I think there could be other letters but not necessarily from anyone in neurology, though, we know that the consultant has seen Tim at his clinic, in Liverpool, and you are correct, he saw Tim in the Welsh clinic 2019 (Bangor?) there is nothing in the consultants letters suggesting that he has been seen more frequently by this consultant or a colleague in either neurology clinic. 2015 we all agree is the first letter, the first time Tim has been referred, first consultation, previously Tim has been seen in the pain clinic.
At the end of the 2015 letter the consultant concludes, "It is clear that the physiotherapy arranged through doctor blank, colleagues at the blank, has been the most helpful intervention to date, and I'm sure this should continue. I confirm that I have absolutely no objection to his continuing with the planned undertake academic studies in horticulture (to complement his practical experience in the field) I will write when I have the scan results (there would have been a letter, maybe sent to Tim's GP, and GP informed Tim?) I enclose information about the PSP association with a copy of this letter that goes to Mr Walker."
There is no mention of follow up visits to the consultants clinic, just a continuation of the care Tim is receiving already. At the start of the 2019 letter, "I saw Mr Walker today with his wife, as you know he has been under review for some years" he is stating that Tim has been under review. But again he is not saying that he has been reviewing him, or another colleague in his unit. Reviews are also undertaken by the GP for people with chronic conditions, so likely reviewed at GP/PC.
The 2019 consultation seems to have been arranged as Tim is complaining of, "The main symptom that Mr Walker described today was that of pressure like headache with throbbing and transitory imbalance, which is present every day there is no doubt that this must be a migraine type phenomenon." he goes on to mention "we also discussed symptoms of parasthesia in his feet and pains up and down his legs, perhaps in an L5 or S1 distribution. He also has a rather atypical disturbance of the anal sphincter function. In short although I think the yield is fairly low, I am undertaking a lumbar spine MRI to exclude a structural lesion."
So the consultant has seen Tim, but doesn't think his new symptoms are connected to CBDS, he is going to do some tests, the second page of the 2019, letter is missing, so we don't know what follow up arrangements were made, I suspect, as nothing serious was found, Tim continued to be monitored by his GP/PC. We don't have any more information. But there are no other letters, to prove that the way Tim's illness was progressing, required him to be regularly seen by a consultant neurologist, or anyone in either neurology clinics.
The 2025, letter interests me, it looks like the consultation has been made primarily because of the new cardiac diagnosis (there could be letters relating to this) Tim wants to know if this is a symptom of CBS, "He asked about cardiac and circulatory problems that may be associated with CBS. Cerebral neurodegenerative conditions of course may be associated with autonomic disturbance to affect circulation but this is very unlikely with CBS" so again a consultation for something raised by Tim, a reason for a consultation, but not found to be connected.
The consultant says "Admittedly the clinical course in this case has been so atypical that we shouldn't discount any possibility. In any event holistic management and maintenance of activity as far as possible is definitely the best option." So again, a consultation request because of a new symptom, again not found to be connected.
Then the consultant says "I was keen to acknowledge in our discussion that his clinical story has been unique and I know he and his wife have been engaged in highly commendable exercise of improving awareness of CBD and CBS. I was very pleased to hear from them that whenever they discuss with others or in public they emphasis benefit of activities, without indicating that the clinical outcome will be as favourable as has been the case for Mr Walker himself."
His last paragraph is interesting, "You may be aware that a cinema release is shortly due which is a retelling of parts of Mr walker's story." He finishes with "As well as arranging an annual follow-up, I have emphasized that I am happy to discuss with him if they have any queries raised by that process. " What is he saying here, has Tim previously asked to have his annual review with the consultant rather than at the GP/PC, who is he indicating by "they ".
You say there will have been other letters, I agree there would have been letters sent about the test results, other letters perhaps, about GP/PC appointments possibly. Salray hasn't shown any, I would imagine that is because they don't confirm serious illness. We can't say for certain from the 2025 letter that the consultant hasn't seen Tim between 2019-2025, it doesn't seem so, but without the second page of the 2019 letter, stating what the follow up would be we can't be certain.
Tim doesn't seem to have been unwell enough to require seeing a neurologist frequently. I think any other letters Salray has would also show that, just my personal feeling. It would be interesting to know what the second page of the 2019 letter contained.