ACNS March 2011 Newsletter
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Transcript of ACNS March 2011 Newsletter
Dear Fellow Members of the ACNS,
Like many of you I came away from this year's meeting rejuvenated
and excited about the future of clinical neurophysiology. Special
thanks go to the organizers of the courses and scientific program:
William O. Tatum IV Aatif M. Husain, and Noor A. Pirzada.
In typical American fashion our discipline has re-invented itself.
Clinical neurophysiology can no longer be lumped with those
terrible stereotypes of 20th century neurology as a field with limited
therapeutic potential. How long have we had to bear the brunt of
jokes like those citing us as purveyors of "perfectly accurate and
totally useless information"? Now, we can hold our heads up high
because we have become do-ers. We are using our techniques in
ways previously unimaginable to dramatically enhance therapies and to avoid neurologic injury.
In effect we have shifted from static to dynamic mode: performing continuous monitoring to
protect the nervous system from harm, measuring nerve conduction in the OR to aid in surgical
decisions, and reading intraoperative electrocorticigraphy, We are intervening in all sorts of
ways: from injecting Botox to treating non-convulsive status epilepticus. All of this has come
about in the span of a decade or so. These are very exciting times!
So much so that Francis Walker mentioned "intervention" as one of the themes for next year's
meeting and I think it is a great idea. By the way, as co-chairs of the scientific program Francis
and Cecil Hahn are eager to hear from you about your suggestions to enhance our annual
meeting. Please put San Antonio on your schedule!
I have a few specific goals for this year. I'd like to see us continue the efforts started by my
predecessors to make our society younger and even more diverse. We should set a modest and
achievable goal for growth in membership as we establish our society as The Home for people
interested in clinical neurophysiology. How about 50 new members? We can all start on both of
these by reaching out to our fellows shortly after the start their training this July. Let's try to
attract members that will be active in the society I would like to enhance the quality of our
educational materials by converting to greener technology with a goal to convert to digital files
for next year's handouts. We should speed up the process of our guideline production, materials
that our members highly value, and set specific goals for delivery, maybe 3 guideline
enhancements per year. We'll have to revamp our committee structure and procedures a bit to
do this. Jonathan Edwards wants to increase the frequency of our newsletter to quarterly, and
use the newsletter to help stay in regular communication with members and improve awareness
of important issues as they arise. Finally, a personal interest is to work on increasing the
involvement of pediatric clinical neurophysiologists. We are very fortunate to have experienced
and very capable administrators to help us work hand in hand to meet our goals, but it will take a
(Continued on page 2)
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11
Clinical Neurophysiology News Newsletter of the American Clinical Neurophysiology Society
Editor Jonathan C. Edwards, M.D
Future Meetings
2012 Annual Meeting
and Courses
February 2-7, 2012
Marriott Rivercenter
San Antonio, TX
Program Co-Chairs:
Cecil Hahn, M.D. &
Francis Walker, M.D.
Call for Proposals for
Symposia, Clinical
Workshops, and Other
Didactic and Interactive
Sessions. Visit
www.ACNS.org for
details. Submission
deadline April 1, 2011
Message from the President
Douglas R. Nordli Jr., M.D
American Clinical
Neurophysiology Society
2009-2010 Council Members
PRESIDENT
Douglas R. Nordli, Jr., M.D.
Children's Epilepsy Center
Chicago, IL
1ST VICE PRESIDENT
Susan T. Herman, M.D.
Beth Israel Deaconess Medical Center
Boston, MA
2ND VICE PRESIDENT
Frank W. Drislane, M.D.
Beth Israel Deaconess Medical
Center
Newton, MA
SECRETARY
Aatif M. Husain, M.D.
Duke University Medical Center
Durham, NC
TREASURER
Stephan Schuele, M.D., M.Ph. Northwestern University Neurology
Chicago, IL
IMMEDIATE PAST PRESIDENT
Peter W. Kaplan, MB, FRCP
Johns Hopkins Medical Center
Baltimore, MD
PAST PRESIDENT
Gareth J. Parry, M.D.
