By Dr Hadi Manji, Consultant Neurologist at The National Hospital for Neurology and Neurosurgery.
The National Hospital for Neurology and Neurosurgery, also known the world over as ‘Queen Square’, opened its doors in 1860. Originally known as The National Hospital for the Relief and Cure of the Paralysed and Epileptic, the hospital was founded mainly through the charitable work of the Chandler family – sisters Johanna and Louisa and their brother Edward. The National Hospital is now part of University College London Hospitals NHS Foundation Trust and offers over 200 beds for neurology, neurosurgery, surgical and medical ITUs, neuropsychiatry and neurological rehabilitation. Most recently a six bed unit dedicated to patients with neuromuscular disorders (NMCCC) was opened using funds raised by Queen Square Enterprises, the first of its kind in the UK.
A unique feature of the National Hospital is a close link with The Institute of Neurology which is also located in Queen Square. The Institute provides research in both basic and clinical neurosciences as well as promoting postgraduate training for scientists and doctors from all over the world. This has greatly facilitated the “bench to bedside” approach to the neurosciences. It is, therefore, not surprising that Queen Square has not infrequently been heralded as the ‘Mecca of Neurology’.
The National Hospital contains numerous, well-renowned departments for the ancillary specialties which can be accessed by private patients who are referred to Queen Square:
- The Neurophysiology department offers nerve conduction tests and electromyography, electroencephalography (EEG) and evoked responses (EP).
- Uro–Neurology, where patients with neurological diseases such as Multiple Sclerosis and Parkinson’s disease are treated for urological complications.
- Neuro-radiology, offering Magnetic Resonance Imaging (MRI) at the dedicated private Queen Square Imaging Centre, Computed tomography (CT) and interventional radiology. The interventional neuroradiology team is one of the largest in the country, treating cerebral aneurysms, arteriovenous malformations and increasingly acute stroke, all of whom are accessible via the Queen Square Private Consulting Rooms.
- A neuropsychology department provides the facilities for cognitive testing in patients with cognitive issues and the Neuro-psychiatry department provides psychiatry services with a dedicated ward.
- Neuropathology is an often underestimated service which is essential to neurological and neurosurgical diagnosis, in brain tumours, inflammatory disorders of peripheral nerve and muscle and also in the central nervous system.
- Patients with dizziness and unsteadiness have in the past been rather heart sink patients for neurologists and also General Practitioners. However, with the expertise in the Neuro-Otology department, these patients can be treated. For example, conditions such as benign paroxysmal positional vertigo (BPPV) can be treated effectively by performing the Epley maneuver, vestibular migraine with appropriate migraine prophylactic drugs and chronic uncompensated vestibular disorders with a specialist vestibular physiotherapy input.
The Consultant Neurologists of Queen Square possess renowned expertise in all necessary sub–specialties:
- Multiple sclerosis and Inflammatory disorders of the central nervous system such as sarcoidosis;
- For peripheral nerve diseases, the MRC Centre for Neuromuscular Diseases hosts consultants who are experienced in dealing with peripheral neuropathy, muscle conditions such as polymyositis, and muscular dystrophy, motor neurone disease and myasthenia gravis.
- Movement disorders including Parkinson’s disease, dystonia and tremor.
- Cognitive disorders including the various forms of dementia including Alzheimer’s disease, Cortical Lewy body disease and fronto-temporal dementia.
- The epilepsy service is supported by a telemetry ward for inpatient investigation of patients with epilepsy and also sleep disorders. The Chalfont Centre for Epilepsy in Buckinghamshire is affiliated to the National Hospital.
In the past neurologists were labeled as being “elephantine in their diagnostic skills but rather murine in their therapeutic skills”. This has dramatically changed in the last 15 years. Stroke, for example, was managed rather nihilistically and usually by general or Care of the Elderly physicians. Now, with thrombolysis being available, similar to myocardial infarction, patients are fast tracked via the acute stroke pathway. The future, as in cardiology, will be with mechanical stroke removal by interventional neuroradiologists. In other areas, such as in multiple sclerosis, there are now up to ten available disease modifying therapies, both injectable and also oral medications, which is huge leap forward for patients with MS. In Parkinson’s disease, although there have been no dramatic new drug interventions, deep brain stimulation (DBS) performed by the Movement Disorders Functional Neurosurgical team here at Queen Square is highly effective in appropriately selected patients. The same applies to patients with epilepsy, a number of whom who are drug resistant and may now be suitable for surgical intervention. Neurosurgical interventions are also now available for a subset of patients with difficult to treat headache syndrome, where cluster headache and chronic migraine can be managed with occipital nerve stimulators.
With this superb background of clinicians, support services in neurophysiology, neuroradiology, neurophysiotherapy and neurorehabilitation, the National Hospital for Neurology and Neurosurgery are in a unique position for the diagnosis, investigation and treatment of neurological and neurosurgical diseases. Private patients now have more opportunity than ever before to seek specialist opinion in an environment which is at the very forefront of neurological medicine.
Dr Hadi Manji is a Consultant Neurologist at The National Hospital for Neurology and Neurosurgery and holds regular clinics at the Queen Square Private Consulting Rooms for private patients. To arrange an appointment with Dr Manji, please contact his private secretary, Laura Gilbert on 0203 448 8952.