Research interests

Headache

Guy’s & St Thomas’s Hospital Charity has twice funded the Unit for Service Delivery and Evaluation of innovation in Headache Services. First 6 GPs with Special Interest in Headache were trained. Intermediate Care Clinics were set up in Southwark and Lambeth. An evaluation found patients seen by the GP with Special Interest Service were more satisfied than patients who saw hospital-based specialists. Commissioners were charged less for the GPwSI service than for hospital care. The RCP/ABN have used this evidence in a report (2011) to recommend this as a service model in all districts.

Prior work funded by the MRC set the stage for this by examining reasons for referral of patients with headache to specialists. GPs refer only 2% of consulters for primary headache to neurologists. These patients reported the same level of headache severity and disability as patients managed in primary care. But referred patients express more fear and anxiety about their headache symptoms. GPs report patient pressure is important in the referral decision, and their wish for a brain scan. This led on to an NIHR funded pilot trial of usual specialist care versus Specialist care plus CBT for people with migraine.

In 2014 LR was CI in a successful proposal to evaluate the impact of open access to Head MRI for GPs, funded by Guy's & St Thomas Charity with over £2million. This forms part of a programme Transforming Outcome & Health Economics Through Imaging (TOHETI), led by Reza Rezavi. The overall aim was to improve pathways between primary and secondary care. GPs reported that if they are to order and explain MRI results in Headache, they would like more education. Patients reported delays particularly in seeing specialists. They reported delays in getting results pf MRIs, especially from GPs.

Fatigue

A Wellcome Trust grant funded the third complex intervention trial by this unit for patients with chronic fatigue. This three-arm RCT of Graded Exercise, Counselling and Usual Care plus a booklet on CBT was published in 2012. No difference was found in outcomes for the three groups.

Epilepsy

Prior work has included trials of nurse interventions for people with new and chronic epilepsy, with 6 papers cited by NICE. In 2008-12 the NIHR SDO funded the unit for a study titled: Can nurse-led rehabilitation for epilepsy patients prevent non-planned admissions? A comparison of cost and effectiveness of service models at two centres. We found 60% of Emergency Department attenders reattended in the same year, with an average rate of 3 pa. Depression and felt stigma were predictors of ED use, and accounts for 50% of their service costs.

In 2013-16 the NIHR HTA funded a large trial of ‘Self-Management education for adults with poorly controlled epILEpsy’ (SMILE). This trial recruited 404 people with epilepsy from London and SE England, and used mixed methods to describe outcomes, including quality of life. Papers published in 2018, described many participants, despite having epilepsy over 20 years, had their first opportunity to discuss their condition with others, and learn together.

SUDEP ACTION funded a study of risks factors for death in epilepsy, using the General Practice Research Database. They funded a follow-up study in 2018.

In 2019 NIHR funded us to describe patients’ views of their care when an ambulance is called, and what alternatives they would like/not like. This bolts-on to a forced-choice experiment starting in 2020.

In 2019 Epilepsy Action funded a systematic review to describe care-plans for elderly people with epilepsy, with the aim of improving training and guidelines for care provided by Geriatricians.

Teaching activities

Leone Ridsdale was Director of Neurology Undergraduate Clinical Teaching 1999-2015, and Chair of Clinical Teaching in Year 3 for Neurology, Opthalmology & Psychiatry. In the past, medical graduates reported lack of competence and confidence in neurology, amounting to ‘neurophobia’. KCL students did 12 a week rotation in clinical neurology, linked with psychiatry teaching. This was evaluated, and KCL students report as much confidence in their neurology knowledge and skills, as in other Year 3 subjects. Students rated neurology as top, tied with cardiology, for interest and as the subject in which they would like to specialize. This was replicated in a follow-up study in 2019. Interestingly the follow-up study found students were twice as likely to want to specialize in Psychiatry than they had been before.