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Neurologist Template

Fampridine follow-up assessment

A professional Neurologist template for healthcare professionals.
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Specialty

Neurologist

Used

0 times

Type

Note

Last edited

06/01/2026

Created by

Javier Vicini

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About this template

This Fampridine Follow-up Assessment template is designed for neurologists to efficiently document patient progress on fampridine. It allows for the tracking of key metrics like 10-meter walk times, 9-Hole Peg Test results, and DSST scores. The template calculates improvement percentages and determines responder status, guiding treatment decisions. It also includes sections for clinical impressions, patient-reported benefits, and adverse events, ensuring a comprehensive record of the patient's response to the medication. This template helps streamline the assessment process, saving time and improving accuracy in neurological practice.

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FAMPRIDINE CLINIC – FOLLOW-UP ASSESSMENT ---------------------------------------- PATIENT DETAILS Full Name: John Smith DOB: 12/03/1960 (Age: 64) NHS Number: 1234567890 Hospital/CH No: CH12345 BASELINE MEASURES (Pre-treatment) 10m Walk: 12.5 sec 9HPT – Dominant: 25 sec 9HPT – Non-Dominant: 28 sec DSST: 45 CURRENT FOLLOW-UP MEASURES 10m Walk: 9.5 sec 9HPT – Dominant: 23 sec 9HPT – Non-Dominant: 26 sec DSST: 50 CALCULATED CHANGE 10m Walk Improvement: 24 % Responder threshold: ≥20% Responder status: Patient is a responder, continue fampridine. 9HPT – Dominant: 25 sec → 23 sec (Δ 8 %) 9HPT – Non-Dominant: 28 sec → 26 sec (Δ 7 %) DSST: 45 → 50 (Δ 11 %) CLINICAL IMPRESSION Mobility improvement noted: Patient reports improved walking speed and ease of movement. Patient-reported benefit: Patient states they feel more stable and confident when walking. Adverse events: No adverse events reported. CLINICIAN NOTES Patient demonstrates significant improvement in 10-meter walk time, indicating a positive response to fampridine. Other measures also show slight improvements. Patient reports subjective benefits. No adverse effects noted. Continue with current dosage and schedule follow-up in 3 months. DECISION Continue fampridine treatment. Schedule follow-up appointment in 3 months to reassess. Clinician: Dr. Emily Carter Date: 1 November 2024 ----------------------------------------

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