Nerve and Muscle Services: Joint working to improve care

Dr Rob Hadden, Chair of the King’s Health Partners Nerve and Muscle Group, explains how experts are coming together to solve some of the hardest challenges in neuromuscular conditions.

Nerve and muscle disorders affect people of all ages, and may cause weakness, walking problems, clumsiness, pain and numbness. These include disorders of the peripheral nerves which send signals from the brain to move the muscles, and sensory nerves sending signals (including pain) from around the body back to the brain. These are closely related parts of the nervous system, and when they go wrong it is often disabling.

In this interview, Dr Rob Hadden [pictured right] explores how the King’s Health Partners Nerve and Muscle Group brings together clinicians and scientists to accelerate research and improve patient care.

What is your role within King’s Health Partners Neurosciences? 

I am chair of the Nerve and Muscle Group at Kings Health Partners. In this role, I bring together individual academic or clinical experts, and encourage communication and collaboration to benefit research and clinical services.

I am also a consultant neurologist and clinical lead for the regional peripheral nerve service. We treat patients affected by neuropathies of various causes including inflammation, diabetes, compression and genetic disorders. I am President of the British Peripheral Nerve Society, the UK national professional association for clinicians working in peripheral nerve disease. I also have an educational role organising the annual King’s College Hospital Neuromuscular Disease Symposium.

Please tell us about the Nerve and Muscle Academic-Clinical Group  

 I’m proud to be to be the chair of this group of fantastic people. There are many individual experts within our field, but we haven’t always been well connected. By setting up the Nerve and Muscle group across Kings Health Partners we have been able to bring them together to work towards a common goal.

Our group has approximately 50 members. Some are clinical consultants that work across our NHS services in nerve diseases, muscle diseases, motor neuron diseases, myasthenia, and related diseases, including diagnostic clinicians such as neurophysiologists and neuropathologists. Other members are fundamental research scientists including principal investigators. Bringing this expertise together in one forum allows us to bridge the gaps between diagnosis, treatment, and the scientific understanding of these conditions.

Both nerve disease and muscle disease are very broad medical fields.  Some are very common, such as diabetic neuropathy and age-related muscle decline, but there are hundreds of rare conditions. At King’s Health Partners we have many super-specialists with expertise in specific areas of either nerve or muscle disease, who can advise less specialist doctors elsewhere. Scientists are constantly trying to expand our knowledge to fill the gaps and give a more complete understanding of these diseases so we can treat patients in the best possible way.

How is the group seeking to improve outcomes for patients with nerve or muscle diseases? 

There is a great amount of impactful work taking place across the group. As one example, my own team - the regional peripheral nerve service – runs a nationally-leading centre for diagnosis of small fibre neuropathy, a group of diseases typically causing severe pain and burning feelings in the legs. We offer highly specialist diagnostic tests including skin biopsy (to directly view the pain-sensing nerves in the skin) and microneurography, which means measurement of the electrical overactivity in these nerves. These tests have shown that small fibre neuropathy may sometimes also cause other common but poorly understood conditions such as fibromyalgia and Postural Orthostatic Tachycardia Syndrome (POTS), which can cause dizziness, fatigue and cognitive dysfunction. We collaborate with the pain department who have offered some new treatments for nerve pain, to treat these patients more effectively.

Our group is also planning a new Biobank so that biopsies of human muscle, nerve and skin taken for clinical purposes can also be used for research, to better understand these diseases and improve future outcomes. We currently have the largest centre in the UK for skin biopsies to assess pain-sensing nerves.

What do you think has had the most positive impact on patients this past year? 

Chronic pain is a very common and disabling condition. Research by Prof Peter McNaughton, one of our fundamental scientists at the Wolfson Centre for Age-Related Diseases, has discovered a new fundamental biological mechanism underlying neuropathic pain. His team has developed new drug treatments for this pain and is working with a pharmaceutical company to further develop the drug and make it widely accessible. This is a major step towards improving outcomes for our patients.

Real progress has been made in some genetic peripheral nerve diseases. We now have revolutionary gene silencing treatments for two disabling previously incurable rare diseases: spinal muscular atrophy, which causes permanent paralysis in children, and transthyretin amyloidosis, which causes neuropathy, pain and heart failure in middle aged people. These treatments stop the disease getting worse when diagnosed early. These are examples of how high quality scientific research can improve care.

 What will your team be focusing on in the coming years? 

We will continue our annual group meeting, open to all King’s Health Partners staff, to publicise the work of our members. Attendance has increased over the past three years, so we hope to continue building interest and facilitating collaboration across different disciplines.

What does your team value most about being part of King’s Health Partners? 

It is exciting to bring expertise together across many dimensions, to create opportunities to improve patient care. King’s Health Partners can help us build on this breadth of specialist knowledge so we can promote ourselves as a leading international clinical science centre in nerve and muscle disease.

At King’s Health Partners Neurosciences we are using our collective expertise to become a global top ten Neurosciences Institute, demonstrated through excellence in research, education and clinical practice.

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