A neurology news update
New data intelligence report analyses how people with neurological conditions in Wessex use hospital services and why
A new Neurology Intelligence Report provides insight into how people with various neurological conditions can be better supported to stay well. The report is the work of NHiS in partnership with Wessex Strategic Clinical Network and CLAHRC, and The National Institute for Health Research. It was launched at an event in Southampton on the 19 April 2016 and can be accessed at www.nhis.com/wessex-neurology-report?utm_ source=announcement&utm_medium=email-and-share&utm_campaign= Wessex-Report-Launch
News from NICE
Suspecting Neurological Conditions – Recognition and Referral
The final scope and equality impact assessment for this NICE guideline have now been published, along with all the stakeholder comments that were received during consultation and NICE’s responses to these comments. See www.nice.org.uk/guidance/indevelopment/gid-cgwave0800/documents http://bit.ly/1WmcIGU
Stroke in Adults Quality Standard update released
The Stroke in adults quality standard has just been updated and is available from www.nice.org.uk/guidance/qs2/chapter/Update-information
Neurological care in England criticised by MPs report
The BBC recently reported that the Department of Health and the NHS are to be held to account in the months and years ahead with regard to provision of neurological care, following the publication of a Public Account Committee report. According to the BBC, the report recommends that NHS England find a way of tackling the problem of variation in services and explain how it will offer everyone with a long-term condition a personalised care plan. It also urges NHS England to make better use of the 650 neurologists in England, as well as other specialist nurses, to improve access to care for patients. Read the report at www.publications.parliament.uk/pa/cm201516/cmselect/cmpubacc/502/50202.htm
Parkinson’s Disease and sleep
According a new global study, sleep is the number one factor influencing well-being in people with Parkinson’s. Other factors highlighted were exercise, pain, stress and mood. You can read more about this study at http://parkinsonslife.eu/global-parkinsons-study-reveals-sleep-as-biggest-influence-on-wellbeing/
If you are interested in how you can help patients with sleep disorders, you may wish to read about the workshop with OT and sleep specialist, Andrew Green, taking place on the 4th of May. Details are available at www.communitytherapy.org.uk
Improving outcomes for people with neurological conditions
The Neurological Alliance is working with the NHS England Long Term Conditions Support Unit and the Strategic Clinical Network Neurology Collaborative to deliver a coordinated programme of work to improve care and outcomes for people living with neurological conditions. www.neural.org.uk/nhs-england-community- project-for-neurology
Improving neurological function in MS
Recent research with the disease modifying MS drug, alemtuzumab, has shown it improves pre-existing disability in people with relapsing-remitting multiple sclerosis. This is according to the commonly used scale in MS, known as the Expanded Disability Status Scale (EDSS). The results lead the authors to conclude that ‘the findings may influence treatment decisions in patients with early, active relapsing-remitting MS displaying neurological deficits’. See www.jns-journal.com/article/S0022-510X(16)30090-9/abstract?rss=yes
Brighton and Sussex University Hospitals reduces general anaesthetic administration by a third
Royal Sussex County Hospital has helped to reduce the administration of general anaesthetic by a third in patients aged 4-17 by expanding its MR capability with the help of new technology from Siemens Healthcare. The MAGNETOM® Aera 1.5T is part of a threefold operation to provide enhanced MR access to paediatric patients, relocate the neurology department and ensure a better experience for inpatients, due to its wide bore and comfort-enhancing features.
“The new MAGNETOM Aera is adjacent to The Royal Alexandra Children’s Hospital which provides a safer and more comfortable transition for our paediatric patients,” states John Wilkinson, Imaging Services Manager at Royal Sussex County Hospital. “Since the installation, Royal Sussex has reduced the administration of general anaesthetic to paediatric patients by a third due to increased compliance and comfort. This is due to a combination of factors including the wide bore system, which makes the process less claustrophobic and an in-bore television, kindly donated by Rockinghorse Children’s Charity so paediatric patients can have a more enjoyable and relaxing experience.”
The system will also be used to ensure better throughput for neurology patients following Royal Sussex’s appointment as a regional centre for neurology.
Ground-breaking treatment for TBI sufferers
Traumatic brain injury is the leading cause of death and disability around the world. Many years of productive life are lost and people suffer years of disability after brain injury. In addition it engenders great economic costs for individuals, families and society. Without effective treatment, many TBI victims lead lives of quiet desperation, isolation, and depression. The Lefaivre Rainbow Effect is ground-breaking treatment for TBI sufferers. Christine Lefaivre’s book and courses explore this transformative treatment, which focuses on the cognitive retraining of the brain based on pre-injury lifestyle as well as the organic damage.
“I have worked with Chris using this model, and have seen clients who initially had Glasgow Coma scores of 4-6 recover, over a period of years, to the point where they could live independently, hold employment, and have normal relationships.” Bill de Bosch Kemper, Neuropsychologist, Canada.
Traumatic Brain Injury Case Management online courses launched this April, and an examination series in conjunction with the University of British Columbia Continuing Studies will follow: http://rainboweffect.ca/
Christine’s textbook is available now in print and ebook formats: Traumatic Brain Injury Rehabilitation: The Lefaivre Rainbow Effect Christine Lefaivre
www.crcpress.com ISBN 9781482228243, priced at £25.99.
