“Practice Current: An interactive exchange on controversial topics” is a new section that debuts in this issue of Neurology: Clinical Practice (NCP). The idea was conceived by Luca Bartolini, MD, editorial team member of the Resident & Fellow Section of Neurology®, and developed in collaboration with the Editors of NCP. Practice Current aims to identify and discuss difficult clinical scenarios and diseases with conflicting or insufficient evidence regarding diagnosis or treatment. The topics will be selected based on relevance to clinical practice.
In the absence of data from clinical trials, anecdotal experience and expert opinion become the main source of knowledge on which medical decisions are made. Clinical approaches and decision-making are apt to change over time and may differ among institutions, regions, and countries. Practice Current allows neurologists to share their own best practices and see real-time survey results. Once preliminary data are collected, a summary of the latest information on the topic and the opportunity to hear from an expert in the field will be provided. This broad exposure to different opinions is meant to help the reader learn from peers and to formulate or modify his or her own point of view.
Practice Current is an interactive initiative that will utilize both online and print. Each controversial topic will be presented as concise clinical questions in the form of an online survey on the NCP Web site. Readers are invited to weigh in on the practice at their institution and then presented with real-time results. Once enough data are collected, readers will be able to view results on a world map display, with the option to recategorize according to the level of training of the voter. This dynamic network will give the readers a unique perspective on how neurologists at different stages of their careers and in different areas of the world approach a clinical scenario. Online participation will remain active, and readers will have the option to participate again if their practice changes over time.
An accompanying article will be published in NCP 1-2 months after the survey is launched. The format will include a concise description of the disease or clinical scenario followed by an analysis of the current literature on the subject. Experts in the field, selected by the editors, will be invited to comment in the form of an interview. Preliminary survey results will be analyzed and compared with the expert opinion to foster critical thinking and provide different perspectives on diagnostic/therapeutic dilemmas. Without a doubt, practice will change over time, and the published NCP article will represent the state of the art at the time of publication and highlight advances and new knowledge.
The first Practice Current topic is the following: How do you treat anti-NMDA receptor encephalitis?
Josep O. Dalmau, MD, PhD, who is a pioneer in the field and Editor of Neurology: Neuroimmunology & Neuroinflammation, was invited to provide his expert opinion. The interview discusses not only immunotherapy protocols, but also reveals an innovative comprehensive approach to treatment. The article also includes a discussion of the latest treatment options in use today.
There is no single correct answer to the clinical questions presented in Practice Current; instead, this is an opportunity for the readers to share their experience, learn from each other and from the experts, and potentially build consensus.
All neurology enthusiasts, either in practice or in training, are invited to join the discussion by participating in the next Practice Current polls found on the NCP Web site. We look forward to your participation.
AUTHOR CONTRIBUTIONS
L. Bartolini: drafting/revising manuscript; J.J. Millichap: drafting/revising manuscript.
STUDY FUNDING
No targeted funding reported.
DISCLOSURES
L. Bartolini serves as the Practice Current Section Editor for Neurology: Clinical Practice. J.J. Millichap has received speaker honoraria from Invitae; serves as Resident & Fellow Section Editor for Neurology and as Editor for Pediatric Neurology Briefs; receives publishing royalties for online monographs from Up-To-Date and BMJ Best Practice; and is principal investigator for institutional research grants from Citizens United for Research in Epilepsy (CURE), Thrasher Research Fund, and UCB Pharma. Full disclosure form information provided by the authors is available with the full text of this article at http://cp.neurology.org/lookup/doi/10.1212/CPJ.0000000000000216.
ACKNOWLEDGMENT
The authors thank Haitham M. Hussein, MD, for input.
Correspondence to: LBartoli@childrensnational.org
Funding information and disclosures are provided at the end of the article. Full disclosure form information provided by the authors is available with the full text of this article at http://cp.neurology.org/lookup/doi/10.1212/CPJ.0000000000000216.
Footnotes
Correspondence to: LBartoli@childrensnational.org
Funding information and disclosures are provided at the end of the article. Full disclosure form information provided by the authors is available with the full text of this article at http://cp.neurology.org/lookup/doi/10.1212/CPJ.0000000000000216.