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Neurological conditions

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What is covered

This NICE Pathway covers the recognition and referral of suspected neurological conditions by non-specialists and management of neurological conditions by specialists.

Updates

Updates to this NICE Pathway

26 November 2019 Cerliponase alfa for treating neuronal ceroid lipofuscinosis type 2 (NICE highly specialised technologies guidance 12) added to neuronal ceroid lipofuscinosis type 2.
13 August 2019 Endovascular insertion of an intrasaccular wire-mesh blood-flow disruption device for intracranial aneurysms (NICE interventional procedures guidance 658) added to intracranial aneurysm.
23 July 2019 Nusinersen for treating spinal muscular atrophy (NICE technology appraisal guidance 588) added to muscle conditions.
30 April 2019 Updated on publication of suspected neurological conditions: recognition and referral (NICE guideline NG127).
8 January 2019 Pipeline Flex embolisation device with Shield Technology for the treatment of complex intracranial aneurysms (NICE medical technologies guidance 10) updated in intracranial aneurysm.
18 December 2018 Transcutaneous neuromuscular electrical stimulation for oropharyngeal dysphagia in adults (NICE interventional procedures guidance 634) added.
21 August 2018 Dinutuximab beta for treating neuroblastoma (NICE technology appraisal guidance 538) added to neuroblastoma.
19 June 2018 Unilateral MRI-guided focused ultrasound thalamotomy for treatment-resistant essential tremor (NICE interventional procedures guidance 617) added.
21 November 2017 Processed nerve allografts to repair peripheral nerve discontinuities (NICE interventional procedures guidance 597) added to nerve, nerve root and plexus conditions.
26 September 2017 Intramuscular diaphragm stimulation for ventilator-dependent chronic respiratory failure caused by high spinal cord injuries (NICE interventional procedures guidance 594) added.
19 July 2016 Ataluren for treating Duchenne muscular dystrophy with a nonsense mutation in the dystrophin gene (NICE highly specialised technologies guidance 3) added.
22 March 2016 Endoscopic carbon dioxide laser cricopharyngeal myotomy for relief of oropharyngeal dysphagia (NICE interventional procedures guidance 550) added.
15 December 2015 Radiofrequency ablation for symptomatic interdigital (Morton's) neuroma (NICE interventional procedures guidance 539) added to nerve, nerve root and plexus conditions.

Person-centred care

People have the right to be involved in discussions and make informed decisions about their care, as described in your care.
Making decisions using NICE guidelines explains how we use words to show the strength (or certainty) of our recommendations, and has information about prescribing medicines (including off label use), professional guidelines, standards and laws (including on consent and mental capacity), and safeguarding.

Your responsibility

Guidelines

The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service. It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian.
Local commissioners and providers of healthcare have a responsibility to enable the guideline to be applied when individual professionals and people using services wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with complying with those duties.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Technology appraisals

The recommendations in this interactive flowchart represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, health professionals are expected to take these recommendations fully into account, alongside the individual needs, preferences and values of their patients. The application of the recommendations in this interactive flowchart is at the discretion of health professionals and their individual patients and do not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.
Commissioners and/or providers have a responsibility to provide the funding required to enable the recommendations to be applied when individual health professionals and their patients wish to use it, in accordance with the NHS Constitution. They should do so in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Medical technologies guidance, diagnostics guidance and interventional procedures guidance

The recommendations in this interactive flowchart represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take these recommendations fully into account. However, the interactive flowchart does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer.
Commissioners and/or providers have a responsibility to implement the recommendations, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this interactive flowchart should be interpreted in a way that would be inconsistent with compliance with those duties.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Short Text

Everything NICE has said on neurological conditions in an interactive flowchart

What is covered

This NICE Pathway covers the recognition and referral of suspected neurological conditions by non-specialists and management of neurological conditions by specialists.

Updates

Updates to this NICE Pathway

26 November 2019 Cerliponase alfa for treating neuronal ceroid lipofuscinosis type 2 (NICE highly specialised technologies guidance 12) added to neuronal ceroid lipofuscinosis type 2.
13 August 2019 Endovascular insertion of an intrasaccular wire-mesh blood-flow disruption device for intracranial aneurysms (NICE interventional procedures guidance 658) added to intracranial aneurysm.
23 July 2019 Nusinersen for treating spinal muscular atrophy (NICE technology appraisal guidance 588) added to muscle conditions.
30 April 2019 Updated on publication of suspected neurological conditions: recognition and referral (NICE guideline NG127).
8 January 2019 Pipeline Flex embolisation device with Shield Technology for the treatment of complex intracranial aneurysms (NICE medical technologies guidance 10) updated in intracranial aneurysm.
18 December 2018 Transcutaneous neuromuscular electrical stimulation for oropharyngeal dysphagia in adults (NICE interventional procedures guidance 634) added.
21 August 2018 Dinutuximab beta for treating neuroblastoma (NICE technology appraisal guidance 538) added to neuroblastoma.
19 June 2018 Unilateral MRI-guided focused ultrasound thalamotomy for treatment-resistant essential tremor (NICE interventional procedures guidance 617) added.
21 November 2017 Processed nerve allografts to repair peripheral nerve discontinuities (NICE interventional procedures guidance 597) added to nerve, nerve root and plexus conditions.
26 September 2017 Intramuscular diaphragm stimulation for ventilator-dependent chronic respiratory failure caused by high spinal cord injuries (NICE interventional procedures guidance 594) added.
19 July 2016 Ataluren for treating Duchenne muscular dystrophy with a nonsense mutation in the dystrophin gene (NICE highly specialised technologies guidance 3) added.
22 March 2016 Endoscopic carbon dioxide laser cricopharyngeal myotomy for relief of oropharyngeal dysphagia (NICE interventional procedures guidance 550) added.
15 December 2015 Radiofrequency ablation for symptomatic interdigital (Morton's) neuroma (NICE interventional procedures guidance 539) added to nerve, nerve root and plexus conditions.

