Multiple Sclerosis Clinical Services at the UCLH National Hospital
for Neurology and Neurosurgery, Queen Square.
Disease-Modifying Drugs (DMDs) Assessment Clinic
The DMD assessment Clinic was established at the end of 1996 to ensure that people
with multiple sclerosis (MS) were offered an opportunity to explore their suitability
for treatment.
The MS team involved in the DMD Clinics have worked within a philosophy of shared
decision making. The main goal is to ensure that the research evidence regarding this
treatment is presented to patients in a clear and accurate way. This ensures that
patients are prepared for Clinic visits and feel confident in decision making.
The team members recognise that attendance at Clinic for assessment of eligibility
for DMDs is an anxious time for patients and their families. To alleviate these
concerns, oral information and support is provided in one-to-one Clinic
appointments and telephone support lines.
At the National Hospital for Neurology and Neurosurgery a DMD Clinic is held each
week and led by one of four consultant neurologists. Patients suitable for treatment
receive explanations on the efficacy of the drug, evidence from the trials, side effects
profile, the rationale behind blood screening, use of anti-pyretic drugs for
management of side effects, treatment of relapses during therapy and any
contraindications. The stopping criteria and the role of neutralising antibodies that
have been associated with decreased drug efficacy are also explained.
The Clinic is structured to allow 45 minutes for each patient to ensure there is
enough time to discuss issues in detail. In cases where the use of DMDs is considered
unsuitable, patients are given a full explanation and offered counselling and support.
These patients often require further symptom management and referral to other
members of the multidisciplinary team. If the patient is unhappy with the outcome of
the assessment clinic, he or she is offered a second opinion with one of the other
prescribing consultant neurologists.