A scan through recent literature in the two fields of palliative medicine and neurology suggests little overlap in their clinical practice. In the three major palliative care journals published, respectively, in UK, Canada and USA, the primary focus is advanced cancer. Fewer than 5% of papers deal with non-cancer conditions, and most often these are respiratory, cardiac and renal diseases, with only ALS representing neurology care. Similarly, published texts and articles in neurology concern themselves primarily with diagnosis, investigation and active treatment of disease, and include relatively little about end-of-life care and effective symptom management in advanced disease.

A small number of exceptions exist. The publication in 2004 of the text ‘Palliative Care and Neurology’, a multiple author work coordinated by neurologist Raymond Volz, reflected a new awareness among neurologists that their responsibility in clinical care ought to extend beyond the major hospital, and ensure effective support and symptom management in home and chronic care settings. A little earlier, in 2001, an issue of Neurology Clinics was devoted entirely to palliative care. Although selective in the number of conditions it addressed, it represented a new direction in the field.

There are readily discernible trends in modern neurology practice that will make it difficult for specialist neurologists to be active in promoting and engaging in the delivery of palliation support for persons affected by chronic neurological conditions.