Motor neurone disease (MND): a personal perspective.

University of New South Wales), on the telephone. He had just received the letter I sent to all my close friends and colleagues when the diagnosis was confirmed. Jim had always emphasised the importance of leaving no stone unturned before accepting a diagnosis of incurable disease, both in his book on headache — which inspired me to do neurology — and during my subsequent clinical training. However, I had to tell him there was no doubt. Four months previously, I had experienced the sudden dramatic onset of widespread muscle fasciculation, without definite weakness, and, after four weeks of rising anxiety, I took my concerns to a colleague. Although at that stage he reassured me that he had found no definite abnormality, I was concerned that during the examination I had not been able to support my weight on my left leg. I then entered a period of uncertainty, during which I could not discuss my fears with family or friends. Three weeks later my colleague found measurable muscle atrophy and hyperreflexia, and electromyography documented fas-ciculation and early muscle denervation. Magnetic resonance imaging and a second opinion finally confirmed the diagnosis of MND. to tell him my news, he tried to focus his mind on practicalities. As a young registrar he had supervised my research for an MD thesis and now, as my Chief of Neurology, he would have to arrange my replacement as Visiting Medical Officer and Director of the Comprehensive Epilepsy Service at Prince of Wales Hospital. However, for some moments all he could say was, " Rod, we go back a long way... ". It is now 16 months since the onset and there has been significant progression of weakness and spasticity. I can look back on my experience of MND thus far and make some observations. Diagnosis The final confirmation of the diagnosis came almost as a relief after the period of uncertainty and false hopes — certainly the worst four months of my life. Once the diagnosis was confirmed, it was as if a great weight had been lifted from my shoulders and I was able to face the challenges ahead. The hardest task was breaking the news to my wife and each of my four children, but then they were able to provide much-needed emotional support. I was also able to begin the complicated process of selling my practice and disengaging myself from all my …