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Guideline Projects in Process

The AAN is currently developing guidelines on the following topics (as of June 2016):

Brain Injury and Brain Death

Disorders of Consciousness (Update)
  • The diagnosis, prognosis, and treatment of VS and MCS
PREDICTION OF OUTCOME IN COMATOSE AFTER CARDIOPULMONARY RESUSCITATION (UPDATE)
  • Update to the 2006 guideline that addressed outcomes and predictors of death or unconsciousness in comatose survivors after cardiac arrest and cardiopulmonary resuscitation (CPR).

Child Neurology

Treatment of Autism: Sleep
  • Do pharmacologic and behavioral treatments reduce the effects of sleep disturbances in this population?
Treatment of Autism: Irritability, Externalizing and Internalizing Behaviors
  • In children with ASD, which complementary and alternative medicine (CAM), behavioral and pharmacological interventions, as compared to placebo or other active interventions, improve symptoms of inattention, impulsivity and hyperactivity?
  • In children with ASD, which CAM, behavioral and pharmacological interventions, as compared to placebo or other active interventions, improve irritability and aggressive behavior?
  • In children with ASD, which CAM, behavioral and pharmacological interventions, as compared to placebo or other active interventions, improve obsessive compulsive behavior, anxiety or depression symptoms?
PHARMACOLOGIC TREATMENT OF MIGRAINE HEADACHE IN CHILDREN
  • In children and adolescents with migraines, do acute treatments, compared with no treatment, reduce headache duration and associated symptoms (especially nausea and vomiting) and maintain headache freedom?
  • In children and adolescents with migraines, do preventive treatments, compared with no treatment, reduce headache frequency?
  • In children and adolescents with migraines, do pharmacologic treatments combined with CBT, compared to no treatment, reduce headache frequency?
TREATMENT OF TICS IN INDIVIDUALS WITH TOURETTE SYNDROME AND CHRONIC TIC DISORDER
  • In children and adults with Tourette Syndrome or a Chronic Tic Disorder, which medical, behavioral and surgical interventions, as compared to placebo or other active interventions, improve tic severity and tic related disability?

Dementia

Detection of Dementia and Mild Cognitive Impairment (Update)
  • What is the evidence for the clinical diagnosis of mild cognitive impairment?
  • What is the outcome of the individuals?
  • Are there useful interventions, medications or otherwise?
  • Is this diagnosis useful to clinicians?
  • Is this diagnosis useful to patients?
BETA-AMYLOID IMAGING FOR ALZHEIMER’S DISEASE
  • Is there a quantitative description of the diagnostic accuracy of amyloid PET? What is its sensitivity and specificity of amyloid PET for determining if AD is the cause of a patient’s symptoms? Without this information, how is a clinician to interpret the results of a positive or negative study?
  • For the clinical indication(s) chosen, how likely is a positive test to be a false positive?
  • What is the quality of the evidence supporting the diagnostic accuracy of amyloid PET?
  • To help the clinician put the role of amyloid PET into perspective, how does the diagnostic accuracy of amyloid PET compare to the common imaging modalities already in routine use—CT or MRI? What is its added value?
  • Is the diagnostic accuracy of amyloid PET high enough to obviate the need to search for reversible etiologies of dementia?
DIAGNOSIS OF DEMENTIA (UPDATE)
  • Update to the 2001 guideline that addressed the accuracy and reliability of dementia diagnostic criteria, laboratory testing, and comorbidities in elderly patients undergoing an initial assessment for dementia.

