March, 2012
Clinical Neurophysiology News Newsletter of the American Clinical Neurophysiology Society Message from the President Dear Fellow Members of the ACNS,
Volume 4, Issue 2
I’m pleased to greet you soon after our extremely successful Annual Meeting in San Antonio, TX. The meeting and courses drew more than 350 attendees, including physicians from 17 countries and many first-time attendees. Special thanks to Program Chairs Cecil Hahn and Francis Walker, Annual Course Chair Bill Tatum, Doug Nordli, all directors and faculty, and our ACNS executive office staff, for putting together a stellar and innovative meeting! The meeting introduced several new features, such as use of the audience response system, more hands-on workshops, a Business of Neurophysiology Course, and a Professional Development Mentoring session for junior members. Look inside for more information and photos from the meeting. Susan T. Herman, M.D.
Future Meetings 2012 Mid-Year Courses September 29-30, 2012 Hyatt Regency Minneapolis Minneapolis, MN
2013 Annual Meeting and Courses February 5-10, 2013 Miami Marriott Biscayne Bay Miami, FL Watch the ACNS website (ACNS.org) for more details.
Editor Jonathan C. Edwards, M.D
We have many exciting activities planned for the next year. Preparation for the Annual Meeting begins a full year before the event. Next year’s Program Chairs, Mark Hallett and Jonathan Edwards, are already hard at work reviewing the many excellent submissions for symposia and workshops. They welcome suggestions for making next year’s meeting in Miami even more successful. We’ll also be continuing our two-day fall courses on NIOM and ICU EEG Monitoring, which will take place September 29-30, 2012 at the Hyatt Regency Minneapolis in Minneapolis, MN. These courses offer an in-depth look at these rapidly evolving fields, including tips for obtaining the necessary resources and building your neurophysiology team. Please participate in several important initiatives. We’re currently reviewing our Continuing Medical Education program in preparation for our upcoming review by ACCME, the CME accrediting organization. Thanks to everyone who completed our recent CME survey, which will help us determine if we are meeting your education needs. If you haven’t completed the survey yet, you can contribute by clicking here. Several neurophysiology codes are due for review by the AMA/Specialty Society Relative Value Scale Update Committee (RUC). Under the guidance of Marc Nuwer, we’ll be asking for your help to complete surveys on the physician work involved in these procedures so we can maintain adequate reimbursement and develop new codes. We also need to ensure that enough of our members are also American Medical Association members to maintain our seat in the AMA House of Delegates. Please consider joining AMA if you are not already a member, so ACNS will continue have a voice in AMA’s health care policies, reimbursement, and performance measures. One of my main objectives this year is to improve our on-line presence and move many of our day-to-day operations to the web. We’ll be rolling out a new web site in the next few months, which will be easier to navigate, contain more information important to our members, and allow on-line collaboration. This April, we’ll administer the first on-line version of our Inservice Exam for clinical neurophysiology fellows and neurology residents, which will provide questionlevel feedback on performance for self-assessment. Soon after that, we will launch a similar selfassessment exam for practicing physicians which will meet the American Board of Psychiatry and Neurology’s Maintenance of Certification requirements. We are also developing a series of (Continued on page 2)
American Clinical Neurophysiology Society 2012-2013 Council Members PRESIDENT Susan T. Herman, M.D. Beth Israel Deaconess Medical Center Boston, MA 1ST VICE PRESIDENT Frank W. Drislane, M.D. Beth Israel Deaconess Medical Center Newton, MA 2ND VICE PRESIDENT Aatif M. Husain, M.D. Duke University Medical Center Durham, NC SECRETARY Jonathan C. Edwards, M.D. Medical University of South Carolina Charleston, SC TREASURER Stephan Schuele, M.D., M.Ph. Northwestern University Neurology Chicago, IL IMMEDIATE PAST PRESIDENT Douglas R. Nordli, M.D. Children’s Epilepsy Center Chicago, IL PAST PRESIDENT Peter W. Kaplan, M.B., FRCP Johns Hopkins Medical Center Baltimore, MD COUNCIL MEMBERS Cecil D. Hahn, M.D. Hospital for Sick Children Toronto, ON Terrence D. Lagerlund, M.D. Mayo Clinic Rochester, MN
Message from the President (continued) (Continued from page 1)
