The list is published in the February 21, 2013, online issue of Neurology, the medical journal of the American Academy of Neurology. Sixteen other medical societies are also releasing their lists.
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. “With one in six people affected by a brain disease, such as headache, multiple sclerosis, and stroke, our goal is to have patients discuss our Choosing Wisely recommendations regarding medical procedures, therapies, and tests with their neurologists,” said Bruce Sigsbee, MD, FAAN, President of the American Academy of Neurology, the world’s largest association of neurologists with more than 25,000 members.
“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, PhD, with Southern California Kaiser Permanente Medical Group and a member of the American Academy of Neurology.
The five recommendations are: Don’t perform electroencephalography (EEG) for headaches. Recurrent headache is the most common pain problem, affecting up to 20 percent 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 percent of people during their lifetime. Carotid artery disease does not cause fainting but instead causes focused neurologic problems such as weakness on one 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, medications often prescribed for MS, 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 less than three percent. Several specialty societies have recommended that surgery for patients without symptoms should be reserved for those with a perioperative (from time of hospitalization for surgery to time of discharge) complication risk of less than 3 percent and a life expectancy of greater than three to five years. American Heart Association guidelines state that it is “reasonable” to perform CEA for asymptomatic patients with greater than 70 percent 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.
Find out more about Choosing Wisely and view the Academy’s full recommendations at http://www.abimfoundation.org/Initiatives/Choosing-Wisely.aspx.
The American Academy of Neurology, an association of more than 25,000 neurologists and neuroscience professionals, is dedicated to promoting the highest quality patient-centered neurologic care. A neurologist is a doctor with specialized training in diagnosing, treating and managing disorders of the brain and nervous system such as Alzheimer’s disease, stroke, migraine, multiple sclerosis, brain injury, Parkinson’s disease and epilepsy. For more information about the American Academy of Neurology, visit http://www.aan.com or find us on Facebook, Twitter, Google+ and YouTube. The mission of the ABIM Foundation is to advance medical professionalism to improve the healthcare system. We achieve this by collaborating with physicians and physician leaders, medical trainees, health care delivery systems, payers, policymakers, consumer organizations and patients to foster a shared understanding of professionalism and how they can adopt the tenets of professionalism in practice. To learn more about the ABIM Foundation, visit www.abimfoundation.org.