Table 1 Skill level thresholds in brain pathology with special reference to epilepsy pathology

0

None:

none

none

none

n.a.

1 ^st year student (veterinary & human medicine, neurobiology)

Untrained technician

I

Basic:

External: Recognition of cerebrum, cerebellum, brain stem and frontal/parietal/temporal/ occipital regions.

Distinction of clinical forebrain, cerebellar and brainstem signs.

Macro: Spotting malacia, gross malformations, mass lesions, haemorrhage.

Easy, Single training, Within weeks

2 ^nd year student,

Trained technician

Internal: Distinction of white vs grey matter.

Micro: None to basic neurohistology.

II

Advanced:

Recognition of brain lobes, major brain regions (e.g. hippocampus thalamus, basal nuclei), tracts and of regions containing expected nuclei.

General: Specific neurolocalisation based on clinical signs.

General: Recognition of basic malformations, mass effects, haemorrhage, infiltrative lesions and basic neurodegeneration.

Demanding, Repeated training, Within months

Pathology & neurology residents

PhD students

General pathologist

Epilepsy-specific: Distinction and localisation of seizure types.

Epilepsy-specific: Histological recognition of stereotypic seizure-associated changes.

III

Expert:

Detailed knowledge of the species-specific topographic and functional anatomy of the brain including gyri and folia organisation, distinct nuclei, cortical areas and their patterning as well as fibre connections, neurotransmitter maps, cell markers and the vascularity.

Capable of subregional and nuclear neuro-localisation.

Recognition and classification of the above named entities, plus of microanomalies, distinct cytopathologies, brain specific disease markers and neurodegenerative disorders.

Demanding, Cont´ training, Within years

A. broad-based

Neurology-trained pathologist

Pathology-trained neurologist

B. topic-based

Neuroscientist

Knowledge and experience in comparative neuropathology including human disorders.