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  1. Article ; Online: Dizziness in Primary Care.

    Kerber, Kevin A

    Primary care

    2024  Volume 51, Issue 2, Page(s) 195–209

    Abstract: Dizziness is a prevalent symptom in the general population and is among the most common reasons patients present for medical evaluations. This article focuses on high yield information to support primary clinicians in the efficient and effective ... ...

    Abstract Dizziness is a prevalent symptom in the general population and is among the most common reasons patients present for medical evaluations. This article focuses on high yield information to support primary clinicians in the efficient and effective evaluation and management of dizziness. Key points are as follows: do not anchor on the type of dizziness symptom, do use symptom timing and prior medical history to inform diagnostics probabilities, do evaluate for hallmark examination findings of vestibular disorders, and seek out opportunities to deliver evidence-based interventions particularly the canalith repositioning maneuver and gaze stabilization exercises.
    MeSH term(s) Humans ; Dizziness/diagnosis ; Dizziness/therapy ; Primary Health Care ; Vestibular Diseases/diagnosis ; Vestibular Diseases/therapy
    Language English
    Publishing date 2024-01-09
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 604005-6
    ISSN 1558-299X ; 0095-4543
    ISSN (online) 1558-299X
    ISSN 0095-4543
    DOI 10.1016/j.pop.2023.12.001
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  2. Article ; Online: Episodic Positional Dizziness.

    Kerber, Kevin A

    Continuum (Minneapolis, Minn.)

    2021  Volume 27, Issue 2, Page(s) 348–368

    Abstract: Purpose of review: This article provides a summary of the evaluation and treatment of patients presenting with episodic positional dizziness.: Recent findings: Positional components are nearly ubiquitous among diagnoses of dizziness, so it can be ... ...

    Abstract Purpose of review: This article provides a summary of the evaluation and treatment of patients presenting with episodic positional dizziness.
    Recent findings: Positional components are nearly ubiquitous among diagnoses of dizziness, so it can be challenging to classify patients with episodic positional dizziness simply based on the history of present illness. Overreliance on the presence of a report of positional components has likely resulted in misapplication or misinterpretation of positional testing and negative experiences with maneuvers to treat positional dizziness. The prototypical episodic positional dizziness disorder is benign paroxysmal positional vertigo (BPPV). BPPV is caused by free-floating particles in a semicircular canal that move in response to gravity. The diagnosis is made by identifying the characteristic patterns of nystagmus on the Dix-Hallpike test. Particle repositioning for BPPV is supported by randomized controlled trials, meta-analyses, and practice guidelines. Other disorders that can present with episodic positional dizziness are migraine dizziness, central lesions, and light cupula syndrome.
    Summary: Episodic positional dizziness is a common presentation of dizziness. Neurologists should prioritize identifying and treating BPPV; doing so provides an important opportunity to deliver effective and efficient care. Providers should also recognize that positional components are common in most causes of dizziness and, therefore, should not over-rely on this part of the history of presentation when considering the diagnosis and management plan.
    MeSH term(s) Benign Paroxysmal Positional Vertigo/diagnosis ; Benign Paroxysmal Positional Vertigo/therapy ; Dizziness/diagnosis ; Dizziness/etiology ; Dizziness/therapy ; Humans ; Nystagmus, Pathologic ; Semicircular Canals
    Language English
    Publishing date 2021-08-05
    Publishing country United States
    Document type Journal Article ; Review
    ISSN 1538-6899
    ISSN (online) 1538-6899
    DOI 10.1212/CON.0000000000000909
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  3. Article ; Online: Validation of Vascular Location Subcodes for Acute Ischemic Stroke by the International Classification of Diseases-10.

    Hirsch, Jason L / Burke, James F / Kerber, Kevin A

    Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association

    2024  Volume 33, Issue 4, Page(s) 107590

    Abstract: Background: Vascular region of infarct is part of the International Classification of Diseases-10 (ICD-10) coding scheme for ischemic stroke. These data could potentially be used for studies about vascular location, such as comparisons of anterior ... ...

