New NICE guidelines on referring patients with neurological conditions

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New NICE guideline will help doctors recognise and refer people with suspected neurological conditions

NICE has published its guideline on recognising and referring people with suspected neurological conditions.

The new guideline offers, for the first time, comprehensive information on neurological conditions in general to help non-specialist healthcare professionals to identify people who should be offered referral for specialist assessment and care.

The guideline makes recommendations about which symptoms and signs should prompt a referral for further neurological assessment. It also covers some examinations, assessment tools and investigative tests non-specialists could use to help them decide whether a person with a suspected neurological condition should have further investigation or be referred to a specialist.

Neurological conditions are illnesses or injuries that affect the brain, spinal cord, muscles or nerves. Some are lifelong and some get better over time. Neurological conditions can be inherited, like muscular dystrophy. They can also develop during childhood, like some types of epilepsy. Some conditions, such as motor neurone disease, or Parkinson’s disease, are more common later in life. Neurological conditions can also develop suddenly at any age, after a head injury or stroke.

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Suspected neurological conditions account for about 1 in 10 GP consultations, and around 10% of emergency medical admissions (excluding stroke) and result in disability for 1 in 50 of the UK population

People with suspected neurological conditions often go to their GP with symptoms that are difficult to diagnose, which in turn can make identifying neurological conditions hard. A recent survey by the Neurological Alliance found that nearly a third of respondents had to see their GP 5 or more times about the health problems caused by their condition before being referred to a neurological specialist. It also found that around 40% of respondents waited more than a year from when they first noticed their symptoms to seeing a specialist.

The guideline aims to make a difference to anyone who might have a neurological condition by making sure:
• GPs can recognise when symptoms could have a neurological cause
• GPs and doctors in emergency departments know when to refer people to a specialist straight away and when to do more tests first
• people who most need to see a specialist can see one sooner
• people are not referred to a specialist if they don’t need to be.

Dr Paul Chrisp, director of the Centre for Guidelines at NICE, said: “People with suspected neurological conditions often need referral to a specialist to be diagnosed. However, we know that some people with neurological conditions are initially misdiagnosed or have a delayed referral to a specialist, and some referrals are unnecessary. These issues with referral can come from non-specialists not recognising neurological conditions.
“This new guideline should help improve outcomes for people with suspected neurological conditions by providing, for the first time, a comprehensive assessment of the key signs and symptoms across the range of possible neurological conditions that should trigger referral to a specialist.”

Richard Grunewald, Chair of the guideline committee: “A non-specialist cannot be expected to keep up with the rapid changes in knowledge and practice in clinical neurology. This new guideline will help non-specialists recognise patients with neurological symptoms, such as dizziness and sleep disturbance, to prompt their referral to specialist assessment and care.”
NICE has today also published its updated guideline on the diagnosis and initial management of stroke and transient ischaemic attack. Among other things it recommends that people with acute ischaemic stroke should be offered a thrombectomy, a procedure to remove the blood clot, up to 24 hours after the onset of symptoms.

The guideline says thrombectomy should be offered alongside clot-busting drugs if there is potential to salvage brain tissue. Until now thrombectomy was usually only recommended up to 12 hours after the onset of symptoms.

The NICE clinical guideline Suspected neurological conditions: recognition and referral is available from the NICE website at https://www.nice.org.uk/guidance/NG127