in a one- or two-story home, and does their main floor have a bathroom?'" Dr. Miyasaki says. She recommends that patients, caregivers, and family members bring up subjects such as living space or work conditions.

For example, for many people living with PD, climbing stairs may become difficult over time. These patients may benefit from advice about how to adapt their living space, such as by adding a chair lift for the stairs or a ramp. Moving to a single-level dwelling can often help them maintain independence for longer. In Dr. Miyasaki's experience, it may take a year or two for someone to accept the necessity of moving to a single-level dwelling. But after the first six months, she has found, most people say it was their wisest decision.

It's also important for family members to discuss any of their own health problems that might interfere with the caregiving role. The wife of a man with PD revealed to Dr. Miyasaki that she was about to undergo a total hysterectomy. She hadn't considered how this would affect her husband, whom she regularly assisted up the stairs. Dr. Miyasaki was able to help arrange for temporary home care so that they could both remain safe.

Dr. Miyasaki also advises people with chronic neurologic conditions to discuss their job responsibilities with their neurologist, who may be able to help if or when modifications become necessary.

"Physically, it might be easy to anticipate when you need modifications to your job—for example, changing a variable shift to a set schedule or switching to a more flexible role with built-in rest periods in case sleeping patterns are disrupted," Dr. Miyasaki says. One of her patients, a research technician, noted that he had difficulty measuring liquids when his PD medications began to wear off. She was able to support him by writing a letter requesting modification to alter his schedule accordingly. She assisted another patient, the CEO of a large investment firm, in getting long-term disability benefits. He'd developed cognitive problems as the result of his PD and couldn't properly fulfill his duties any longer.

How Will This Test Impact My Care?

Ronald C. Petersen, M.D., Ph.D. AAN member and director of the Mayo Clinic Alzheimer's Disease Research Center in Rochester, MN, recognizes that more testing isn't always better—especially for dementia , in which biomarkers are becoming increasingly available to help identify causes. (A biomarker is a laboratory measurement that reflects the activity of a disease.) "Nevertheless, a condition such as AD is diagnosed on the basis of a thorough history and neurologic examination, not a test," he says.

"When a doctor recommends a PET scan (an imaging test that uses a radioactive substance to look for disease), an amyloid imaging scan (a type of PET scan that detects beta-amyloid deposits characteristic of AD), or a spinal tap for tau and beta-amyloid, patients should ask what each test would add to the certainty of the diagnosis. Patients should also ask if a test will lead to any different recommendations or help with the prognosis, and if any risks are associated with it," Dr. Petersen says. Keep in mind that testing often is not covered by insurance.

Clinical symptoms and history are often enough to diagnose AD with a reasonable degree of certainty, according to Dr. Petersen. "If an 85-year-old man with a gradual history of forgetfulness becomes unable to use his checkbook but is able to live alone, the probability of AD is high, and you don't need to do an exotic test," he says. Additional testing is typically warranted when the person has unusual symptoms—such as problems with language instead of memory—or is unusually young with no family history of AD, he says.

What Side Effects Can Occur With This New Medication?

You may be reluctant to start taking a drug because you've heard about someone doing poorly on it. Maybe you've been warned about its side effects. Sometimes, the side effects do outweigh the benefits of treatment. Asking your neurologist about possible side effects allows her to address your concerns and set the record straight about potential harms.

Jay E. Selman, M.D., AAN member, and chief of neurology at Blythedale Children's Hospital in Valhalla, NY—whose areas of expertise include epilepsy , autism, Tourette's syndrome, and traumatic brain injury-believes it's essential to have an open and thorough discussion about all the possible side effects of any medication you're about to start.

The parents of an 8-year-old boy evaluated by Dr. Selman declined a trial of methylphenidate (Ritalin) for severe attention deficit-hyperactivity disorder (ADHD). The reason was that the father—who'd heard methylphenidate was "just like what the street gangs were selling"—was dead set against all medications. But after Dr. Selman informed him about potential side effects and explained that the medication was not addictive when used appropriately and supervised by a physician, the father agreed to a trial. "At the next visit, the reports from teachers and family noted a significant improvement in his attention, and we were able to make further adjustments to the dose," Dr. Selman recalls.

When children are patients, the subject may require discussion with the patient as well as with parents. "All communication requires a framework based upon the child's chronological and developmental age, the seriousness of the underlying condition, and the family dynamics," Dr. Selman explains. He typically asks children and teens to notify their parents if they don't feel well, or if something is different, so that the family may contact him. He asks older adolescents to call him directly, as well. He advises all patients to call him immediately if they observe something of concern.

Your neurologist typically discusses those side effects that he or she believes are most likely to occur or have the most serious consequences. Dr. Selman first addresses those that are potentially dangerous, such as a rash that may develop with the anticonvulsant lamotrigine (Lamictal). He then mentions those that may occur frequently, such as gastrointestinal upset with a nonsteroidal anti-inflammatory drug or appetite suppression and sleep problems with an ADHD drug. He likens the discussion to the other day-to-day decisions we all make about relative risks and benefits. "I might say to someone, 'To get to my office today, you had to decide whether to take the parkway or local streets by weighing travel time, the risk of weather and road conditions, and so forth. We do the same thing when we weight the benefits of the treatment versus the potential adverse effects.'"

Giving the patient and the family as active a role as possible in decision-making is important to Dr. Selman, who lets patients know he will continue to work with them, even if they decide not to follow his recommendations.

How Will This Treatment Improve My Quality of Life?

Lily Jung Henson, M.D., has been taking care of patients with MS for 23 years, currently as chief of staff at Swedish Issaquah Hospital and medical director of Swedish Issaquah Neurology, both in Issaquah, WA. "Neurologists tend to think about treatment success as it pertains to disease activity—in the case of MS, relapses or progression. But patients may care more about how they feel between the disease episodes or as a result of the side effects of the medicine," she notes.

"For example, we may be very happy because the patient is having fewer exacerbations of the disease and showing no progression. But, the patient might be miserable because she is unable to participate in activities she used to love, like going to her child's soccer game," Dr. Jung Henson says.

"In a situation like that, no matter how well the drug is doing in terms of reducing flare-ups, the side effects demand switching to a more tolerable drug," she says. In addition, Dr. Jung Henson says, she would discuss adjusting the woman's schedule to leave more energy for soccer games, consider prescribing anti-fatigue medications to give her more energy while there, and recommend that she wear a cooling vest and drink cool liquids in very warm weather.

