What's New: Neurology

A new  provides  practical advice for patients with epilepsy and seizures. 

The revised topic includes key history-taking prompts to aid in the  assessment and diagnosis of new-onset headache. Two quick reference tables help clinicians differentiate between types of  primary  and  secondary  headaches. 

Calcitonin gene-related peptide (CGRP)–targeted therapies are approved for treatment of migraine prophylaxis in adults. New guidance covers:

Additional options are provided for  menstrual migraine, including short-term prophylaxis and the use of contraception or menopausal hormone therapy as treatment. 

The intranasal formulation of sumatriptan has been discontinued in Australia; alternative treatment recommendations are included for migraine in children and cluster headache .

A new algorithm supports the time-critical management of patients with suspected stroke or transient ischaemic attack at the point of care.

A new figure summarises time frames for reperfusion therapy in the treatment of acute ischaemic stroke helps clinicians assess thrombolysis and endovascular thrombectomy eligibility beyond 4.5 hours and 6 hours respectively post stroke onset.

Restless legs syndrome can severely affect quality of sleep and daily function for some patients. If drug management is indicated, levodopa is now preferred for mild symptoms, while gabapentinoids are recommended for more severe symptoms. Dopamine agonists are no longer first-line because of the higher likelihood of augmentation, where symptoms worsen during or after treatment. Strategies a specialist may use to manage augmentation have been outlined in the guidelines.

A new printable handout provides practical advice to share with patients experiencing restless legs syndrome or periodic limb movement disorder.

Drug information for disease-modifying therapies for multiple sclerosis has been updated with a primary-care focus in mind; the table describes efficacy profile, safety considerations and monitoring requirements of disease-modifying therapies for multiple sclerosis.

A change in treatment may sometimes be needed for patients with multiple sclerosis, whether due to suboptimal response, side effects or changes in disease activity. General considerations for switching disease-modifying therapies in multiple sclerosis are included as a point of reference for all members of the healthcare team to help support patients manage medication changes.

Peripheral neuropathy can be challenging to assess in general practice, especially when symptoms are subtle or overlap with other conditions. The update includes a step-by-step flowchart to aid in the initial work up, diagnosis and management, including when referral to a neurologist is required.

The revised topic on facial nerve palsy clarifies the role of corticosteroids and antivirals for treatment of Bell palsy and Ramsay Hunt syndrome.

Hereditary transthyretin amyloidosis and spinal muscular atrophy are inherited neuropathies with disease-modifying therapies ; new content has been added about available drug treatment.

A new topic has been developed to support clinicians in recognising and managing functional neurological disorders .                    

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