ANN Meeting Top Five Recommendations


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. 


  1. Don’t perform EEGs for headaches. 
  2. Don’t perform imaging of the carotid arteries for simple syncope without other neurologic symptoms. 
  3. Don’t use opioids or butalbital for treatment of migraine, except as a last resort. 
  4. Don’t prescribe interferon-β or glatiramer acetate to patients with disability from progressive, non-relapsing forms of multiple sclerosis. 
  5. 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.

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1 comment

  • Anyone else bothered by the fact that the top 5 recommendations from the AAN begin with "Don't?"

    How about telling us what we can do.

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