The goal of a given treatment may not directly address quality of life, such as physical activity, social activity, personal fulfillment, mobility, and independence. Don't forget to remind your doctor that these things matter.

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But it doesn’t have to. Based on our experience working with both families and physi cians, we’ve learned what it takes to make that first visit as beneficial as possible. You can download th e full Child Neurologist New Visit Toolkit from our website, but here are five quick tips of how to prepare for your first visit with a child neurologist.

• Bring everything. If you think it might be helpful for the doctor to see, bring it. This could include notes from any previous visits to a primary care physician or ER doctor; videos of relevant seizures, movements or other behaviors; copies of test results or assessments; journal entries you have of symptoms; family history documents; or whatever else you have on record that support the concerns you have for your child.  
• Set a primary goal for your visit. Are you hoping for a diagnosis? A treatment plan, med adjustment? Whatever is top of mind for you and your family, make sure you are able to articulate what your child needs.  
• Relay everything. Unfortunately, many parents have experienced the pain of having their concerns dismissed by previous doctors. But this is your time to share everything with a specialist, so take advantage of it, and be fully honest about what your child has been experiencing.  
• Bring another adult. If you plan to be the key speaker at the appointment, bring another adult who can help take notes. This will allow you to be fully engaged in the conversation with the doctor, but also leave with a written record of anything you might forget.  
• If possible, let your child be involved. If they’re able to verbally communicate and describe their own symptoms, prepare them to be an active participant in the conversation with the doctor. This will help your child feel involved in the process and gives them skills to advocate for themselves.  

Whatever you’re feeling as you head into your first visit with a neurologist, we want to help you enter it with confidence so that you can make the most of it. Download our Child Neurologist New Visit Toolkit to fully prepare for the visit.  

What Does a Pediatric Neurologist Do On Your First Visit?

• December 21, 2022

Bringing your child to a doctor can be a worrying experience. It may even be more so to bring them to a new doctor. And it may even be intimidating when you bring them to a specialist like a pediatric neurologist . The best way to cool your nerves is to be armed with information about what will happen on your first pediatric neurologist visit.

Bring Prepared Information About Your Child’s Neurology

As with any new doctor, it is in your best interest to provide as much information as possible for a potential diagnosis. If your child has ever had any neurological, psychological, or medical evaluations you should bring documentation of the results. It will be beneficial to provide any supporting information from any other neurologically related testing, especially school testing or evaluations. Some examples of tests where results will be helpful include: Electrophalogram (EEG) , MRIs, and other lab work such as blood work and genetic testing. If you believe there is anything that would assist your pediatric neurologist in diagnosing concerning conditions like seizures or epilepsy , bring it with you.

You or your child may also have concerns or questions of your own. Preparing for your visit by creating a list of such concerns may help ease you through the process of your first visit. It will also assist in guiding your pediatric neurologist to a more firm diagnosis to provide unique information which may be missed by test results.

Your Child’s First Pediatric Neurologist Visit

Everything will be done to keep you and your child as comfortable as possible. Every child is different, and experiencing neurological issues can create a lot of friction. If you believe it to be helpful, reach out to the office before your first visit to make the process easy and smooth.

Your first pediatric neurologist visit may take around an hour depending on the amount and types of tests and diagnostic procedures used for the initial visit. Your specialist may use everything from asking questions about your child’s mental status to sensory exams to reflex tests, motor function capabilities, and more.

Upon examining your child with all of the provided information and tests, your specialist will provide a diagnosis for your child unless more information and testing will be helpful. Additionally, should a referral to a different type of specialist be necessary, like an occupational therapist or psychologist, you will be informed.

If you would like to learn more or you would like to schedule your first Pediatric Neurology appointment, please call 732-856-5999.

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A Physician’s Journey into the Minds of Coma Patients

In studying people with severe brain injuries, Columbia neurologist Jan Claassen hopes to better identify those likely to regain consciousness. 

Nick LaRock was going to pull through . Physically, at least.

A thirty-three-year-old high-school history teacher, LaRock had been discovered by his girlfriend sprawled out on the floor of his Manhattan apartment late one Sunday evening, moaning incomprehensibly. Rushed by ambulance to Columbia University Irving Medical Center, Columbia’s shared medical campus with NewYork-Presbyterian Hospital, he arrived unconscious and unresponsive, fighting for his life. Doctors in the neurocritical-care unit recognized that LaRock had suffered a massive brain hemorrhage and took extraordinary measures to save him, even bringing in surgeons to drill a hole in his skull to relieve pressure that threatened to irreparably damage his brain. Their efforts paid off. A few days later, LaRock was stable but in a coma, his motionless body surrounded by a humming nest of life-support machines that regulated his breathing and other vital functions.

Now, looking back on that time in January 2021, LaRock’s parents recall the relief they felt at learning that Nick would survive, but also the troubling questions that soon weighed on them. “I remember asking one of the doctors, ‘Are we past the point where he’s going to die?’ and she said, ‘Yes, I think so.’ That was obviously a big moment for us,” says Joseph LaRock, Nick’s father. “Of course, you’re next wondering, When is he going to wake up? And what is he going to be like when he does?” says Beth LaRock, Nick’s mother. “I mean, is he still going to be our Nick? Is he still going to be my boy, or is he going to be a shell of himself?”

Nick’s parents couldn’t bring themselves to ask the doctors those questions. Afraid of the answers they might receive, they distracted themselves by searching for clues that their son might be mentally present. Every morning, having driven three hours from their home on Long Island, where Joe works as a restaurant manager and Beth runs a program for adults with developmental disabilities, they would slip quietly into their son’s room, kiss him on the forehead, and perch themselves on chairs beside his bed. They would stroke his chilly hands, whisper reassurances, and wait for any glint of recognition — a tilt of the head, the flutter of an eyelid, the squeeze of a finger. When these signs didn’t come, they would talk to him nonetheless. “I would give him updates about his younger sister, my job at the restaurant, the New York Jets, the weather — anything I could think of,” says Joe. “I’d tell him that we knew he was in there. And that we needed him back.”

