NEURO

It is no secret that an increasing number of neurologists are burned out at work. The impact on business caused by COVID-19 has only made this worse. With lower caseloads, this might be a good time to work on your resilience. A good place to start is by taking a stock of your core values. “This is a handful of truly fundamental qualities and characteristics that you intend to bring into your organization,” Brian Donnelly, an executive coach and whose led a range of healthcare businesses, told an audience at the 2019 annual meeting of the Medical Group Management Association. “You cannot phone a friend or poll the audience. You do not form a subcommittee to generate what your core values are. The core values come from you. It is the culture you intend to create for your organization. And it also helps you define the kind of people you intend to attract and retain.” Take That, Burnout! Work that aligns well with your core values will be more rewarding and less likely to cause burnou

More than one-third of Americans suffer from chronic pain and no two individuals would describe their experience in the same way. Considering how much medicine is thrown at it – and how powerful it is – pain is one of the most subjective measures in all of medicine. It has also led to problems like the opioid epidemic . The severity of this problem has energized scientists to search for an objective measure of pain. Now, researchers at the University of Birmingham in England and the University of Maryland School of Dentistry in the U.S. say they have found one: electroencephalography (EEG). EEG measures the brain’s electrical activity in the form of different kinds of waves, or oscillations. Of relevance to this study are alpha brain waves, the oscillations produced by the brain at rest when it is not processing much information. Alpha oscillations typically measure at speeds between 8 and 12 Hz, and these waves tend to be slower in chronic pain patients. The purpose of the new

In the early months of the pandemic it became clear that the elderly and those with comorbidities were going to be hit the hardest. For many young adults, there was a sense of immunity, evidenced in places like Florida where spring breakers continued to flock. It was also during this time that neurologists began seeing an odd increase in young, healthy adults having massive strokes. Dr. Jaime Hatcher-Martin “We had to really start thinking about the possibility of COVID in patients, even if they didn’t necessarily have the classical respiratory symptoms,” Dr. Jaime Hatcher-Martin, a neurologist with SOC Telemed , told us. “We had to consider that as a possible etiology for strokes and hemorrhages, especially in patients that were younger and those that didn’t have any other risk factors.” “The strokes that were coming to people’s attention were people who really didn’t have tons of risk factors otherwise,” added Dr. Elaine Jones, another neurologist working for the same company.

In early April 2020, two things were clear: The COVID-19 outbreak had reached the level of a pandemic, and it was peaking in Italy. Those on the ground there were inundated, and they knew the lessons they were learning could help those still in front of the virus. They began sharing their experiences then and continue to do so, even as their case counts wane and those in places like the U.S. are on the rise. The Italians recently released a set of recommendations regarding the ordering and safe performance of electroencephalograms (EEG) during the different phases of this pandemic. Their paper, published in the journal Neurological Sciences on July 22, 2020, is a collaboration between three major Italian medical associations: the Italian Society of Neurophysiology (SINC), the Italian League Against Epilepsy (LICE), and, notably, the Italian Association of Neurophysiology Technologists (AITN). Similar to the recommendations by their American counterparts, the authors write: “Durin

From drive-by birthday celebrations to Zoom dinner parties, COVID-19 has shifted what it means to be social. And as ASET-The Neurodiagnostic Society ramps up its first-ever virtual annual meeting, the organization is helping to define what it means for professional communities to stay connected and grow together while social distancing. ASET’s annual conference has been held in an American city every summer since 1960. It brings together hundreds of neurodiagnostic technologists as well as renowned leaders and educators in the field. This year, the meeting was going to be held in San Diego before it was derailed by the pandemic and moved completely online. The virtual conference will run for three days, August 20-22, 2020, and the registration deadline is August 17. You can register here . “We at ASET are so excited to still be able to bring neurodiagnostic technologists the educational content they have come to expect from us,” said Linda Kelly, ASET’s director of education. “We k

