United Council For Neurologic Subspecialties Research Articles

Real-world approaches to outpatient treatment of status migrainosus: A survey study.

Identify how the American Headache Society (AHS) membership manages status migrainosus (SM) among outpatients. SM is defined as a debilitating migraine attack lasting more than 72 h. There is no standard of care for SM, including whether a 72-h duration is required before the attack can be treated as SM. The Refractory Headache Special Interest Group from AHS developed a four-question survey distributed to AHS members enquiring (1) whether they treat severe refractory migraine attacks the same as SM regardless of duration, (2) what their first step in SM management is, (3) what the top three medications they use for SM are, and (4) whether they are United Council for Neurologic Subspecialties (UCNS) certified. The survey was conducted in January 2022. Descriptive statistical analyses were performed. Responses were received from 196 of 1859 (10.5%) AHS members; 64.3% were UCNS certified in headache management. Respondents treated 69.4% (136/196) of patients with a severe refractory migraine attack as SM before the 72-h period had elapsed. Most (76.0%, 149/196) chose "treat remotely using outpatient medications at home" as the first step, 11.2% (22/196) preferred procedures, 6.1% (12/196) favored an infusion center, 6.1% (12/196) sent patients to the emergency department (ED) or urgent care, and 0.5% (1/196) preferred direct hospital admission. The top five preferred medications were as follows: (1) corticosteroids (71.4%, 140/196), (2) nonsteroidal anti-inflammatory drugs (NSAIDs) (50.1%, 99/196), (3) neuroleptics (46.9%, 92/196), (4) triptans (30.6%, 60/196), and (5) dihydroergotamine (DHE) (21.4%, 42/196). Healthcare professionals with expertise in headache medicine typically treated severe migraine attacks early and did not wait 72 h to fulfill the diagnostic criteria for SM. Outpatient management with one or more medications for home use was preferred by most respondents; few opted for ED referrals. Finally, corticosteroids, NSAIDs, neuroleptics, triptans, and DHE were the top five preferred treatments for home SM management.

Promoting Growth in Behavioral Neurology: A Path Forward.

Behavioral neurology & neuropsychiatry (BNNP) is a field that seeks to understand brain-behavior relationships, including fundamental brain organization principles and the many ways that brain structures and connectivity can be disrupted, leading to abnormalities of behavior, cognition, emotion, perception, and social cognition. In North America, BNNP has existed as an integrated subspecialty through the United Council for Neurologic Subspecialties since 2006. Nonetheless, the number of behavioral neurologists across academic medical centers and community settings is not keeping pace with increasing clinical and research demand. In this commentary, we provide a brief history of BNNP followed by an outline of the current challenges and opportunities for BNNP from the behavioral neurologist's perspective across clinical, research, and educational spheres. We provide a practical guide for promoting BNNP and addressing the shortage of behavioral neurologists to facilitate the continued growth and development of the subspecialty. We also urge a greater commitment to recruit trainees from diverse backgrounds so as to dismantle persistent obstacles that hinder inclusivity in BNNP-efforts that will further enhance the growth and impact of the subspecialty. With rapidly expanding diagnostic and therapeutic approaches across a range of conditions at the intersection of neurology and psychiatry, BNNP is well positioned to attract new trainees and expand its reach across clinical, research, and educational activities.

Online Core Curriculum and Mastery (OCCAM): A Behavioral Neurology & Neuropsychiatry (BNNP) Curricular Needs Assessment.

Behavioral neurology & neuropsychiatry (BNNP) fellowships are accredited by the United Council for Neurologic Subspecialties (UCNS). Programs cover the UCNS-recommended topics differently. A curriculum accessible to all fellowships would standardize education and identify gaps in topics that are less well covered across programs. The purpose of the present needs assessment was to inform the development of the Online Core Curriculum and Mastery: BNNP (OCCAM-BNNP), a website for all UCNS-accredited BNNP programs. Program directors and fellows were surveyed to learn how well topics are covered and identify educational gaps, or specific topics on the UCNS website that are less well represented among programs. Thirty-seven fellowship program directors listed on the UCNS website were invited to take the survey and forward it to both current fellows (graduating in 2021) and recent graduates (graduated from 2015 to 2020). There were 29 responses from 37 programs. Of the 34 topics that respondents rated on a 1-5 Likert scale (from "not covered" to "completely covered"), 15 of 34 (44%) were identified as having >40% of responses as mostly "not covered," "incompletely covered," or "partially covered." Ninety-seven percent of respondents affirmed that it would be useful to have a free web-based resource for BNNP education. Slightly under one-half of all BNNP topics were not well covered. A survey was undertaken to identify and fill the educational gaps indicated by fellowship directors and fellows, and the OCCAM-BNNP website was developed as a repository for relevant content, providing a resource that many BNNP clinicians would find useful.