University Minneapolis
Minneapolis, MN
COUNCIL MEMBERS
Jonathan C. Edwards, M.D.
Medical University of South Carolina
Charleston, SC
Terrence D. Lagerlund, M.D.
Mayo Clinic
Rochester, MN
Suzette LaRoche, M.D.
Emory University Medical Center
Atlanta, GA
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
Elizabeth J. Waterhouse, M.D.
Medical College of Virginia Medical
Center
Richmond, VA
Message from the President (continued)
little effort from all of us to make this happen. Please, if you know of young, dynamic,
energetic folks who might want to contribute to these projects, point them our way. Reach
out to Tobias Loddenkemper and Stephan Schuele for any suggestions you have about
bolstering membership.
Thanks to those of you who were able to visit with us in New Orleans and please spread the
word about the exciting developments within our society so that even more of our colleagues
join us in San Antonio. In the meantime, here's hoping your impedances are low, your
tracings are clean, and the signal to noise ratio of all of your professional endeavors is high!
Doug
President American Clinical Neurophysiology Society
(Continued from page 1)
Incoming
President,
Dr. Doug
Nordli (left),
presents a
plaque to
ACNS
President
Dr. Peter
Kaplan
(right) in
honor of his
leadership
over the past
year.
Highlights of the Annual Meeting
This year’s Annual Meeting, which took place in New Orleans under the direction of Co-
Chairs Dr. Aatif Husain and Noor Pirzada, was a huge success despite severe weather
conditions throughout the USA all week. With only a handful of meeting and course
registrants canceling due to the weather, there were a total of 269 attendees. Individuals
traveled to New Orleans from 39 states, including Puerto Rico, and also Canada, England,
Italy, Japan, Nepal, Netherlands, Qatar, Saudi Arabia, Thailand and West Indies. In
addition, there were 16 exhibitors and representation from the ABCN, ABRET, ASET and
the ASNM.
Attendees learned about the exciting research in clinical neurophysiology, networked with
colleagues, reunited with friends, and enjoyed an ever joyous, though cold, New Orleans!
The ACNS remains the only place where all aspects of clinical neurophysiology are
discussed and debated. This year the Jasper award was presented to a most deserving
pioneer of clinical neurophysiology, Dr. C. William Erwin. The Gloor awardee was Dr. Paul
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Summary of the Annual Courses
by: William O. Tatum IV, D.O., Annual Course Chair
This year the ACNS met in the heart of Dixie in the wake of unfavorable weather conditions in the north. The roster of
courses included notable contributions in several areas of clinical neurophysiology provided by eminent leaders in the
field of EMG, sleep physiology, and provided the latest developments in the emerging fields of ICU and
neurophysiologic intraoperative monitoring.
Brand new features this year took the ACNS to a higher level of course direction by implementing co-moderators that
were able to co-direct the well-rounded faculty of extremely dedicated professionals. The breakfast seminars included
the ever-popular evoked potential reading session, the limited-entry nerve conduction workshop, and the new
quantitative EEG primer as an early morning complement to the didactic courses to successfully complement this
years’ outstanding program.
In the up and coming year, the ACNS will further evolve the Annual Courses segment to pilot an AM-PM graded
degree of difficulty in addition to highlighting the return of the hottest topics in EEG. Addressing the gaps in the field
of clinical neurophysiology and new emerging areas of interest promises will be the directives to make the 2012 annual
meeting one you don’t want to miss to learn about the latest developments in clinical neurophysiology.
Nunez, who in his lecture challenged the audience to think about consciousness in terms new to most
neurophysiologists. The Schwab award was presented in absentia to Dr. Andrew Eisen, who could not attend due to
unavoidable circumstances. The plenary sessions were very well received as well, and the special session on Human
Adaptation to Spaceflight by Dr. Story Musgrave, surgeon and NASA astronaut, was a truly unique and wonderful
experience. Dr. Musgrave graciously signed autographs and shared experiences with attendees before and after his
program.
