A Thriving Specialty in Krasnoyarsk Krai

EEG training in Krasnoyarsk State Medical University's department of genetics and clinical neurophysiology. Courtesy Diana Dmitrenko

Krasnoyarsk is the scientific center of Siberia, with Krasnoyarsk State Medical University, which is named after Prof. V.F. Vojno-Yasenetsky, forming the hub of research, academic training, and clinical practice in the Krasnoyarsk Krai. The field of neurology is particularly dynamic here. Numerous projects that are important for the development of neurological science, practice, and care have flourished with help from the All-Russian Society of Neurologists (ARSN) and specialists from the Krasnoyarsk State Medical University, elsewhere in the country, and from overseas.

There are 501 neurologists in the region, with more than half of them based in the industrial cities of Krasnoyarsk, Norilsk, Achinsk, and Kansk and Minusinsk. The regional branch of the ARSN has a membership of 343 pediatric and adult neurologists, and the Krasnoyarsk Regional Society of Clinical Neurophysiologists has 61 members. Annually, there are more than 10 training seminars for neurologists, several regional and interregional neurological conferences, and at least one ARSN conference in Krasnoyarsk. There are many conferences on rehabilitation and epilepsy as well as teleconferences with neurological centers in Germany, Switzerland, and other countries.

Training

Most of the region's neurologists train at the Institute of Postgraduate Education of Krasnoyarsk State Medical University in the departments of neurosurgery and neurology; neurology, which includes a course in traditional medicine; and medical genetics and clinical neurophysiology. They can also train at other institutes in Siberia, Moscow, St. Petersburg, and other cities.

Programs for continuous medical education (CME) have been implemented through the World Federation of Neurology and the education committee of the ARSN. These programs are important as a means of delivering educational materials and information about new developments and advances in the specialty to all neurologists, especially those in remote areas. Online CME conferences, training seminars, and clinical analyses of difficult diagnostic cases in neurological practice are important for postgraduate education of our neurologists and are carried out regularly.

A patient undergoes analysis of gait with simulation at the Krasnoyarsk Centre of Rehabilitation Courtesy Dr. Semen Prokopenko

Pediatric and Adult Care

As in other regions of Russia, there is a special system of paediatric neurology in Krasnoyarsk Krai focusing on diagnostics, prophylaxis, treatment, and rehabilitation in children and teenagers with the diseases of the nervous system. Generally, these neurologists are former paediatricians who have received special professional retraining or completed and internship in paediatric neurology and/or paediatric and adult neurology. They work in children's outpatient departments and hospitals. In Krasnoyarsk, there are specialised paediatric neurological wards only in children's hospitals, with separate neurological departments for children aged 1-3 years and aged 3-18 years. There are 40-60 beds in these wards. Often, there is a demand for more beds, so they are added as needed—though never more than 10.

On average, a neurologist working in the children's wards takes care of 20 patients a day. The average length of a hospital stay for these children is about 2 weeks. In Krasnoyarsk Regional Children's Hospital and in children's hospitals of industrial cities, the specialised neurological help is provided in the wards for internal medicine (and, if needed, for infectious diseases). Neurologists in outpatient departments examine about 24 children a day.

Adult patients with neurological diseases are treated in the neurological wards in the hospitals and outpatient departments. Usually, they stay in the neurological departments for about 16 or 17 days. Neurologists who work in outpatient departments and polyclinics for adults in the rural districts of Krasnoyarsk Krai see about 24-26 patients a day. Moreover, neurologists also visit patients with acute neurological pathology at home. Patients with brain trauma are treated in the departments of neurosurgery of big clinics or in the departments of surgery in central district hospitals.

From Isolation Centers to Telemedicine

Compared with hospitals in Krasnoyarsk, neurological care in more remote regions is of a lower quality as they have no modern diagnostic and laboratory equipment. Historically, there are territorial isolation centers in the settlements of central and eastern Siberia, where there is a prevalence of hereditary disorders. So in an effort to improve diagnostics, care, and education in neurology, the department of medical genetics and clinical neurophysiology and the Centre for Medical Genetics were founded in 2006 as part of the Institute of Postgraduate Education at Krasnoyarsk State Medical University. In Krasnoyarsk and Norilsk, the departments and wards are equipped with modern diagnostic techniques comparable with those in Moscow polyclinics and other big industrial cities in Russia. But these methods are available only in big hospitals. Krasnoyarsk is a vast region, and patients in its remote rural areas are treated in their local hospitals by specialists from the Krasnoyarsk Regional Clinical Hospital who travel to the areas on an air medical service.

If necessary, seriously ill patients are transferred to neurological departments or the intensive care unit of Krasnoyarsk Regional Clinical Hospital by air medical service or emergency ambulance. The most difficult situation with emergency neurological care is in distant northern districts, because the connection with settlements in winter is possible only by aviation and in summer, by river transport.

In the last 3 years, specialists at larger hospitals in the region have begun using telemedicine in their consultations for difficult-to-treat neurological patients and those in remote areas. In 2009, the region's ministry of health care introduced tele-consultations and teleconferences both in health care institutions and in remote rural hospitals. Key specialists from the Krasnoyarsk Regional Clinical Hospital, Krasnoyarsk State Medical University, and specialised diagnostic centres in Krasnoyarsk participate in this form of care.

Subspecialty Focus Neurological science and practice in Krasnoyarsk focus on neurorehabilitation, epileptology, and neurogenetics. Krasnoyarsk is one of eight territories selected to pilot a federal program aimed at improving stroke care. The Centre of Neurology and Neurorehabilitation, with its modern methods of rehabilitation, is one of those venues. Three hospitals—Krasnoyarsk Regional Clinical Hospital No. 1, Urban Hospital of Krasnoyarsk, and the Central Regional Hospital in Minusinsk— are part of the program. A stroke-care register has been started at Clinical Hospital No. 51 in Zheleznogorsk.

At the beginning of this year, the Centre of Epileptology, Neurogenetics, and Brain Research was established at the University Clinic at Krasnoyarsk State Medical University. Data on the epidemiology of epilepsy are being collected with guidance from specialists at Russian State Medical University in Moscow. This effort is seen as an important component in efforts to improve care for patients with this disease. ■

At time of publication (October 2009) 

Dr. Shnayder is head of the department of medical genetics and clinical neurophysiology at the Institute of Postgraduate Education at Krasnoyarsk State Medical University in the Russian Federation..

Dr. Prokopenko is head of the department of neurology, also at the Krasnoyarsk State Medical University.