NF1 Recommendation-Based Care Delivery: A Survey of Patients and Caregivers (P3-7.002)

NF1 Recommendation-Based Care Delivery: A Survey of Patients and Caregivers (P3-7.002)

Barriers to participation in a prospective clinical trial for schwannomatosis-related pain (P7-13.003)

Barriers to participation in a prospective clinical trial for schwannomatosis-related pain (P7-13.003)

Comparison of a STIR- and T1-based radiomics model to differentiate between plexiform neurofibromas and malignant peripheral nerve sheath tumors in neurofibromatosis type 1 (NF1) (S17.010)

Comparison of a STIR- and T1-based radiomics model to differentiate between plexiform neurofibromas and malignant peripheral nerve sheath tumors in neurofibromatosis type 1 (NF1) (S17.010)

Ahead of the pain: Where we stand after a decade of growth in United Council for Neurologic Subspecialties-certified headache subspecialists.

To characterize the geographic distribution of United States (US) headache subspecialists in 2021 compared to 2012 and analyze trends in distribution of and growth by geography. Headache disorders are the second-highest cause of disease burden worldwide. Historically, headache disorders have been treated by primary care and emergency physicians, often suboptimally. Our 2012 study identified further disparities in geographic distribution of United Council for Neurologic Subspecialties (UCNS)-certified headache subspecialists. This correlational population study explores the current geographic distribution of and changes in subspecialists by aggregating data from the UCNS, National Health Interview Survey, US Census, Bureau of Economic Analysis, and American Community Survey. In 2021, there were 692 UCNS-certified headache subspecialists. There continued to be higher subspecialist density in the Northeast (1:34,678) and Midwest (1:55,005), with the highest density in Vermont (1:12,510) and Connecticut (1:20,419). The highest absolute subspecialist increases were in the South (99), California (35), and Texas (25). The highest relative subspecialist increases were in the West (105%), Vermont (500%), and Mississippi (500%). The univariable regressions showed significant associations between number of subspecialists and adult headache population (R2 =0.797, p < 0.001), between subspecialist density and personal income (R2 =0.935, p=0.033), and between growth in subspecialists and poverty rate (R2 =0.553, p=0.022). However, the multivariable regressions showed that only the adult population was significantly associated with number of subspecialists (adjusted R2 =0.806, p < 0.001). Overall, there has been substantial growth in the number of UCNS-certified headache subspecialists in the US, especially relative to growth in adult headache population. Subspecialist density continues to be highest in the Northeast and is associated with higher per capita personal income. However, there has been encouraging growth in geographies that previously had little to no access. These findings represent positive progress, but there is more to be done to both increase access to optimal headache care by subspecialists nationally and decrease geographic disparities in access to care.

Essential components of care in a multidisciplinary headache center: Perspectives from headache neurology specialists.

