This year, the Neurology Academy celebrate 16 years since it first launched the Parkinson’s MasterClass.
Beginning as a conversation amongst clinical colleagues, the four founders Dr Peter Fletcher, Doug MacMahon, Sue Thomas and David Stewart, were concerned about a lack of knowledge about Parkinson’s.
Intending to run just two programmes of training and mentoring ‘for clinicians, by clinicians’, the MasterClass has now supported over 1,500 healthcare professionals to develop Parkinson’s specialisms, and is routinely booked up over a year in advance. The Foundation level course has doubled its capacity, increasing to give much needed spaces to the junior registrars who now need to include Parkinson’s training in their rotation.
‘It feels like there’s a dearth of doctors specialising as geriatricians at the moment – we want to inspire the registrars we see, and encourage them in pursuing Parkinson’s care,’ says Sarah Gillett, our Managing Director.
With the rise in an aging population, geriatrics is a growing demand, and Parkinson’s patients regularly fall in the ‘older people’ bracket; the British Geriatrics Society note that the condition is one of the most common neurological conditions to affect older people. Members of our faculty are often saying how rewarding they find caring for people with Parkinson’s, and many began teaching to encourage other young doctors to think about going into geriatrics.
The Parkinson’s Masterclass is now one element of the Neurology Academy, which supports a broad range of professionals across a wider array of topics – all with an ongoing drive to enable existing clinical specialists to share their knowledge and enthusiasm with their peers, encouraging confidence and improved practice across the UK.
To celebrate the past 16 years, the Neurology Academy is featuring a Star Showcase, sharing the stories of some of its once-students, now faculty members to inspire and encourage other professionals in their own journeys.
For more information, please contact Sarah Gillett, Managing Director Neurology Academy, at sarahgillett@neurologyacademy.org or call her on (T) 01143 27 02 30 or (M) 07771 54 56 20
The full story is running on the Neurology Academy website and uses the Twitter hashtag #PdMC16
All MS MasterClass attendees carry out a workplace project as a key part of the course. This will be on an issue they choose in the area that they work, from service development to epidemiology, audit to patient management. Projects are presented to their course peers and the teaching faculty, who jointly choose a winner and a runner up for the year.
MasterClass 3 project award winner
Rachel Dorsey-Campbell, Impact of a pharmacy-led prescribing service on the monitoring of natalizumab patients
Runner up: Dr Jessica Vaz, JCV in Jersey
MasterClass 2 project award winner
Dr Francisco Javier Carod Artal, Epidemiology of MS in the Highlands: Prevalence, incidence and time to get a proper diagnosis and start DMT
Runner up: Dr Rachelle Shafei, Listeriosis prevention in alemtuzumab treated patients
22 July: World Brain Day 2018 – Clean Air for Brain Health
Global air pollution is not a problem that only affects lung health. Recent data show that airborne pollutants account for 30 percent of acute stroke cases worldwide. Cleaning up the air we breathe would help to prevent various serious and common neurological disorders, as the World Federation of Neurology aims to emphasise on World Brain Day 2018, which is devoted to highlighting the negative impact of air pollution on brain health.
Every year on 22 July, the World Federation of Neurology (WFN) stages World Brain Day. Around 120 organisations around the world participate in this awareness-raising initiative. The focus in 2018 is a topic that is growing in importance as a result of a number of recent scientific studies: the negative effects of high air pollution levels on the brain. “Clean Air for Brain Health” is this year’s theme.
The impact on health of environmental pollution, and air pollution in particular, is increasing all the time. Recent estimates put the annual number of deaths attributable to polluted air at 9 million worldwide.
“The Global Burden of Disease study, carried out by an international team using data from 188 countries, found that up to 30 percent of the global stroke burden can be traced back to pollutants in the air,” explained World Brain Day Chair Prof Mohammad Wasay from Karachi. “This was the reason behind our decision to select an aspect of environmental pollution as the theme for World Brain Day 2018.”
A complex global problem
The connection between harmful gases and particles in the air and brain health is a worldwide problem, and also a complex one. According to Prof Jacques Reis, head of the World Federation of Neurology’s Environmental Neurology Applied Research Group:
Air pollution refers to diffuse, often invisible contamination by damaging bioaerosols containing pollen, spores, particles and toxic substances. The pollutants can stem from natural sources or may be due to human activity.”
