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Clinical Neurophysiology News
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Dear Fellow Members of the ACNS,
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.
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 question-
level feedback on performance for self-assessment. Soon after that, we will launch a similar self-
assessment 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
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Clinical Neurophysiology News Newsletter of the American Clinical Neurophysiology Society
Editor Jonathan C. Edwards, 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.
Message from the President
Susan T. Herman, M.D.
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
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
Message from the President (continued)
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
(Continued from page 1)
Incoming
President, Dr.
Susan Herman,
presents a plaque
to ACNS
President, Dr.
Doug Nordli, in
honor of his
leadership over
the past year.
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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!
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 the Annual Meeting
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
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Summary of Annual Courses (continued)
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 clini-
cal neurophysiology research. The Robert S. Schwab Award is presented annually by the American Clinical Neuro-
physiology 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.
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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.
CONGRATULATIONS NEW ACNS FELLOW MEMBERS!
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Congratulations to the fifteen ACNS members who have been upgraded to Fellow Member status! Dr. Nordli pre-
sented certificates to those who were present at the Annual Business Meeting. Pictured with Dr. Nordli are Drs. San-
zenbacher, 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.
Consortium of Clinical Neurophysiology Program Directors Meeting A
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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 sug-
gestions of the program directors, and as a result, improving the Clinical Neurophysiology Programs. Thank you to all
who attended.
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.
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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
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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.
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.
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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.
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.
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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
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 31-33ºC) 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.
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 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 102.70F. Her sis-
ter and a cousin had seizures too with sudden stiffening, loss of consciousness, and rhythmic body jerking during fe-
vers. 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 pre-
scription 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 character-
ized 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 poly-
spike-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-and-
waves 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
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Case of the Month
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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.
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, Romney’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, don’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. Let’s get down to business! We
can be contacted at [email protected] for anyone wishing to join our committee, provide comments and suggestions or
pose questions.
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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
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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
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
Save the Date!
Exhibitors show dates are February 8 and 9, 2013.
