This is a really interesting shift in thinking; forgive me for it not being my thoughts or findings. It’s a copy of an article in Health Day News, entitled: 

Five tests, procedures and treatments that neurologists and their patients should question are outlined in a list released by the American Academy of Neurology (AAN) as part of the Choosing Wisely campaign.

“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,” AAN president Dr. Bruce Sigsbee said in an academy news release.

The American Board of Internal Medicine Foundation-led Choosing Wisely campaign involves about 35 medical specialty groups and is intended to encourage patients and doctors to discuss appropriate care while avoiding unnecessary tests and treatments. The AAN is one of 17 medical societies that recently released advice lists.

Here are the A.A.N five neurology-related recommendations:

  1. Do not perform electroencephalography (EEG) for headaches. Recurrent headache, which is the most common pain problem, affects up to 20 percent of people. EEG increases costs but has no advantage over clinical evaluation in diagnosing headache and it does not improve outcomes.
  2. Do not perform imaging of the carotid arteries in the neck for simple fainting in the absence of other neurological symptoms. Fainting affects up to 40 percent of people during their lifetime. Carotid artery disease does not cause fainting; rather, it causes focused neurological problems such as weakness on one side of the body. Therefore, carotid imaging will not identify the cause of the fainting, but it does increase costs.
  3. When treating migraine, Opioid or butalbital drugs should only be used as a last resort. More effective, migraine-specific treatments are available, and frequent use of these drugs can worsen headaches. Opioid (narcotic) use should be reserved for patients with medical conditions that prevent the use of migraine-specific treatments or for patients for whom these treatments don’t work.
  4. Do not prescribe interferon-beta or glatiramer acetate to patients with disability from progressive, non-relapsing forms of multiple sclerosis. These medications, often prescribed for MS, do not prevent the development of permanent disability in progressive forms of the disease. However, they do have frequent side effects that may negatively affect quality of life, and increase costs as well.
  5. Do not recommend carotid endarterectomy for people who have narrowing of the carotid arteries in the neck but have no symptoms, unless the patient’s risk of complication is less than 3 percent. Carotid endarterectomy is a type of surgery meant to reduce the risk of stroke.”

The recommendations were published online recently in the journal Neurology.

I would be interested to hear your thoughts.

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