webinars on clinical neurophysiology topics (NIOM and ICU EEG), which should begin in April or May. There are many opportunities to become involved in ACNS activities, and we invite all members to volunteer their time and talents. One of the strengths of our society is its relatively small size, allowing us to adapt quickly and develop new initiatives to better serve our members. A perfect example is this Newsletter, now in its third year, edited by Jonathan Edwards. Over the next year, we’ll highlight some of our committees in the Newsletter, introducing you to the Chairs and the committees’ ongoing projects. This issue highlights the rejuvenated Practice of Clinical Neurophysiology Committee, co-chaired by Yafa Minazad and Deborah Briggs. We continue to develop and revise our clinical neurophysiology guidelines, such as the recently published joint AAN and ACNS guidelines on intraoperative monitoring. This year, we aim to publish new guidelines on ICU EEG and ICU EEG nomenclature, intracranial EEG monitoring, motor evoked potentials, and qualifications of neurophysiology personnel (joint guidelines with ASET – The Neurodiagnostic Society and the American Society of American Society of Neurophysiologic Monitoring). Looking at the list above, it will be a busy year! Thanks for your continuing involvement in ACNS, and feel free to contact me or the ACNS office if you have a great new idea. Over the 15 years I’ve been involved with ACNS, it has become stronger, younger (well, maybe not so young anymore…), and more vital. We hope to see this trend continue, and encourage you to recruit your colleagues, fellows and residents to join ACNS or attend one or our meetings. We’ll do our best to keep them! Yours sincerely,
Sue Susan T. Herman, MD President American Clinical Neurophysiology Society
Suzette LaRoche, M.D. Emory University Medical Center Atlanta, GA Tobias Loddenkemper, M.D. Children’s Hospital Boston Boston, MA Jaime R. Lopez, M.D. Stanford University Neurology Stanford, CA Suraj Ashok Muley, M.D. St. Joseph's Hospital and Medical Center Phoenix, AZ Piotr W. Olejniczak, M.D. Louisiana State University Health Sciences Center New Orleans, LA William O. Tatum IV, D.O. Mayo College of Medicine Jacksonville, FL Francis O. Walker, M.D. Department of Neurology Winston-Salem, NC
Incoming President, Dr. Susan Herman, presents a plaque to ACNS President, Dr. Doug Nordli, in honor of his leadership over the past year.
ACNS Newsletter
Summary of the Annual Meeting By: Cecil D. Hahn, M.D. and Francis O. Walker, M.D. This year’s very successful annual meeting took place in San Antonio under the direction of co-chairs Cecil Hahn and Francis Walker. Attendees had the opportunity to learn the latest advances in clinical neurophysiology, network with colleagues, reunite with friends, and enjoy the warm Texan hospitality!
Volume 4, Issue 2
We enjoyed a record attendance of 381 registrants coming from as far as Austria, Brazil, Canada, Cuba, Denmark, Germany, Ghana, Honduras, Japan, Mexico, The Netherlands, Saudi Arabia, Turkey, and the United Kingdom. The meeting featured 19 exhibitors, and representatives from ABCN, ABRET, ASET, ASNM and ACMEGS. The program began with the Presidential Lecture delivered by Dr. Nordli, who reminded us of the extraordinary value of the routine EEG for providing insight into brain function, and for predicting the long-term consequences of febrile seizures of childhood. This year’s Schwab awardee, Dr. William Kennedy, recollected that he interviewed for his first job with the illustrious Dr. Schwab and chose to decline the offer! Dr. Kennedy described advances in measuring the function of small fibers in the peripheral nervous system and challenged the audience to come up with better clinical neurophysiological tests to evaluate them. Dr. Damian Cruse presented a special lecture on his pioneering work evaluating consciousness among patients with severe brain injury, challenging our assumptions about the limits of consciousness and generating lively debate. The Gloor lecture was delivered by Dr. Donald Schomer, who spoke on lessons learned about human cognition through the use of intracranial EEG. Dr. Warren Blume was honored with the Herbert Jasper Award for his lifetime of outstanding contributions to the field of clinical neurophysiology. These key presentations led to a series of exciting discussions of both new and established techniques in clinical neurophysiology. This year’s scientific program featured greater interactivity during the plenary sessions, workshops and special interest groups, taking advantage of the meeting’s intimate scale. For the peripheral nervous system the focus was on integrating newer technologies with routine electrodiagnosis. Dr. Fisher’s session focused on F-waves, conduction block and impedence electromyography as tools that could explore the role of the periperhal nervous