american academy of neurology
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2022 ◽  
Vol 66 (9-10) ◽  
pp. 57-63
Author(s):  
B. S. Belov ◽  
L. P. Ananyeva

Lyme disease (LD) or tick-borne borreliosis affects thousands of people every year in different regions of the world, primarily in the United States and Europe. Given the great social and medical importance of this problem, an updated version of the clinical guidelines for the prevention, diagnosis and treatment of PD was published in November 2020 by a committee of experts of the Infectious Diseases Society of America (IDSA), the American Academy of Neurology (AAN) and the American College of Rheumatology (ACR). This article discusses the main issues of the use of antibacterial drugs in LD. The most commonly used medications are doxycycline, amoxicillin, cefuroxime axetil, and ceftriaxone. Patients with erythema migrans receive appropriate antibiotics for 7–14 days, depending on the medication used. In case of other clinical manifestations of LD, the duration of treatment is extended to 14–28 days. Antibiotic prophylaxis is carried out using a single oral dose of 200 mg doxycycline for adults and 4.4 mg/kg (with a maximum of 200 mg) for children. This treatment scheme is highly efficient, easy to administer, and has a relatively low risk of adverse events.


Neurology ◽  
2021 ◽  
pp. 10.1212/WNL.0000000000013222
Author(s):  
Raghav Govindarajan ◽  
Anh-Thu N Vu ◽  
Rachel Marie E. Salas ◽  
Alexandra Michelle Miller ◽  
David J Sandness ◽  
...  

The standard neurology clinical experience in medical school focuses primarily on bedside patient encounters; however, the limitations of the clinical environment due to the current COVID-19 pandemic have accelerated the need for virtual curriculum development. To provide guidance to Neurology clerkship directors during this unprecedented time, the American Academy of Neurology (AAN) Undergraduate Education Subcommittee (UES) formed a workgroup to develop an outline for a ‘virtual curriculum’, provide recommendations, and describe models of integrating virtual curricula into the neurology clerkship.In this overview, we discuss different methods of virtual instruction, hybrid models of clerkship training and the challenges to its implementation, professionalism issues, and modification of feedback and assessment techniques specific to the virtual learning environment. We also offer suggestions for implementation of a hybrid virtual curriculum into the neurology clerkship.The virtual curriculum is intended to supplement the core neurology in-person clinical experience and should not be used for shortening or replacing the required neurology clinical clerkship.


Neurology ◽  
2021 ◽  
Vol 97 (23) ◽  
pp. 1072-1081
Author(s):  
David Gloss ◽  
Kimberly Pargeon ◽  
Alison Pack ◽  
Jay Varma ◽  
Jacqueline A. French ◽  
...  

ObjectiveTo update a 1996 American Academy of Neurology practice parameter.MethodsThe authors systematically reviewed literature published from January 1991 to March 2020.ResultsThe long-term (24–60 months) risk of seizure recurrence is possibly higher among adults who have been seizure-free for 2 years and taper antiseizure medications (ASMs) vs those who do not taper ASMs (15% vs 7% per the 1 Class I article addressing this issue). In pediatric patients, there is probably no significant difference in seizure recurrence between those who begin tapering ASMs after 2 years vs 4 years of seizure freedom, and there is insufficient evidence of significant difference in risk of seizure recurrence between those who taper ASMs after 18 months of seizure freedom and those tapering after 24 months. There is insufficient evidence that the rate of seizure recurrence with ASM withdrawal following epilepsy surgery after 1 year of seizure freedom vs after 4 years is not significantly different than maintaining patients on ASMs. An epileptiform EEG in pediatric patients increases the risk of seizure recurrence. ASM withdrawal possibly does not increase the risk of status epilepticus in adults. In seizure-free adults, ASM weaning possibly does not change quality of life. Withdrawal of ASMs at 25% every 10 days to 2 weeks is probably not significantly different from withdrawal at 25% every 2 months in children who are seizure-free in more than 4 years of follow-up.RecommendationsFourteen recommendations were developed.


Author(s):  
Jeffrey Kaplan ◽  
Tamara Miller ◽  
Matthew Baker ◽  
Bryan Due ◽  
Enxu Zhao

Aim: To determine whether clinicians evaluate American Academy of Neurology (AAN) quality metrics for patients with multiple sclerosis (MS) relapse and whether repository corticotropin injection (RCI) improves clinical and patient-reported outcomes associated with these metrics at 2 and 6 months after treatment. Methods: A multicenter, prospective, observational registry evaluating patients receiving RCI for MS relapse (N = 125) categorized data according to AAN quality metrics involving diagnosis, disability, fatigue, cognitive impairment, depression, and quality of life. Results: Clinicians assessed all 11 AAN quality metrics in patients with MS relapse. Disability, fatigue, cognitive impairment, depression, and quality of life outcomes improved with RCI therapy. Conclusion: RCI was associated with improved quality metrics, and AAN guidelines were followed during routine RCI treatment for MS relapse.


Neurology ◽  
2021 ◽  
pp. 10.1212/WNL.0000000000013079
Author(s):  
Mary A O'Neal ◽  
Nassim Zecavati ◽  
Melissa Yu ◽  
Rebecca Spain ◽  
Scott M Friedenberg ◽  
...  

