Neurodigest Issue 1

An introduction from the Editor

A warm welcome from Neurodigest – Download a PDF of the entire issue here. I very much hope that this, our first edition, will entertain and educate in equal measure. Neurodigest aims to bring together health professionals involved in the planning and implementation of care for patients with chronic neurological conditions and to identify and disseminate best practice. It is aimed particularly at those health professionals working in primary care and within a community setting.

David Bateman starts by outlining the exciting opportunities CCG commissioning provides. The ability for stakeholders to plan a joined-up service, tailored to local requirements, is indeed a vision for the future we would all welcome. GPwSI have been a part of that vision for a number of years now. They have been integral in blurring/breaking down the primary/secondary care boundary.

Estelle McFadden outlines how it has been possible to take specialist skills out of the hospital and into the community for the benefit of all parties. Who to worry about and who to reassure is the question we grapple with in general practice on a daily basis. As primary care physicians we always fret about missing the one serious secondary headache among many. Andrew Dowson provides us with a guiding light through this mire to help direct our management of this most common of neurological symptoms.

One of the corner stones of good care for patients with epilepsy is prompt and regular access to specialist services. Greg Rogers, in his role as clinical champion, outlines how, with the support of the RCGP, he has embarked on a 3 year mission to reduce the “treatment gap”.

Karen Lanyon highlights the importance of looking beyond the seizure frequency to identify patients suffering from low mood, anxiety or cognitive difficulties which can all conspire to effect compliance with taking anti-epileptic medication.

The treatment of Parkinson’s Disease has certainly become more complex over the last 15 years, although sadly there is some merit in the view that this has not lead to the improvement in motor control we would have wished for. Dr Barnes outlines some of the pitfalls to avoid in prescribing for this patient group, along with a reminder to watch out for patients with Parkinsonism on “dizzy pills”. We have however become much more successful in understanding and treating some of the nonmotor complications.

Shahid Dadabhoy reminds us of some of these symptoms and provides management strategies. We may not feel confident in altering our patient’s dopaminergic therapy but we should be actively seeking out and helping our patients manage these symptoms in the community. Of course what patients really need is access to a team based approach for their needs, bringing together an integrated professional skill mix to maximise their quality of life. Catherine Atkinson outlines the gold standard approach from the Royal Free Neurological rehabilitation centre and its extensive community team.

Sadly Keith Swankie’s story is all too familiar. The diagnosis of rare conditions, particularly ones that mimic more common ones, is always a challenge and reminds us all to keep thinking, particularly if patients don’t fit in the boxes we have made for them.

Changing tack, Sue Thomas educates us on the important role of Neurological Commissioning Support. If we know what is going on then we can design the appropriate services to improve the quality of care with a by-product of increased efficiency, rather than that being the goal.

These changes are being implemented across the 12 strategic clinical networks in England. We have asked 4 of these SCNs to shine a spotlight on what they are doing to bring David Bateman’s vision of the future to fruition.

We very much hope you enjoy reading Neurodigest. Should you wish to offer your thoughts/ comments on any of the subjects being aired, or you would like to contribute to a future issue please get in touch with the Publisher via

Alistair Church, Neurodigest Editor