    Abstract Background: Vascular region of infarct is part of the International Classification of Diseases-10 (ICD-10) coding scheme for ischemic stroke. These data could potentially be used for studies about vascular location, such as comparisons of anterior versus posterior circulation stroke. The objective of this study was to evaluate the validity of these subcodes.
    Methods: We selected a random sample of 100 hospitalizations specifying 50 with anterior circulation ICD-10 ischemic stroke (carotid, anterior cerebral artery [CA], middle CA) and 50 with posterior circulation stroke (vertebral, basilar, cerebellar, posterior CA). The gold standard primary vascular distribution was scored using imaging studies and reports, blinded to the subcode. We compared gold-standard distribution to coded distribution and calculated the operating characteristics of ICD-10 posterior circulation versus anterior circulation codes with the gold standard. We also calculated the kappa statistic for agreement across all 7 vascular regions.
    Results: In our population of 100 strokes, mean NIHSS was 8 (SD, 8). Head CT was performed in 95 % (95/100) and MRI in 77 % (77/100). The gold standard classified 55 primary posterior circulation strokes (26 PCA, 16 cerebellar, 8 basilar, 5 vertebral), 44 primary anterior circulation strokes (35 MCA, 6 carotid, 3 ACA), and 1 stroke with no infarct on imaging. The accuracy of the ICD-10 classification for primary posterior circulation stroke versus anterior circulation/no infarct was: sensitivity 89 % (49/55); specificity 98 % (44/45); positive predictive value 98 % (49/50); negative predictive value 88 % (44/50). The reliability of the 7-region classification was excellent (kappa 0.85).
    Conclusions: We found that ICD-10 classification of vascular location in routine practice correlates strongly with gold-standard localization for hospitalized ischemic stroke and supports validity in differentiating posterior versus anterior circulation. At a more granular vascular level, the location reliability was excellent, although limited data were available for some subcodes.
    MeSH term(s) Humans ; Ischemic Stroke ; International Classification of Diseases ; Reproducibility of Results ; Stroke/diagnostic imaging ; Posterior Cerebral Artery
    Language English
    Publishing date 2024-01-27
    Publishing country United States
    Document type Journal Article
    ZDB-ID 1131675-5
    ISSN 1532-8511 ; 1052-3057
    ISSN (online) 1532-8511
    ISSN 1052-3057
    DOI 10.1016/j.jstrokecerebrovasdis.2024.107590
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  4. Article ; Online: Acute Vestibular Syndrome.

    Kerber, Kevin A

    Seminars in neurology

    2020  Volume 40, Issue 1, Page(s) 59–66

    Abstract: The acute vestibular syndrome (AVS) is a label for presentations of new-onset severe dizziness, vertigo, or imbalance, with examination findings of nystagmus or gait unsteadiness. The prototypical AVS presentation is the acute unilateral vestibulopathy ... ...

    Abstract The acute vestibular syndrome (AVS) is a label for presentations of new-onset severe dizziness, vertigo, or imbalance, with examination findings of nystagmus or gait unsteadiness. The prototypical AVS presentation is the acute unilateral vestibulopathy due to vestibular neuritis. Stroke is also a serious concern in patients with AVS. Most other peripheral vestibular disorders present as episodic or chronic syndromes. In this article, the diagnostic considerations, exam findings, and management of AVS are reviewed.
    MeSH term(s) Acute Disease ; Humans ; Stroke/complications ; Stroke/diagnosis ; Syndrome ; Vestibular Diseases/diagnosis ; Vestibular Diseases/etiology ; Vestibular Diseases/physiopathology ; Vestibular Neuronitis/complications ; Vestibular Neuronitis/diagnosis
    Language English
    Publishing date 2020-01-28
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 603165-1
    ISSN 1098-9021 ; 0271-8235
    ISSN (online) 1098-9021
    ISSN 0271-8235
    DOI 10.1055/s-0039-3402739
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  5. Article ; Online: Artificial Intelligence and the Practice of Neurology in 2035: The Neurology Future Forecasting Series.

    Jones, David T / Kerber, Kevin A

    Neurology

    2022  Volume 98, Issue 6, Page(s) 238–245

    Abstract: High-quality health care delivery relies on a complex orchestration of the flow of patient data. Incorporating advanced artificial intelligence (AI) technologies into this delivery system has tremendous potential to improve health care, but also carries ... ...

    Abstract High-quality health care delivery relies on a complex orchestration of the flow of patient data. Incorporating advanced artificial intelligence (AI) technologies into this delivery system has tremendous potential to improve health care, but also carries with it unique challenges. The nature of neurologic disease, and the current state of neurologic care delivery, makes this area of medicine well positioned for AI-driven innovation by 2035. Business, ethics, regulation, and medical education will need to evolve in concert. The information technology and data standards requirements for this potential transformation are underappreciated and will be a major driver of changes across the industry. Using AI on patient data to drive health care innovation to improve patients' lives as the primary goal will facilitate widespread acceptance and adoption of the practices required for a successful AI transformation in neurology. In planning the incorporation of AI into clinical practice, the tenets of rigorous research will need to be vigilantly applied to prevent unwarranted costs and inconveniences while promoting meaningful health outcomes.
    MeSH term(s) Artificial Intelligence ; Delivery of Health Care ; Forecasting ; Humans ; Neurology ; Technology
    Language English
    Publishing date 2022-01-25
    Publishing country United States
    Document type Journal Article
    ZDB-ID 207147-2
    ISSN 1526-632X ; 0028-3878
    ISSN (online) 1526-632X
    ISSN 0028-3878
    DOI 10.1212/WNL.0000000000013200
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  6. Article ; Online: Benign paroxysmal positional vertigo: A practical approach for emergency physicians.