By any standard neurological assessment, their son’s prospects for recovery did not look good. Nick had experienced immense bleeding in his brain and now, nearly a week later, had still not opened his eyes. He appeared to be slipping into a long-term coma — a state that few patients with brain injuries ever awaken from with their personalities and mental faculties intact. “Nick’s injury was severe, and time was not on his side,” says Jan Claassen , a Columbia neurologist who directs CUIMC’s neurocritical-care unit and helped coordinate Nick’s treatment. 

The longer a patient remains unresponsive, Claassen explains, the less likely they will achieve a good cognitive recovery, if they do awaken. Instead, they might emerge in a semiconscious, cognitively diminished state, requiring round-the-clock care. Many such patients spend the rest of their days hooked up to ventilators and feeding tubes, battling respiratory and urinary-tract infections. “If a person doesn’t regain consciousness within a week or two, we get very concerned,” Claassen says, noting that brain-injured patients who don’t awaken within that time frame are often taken off life support to prevent their prolonged suffering.

Yet Claassen, who is a leading authority on brain injuries, also believes that not all coma patients are as mentally incapacitated as they appear to be. At the time of Nick’s injury, he was conducting an unusual clinical trial at CUIMC in which every brain-injured patient who seemed to be in a coma was, with their family’s permission, given a series of sophisticated tests designed to reassess their brain function.

Joe and Beth LaRock agreed to have Nick evaluated. They were told that the results of the test would not inform Nick’s care, since the technique was experimental, but that his participation could eventually help others. So once or twice a day, in the morning and afternoon, members of Claassen’s research team gently put earbuds into Nick’s ears and played a series of recorded messages that asked him to perform simple physical tasks, like squeezing and relaxing his right hand. A collection of electroencephalogram (EEG) sensors stuck to Nick’s scalp then recorded the electrical pops and crackles of his neurons, which were transmitted to a supercomputer located down the hall. There a team of Columbia data scientists and biostatisticians would analyze the millions of resulting data points using an artificial-intelligence program, looking for clues that Nick might have heard the commands, understood them, and attempted to respond. Gradually, a pattern emerged. The computer detected what no neurologist could have: Nick was in there .

The word “coma” is derived from the ancient Greek koma , meaning deep sleep, but the condition that it describes — a prolonged state of unconsciousness caused by injury or illness — has only become common in the modern era. Before the mid-twentieth century, most people who experienced severe brain injuries, whether from strokes, oxygen deprivation, or blows to the head, quickly died. That is because the brain, when traumatized, loses its ability to coordinate essential bodily functions. Most critically, it stops transmitting motor signals that control reflexive muscle movements, including those in the diaphragm that draw air into the lungs; without them, a person asphyxiates. Only when mechanical ventilators became widely available in hospitals, in the 1950s and 1960s — a development inspired by the polio epidemic — did it become possible to sustain large numbers of brain-injured patients in comas. “Around then, modern emergency medical services also proliferated,” says Claassen, “which meant that people could be stabilized at the scene of injury and transported to hospitals quickly enough to be saved by the new equipment.”

Soon the study of brain injuries was among the most rapidly evolving and intellectually vibrant areas in medicine. By carefully observing patients who emerged from comas, physicians discovered previously unknown “disorders of consciousness,” including the vegetative state, a condition in which patients may open their eyes but are otherwise unresponsive and unaware; and the minimally conscious state, in which they may show intermittent awareness and attempts at communication. These disorders were initially thought to be chronic, but researchers eventually realized that some patients improved over time, which contributed to a new understanding of the brain’s capacity for reorganization, repair, and regeneration. There were other surprises too. In the 1960s, the American neurologists Fred Plum and Jerome Posner noticed that a tiny percentage of patients who appeared to be in a vegetative state were actually fully conscious and intellectually intact. Paralyzed except for their eyes, they could not respond to their examiners and so had been written off as mentally vacant. Plum and Posner called the condition “locked-in syndrome.” These patients could be taught to communicate by blinking and glancing from side to side — a method that the French journalist Jean-Dominique Bauby famously used to dictate his 1997 memoir about living with the syndrome, The Diving Bell and the Butterfly . Neurologists say that the discovery of locked-in syndrome had a profound impact on their field, impressing upon clinicians the need to be exceptionally vigilant when conducting exams, lest they miss the desperate human peering back into their penlights.

“I was taught that someone who remained in a coma for more than just a couple of days after a brain injury was basically hopeless. But I saw for myself that wasn’t true.”

Claassen, who grew up outside Cologne, Germany, began his career at the University of Hamburg’s teaching hospital, caring for coma patients, in the late 1990s. At that time, he recalls, neurologists who treated people in the earliest stages of brain injury had to be masters of improvisation. Because only a few decades of clinical history had been amassed on the topic, doctors received little guidance from textbooks or senior colleagues on important matters such as how to improve a comatose patient’s chances for recovery or when to speak with family members about the possibility of withdrawing life support. Those clinical guideposts that did exist, Claassen says, often underestimated patients’ prospects. “As a young doctor, I was taught that someone who remained in a coma for more than just a couple of days after a brain injury was basically hopeless,” says Claassen, a tall and slender fifty-five-year-old with piercing blue eyes and a gentle demeanor. “But I saw for myself that wasn’t true.” 

Despite the stressful, fast-paced, and sometimes chaotic nature of his work — the nonstop decisions about continuing or withdrawing life support, in particular, are said to contribute to high rates of burnout among doctors in neurocritical-care units — Claassen thrived, seeing endless opportunities to advance both clinical care and scientific knowledge. “I’ll never forget the first time I saw a patient who’d appeared to be lost forever wake up,” he says. “One day he was completely unresponsive, and the next time I saw him he was sitting at a table playing cards. There was something about that transformation that left me awestruck. I knew I had to devote my life to helping these people. And I had to learn everything possible about what their experiences revealed about human consciousness — what it is, why it breaks down, and how it can arise again.” 

In Hamburg, Claassen dove into clinical research, exploring new ways of diagnosing and assessing the severity of brain injuries. He came to CUIMC in 1999, lured in part by the medical center’s embrace of new electrophysiological and neuroimaging technologies that he believed were poised to revolutionize his field. For example, physicians in Columbia’s neurocritical-care unit had just begun to use computational analysis of EEG signals to peer inside patients’ brains in real time and better diagnose and treat their injuries. They had also started to compile an unusually large database of patient outcomes, which they studied for insights into the effectiveness of their treatments. “I thought this was critically important, because although we’d gotten very, very good at saving the lives of people who’d suffered brain injuries, we still knew little about how to improve their chances of having a good recovery,” Claassen says. “To make progress, we had to observe the brain in new ways.”

