WIREDGOV

NICE’s new guideline is the first to offer comprehensive information on neurological conditions to help non-specialist healthcare professionals to identify people who should be referred for specialist assessment and care.

The new guideline published yesterday (1 May 2019) makes recommendations about which symptoms and signs should prompt a referral for further neurological assessment. It also covers some examinations, assessment tools and investigative tests for helping to decide whether a person with a suspected neurological condition should have further investigation or be referred to a specialist.

Neurological conditions are illnesses or injuries that affect the brain, spinal cord, muscles or nerves. Some are lifelong and some get better over time.  Some, like muscular dystrophy, are inherited while others can develop during childhood - for example some types of epilepsy. Some neurological conditions, such as motor neurone disease, or Parkinson’s disease, are more common later in life. Neurological conditions can also develop suddenly at any age, after a head injury or stroke.

Suspected neurological conditions account for about 1 in 10 GP consultations and around 10% of emergency admissions (excluding stroke) and result in disability for 1 in 50 of the UK population1

People with suspected neurological conditions often go to their GP with symptoms that are difficult to diagnose.  A recent survey by the Neurological Alliance2 found that nearly a third of respondents had to see their GP 5 or more times about the health problems caused by their condition before being referred to a neurological specialist. It also found that around 40% of respondents waited more than a year from when they first noticed their symptoms to seeing a specialist.

The NICE guideline aims to make a difference to anyone who might have a neurological condition by making sure: 

• GPs can recognise when symptoms could have a neurological cause
• GPs and doctors in emergency departments know when to refer people to a specialist straight away and when to do more tests first
• people who most need to see a specialist can see one sooner
• people are not referred to a specialist if they don’t need to be.

Dr Paul Chrisp, director of the Centre for Guidelines at NICE, yesterday said:

“People with suspected neurological conditions often need referral to a specialist to be diagnosed. However, we know that some people with neurological conditions are initially misdiagnosed or have a delayed referral to a specialist, and some referrals are unnecessary. These issues with referral can come from non-specialists not recognising neurological conditions.

“This new guideline should help improve outcomes for people with suspected neurological conditions by providing, for the first time, a comprehensive assessment of the key signs and symptoms across the range of possible neurological conditions that should trigger referral to a specialist.”

Richard Grunewald, Chair of the guideline committee, yesterday said: 

“A non-specialist cannot be expected to keep up with the rapid changes in knowledge and practice in clinical neurology. This new guideline will help non-specialists recognise patients with neurological symptoms, such as dizziness and sleep disturbance, to prompt their referral to specialist assessment and care.”

References:

1. Local adult neurology services for the next decade: report of a working party, Royal College of Physicians.
2. The Neurological Alliance: The invisible patients: revealing the state of neurology services. January 2015.