Motor neurone disease (MND) is a rapidly progressive neurodegenerative condition. It affects people of all ages, but is more common with increasing age (especially over 50 years) and men are affected twice as often as women. The prevalence is relatively low, as individuals usually live for only a few years with MND. There are around 1,200 new diagnoses a year, and 4,000 people affected at any one time in the UK. It will probably become more frequent with an ageing population, and the prevention of death from vascular and other causes. The Motor Neurone Disease Association has a network of regional care advisers, and visitors, and can provide support and information for the GP. MND is a devastating physical condition, and can have equally devastating effects on emotions, also affecting family, friends, and members of the multidisciplinary team. Some patients experience difficulties accessing resources, which the GP may help in mobilising. There may also be problems in understanding and communication, where the GP may play a key role.

Many patients experiencing a first seizure will present to their GP. A seizure is defined as the clinical manifestation resulting from an excessive and abnormal discharge of a population of neurones. The individual lifetime risk of developing a non-febrile seizure is around 5% and approximately a third of patients will go on to experience further seizures and hence be diagnosed as having epilepsy. When evaluating a patient with a first seizure an accurate history is key and other potentially life-threatening diagnoses, especially cardiac disease, must be ruled out. Patients who have fully recovered should be directly referred to a first seizure clinic, where further tests and AEDs may be considered. Doctors should provide support and advice to the first seizure patient and be aware of the medical and social consequences of a diagnosis of seizures or epilepsy. Patients who have not recovered from their seizure, have an abnormal examination, or about whom there is diagnostic doubt, should be referred to the emergency department or specialist services for further investigations including brain imaging and lumbar puncture.

MG has a prevalence of around 20 per 100,000, so an average UK practice may expect to have only one patient. The condition is treatable. The incidence is bimodal with a 2:1 female to male ratio in the younger population and a reversed sex ratio over the age of 60. The reported incidence has been increasing since the mid-1980s, mainly because of increased recognition of late-onset disease. However, the condition is probably still underrecognised in the very elderly and may be mistaken for other disorders such as stroke, motor neurone disease or Parkinson's disease.

Vertigo is a common but complex challenge. In one postal survey of  patients from general practice, 7% reported at least one episode of vertigo in the past year.¹ A full-time GP may expect to encounter 10-20 cases of vertigo each year² and it is often seen as a potentially difficult symptom to diagnose and manage. The first problem is that the terms vertigo, dizziness, giddiness and imbalance are used in different ways by different clinicians. Dizziness and vertigo are often used interchangeably by both patients and clinicians (including the authors). The second problem is that the control of balance is complicated and diagnosing the cause of a balance disorder can take time which is usually at a premium in most clinics. Third, vertigo can be caused by many different pathologies, some of which are potentially life threatening, and it is managed by several specialties. However, much of this can be overcome by using a logical, systematic approach to the diagnosis and subsequent referral or management of the patient.

Restless legs syndrome has an estimated prevalence of 10-15% in the general population;² this equates to around nine million affected adults in the UK. It is equally common in men and women,³ although it is associated with pregnancy, which increases lifetime prevalence in women. There is an age-related increase in prevalence, so it is more often seen in middle-aged and elderly patients.1 It may affect children and adolescents,⁴ although formal recognition may take years as in many patients the symptoms are mild and vague. Patients with early-onset restless legs syndrome often have a family history of the condition.⁵ There is no known anatomical pathology associated with restless legs syndrome.

Migraine is a common, disabling primary headache disorder. it affects 15% of the UK population (7.6% of men and 19.1% of women) and is especially prevalent in patients <50 years. It contributes to 25 million lost work or schooldays every year.¹ Migraine is a chronic disease with episodic manifestations. The natural history tends to follow a waxing and waning course, with patients experiencing phases of infrequent attacks and/or chronic headaches interspersed with attack-free remissions.² Migraine can be classified into two major subtypes, with and without aura, occurring in 20-30% and 70-80% of cases, respectively.Other clinically important variants include chronic migraine, basilar and hemiplegic migraine, migraine in pregnancy and menstrual migraine.