Over the next few years, Claassen achieved a number of breakthroughs using EEG and other brain-monitoring techniques. In one series of influential studies, he and colleagues discovered that some comatose patients experience life-threatening brain seizures that are only detectable with EEG. They showed that administering anti-seizure drugs to these patients may save their lives. In a related line of research, Claassen’s team demonstrated that miniaturized EEG sensors implanted in the heads of coma patients can help identify when they need interventions to adjust their blood pressure, oxygen levels, and other vitals. Many of the protocols that the Columbia team developed are now followed by physicians around the world.

In 2014, Claassen was named the head of CUIMC’s neurocritical-care unit, an eighteen-bed facility that treats all types of brain injuries, from strokes to blunt traumas to side effects of heart attacks. He quickly set about expanding its research operations, hiring data scientists, investing in supercomputing technology, and encouraging its physicians to innovate whenever possible. “We also cultivated partnerships with faculty in other Columbia units, including the Department of Biomedical Informatics, the Department of Neurological Surgery, and the Data Science Institute,” he says. “I thought that if we brought the full weight of the University’s intellectual resources to bear on studying brain injuries, we could really move the needle on the quality of care that’s available.”

Claassen soon saw an opportunity to make a big impact. Around the time he was appointed chief of the neurocritical-care unit, the field of neurology was abuzz with speculation about several anomalous case studies that had cropped up in the medical literature. The cases all involved patients who appeared to be unconscious but whose brain activity suggested they were alert. One British woman diagnosed as being in a vegetative state was slid into a functional magnetic resonance imaging (fMRI) machine and asked to imagine that she was swinging a tennis racket. She exhibited patterns of neuronal activity that indicated that she was enthusiastically playing along. Similar results were found in others who had suffered different types of brain injuries and since shown no outward signs of awareness. The neurologists behind the accounts had given the phenomenon a name — “covert consciousness” — but knew little about it.

“Some compared it to locked-in syndrome, except that these patients couldn’t even move their eyes, so they seemed to be really locked in,” says Claassen. “Which is obviously terrifying.”

But how conscious were these people, exactly? Were they fully aware of themselves and their surroundings or only faintly so? And how common was the phenomenon?

Many neurologists were skeptical that it would be possible to gain a proper understanding of covert consciousness because of practical constraints. The fMRI scanner, which produces highly detailed brain images and was therefore the first choice of many scientists studying the condition, was only suitable for observing small numbers of patients with severe brain injuries. People hooked up to life-support machines and those with metal implants could not easily go into the scanner. Meanwhile, an EEG, although easier to administer, was seen as poorly suited to detecting signs of covert consciousness in bustling hospital settings, where its sensors tended to pick up stray electrical signals from other medical equipment. 

“You can deal with that kind of electrical interference pretty easily when using EEG to observe broad patterns of neuronal activity, which is how the tool has traditionally been used, but if you’re attempting to observe a person’s individual thoughts, as when looking for signs of covert consciousness, it would be more difficult,” says Claassen. “Then you’d face a serious analytic challenge.”

Yet as someone who had been working with EEG his entire career and knew its strengths and limitations, Claassen thought that he could adapt the technology for this purpose. He saw advantages in using the relatively cheap tool, which was widely available in hospitals around the world. “If we developed a test that worked, we wanted patients everywhere to have access to it,” says Claassen, noting that he drew inspiration from earlier research by Cornell neurologist Nicholas Schiff, who had shown that EEG could be used to detect covert consciousness in quieter settings. So in the summer of 2014, Claassen and his colleagues launched the first major effort to identify people with the condition in a neurocritical-care unit.

On a recent Thursday morning, in a small, sparsely furnished office in CUIMC’s neurology department, Qi Shen, a Columbia data scientist, is looking at two large computer screens. Her eyes dart back and forth between the brightly colored digital images of human brains. “Most of the time, it’s like we’re looking into mist,” says Shen, who is a member of Claassen’s research team. “And then if we’re persistent, we may see a picture emerge — very faintly at first. We can then examine the data in many different ways to determine if we’re truly detecting a signal amidst the noise.”

The signal that Shen is hunting for? Consider it the shadow of a human thought. It will appear as a distinct and consistent difference in the levels of neuronal activity in various brain regions as a person hears commands played for them over headphones. For someone who is conscious but immobile, this could be an attempt at communication. A tiny salutation back from the void. 

“We’re looking specifically at regions that are responsible for higher cognitive functions, including language comprehension, to make sure we’re detecting signals that represent active engagement with the stimuli,” says Claassen, who is seated beside Shen. 

This work is challenging in part because of the brain’s sheer complexity. Even when it is injured and functioning at a reduced level, its hundred billion neurons are still firing constantly. The imprecision of EEG sensors adds to the challenge. “They’ll detect electrical activity in brain regions other than the ones we’re interested in and even in other parts of the body, including the heart,” says Claassen. “We need to do a lot of creative analytics to weed out artifacts from our data.”

Despite these challenges, Claassen’s team has managed to produce the most detailed descriptions to date of covert consciousness in acutely brain-injured patients. This research, based on observations of hundreds of CUIMC patients and published in numerous papers, suggests that the phenomenon is real, surprisingly common, and a useful indicator of a patient’s potential for recovery. 

“We’re still a couple of years away from incorporating this into practice, because our technology needs fine-tuning,” Claassen says, “but we’ve certainly demonstrated that covert consciousness is a major clinical concern and that detecting it has great potential to guide patient care.” 

The Columbia researchers’ first big discovery on the topic came in 2019, when they showed that about 15 percent of brain-injured patients in comas exhibit signs of covert consciousness, which is also known as cognitive-motor dissociation, or CMD. They also found that these patients are much more likely to awaken from a coma and achieve a robust recovery. Then last year they found evidence that covert consciousness is caused by a communication breakdown between the brain regions responsible for higher-order cognition and the brain regions that control muscle movement.