Chances are, if you are a diagnostic technologist, you haven’t run EEGs on a lot of kids with epilepsy lately. This is according to a new study of how COVID-19 has changed the care of children with epilepsy. Nearly all neurologists polled for this study said they had curtailed their EEG testing, with about half saying it was used only for urgent cases. The ramifications of this finding are unclear. Electroencephalography (EEG) plays an important role in diagnosing and treating epilepsy. It helps neurologists determine the type of epilepsy and syndrome as well as subtle seizures that can be otherwise easily missed. For children this is especially important because a quick and accurate diagnosis can be crucial in preventing developmental delays and greater lifelong disability. In response to this urgency, a global research team, based in the U.S., has started collecting data on the impact that the pandemic is having on children with epilepsy. A paper summarizing their findings was

A national shortage of neurologists has for years resulted in patients falling through the cracks, especially those with mobility issues or who live in remote areas. The broadening of telemedicine reimbursement, brought on by the COVID-19 pandemic, has served as a net for many of these previously unseen patients. We spoke to one neurologist, Dr. Elaine Jones, who shared how this is particularly helping neurology patients in one small town in Alaska. Jones has been practicing telemedicine for years. Well before the coronavirus hit, she was able to see patients remotely from an office she set up in the home she shares with her elderly parents in South Carolina. Dr. Elaine Jones “When COVID hit, it was kind of nice that I was already doing telemedicine so I didn’t have to worry about exposure and working in an ER,” Jones told us in a recent interview. For the last handful of years she has been working for SOC Telemed , serving ERs remotely across the country. Jones ran a private n

An analysis of EEG data from novel coronavirus patients, published in the French journal Neurophysiologie Clinique , could not find any patterns that could be linked specifically to COVID-19 – but more research like this was deemed necessary. In the early months of the COVID-19 pandemic, EEG technologists were among a group of healthcare workers making the news because they were actually working less while ERs, ICUs, and respiratory care personnel were stretched beyond capacity. Evidence linking the coronavirus to neurological complications – such as change in consciousness, stroke, and encephalopathy – began to slowly build . It was accompanied by an increase in research looking at just how the virus impacts the brain. Professionals working with patients positive for COVID-19 began to notice some neurological problems like confusion, possible seizures, and a slowness to wake from anesthesia. That’s when EEG techs were asked to garb up in full PPE and perform EEGs. ASET- The Neu

Though COVID-19 has most notably affected the respiratory system, case studies with related neurological disease began trickling in soon after the pandemic started. Those reports have continued to grow, including cases of central and peripheral nervous system disorders. The exact injury mechanism, however, has been elusive. A new multidisciplinary study out of the United Kingdom takes one of the deepest dives yet into the many ways COVID-19 wreaks havoc on the nervous system. In early March 2020, it started to become apparent that COVID-19 was linked to the development of certain neurological conditions, including encephalopathy, stroke, and Guillain-Barré Syndrome (GBS). Dr. Elaine Jones “There were a lot of neurologic presentations that ended up being COVID-positive patients,” Dr. Elaine Jones, a neurologist who does telehealth in ERs across the country, told us. “We are still working through that data to see what it was. Some of it, we think, was inflammation of the vessels.

While COVID-19 has forced distance between individuals, it has caused professional medical organizations to pool resources and cooperate in new ways. For the neurodiagnostic community and their patients this will confer benefits not just during the pandemic but likely for years to come. As soon as the novel coronavirus began to spread in the U.S., ASET- The Neurodiagnostic Society started working with other organizations to help keep their members and the patients they care for safe. In April, ASET leaders began meeting every Friday, sharing information with their counterparts at the American Epilepsy Society (AES) and the American Academy of Neurology (AAN). An early result of this collaboration was the prompt publication of ASET’s COVID-19 resource sheet . This web page covers topics such as cleaning and disinfection, respiratory isolation precautions, proper donning and doffing of PPE. It also explores COVID-19 issues related to sleep, IONM, and NCS/NCV studies. Connie Kubiak

