NEURO

Outside of the vaccine debate, few medical topics can get people riled up like Lyme disease. In fact, the term “Lyme wars” is often used to describe the debate about the diagnosis and treatment of this tick-borne disease. The bad news is that this debate probably isn’t going away anytime soon. The good news is that The American Academy of Neurology, Infectious Diseases Society of America, and American College of Rheumatology have introduced new draft guidelines in an effort to reduce some of this conflict and make treatment decisions easier for those on the front lines. Prevention of Lyme Disease Beginning with prevention, the new guidelines address how to handle a “high-risk” tick bite, which must: Be from an Ixodes tick Occur in a highly endemic area Come from an engorged tick attached for 36 hours or more. If these three requirements are met, a single dose of oral doxycycline should be administered within the first 72 hours after tick removal. If the bite does not satisfy

Since the late 1990s neurologists have been involved in the remote care of patients using telemedicine. This has primarily been through telestroke programs, but the application of this technology-driven mode of care has increased to include more than just stroke patients. Today, according to the American Hospital Association , “[Seventy-six] percent of U.S. hospitals connect with patients and consulting practitioners at a distance through the use of video and other technology.” With this increase in use has come some perspective. Eric Anderson, MD, PhD , a national leader in telemedicine, shared some of his in a talk, Telemedicine Fails: What Not to Do in a Telemedicine Encounter, at the 2019 annual meeting of the American Academy of Neurology (AAN). One of his main takeaways: Telemedicine is just a tool, and remote physicians should know its limitations. In other words, there are a lot of things you can do with telemedicine, but there are also quite a few things you should not

Of all the medical specialties, neurologists see some of the most complex patients. This idea bears out anecdotally among the neurologists we have interviewed here at Neurology Insights but also statistically. In this 2018 study published in JAMA , neurologists were ranked #3 among physician types for patient complexity as well as for their number of comorbidities (Nephrologists were ranked #1, if you must know). Not surprisingly, among the comorbidities they listed: diabetes . In addition to the neurological sequelae associated with diabetes, this complex and chronic condition often requires well-coordinated care involving repeated testing and care by other providers. A new study published last month (June, 2019) in the journal PlosOne , shows that all this can be improved when these complex patients have access to a patient portal . “A patient portal is a secure online website that gives patients convenient, 24-hour access to personal health information from anywhere with an Inte

Skepticism is part and parcel of the practice of medicine. First Do No Harm looms large in every encounter. So when new practice modalities gain popularity, it’s not surprising that they take some time to gain widespread usage, particularly when their mechanism of action is unclear. Acupuncture definitely falls into that category, but its use is gaining momentum and its acceptance is growing. The American Academy of Neurology has added the Section on Neurohealth & Integrative Neurology because of the growing acceptance of complementary and alternative medicines into mainstream medicine , including acupuncture. At the 2019 AAN Annual Meeting, Jennifer Bickel, MD, provided an acupuncture demonstration for those who wanted to experience the treatment. She walked the attendees through a mini-acupuncture session, with needling at the LV3 point on both feet. Full disclosure: this author found it mildly unpleasant, but she also wasn’t in need of pain relief at the time. Other attende

“If I have any choice in the matter, I will never go back,” says Colorado neurologist Pearce J. Korb, MD , about his use of medical scribes in clinical practice. “Now I walk in a room and I look at somebody face-to-face, patients and their families, and I talk to them. I have to admit as a young faculty member I was in that computer space and not looking at my patient. So, that’s huge for me.” If you read our article, Have You Considered Adding a Medical Scribe to Your Practice? , you know that Dr. Korb is not alone in his enthusiasm for scribes. In fact, he joined Dr. Jennifer McVige (mentioned in that previous article) at the 2019 annual meeting of the American Academy of Neurology, speaking to a standing-room-only crowd about the benefits of using medical scribes. “We are trying to fix the problem of egregious regulation of our documentation,” said Dr. Korb. Medical scribes are a popular way to do this—as evidenced by the fast growing medical scribe industry. By some estimates ,

