Patients set to miss out on the benefit of brain breakthroughs

The big issue for neurology is to be able to provide the standard of service available in other developed countries

NEW BREAKTHROUGHS in treating and preventing neurological conditions could reduce much human suffering over coming years. But Irish patients may not reap the benefits, instead facing lengthy waiting lists to see consultants, followed by a lack of available support and rehabilitation services, according to those working in the field.

Around 700,000 people in Ireland have neurological conditions such as stroke, dementia, migraine, epilepsy, Parkinson's disease and multiple sclerosis.

It already costs the State about €1 billion each year, and our healthcare system may not be able to handle the increasing burden in the future, according to the Neurological Alliance of Ireland (NAI).

The answer lies in providing more resources, and also in smarter use of the ones we already have, according to a number of experts, who will today address a conference run by NAI in Dublin to mark Brain Awareness Week.

"The big issue for neurology is to provide a comprehensive service to the standard that is being provided in other developed countries," says Prof Peter Kelly, a consultant neurologist at the Mater Misericordiae Hospital. "We have the lowest ratio of consultant neurologists per head of population compared to any country in the developed world."

In practice, this means patients face long waits to be assessed, often as their conditions worsen, and are sometimes forced into the private system for treatment, says Kelly, who directs stroke services at the Mater.

He will today highlight the need to improve services to treat stroke, which is the third-biggest killer in Ireland and the leading cause of permanent neurological damage. New clot-busting treatments can potentially save the lives of people with severe stroke, but they must be given quickly and by trained experts who need to assess them immediately when they come into hospital, he explains.

"Given in the right way they can either completely cure paralysis or can result in major improvements in disability," he says. "People can come in with paralysis, get the medicine and a couple of hours later the paralysis is gone and they want to go home. It's stunning when you see it in practice."

Dedicated stroke units that organise expert care can also improve the longer-term fate of patients with stroke, adds Kelly. But with only one such unit here, the Republic lags far behind the UK, where between 70 and 90 per cent of hospitals deliver that service.

A twin-track approach of clot-busting drugs and dedicated stroke units could save or transform the lives of around 1,000 patients each year, according to Kelly. But for that to happen, patients need to receive quick and appropriate attention: "It's about the way we organise services when the patient comes into the hospital," he says.

Science is also making strides in dementia, particularly in prevention, according to Prof Des O'Neill, a consultant geriatrician at Tallaght Hospital. Studies have shown that controlling high blood pressure can help reduce the development of dementia, a symptom that can be caused by a number of conditions, including Alzheimer's disease.

"There's great hope around prevention and I think it is important that we look at the whole population for reducing blood pressure and examine things like salt in the diet," says O'Neill.

But again there's a need here for improved services, he adds, noting that the ageing "baby boom" generation and their carers will rightly demand a high level of care.

Service provision is also a hot issue when dealing with epilepsy, according to Dr Colin Doherty, a consultant neurologist at St James's Hospital. Many patients with the condition, which affects around 37,000 people in Ireland, come to accident and emergency and might have to wait several days there, he explains. But the burden on patients and healthcare resources could be slashed if a neurologist could see them at that point of entry.

"If we get down directly to accident and emergency to see them, we could probably discharge about a third of these patients," he says. "There were more than 400 admissions [ at St James's] with epileptic seizures in 2005 and we would have been able to discharge 125 directly. The average length of stay would have been about 10 days. So you would have just given more than 1,000 bed days back into the system immediately."

Patients could then be followed up and managed as outpatients or in the community, and centres could be set up around the country on a wider scale. Doherty believes the costs of more permanent change are modest, but he has no way of engaging with the Health Service Executive (HSE) to make it happen.

"I consider this to be a project which presses all the HSE buttons. We are keeping people out of the hospital, we are providing them with quality care, we are following them up in the outpatients early, we are doing the investigations in a community-based setting. We are doing all the things they want, and yet there's no person you can go to, no way of interacting with them to say this is something that should be supported," he says.

"I think if Brendan Drumm was listening to me now he'd be saying 'yes, we need to do this' and he'd make a few phone calls, and they would disappear into the bureaucracy. So when you have come up with an innovative solution, how do you translate that simple method of getting people in, knowing what to do and getting it done," he asks. "Because if you can't deliver the service, it means nothing."

The conference 'Neurological Conditions: The Health Care Challenge of the Next Decade' is being held today at the Royal College of Surgeons in Ireland. International Brain Awareness Week runs until March 16th. For details about local events see www.nai.ie