    Edlow, Jonathan A / Kerber, Kevin

    Academic emergency medicine : official journal of the Society for Academic Emergency Medicine

    2022  Volume 30, Issue 5, Page(s) 579–588

    Abstract: Benign paroxysmal positional vertigo (BPPV) is a very common condition in the population and an important cause of acute vertigo or dizziness in patients presenting to an emergency department (ED). Despite this, abundant evidence shows that current ED ... ...

    Abstract Benign paroxysmal positional vertigo (BPPV) is a very common condition in the population and an important cause of acute vertigo or dizziness in patients presenting to an emergency department (ED). Despite this, abundant evidence shows that current ED management of patients with BPPV is suboptimal. Common ED management processes include brain imaging and treatment with vestibular suppressant medications such as meclizine, neither of which is recommended by current guidelines. The most efficient management of BPPV is to perform a bedside test (Dix-Hallpike test) and then to treat the patients with a bedside positional (the Epley) maneuver. In this practical review we emphasize the efficient management for the most common form of BPPV-posterior canal BPPV. Using this management will reduce resource utilization (laboratory testing, brain imaging, specialist consultation), reduce ED length of stay, and reduce use of ineffective mediations that have side effects but little therapeutic effect. Application of these practices would improve important patient-centered outcomes such as symptom reduction, radiation exposure, side effects from medications, and less need for urgent follow-up with another health care provider. The article also discusses the approach to patients in whom the Dix-Hallpike and/or Epley maneuvers do not seem to work. This includes a discussion the second most common variant of BPPV (horizontal canal BPPV) and criteria for safe discharge of patients. Another important advantage of learning BPPV best practices is that it is enormously satisfying for the clinician, not unlike treating a child with a nursemaid's elbow.
    MeSH term(s) Child ; Humans ; Benign Paroxysmal Positional Vertigo/diagnosis ; Benign Paroxysmal Positional Vertigo/therapy ; Patient Positioning/methods ; Dizziness ; Brain ; Physicians
    Language English
    Publishing date 2022-08-13
    Publishing country United States
    Document type Journal Article
    ZDB-ID 1329813-6
    ISSN 1553-2712 ; 1069-6563
    ISSN (online) 1553-2712
    ISSN 1069-6563
    DOI 10.1111/acem.14558
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  7. Article ; Online: Geographic Variation in the Use of Audiovestibular Testing-Too Much or Too Little?

    Kerber, Kevin A

    JAMA otolaryngology-- head & neck surgery

    2019  Volume 146, Issue 2, Page(s) 150–151

    MeSH term(s) Aged ; Audiometry/standards ; Audiometry/statistics & numerical data ; Cross-Sectional Studies ; Facilities and Services Utilization ; Humans ; Medicare/economics ; Practice Patterns, Physicians' ; Quality Improvement ; United States ; Vestibular Function Tests/standards ; Vestibular Function Tests/statistics & numerical data
    Language English
    Publishing date 2019-11-20
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2701825-8
    ISSN 2168-619X ; 2168-6181
    ISSN (online) 2168-619X
    ISSN 2168-6181
    DOI 10.1001/jamaoto.2019.3950
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  8. Article: Acute Vestibular Syndrome

    Kerber, Kevin A.

    Seminars in Neurology

    (Neuro-Otology)

    2020  Volume 40, Issue 01, Page(s) 59–66

    Abstract: The acute vestibular syndrome (AVS) is a label for presentations of new-onset severe dizziness, vertigo, or imbalance, with examination findings of nystagmus or gait unsteadiness. The prototypical AVS presentation is the acute unilateral vestibulopathy ... ...

    Series title Neuro-Otology
    Abstract The acute vestibular syndrome (AVS) is a label for presentations of new-onset severe dizziness, vertigo, or imbalance, with examination findings of nystagmus or gait unsteadiness. The prototypical AVS presentation is the acute unilateral vestibulopathy due to vestibular neuritis. Stroke is also a serious concern in patients with AVS. Most other peripheral vestibular disorders present as episodic or chronic syndromes. In this article, the diagnostic considerations, exam findings, and management of AVS are reviewed.
    Keywords vertigo ; acute vestibular syndrome ; vestibulopathy ; stroke
    Language English
    Publishing date 2020-01-28
    Publisher Thieme Medical Publishers
    Publishing place Stuttgart ; New York
    Document type Article
    ZDB-ID 603165-1
    ISSN 1098-9021 ; 0271-8235
    ISSN (online) 1098-9021
    ISSN 0271-8235
    DOI 10.1055/s-0039-3402739
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  9. Article ; Online: Coding and Reimbursement for Vestibular Tests by the U.S. Centers for Medicare and Medicaid Services (CMS).

