Conditions & treatments covered

Ten consultant neurologists have their practice at the unit. They are at the top of their profession with most holding senior positions in London's renowned teaching hospitals.

The consultants are supported by nursing staff and therapists who all have post-graduate training in neurological disorders including neurophysiotherapists, neuropsychologists, occupational therapists, speech therapists, dieticians and pharmacists.

24 hour medical cover is provided by a specialist Resident Medical Officer and there is an on-call Consultant Neurologist rota.

Understanding Neurology

Neurology is the specialist branch of Medicine that deals with the nervous system. This includes the brain, spinal cord, peripheral nerves and muscles. The special senses of smell, vision, hearing and balance also often involve neurologists usually overlapping with ophthalmologists (eye specialists), and Ear Nose and Throat (ENT) surgeons. Neurosurgeons, not Neurologists, perform any surgical procedures required but the two specialities, by necessity, have to work closely together.

Closely allied to the Neurology team are our Neurophysiology consultants, who undertake electrical studies on the nervous system. These include nerve conduction tests (NCT) and electromyograms (EMG) which are electrical stimulation tests looking at the function of nerves and muscles, for example, in the hands and feet. Neurophysiologists also interpret electroencephalograms (EEG) brain wave tests which are used in the diagnosis of patients with seizures and epilepsy.

Common Neurological Conditions

Stroke and transient ischaemic attack (TIA)

A stroke occurs when the blood supply to part of the brain is interrupted by a blockage in the blood supply or when there is a haemorrhage due to a burst blood vessel. A patient will complain of weakness in an arm and or leg, difficulty with speech and /or language, lost vision in part of the visual field or complain of numbness and/ or tingling down one side of the body. If the blood supply is interrupted for a short time only, the brain cells may recover function – this is a transient attack (TIA). It is vital to seek urgent medical opinion when these events occur.

Approximately 1 - 2 people per 1000 have strokes each year in the UK.

In patients who have suffered a TIA, the risk of a full blown stroke is high and an urgent assessment needs to be carried out by a neurologist to try and prevent this from happening. Investigations will include a brain scan ; carotid dopplers - which study the main carotid arteries supplying the brain, in case there is a severe narrowing that may be amenable to treatment by surgery (carotid endarterectomy or stenting); cardiac (heart) assessment; and blood tests. In patients who have already suffered a stroke, there are treatments now available (thrombolysis) which, if given quickly enough to appropriate patients, may prevent further damage.

Migraine

This is a common cause of headache with 10% of the population being affected with different levels of severity. The other common causes of headache are muscle tension or cervicogenic headache and headache due to overuse of painkillers.

Migraine is a headache characterised by a one sided throbbing headache with associated nausea and vomiting, sensitivity to light (photophobia), noise (phonophobia) and/or smells (osmophobia). The underlying mechanism is believed to be due abnormal wiring within the brain. The disorder often runs in families.

Migraine attacks may be triggered by a variety of causes including stress or even relief after a period of stress, lack of or too much sleep, certain foods such as cheese, red wine and chocolate. Each sufferer will be able to identify differing triggers – some are unusual, such as a change in barometric pressure or a specific perfume!

Although migraine is not life threatening, it causes a great deal of distress and suffering both in those afflicted and in their families.

Treatments are available in the form of medication for acute attacks. In those who suffer with frequent attacks, medication is available for the prevention of the migraine attacks (prophylaxis).

Epilepsy

Epilepsy is diagnosed when a person has had two or more seizures. Approximately 1 in 200 adults suffer with this condition. Epilepsy may be caused by a variety of conditions including head injury, brain tumours, and stroke or after a brain infection such as meningitis or encephalitis. In some patients, epilepsy may run in families or no cause is identified. Anyone who has suffered with a seizure needs to see a neurologist for an assessment. Epilepsy can be managed by drug treatment, usually under the supervision of a neurologist.

Multiple Sclerosis (MS)

MS is an inflammatory condition that affects the brain and spinal cord, the so-called central nervous system. This may occur in attacks with some or complete recovery between attacks (relapsing /remitting), or it may be progressive, with patients slowly getting worse.

The disease increases in frequency the further one moves away form the equator and is therefore more common in colder climates, with the highest frequency in the North of Scotland. In the UK, about 60 per 100,000 people are affected. It is more common in females.

The underlying cause is unknown but it is believed that a person may be genetically susceptible to the disease that may be triggered by an unknown virus.

