Neuroscience services - what good looks like

Specialised adult neuroscience services

Nuffield Trust 1 October 2020

• NHS England’s Specialised Commissioning team lead a national programme aimed at improving specialised adult neuroscience services in England. The work programme seeks to support emerging regional teams as well as Integrated Care Systems in the NHS, through establishing ‘what good looks like’ for specialised neuroscience services for a local population.
• Neurosurgery
• Specialised neurology

Deep brain stimulation for refractory epilepsy in adults [IPG678]

Deep brain stimulation for refractory epilepsy in adults [IPG678]
NICE Interventional procedures guidance 12 August 2020

• The procedure should only be done in neurosurgery centres that specialise in managing epilepsy.

Artificial intelligence for analysing CT brain scans

Artificial intelligence for analysing CT brain scans
NICE Medtech innovation briefing [MIB207] 17 March 2020

• Review of six AI software packages designed to automatically detect and notify healthcare professionals of abnormalities after analysis of brain CT scans. Includes costs.

Refractory Epilepsy Specialist Clinical Advisory Service

Refractory Epilepsy Specialist Clinical Advisory Service
NHS England 6 February 2020

• This Service Specification covers the provision of a specialist clinical advisory service, supporting clinicians working with patients to optimise the treatment of refractory epilepsy.

Refractory Epilepsy Specialist Clinical Advisory Service

Refractory Epilepsy Specialist Clinical Advisory Service
NHS England 6 February 2020

• This Service Specification covers the provision of a specialist clinical advisory service, supporting clinicians working with patients to optimise the treatment of refractory epilepsy.

Multiple sclerosis: prevalence, incidence and smoking status - data briefing

Multiple sclerosis: prevalence, incidence and smoking status - data briefing
PHE 4 February 2020

• Findings from a study using a sample of anonymised primary care records in relation to the prevalence, incidence and demographic characteristics of patients with a diagnosis of multiple sclerosis (MS) in England.

Walking and Living Independently With Spina Bifida: A 50-year Prospective Cohort Study

Walking and Living Independently With Spina Bifida: A 50-year Prospective Cohort Study

Dev Med Child Neurol, 61 (10), 1202-1207. Oct 2019

• From 1972 to 2017, a cohort of 117 (born 1963–1971) survivors with spina bifida and/or carers was surveyed approximately every 5 years by clinical examination and/or postal questionnaire/ telephone interview. Analysis showed that:
• By age 50 years, the percentage of patients who could walk more than 50m had declined to 27%.
• By age 50 years, the percentage living independently had doubled to over 50%.
• Survivors without a history of raised intracranial pressure or cerebrospinal fluid shunt revision are more likely to live independently.

Cerebral palsy in adults [Quality Standard]

Cerebral palsy in adults [QS191]
NICE Quality standard January 2020

Thrombectomy Service – Final report from the Stakeholder Forum

Thrombectomy Service – Final report from the Stakeholder Forum
Thames Valley Clinical Senate December 2019

• Only hospitals with a neuroscience centre can meet the requirements for a thrombectomy service and so the hospitals delivering the service will need to cover a wide geographical catchment.
• The Clinical Senate reviewed the requirements for safe and effective delivery of a thrombectomy service across a wider geography and looked ahead to the potential delivery of a 24/7 service and the implications for the service in the interim. This report aims to understand the issues from the different perspectives of the local trusts, the hyper-acute stroke unit and the patients and their families.

Multiple sclerosis in adults: management

Multiple sclerosis in adults: management [NG186]
NICE updated November 2019
This guideline covers diagnosing and managing multiple sclerosis in people aged 18 and over. It aims to improve the quality of life for adults with multiple sclerosis by promoting symptom management, comprehensive reviews and effective relapse treatment.
Updates relate to use of Sativex (a THC:CBD spray) and gabapentin

vCJD transmission by blood components: risk assessment

vCJD transmission by blood components: risk assessment
DHSC 31 October 2019

• A mathematical model to estimate the number of cases of variant Creutzfeldt-Jakob Disease (vCJD) that could be caused by transfusions of blood products.

RightCare Progressive Neurological Conditions Toolkit

RightCare Progressive Neurological Conditions Toolkit
RightCare 15 August 2019

• This toolkit will support systems to understand the priorities in care for people living with various progressive neurological conditions including multiple sclerosis (MS), motor neurone disease (MND), Parkinson's and the atypical Parkinsonism's of multiple system atrophy (MSA), progressive supranuclear palsy (PSP) and corticobasal degeneration (CBD). It provides the opportunity to assess and benchmark current systems to find opportunities for improvement.

Hyperacute neurology at a regional neurosciences centre: a 1-year experience of an innovative service model.

Hyperacute neurology at a regional neurosciences centre: a 1-year experience of an innovative service model.
Clin Med (Lond). 2019 Mar;19(2):119-126. doi: 10.7861/clinmedicine.19-2-119.
This paper reports the results from the first year of the St George's Hospital hyperacute neurology service (HANS). The outcomes include admission avoidance from ED, and a reduction in length of stay for non stroke patients and reduction in occupancy of stroke beds by non-stroke cases.

Abstract

Neurosurgery (adults) service specification

Neurosurgery (adults)
NHS England 15 February 2019

• Service specification for the provision of adult neurosurgery.

Rehabilitation for people with multiple sclerosis

Rehabilitation for people with multiple sclerosis: an overview of Cochrane Reviews
Cochrane Systematic Review 14 January 2019

• Review of 15 Cochrane reviews (168 clinical trials) showed some benefits for people with MS who participated in exercise and physical activity programmes or multidisciplinary rehabilitation programmes (where the intervention is provided by a team of health professionals from different professions). They found improvements in everyday activities, function, and health‐related quality of life, compared with those who were not offered rehabilitation. 
• Evidence for other rehabilitation modalities was limited, due to lack of good‐quality studies. 

Cerebral palsy in adults: NICE guidance

Cerebral palsy in adults [NG119]
NICE January 2019

• This guideline covers care and support for adults with cerebral palsy. It aims to improve health and wellbeing, promote access to services and support participation and independent living.

Therapy-led spasticity interface service - case study

Case study: Therapy-led spasticity interface service
NHS Improvement 10 December 2018

• A therapy-led spasticity interface service (SIS) run by Northern Devon Healthcare NHS Trust provides a one-stop shop approach to spasticity management, including assessment, pharmacological review, botulinum toxin therapy, rehabilitation, postural management, splinting and orthotics, and support for self-management.

Brain and spinal stimulation therapies for phantom limb pain: a systematic review

Brain and spinal stimulation therapies for phantom limb pain: a systematic review
Health Technology Assessment 22(62) November 2018. https://doi.org/10.3310/hta22620

• Studies of neurostimulation treatments did not provide robust results; therefore, there is much uncertainty about which treatments are best for chronic phantom limb pain.

Specialised commissioning prioritisation results – June 2018

Specialised commissioning prioritisation results – June 2018
NHS England 7 July 2018

• A list of the latest innovative new treatments approved by NHS England. Non drug innovations include:
• Left Atrial Appendage Occlusion for patients with atrial fibrillation and relative or absolute contraindications to anticoagulation (adults)
• Selective dorsal rhizotomy
• Total pancreatectomy with islet transplantation for chronic pancreatitis

Brain tumours (primary) and brain metastases in adults, NG99

Brain tumours (primary) and brain metastases in adults, [NG99 ]
NICE July 2018

• This guideline covers diagnosing, monitoring and managing any type of primary brain tumour or brain metastases in people aged 16 or over. It aims to improve diagnosis and care, including standardising the care people have, how information and support are provided, and palliative care.