Neurology

e-Learning | Management of dementia

This is a new guideline from NICE on the management of dementia. Most of this is not new, but there were a couple of things I wasn't fully aware of. I'll list the things that were new to me, then do a bit of a summary. Cognitive testing. NICE lists a few recommended tests we…
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Nice | Alzheimer’s drugs

This is a guideline update from NICE on the use of  donepezil, galantamine, rivastigmine and memantine in Alzheimer's disease. Donepezil, galantamine and rivastigmine (the acetylcholinesterase - AChE - inhibitors) can now be used in mild disease, as well as in moderate disease. These drugs all work by increasing the level of ACh at sites of…
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Motor neurone disease – MND

Motor neurone disease (MND) has been in the spotlight recently courtesy of the film, ‘The Theory of Everything’. This summary produced by the MND Association with the RCGP aims to aid GPs in diagnosing this rare condition, and has been reproduced with kind permission of the MND Association. Diagnosis of MND Remember that MND can…
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Nice | Multiple sclerosis

Nice's latest MS guideline does not cover DMARDs, and a lot of this is not new to us. Take home messages Diagnosis should be made by a neurologist, so refer if you suspect it Tests to do in GP before referral FBC, LFT, TFT, Bone profile, UE, glucose ESR and CRP B12 HIV Relapses -…
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Trigeminal neuralgia

Although rare, trigeminal neuralgia can have a huge impact on a patient’s quality of life. This useful BMJ review gives us guidance on how to spot it and treat it effectively, something your patients with trigeminal neuralgia will no doubt thank you for! (BMJ 2014;348:g474). What is trigeminal neuralgia? A facial pain syndrome which usually…
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Nice | New treatments for BPH, MS and migraine

Sometimes NICE does technology appraisals and I always figure it's nice to know what's out there - even if we're not doing it ourselves, if for no other reason than that I know what to say when a patient appears with a Daily Mail cutting... So here are a few on common problems... Prostatic urethral…
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Nice | Head injury

This updated guideline on head injury from NICE doesn't change much in practice for us. The previous guideline came out quite a long time ago, so I don't think I'd ever read it. It does have a useful list of when we 'should' refer after head injury. Most of it is pretty obvious, but I've included the…
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Nice | Neuropathic pain

This guideline updates the advice on managing neuropathic pain. It's worth a look through as there are some changes. The main things are: Diabetic neuropathy - now to be treated in the same way as other neuropathies Do not use - Lidocaine, imipramine and nortriptyline don't have enough evidence behind them to be advised. This doesn't mean…
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Nice | Stroke rehabilitation

Most of this guidance is aimed at secondary care and the services advised seem to be happening already locally. An interesting section on returning to work, is however relevant to us, so I've pulled out some of the less obvious bits: • Both cognitive and emotional changes, in addition to physical ones,  can occur after…
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