    Fife, Terry D / Desmond, Alan L / Kerber, Kevin A

    Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology

    2021  Volume 42, Issue 10, Page(s) e1544–e1547

    Abstract: Coding and insurance reimbursement is a part of the healthcare system in the United States but is subject to periodic modifications. In addition to changes in the evaluation and management (E/M) codes that took effect in 2021, there are some differences ... ...

    Abstract Coding and insurance reimbursement is a part of the healthcare system in the United States but is subject to periodic modifications. In addition to changes in the evaluation and management (E/M) codes that took effect in 2021, there are some differences in coding for some diagnostic vestibular function test procedures. Two new codes for vestibular myogenic evoked potential testing were added and previous codes for auditory evoked potential codes 92585 and 92586, which some facilities had used to bill for vestibular myogenic evoked potential testing, have been eliminated. This article outlines the current state of coding and reimbursement by CMS for vestibular procedures.
    MeSH term(s) Aged ; Centers for Medicare and Medicaid Services, U.S. ; Humans ; Medicaid ; Medicare ; United States
    Language English
    Publishing date 2021-05-17
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2036790-9
    ISSN 1537-4505 ; 1531-7129
    ISSN (online) 1537-4505
    ISSN 1531-7129
    DOI 10.1097/MAO.0000000000003314
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  10. Article ; Online: Lecanemab: Looking Before We Leap.

    Burke, James F / Kerber, Kevin A / Langa, Kenneth M / Albin, Roger L / Kotagal, Vikas

    Neurology

    2023  Volume 101, Issue 15, Page(s) 661–665

    Abstract: Lecanemab, a novel amyloid-sequestering agent, recently received accelerated Food and Drug Administration approval for the treatment of mild dementia due to Alzheimer disease (AD) and mild cognitive impairment (MCI). Approval was based on a large phase 3 ...

    Abstract Lecanemab, a novel amyloid-sequestering agent, recently received accelerated Food and Drug Administration approval for the treatment of mild dementia due to Alzheimer disease (AD) and mild cognitive impairment (MCI). Approval was based on a large phase 3 trial, Clarity, which demonstrated reductions in amyloid plaque burden and cognitive decline with lecanemab. Three major concerns should give us pause before adopting this medication: Its beneficial effects are small, its harms are substantial, and its potential costs are unprecedented. Although lecanemab has a clear and statistically significant effect on cognition, its effect size is small and may not be clinically significant. The magnitude of lecanemab's cognitive effect is smaller than independent estimates of the minimally important clinical difference, implying that the effect may be imperceptible to a majority of patients and caregivers. Lecanemab's cognitive effects were numerically smaller than the effect of cholinesterase inhibitors and may be much smaller. The main argument in lecanemab's favor is that it may lead to greater cognitive benefit over time. Although plausible, there is a lack of evidence to support this conclusion. Lecanemab's harms are substantial. In Clarity, it caused symptomatic brain edema in 11% and symptomatic intracranial bleeding in 0.5% of participants. These estimates likely significantly underestimate these risks in general practice for 3 reasons: (1) Lecanemab likely interacts with other medications that increase bleeding, an effect minimized in Clarity. (2) The Clarity population is much younger than the real-world population with mild AD dementia and MCI (age 71 years vs 85 years) and bleeding risk increases with age. (3) Bleeding rates in trials are typically much lower than in clinical practice. Lecanemab's costs are unprecedented. Its proposed price of $26,500 is based on cost-effectiveness analyses with tenuous assumptions. However, even if cost-effective, it is likely to result in higher expenditures than any other medication. If its entire target population were treated, the aggregate medication expenditures would be $120 billion US dollars per year-more than is currently spent on all medications in Medicare Part D. Before adopting lecanemab, we need to know that lecanemab is not less effective, vastly more harmful, and 100× more costly than donepezil.
    MeSH term(s) Aged ; Humans ; Alzheimer Disease/drug therapy ; Alzheimer Disease/epidemiology ; Dementia ; Donepezil/therapeutic use ; Medicare ; United States ; Antibodies, Monoclonal, Humanized/therapeutic use
    Chemical Substances Donepezil (8SSC91326P) ; lecanemab (12PYH0FTU9) ; Antibodies, Monoclonal, Humanized
    Language English
    Publishing date 2023-07-21
    Publishing country United States
    Document type Journal Article
    ZDB-ID 207147-2
    ISSN 1526-632X ; 0028-3878
    ISSN (online) 1526-632X
    ISSN 0028-3878
    DOI 10.1212/WNL.0000000000207505
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