Patients who have suffered an attack with, for example, weakness of the arm and/or legs, tingling in the limbs, double vision or unsteadiness and inco-ordination, need to be seen by a neurologist. Investigations that may be necessary include a MRI scan, visual evoked responses (which are neurophysiological tests studying the pathway of vision from the eyes to the brain), and perhaps a lumbar puncture test.

Treatment for an acute attack may be with steroids given into the vein (intravenously). Treatment with disease modifying drugs (DMD) such as interferons and copolymer 1. can now reduce the number of relapses. Physiotherapy is an important aspect in the management of any patient with MS.

 

Parkinson's Disease (PD)

PD is due to the loss of certain nerve cells within that part of the brain that controls movement (basal ganglia). Patients may present with some or all of the following – slowness of movement, stiffness, tremor and instability. There are differing causes of Parkinsonism of which PD is one cause – others include multiple small strokes; certain drugs such as those used in psychiatric disorders; dizziness or nausea and vomiting for long periods; rarer conditions such as multiple system atrophy and progressive supranuclear palsy (PSP); and repeated head injuries as may occur in boxers.

PD occurs in about 1 in 1000 rising to 5 in 1000 after the age of 70 years. In the UK, at any one time there are about 100,000 sufferers.

Although there are no specific tests for PD, it is necessary to be seen by a neurologist to make the diagnosis and also to exclude other causes.

There is no cure for PD but there are good treatments in the form of tablets that will help alleviate the symptoms of tremor and slowness. There are also surgical options in patients who are suitable.

Dementia

Dementia is a condition which reflects a decline in mental ability due to nerve cell loss in different parts of the brain. Patients or their relatives may complain of memory loss, impaired reasoning or judgement, changes in mood, behaviour and personality.

The most common cause of dementia in the UK is Alzheimer's disease. Other causes include multiple strokes, fronto-temporal dementia (another degenerative condition of the brain) and diffuse cortical Lewy body disease where patients may also have Parkinsonism.

Dementia usually affects older people – approximately 5% in those over the age of 65 years and 20% of those over the age of 80 years.

Any patient suspected of having dementia should see a neurologist who will try and exclude other reversible causes such as depression, vitamin deficiencies, thyroid disease, brain infections and rarely tumours. Investigations carried out may include blood tests, brain scan (MRI or CT scan), EEG, a neurocognitive assessment where memory and other brain functions can be assessed by a neuropsychologist with special tests that are a little like IQ tests.

There is no cure for Alzheimer's disease but there are treatments available that may help to slow down the progression of the disease by a few months.

Diagnosis of Neurological Conditions

 

Neurologists reach a diagnosis by taking a detailed history and performing a neurological examination (which varies in length depending on the complexity of the problem), after which investigations may be indicated, all of which are available at the Wellington Hospital and may include imaging with the latest MRI or 64 slice CT scan or neurophysiological tests as detailed here.

The treatment options once a diagnosis is reached may be:

  • Drugs
  • Reurorehabilitation
  • Referral to a neurosurgeon or other specialist; or
  • Monitoring the symptoms without any intervention.

Neurophysiology

The study of the electrical signals from the brain, spinal cord, eyes, ears, nerves and muscle are performed on the Mezzanine Level of the South Building.

These tests include routine, portable, sleep-deprived and prolonged electroencephalogram (EEG), multiple sleep latencies test (MSLTs) visual evoked potentials (VEPs), brain stem auditory evoked potentials (BSAEPs), upper & lower limb somatosensory evoked potentials (SEPs), spinal cord, acoustic & facial intra-operative monitoring (IOM), nerve conduction studies (NCS), electromyography (EMG), and EMG guided Botox injections (BOTOX), the latter three are performed by two Consultant Neurophysiologists who visit The Wellington on a rota basis. The other tests are performed by experienced Neurophysiology Technicians with the results reported by these Consultants within 24 hours.

 

 

Neuropsychology

Neuropsychology is a branch of clinical psychology that aims to identify and understand changes in thinking and behaviour that can result from injuries to the brain.

Within The Wellington the main role of the neuropsychologist is cognitive assessment: that is identifying and measuring the extent of any changes in thinking ability, including attention, memory, reasoning and perception. Finding solutions to acquired problem behaviours is also part of the role of the neuropsychologist as well as addressing the emotional and adjustment changes that frequently follow acute or chronic illness, in either the patient themselves or their relatives.

The neuropsychology department is currently made up of six full time clinical and neuropsychologists all with extensive experience in cognitive rehabilitation and assessment. The department also has a busy outpatient source to cater for the needs of these patients who have been discharged from the inpatient programme or to meet the needs of those referred directly from the community.