The President of the ACNS, Dr. Peter Kaplan, kicked off the Presidential Symposium with a discussion about
nonconvulsive status epilepticus (NCSE). Drs. Bryan Young and Frank Drislane discussed the important issues of
neuronal injury and treatment of NCSE. Other central neurophysiology topics presented included neonatal ICU EEG
monitoring and neurophysiology of hypothermia. A debate about the utility of invasive EEG monitoring in temporal
lobe epilepsy drew a large audience, as did the workshop on quantitative ICU EEG analysis. A discussion on “How Not
to Read an EEG,” generated passionate discussion about “over reading” of EEGs. In addition to the course on
neurophysiologic intraoperative monitoring (NIOM), a symposium on localization of eloquent cortex further enhanced
the NIOM education.
A wide range of EMG/Neuromuscular topics were presented at the 2011 meeting in New Orleans. These included
comprehensive symposia on Clinical and Electrophysiologic features of Neuromuscular Junction disease, State of the
art Quantitative studies of Autonomic function and a discussion on all aspects of primary Muscle disease, which were
very well received by the participants. Workshops on Focal Neuropathies and EMG waveform recognition provided an
excellent review for trainees, practitioners as well as academic faculty. The Special Interest Group (SIG) meeting
provided an appropriate forum for attendees with specialized interests to interact and an interesting topic discussed at
this year’s Neuromuscular SIG meeting was identification of Neuromuscular diseases by quantification of decomposed
needle EMG. The EMG section is continuing to grow and we hope that in the future, with increasing awareness of the
EMG/Neuromuscular programs provided at our annual meetings we will attract a sizable number of participants. Based
on feedback from our membership we hope to provide more “hands on” EMG sessions next year.
New this year was special interest group (SIG) meetings for NIOM, ICU EEG, EMG, and sleep. All SIGs were well
attended and received very favorable evaluations. The ACNS annual meeting continues to be an excellent opportunity
for residents/fellows to submit posters, and a record number of travel fellowships were awarded this year to trainees
whose abstracts were accepted. The Program Committee for the 2012 meeting, chaired by Drs. Cecil Hahn and Francis
Walker, is already planning for next year’s meeting. Proposals are being sought now for symposia, discussion groups,
debates, and workshops. We hope to see you again in San Antonio in 2012!
Highlights of the Annual Meeting (continued)
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Dr. Andrew Eisen, Professor Emeritus of
Neurology at the University of British Columbia,
Canada, was awarded the 2011 Robert S. Schwab
award but was unable to attend the meeting.
Congratulations Dr. Eisen!
Awards
ACNS President,
Dr. Peter Kaplan,
presents Dr. C.
William Erwin with
the 2011 Herbert H.
Jasper Award.
ACNS President,
Dr. Peter Kaplan,
and Dr. Mark
Hallett, Councilor,
present Dr.
Paul Nunez with
the 2011 Pierre
Gloor Award.
Congratulations to the winners of the highest awards bestowed by the ACNS! The Herbert H. Jasper Award is given to
an individual for a lifetime of outstanding contributions to the field of clinical neurophysiology; the Pierre Gloor Award
is given to an individual for outstanding contributions to clinical neurophysiology research; and the Robert S. Schwab
Award is given to an individual for outstanding achievement in the field of Clinical Neurophysiology.
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The 2011 ACNS Neurophys Bowl, with Co-Chairs Larry Hirsch and Mark Ross, was a huge
success and enjoyed by participants and attendees alike. Four teams competed – two in the
“Up and Coming” category (including a Travel Fellows team) and two in the “Old and Wise”
category. In the end, after a dramatic comeback, the Up and Coming “Fast Ripples” (Drs.
Mike McGarvey, Cecil Hahn, Sarah Schmitt and Shafeeq Ladha) defended their title in a nail-
biter, once again defeating the Old and Wise runner-ups, the “Left Temporal Slow
Waves” (Drs. Francis Walker, Susan Herman, Mark Hallett and Marc Nuwer).