Still, major questions remain unanswered. Claassen’s team has yet to determine, for example, the level of consciousness of the patients who respond to their commands. The scientists can only say for certain that these patients are sufficiently aware to distinguish between prompts like “start opening and closing your right hand” and “stop opening and closing your right hand.” The Columbia scientists have attempted to communicate with these patients in more meaningful ways, inviting them to open or close their hands to convey meaning in the style of Morse code, but the results so far are difficult to interpret. “We’re not sure if they’re cognitively incapable of participating in a higher-level interaction or if something else might be getting in the way — like they’re confused, distracted, or simply frustrated,” says Ángela Velázquez, a Columbia physician involved in the project. “But we’re continuing to improve our methods and remain optimistic that we may reach them.”

Claassen says that he has spoken to patients who regained their mental faculties after testing positive for covert consciousness, and he’s found that so far none can recall their time in the neurocritical-care unit. From Claassen’s perspective, this is a mixed blessing. “Of course, it’s fortunate that they don’t seem to remember a possibly traumatic experience,” he says. “On the other hand, it means that this phenomenon remains a mystery, a black box that we cannot peer into.” He still operates on the assumption that some coma patients may be fully conscious and that memories could be formed. “The human mind is very adept at blocking out terrible experiences,” he says. “That certainly could be happening here.”

Joseph J. Fins, a Cornell physician and medical ethicist who has written extensively about covert consciousness, says that the prevailing opinion among scientists who study the phenomenon is that people who test positive for it likely possess a wide range of cognitive abilities. “I think it’s possible that some of these patients are fully aware, others barely awake, and still others somewhere in between,” he says. “Clearly it’s a moral imperative for us to try to reach them if possible.”

Today, the Columbia researchers are pressing forward in their attempts to make contact with patients who are unresponsive. Their most ambitious plan is to develop a brain–computer interface similar to those that have been used to decode the thoughts of paralyzed people and to help them control keyboards and other communication devices. Claassen imagines that such a technology, by detecting distinct patterns of brain activity, could enable patients to answer yes-or-no questions and even summon hospital staff when they need help. “Are they in pain, uncomfortable, feeling hot or cold, or extremely anxious?” he says. “Being able to express themselves would dramatically improve the care we provide and make them feel less isolated.”

The scientists are also fine-tuning their EEG test to make it more accurate. For now their methods are adequate for studying covert consciousness and estimating its prevalence but not for informing the care of individual patients. For example, people who are conscious but unable to comprehend language — a common result of brain injuries — will slip through the cracks, since their brains will be unable to process spoken requests and demands. (To identify such patients, Claassen’s team is now expanding the test to include a nonverbal component that looks for brain signals that indicate a person is aware of other types of stimuli.) False positives are also a concern. The key to improving the diagnostic, Claassen says, is to build a much larger database of patient results. To this end, the Columbia doctors continue to screen their own coma patients for covert consciousness, while also making their data-gathering methods and analytic algorithms freely available to the research community, to encourage others to join the effort. Claassen has also helped found an international nonprofit, the Curing Coma Campaign, in part to promote research on covert consciousness. 

“This is a topic of such urgency that we need to break down institutional barriers and pool our knowledge and resources, so that we can get this technology out into the world as rapidly and safely as possible,” says Claassen. The team recently helped physicians at the University of Miami’s teaching hospital implement their testing methods, and it is in conversation with several other institutions that are interested in collaborating.

Perfecting the EEG test is critical, Claassen says, because its results are likely to inform the agonizing decisions that many families confront about whether to take their loved ones off life support. In the US and Europe today, the majority of people who remain comatose for more than a couple of weeks following a brain injury are removed from life support. “It’s around that point that you need to perform surgical procedures, including a tracheotomy and the insertion of a feeding tube, to sustain patients,” Claassen says. Decisions about withdrawing life support in such circumstances are ultimately made by families in close consultation with physicians, who often struggle to provide guidance, since an individual’s chances for recovery are difficult to assess. “Clearly some patients will have no chance of waking up,” he says, “and we can identify them early on.” These include people with catastrophic injuries to the midbrain and brainstem. “But in other patients, it’s extremely difficult to predict recovery,” he says. “It’s as much art as science.” For families, he says, the lack of clarity can be exasperating. “These are people who are facing one of the most difficult decisions they’ll ever have to make. What they would like to do is know the future.” 

The picture is clouded by a lack of long-term epidemiological data. Since at some hospitals people are kept on life support for less than a week, it’s difficult to know how many of them might ultimately awaken and recover if they were sustained for longer. Claassen and his colleagues have conducted research aimed at addressing this question, too. In one study, published in the journal Neurocritical Care in 2022, he and several Columbia colleagues tracked the lives of people who had slipped into comas after suffering severe brain injuries in Japan, where, for a variety of cultural and legal reasons, comatose patients are rarely taken off life support. The Columbia team’s findings offered a measure of reassurance to Western neurologists, showing that Japanese physicians’ initial assessments of their patients’ long-term chances for recovery usually proved accurate. “In other words, patients who might have been removed from life support early on if they’d been in the US, based on the apparent severity of their conditions and other factors, did not, in fact, end up faring well on the whole,” says Claassen. Yet the Columbia researchers also discovered that a small minority of Japanese patients who were initially predicted to have no chance of meaningful recovery did eventually wake up, with some regaining a high level of cognitive function and even managing to live independently. It is the promise of identifying patients like these, whose inner life and potential is hidden from conventional diagnostics, that drives Claassen. Yet he insists that his test for covert consciousness must be made foolproof before it can be introduced in the clinic. Imagine, he offers, if a patient were to be disconnected from life support simply for having been erroneously labeled as not having covert consciousness. Or if someone were to be kept alive for months or years in an unresponsive state, possibly suffering, on the faulty belief that she did.

“We have to get this absolutely right, so that we don’t mislead people in either direction,” Claassen says.

In some ways, the Columbia team’s research has already influenced the clinical care that they provide. With a deepened appreciation for how unpredictable brain injuries can be, Claassen says, he and his colleagues have rededicated themselves to helping family members navigate the difficult process of serving as surrogates for their loved ones’ care decisions. “We encourage a lot of open conversations about how comatose patients would likely regard the uncertainties surrounding their prognosis and the available care options, and how they would wish to proceed,” he says. And at the bedside, doctors and nurses in Claassen’s unit are careful to avoid speaking about patients as if they are not there. “We always operate on the assumption they can hear us speaking,” Claassen says. “And we encourage their loved ones to do the same.”