system of a variety of peripheral, and mixed central and peripheral disorders. Dr. Dimberg’s session showed how muscle histopathology and clinical findings correlated with findings on ultrasound and higher profile imaging techniques such as MR, CT, and PET. Dr. Muley’s session explored the diagnosis and management of critical illness associated weakness. New to the program were a series of hands-on demonstrations of impedence electromyography, neuromuscular ultrasound, and central and peripheral magnetic stimulation. The program also featured interactive workshops on quantitative EEG analysis, treatment of epileptiform patterns ICU EEG monitoring. Several strong special interest groups rounded out the offerings. Competition was fierce at the ever-popular Neurophys Bowl, which drew a full house! A strong showing of 76 posters were presented at the meeting. This year we raised the profile of the poster sessions by conducting a series of poster tours highlighting posters of particular merit, which proved to be very popular. Travel fellowships were awarded to the six highest ranked posters authored by a trainee. The Program Committee for the 2013 meeting, chaired by Drs. Jonathan Edwards and Mark Hallett, is already well into planning for next year’s meeting, and we look forward to seeing you in Miami, from February 5-10, 2013!
Summary of Annual Courses By: William O. Tatum, IV, D.O. The courses this year were outstanding. San Antonio was a perfect setting for attendees to participate in the annual courses with its downtown riverfront area and excellent southern accommodations centered at the historical Alamo. The Course Committee has outdone itself in 2012 with another series of “firsts” contributing to the largest and most successful attendance at the ACNS annual meeting in more than five years. Each course was led by two leading experts using a team approach that ensured comprehensive coverage of each topic. The growth areas in clinical (Continued on page 4)
ACNS Newsletter Volume 4, Issue 2
Summary of Annual Courses (continued) (Continued from page 3)
neurophysiology were targeted to feature full-day courses in NIOM, EEG, EMG, and ICU EEG monitoring. The 2-day NIOM course this year included an expert diverse faculty with outstanding content to provide those in attendance with a clinically-relevant series of topics from beginning to end under the direction of Drs. Jaime Lopez and Alan Legatt. Intraoperative technique by leading experts bridged the talent of our Society by spanning peripheral and central clinical neurophysiology. The ICU EEG Course returned by popular demand with the highest attendance of all the courses guided by the leadership of Drs. Larry Hirsch and Suzette LaRoche. New approaches to long-term EEG monitoring of critically ill adults and children included a program that was world class covering cutting edge information on neurophysiology in the ICU. The EEG Course this year featured an “all professor” faculty experienced in the electroclinical application in epilepsy. A novel course design was instituted to address the interests of both beginner and expert alike, focusing on the age-related changes in EEG in the newborn to the elderly under the auspice of Drs. Raj Sheth and William Tatum. The EMG course this year was led by Drs. Devon Rubin and Brent Goodman and boasted an interactive program with audiovisual enhancement promoting discussion on the latest techniques utilized in the EMG laboratory. For all the courses, the pilot use of an audience-response system successfully compared to large scale national meetings but with the personal touch of a smaller, dedicated, and focused society meeting that our membership has come to treasure. Perhaps one of the greatest achievements this year was the development of morning courses. This served to broaden the topics of interest for our attendees with varied and widespread interest in clinical neurophysiology. The numbers of those in attendance confirmed their resounding success. Special breakfast seminars led by Dr. Nick Abend on Neonatal EEG, Dr. Ron Emerson interpreting Evoked Potentials, and Dr. Rod Radtke outlining sleep neurophysiology were held on Wednesday. Dr. Chip Epstein led a marvelous workshop on EEG and EMG technology, Dr. Mark Ross’s reviewed high quality nerve conduction studies, while Dr. Art Leis led a first rate seminar on applied autonomic neurophysiology to further augment the annual courses on Thursday. These new topics in clinical neurophysiology were well received with excellent attendance despite the early morning hour. The success of our courses this year was a direct reflection of the dedication by our faculty and organizers to make the annual meeting this year one of our best efforts yet!
