Clinical Practice Neurology

[Stefanie Mordaunt]

MayoClinic's Neurology in Clinical Practice provides a review and update on the clinical presentation, workup, and management of neurological diseases that neurologists, internists, family practitioners, physician assistants and nurse practitioners are most likely to encounter. This course is an intensive, practical review that emphasizes evidence-based approaches to problems that span the realm of neurology. The conference is made up of didactic sessions incorporating case presentations, and question and answer panel discussions. This course features an American Board of Psychiatry and Neurology (ABPN) Self-Assessment Activity awarding MOC credits.

Attendees of the Neurology in Clinical Practice 2024 conference have the opportunity to take an ABPN self-assessment module (100 questions) and receive 26.25 ABPN credits. You must attend the Neurology in Clinical Practice conference (in-person or via livestream) to purchase for the self-assessment. The questions will be released after the general session concludes on July 21, 2024 and must be completed before August 20, 2024.

Attendance at any Mayo Clinic course does not indicate or guarantee competence or proficiency in the skills, knowledge or performance of any care or procedure(s) which may be discussed or taught in this course.

The Neurology in Clinical Practice conference is an annual Mayo Neurology course that brings together a multidisciplinary faculty from across our three campuses in Rochester, MN; Jacksonville, FL; and Scottsdale, AZ. The course format consists of case-based presentations in the morning and is reinforced with optional afternoon workshops.

The Westin River North has reserved a limited block of traditional rooms at a special group rate of $275 (USD), single or double occupancy, run of house, per night, for course participants and guests. Group rates apply three days prior to and three days after the course dates, based on group room availability. To ensure accommodations at the discounted rate, make your reservations directly with the hotel before the block is full or by June 24, 2023, whichever comes first.

Accreditation Statement

In support of improving patient care, Mayo Clinic College of Medicine and Science is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC) to provide continuing education for the healthcare team.

Sponsorship and Exhibit Opportunities

Thank you for your interest in exhibiting at or supporting this conference with a sponsorship. The exhibit space is currently fully committed.

If you are interested in hosting a product theater, Friday breakfast is currently available - contact us for more information or to submit an agreement.

Paul M Lantos, Jeffrey Rumbaugh, Linda K Bockenstedt, Yngve T Falck-Ytter, Maria E Aguero-Rosenfeld, Paul G Auwaerter, Kelly Baldwin, Raveendhara R Bannuru, Kiran K Belani, William R Bowie, John A Branda, David B Clifford, Francis J DiMario, Jr, John J Halperin, Peter J Krause, Valery Lavergne, Matthew H Liang, H Cody Meissner, Lise E Nigrovic, James (Jay) J Nocton, Mikala C Osani, Amy A Pruitt, Jane Rips, Lynda E Rosenfeld, Margot L Savoy, Sunil K Sood, Allen C Steere, Franc Strle, Robert Sundel, Jean Tsao, Elizaveta E Vaysbrot, Gary P Wormser, Lawrence S Zemel

Summarized below are the 2020 recommendations for the prevention, diagnosis, and treatment of Lyme disease. The panel followed a systematic process used in the development of other IDSA, AAN, and ACR clinical practice guidelines, which included a standardized methodology for rating the certainty of the evidence and strength of recommendation using the GRADE approach (Grading of Recommendations Assessment, Development, and Evaluation) (see Figure 1). A detailed description of background, methods, evidence summary and rationale that support each recommendation, and knowledge gaps can be found online in the full text.

We recommend against testing a removed Ixodes tick for B. burgdorferi (strong recommendation, moderate-quality evidence). Comment: The presence or absence of B. burgdorferi in an Ixodes tick removed from a person does not reliably predict the likelihood of clinical infection.

In patients who develop an erythema migrans-like skin lesion following the bite of the lone star tick (Amblyomma americanum), an illness referred to as STARI, we make no recommendation for or against the use of antibiotics (no recommendation; knowledge gap). Comment: In certain geographic regions both STARI and Lyme disease are endemic [4]. Distinguishing single erythema migrans due to Lyme disease from STARI may not be possible clinically unless the responsible tick has been identified [5]. When STARI cannot be distinguished from Lyme disease-associated erythema migrans in areas endemic for both conditions, antibiotic therapy directed toward Lyme disease is indicated.