After one week in a coma, Nick LaRock began to move his fingers. Then he tilted his head slightly, toward a window. And his breathing changed: rather than inhaling in sync with his ventilator, he suddenly seemed to be battling it, insisting on his own rhythm.

“He sounded like he was gasping at first, and I hollered for the nurse,” remembers his mother, Beth. “But she told me it was a good sign — it meant that he was starting to breathe on his own.”

The next few days brought more surprises, for Nick’s parents and doctors alike. He opened his eyes. Said his name. Held up two fingers. Picked up a cup of water and drank from it. Spoke a full sentence. “Whenever he talked, he sounded groggy, like he was still half asleep, and he was very confused,” says his father, Joe. “But it was Nick. We could tell. He was coming back to us.”

In the hallways of CUIMC’s neurocritical-care unit that week, Claassen says, doctors and nurses walked a little lighter, smiled a little wider. “When a very sick patient starts showing signs of recovery, it’s definitely something that we celebrate,” he says. “Everybody is excited. You might even hear whoops of joy.”

By the end of his second week at CUIMC, Nick was conversing with his caretakers, albeit in a laconic drawl that his family said was new, and he was cleared for transfer to another hospital closer to his home. Soon after, he entered a rehabilitation center on Long Island, where he began the hard work of starting his life over. Paralyzed on the right side of his body as a result of the brain hemorrhage, he spent the next several months relearning how to walk, navigate stairs, climb in and out of bed, shower, and dress himself. Suffering from mild cognitive impairment, he had to be taught to read, spell, and enunciate certain words.

“In movies, we’re used to seeing people come out of comas and pick up their lives right where they left off, but the reality is very different, especially for people who’ve suffered severe brain injuries,” says Claassen. “Recovery is a very long, slow, and painful process.”

Today Nick is living on his own, in an apartment in Upper Manhattan. A mild-mannered, composed, and agreeable young man, he speaks reflectively about the challenges he’s faced over the past three years. He is not currently working but dreams of returning to the classroom. He taught American history in New York City schools for ten years before his injury and says the job was the core of his identity. “I’ve actually tried to go back to teaching but found it too difficult,” he says. “I don’t know if that will change.” Reading is still arduous for him, and he says he is self-conscious now in a way that he wasn’t before the injury, when he could easily hold thirty-five boisterous teenagers in rapt attention. “I struggle to find the right words and formulate my thoughts,” he says. “Other people might not notice, but I do, and it bothers me.” Even if he cannot teach, he says, he will be fine. He notes that he’s given up many other things as a result of his paralysis: playing saxophone and ukulele, golfing, bicycling, gaming, slicing vegetables, and wearing shirts with buttons. “And I’ve survived,” he says. “I’m just a different person now. I’m more likely to be found sitting in the park, simply enjoying being here. I feel very lucky.”

From a medical standpoint, Claassen says, Nick’s recovery has been extraordinary. “Considering the severity of his original injury and the length of his coma, it’s tremendous,” he says. “Quite unexpected.”

The supercomputer in Claassen’s office predicted it, though. Back in 2021, every time Columbia researchers asked Nick to imagine opening his hand and then closing it again, they observed two distinct patterns of neuronal activity in his brain’s motor-control center. These patterns closely resembled those seen in fully conscious, healthy subjects who had undergone the same exercise. Nick, like other former patients identified by the Columbia researchers as having covert consciousness, doesn’t remember this. But he doesn’t remember anything from three months before his brain hemorrhage until nearly four months after it. “From October 2020 until May 2021 is just kind of wiped from my mind,” he says. 

Even if the Columbia team’s experimental new diagnostic had been in clinical use at the time, it would have had little bearing on Nick’s care. He woke up several days before his Columbia doctors would have talked to his parents about long-term life-support options. 

So the real question is this: are there many more people lying unresponsive in hospital beds right now who might similarly spring to life, if only given additional time to heal? And if so, is it possible to identify them? “It’s difficult to know for sure — there are uncertainties at every turn here,” says Claassen. “But we need to look, and we are making great progress.”

This article appears in the Spring/Summer 2024 print edition of Columbia Magazine with the title "Hidden Minds."

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Real madrid set for second wembley visit: what happened on the first.

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Real Madrid has only played at Wembley Stadium once before, in 2017.

The Champions League final will be held at Wembley Stadium on Saturday, June 1st, as it will welcome German side Borussia Dortmund and Spanish outfit Real Madrid. It will be a second Champions League final at Wembley for Dortmund, who lost to Bayern Munich there in 2013, but only a second-ever visit for Real Madrid.

Los Blancos have only once before played at Wembley Stadium, never having coincided with a European final there and given the nature of the arena as a stadium primarily used for finals and international competitions.

That visit came in November 2017, while Tottenham Hotspur was using the stadium as their home due to ongoing building work to prepare them to move into their new facility in North London.

The fixture was a Champions League group stage game, with Tottenham springing a surprise on Real Madrid as they ran out 3-1 winners in front of 83,000 spectators. It remains Real Madrid's only visit to the stadium to this day.

Zinedine Zidane was the coach on the night, though only three of those who played are likely to be involved in the final. Among them are current captain Nacho Fernández and midfield duo Luka Modrić and Toni Kroos.

English midfielder Dele Alli scored twice for Tottenham to give them the lead, with Christian Eriksen, now with Manchester United, scoring a third. Cristiano Ronaldo pulled one back for the visitors in the closing stages.

These Are The Worst (And Best) Cities For Low-Income Homebuyers—As Prices Keep Rising

New fbi warning as hackers strike email senders must do this 1 thing, a ukrainian m 2 fighting vehicle sneaked up on a russian t 80 tank at night and hit it with a missile from a mile away.

Real Madrid fielded a star-studded side including Cristiano Ronaldo and Karim Benzema.

Carlo Ancelotti's Wembley record

This will be Carlo Ancelotti's fifth visit to Wembley, having previously made four appearances at the stadium while in charge of Chelsea. His previous visits include a run of three victories and one defeat, with two coming in the FA Cup and two in the Community Shield.

His first visit came in 2009, with a 4-1 penalty shoot-out win over Manchester United in the Community Shield after a 2-2 draw, with Petr Cech providing the heroics to save two penalties.