Sources

NICE guidance and other sources used to create this interactive flowchart.
Nusinersen for treating spinal muscular atrophy (2019) NICE technology appraisal guidance 588
Dinutuximab beta for treating neuroblastoma (2018) NICE technology appraisal guidance 538
Processed nerve allografts to repair peripheral nerve discontinuities (2017) NICE interventional procedures guidance 597
Radiofrequency ablation for symptomatic interdigital (Morton's) neuroma (2015) NICE interventional procedures guidance 539
Endoscopic thoracic sympathectomy for primary facial blushing (2014) NICE interventional procedures guidance 480
Phrenic nerve transfer in brachial plexus injury (2013) NICE interventional procedures guidance 468
Selective dorsal rhizotomy for spasticity in cerebral palsy (2010) NICE interventional procedures guidance 373
Lumbar infusion test for the investigation of normal pressure hydrocephalus (2008) NICE interventional procedures guidance 263
Coil embolisation of ruptured intracranial aneurysms (2005) NICE interventional procedures guidance 106
Coil embolisation of unruptured intracranial aneurysms (2005) NICE interventional procedures guidance 105
Supraorbital minicraniotomy for intracranial aneurysm (2004) NICE interventional procedures guidance 84
Selective peripheral denervation for cervical dystonia (2004) NICE interventional procedures guidance 80
Lumbar subcutaneous shunt (2004) NICE interventional procedures guidance 68
Cerliponase alfa for treating neuronal ceroid lipofuscinosis type 2 (2019) NICE highly specialised technologies guidance 12
SecurAcath for securing cerebrospinal fluid catheters (2017) NICE medtech innovation briefing 107

Quality standards

Quality statements

Effective interventions library

Effective interventions library

Successful effective interventions library details

Implementation

Information for the public

NICE has written information for the public on each of the following topics.

Pathway information

Person-centred care

People have the right to be involved in discussions and make informed decisions about their care, as described in your care.
Making decisions using NICE guidelines explains how we use words to show the strength (or certainty) of our recommendations, and has information about prescribing medicines (including off label use), professional guidelines, standards and laws (including on consent and mental capacity), and safeguarding.

Your responsibility

Guidelines

The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service. It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian.
Local commissioners and providers of healthcare have a responsibility to enable the guideline to be applied when individual professionals and people using services wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with complying with those duties.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Technology appraisals

The recommendations in this interactive flowchart represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, health professionals are expected to take these recommendations fully into account, alongside the individual needs, preferences and values of their patients. The application of the recommendations in this interactive flowchart is at the discretion of health professionals and their individual patients and do not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.
Commissioners and/or providers have a responsibility to provide the funding required to enable the recommendations to be applied when individual health professionals and their patients wish to use it, in accordance with the NHS Constitution. They should do so in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Medical technologies guidance, diagnostics guidance and interventional procedures guidance

The recommendations in this interactive flowchart represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take these recommendations fully into account. However, the interactive flowchart does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer.
Commissioners and/or providers have a responsibility to implement the recommendations, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this interactive flowchart should be interpreted in a way that would be inconsistent with compliance with those duties.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Supporting information

Glossary

attention deficit hyperactivity disorder
Alcohol Use Disorders Identification Test
benign paroxysmal positional vertigo
(consider a routine referral)
(a subjective sensation of spinning (vertigo) or a more vague sensation of unsteadiness, and sometimes a feeling of light-headedness or pre-syncope)
Driver and Vehicle Licensing Agency
erythrocyte sedimentation rate
(a condition in which people experience neurological symptoms in the absence of any identifiable causative physical or structural abnormality)
head impulse-nystagmus-test of skew
neuronal ceroid lipofuscinosis type 2
(irritation or damage to a nerve root as it exits the spinal canal: it is most commonly caused by mechanical compression from a prolapsed intervertebral disc or degenerative arthritis of the spine; less frequently, an infection such as herpes zoster or Lyme disease is the cause; symptoms include neck or low back pain radiating into a limb, tingling (paraesthesia), reduced or absent deep tendon reflex(es) and weakness in the distribution of the nerve root)
(to be seen by the specialist service within a few hours, or even more quickly if necessary)
(to be seen by the specialist service within 2 weeks)
(a routine referral)
spinal muscular atrophy
sudden unexpected death in epilepsy
tripeptidyl peptidase 1

Paths in this pathway

Pathway created: March 2014 Last updated: November 2019

© NICE 2019. All rights reserved. Subject to Notice of rights.

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