Awards Congratulations to the 2012 recipients of the ACNS' highest awards! The Herbert H. Jasper Award is presented annually by the American Clinical Neurophysiology Society to an individual who has made a lifetime of outstanding contributions to the field of clinical neurophysiology. The Pierre Gloor Award is presented annually by the American Clinical Neurophysiology Society for outstanding current contributions to clinical neurophysiology research. The Robert S. Schwab Award is presented annually by the American Clinical Neurophysiology Society to an individual who has made significant contributions in the area of clinical neurophysiology.
Dr. Francis Walker, 2012 Program Co-Chair, presents the Robert S. Schwab Award to Dr. William Kennedy. Dr. Kennedy presented a lecture entitled Novel Methods to Detect Change in Peripheral and Autonomic Nerves: Searching for Electrodiagnostic Correlations.
ACNS Newsletter Volume 4, Issue 2
Dr. Cecil Hahn, 2012 Program Co-Chair, and Dr. Doug Nordli, ACNS President, present the Herbert H. Jasper Award to Dr. Warren Blume.
Dr. Peter Kaplan, ACNS Past President, and Dr. Doug Nordli, ACNS President, present the Pierre Gloor Award to Dr. Donald Schomer. Dr. Schomer's lecture was entitled Human Cognition: Lessons Learned Through Intracranial EEG.
Journal of Clinical Neurophysiology Dr. John Ebersole, Journal Editor, welcomes suggestions and guest editors for special issues of the Journal. Potential authors may now submit their manuscript online at www.EditorialManager.com/JCNP.
ACNS Newsletter Volume 4, Issue 2
CONGRATULATIONS NEW ACNS FELLOW MEMBERS!
Congratulations to the fifteen ACNS members who have been upgraded to Fellow Member status! Dr. Nordli presented certificates to those who were present at the Annual Business Meeting. Pictured with Dr. Nordli are Drs. Sanzenbacher, Britton, Afra, Eccher, McGarvey and Yingling. The complete list of new Fellow Members is below.
Pegah Afra, M.D. Richard V. Andrews, M.D. David Anschel, M.D. Jeffrey Britton, M.D. Matthew A. Eccher, M.D. Joshua Ewen, M.D. Morris A. Fisher, M.D. Giancarlo Gierbolini, M.D. Cecil D. Hahn, M.D., M.P.H. Jaime R. Lopez, M.D. Michael L. McGarvey, M.D. Suraj Ashok Muley, M.D. Karl Sanzenbacher, M.D. Tammy Tsuchida, M.D., Ph.D. Charles Yingling, Ph.D.
ACNS Newsletter
Consortium of Clinical Neurophysiology Program Directors Meeting The Consortium of Clinical Neurophysiology Program Directors (CCNPD) met at the recent Annual Meeting in San Antonio, TX. We had a successful meeting with 18 attendees. Closer collaboration and exchange of information was recommended among individual programs. We look forward to continuously improving the consortium from the suggestions of the program directors, and as a result, improving the Clinical Neurophysiology Programs. Thank you to all who attended.
Volume 4, Issue 2
2012 Neurophys Bowl
The 2012 ACNS Neurophys Bowl, with Co-Hosts Larry Hirsch and Mark Ross, was a huge success and was enjoyed by participants and attendees alike. Four teams competed viciously for the coveted title, as the Honorable Judge Nordli presided over the mayhem. In the end, the Old and Wise team named the Bereitschaft Potentials (Francis Walker, Stephan Schuele, Alan Legatt and Peter Kaplan) emerged as the victors, despite their sometimes slow-to-respond rubber chickens (what happens in the neurophys bowl stays in … ). The Active Discharges (Susan Herman, Mark Hallett, Morris Fisher and Marc Nuwer) put up a good fight, and the audience held their own when the teams on stage were stumped (and received valuable Texan prizes for this). The semifinal rounds were top-notch as well. Perhaps the highlight was when Akio Ikeda and team had to identify the diagnosis (anti-NMDA encephalitis) based on an EEG of a case report which turned out to be from Professor Ikeda’s own publication; to top it off, he pointed out that the publication had been rejected by our Society’s own Journal of Clinical Neurophysiology. A big thank you and congratulations for the brilliant performance of the two Up and Coming team participants: Ahmad Nizam, Prabhu Emmady, Cecil Hahn, Akio Ikeda, Ayako Ochi, Hiroshi Otsubo and Reza Zarnegar! Again, thanks to all those who competed and attended. If anyone is interested in contributing a few questions for next year’s Bowl, please contact the Co-Chairs … and start getting your team together for the 2013 Neurophys Bowl in Miami!