Later that same season, in 2010, a 3-0 win over Aston Villa in the FA Cup semi-final set the Italian's team up for a 1-0 victory against Portsmouth in the final. That teed them up for another Community Shield visit in August 2010, though Sir Alex Ferguson's Manchester United would get their revenge one year later with a 3-1 win.

Jude Bellingham’s second home

One man in the Real Madrid ranks who is no stranger to Wembley is Jude Bellingham, who has played at the stadium on 15 occasions for the English national team. The tally has earned him an impressive run of 12 wins, two draws and only one defeat.

That defeat came in March when future Real Madrid player Endrick scored a late winner for Brazil at Wembley, consigning Bellingham to his first defeat on the turf of the famous British stadium.

What is clear is that Bellingham is no stranger to the arena, and his last outing will boost Real Madrid fans' optimism. It came in a 2-2 draw with Belgium, where Bellingham scored his first goal at Wembley with a 95th minute equaliser.

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China Launches Spacecraft to the Far Side of the Moon

If successful, the Chang’e-6 mission will be the first in history to return a sample from a part of the moon that we never get to see from Earth.

By Katrina Miller

On Friday, China launched a second lander to the lunar far side. If the mission is successful, it will be the first in history to bring back a sample from the part of the moon that Earth never sees.

The mission is called Chang’e-6, named after the Chinese moon goddess and pronounced “chong-uh.” It lifted off on time at 5:27 p.m. local time under gloomy skies from the Wenchang space site on Hainan Island in southern China, carried to space by a Long March 5 rocket. About 32 minutes after the launch, the spacecraft separated from the rocket and the mission proceeded on a 5-day journey to the moon.

Why the far side of the moon?

Unlike Earth, whose erosion and shifting crust constantly renew its surface, the moon remains frozen in time. By studying samples from different parts of the lunar surface, scientists seek information about the origin and evolution of Earth’s satellite. But so far, the United States, the former Soviet Union and China have gathered samples only from the near side of the moon.

The far side of the moon — it is not actually the dark side of the moon — is distinct from the near side. It has a thicker crust, more craters and fewer maria, or plains where lava once flowed. But no one really knows why the two sides of the moon are so different.

“People want to know why this happened,” said Yi Xu, a professor at the Space Science Institute of Macau University of Science and Technology and a member of the Chang’e-6 science team. “If we can collect some samples on the far side, then we can maybe get some clues to these questions.”

What will Chang’e-6 do?

Chang’e-6 is the latest in a series of Chinese lunar missions designed to orbit or land on the moon. The mission will last 53 days.

The first to visit the far side of the moon, in 2019, was Chang’e-4, which included a rover to explore the moon’s Von Karman crater. China remains the only nation to send a lander to the other half of the moon.

“China has found its niche, to explore the lunar far side,” said Roberto Bugiolacchi, a planetary geologist also at Macau University of Science and Technology who has analyzed data from prior Chinese moon missions.

In 2020 another mission, Chang’e-5, gathered nearly four pounds of regolith from the moon’s near side and brought it to Earth. Scientists in other countries, including some in the United States, recently petitioned to study those samples.

Chang’e-6 will follow in Chang’e-5’s footsteps, but on the lunar far side. It will take five days after launch for the mission to reach the moon . There, it will orbit the moon for about 20 days. Then, after a brief stay on the surface of 48 hours, it will spend additional weeks in lunar orbit preparing for a five-day return trip to Earth.

The mission’s orbiter will circle the moon while its lander descends into the 1,616-mile-wide South Pole-Aitken basin on the lunar surface. The impact that created the basin — among the largest in the history of the solar system — is thought to have dug up material from the lunar mantle. If that material can be retrieved, scientists can learn more about the history of the moon’s insides.

“It’s very, very exciting,” said Jim Head, a planetary geologist at Brown University who collaborated with Chinese researchers to analyze the Chang’e-5 lunar sample. “Just like before the Apollo samples were returned. But now, it’s the other side of the moon.”

According to Yuqi Qian, a lunar geologist at the University of Hong Kong, the Chang’e-6 lander is equipped with a camera, spectrometer and radar to investigate its surroundings and pick a spot to collect a sample. It will gather soil from the surface using a mechanical arm and collect a subsurface sample from as far down as 6.5 feet with a drill.

A vehicle on the lander will then lift off from the moon, passing the sample on to the orbiter’s re-entry module for its return back to Earth.

Because the same side of the moon always faces Earth, it is impossible to directly establish communications with the lunar far side. In 2018, China sent the Queqiao satellite into lunar orbit to relay information from Chang’e-4 to Earth. In March, it launched a second satellite called Queqiao-2. The pair will be used in tandem to remain in contact with Chang’e-6 during sample collection.

How does Chang’e-6 fit into China’s broader space exploration goals?

China’s lunar exploration program is one facet of the nation’s growing presence in space, which includes missions to Mars and future visits to asteroids . The Chang’e mission series, designed in the 1990s, included three phases: orbiting, landing and sampling. So far, it has a 100 percent success rate.

With the return of the Chang’e-6 sample, Dr. Qian said, China’s lunar exploration will pivot to a new strategy: investigation, construction and utilization. Its next two missions are already in development.

Chang’e-7, expected to launch in 2026, will search for water near the lunar south pole. Chang’e-8 will survey material in the same region that could potentially be used to build future infrastructure, according to the China National Space Administration .

China hopes to send astronauts to the moon in 2030 and is also working on establishing a permanent, international lunar research base by the 2030s.

What other missions have been to the moon this year?

If the first leg of Chang’e-6’s journey is successful, the spacecraft will be the third to land on the moon in 2024.

Japan reached the moon with the Smart Lander for Investigating Moon, or SLIM, on Jan. 20. The small spacecraft ended up in an awkward configuration, with its engine nozzle pointed toward space . But it also made Japan the fifth country to reach the moon’s surface. Unexpectedly, the SLIM lander has continued to function on the lunar surface long after Japan’s space agency had expected to lose contact with the robotic vehicle.

The year’s second moon landing was the first by a privately operated spacecraft. Odysseus, built by Intuitive Machines of Houston, reached the lunar surface on Feb. 22 . But the spacecraft toppled over , limiting the amount of science it could finish before freezing during the lunar night. Intuitive Machines has plans for another mission soon.

Katrina Miller is a science reporting fellow for The Times. She recently earned her Ph.D. in particle physics from the University of Chicago. More about Katrina Miller

What’s Up in Space and Astronomy

Keep track of things going on in our solar system and all around the universe..

