Many centres in the UK care for patients with motor neuron disease (MND) in a multidisciplinary clinic (MDC). It has been demonstrated that such care results in better prognosis for survival 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 a specialist clinic has not been established. Hence, we performed a retrospective review of hospital notes of patients with MND who were diagnosed and followed up in a GNC between 1998 and 2002 and in an MDC between 2006 and 2010. Overall, 162 patients attended a GNC, and 255 attended the MDC. The median survival from diagnosis was 19 months for patients who attended the MDC, compared to 11 months for those attending the GNC (hazard ratio 0.51, 95% CI 0.41-0.64). The Cox hazards model identified attendance at an MDC as an independently positive prognostic factor (HR 1.93, 95% CI 1.37-2.72, p< 0.001). We concluded that care at an MDC improves survival. While this effect is augmented by the increased use of riluzole, NIV and PEG, the data suggest that coordinated care independently improves the prognosis of MND patients.
BackgroundMany 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.ObjectivesTo compare survival of patients followed-up in a GNC with those in a MDC.MethodsA 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.ResultsIn 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.DiscussionAttendance 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.
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