A surprising thing happened in the early months of the coronavirus pandemic: Emergency rooms went quiet. As they began preparing for virus patients to come in, physicians began to wonder. Where are all the heart attack patients? Where are all the stroke patients? Many worried they were at home dying, too afraid of the virus to come in for care. Evidence is now emerging that this is likely what was happening. “We went maybe two to three weeks — the latter part of March [2020], first part of April — where we didn’t give one TPA,” Dr. Heidi Schwarz, a neurologist at The University of Rochester , told us. Rochester’s chief medical officer, Dr. Michael Apostolako, told the New York Times in May that ER visits had dropped by 50 percent. Patients with strokes who were coming in were coming in too late for treatment. Dr. Elaine Jones, a neurologist who sees patients in ERs across the country through SOC Telemed , said in May that there was about a 40 percent drop in ER volume, “and our

With neurology practices facing ever narrowing profit margins, diversifying sources of income becomes increasingly important. One popular way to do this is by adding clinical trials to your practice – it can be lucrative and rewarding, says Dr. David Weisman. But Weisman also urges caution before taking the plunge. Clinical trials can be hard in ways you may not realize. Weisman, a practicing neurologist just outside of Philadelphia , founded the Clinical Trial Center at Abington Neurological Associates in 2008. When he started the center, he says, he didn’t really know how to build a trial center, and he didn’t know it was going to take off. “But I knew how to do trials, thanks to my fellowship,” he adds. “I thought that it would be good because it is a very moral and ethical thing to do; we are trying to beat Alzheimer’s disease.” Dr. David Weisman He still directs the center and is currently running about 40 drug trials (the COVID-19 pandemic notwithstanding ). “It’s been

Antidepressants are among the top five most commonly prescribed drugs in both the U.S. and Canada. And yet, it can be difficult to predict the effectiveness of these drugs when first prescribed, leading to a lot of trial and error. Electroencephalography (EEG), it turns out, may finally offer some clues to help fast track treatment. More than 265 million people globally suffer from depression, and it is the world’s leading cause of disability, according to the World Health Organization . Fortunately, there are many effective treatments including several classes of medication. It can, however, take a long time – trying one drug and then the next – to find the best treatment for any given individual. Sometimes this means months or years of unnecessary suffering and death. For this reason, researchers have long tried to find biomarkers that can help predict which treatments might work best. A biomarker is a measurable substance (like an antibody) or activity (like a certain brain wa

Now that techs are returning to the lab and performing more EEGs, some are voicing concern over performing one specific activation procedure: hyperventilation (HV). This commonly used technique’s potential for spreading the novel coronavirus is driving their worries. According to ASET- the Diagnostic Society , activation procedures are commonly used during EEG testing as a way to “induce, enhance, or better define abnormal EEG patterns.” These activators include sleep, photic stimulation, and hyperventilation. Hyperventilation, also called overbreathing, is usually performed at a rate of 18 to 24 breaths per minute for 3 to 5 minutes. “Hyperventilation is a standard part of all routine EEGs for patients who are developmentally able to participate and do not have a contraindication (such as Moya Moya),” says Dr. Sophia French, a child neurologist at Oregon Health and Science University in Portland, Oregon. “It is most valuable in patients with concern for generalized epilepsies, such

Many of the pandemic-related changes to telemedicine are likely here to stay,  as we concluded in our last post thanks to the insights of four industry experts. They also emphasized that for telemedicine to be truly sustainable, people will have to improve the way they implement it. For many physicians, the move to telemedicine has been – and still is – challenging. It has forced them to wear more hats than usual. In addition to doctoring, they are handling many tasks normally handled by in-office staff, medical assistants, and even IT professionals. “The first five to seven minutes are spent being an unpaid IT consultant to ensure connectivity,” neurologist Laurence Kinsella told us. “You never know how that is going to go and sometimes you just have to switch and just go with an audio call.” Neurologist Heidi Schwarz said telemedicine is “a lot more labor intensive for the docs as it’s structured right now, because we don’t have techs. It’s time consuming doing things like medica

