By Lord Walton of Detchant – 2nd February 2011

Lord Walton of Detchant calls for clarity in determining how multiple sclerosis care will be commissioned, following proposed restructures to the health service.

Multiple sclerosis is a chronic disease of the central nervous system involving the brain, spinal cord and sometimes the optic nerves. it is the commonest neurological disease affecting adults, involving approximately two million people worldwide and about 100,000 people in the UK.

Symptoms vary in severity; sometimes the disease is progressive but more often it is a relapsing and remitting disorder, in that episodes of weakness, numbness or visual failure occur but then recover wholly or in part, only for further such events to occur at a later date, often resulting ultimately in progressive disability.

Since the introduction of interferons in treatment some 20 years ago, these drugs and many more discovered since have been shown to be effective in reducing the severity of symptoms, in promoting remission and in delaying progression of the disease, particularly in the relapsing and remitting variety of the condition. These are so-called ‘disease-modifying drugs’.

Unfortunately, recent evidence shows that only about 12 per cent of patients with multiple sclerosis in the UK are currently receiving these remedies, and a report published by the department of health on medicines’ usage ranked the UK 13 out of 14 comparative countries with regard to MS drugs.

This finding is not consistent with the ten-year national service framework launched by the government in 2005 relating to the treatment of long-term conditions, and it is clear that substantial improvement in the availability of these drugs is needed.

The department of health introduced a risk-sharing scheme, enabling manufacturers of these drugs to share the cost of providing them while research was undertaken over a period of ten years to ascertain their long-term cost-effectiveness. it is unclear how future MS services will be commissioned, as between the new National Health Commissioning Board and local GP consortia, and this also needs to be clarified.

Lord Walton of Detchant Kt TD MA MD DSc FRCP FMedSci is a former consultant neurologist and professor of neurology. He was elevated to the peerage in 1989 and sits as a crossbencher.

The Baptist Health system was recognized Tuesday for being among the fastest in the country at getting stroke patients from the front door to clot-busting therapy — a development remarkable for how far the city has come in stroke care in the past two years, observers said.

The American Heart Association added the Baptist system to its Target Stroke Honor Roll — one of 32 hospitals or systems nationwide to qualify.

Baptist officials reported 72 percent of their patients qualifying for tissue plasminogen activator, or tPA, got the drug within an hour of arriving at the hospital during a recent evaluation period. The average among participating hospitals is about 27 percent.

“The importance of it is that the more rapidly you get tPA, for those people who are eligible, the better your chances are of improvement,” said Dr. Dicky Huey, medical director of Baptist’s stroke program. “It’s critically important because one minute of brain ischemia or loss of blood supply can kill two million nerve cells.”

The Baptist system has aggressively built up and promoted its stroke care since 2008, when emergency medical officials complained San Antonio hospitals were lagging far behind.

That year, Suzanne Hildebrand, a founder and former president of the San Antonio chapter of Mothers against Drunk Driving, ramped up the pressure when her husband, Ray Hildebrand — who died in July of complications from a fall — suffered a severe stroke and lingered at Northeast Baptist Hospital for hours as doctors tried to transfer him to a hospital capable of treating him.

At the time, San Antonio was one of the few U.S. cities with no hospitals certified as stroke centers. Today it has 10, including the five Baptist hospitals, four in the Methodist Healthcare system, and University Hospital.

More important, hospitals work with EMS systems in a regional stroke alert system, in which paramedics in the field alert emergency rooms to scramble their stroke teams. That’s important because tPA can usually be given only within a few hours of when symptoms begin.

“We were transferring patients out of the city of San Antonio for acute stroke care, and now we’re able to care for them in our own city, in our own facilities,” said Dr. Craig Manifold, medical director of San Antonio Emergency Medical Services. “The coordination of care, the multiple hospital systems who are engaged in this, has just made significant improvements in stroke care in our region.”

“San Antonio took on the challenge, which was a very big challenge,” said Carol Winick, vice president of quality for the American Heart Association. “You’ve got huge, very competitive (hospital) systems in San Antonio. A huge EMS system, which is a bear in and of itself.”

That was a boon to James Patterson, 72, a retired lab manager at Southwest Research Institute, whose face and arm suddenly became numb in August. And even though his wife drove him to nearby Northeast Baptist — experts say people with stroke symptoms should call 911 — he was examined quickly and treated with tPA.

“Within a couple hours, feeling started coming back,” Patterson said. “And I stayed in the hospital three days and left with no aftereffects.”

Symptoms

• Sudden numbness or weakness of the face, arm or leg, especially on one side.

• Confusion or trouble speaking.

• Sudden vision changes.

• Dizziness or loss of balance, difficulty walking.

On the Web

Target Stroke Honor Roll hospitals

Baptist Health System