Comprehensive headache care involves numerous specialties and components that have not been well documented or standardized. This study aimed to elicit best practices and characterize important elements of care to be provided in multidisciplinary headache centers. Qualitative, semi-structured telephone interviews with a purposive sample of headache neurology specialists from across the US, using open-ended questions. Interviews were recorded, transcribed, and coded. Coded data were further analyzed using immersion/crystallization techniques for final interpretation. Mean years providing headache care was 17.7 (SD=10.6). Twelve of the 13 participants held United Council for Neurologic Subspecialties headache certification. Six described their practice site as providing multidisciplinary headache care. Participants explained most of their patients had seen multiple doctors over many years, and had tried numerous unsuccessful treatments. They noted patients with chronic headache frequently present with comorbidities and become stigmatized. All participants asserted successful care depends on taking time to talk with and listen to patients, gain understanding, and earn trust. All participants believed multidisciplinary care is essential within a comprehensive headache center, along with staffing enough headache specialists, implementing detailed headache intake and follow-up protocols, and providing the newest medications, neuromodulation devices, botulinum toxin injections, monoclonal antibodies, nerve blocks and infusions, and treatment from a health psychologist. Other essential services for a headache center are other behavioral health practitioners providing cognitive behavioral therapy, mindfulness, biofeedback and pain management; and autonomic neurology, neuropsychology, vestibular audiology, sleep medicine, physical therapy, occupational therapy, exercise physiology, speech therapy, nutrition, complementary integrative health modalities, and highly trained support staff. While headache neurology specialists form the backbone of headache care, experts interviewed for this study maintained their specialty is just one of many types of care needed to adequately treat patients with chronic headache, and this is best provided in a comprehensive, multidisciplinary center.

Gender Dichotomy in Headache Medicine and Other Fellowships Within United Council for Neurologic Subspecialties (UCNS) (356)

Gender Dichotomy in Headache Medicine and Other Fellowships Within United Council for Neurologic Subspecialties (UCNS) (356)

Autonomic medical practice viewed through the lens of physician-rating websites.

To survey online patient ratings of physicians practicing autonomic medicine. Online patient review scores of US physician members of the American Autonomic Society were compared to scores of US physicians in general and to indices of professional expertise. The 68 autonomic physicians who had been rated scored 3.80 ± 0.82 on a composite five-star scale, in which 5 was the most favorable score, as compared to 3.84 ± 0.98 for all US physicians (no significant difference, p = 0.8). Scores correlated inversely with autonomic physicians' number of scientific publications (p = 0.01), h-index (p = 0.01), and m-index (p = 0.0004). Scores of diplomates of the United Council for Neurologic Subspecialties certified in autonomic disorders or who were ranked in the top 1% of US physicians by Castle Connolly had scores comparable to those of other autonomic physicians. Scores did not correlate with physician gender, number of reviews, or years in practice. A quality patient experience, accurate diagnosis, and appropriate treatment are goals shared by patients and autonomic specialists. In this study, patient reviews of autonomic physicians were comparable to those of physicians across specialties. Metrics of greater autonomic expertise were associated with equal or lower patient satisfaction scores. In conclusion, compiled subjective reviews are a useful but incomplete indicator of autonomic physician quality and expertise. An ideal profile would combine clinical and nonclinical indicators of professional competence. Reliable information is needed to empower autonomic patients to make truly informed healthcare choices.

Specialty Classifications of Physicians Who Provide Neurocritical Care in the United States.

We sought to characterize the specialty classification of US physicians who provide critical care for neurological/neurosurgical disease. Using inpatient claims between 2009 and 2015 from a nationally representative 5% sample of Medicare beneficiaries, we selected hospitalizations for neurological/neurosurgical diseases with potential to result in life-threatening manifestations requiring critical care. Using Current Procedural Terminology® codes, we determined the medical specialty of providers submitting critical care claims, and, using National Provider Identifier numbers, we merged in data from the United Council for Neurologic Subspecialties (UCNS) to determine whether the provider was a UCNS diplomate in neurocritical care. We defined providers with a clinical neuroscience background as neurologists, neurosurgeons, and/or UCNS diplomates in neurocritical care. We defined neurocritical care service as a critical care claim with a qualifying neurological/neurosurgical diagnosis in patients with a relevant primary hospital discharge diagnosis and ≥ 3 total critical care claims, excluding claims from the first day of hospitalization since these were mostly emergency-department claims. Our findings were reported using descriptive statistics with exact confidence intervals (CI). Among 1,952,305 Medicare beneficiaries, we identified 99,937 hospitalizations with at least one claim for neurocritical care. In our primary analysis, neurologists accounted for 28.0% (95% CI, 27.5-28.5%) of claims, neurosurgeons for 3.7% (95% CI, 3.5-3.9%), UCNS-certified neurointensivists for 25.8% (95% CI, 25.3-26.3%), and providers with any clinical neuroscience background for 42.8% (95% CI, 42.2-43.3%). The likelihood of management by physicians with a clinical neuroscience background increased proportionally with patients' county-level socioeconomic status and such providers were 3 times more likely to be based at an academic medical center than other physicians who billed for critical care in our sample (odds ratio, 2.9; 95% CI, 1.1-8.1). Physicians with a dedicated clinical neuroscience background accounted for less than half of neurocritical care service in US Medicare beneficiaries.