Watch for details of the Fourth Annual ACNS Neurophys Bowl which will be held in February of 2013 at the Miami Marriott Biscayne Bay in Miami, Florida. Individual and Team Registration Form can be found on the ACNS website: www.ACNS.org.
Volume 4, Issue 2 ACNS Newsletter
ACNS Newsletter Volume 4, Issue 2
Focus on Fellows
American Clinical Neurophysiology Society 2012 Travel Fellows
Six neurophysiology fellows won travel scholarships to this year's Annual Meeting in San Antonio. They presented exceptionally high quality posters on a wide range of topics. As we did last year, we will shine the spotlight on these fellows in this issue and upcoming issues of Clinical Neurophysiology News. Follow their exciting future in the clinical neurophysiology field as we publish their projects and upcoming plans! Valeriya S. Poukas, M.D., Hospital of the University of Pennsylvania, Philadelphia, PA The Risk of Post-Traumatic Epilepsy Based on cEEG Data in the ICU Sandipan Pati, M.D., Barrow Neurological Institute, Phoenix, AZ Hypothermia Prevents EEG Progression and Glial Injury During Status Epilepticus Leslie H. Lee, M.D., Stanford University Medical Center, Palo Alto, CA Case Series: Intraoperative Neurophysiologic Monitoring (IONM) Changes During Presumably "Non-Critical" Periods of Surgery Matthew T. Sweney M.D., M.S., University of Utah, Salt Lake City, UT A Case of Post-anoxic Encephalopathy During and After Hypothermia Danielle A. Becker, M.D., M.S., University of Pennsylvania, Philadelphia, PA Outcome from Spinal Ischemia after Aortic Repair Ahmad Nizam, M.D., Vanderbilt University, Nashville, TN GPEDs: Etiologies, Prognosis, and Relation to Seizures
ACNS Newsletter
Focus on Fellows (continued) Danielle Becker, MD, MS. I am currently a fourth year neurology resident at the Hospital of the University of Pennsylvania. The primary mentors for my project were Dr. Michael McGarvey and Dr. Steven Messe.
Volume 4, Issue 2
Please briefly summarize the project that you presented, including the rationale, methods, what you found, and what the significance may be. Rationale: Descending thoracic (DTA) and thoracoabdominal aorta (TAA) aneurysms are associated with a significant risk of mortality and morbidity if left untreated. However, a potentially devastating complication of DTA/TAA surgery is spinal cord ischemia. Patients with spinal ischemia have highly variable outcomes, although many do poorly. Neurologists are often consulted on patients who develop spinal ischemia to help with treatment goals and prognosis; however, no specific prognostic criteria have been developed. The goal of this study was to identify predictors of outcome and generate a prognostic score that can aid the treating team in patient management and disposition as well as provide information to the family. Methods/Results: We performed retrospective review of 224 consecutive thoracic aortic surgery patients to determine who developed spinal ischemia (N=75), defined as changes on intraoperative SSEP/EEG consistent with spinal cord ischemia and/ or paraparesis/paraplegia post-operatively, not clinically consistent with peripheral nerve, muscular, or ischemic brain injury. The outcome of interest was poor outcome, defined as death or discharge with a lower extremity motor score < 40, indicating impaired ambulation. Demographic and clinical characteristics were tested in univariate analyses and significant factors (p<0.10) were incorporated in multivariate modeling to determine independent predictors of poor outcome. In multivariable analysis, Crawford II, III, or V procedure (OR 4.8, CI 1.4 - 16.7, p = 0.02); near to complete paraplegia at diagnosis (OR 4.5, CI 1.4 - 14.0, p = 0.01); and post-operative renal failure (OR 6.1, CI 1.7 - 21.2, p = 0.005) were all independently associated with poor outcome. Assigning one point to each of these variables generated a prognostic score that accurately stratified which patients were likely to achieve a poorer outcome. Significance: Spinal ischemia during or after surgery of the thoracic aorta often leads to death or disability. All 9 patients who had permanent SSEP changes had clinical evidence of paresis or paraplegia within 1 day of surgery, supporting that SSEPs are sensitive to picking up paraplegia. Patients with transient intraoperative neurophysiologic changes were least likely to have a poor outcome, suggesting that aggressive MAP and CSF goals may prevent significant spinal ischemia and improve outcome. Characteristics known at the time of the event can accurately predict the likelihood of poor outcome. The resulting prognostic score can serve as a tool to aid the surgeons, intensive care physicians, and consulting neurologists in predicting outcome in patients with spinal ischemia. What are your plans for the next couple of years -more fellowship training? -starting a new job, and if so, where? I will be starting a two-year Fellowship in Epilepsy, with some focus on intraoperative monitoring, in July 2012. What type of career are you hoping for over the next few years? Clinical academic medicine/Physician scientist - Ideally, splitting my time between clinical research, seeing patients, IOM and EEG reading, and teaching at an academic center. Are there any particular role models who you worked with and who influenced your interest in clinical neurophysiology and career plans? Dr. Michael McGarvey and Dr. Steve Messe have been wonderful role models and mentors and introduced me to the world of IOM. They also were instrumental in helping me develop my career goals up to this point.