Additionally, the phenomenon can vary sharply – both quantitatively and qualitatively – depending on the situations in which people live and work. It includes:
Indoor air pollution, e.g. from heating systems, cooking on open wood fires, kerosene and tobacco
Outdoor pollution, e.g. industrial and vehicle exhaust fumes, waste incineration and dust
A distinction is made between primary and secondary air pollutants: the former are gases and particles that themselves have harmful effects, while the latter are the result of chemical reactions between natural and/or man-made substances (such as ozone)
“The problem is different in major cities compared with rural areas. Some air pollutants have a local or regional impact, but the effects of others can be international,” says Prof Reis.
In May this year, the World Health Organisation (WHO) found that nine-tenths of the world’s population breathe polluted air. And three billion people use harmful fuels in their homes for cooking and/or heating.
Understanding of toxic effects constantly improving
In recent years, scientists have uncovered significant evidence of the way in which air pollution affects the brain, and how this is damaging neurological health all over the world. As Prof Reis explains: “Pollutants enter the body through the respiratory and alimentary tracts. They cause subthreshold inflammatory responses, and reach the brain either via the blood stream or the upper respiratory tract. The resulting damage to intestinal microbiota can also have an impact on the brain.”
The list of potential effects is long: atherosclerosis, oxidative stress, inflammatory responses throughout the body, blood vessel damage, increased blood pressure, impairment of the blood-brain barrier’s protective mechanisms, and heart problems could be connected to air pollution. Possible damage to brain cells such as microglia cells and astrocytes has also been identified. At the cellular level, air pollutants interfere with mitochondria – often referred to as cells’ “powerhouses” – and genetic material like DNA. Pollutants bring about epigenetic changes and shorten telomeres, the protective caps on the ends of chromosomes. The latter is seen as a sign of cell ageing.
Little wonder, then, that air pollution is suspected of playing a part in a growing number of syndromes and neurological diseases. Initial findings suggest it could play a role in autism, attention deficit disorders in children, dementia and the development of Parkinson’s disease, although reliable data are not yet available.
Caused by humans – but modifiable
Decisive changes in behaviour could significantly reduce the risks posed by environmental factors that cause brain health to deteriorate. “Preventing neurological disorders is not just a concern for individuals; action needs to be taken at the societal level as well. This is particularly true of man-made environmental impacts, which mankind in turn can ultimately influence. These are important risk factors for diseases affecting the blood vessels in the brain, as well as neurodegenerative conditions,” said Prof Wolfgang Grisold, the WFN’s Secretary General.
“This worldwide public health problem requires effective environmental and health-policy strategies aimed at reducing air pollution. It is not just a matter of lung health, but the health of the very organ that makes us humans: our brains,” Prof Grisold emphasised.
Wake-up call for the international community
Speaking about this year’s World Brain Day, WFN President Prof William Carroll believed that there is only one possible interpretation of the available scientific data on the effects of air pollution on brain health: “Each and every one of us, every country in the world and the international community must see this as a wake-up call. Policymakers need to do more to tackle neurological disorders and diseases. This means making brain health one of the highest-level healthcare priorities and providing additional funds to address the issue.”
The annual World Brain Day takes place on 22 July and is devoted to a different topic each year. The choice of date was no coincidence: the WFN was founded on 22 July 1957.
Unilateral MRI-guided Focused Ultrasound Thalamotomy for Treatment-resistant Essential Tremor Recognised by National Institute for Health and Care Excellence
INSIGHTEC®, a global medical technology innovator of incisionless surgery, has announced that The National Institute for Health and Care Excellence (NICE) issued a positive NICE guidance for unilateral MRI-guided focused ultrasound thalamotomy for treatment-resistant essential tremor (ET). ET affects more than one million people in the UK and impacts their ability to perform everyday tasks due to uncontrollable shaking of their hands.
The Imperial College Healthcare NHS Trust is the first and only site in the UK with the Exablate Neuro™ technology to treat essential tremor. To date 16 patients with ET have been treated at St. Mary’s by an expert, multidisciplinary team including Professor Wladyslaw Gedroyc, Consultant Radiologist, Dr. Peter Bain, Consultant Neurologist and Professor Dipankar Nandi, Consultant Neurosurgeon.
Essential tremor patients treated at St Mary’s have experienced very substantial improvement in the severity of their tremor as well as their quality of life. In addition, the safety profile is favourable with minor, often temporary side effects experienced by this group.
Professor Dipankar Nandi, Consultant Neurosurgeon and Head of Department, St Mary’s Hospital, Imperial College Healthcare NHS Trust.