Never miss an eclipse, a meteor shower, a rocket launch or any other 2024 event  that’s out of this world with  our space and astronomy calendar .

A celestial image, an Impressionistic swirl of color in the center of the Milky Way, represents a first step toward understanding the role of magnetic fields  in the cycle of stellar death and rebirth.

Scientists may have discovered a major flaw in their understanding of dark energy, a mysterious cosmic force . That could be good news for the fate of the universe.

A new set of computer simulations, which take into account the effects of stars moving past our solar system, has effectively made it harder to predict Earth’s future and reconstruct its past.

Dante Lauretta, the planetary scientist who led the OSIRIS-REx mission to retrieve a handful of space dust , discusses his next final frontier.

Is Pluto a planet? And what is a planet, anyway? Test your knowledge here .

Boeing forced to scrub first crewed Starliner launch to the space station

NASA and Boeing were forced to stand down from an attempted launch to the International Space Station on Monday because of a last-minute issue that cropped up with a valve on the spacecraft’s rocket.

Boeing’s Starliner capsule had been scheduled to lift off at 10:34 p.m. ET from Florida’s Cape Canaveral Space Force Station on its first crewed test flight. NASA astronauts Barry “Butch” Wilmore and Sunita Williams were on board the capsule and strapped into their seats when the launch attempt was called off, roughly two hours ahead of the planned liftoff.

NASA announced early Tuesday that a second attempt would occur no earlier than Friday .

Mission controllers declared Monday’s launch “scrub” after an anomaly was detected on a valve on United Launch Alliance’s Atlas V rocket, which the Starliner capsule was to ride into orbit.

United Launch Alliance officials said in a post on X that the launch attempt was scrapped “out of an abundance of caution for the safety of the flight and pad crew,” adding that the team needs “additional time to complete a full assessment.”

The analysis will include whether the pressure regulation valve, located on the rocket’s upper stage, needs to be replaced, which may cause a longer delay.

The crewed Starliner flight, when it occurs, will be a crucial final test before NASA can authorize Boeing to conduct routine flights to and from the space station.

Officials at NASA and Boeing have said safety is paramount for the spacecraft’s first flight with humans onboard.

The scrubbed launch is yet another setback for Boeing, which has already dealt with years of delays and budget overruns with its Starliner program. It has fallen significantly behind SpaceX, which has been flying crewed missions to and from the space station for NASA since 2020.

Both SpaceX’s Crew Dragon capsule and Boeing’s Starliner craft were developed as part of NASA’s Commercial Crew Program. The initiative began more than a decade ago, following the retirement of the agency’s space shuttles, to support private companies in building new space vehicles to take astronauts to low-Earth orbit.

Starliner’s first uncrewed flight in 2019 was thwarted by software issues, forcing mission controllers to cut the test short before the vehicle could attempt to rendezvous and dock with the ISS. A second attempt was then delayed several times by fuel valve issues, and it wasn’t until 2022 that Boeing was able to carry out a successful uncrewed flight to and from the space station .

Denise Chow is a reporter for NBC News Science focused on general science and climate change.

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'what happens next in agriculture will happen first in nebraska'.

2 days ago · 3 min read

‘What happens next in agriculture will happen first in Nebraska’

The future of agriculture innovation is now centered in Nebraska.

Federal, state and campus leaders celebrated that future during the May 6 groundbreaking of the National Center for Resilient and Regenerative Precision Agriculture at Nebraska Innovation Campus. Learn more in the video above.

The federally-funded $160 million laboratory will double the U.S. Department of Agriculture's science and support staff presence at the University of Nebraska–Lincoln. The first phase of construction will feature 15,000 square feet of greenhouses and 10,000 square feet of headhouse space. It will connect to the Greenhouse Innovation Center at NIC.

The new greenhouse space will allow ARS to perform research on wheat, barley, sorghum, forage and bioenergy grasses, and other crops. Research on how these plants respond to emerging pests and pathogens under a full range of environmental conditions will empower scientists to make cutting-edge discoveries with the goal of developing climate-resilient crops for the U.S. agriculture industry.

“This project is a testament to the long history of innovation, ingenuity and adaptability of agricultural producers across the United States and right here in Nebraska. It celebrates an incredibly productive 120-year partnership between USDA-ARS and the University of Nebraska-Lincoln, and it exemplifies the passion and dedication of agricultural, state, and federal leaders,” said Mike Boehm, vice chancellor for UNL’s Institute of Agriculture and Natural Resources. “Nebraska is a special place with incredible people, and the ripples of what we do here often extend around the globe. I believe the work that will take place in this facility will usher in a new era of American agriculture, and I’m thrilled that what happens next in agriculture will happen first in Nebraska.”

Leaders who provided remarks during the groundbreaking ceremony include: Chris Kabourek, interim president of the University of Nebraska system; Chancellor Rodney D. Bennett; Gov. Jim Pillen; U.S. Reps. Don Bacon and Mike Flood; U.S. Sens. Deb Fischer and Pete Ricketts; and Simon Liu, USDA-ARS administrator.

. @USDA ’s new ARS facility at @UNLincoln marks the beginning of an initiative that will expand the ag frontier. The funding we secured for this project will attract students, scientists, & industry leaders to the state, cementing NE’s role as a leader in ag innovation. pic.twitter.com/xFzixvgu3i — Senator Deb Fischer (@SenatorFischer) May 7, 2024

The groundbreaking also drew positive media coverage. Learn more by clicking the links below.

• Lincoln Journal Star — New $160M USDA research facility breaks ground at Nebraska Innovation Campus
• KETV —  $160 million USDA research center breaks ground at Innovation Campus
• Nebraska Examiner — USDA, UNL celebrate 'new frontier' of Nebraska's ag research and innovation partnership

I am excited to break ground today at @NIC_Innovates alongside esteemed guests & partners. This collaboration between @UNLincoln & @USDA marks a historic 100-plus year partnership. Together, we’ll pioneer solutions for a sustainable future in farming and food production. pic.twitter.com/jhFUdXZO8L — Rodney D. Bennett (@RodneyDBennett) May 6, 2024

Related Links

• Learn more about the project
• U.S. Department of Agriculture
• National Center for Resilient and Regenerative Precision Agriculture

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