“Like some virulent bacteria doubling on the agar plate, the E.M.R. grows more gargantuan with each passing month, requiring ever more (and ever more arduous) documentation to feed the beast,” wrote Danielle Ofri, M.D., in this New York Times article. She is not alone in her concerns about the runaway paperwork problem faced by doctors today. Some research has shown that documentation takes up more than half a physician’s time. Time on paperwork means time away from patients, and this has some asking themselves why they even went to medical school in the first place. It is no surprise then that EMR demands are increasingly seen as a major contributor to the rising rates of burnout among physicians ( neurologists in particular ). The effort to address this issue has led to an increased use of a new category of medical assistant— medical scribes . A medical scribe is someone (non-licensed) who accompanies a physician, taking notes during patient encounters, retrieving test results,

CBD shops are popping up all over the country, and 33 states have legalized some form of medical marijuana. But the reality is that marijuana is still a Schedule 1 substance according to the DEA. Federally, it’s illegal to use, sell, or possess marijuana in the U.S., regardless of what any state law says about it. Even so, many neurologists believe their patients can benefit from marijuana’s therapeutic benefits. So how can they incorporate it into their practice without getting on the wrong side of the law? It’s not easy. Both the physician and the patient accept some risk when they do. You can probably guess that the most important legal recommendation is to get your own legal counsel on the topic. Each state has different laws about how these substances may be used. Understanding them so that you stay on the right side of both state and federal law is critical for you and your patients. No blog post or presentation can cover the specifics you will have to deal with if you choos

In the U.S. there are just three formal neurology fellowship programs for Advanced Practice Providers (APPs). “That’s simply not enough,” says Calli Cook, DNP, FNP-C , considering how many are entering the field. “So, the vast majority of the time the training falls on the practice hiring the APP.” That can be a pretty big hump to get over, considering the benefit they can bring to the practice of neurology . Adding an APP—the collective term used most commonly for nurse practitioners (NP) and physicians assistants (PA)—is increasingly seen as a solution to many of the problems plaguing neurology practice today. “Wait time for new patient referrals decreased from four months to two to three weeks,” said Dr. James C. Stevens, MD, of Fort Wayne Neurological Center to an audience at the recent annual meeting of the American Academy of Neurology (AAN). He also said APPs have been a consistent profit center for his practice and their use has resulted in increased satisfaction among pati

As a physician, it’s likely you’ve counseled a parent or two who are confused or frustrated with their teenagers. And if you have parented a teenager you may have personal experience with those exact feelings. The confusion is compounded by the fact that brain research on this developmental stage has not kept up with that of early and late life. This was the point made by Frances E. Jensen, MD , at the American Academy of Neurology meeting in May. Jensen is the author of The Teenage Brain , and Chair of the Department of Neurology, Perelman School of Medicine at University of Pennsylvania. She emphasized that this lack of research has led to many myths about teenagers—myths such as “teens are lazy” or “adolescents are impulsive and unreliable.” But Dr. Jensen pointed out some actual facts about the teen brain during her presentation. For example, melatonin is released later in teenagers than in children and adults. So that teenager who appears lazy is actually being forced to adap

Between 2012 and 2016, visits to nurse practitioners (NPs) and physician assistants (PAs) increased 129 percent. That’s according to a 2018 insurance claims review of primary care office visits, which also reported an 18 percent drop in PCP visits in that same time frame. Along with this trend have come some tensions and some sense of competition between Advanced Practice Providers (APPs) and physicians. It has also prompted calls of concern like this nursing industry article that urges providers to put egos aside and patients first. Does this mean the same thing is going to happen in neurology, now that APPs are increasingly entering the field? The American Academy of Neurology (AAN) doesn’t seem to think so. The AAN has made a concerted effort to bring APPs into their group . This is largely because of the shortage of neurologists (which is slated to worsen over the next decade) as well as their high level of burnout. In other words, neurologists can use all the help they can get

