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MINNEAPOLIS -- February 27, 2013 -- The American Academy of Neurology (AAN) has released a list of 5 tests, procedures, and treatments that doctors and their patients should question as part of the Choosing Wisely campaign by the American Board of Internal Medicine (ABIM) Foundation.
The list is published in the online edition of the journal Neurology.
Choosing Wisely is an initiative endorsed by the AAN and 33 other medical specialty societies intended to spark conversations between physicians and patients about what care is appropriate for their condition, avoiding unnecessary tests and procedures.
“A broad range of neurologists reviewed the evidence that contributed to these recommendations, aimed at helping other neurologists and their patients make informed decisions based on a patient’s individual situation,” said lead author Annette Langer-Gould, MD, Southern California Kaiser Permanente Medical Group, Los Angeles, California.
The 5 recommendations are:
· Don’t perform electroencephalography (EEG) for headaches. Recurrent headache is the most common pain problem, affecting up to 20% of people. The recommendation states that EEG has no advantage over clinical evaluation in diagnosing headache, does not improve outcomes, and increases costs.
· Don’t perform imaging of the carotid arteries in the neck for simple fainting without other neurologic symptoms. Fainting is a frequent complaint, affecting up to 40% of people during their lifetime. Carotid artery disease does not cause fainting but instead causes focused neurologic problems such as weakness on 1 side of the body. Due to this, carotid imaging will not identify the cause of the fainting and increases cost.
· Don’t use opioid or butalbital treatment for migraine except as a last resort. Opioid and butalbital treatment for migraine should be avoided because more effective, migraine-specific treatments are available. Frequent use of opioid and butalbital treatment can worsen headaches. Opioids should be used only for those with medical conditions preventing the use of migraine-specific treatments or for those who fail these treatments.
· Don’t prescribe interferon-beta or glatiramer acetate to patients with disability from progressive, non-relapsing forms of multiple sclerosis (MS). Interferon-beta and glatiramer acetate do not prevent the development of permanent disability in progressive forms of multiple sclerosis. These medications increase costs and have frequent side effects that may negatively affect quality of life.
· Don’t recommend CEA for asymptomatic carotid stenosis unless the complication rate is low, or <3%. Several specialty societies have recommended that surgery for patients without symptoms should be reserved for those with a perioperative complication risk of <3% and a life expectancy of greater than 3 to 5 years. American Heart Association guidelines state that it is “reasonable” to perform CEA for asymptomatic patients with greater than 70% stenosis if the surgical complication rate is “low.” Reported complication rates vary widely by location, and are dependent on how complications are tracked. Despite calls 15 years ago for rigorous monitoring, most patients will likely need to rely on the surgeon’s self-reported rates.
SOURCE: American Academy of Neurology
The list is published in the online edition of the journal Neurology.
Choosing Wisely is an initiative endorsed by the AAN and 33 other medical specialty societies intended to spark conversations between physicians and patients about what care is appropriate for their condition, avoiding unnecessary tests and procedures.
“A broad range of neurologists reviewed the evidence that contributed to these recommendations, aimed at helping other neurologists and their patients make informed decisions based on a patient’s individual situation,” said lead author Annette Langer-Gould, MD, Southern California Kaiser Permanente Medical Group, Los Angeles, California.
The 5 recommendations are:
· Don’t perform electroencephalography (EEG) for headaches. Recurrent headache is the most common pain problem, affecting up to 20% of people. The recommendation states that EEG has no advantage over clinical evaluation in diagnosing headache, does not improve outcomes, and increases costs.
· Don’t perform imaging of the carotid arteries in the neck for simple fainting without other neurologic symptoms. Fainting is a frequent complaint, affecting up to 40% of people during their lifetime. Carotid artery disease does not cause fainting but instead causes focused neurologic problems such as weakness on 1 side of the body. Due to this, carotid imaging will not identify the cause of the fainting and increases cost.
· Don’t use opioid or butalbital treatment for migraine except as a last resort. Opioid and butalbital treatment for migraine should be avoided because more effective, migraine-specific treatments are available. Frequent use of opioid and butalbital treatment can worsen headaches. Opioids should be used only for those with medical conditions preventing the use of migraine-specific treatments or for those who fail these treatments.
· Don’t prescribe interferon-beta or glatiramer acetate to patients with disability from progressive, non-relapsing forms of multiple sclerosis (MS). Interferon-beta and glatiramer acetate do not prevent the development of permanent disability in progressive forms of multiple sclerosis. These medications increase costs and have frequent side effects that may negatively affect quality of life.
· Don’t recommend CEA for asymptomatic carotid stenosis unless the complication rate is low, or <3%. Several specialty societies have recommended that surgery for patients without symptoms should be reserved for those with a perioperative complication risk of <3% and a life expectancy of greater than 3 to 5 years. American Heart Association guidelines state that it is “reasonable” to perform CEA for asymptomatic patients with greater than 70% stenosis if the surgical complication rate is “low.” Reported complication rates vary widely by location, and are dependent on how complications are tracked. Despite calls 15 years ago for rigorous monitoring, most patients will likely need to rely on the surgeon’s self-reported rates.
SOURCE: American Academy of Neurology
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