The American Academy of Neurology's top five choosing wisely recommendations

Neurology. 2013 Sep 10;81(11):1004-11. doi: 10.1212/WNL.0b013e31828aab14. Epub 2013 Feb 20.


Objective: To discuss the American Academy of Neurology (AAN)'s Top Five Recommendations in the Choosing Wisely campaign promoting high-value neurologic medicine and physician-patient communication. The AAN published its Top Five Recommendations in February 2013 in collaboration with the American Board of Internal Medicine Foundation and Consumer Reports.

Methods: A Choosing Wisely Working Group of 10 AAN members was formed to oversee the process and craft the evidence-based recommendations. AAN members were solicited for recommendations, the recommendations were sent out for external review, and the Working Group members (article authors) used a modified Delphi process to select their Top Five Recommendations.

Results and recommendations: The Working Group submitted 5 neurologic recommendations to the AAN Practice Committee and Board of Directors; all 5 were approved by both entities in September 2012. Recommendation 1: Don't perform EEGs for headaches. Recommendation 2: Don't perform imaging of the carotid arteries for simple syncope without other neurologic symptoms. Recommendation 3: Don't use opioids or butalbital for treatment of migraine, except as a last resort. Recommendation 4: Don't prescribe interferon-β or glatiramer acetate to patients with disability from progressive, nonrelapsing forms of multiple sclerosis. Recommendation 5: Don't recommend carotid endarterectomy for asymptomatic carotid stenosis unless the complication rate is low (<3%).

MeSH terms

  • Disease Management*
  • Humans
  • Medication Reconciliation / standards*
  • Nervous System Diseases / diagnosis*
  • Nervous System Diseases / therapy*
  • Neurology / organization & administration
  • Neurology / standards*
  • Societies, Medical / organization & administration
  • Societies, Medical / standards
  • United States