Neurology

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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Nerve stimulation in Back Pain and in Neuralgia

These two guidelines from NICE look at nerve stimulation done in novel ways. You may see patients starting to have this, so it's worth knowing about. The first guideline looks at Peripheral Nerve Field Stimulation (PNFS) for low back pain. Here electrodes are inserted subcutaneously under local anaesthetic and then an implantable stimulator. The second…
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Headaches in Young People and adults

This is a monster of a guideline from NICE, which is only aimed at people over the age of 12. This email contains the summary, but if you want to read more, then use the link at the bottom.   My main feeling about this guideline, having trawled though the 360 pages of evidence, is that it is…
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Urinary incontinence in neurological disease

This guideline outlines the urological problems commonly associated with neurological disease. Most of this is familiar stuff. I will highlight things that stick-out or are new. Remember that urological problems can be associated with bowel problems and sexual problems too and that these can cause social problems (such as carer stress) as well as physical…
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Spasticity in children

This guideline is really aimed at the ‘Network Teams’ (ie multidisciplinary) involved in caring for these children. There were a few things that I was not aware of. Though they won’t alter our practice much, it may give a better appreciation of the treatments patients may be having. The drug treatments and ‘Hip Migration’ are…
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Botulinum A for migraine

This guideline advises that Botulinum A toxin injection can be considered for the management if migraine if the patient has: Not responded to at least 3 prior therapies AND Been appropriately managed for medication overuse AND Headaches on at least 15d per month AND Migraines on at least 8d per month Treatment should be stopped…
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Meningitis – HPA advice

This publication from the HPA mostly summaries advice from the NICE guideline. Given it’s importance to us though, here’s a quick summary: Who should you give antibiotics to if you suspect meningitis? If they have a non-blanching rash If you suspect meningococcal septicaemia If transfer to hospital could be delayed (eg in rural areas). NB…
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Nice | Epilepsy in women

Epilepsy can have specific implications for women in terms of contraception, pre-conception, pregnancy and child-care. Obviously the latter of these applies to dads too; the new NICE guideline recognises all of this. Contraception I have added in some of the FSRH information here to clarify some points. Enzyme Inducers - Carbamazepine and phenytoin. This will impact…
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Epilepsy

This is an epic guideline on epilepsy from NICE, but does have some really useful stuff for us and some helpful stuff to refer to if needed. I am not summarising everything as there’s too much, but I’ve pulled out what was new to me or seemed to alter practice. I am doing a separate plog on…
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Alzheimer’s drugs

Some new alzheimers drugs Donepazine, galantamine and rivastigmine can now be used in mild, as well as in moderate disease. Memantine can be used if someone is intolerant to or has contraindications to the other drugs and can also be used in severe disease. Initiation is still by specialists but follow-up can be done by…
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