Treatment recommendations for elderly patients with newly diagnosed glioblastoma lack worldwide consensus.

Glioblastoma predominantly occurs in the 6th and 7th decades of life. The optimal treatment paradigm for elderly patients is not well established. We sampled current worldwide management strategies for elderly patients with newly diagnosed glioblastoma. A web-based survey was developed and distributed to 168 radiation oncologists, neuro-oncologists and neurosurgeons identified through the United Council for Neurologic Subspecialties and the CNS committees for North American, European and Asian Organizations. Questions addressed treatment recommendations in order to determine whether management consensus exists in this patient subset. There were 68 (40%) respondents. Across respondents, the most important factors directing treatment were KPS (94%) and MGMT methylation status (71%). Only 37% of respondents strictly factor in age when making treatment recommendations with 59% defining elderly as greater than 70 years-old. The most common treatment recommendations for MGMT-methylated elderly patients with KPS > 70 were as follows: standard chemoRT (49%), short course chemoRT (39%), and temozolomide alone (30%). The most common treatment recommendations for MGMT-unmethylated patients with KPS > 70 were as follows: short course RT alone (51%), standard chemoRT (38%), and short course chemoRT (28%). Treatment recommendations for patients with KPS < 50 were short course RT alone (40%), best supportive care (57%), or TMZ alone (17%). Individuals practicing in North America were significantly more likely to recommend standard chemoradiation for patients compared to their European counterparts. Worldwide treatment recommendations for elderly patients with newly diagnosed GBM vary widely. Further randomized studies are needed to elucidate the optimal treatment strategy for this subset of patients.

Physician training in critical care in the United States: Update 2018.

Critical care fellowship training in the United States differs based on specific specialty and includes medicine, surgery, anesthesiology, pediatrics, emergency medicine, and neurocritical care training pathways. We provide an update regarding the number and growth of US critical care fellowship training programs, on-duty residents and certified diplomates, and review the different critical care physician training pathways available to residents interested in pursuing a fellowship in critical care. Data were obtained from the Accreditation Council for Graduate Medical Education and specialty boards (American Board of Internal Medicine, American Board of Surgery, American Board of Anesthesiology, American Board of Pediatrics American Board of Emergency Medicine) and the United Council for Neurologic Subspecialties for the last 16 years (2001-2017). The number of critical care fellowship training programs has increased 22.6%, with a 49.4% increase in the number of on-duty residents annually, over the last 16 years. This is in contrast to the period of 1995 to 2000 when the number of physicians enrolled in critical care fellowship programs had decreased or remained unchanged. Although more than 80% of intensivists in the US train in internal medicine critical care Accreditation Council for Graduate Medical Education-approved fellowships, there has been a significant increase in the number of residents from surgery, anesthesiology, pediatrics, emergency medicine, and other specialties who complete specialty fellowship training and certification in critical care. Matriculation in neurocritical care fellowships is rapidly rising with 60 programs and over 1,200 neurocritical care diplomates. Critical care is now an increasingly popular fellowship in all specialties. This rapid growth of all critical care specialties highlights the magnitude of the heterogeneity that will exist between intensivists in the future.

The State of Neurocritical Care Fellowship Training and Attitudes toward Accreditation and Certification: A Survey of Neurocritical Care Fellowship Program Directors.