During the treatment, ultrasound waves pass safely through the skull to ablate a tiny spot in the brain considered to be responsible for the tremor. The result is often an immediate improvement of the tremor in the treated hand. Due to the incisionless nature of focused ultrasound, there is no risk of infection and patients recover quickly.
The positive NICE guidance adds to the growing body of positive health technology determinations for incisionless brain surgery using INSIGHTEC’s Exablate Neuro. This is a critical step toward increased patient access to our technology around the globe.
Maurice R. Ferré, MD, Chief Executive Officer and Chairman of the Board of INSIGHTEC
For more information on the NICE guidance, please visit NICE.org.uk.
About INSIGHTEC
INSIGHTEC is a global medical technology innovator transforming patient lives through incisionless brain surgery using MR-guided focused ultrasound. The company’s award-winning Exablate Neuro™ is used by neurosurgeons to perform the Neuravive™ treatment to deliver immediate and durable tremor relief for essential tremor patients. Research for future applications in the neuroscience space is underway in partnership with leading academic and medical institutions. INSIGHTEC is headquartered in Haifa, Israel, and Miami, Florida, with offices in Dallas, Tokyo and Shanghai.
Significant milestone for people with multiple sclerosis as people with relapsing-remitting form gain access to new first-in-class treatment with twice-yearly dosing
22 June 2018, Welwyn Garden City – The National Institute for Health and Care Excellence (NICE) today published a positive final appraisal determination (FAD) for OCREVUS® (ocrelizumab) to treat people living with relapsing-remitting multiple sclerosis (RRMS).[i]
NICE has recommended the use of ocrelizumab for treating RRMS in adults with active disease, defined by clinical or imaging features, when alemtuzumab is contraindicated or otherwise unsuitable.1 Ocrelizumab is a first-in-class treatment with twice-yearly dosing and has less burdensome monitoring requirements than currently available disease-modifying treatments.
The NICE announcement is a significant milestone for people with RRMS who gain access to a new treatment option. Ocrelizumab has been shown to reduce the number of relapses per year by nearly half and slow the risk of progression of the disease compared with current treatment, subcutaneous interferon beta-1a.[ii]
The majority of people with multiple sclerosis (MS) have a relapsing-remitting form at diagnosis with 100 people in the UK diagnosed with MS every week.[iii],[iv] MS affects approximately 100,000 people across the UK with 85 percent of those suffering from RRMS.4,[v]
There is significant unmet need in the treatment of MS, particularly for those with PPMS who currently have no disease-modifying treatment options. We welcome this positive NICE review for RRMS, and hope that it brings us closer to the treatment being made available to people with early PPMS too.
Jo Sopala, Director of Development, MS Trust.
NICE review is ongoing for ocrelizumab in early PPMS, for which there is currently no treatment available. Disability accumulates twice as fast in PPMS as in RRMS, meaning that people with PPMS may have to rely on mobility aids or become wheelchair bound, are unable to work, and need carers to look after them sooner.[vi] Ocrelizumab is the first and only licensed treatment for early PPMS which means the process for reimbursement is more complex and will take longer.
As of today, over 50,000 patients have received treatment with ocrelizumab worldwide and we are delighted that NICE has now recognised ocrelizumab as a cost-effective new treatment option for NHS patients with RRMS. It is important that we continue to work collaboratively with NICE to ensure people with early PPMS are also able to access ocrelizumab through the NHS as soon as possible.
Dr Marius Scholtz, Integrated Franchise Lead, Neuroscience, Roche Products UK.
References
[i] National Institute for Health and Care Excellence (2018) Final Appraisal Determination: Ocrelizumab for treating relapsing multiple sclerosis. June 2018.
[ii] Ocrevus (Ocrelizumab) Summary of Product Characteristics 2018.
[xii] Ziemssen T, (2005). Modulating processes within the central nervous system is central to therapeutic control of multiple sclerosis. J Neurol, 252 (5), v38-v45.
[xvi] Multiple Sclerosis Trust. Primary progressive MS. Available at: https://www.mstrust.org.uk/a-z/primary-progressive-ms#treatments. Last accessed June 2018.
[xx] Hauser SL, et al. (2017). Ocrelizumab versus Interferon Beta-1a in Relapsing Multiple Sclerosis. N Engl J Med, 376: 221-234.
[xxi] Montalban X, et al. (2017). Ocrelizumab versus Placebo in Primary Progressive Multiple Sclerosis. N Engl J Med, 376: 209-220.
