I attended the Association of British Neurologists ‘Need to Know’ Neurology afternoon course for GPs on Tuesday 6th May 2014 in Cardiff and found the presentations to be uniformly interesting and relevant for general practice. Indeed I filled a complete notepad with personal notes from the talks which is a good indication to me of the wisdom imparted!
The meeting was chaired by Dr Alistair Church, a local GP and part-time Neurologist. He had obviously primed the presenters to make the sessions of practical use to GPs with information for our needs for daily practice. The long waiting times for Neurology specialist consultations make this an essential part of any educational workshop.
The first session was on Parkinson’s Disease and Tremor by Dr Ralph Gregory. He described the different presenting symptoms and signs and interestingly the very early premonitory symptoms in PD such as loss of smell which can start many years before motor symptoms. The close liaison in particular with specialist nurses appears to be an essential part of PD management for the GP, especially as the advice is not to delay treatment in order to avoid (as much as possible) effects on quality of life.
The talk on dizziness by Dr Geraint Fuller was stimulating and showed the value of video access nowadays for looking at clinical signs and examination techniques online.
Dr Phil Smith talked about epilepsy and blackouts and differential diagnoses with practical advice on how to distinguish one from another. The value of any witness statements was emphasised and the need to exclude cardiac syncope such as with the long QT patient. It was interesting to see video accounts of patients describing their symptoms and the fact that the ‘way’ the patient tells the history is often important in making the diagnosis. I am not convinced I could exclude such organic causes without further specialist input but this was an educational insight into how to begin to clarify the diagnosis.
Dr Lionel Ginsberg presented his talk on Stroke versus TIA. His suggestion that a TIA would be better described as a ‘non disabling stroke’ makes sense and fits with local thoughts on prophylactic medication for a ‘TIA’ patient. Speed for carotid endarterectomy for the TIA patient was stressed as well as thrombolysis for the stroke patient. It was very useful to look at the list of symptoms and signs which help in differentiating migraine and transient epileptic amnesia from a TIA.
Hints on Headaches by Dr Richard Davenport brought migraine clearly into focus as well as cluster headaches as one of the Trigeminal Autonomic Cephalgia type headaches. A list of useful websites and the symptomatic ‘staircase’ (ladder) for treatment options was given.
Numbness and Tingling by Dr Gareth Llewelyn was our last session. This was a lively presentation so none had the same from their seats! The update in anatomy of the trigeminal nerve distribution was useful as was the reminder to exclude diabetes in patients presenting with truncal tingling sensations.
All in all: a very good afternoon. Many thanks to the presenters, Alistair and to ABN.
Useful websites and references
- http://www.sign.ac.uk 107 2008
- http://www.nice.org.uk 150 2012
- Canadian Headache Society Guideline for migraine prophylaxis. C J Neur Sci 2012; 39 (suppl. 2)
- Preventive Pharmacologic Treatments for Episodic Migraine in Adults. J Gen Intern Med 2013.
- BMJ 2011; 342:540-43
- Davenport RJ The bare essentials:Headache
- Pract Neurol2008;8:335-343
- Pringsheim T, Davenport WJ, Dodick D. Acute treatment and prevention of menstrually related migraine headache.
- Temporal arteritis.J R Coll Physicians Edinb 2012:42:341-9
ACNR 2014: V14;I3
Published online 15/7/14