Thanks also to the “Normal Variants” (Drs. Madeleine Grigg-Damberger, Bruce Fisch, Bill Tatum and Francis
Walker) for competing, and to The Honorable Peter Kaplan, President and Neurophys Bowl Judge.
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 2012 Neurophys Bowl in San Antonio! The registration form can be found on the
ACNS website (www.ACNS.org) or by contacting the ACNS Executive Office by phone (860-243-3977) or email
Neurophys Bowl - 2011
Thank You 2011 Annual Meeting Exhibitors!
Blackrock Microsystems
Cadwell Laboratories, Inc.
CareFusion
Compumedics USA
Electrical Geodesics, Inc
Elekta, Inc
Grass Technologies
Ideal Health Careers, Inc.
IOM Solutions
Ives EEG Solutions, Inc.
Lippincott, Williams & Wilkins
Max Neuro Supply, Inc.
Natus Medical Incorporated
Nihon Kohden America
PMT Corporation
Rochester Electro-Medical, Inc.
Thank you also to CareFusion for loan of
EEG Equipment for the Nerve Conduction Workshop!
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Focus on Fellows
ACNS President, Dr. Peter Kaplan, and 2011 Travel Fellows.
Twelve neurophysiology fellows from around the world won travel scholarships to this year’s ACNS annual meeting in
New Orleans. They presented posters on a wide range of topics, and the projects were of exceptionally high quality.
Over the next few issues of Clinical Neurophysiology News, we will shine the spotlight on these fellows. This group of
new colleagues includes some rising stars in our field. Please keep an eye out for them as we discuss their background,
their projects and their upcoming plans.
American Clinical Neurophysiology Society 2011 Travel Fellows
Allan Azarion, M.D.
University of Pennsylvania, Philadelphia, Pennsylvania
Mackenzie Cervenka, M.D.
Johns Hopkins University, Baltimore, Maryland
Leo L.K. Chen, M.D.
UCLA Medical Center, Los Angeles, California
Brandon Foreman, M.D.
Columbia University, New York, New York
Koichi Hagiwara, M.D.
Kyushu University, Fukuoka, Japan
Ram Mani, M.D.
University of Pennsylvania, Philadelphia, Pennsylvania
John J. Millichap, M.D.
Children's Memorial Hospital, Chicago, Illinois
Wei Ping Kay Ng, M.D.
National University Health System, Singapore
Rajdeep Singh, MBBS, MS
Duke University Medical Center, Durham, North Carolina
Fleny S. Thomas, M.D.
University of New Mexico, Albuquerque, New Mexico
Wang Xinning, M.D.
Peking Union Medical College, Beijing, China
Wang Yue, M.D.
Tianjin Medical University, Beijing, China
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Focus on Fellows (continued)
Wang Yue, MD.
Dr. Wang Yue is currently a trainee at the Department of Neurology at Tianjin Medical University
General Hospital. Her primary mentor is Professor Cui Li-ying, and she is also mentored by Dr. Liu
Ming-sheng.
In describing the project that she presented, she told Clinical Neurophysiology News:
“The rationale of the project was to recognize different pattern of GBS by serial electrophysiological studies,
as well as their prognosis. In this study, eighteen patients with GBS were studied by clinical and
electrophysiological methods”.
As she explains further, she and her colleagues found that
“electrodiagnostic results showed that 55.6% of the patents had acute inflammatory demyelinating
polyneuropathy (AIDP), 11.1% had AMAN, and 33.3% were unclassified. The type of GBS in two patients was
verified as AIDP by serial electrodiagnostic studies instead of AMAN.”
In terms of the essential take-home point of this study, she indicates that:
“it is important to follow up patients with GBS by sequential eletrophysiological studies in discriminating
between demyelination and axonal degeneration”.
In terms of her future, she plans to continue her fellowship training, and pursue a career in Academic Medicine, either
as an academic clinician or physician scientist. She especially acknowledges Professor Cui Li ying as a role model that
has influenced her interest in clinical neurophysiology and her career plans.
