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Who is at risk and why

Adults :: Long term neurological conditions :: Who is at risk and why

A long term neurological condition (LTNC) results from disease of, injury or damage to the body's nervous system. LTNCs are numerous and varied. Some may be present at birth and lead to learning disability. Some appear in childhood and others have an adult onset. The time course of different conditions also varies considerably, ranging from a few months to decades between diagnosis and death.

Broadly speaking there are four categories of LTNC:
• Sudden onset conditions – followed by a partial recovery, e.g. spinal cord injury
• Intermittent and unpredictable conditions – causing variation in the level of care needed, e.g. epilepsy, or early multiple sclerosis (MS)
• Progressive conditions – with increasing dependence on others for help as the condition deteriorates, e.g. motor neurone disease (MND), Parkinson's disease (PD) or late stages MS.
• Stable neurological conditions – for which the needs change with development or ageing, e.g. post–polio syndrome or cerebral palsy in adults.

Approximately 10 million people across the UK have a LTNC (migraine accounts for 8 million of these). The impact on the health and social care sector is considerable — it is estimated that LTNCs account for 19% of acute hospital admissions, 10% of visits to A&E and 17% of GP consultations (being the third most common reason for seeing a GP). They also make up 25% of the burden of chronic disability in people aged 16–64, affecting one in fifty of the UK's population. Approximately 350,000 people need assistance with daily living and around 850,000 people provide care for someone affected by a LTNC. Thirty-three percent of disabled people living in residential care have a LTNC.[1][2]

A small number of LTNCs have relatively high prevalence. There are other conditions that are much rarer, but which collectively impose a large burden of illness on the population. People with LTNCs require support from a range of services, with much of the care for some conditions coming from specialties other than neurology, such as geriatrics and general medicine.[3]

Studies have found it challenging to get a clear local picture of healthcare activity due to LTNCs. Routine data usually centre on hospital admissions, which are likely to underestimate the true level of overall activity. Admissions tend to be most concentrated around the time of diagnosis and/or changes with the stages of disease trajectory.

Summary profiles can be found in a 2010 HNA for Oxfordshire,[4] providing 2–3 page summaries of a range of LTNCs. The information provided for each condition includes age of onset, symptoms, diagnosis, treatment, longer term support, and end of life care.


References

[1]   Shather Z. Commissioning Neurology Services in Richmond 2013; Unpublished.
[2]   Skills for Health Workforce Projects Team. Long term neurological conditions: a good practice guide to the development of the mutlidisciplinary team and the value of the specialist nurse 2008; MS Society. http://www.mssociety.org.uk/sites/default/files/Documents/Professionals/Long%20Term%20Neurological%20Conditions_good%20practice%20guide_professionals%20resource.pdf .
[3]   Fell, Gibbons C. Long Term Neurological Conditions - Strategic Health Needs Assessment 2010; Bradford and Airedale NHS.
[4]   Pittam G, Haywood D. Health Needs Assessment for long term neurological conditions. A report for Oxfordshire PCT 2010; Oxfordshire PCT. http://mycouncil.oxfordshire.gov.uk/documents/s2460/JHO_MAY2010R07.pdf .