Lyme disease is a tick-borne infection caused by spirochetes in the Borrelia burgdorferi sensu lato complex and transmitted to humans by the bite of certain species of Ixodes ticks [7, 8]. It is the most common vector-borne infectious disease of humans in the temperate northern hemisphere, affecting hundreds of thousands of people annually in North America and Eurasia. In North America, Lyme disease is found predominantly in 3 regions: the northeastern states from Virginia to eastern Canada (including Ontario, Quebec, and the eastern maritime provinces); the upper Midwest, particularly Wisconsin and Minnesota; and in northern California.

Lyme disease is a complex infection, and clinical disease can manifest as early as days and as late as many months following an infectious tick bite. Presentations include a skin lesion at the site of the tick bite and disseminated disease resulting in skin lesions distant from the tick-bite site, neuropathy, meningitis, cardiac conduction abnormalities, and/or arthritis. Interpretation of diagnostic tests for Lyme disease presents certain challenges due to the dynamics of the serologic response following infection. Finally, treatment options, including the drug, route, and duration of treatment may differ for different disease manifestations.

This guideline encompasses the prevention, diagnosis, and treatment of Lyme disease, as well as Lyme disease complicated by simultaneous coinfection with other tick-borne pathogens in North America. In contrast to the 2006 Infectious Diseases Society of America (IDSA) guideline, this guideline only addresses anaplasmosis and babesiosis in the context of a coinfection. Anaplasmosis is now addressed in the rickettsial disease guidelines developed by the Centers for Disease Control and Prevention (CDC) [9], and babesiosis recommendations can be found in a separate IDSA guideline (in press).

This guideline is primarily intended for medical practitioners in North America, although many recommendations will be applicable to patients in Europe and Asia. As Eurasian strains of B. burgdorferi sensu lato can cause clinical signs not associated with North American strains, this guideline also includes recommendations for evaluation and treatment of patients who present with borrelia lymphocytoma and acrodermatitis chronica atrophicans after travel to endemic areas.

This guideline is preceded by guidelines by the IDSA [12] and American Academy of Neurology (AAN) [13]. This guideline is a collaborative effort by IDSA, AAN, as well as the American College of Rheumatology (ACR). Recognizing that Lyme disease is evaluated and treated by physicians from different subspecialties in varied clinical settings, this guideline has official representation from numerous organizations including scientific, primary care, and medical specialties.

An initial list of relevant clinical questions for these guidelines was created by the whole panel for review and discussion. The final set of clinical questions was approved by the entire committee. All outcomes of interest were identified a priori and explicitly rated for their relative importance for decision making. Each clinical question was assigned to a pair of panelists.

Evidence summaries for each question were prepared by the technical team from Tufts Medical Center. The risk of bias was assessed by the technical review team using the Cochrane risk of bias tool for randomized controlled trials [15], the Newcastle-Ottawa scale (NOS) for nonrandomized studies [16] and QUADAS-2 tool for diagnostic test accuracy studies [17]. The certainty in the evidence was initially determined for each critical and important outcome, and then for each recommendation using the GRADE approach for rating the confidence in the evidence [1, 2] (see Figure 1). Evidence profile tables and quality of evidence were reviewed by the guideline methodologists (Y.F.Y. and V.L.). The summaries of evidence were discussed and reviewed by all committee members and edited as appropriate. The final evidence summaries were presented to the whole panel for deliberation and drafting of recommendations. Literature search strategies, PRISMA flow diagrams detailing the search results, data extraction and evidence profiles tables, and additional data, such as meta-analysis results when appropriate, can be found in the supplementary materials (.docx).

The entire panel met for a 2-day face-to-face meeting in Arlington, Virginia, in January 2017 for the presentation of evidence summaries and the development of the recommendations. All members of the panel participated in the preparation of the guideline and approved the recommendations.

Public comment allows for key stakeholders to review and identify gaps in a guideline before its finalization and publication. In 2015, the guideline panel held a 60-day public comment period requesting input on its project plan that laid the groundwork for the new Lyme disease guidelines. In June 2019, the panel opened a second 75-day public comment period requesting feedback on the full guideline. The panel reviewed the feedback from the public comment phase and updated the guideline as needed.

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