Wang Xinning, MD
As we all know, great mentors have a tremendous influence on the careers of the next generation of
academic physicians. Dr Wang Xinning presented an excellent project, and also names Professor
Cui Li-ying as a mentor who aroused her interest in electromyography and NCS. Wang Xinning
attended the ACNS meeting as a travel scholarship winner from the Department of Neurology,
Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union
Medical College.
Her presentation was titled "A Clinical Neurophysiological Study of Hirayama Disease". About her project, she told
Clinical Neurophysiology News:
“Neurophysiological studies, including electromyography(EMG), motor conduction velocity (MCV), sensory
conduction velocity(SCV) and F-wave, were performed in 27 patients with the diagnosis of Hirayama Disease.
EMG was selectively performed on upper and lower extremities, sternocleidomast and thoracic paraspinal
muscle according to the clinical features of the patient”.
She and her colleagues reported that
“decreased compound muscle action potentials (CMAP) were found in nerve conduction velocity
examinations. The abnormality rate of median F-wave persistence was 22.2%. The study of EMG
demonstrated the neurogenic lesion in all patients with spontaneous potentials, prolonged latency or augment
of amplitude in motor unit potentials (MUPs), or abnormal pattern of MUPs recruitment. 33.3% of patients
showed EMG abnormalities only in upper extremities, whereas 66.7% of patients have abnormalities in lower
extremities, sternocleidomast and thoracic paraspinal muscle. Changes of EMG showed that the right side
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Focus on Fellows (continued)
were more affected than the left side. As a result, EMG can detect neurogenic lesion in one or more segments
in patients with Hirayama disease”.
She plans to pursue this topic further, by indicating that neurophysiological methods will be used to evaluate disease
activity in a follow-up study. She has also planned study of amyotrophic lateral sclerosis. She will be completing her
fellowship in 2012, and hopes for a career in academic medicine.
Kay Wei Ping Ng, MB.BS, MRCP (UK), M.Med (Singapore)
Dr. Kay Wei Ping Ng presented a poster from a very interesting project titled " Evolving Axonal
Neuropathy: A Rare Complication of Colchicine". She is currently in her final year of a three-
year specialist Neurology training program in Singapore at the University Medicine Cluster,
National University Health System. Her primary mentor on this project was Dr Rahul
Rathakrishnan, and other colleagues who participated in the study included Dr. Yee Cheun Chan
and Prof. Einar Wilder-Smith.
When asked to describe her project for Clinical Neurophysiology News, she told us:
“We aimed to highlight acute evolving neuromyopathy as a possible complication of colchicine, and how its
recognition can avoid redundant and invasive further investigations or treatments. We featured 2 patients with
serial clinical examinations, nerve conduction studies (NCS) and needle electromyogram (EMG) studies. Both
had chronic kidney disease, taking customary doses of colchicine, presenting with subacute proximal, then
distal, limb weakness and sensory loss. The first patient had an initially normal NCS 3 days following the
onset of her symptoms. Repeat NCS was suggestive of an evolving sensorimotor axonal polyneuropathy. The
NCS for the second patient performed 2 weeks after symptom onset showed a moderate sensorimotor axonal
polyneuropathy, and EMG showed myotonic discharges.
Both patients made a full clinical recovery weeks after colchicine cessation, but while EMG abnormalities
resolved, the NCS abnormalities remained. These cases illustrate how NCS changes may lag behind clinical
onset and recovery in colchicine neuromyopathy. We therefore propose that patients with neuromyopathy on
colchicine should be observed for at least a few weeks following drug cessation before unnecessary
investigations or treatments are performed”.
She will be completing her Neurology training this year, and has great enthusiasm for a career in academic Neurology.
She plans to obtain board accreditation in Neurology this year, and intends to pursue a fellowship in the United States,
“to expand my horizons in both clinical medicine and research. I am excited with the prospect of being able to
bring new insights and techniques back to my hospital practice to further improve patient care”.
