AAN issues top five Choosing wisely recommendations

Annette M. Langer-Gould, M.D., Ph.D., from the Los Angeles Medical Center, and colleagues from the AAN's Choosing Wisely Working Group discuss the development of evidence-based recommendations promoting high-value neurologic medicine and physician-patient communication. Recommendations were solicited from AAN members and were reviewed externally. The Top Five Recommendations were selected using a modified Delphi process.

After approval from the AAN Practice Committee and Board of Directors, the authors reported the Top Five Recommendations: (1) not performing electroencephalography for headaches; (2) not performing imaging of carotid arteries for syncope in the absence of other neurologic symptoms; (3) not using opioids or butalbital for migraine, except as a last resort; (4) not prescribing interferon-β or glatiramer acetate for disability associated with progressive, non-relapsing multiple sclerosis; and (5) not performing carotid endarterectomy for asymptomatic carotid stenosis unless the complication rate is lower than 3 percent.

"Moving forward, the AAN's goal is to develop successful implementation strategies for its first Top Five list and to obtain accurate estimates of how much wasteful spending and patient harm can be prevented if these or future recommendations are followed," the authors write.

Several authors disclosed financial ties to the pharmaceutical and health care industries.

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Journal reference: Neurology

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