Epilepsy

Efficacy and Tolerability of the New AEDs: Treatment of new-onset epilepsy (Update)
  • For adults and children with newly diagnosed epilepsy, are FBM, GBP, LTG, OXC, TGB, TPM, LEV, ZNG, PGB, LCM, RFN, EZG, VGB, and CLB effective as monotherapy, and how does their efficacy and tolerability compare with those of older AEDs?
Efficacy and Tolerability of the New AEDs: Treatment-resistant epilepsy (Update)
  • For adult patients with TR focal epilepsy are these AEDs when used as adjunctive therapy (relative to no adjunctive therapy) effective in reducing seizure frequency?
  • For adult patients with TR focal epilepsy are these AEDs when used as monotherapy effective in reducing seizure frequency?
  • For adult and pediatric patients with TR idiopathic generalized epilepsy (IGE) are these AEDs when used as adjunctive therapy effective in reducing seizure frequency?
  • For adult and pediatric patients with LGS are these AEDs when used as adjunctive therapy effective in reducing seizure frequency?
  • For pediatric patients with TR focal epilepsy are these AEDs when used as adjunctive therapy (relative to no adjunctive therapy) effective in reducing seizure frequency?
  • For pediatric patients with TR focal epilepsy are these AEDs when used as monotherapy effective in reducing seizure frequency?
  • Have new serious adverse events (AEs) been identified in these AEDs?
Timing of AED withdrawal in seizure-free patients with epilepsy
  • For children with epilepsy, is there a preferred time for attempting drug discontinuation in patients who are seizure free?
  • For adults with epilepsy, is there a preferred time for attempting drug discontinuation in individuals who are seizure free?
  • Are there risk factors making it more or less likely an individual will have seizure recurrence on medication withdrawal?
  • Are there specific counseling recommendations that would help the patient make an informed decision about the risk and benefits of drug discontinuation?
MANAGEMENT ISSUES FOR WOMEN WITH EPILEPSY-FOCUS ON PREGNANCY (UPDATE)
  • Update to the three 2009 guidelines that addressed obstetrical complications and change in seizure frequency, teratogenesis and perinatal outcomes, and vitamin K, folic acid, blood levels, and breastfeeding

Movement Disorders

Treatment of cerebellar motor dysfunction and ataxia
  • For patients with cerebellar motor dysfunction, do pharmacologic therapies compared to no (or alternative) treatments improve motor symptoms with acceptable safety and tolerability?
  • For patients with cerebellar motor dysfunction, do surgical or other interventional therapies (e.g. physical training) improve motor symptoms with acceptable safety and tolerability?
  • For patients with cerebellar motor dysfunction, does magnetic stimulation compared to no (or alternative) treatments improve motor symptoms with acceptable safety and tolerability?
TREATMENT OF TICS IN INDIVIDUALS WITH TOURETTE SYNDROME AND CHRONIC TIC DISORDER
  • In children and adults with Tourette Syndrome or a Chronic Tic Disorder, which medical, behavioral and surgical interventions, as compared to placebo or other active interventions, improve tic severity and tic related disability?
INITIATION OF TREATMENT OF PARKINSON DISEASE (UPDATE)
  • Update to the 2002 guideline that addressed the following questions: 1) Does selegiline offer neuroprotection; 2) what is the best agent with which to initiate symptomatic treatment in de novo PD; and 3) is there a benefit of sustained release levodopa over immediate-release levodopa?

Multiple Sclerosis

Immunization and MS (update)
  • Are vaccine-preventable infectious diseases more frequent in patients with MS than in the general population?
  • Do vaccine-preventable infectious diseases increase the risk of MS exacerbations?
  • Does vaccination increase the risk of developing MS?
  • Does vaccination increase the risk of exacerbations of MS?
  • Are live attenuated vaccines as effective in patients with MS as in the general population?
  • Are inactivated vaccines as effective in patients with MS as in the general population?
  • Does immunomodulating treatment of MS with corticosteroids, interferons, glatiramer acetate, mitoxantrone, natalizumab, alemtuzumab, or fingolimod reduce effectiveness of vaccinations in MS?
DISEASE MODIFYING THERAPY FOR MS
  • This guideline addresses starting, switching and stopping disease modifying therapy in MS patients. All questions will be answered by MS disease subgroup- relapsing-remitting MS, primary progressive MS, and secondary progressive MS with and without relapses. In addition, data on patients with clinically isolated syndromes of demyelination will be included where applicable.

Neuromuscular

Muscular Dystrophy: Myotonic
  • In patients with DM, what interventions improve clinical myotonia?
  • Do patients with DM1 and DM2 have increased anesthesia/analgesia or other drug-related complications as compared with control subjects?
  • Do patients with DM1 and DM2 have CNS abnormalities as determined by neuropsychological testing, brain MRI, and brain autopsy?
  • Do patients with DM1 and DM2 have increased risks for cardiac complications?
  • Do patients with DM1 and DM2 have increased risks for respiratory complications?
  • In patients with DM, what is the frequency of important gastrointestinal symptoms (such as constipation, diarrhea, abdominal pain, and dysphagia) and serious complications (such as nonmechanical ileus, volvulus, intestinal necrosis, gall bladder diseases, and aspirations) in comparison with control subjects?
  • In patients with DM, how common is excessive daytime sleepiness (EDS)?
  • In patients with DM what interventions improve EDS?