Neurocritical care as a recognized and distinct subspecialty of critical care has grown remarkably since its inception in the 1980s. As of 2016, there were 61 fellowship training programs accredited by the United Council for Neurologic Subspecialties (UCNS) in the United States and more than 1,000 UCNS-certified neurointensivists from diverse medical backgrounds. In late 2015, the Program Accreditation, Physician Certification, and Fellowship Training (PACT) Committee of the Neurocritical Care Society (NCS) was convened to promote and support excellence in the training and certification of neurointensivists. One of the first tasks of the committee was to survey neurocritical care fellowship training program directors to ascertain the current state of fellowship training and attitudes regarding transition to Accreditation Council for Graduate Medical Education (ACGME) accreditation of training programs and American Board of Medical Specialties (ABMS) certification of physicians. First, the survey revealed significant heterogeneities in the manner of neurocritical care training and a lack of consistency in requirements for fellow procedural competency. Second, although a majority of the 33 respondents indicated that a move toward ACGME accreditation/ABMS certification would facilitate further growth and mainstreaming of training in neurocritical care, many programs do not currently meet administrative requirements and do not receive the level of institutional support that would be needed for such a transition. In summary, the results revealed that there is an opportunity for future harmonization of training standards and that a transition to ACGME accreditation/ABMS certification is preferred. While the results reflect the opinions of more than half of the survey respondents, they represent only a small sample of neurointensivists.

Our Headache Fellowship: a 10-year history

There has been a clear trend in American medical education after World War II toward training specialization and subspecialization. After some early specialization efforts by the American Board of Psychiatry and Neurology, further efforts were undertaken by the United Council for Neurologic Subspecialties (UCNS), leading to the introduction of the neurologic subspecialty of Headache Medicine in March, 2005. The training program at our center at the Brigham and Women's Hospital Department of Neurology, Harvard Medical School, in Boston, Massachusetts, was accredited in 2008 and has graduated 14 trainees since its inception. Our experience is reviewed.

RTRB-14TREATMENT RECOMMENDATIONS FOR ELDERLY PATIENTS WITH NEWLY DIAGNOSED GLIOBLASTOMA LACK WORLDWIDE CONSENSUS

This study explored the current worldwide management strategies for elderly patients with newly diagnosed glioblastoma. A web-based survey was distributed to 168 radiation oncologists (RO), neuro-oncologists (NO) and neurosurgeons (NS) from the United Council for Neurologic Subspecialties and CNS subcommittees of international cancer groups. Questions addressed the influence of molecular information, age, and comorbidities on treatment recommendations to determine whether management consensus exists. Respondents were allowed to choose more than one response. There were 58 (39%) respondents (50% NO, 3.5% NS and 50% RO) with 73% having > 10 years experience. 90% were academicians and 55% reportedly saw >50 patients with GBM annually. The most important factors influencing treatment decisions were KPS (92%), MGMT methylation status (72%), and comorbidity index (31%). Only 42% of respondents factor in age with 60% defining elderly as > 70 years-old. The most common recommendations for MGMT-methylated elderly patients with KPS > 70 were standard chemoRT (58%), temozolomide alone (28%), and short course RT (28%). The most common recommendations for MGMT-unmethylated patients with KPS > 70 were standard chemoRT (45%), short course RT (45%), and short course chemoRT (20%). Recommendations for patients with KPS < 50 were short course RT (52%), supportive care (50%), or TMZ alone (22%). Novo-TTF is or will soon be available at 74% of institutions. The majority (85%) of institutions do not have a clinical trial specifically for elderly patients with GBM, although 94% expressed interest in participating in such a trial. 98% of respondents are willing to randomize MGMT-unmethylated elderly patients to an arm without TMZ. Over 90% of respondents are willing to use short course RT as the standard RT for elderly patients, irrespective of MGMT methylation status. This study highlights that worldwide treatment recommendations for elderly patients with newly diagnosed GBM vary widely. Further randomized studies are warranted to elucidate the optimal treatment strategy.

So many migraines, so few subspecialists: analysis of the geographic location of United Council for Neurologic Subspecialties (UCNS) certified headache subspecialists compared to United States headache demographics.