ACNS Newsletter
Focus on Fellows (continued) Ahmad Nizam, MD I am currently in the Neurology Department at Vanderbilt University. The primary mentor for my project was Amir Arain, MD.
Volume 4, Issue 2
Please briefly summarize the project that you presented, including the rationale, methods, what you found, and what the significance may be. Generalized periodic epileptiform discharges is a well known EEG pattern that hasn't received the attention it deserves in the medical literature. Some of the literature about GPEDs was from the old era when routine EEGs predominated. The current wide use of continuous EEG and its predominance in our intensive care unit prompted me to revisit this topic, to study its etiologies, prognosis and occurance of clinical convulsions in patients with GPEDs. We searched our EEG report database over one year period for the presence of generalised periodic epileptiform discharges. We reviewed the medical records of the patients and extracted the following data: patient demographics, etiology of the GPEDs, outcome, occurance of convulsions, treatment that was applied, brain imaging results, duration of the GPEDs pattern and other EEG pattern that emerged later in patients who had GPEDs. We identified 19 patients with GPEDs. It resulted from anoxia in 58% of the cases, and from epilepsy, CNS infection, CJD, and chemotherapy in the rest. 84 % of the total and 91% of the cases resulting from anoxia had poor neurological outcome. 48 % of the cases had convulsions. The GPEDs pattern lasted for up to 18 days in our study patients and in 42% of our patients other EEG patterns emerged later during thier monitoring (burst-suppression, PLEDs, generalized slowing , and triphasic waves). In this study we confirmed the heterogenous etiologies of the GPEDs pattern and its bad prognosis, we showed the predominance of anoxia among its different etiologies and the possible worse prognosis in cases resulting from anoxia. We also showed the dynamic nature of the GPEDs; that it does not always represent a terminal pattern and that it can be replaced by other EEG patterns. What are your plans for the next couple of years -more fellowship training? -starting a new job, and if so, where? I am currently looking for a job. I would like to practice both general neurology and clinical neurophysiology. What type of career are you hoping for over the next few years? I'm open to both academic and private jobs. Are there any particular role models who you worked with and who influenced your interest in clinical neurophysiology and career plans? I owe Dr.Bassel Abou-Khalil from Vanderbilt University. He served as a role model not only for me but for tens and may be hundreds of the clinical neurophysiologists and epileptologists who graduated from Vanderbilt. He always impressed me with his deep knowledge of medical literature and motivated me to read and search for answers to questions I have in my mind.