She cites several mentors who have guided her interest in academic Neurology. “Dr. Rahul Rathakrishnan, who trained
in epileptology at the Montreal Neurological Institute, has always been very supportive of my interest in research, and
has also helped deepen my interest in EEG reading. In addition, Dr Yee Cheun Chan and Prof Einar-Wilder Smith have
both brought me through multiple nerve conduction studies and electromyograms, and were the ones to encourage me
to submit an abstract for the ACNS meeting. I am also very grateful to my head of division, Prof Benjamin Ong, and
the rest of my department for allowing me the training opportunities”.
The opportunity to present her work at the ACNS meeting has been a great experience for her. She informed us that:
“The ACNS meeting had also given me the chance to exchange experiences with fellow neurology residents
and fellows, and I was thrilled to attend presentations given by the authors of the journals and texts that we
study from! I would say that this meeting itself has intensified my interest in the subject, where, having seen my
mentors' obvious enthusiasm for clinical neurophysiology being mirrored in people from all over the world, I
am encouraged to be a part of that community as well”.
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Focus on Fellows (continued)
Koichi Hagiwara, M.D., Ph.D.
Dr. Koichi Hagiwara attended the ACNS annual meeting as a traveling scholar from the
Department of Clinical Neurophysiology, Kyushu University, Fukuoka, Japan. His primary mentor
for this project was Dr Shozo Tobimatsu. His co-investigators included Drs Katsuya Ogata,
Tsuyoshi Okamoto, Hiroshi Shigeto, and Yuko Somehara.
In describing his project, Dr. Hagiwara told Clinical Neurophysiology News:
“Age-related electrophysiological changes in the primary somatosensory cortex (SI) are well established: the
amplitude of the N20 component of median nerve somatosensory evoked potentials typically increases with
age, probably because of cor125ical disinhibition. The secondary somatosensory cortex (SII) receives direct
input from the SI and the thalamus. In our study, we quantified age-related changes in the SII using
magnetoencephalography (MEG). We recorded somatosensory evoked magnetic fields (SEFs) in response to
right median nerve stimulation in 72 healthy volunteers (36 females, 22-69 years of age)”.
In terms of the key findings, he informed us that
“The latency, amplitude and dipole moment of the N20m correlated positively with age. In contrast, the
latency of the SII response (80-120 ms) correlated inversely with age. There were no significant age-related
correlations for the amplitude and dipole strength of the SII response. We also analyzed time-frequency
domain to evaluate two indexes for neural synchrony. One is a phase-locking factor (PLF), which is an index
of phase synchronization with respect to the stimuli. The other is a phase-locking value (PLV), which is an
index of phase synchronization between the two cortical areas (i.e., SI and SII). The PLF analysis revealed
increased phase-locked oscillations both in the SI and SII. The PLV analysis showed enhanced phase
synchrony between the SI and SII, particularly in the gamma-frequency band. The incresed PLFs and PLVs
indicate age-associated increase in cortical excitability in the two cortical areas. As in the SI, the increase in
the PLFs in the SII began from the early post-stimulus period, probably because of the direct thalamocortical
pathway to the SII”.
Dr. Hagiwara tells us that significance of the study was in demonstrating that:
“Age-related plastic change of the SII was suggested by the shortening of the latency in the SEF analysis.
Increased PLFs and PLVs may reflect cortical disinhibition in the SI as well as the SII. Our results suggest
that the age-related plastic changes of the SII may result from enhanced short-latency inputs to the SII, which
is mediated by the direct thalamocortical pathway”.
Dr. Hagiwara plans to continue to work as a Neurologist a Neurophysiologist, and hopes to develop his career with
further training. He cites Dr. Yoriaki Yamashita as an important role model who has influenced his interest in
neurophysiology and his career plans.
Please check upcoming issues of Clinical Neurophysiology News where we will focus on additional 2011 Travel
Fellows.
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.
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.
Case Study:
A 63 year old right-handed female had a recent quintuple bypass for coronary artery disease with comorbid hyperten-
sion, diabetes, and chronic renal insufficiency. She was at home and suddenly collapsed, though was “immediately”
resuscitated after her husband called 911. She was asystolic on arrival and in the ED had a witnessed “grand mal” sei-
zure during intubation and was administered Levitiracetam (LEV) 1000 mg IV. A CT brain was normal. Neurology
evaluation on arrival to the NICU demonstrated a comatose patient despite a transient reduction of neuromuscular
blocking medication. What is featured on the EEG in (A), and what actions were taken to result in (B)?