Goals:To define fragmentation in neurological care delivery; explain the positive and negative drivers in neurologic practice that contribute to fragmentation; illustrate situations that increase fragmentation risk; emphasize the costs and impact on both patients and providers; propose solutions that allow for more cohesive care.Work group:The Transforming Leaders Program (TLP) class of 2020 was tasked by American Academy of Neurology (AAN) leadership to identify the leading trends in inpatient and outpatient neurology and to predict their effects on future neurologic practice.Methods:Research material included AAN data bases, PubMed searches, discussion with topic experts and AAN leadership.Results:Trends in care delivery are driven by changes in the work force, shifts in health care delivery, care costs, changes in evidence-based care and patient factors. These trends can contribute to care fragmentation. Potential solutions to these problems are proposed based on care models developed in oncology and medicine.Limitations:This paper shares our opinions as there is a lack of evidence-based guidelines as to optimal neurological care delivery.


2021 ◽  
Vol 5 (3) ◽  
pp. 69-80
Author(s):  
Juan Mena ◽  
Soraya Peña ◽  
Saul Polanco ◽  
Jorge Rosario ◽  
Sebastián Ureña ◽  
...  

Introducción: la enfermedad coronavirus 2019 (COVID-19), causada por el virus llamado SARS-Cov-2, fue declarada pandemia por la Organización Mundial de la Salud (OMS). Afecta principalmente a los sistemas respiratorio y cardíaco, influyendo en otros como el sistema nervioso. En este sentido, la pregunta de investigación que orienta este estudio es: ¿cuáles serían las manifestaciones neurológicas en adultos diagnosticados con COVID-19? Metodología: se realizó una revisión sistemática a través de los metabuscadores: PubMed, American Academy of Neurology (AAN), SciELO, ELSEVIER, y, finalmente, MedScape. Los criterios de inclusión fueron: investigaciones científicas sobre COVID-19 publicadas durante el periodo 2019, investigaciones en español y/o inglés, e investigaciones con enfoque en manifestaciones neurológicas; para el manejo del sesgo se utilizó la herramienta del ROBVIS y la revisión se realizó bajo la guía PRISMA. Resultados: se seleccionaron un total de 32 artículos, 14 revisiones sistemáticas y 18 estudios observacionales (series de casos y reportes de caso). Las manifestaciones neurológicas en pacientes diagnosticados con COVID-19, obtenidas de 30 artículos, fueron: cefaleas, mialgias, anosmia, ageusia. El grupo etario entre 50 y 70 años fue el más predominante al presentar manifestaciones neurológicas por COVID-19, disponiendo de un total de 14 artículos. Las condiciones neurológicas preexistentes más predominantes son el Alzheimer y el Parkinson, extraídas de un total de 11 artículos. Conclusión: no hay duda de que la COVID-19 es sumamente variable en cuanto a su forma de presentación, al punto de tener una notable incidencia y variabilidad de efectos sobre el sistema nervioso. Afectando en mayor medida a personas de edad avanzada y con condiciones neurológicas de base.


2021 ◽  
Vol 3 (Supplement_4) ◽  
pp. iv7-iv8
Author(s):  
Timothy Brown ◽  
Christina Zoccoli ◽  
Alireza Mansouri ◽  
Michael Glantz

Abstract BACKGROUND Despite an American Academy of Neurology Practice Guideline and ASCO/SNO endorsement against the routine use of anticonvulsant prophylaxis in patients with primary and metastatic brain tumors, there remains widespread variation in practice and several unanswered questions. METHODS Exhaustive evidence-based literature searches were conducted, and patient-level data from randomized controlled trials (RCTs) were analyzed to answer three questions: does anticonvulsant prophylaxis reduce the risk of first seizures in patients with primary and metastatic brain tumors; does prophylaxis improve one-year overall survival in patients with primary and metastatic brain tumors; and what effect have practice guidelines had on practice patterns. RESULTS Five RCTs (n=441 patients) addressed anticonvulsant prophylaxis in patients with brain tumors. Overall, anticonvulsant prophylaxis did not reduce the risk of a first seizure in patients with any brain tumor (RR= 0.95 [0.58-1.55], p= 0.85, anticonvulsant prophylaxis vs. placebo), brain metastasis (RR = 0.96 [0.73-1.25], p=0.77, 5 RCTs) or primary brain tumors (RR= 1.03 [0.19-5.72], p=0.97, 4 RCTs). Eleven RCTs of anticonvulsant prophylaxis (n=3767 patients with CNS tumors) provided data for survival analysis and demonstrated a lower RR of death at one year compared to those who did not receive prophylaxis (0.88 [0.81-0.94] p = 0.0006). Physician-reported practice of prescribing anticonvulsant prophylaxis diminished only negligibly after initial guideline publication (54.9% [1 study] vs. 51.6%, [3 studies] p<0.014). CONCLUSION Prophylactic anticonvulsants in patients without a history of seizures does not reduce the risk of first seizures in patients with primary or metastatic brain tumors. Despite this, anticonvulsant prophylaxis provides a small survival benefit at one year, although, this finding may be driven by confounded studies. Rates of anticonvulsant prophylaxis prescription have decreased only minimally and remain very high despite strong evidence against this practice and guideline publication. Evidence-based medicine requires additional mechanisms for encouraging practice change.


Neurology ◽  
2021 ◽  
Vol 97 (10) ◽  
pp. 489-495
Author(s):  
James A. Russell ◽  
John C. Hutchins ◽  
Leon G. Epstein ◽  

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