[xxii] Lehmann-Horn et al. (2013) Targeting B Cells in the treatment of multiple sclerosis: recent advances and remaining challenges. Ther Adv Neurol Disord. 6 (3) 161-173.
[xxiii] Dilillo DJ, et al. (2008). Maintenance of long-lived plasma cells and serological memory despite mature and memory B cell depletion during CD20 immunotherapy in mice. J Immunol, 180:361–71.
The National Institute for Health and Care Excellence (NICE) has issued its Final Appraisal Determination (FAD) recommending the use of four out of six disease-modifying therapies (DMTs) in relapsing-remitting multiple sclerosis. Rebif® (interferon β-1a), Avonex® (interferon β-1a), Extavia® (Interferon β-1b) and Copaxone® (glatiramer acetate) have been recommended, within their marketing authorisations, as options for treating relapsing-remitting multiple sclerosis in the NHS provided the companies provide the drugs with the discounts agreed in the patient access schemes. NICE does not recommend Betaferon® (interferon β-1b), concluding that it would not be a good use of NHS resources. NICE has also stated it is not in a position to recommend pegylated interferon β-1a (Plegridy®) and that there will be a separate single technology appraisal for this drug. These recommendations are not intended to affect treatment with a beta interferon or glatiramer acetate that was started in the NHS before this guidance was published.
The National Institute for Health and Care Excellence (NICE) have been appraising the clinical and cost-effectiveness of beta interferons (interferon β-1a (Avonex®, Rebif®), Pegylated interferon β-1a (Plegridy®), and interferon β-1b (Betaferon®/Extavia®) and glatiramer acetate (Copaxone®) in multiple sclerosis, against best supportive care, in the context of a multiple technology appraisal.
The recent FAD follows a preliminary decision in December 2017 to recommend only Extavia® (interferon β-1b) as an option for treating multiple sclerosis
Epistatus is licensed for use in the treatment of prolonged, acute convulsive seizures in children and adolescents aged 10 to less than 18 years, who have been diagnosed with epilepsy1. Epistatus is presented “ready-to-use” in a novel, pre-filled, single-dose syringe, in a volume of 1 mL, to provide carers with the confidence that they are administering the correct dose1,2.
Epistatus has been developed specifically for buccal administration. The pre-filled syringe comes in a robust, tamper-resistant pack, which is UV-resistant to maximise shelf life1. It is portable and is carried by your patients at all times2.
The single-dose pack meets the principles of the Medicines Optimisation and NHS RightCare approach to help reduce wastage3and is compliant with the Falsified Medicines Directive that will come into force in February 20194.The NHS price for a single 10mg in 1mL pre-filled syringe is £45.76.
Please visit www.epistatus.co.uk for further information about Epistatus 10mg oromucosal midazolam pre-filled syringe, or to find out more about a budget model to calculate the financial impact of prescribing multipack buccal midazolam versus single-pack Epistatus.
The Acquired Brain Injury (ABI) Alliance, a collaborative venture between charities, professional groups and industry coalitions working in the field of ABI, launched its Rehabilitation Prescription (RP) Campaign on 1st May.
Speaking at the launch event in London, Professor Michael Barnes, ABI Alliance Chair said: “The Rehabilitation Prescription is a valuable tool that documents the rehabilitation needs of the individual with an ABI. It has no value if the individual with an ABI and their General Practitioner don’t receive a copy. And if the individual and the GP don’t know what rehabilitation is required then no access to services can be planned or implemented”.
The ABI Alliance believes that the RP should be given to every individual, both children, young people and adults with an ABI, on discharge from hospital, with a copy sent to their GP. This will then provide a useful resource for the GP to work with the individual and facilitate access to rehabilitation services in the community, maximising the individual’s health outcomes.
The results of the National Clinical Audit October 2016 ‘Specialist Rehabilitation for Patients with Complex Needs Following Major Injury (NCASRI)’ were discussed at the launch. The NCASRI report showed that although all 22 Major Trauma Centres reported that they routinely complete a RP, in one-third of the centres the RP was either sometimes or always given to the patient, but in the remaining two-thirds it was a clinically-held tool.
A Freedom of Information Request was sent last year to all Clinical Commissioning Groups by the United Kingdom Acquired Brain Injury Forum (UKABIF) asking if they logged RPs. The feedback was poor, only four CCGs were positive and recognition of the RP was inexcusably low.
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