Neurology June 2012 Volume 2 Issue 2

Summary: The prevalence of gait disturbances and falls increases dramatically with age, but these problems are not universal in the elderly. They should trigger a systematic search for underlying disease states, many of which can be treated medically or surgically, or significantly ameliorated through provision of physical therapy focused on gait training and aids to ambulation, removal of safety hazards in the environment, and the elimination of polypharmacy. While cardiovascular, orthopedic, and rheumatologic diseases account for the majority of gait disturbances in the elderly, the aim here is to outline an approach to the diagnosis and treatment of a broad array of neurologic conditions causing gait disturbance in the elderly.(C)2012AAN Enterprises, Inc.

Summary: Getting the facts about risk and benefit is a critical part of medical decision-making. But when doctors and patients disagree on what is reasonable risk, it takes more than a grasp of the data to establish the way forward. Our competence as physician-scientists relies on our ability to master the mechanics and information flow of our specialty. But we physicians, curious amalgams of scientists, scholars, researchers, and healers, should be aware of how we respond to the uniqueness of each of our physician-patient relationships, and be willing to explore ways in which the psychological and interpersonal dynamics influence the ethical, medically correct choices we pursue in them.(C)2012AAN Enterprises, Inc.

Summary: Health insurers look for reliable, published evidence such as evidence-based guidelines put forth by medical specialty societies to craft their coverage policies. These guidelines generate both beneficial and controversial consequences on policies. Coverage policies aim to address the most typical clinical presentations. The American Academy of Neurology guideline for IV immunoglobulin strengthens the case for coverage when it is used to treat Guillain-Barre syndrome and chronic inflammatory demyelinating polyradiculoneuropathy. The guideline is less likely to strengthen coverage for several other diagnoses with lower levels of evidence. The responsibility to clarify specific situations when patient need falls outside of what is considered to be routine evaluation or treatment rests heavily on the physician. Advice on appealing an unfavorable coverage decision is also provided to the reader.(C)2012AAN Enterprises, Inc.

Summary: Intraoperative neuromonitoring (IONM) is a growing field within neurology. IONM uses a variety of neurophysiologic modalities to detect signs of potential injury to neural structures while a patient is undergoing surgery. An early warning to the surgeon about signal changes may prevent permanent neurologic disability. Since all monitoring is done in real time, the work pace is fast. The operating room environment poses additional challenges for signal acquisition and interpretation. Specific training in the field is becoming increasingly available. Several practice models exist and IONM can be performed in an academic or a private practice setting. A career in intraoperative neuromonitoring can offer lots of opportunities, a high degree of job satisfaction, and flexibility to those choosing to enter the field.(C)2012AAN Enterprises, Inc.