154 The natural history of motor neurone disease (MND): assessing the impact of specialist care. Issue 3 (9th February 2012)

• Record Type: Journal Article
• Authors: Aridegbe, T; Kandler, R; Walsh, T; Shaw, P J; McDermott, C J
• Is Part Of: Journal of neurology, neurosurgery and psychiatry. Volume 83:Issue 3(2012)
• Page Start: e1
• Page End: e1
• Publication Date: 2012-02-09
• Subjects: Neurology -- Periodicals; Nervous system -- Surgery -- Periodicals; Psychiatry -- Periodicals; 616.8
• DOI: 10.1136/jnnp-2011-301993.196
• Languages: English
• ISSNs: 0022-3050

Abstract

Abstract : Background: Many centres in the UK offer care to patients with MND in a multi-disciplinary clinic (MDC). It is has been demonstrated that MDC care results in a better outcome than care from a General Neurology Clinic (GNC). Whether this is due to higher use of disease modifying interventions or an independent factor of attendance at an MDC has not been established. Objectives: To compare survival of patients followed-up in a GNC with those in a MDC. Methods: A retrospective review was undertaken of hospital notes of patients with MND, who were diagnosed and followed-up in a GNC between 1998 and 2002 and in a MDC between 2006 and 2010. Survival modelling between the groups was assessed using Kaplan–Meier analysis and significance measured by the log rank test. Multivariate analysis of risk was assessed using the Cox proportional hazard model. Results: In all, 162 patients attended a GNC, and 255 attended a MDC. Patients attending the MDC used riluzole, non-invasive ventilation (NIV) and percutaneous endoscopic gastrostomy (PEG) more often, and had an improved survival time of 7–8 months (p<0.001). In Cox multivariate analysis, attending an MDC was found to be a significant positive prognostic factor (HR 1.72, 95% CI 1.37 to 2.16, p<0.001). Mean survival for MND patients not using riluzole, NIV or PEG improved by an average of 3 months from symptom onset and date of diagnosis. Discussion: Attendance at a specialist clinic is associated with improved survival, independently of disease modifying interventions. This suggests that coordinated care improves the prognosis of MND patients. This effect is augmented by the increased use of riluzole, NIV and gastrostomy.