To evaluate the geographic location of the United Council for Neurologic Subspecialties (UCNS)-certified headache subspecialists as compared with ratios of expected migraine and chronic migraine populations in the United States. The UCNS is a professional medical organization that accredits fellowship programs and certifies physicians who demonstrate competence in various neurologic subspecialties, including headache medicine. There are a limited number of UCNS-certified headache subspecialists currently practicing in the United States. All of the UCNS-certified headache subspecialists were geographically located and compared with demographic data about state populations obtained from the U.S. Census. The expected migraine and chronic migraine populations were calculated for each state based on recently published epidemiologic data. Ratios of UCNS-certified headache subspecialists to expected migraine and chronic migraine populations were compared for each state. These data were then organized by U.S. Census region and division. As of the 2012 examination cycle, 416 UCNS-certified headache subspecialists are currently practicing in the United States. The states with the highest number of headache subspecialists include New York, California, Ohio, Texas, Florida, and Pennsylvania. Six states have zero headache subspecialists, eight states have one headache subspecialist, and five states have two headache subspecialists. As per the U.S. Census, the total U.S. population for ages 12 years and older is 259,908,563. The total expected migraine population (11.79% of the general population) for ages 12 years and older is 30,594,362. The total expected chronic migraine population (0.91% of the general population) for ages 12 years and older is 2,361,397. The states with the best ratios of headache subspecialists to expected migraine and chronic migraine populations include the District of Columbia, New Hampshire, New York, and Nebraska. Besides states with zero headache subspecialists, the states with the worst ratios of headache subspecialists to expected migraine and chronic migraine populations include Oregon, Mississippi, Arkansas, and Kansas. When organized by U.S. Census regions, the Northeast has the best ratios of headache subspecialists to expected migraine and chronic migraine populations, while the West has the worst ratios of headache subspecialists to expected migraine and chronic migraine populations. In terms of U.S. Census divisions, the Middle Atlantic has the best ratios of headache subspecialists to expected migraine and chronic migraine populations, while the East South Central has the worst ratios of expected migraine and chronic migraine populations. There is a disproportionately small number of UCNS-certified headache subspecialists compared with the extensive expected migraine and chronic migraine populations in the United States. More UCNS-accredited fellowship programs and more UCNS-certified headache subspecialists are needed in order to ameliorate this disparity.

Accrediting Neurology Fellowships Accelerates Subspecialization

OPINION article Front. Neurol., 23 July 2013Sec. Neurology Education Volume 4 - 2013 | https://doi.org/10.3389/fneur.2013.00094

Traumatic Brain Injury: Why Psychiatrists Matter

Back to table of contents Previous article Next article From the ExpertsFull AccessTraumatic Brain Injury: Why Psychiatrists MatterJonathan Silver, M.D.Jonathan SilverSearch for more papers by this author, M.D.Published Online:7 Dec 2012https://doi.org/10.1176/pn.47.23.psychnews_47_23_26-bEach year in the United States, almost 2 million people sustain a traumatic brain injury (TBI); it is the second most common neurologic disorder (after headache), and more common than stroke and Alzheimer’s disease. The “signature injury” of our wounded warriors from Iraq and Afghanistan, athletes who sustain concussions, and former Rep. Gabrielle Giffords’ traumatic brain injury has increased the awareness of the extent of this disorder.While attention is often focused on physical and cognitive sequelae, the occurrence of psychiatric disorders is significant and complicates functioning and treatment. While neurologists, physiatrists, and internists see many individuals with TBI, psychiatrists have a critical role to play in the treatment of these patients. We need to know the common physical sequelae (such as vestibular and visual problems, headaches), as well as the appropriate evaluation and treatment of emotional and behavioral problems (irritability, depression, anxiety, fatigue, sleep disorders).There are several important facts that psychiatrists should know when evaluating a patient who has sustained a mild TBI. First, one does not have to lose consciousness to sustain a concussion: any alteration in sensorium (including feeling dazed, seeing stars, and so on) is sufficient for the diagnosis of TBI. Second, medical records are often inaccurate (up to 50 percent of concussions are missed in the emergency room). Third, patients confuse “posttraumatic amnesia” (where they do not remember what happened for a period before and after the injury) with being unconscious. Unless there is a witness, the patients know only that they have no recall—not whether they were unconscious. Fourth, imaging modalities (MRI, CT) are most often normal. Newer techniques such as DTI (diffusion tensor imaging) are promising, but “not ready for prime time.” Lastly, the vast majority of individuals with a concussion have significant or complete recovery within a few months. Thus, it is important to be optimistic regarding recovery. In fact, the presence of psychiatric disorders is a major factor in impairing ability to function following injury.After TBI, there is an increased risk of developing almost every psychiatric disorder, especially depression and anxiety. In patients who have suffered trauma, the presence of TBI increases the likelihood of posttraumatic stress disorder (PTSD), panic disorder, agoraphobia, and social phobia; and it is the psychiatric disorder, not TBI, that increases the likelihood of self-reported functional impairment. Multiple studies have shown that coexistent anxiety or depression increases the severity of postconcussive symptoms, and psychological distress and results in poorer outcome as well as impaired performance on neuropsychological tests.In soldiers who have returned from Iraq and Afghanistan, the presence of PTSD is more strongly correlated with “postconcussive” symptoms and health and psychosocial outcomes than is the occurrence of a mild TBI. Symptoms of PTSD overlap with symptoms following concussion, and PTSD may occur in situations where a mild brain injury also occurs. It is important, but difficult, for clinicians to sort out when symptoms are due to PTSD and not the lingering effects of brain injury.Because those who have sustained a traumatic brain injury almost, by definition, have experienced a traumatic event, the emotional and psychological repercussions of the event must be explored. Depression, anxiety, irritability, in addition to problems with concentration, memory, fatigue, and sleep, can improve with appropriate and informed treatment, including pharmacologic modalities. Psychiatrists need to be aware of the evidence substantiating the treatment options to provide patients the best care possible. Lastly, since TBI is one of the few preventable neuropsychiatric disorders, we need to counsel our patients regarding appropriate interventions, including the dangers of cell phone use (even hands free) while driving or walking. To provide a professional example, I suggest that physicians should not call our patients while either we or they are driving. Jonathan Silver, M.D., is a clinical professor of psychiatry at the New York University School of Medicine. He is a past president and fellow of the American Neuropsychiatric Association and a diplomate in behavioral neurology and neuropsychiatry from the United Council for Neurologic Subspecialties. He is a coauthor of the Textbook of Traumatic Brain Injury, Second Edition, by American Psychiatric Publishing. Members can purchase the book at a discount at www.appi.org/SearchCenter/Pages/SearchDetail.aspx?ItemId=62357. ISSUES NewArchived