In response to the COVID-19 pandemic, the Centers for Medicare & Medicaid Services instituted unprecedented expansions to their policies on telemedicine reimbursement. This has dramatically dropped barriers that had been slowing progress in this arena. The question being batted around now is: When the pandemic ends, we still have this same expanded access to telemedicine? Dr. Jaime M. Hatcher-Martin We called up four neurologists – Dr. Heidi Schwarz, Dr. Kim Hutchison, Dr. Laurence Kinsella, and Dr. Jaime Hatcher-Martin – and posed that question to them. “In a good way we’ve sort of let the cat out of the bag,” says Hatcher-Martin. Here’s what else they had to say, with their answers lightly edited for clarity. Heidi Schwarz, MD “Our institution strongly feels that telemedicine is here to stay. The thought is: studies will show that this is equivalent as far as quality of care. “There are already studies out there showing that patients often prefer this mode of physician

Single-use EEG cup electrodes got another boost recently when they were discussed by industry leaders at a town hall held by ASET-The neurodiagnostic Society. ASET convened the meeting to address issues surrounding the resumption of neurodiagnostic services amid a pandemic . Their panel of experts included EEG technologists in leadership positions at medical centers across the country. “We use disposables for everything,” was a phrase used more than once when panelists were asked which EEG electrodes they are using now that labs are reopening. “I personally think we should all be using disposables,” said panelist Cheryl Plummer, manager of the Epilepsy Monitoring Unit at Presbyterian Hospital in Pittsburgh, Pennsylvania. “But I know that might not be possible everywhere.” We recently wrote about how the COVID-19 pandemic has led to a surge in the use of single-use electrodes over reusables. The impetus for the increase largely comes down to infection control, but as the townhall p

In 2007, neurologist Kim Hutchison moved with her husband and two kids to Saipa n, the island in the U.S. Commonwealth of the Northern Mariana Islands in the Pacific Ocean. She had no intention of practicing medicine. But not only did she end up opening a neurology and sleep medicine clinic, she also expanded her ability to practice medicine in ways that would unknowingly prepare her for a worldwide viral pandemic. Hutchison moved more than 10 years ago because her husband, also a physician, got a year-long contract job there. “I was going to take a year sabbatical with my kids, who were very young at the time.” Hutchison said in a recent phone interview. “But once we got over there, they just started calling me. There was no other neurologist on the Island. I started picking up on the horrible end-stage renal disease, high blood pressure, and stroke there, and put it together with my training that sleep apnea was way underdiagnosed and undertreated.” Kimberly Hutchison She soo

In a new study , researchers used EEG on newborns to see if they could quantify brain changes associated with consuming alcohol and tobacco during pregnancy. They found that both alcohol and tobacco consumption were associated with EEG changes. For alcohol this manifested as an increase in low-frequency brain activity in the temporal lobe. With tobacco, researchers observed a decrease in high-frequency brain activity in the central brain. The scientific community has long known that alcohol and tobacco consumption during pregnancy can have a long-term negative impact on a child’s health. What is still not known, however, is just how much it takes to cause this negative effect, and what the mechanism of that effect looks like. This study aims to fill in these gaps. The research included 1,739 infants and their mothers from the Northern Plains region of the U.S. and Cape Town, South Africa. Before birth, pregnant women were recruited and asked about their alcohol and tobacco use. Ba

In May at the University of Rochester, the neurology department sent out a needs-assessment survey to faculty and staff asking if they felt supported and if their wellness needs were being addressed. Seven out of 10 said yes. This is remarkably high considering they were in the middle of the COVID-19 pandemic and furloughs had just been announced at the hospital. What was this department doing to merit good ratings at a time like this? They were focusing on their employees’ wellness. Their efforts had actually started in January 2020, before most anyone had even heard of the novel coronavirus. In response to growing levels of burnout among healthcare workers — a national phenomenon that has hit neurologists particularly hard — Dr. Robert Holloway, neurology chair at Rochester, in Rochester, New York, created a director of wellness position. Andrea Wasilewski He hired neuro-oncologist Dr. Andrea Wasilewski for the new role. Prior to taking this job, Wasilewski had spearheaded