ACNS Newsletter
Focus on Fellows (continued) Sandipan Pati, M.D. Dept of Neurology, Barrow Neurological Institute Mentors: David M. Treiman. M.D. Marwan Maalouf, M.D., Ph.D. Others: J. Yin, G. Yan, S. Marsh, J. Georges, F. D. Shi
Volume 4, Issue 2
Please briefly summarize the project that you presented, including the rationale, methods, what you found, and what the significance may be. Status epilepticus (SE) generally has poor long term outcomes. The aim of this study is to assess the neuroprotective effects of hypothermia therapy in a validated rodent model of limbic SE. Adult male Sprague-Dawley rats (n = 38) were induced SE for 4.5 hours using lithium-pilocarpine. Half of the rats were subjected to hypothermia (rectal temperature 31-33ยบC) beginning at the time of SE induction. The outcome was assessed at 24 hours. Hypothermia attenuates neuro-glial injury (as evidenced by H and E, cresyl violet histopathology; western blotting using NeuN, Iba1, activated caspase-3; Elisa for IL-1b) and progression of EEG during prolonged status epilepticus. It improved survival rate (odds ratio of surviving 9.53 (p <0.05). This may be translated into clinical practice as an adjunctive therapy to attenuate neuronal damage during SE. What are your plans for the next couple of years -more fellowship training? -starting a new job, and if so, where? Two-year Fellowship in Clinical Neurophysiology, EEG, Epilepsy at Massachusetts General Hospital, Boston. What type of career are you hoping for over the next few years? Clinical Academic Medicine Are there any particular role models who you worked with and who influenced your interest in clinical neurophysiology and career plans? My interest in the field of clinical neurophysiology and epilepsy sparked after working with some brilliant clinical scientists like John Duncan, Sanjay Sisodiya (both at Queen Square, London) and David Treiman (at Barrow Neurology). I am encouraged and constantly self motivated by reading the work of Susan Herman, Robert Fisher, Lawrence Hirsch, and Sydney Cash. I aim to translate neurophysiology from diagnosis to therapy and in prognostication in the setting of critical care and intraoperative.... a truly interventional neurophysiologist.
ACNS Membership If you are not presently a member of the ACNS, please consider joining. Membership benefits include reduced fees for CME-accredited meetings and courses, reduced dues for members in training and early practice physicians, a subscription to the Journal of Clinical Neurophysiology and MORE! For additional information on ACNS and the benefits of membership, please visit the ACNS website: www.acns.org.
ACNS Newsletter
Case of the Month Each issue of Clinical Neurophysiology News will feature a clinical case submitted by an ACNS member. The answer to the case will be available in the Members Only section of the ACNS website (www.ACNS.org). This issue’s case is submitted by William O. Tatum IV, D.O.. For the answer, sign in to the Member’s Only section of the ACNS website: www.ACNS.org.
Volume 4, Issue 2
Case Study: A 15 year old girl was born the 2nd of 3 children with a normal birth, maternal labor, delivery and development. Ear infections were recurrent as a child. At 1 year of age she experienced a convulsion during a fever of 102.7 0F. Her sister and a cousin had seizures too with sudden stiffening, loss of consciousness, and rhythmic body jerking during fevers. At the hospital she was diagnosed with a febrile seizure (FS). A CT of the brain and spinal tap were normal. Later an EEG was normal. She experienced recurrent FS during fevers with her ear infections. She was given a prescription for prolonged seizures in case of a prolonged seizure. She was begun on carbamazepine when she developed convulsions that occurred without fever at 7 years old. With treatment a 2nd type of seizure became noted characterized by single body jerks that would lead to “head nods”. A pediatric epileptologist was consulted after a focal seizure. Brain MRI was normal (see figure 1) and EEG (figure 2) had a normal background with generalized spike-and polyspike-and-waves. AED change to valproate led to seizure control.
1
2
Figure: (1) Normal coronal brain MRI and (2) EEG demonstrating a single generalized polyspike-and-wave in second 2 and generalized spike-andwaves in second 7.
A diagnostic test was performed.
For the answer and references, please sign in to the Members-Only section of the ACNS website: www.ACNS.org If you do not know your login and/or password, please call the ACNS Executive Office at 860-243-3977 or email ACNS@ssmgt.com
ACNS Newsletter
Changes to CPT 2012 By: Marc Nuwer, M.D., Ph.D. CPT codes 95938 and 95939 have been added to the CPT 2012 book as allowable base codes for Intraoperative Neurophysiologic Monitoring, CPT 95920. The change was made as an erratum to the 2012 book, meaning it is effective retroactive to January 1, 2012. RUC Surveys: RUC surveys to set new RVUs for new NCV and autonomic testing codes are in progress. We had expected EEG code surveys too. However the EEG surveys will be carried out this summer for CPT 95816, 95819 and 95822, the three routine EEG codes. Members are strongly encouraged to sign up for participation in the surveys. Solicitations will be sent to membership by email.
