OBJECTIVE: To discuss the American Academy of Neurology (AAN)’s Top Five Recommendations in the Choosing Wisely campaign promoting high-value neurologic medicine and physician-patient communication. The AAN published its Top Five Recommendations in February 2013 in collaboration with the American Board of Internal Medicine Foundation and Consumer Reports.
METHODS: A Choosing Wisely Working Group of 10 AAN members was formed to oversee the process and craft the evidence-based recommendations. AAN members were solicited for recommendations, the recommendations were sent out for external review, and the Working Group members (article authors) used a modified Delphi process to select their Top Five Recommendations.
RESULTS AND RECOMMENDATIONS: The Working Group submitted 5 neurologic recommendations to the AAN Practice Committee and Board of Directors; all 5 were approved by both entities in September 2012.
- Don’t perform EEGs for headaches.
- Don’t perform imaging of the carotid arteries for simple syncope without other neurologic symptoms.
- Don’t use opioids or butalbital for treatment of migraine, except as a last resort.
- Don’t prescribe interferon-β or glatiramer acetate to patients with disability from progressive, non-relapsing forms of multiple sclerosis.
- Don’t recommend carotid endarterectomy for asymptomatic carotid stenosis unless the complication rate is low (<3%)
The AAN meeting will soon be upon us, will Prof G be going Statewise? I expect so and will be your roving reporter.
P.S. Hope they can make recommendations a bit quicker in future as the biology has told us for some time about immunosuppressives and progression.