A B
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
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Case of the Month
The Board and Commissioners of CAAHEP want to thank
American Clinical Neurophysiology
Society
For joining us as a partner in the important process of accrediting ENT educational programs.
The quality assurance that accreditation of these programs
promotes protects patients and students as well as enhancing the profession.
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,
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 Membership A
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Medicare Physician Fee Schedule Changes for 2011
by: Dr. Marc Nuwer
Relative Value (RVU) changes for Neurodiagnostic procedures were mixed for the calendar year 2011. The overall
Conversion factor declined, which affected all codes for all fields. The combined effect of the RVU changes and
Conversion factor changes on technical components improved moderately. In contrast, most professional fees were
unchanged or declined.
The improvements in most Neurodiagnostics were the result of AMA action by ACNS along with AAN and other
societies. Specifically, your society lobbied AMA and the Center for Medicare and Medicaid Services (CMS) to audit
the actual practice costs for physician’s practices. The societies believed that CMS was not crediting neurologists as
having as high of practice costs as actually occurred in real practice. A neutral outside firm conducted the audit.
Practice expenses were measured by reviewing the portions of practices’ income tax statements’ pertaining to practice
costs. As was expected by ACNS and AAN, the actual costs of neurologists’ practices was higher than previously
considered by CMS. Over the past year and the next several years, CMS is adjusting neurologists’ practice expenses
upward. This applies most directly to services provided in office by neurologists such as EEG. Services provided
most by other specialties, e.g. Sleep testing, was affected much less. Whereas neurologists’ practice expenses had
been too low, some other specialties practice expenses had been too high. The latter specialties are seeing a drop in
their services’ RVUs.
A second effect also occurred. The Sleep Testing RVUs were reassessed. In the old way of assessing RVUs, each
service was assessed as a single stand-alone test. More recently it came to CMS’s attention that polysomnography
often was performed by one technologist for two patients. That was an economy of scale not accounted for in the
previous RVU system. That was factored into the RVUs for Sleep Studies recently, resulting in a drop in RVUs for
polysomnography.
Technical Professional
Component Component
EEG + 26-28% + 0%
PSG - 27-29% - 4-6%
MSLT + 16% - 33%
EPs + 17-26% - 1-2%
Video-EEG N/A + 0
EMG + 19- 24% + 0
NCV + 16 - 0-2%
At the same time, outpatient visits saw modest gains. Levels 4 and 5 new and established office patients increased by
2%.
ACNS 2012 Annual Meeting and Courses
February 2-7, 2012
Marriott Rivercenter
San Antonio, TX Program Co-Chairs: Cecil Hahn, M.D. &
Francis Walker, M.D.
Call for Proposals for Symposia, Clinical Workshops, and
Other Didactic and Interactive Sessions
Proposals are being sought for Symposia, Clinical Workshops and other
didactic and interactive sessions for the 2012 American Clinical
Neurophysiology Society (ACNS) Annual Meeting which will take place
at the Marriott Rivercenter in San Antonio, Texas. This call for proposals
is to enhance the opportunities for clinicians and investigators to introduce
advanced scientific or clinical topics for those interested in the field of
clinical neurophysiology. All details and submission forms are on the
ACNS website: www.ACNS.org. Please note: Submission deadline is
April 1, 2011.
AC
NS
New
slett
er
Vo
lum
e 3
, Is
sue 2
One Regency Drive
P.O. Box 30
Bloomfield, CT 06002
Phone: 860-243-3977
Fax: 860-286-0787
E-mail: [email protected]
Website: www.ACNS.org
American Clinical Neurophysiology Society
2013 Annual Meeting and Courses
February 5 - February 10, 2013
Miami Marriott Biscayne Bay
Miami, Fl
Watch the ACNS website for details:
www.ACNS.org