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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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

(ACNS@ssmgt.com).

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

ACNS@ssmgt.com

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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

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, Is

sue 2

One Regency Drive

P.O. Box 30

Bloomfield, CT 06002

Phone: 860-243-3977

Fax: 860-286-0787

E-mail: ACNS@ssmgt.com

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