“What we have is an untapped resource—mid- to late-career physicians now have the bandwidth to share their passions and experience.” This is just a bit of the wisdom shared by Heidi Schwarz, MD , at the American Academy of Neurology’s annual meeting earlier this month. In the panel discussion titled “Not Dead Yet: How to Remain Relevant and Engaged in Mid to Late Career,” Dr. Schwarz discussed burnout, engagement, and relevance with colleagues Laurie Gutmann, MD , and Ludwig Gutmann, MD . It must be said that any practicing neurologist who makes diagnoses, formulates treatment plans, and generally provides the high standard of care promoted by the AAN is still quite relevant. But the panel rightly pointed out the unique challenges—and opportunities—facing neurologists later in their careers. They often find themselves at a point where they are seeking more meaning and ways to share their hard-won knowledge and experience. Burnout Burnout is a perennial topic at AAN , and understand

The introduction of e-cigarettes brought promise for good and bad. We hoped it would be the answer for smokers who really wanted to quit, offering a way to focus on tapering the nicotine addiction while reducing other substances, such as tar, that cause so many health issues. E-cigarettes also offer an outlet for the physical habits that accompany smoking. But few studies have shown that e-cigarettes actually help people quit smoking. Some show they don’t reduce cigarette use, and a couple even suggest they increase cigarette use. In addition, concerns over e-cigarette use among teens have been front of mind since their introduction. Vice reported way back in 2014 that there were 460 brands selling 7,700 flavors of e-cigarette juice with names like Atomic Cinnamon, Sour Apple, or Lava Flow. It sounds suspiciously like a new product targeting a young, untapped market rather than a smoking cessation product targeting established smokers. At the American Academy of Neurology meetin

“I would have thought more people would tell their doctors,” says Dr. Nina Sanford on her findings that 29 percent of cancer patients using alternative medicine during treatment don’t disclose its use. Dr. Sanford is an assistant professor of radiation oncology at the University of Texas Southwestern Medical Center, and she is lead author of a study just published (April 2019) in JAMA Oncology . Despite a high use of Complementary and Alternative Medicine (CAM) among neurology patients, neurologist Sarah Mulukutla, MD, MPH , says, more than half of those patients are not telling their providers. “So what actually is going on, is that we have two separate healthcare models.” We’ve heard this before. The disconnect between these two models of healthcare (CAM vs allopathic care) means that when physicians are deciding on the best treatment, they are missing half the picture. For cancer patients, who according to the JAMA study seek out CAMs at a higher proportion than others, this c

We are just days away from the annual meeting of the American Academy of Neurology (AAN), being held in Philadelphia this year. But we are already weeks into the buzz about it on Twitter. The hashtag for the conference, #AANAM , started showing up in early April in tweets from organizers, speakers, and future attendees. Here is one: The author of this tweet, David Evans, MBA (@davidevanstx) , is a healthcare executive we interviewed for a post about practice management  after he spoke at the AAN conference in 2018. What he and other #AANAM users know is that using Twitter before, during, and after a medical conference is a terrific way to leverage the platform. It is a unique opportunity to make your voice heard and to get value from the conference beyond the days you attend. The AAN is so enthusiastic about this added value that they have set up a virtual scavenger hunt (with prizes) to encourage the use of Twitter and Instagram during this year’s conference. There is more i

When the Pokémon Go game launched a few years back, there was much talk about the possibility of it creating healthy habits by getting kids moving around in the outdoors. But Pokémon Go seems to have gone the way of most video games—a fun distraction at best, a dangerous habit at worst. But the idea of video games providing health benefits isn’t dead, and in fact, new research demonstrates a potential role for them in stroke rehabilitation. Specifically, scientists at Northwestern University’s Feinberg School of Medicine wondered if there was a way to aid rehabilitation by providing feedback through a video game, the idea being that we learn through trial and error, with feedback being the key to learning from the errors. Much of the motor difficulty stroke patients experience is because their muscles abnormally coactivate so that the action of one muscle works against the action of another. So the researchers developed an 80s-style video game that provides feedback to help th