Stroke and Vascular Neurology

PREVENTION OF STROKE IN PATIENTS WITH CLINICALLY SIGNIFICANT INTRACRANIAL ATHEROSCLEROSIS
  • For patients with a history of symptomatic intracranial atherosclerosis, what factors (degree of stenosis, length of stenosis, vascular bed, imaging modalities, sex of patient, race/ethnicity of patient, time from initiating event, whether patient on maximal medical therapy) predict an increased risk of recurrent stroke?
  • Medical, endovascular, and surgical procedures are used to prevent recurrent stroke after a stroke related to intracranial atherosclerosis. No comprehensive evidence-based guideline exists to guide management and future research in patients with symptomatic intracranial atherosclerosis.
  • For patients with a history of symptomatic intracranial atherosclerosis, which medical therapies, as compared with no therapy or an alternative therapy, reduce the risk of recurrent stroke?
  • For patients with a history of symptomatic intracranial atherosclerosis, do endovascular or extracranial/intracranial bypass procedures, as compared with no procedure or an alternative procedure, reduce the risk of recurrent stroke?
TPA AND IA THROMBECTOMY
  • Scoping in progress

Other

Lyme Disease
  • The Infectious Diseases Society of America (IDSA), the American Academy of Neurology (AAN) and the American College of Rheumatology (ACR) are jointly developing a systematic review and clinical practice guideline on the treatment of Lyme disease. The author composition is made up of representatives from IDSA, AAN, and ACR with representation from the American Academy of Family Physicians (AAFP), American Academy of Pediatrics - Committee on Infectious Diseases (AAP-COID), American Academy of Pediatrics - Section on Emergency Medicine (AAP-EM), American College of Physicians (ACP), Association of Medical Microbiology and Infectious Diseases - Canada (AMMI-CA), Child Neurology Society (CNS), Pediatric Infectious Diseases Society (PIDS), Entomological Society of America (ESA), and European Society of Clinical Microbiology and Infectious Diseases (ESCMID). Members representing the disciplines of cardiology, microbiology, pathology, and a methodologist with expertise in GRADE are also included. Finally, the panel includes a healthcare consumer representative, three patients with confirmed Lyme disease, and a parent of a pediatric patient with confirmed Lyme disease. See more at http://www.idsociety.org/Lyme_Response_Public_Comment/
Vestibular Testing (Update)
  • For patients with suspected superior canal dehiscence syndrome (SCD), does cVEMP accurately identify patients with SCD compared to other methods?
  • For patients with suspected vestibular symptoms, does cVEMP accurately identify the presence of underlying vestibular dysfunction?
  • For patients with suspected CNS disorders affecting the vestibulospinal tracts, does cVEMP identify the presence of underlying disease affecting these brainstem and spinal cord pathways?
NEUROLOGIC RISK OF IMMUNIZATION (UPDATE)
  • Questions currently under determination.
USE OF EPIDURAL STEROID INJECTIONS TO TREAT RADICULAR LUMBOSACRAL PAIN (UPDATE)
  • In patients with radiculopathy (lumbar, cervical), do epidural corticosteroid injections, compared to placebo or active control: a) reduce pain; b) improve disability or physical function/impairment/ ADL/self-management/ independence/; c) improve QOL or other patient reported outcomes; d) influence subsequent surgery; e) reduce analgesic or opioid use; f) reduce time to pain relief?
  • In patients with spinal stenosis (lumbar, cervical), do epidural corticosteroid injections, compared to placebo or active control: a) reduce pain; b) improve disability or physical function/impairment/ ADL/self-management/ independence/; c) improve QOL or other patient reported outcomes; d) influence subsequent surgery; e) reduce analgesic or opioid use; f) reduce time to pain relief?

Suggest a Topic

On a quarterly basis, the Guideline Development, Dissemination, and Implementation Subcommittee will review and approve guideline topics. If you have an interest in suggesting a topic, please complete the topic nomination form and submit to guidelines@aan.com for consideration.

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