Lumie lights to be used in Cambridge University research into Huntington’s Disease
Cambridge-based light therapy specialist Lumie is to supply some of its lamps for use in a research study into Huntington’s Disease that is to be conducted by the School of Clinical Medicine’s Neurology Unit at Cambridge University.
24 of Lumie’s most powerful light boxes, Lumie Brazil, are being donated to the research project that will examine the efficacy and tolerability of two non-pharmaceutical interventions to improve the life and sleep quality of people who have Huntington’s disease. One of these interventions is bright light therapy, the other being sleep restriction therapy.
Huntington’s disease is caused by an inherited faulty gene that damages certain nerve cells in the brain. This brain damage gets progressively worse over time and can affect movement, cognition (perception, awareness, thinking, judgement) and behaviour. Early features can include personality changes, mood swings, fidgety movements, irritability and altered behaviour.
Cambridge-based Lumie is a light therapy specialist whose products promote a healthy sleep/wake cycle by regulating the body clock as well as helping patients to feel more energetic and productive throughout the day. Lumie Brazil offers a much higher light intensity than standard lighting, emitting 10,000 lux at 35cms. To put that in context, on a bright day but not in direct sunlight the level of brightness ranges from 10,000 to 25,000 lux while in direct sunlight that goes up from 32,000 to 100,000 lux. Bright light has been shown to have an immediate impact, increasing levels of alertness, boosting mood and improving performance.
New MR applications to provide greater efficiency in neurology departments
Siemens Healthcare has launched a range of MR applications to help hospitals reduce the time needed for MR imaging within neurology. It is estimated that 20 to 25% of all MR examinations are neurological, with the number expected to grow in 2016. The applications have therefore been designed to help organisations increase patient throughput in order to maintain an efficient workflow.
One of the applications, Simultaneous Multi-Slice (SMS) EPI, employs an innovative technique to acquire imaging slices simultaneously rather than sequentially, reducing 2D acquisition times with acceleration factors up to eight. Simultaneous Multi-Slice (SMS) EPI can bring DTI and BOLD into clinical routine. This can particularly benefit surgical neurology cases through surgical mapping, potentially helping to reduce post-surgical deficits, and ultimately leading to improved efficiency in the utilisation of operating room resources.
A further application, GOBrain, enables clinically validated brain examinations in just five minutes. This can improve patient throughput, and costs per scan can potentially be reduced. Shorter scan times can also be better tolerated by patients, and can help reduce the need of sedations and rescans.
In addition to speed and quality, standardisation across systems is also an important element for hospitals. Siemens Healthcare has introduced the syngo® MR E11 software platform, a uniform application platform for the MAGNETOM® family and the Biograph mMR MR-Pet system. The focus, in addition to expanding the application offering, is achieving consistency across the entire fleet of systems and managing these effectively.
Xadago – a new treatment for PD
The first new treatment for PD in 10 years will launch in the UK in May. Xadago has had marketing authorisation in Europe since February 2015, having been approved as an add-on to L-dopa alone or in combination with other PD medications in mid-late stage PD patients with motor fluctuations.
The active substance in Xadago, safinamide, is a monoamine oxidase-B (MAO-B) inhibitor. It blocks the enzyme monoamine oxidase type B (which breaks down dopamine), thereby helping to restore dopamine levels in the brain and improving the patient’s symptoms.
Xadago, as an add-on treatment to levodopa with or without other medicines for Parkinson’s disease, has been compared with placebo in two main studies involving 1,218 patients with late stage Parkinson’s Disease who experienced fluctuations. In both studies, 6 months treatment with Xadago increased the time during the day during which patients were ‘on’ and able to move by 30-60 minutes when compared with placebo. Another study showed maintenance of this effect for 24 months. Xadago is available as tablets (50 and 100 mg).
Find out more at a series of meetings organised by Profile Pharma. See advertisement on page 16 or call 01444 412772 for more details.
Danish design offers a lift for rehabilitation patients
Patients in the UK are learning to walk again and being given new hope from a Danish invention. A new bodyweight-supported rehabilitation invention from Danish mobility company Ergolet offers earlier rehabilitation including gait-training, which improves motor function and strength after serious health problems such as an acquired brain injury.
The Ergo Trainer linear body relief system gives patients an equal body-weight support during training, removes the risk and fear of falls or strain, and props up user confidence along with their weight to let rehabilitation start earlier.
Developed in collaboration with Copenhagen University, its inventors say it offers increased mobility for people recovering from acquired brain injury caused by strokes, accidents and tumours, or learning to use prosthetic limbs.
“We can intensify physical training and show significantly faster, better recovery through an ergonomically designed device which makes the user feel safe and secure, and makes exercise fun and motivating”, said UK sales director David Lomas.
“Typically, products come with a built-in treadmill which is very limiting. Ergo Trainer is used with a variety of equipment or for various floor exercise. Clients can even kick a football around”.
It was developed in co-operation with the Centre for Rehabilitation of Brain Injury (CRBI), Copenhagen, and used in patient studies there with dramatic results. CRBI’s neurorehabilitation specialist Jørgen Jørgensen said stroke patients facing paralysis improved their walking speed by an average of 65% after a 12 week period.
Ergolet will run workshops at Neurological Rehabilitation Expo, on June 15-16 2016 with CRBI study results presented by Jørgen Jørgensen. Book free tickets at www.neurorehabexpo.co.uk
ACNR 2015;16(1): 34-35. Published online 14/6/16