Subspecialization in neurology: the role of the united council for neurologic subspecialties

AAN= : American Academy of Neurology; ABMS= : American Board of Medical Specialties; ABPN= : American Board of Psychiatry and Neurology; ACGME= : Accreditation Council for Graduate Medical Education; ANA= : American Neurological Association; AUPN= : Association of University Professors of Neurology; CNS= : Child Neurology Society; PCN= : Professors of Child Neurology; RCPSC= : Royal College of Physicians and Surgeons of Canada; UCNS= : United Council for Neurologic Subspecialties. In recent decades, there has been considerable growth in neurologic subspecialties. In response to this trend, the American Academy of Neurology (AAN), American Neurological Association (ANA), Association of University Professors of Neurology (AUPN), Child Neurology Society (CNS), and Professors of Child Neurology (PCN) helped establish the United Council for Neurologic Subspecialties (UCNS) in order to provide accreditation of training (fellowship) programs in neurologic subspecialties and certification of graduates of these programs (and, during a limited “practice track” period, practitioners qualified by their substantive experience). This article reviews the reasons why UCNS was established, how it operates, and what it has accomplished. In the first issue of Neurology ® in 1951, an article by Pearce Bailey, MD, entitled “The past, present, and future of neurology in the United States,” noted that by the end of World War II, neurology had not yet attained “unchallenged professional autonomy as a medical specialty.”1 Bailey pointed to the establishment of the AAN in 1948 as reason for hope that there would be “a new renaissance of neurology in the near future” and he concluded that “[t]he time has come for neurology as a specialty to assume responsibility for the total medical treatment of neurologic patients.” In the decades since Bailey's article, AAN has undertaken many initiatives to help neurologists achieve this goal. In 1998, AAN President Francis I. Kittredge, Jr, MD, FAAN, appointed a Commission on Subspecialty Certification that was chaired by Stephen M. Sergay, MB BCh, FAAN. This was a time of major change in neurology. Neuroscience was advancing at an explosive rate. New technologies and treatments were developed that promised dramatic advances in neurologic care. The boundaries between emerging areas of practice in neurology and other specialties were becoming blurred. The number of AAN sections was growing fast, and new subspecialties did …