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Medlink (www.medlink.com) and eMedicine (www.emedicine.com/ neuro) tout themselves as comprehensive web based neurology “textbooks”. Medlink is a US based service devoted solely to neurology. It has the disadvantage of a hefty fee for access: $416 annually (or $319 if you agree to view adverts). On the plus side you receive a CD updated quarterly—copy this to your laptop’s hard drive and you can carry around a textbook that contains about 1000 articles (with a total word count I estimate at over double Bradley’s Neurology in clinical practice). Furthermore, the site and CD include pictures and over 100 videos. There is no annoying bar on copying these or the text, so a multimedia presentation on the neurological topic of your choice can be prepared, in theory at least, in minutes. Searching for articles is straight forward, and each topic is laid out in the same logical order. Further attractions include web forums, patient information leaflets, and a news section.
eMedicine is also a US based site, but in contrast encompasses the whole of clinical medicine. The service, in its basic form (restricted access to pictures), is free, although you have to suffer banner adverts and a registration procedure. In length and format comparable to Medlink, 384 neurology topics are listed, but in general with superior information on treatment.
To evaluate these sites I picked on some issues raised from recent consultations: the management of migraine in pregnancy, the switching of anticonvulsants, the third line management of essential tremor, and the clinical diagnosis of subarachnoid haemorrhage. Secondly, I assessed the information on a number of rare disorders I have encountered in the past few months: familial episodic ataxia, Hallervorden-Spatz syndrome, and hemimasticatory spasm.
The rarities were dealt with relatively well by both sites, although the referencing and, to a lesser extent, the depth of material was better at Medlink. It was disappointing that neither suggested the correct spelling (as “Google” would) when “Hallevorden” was entered, although surprisingly eMedicine did come up with two related articles containing this mistake. The treatment of migraine in pregnancy was not specifically discussed by either site, although eMedicine provided some information. Medlink also failed to provide useful advice on switching anticonvulsants, whereas eMedicine did at least give specific guidance on speed of withdrawal. The management of essential tremor was dealt with in depth by both services, with eMedicine, in contrast to Medlink, giving pragmatic guidance for situations where evidence is lacking. The difficult, but common, issue of clinically distinguishing subarachnoid haemorrhage from a benign headache was not addressed by either site. Furthermore, Medlink did not mention spectrophotometry and eMedicine did not discuss the evidence (or lack of it) for the use of this test. These criticisms should not detract from the fact that these sites are impressive resources that should be commended for what they have achieved. And the future? Hopefully an even more comprehensive resource, including high quality video, no banner adverts, and no fee. A challenge, perhaps, for national/international neurological associations in the digital age?