Volume 4, Issue 2
Minding Your Business! By: Yafa Minazad, D.O. and Deborah Briggs, M.D. We are delighted to announce the re-vitalization of the Practice of Clinical Neurophysiology Committee of ACNS. My Co-Chair, Dr. Deborah Briggs, and I are looking forward to serving the members of ACNS and AAN. Our main goal is to support members with information and practice tools as they face the challenges of evaluating practice options, as well as developing outpatient and hospital-based programs that involve neurophysiology. We all know this is a critical time in healthcare. Changes are coming, whether it is Affordable Care Act, Romneyâ&#x20AC;&#x2122;s health plan, or some other healthcare proposition. Physician reimbursement is usually the first target of any healthcare dollar cuts. Incentives and bonuses although being heavily negotiated, donâ&#x20AC;&#x2122;t look promising for specialists at this time. Corporations, instrumentation companies and pharmaceuticals are also fighting for those dollars with heavy lobbying and monumental business transactions such as merging and buy-outs. Despite varying opinions, a few themes are heard persistently including quality care measures, patient satisfaction and healthcare at an affordable cost. However, no viable healthcare reform can be achieved without physicians taking charge. This is the time for physicians to show what they bring to the table. We electrophysiologist need to release our leadership and entrepreneurial spirit. Most of us will need to attach our clinical skills to hospital-aligned, financially feasible programs. This is the time to think of innovative ideas, where we design incentives for better health care and take charge of programs to rapidly improve quality of care in a cost efficient manner. For instance, developing a hospital-based neuro-diagnostic program is an avenue to put highly trained neurophysiologists in charge of the care delivered to patients. This assures proper implementations of policies and procedures, ability to implement effective quality control measures, limits hospital liability, and avoids excess cost often associated with vendor services. This column will serve as one of the avenues to be used to communicate with members about the latest business happenings in neuro-electrophysiology. We want to empower and educate members with the necessary resources on neurophysiology indications, protocols, documentation, quality control metrics, coding and billing. We hope to accomplish this by building together a roadmap that will incorporate planning, developing and operating various electrophysiology programs and practice models. Another avenue for communication will be a course in Business Development and Practice Management in Neurophysiology. We hope this crash course neurology MBA will cover the most important topics that any neurologists must know before they enter into the world of practice models and make critical decisions on how to proceed. We are recruiting experts including hospital administrators, attorneys, and risk management specialists to help us with these topics. We encourage all of our members to take full advantage of this opportunity, especially fellows, new grads and residents. Watch the ACNS website for details and dates: www.ACNS.org. We look forward to communicating with you quarterly and seeing you at ACNS 2013. Letâ&#x20AC;&#x2122;s get down to business! We can be contacted at info@ACNS.org for anyone wishing to join our committee, provide comments and suggestions or pose questions.
ACNS Newsletter Volume 4, Issue 2
Thank You 2012 Annual Meeting Exhibitors! Cadwell Laboratories, Inc. CareFusion Compumedics USA Electrical Geodesics, Inc Elekta, Inc. Grass Technologies Lippincott, Williams & Wilkins Natus Medical Incorporated Neuralynx Inc. Nihon Kohden America PMT Corporation Rochester Electro-Medical, Inc. Sleep Med/Digitrace Incorporated UCB Pharma, Inc. WR Medical Electronics Company Thank You to our Non-Profit Organization Exhibitors! ABCN - American Board of Clinical Neurophysiology ASET - The Neurodiagnostic Society ABRET - American Board of Registration of Electroencephalographic and Evoked Potential Technologists ACMEGS - American Clinical Magnetoencephalography Society ASNM - American Society of Neurophysiological Monitoring And another Thank You to the following vendors for loan of equipment for workshops! Cadwell CareFusion Convergence Medical Devices Esaote North America MagStim Persyst
ACNS Newsletter
Mark your Calendar! American Clinical Neurophysiology Society Neurophysiologic Intraoperative Monitoring and ICU EEG Monitoring Courses September 29 - 30, 2012 Hyatt Regency Minneapolis Minneapolis, MN Watch the ACNS website for more details: www.ACNS.org
Volume 4, Issue 2
Save the Date! Exhibitors show dates are February 8 and 9, 2013.
American Clinical Neurophysiology Society One Regency Drive P.O. Box 30 Bloomfield, CT 06002 Phone: 860-243-3977 Fax: 860-286-0787 E-mail: ACNS@ssmgt.com Website: www.ACNS.org