Background
Sophie Cho, M.D., Director, Neurology Consultation Service and Clinic Director
The NINDS intramural program provides neurological consultation services to the NIH Clinical Center with 24/7 coverage, 365 days a year, through the Neurology Consult Service. The service is staffed by neurological care providers who serve the patient care goals of the Clinical Center with diligence and attentiveness. The complex disease presentation of patients requiring neurological consultation is done with careful evaluation of the pathophysiological mechanism of a systemic disease or therapeutic intervention causing neurological injury. Such investigations have led to an increased understanding of the primary disease and informed therapeutic interventions to arrest and reverse neurological injury.
The Neurology Consult Service provides inpatient and outpatient consultation services and is staffed by an in-house adult neurologist (available 24/7, with after-hours coverage provided by Clinical Fellows), pediatric neurologist, and nurse practitioners. The inpatient team also serves as a teaching service and medical students, residents and fellows from around the country visit and do elective rotations with the service[NA([1] .
Adult outpatient neurology consultations are scheduled on Tuesday and Wednesday afternoons. Outpatient pediatric neurology services are provided on most weekdays by the in- house and visiting pediatric neurologist. The consult attending reviews patient records and collaborates with principal investigators to provide the most accurate evaluation possible. For patients with chronic care needs, the consult team participates in multidisciplinary care meetings to ensure a smooth transition to community-based care, which may include the patient’s primary care provider and outside neurology team. Consultations with neurology subspecialists may be arranged based on complexity of the disease manifestation.
Weekly Consult Conference Rounds
The NINDS Neurology Consult Service holds case conference every Thursday morning at 9 am at 7C101. Attendance is recorded, and permission to attend is required due to patient-sensitive information discussed during these conferences. This forum encourages open and candid discussions about complex disease presentations, generating rich dialogue regarding evaluation and treatment of rare and elusive neurological diseases. Providers from other institutes are welcome to attend and present cases even if the patient has not been evaluated by the NINDS consultation service.
Types of Diseases Seen on the Consult Service
Every patient seen by the Neurology Consult Service is enrolled in a research protocol at the NIH. While the service does not manage or maintain any primary protocols, it provides vital insight, assessment, and recommendations on consult requests ranging from phenotyping to therapeutics discussion on rare and complex diseases, including neuroinflammatory, neuroinfectious and oncologic conditions. The neurological manifestations of such are often unknown and/or poorly described. As such, the role of the Neurology Consult Service is invaluable in defining the extent of disease and recording complications of therapeutic interventions.
A few examples of such diseases are:
- Edheim-Chester disease
- STAT1 mutations
- HIV-associated motor neuron disease
- Common Variable Immune Deficiency (CVID) related brain lesions
- CAR TIL Therapy for B-Cell lymphomas, glioblastoma multiforme (GBM), multiple myeloma
- McCune Albright Syndrome
- Autoimmune polyendrocinepathy-candidiasis-ectodermal dystrophy (APECED)
- Neurocysticercosis
- Chronic cryptococcal meningitis with spinal arachnoiditis in non-immunocompromised
- Cancer immunotherapy-related neurological complications including intrathecal methotrexate-related complications with stroke-like episodes, PRES, cyclosporine-induced neurological toxicity
- SLE-related neurological involvement
- Lyme disease-related neurological involvement
- Phelan McDermid Syndrome and epilepsy
Lumbar Puncture Service
The Neurology Consult Service assists with lumbar punctures for complicated patients who are enrolled in protocols at the NIH. The service is currently very limited but plans to expand it in the future with ultrasound-guided lumbar punctures. Contact the neurology consult service at the number listed below with questions regarding the feasibility of acquiring such services.
Outpatient Clinic Days
- The Adult Neurology Clinic Days are Tuesdays and Wednesdays from 1-5 pm.
- Consultations are performed at various outpatient clinics at the Clinical Center depending on the protocol in which the patient is enrolled. Each consult requires preparation, and previous records, including neuroimaging and neurological evaluations, as well as the reason for the consultation, should be received in advance of the appointment. Disposition for chronic care needs will be addressed during the initial consultation request. Please call the number listed below for further information.
- Urgent neurological consultations (same day consults) should be communicated directly to the consult attending of the day.
- Emergent consultations should be obtained via activating the brain code services.
- Pediatric Neurology Clinic Days are with Drs. Ariane Soltados and Andrea Gropman.
Neurology Education Series
The Neurology Consult Service provides “Improving in Clinical Neurology” education series for practicing neurological care teams. These lectures are brief, focused on clinical care and are updates on current practices. They are held in conjunction with the weekly Consult Conference Rounds in the 7C101 conference room and are announced with some advanced notice. Previous topics include:
- Pediatric Neurology Update (Dr. Ariane Soldatos)
- Stroke Update (Dr. John Lynch)
- Paroxysmal Movement Disorders (Dr. Barbara Karp)
- Status Epilepticus Management (Dr. Shubhi Agrawal)
- Neurosarcoidosis (Dr. Yasir Jassam)
The Neurology Consult Service serves as a starting point for clinical rotators who are completing elective rotations from institutes around the country and world. These include medical students, neurology residents and fellows at various stages of training. After obtaining permission from the consult attending, NIH Summer students and IRTAs may observe clinical discussions to gain an understanding of how neurological care is approached, an invaluable opportunity before embarking on the journey to medical graduate sciences and medical school[NA([2] .
Patient Quality Improvement Efforts
The NINDS Neurology Consult Service has significantly advanced patient-centered quality improvement efforts at the Clinical Center. Initiatives include the establishment of the NINDS Clinical Practice Committee, participation in hospital wide M&M rounds, and the NINDS Patient Safety M&M rounds. The NINDS Patient Safety M&M rounds include areas such as:
- Structuring Patient Follow-up on NINDS protocols
- Stroke Management at the NIH Clinical Center
- Approaching a "Brain Code" at NIH
Lecture series known as "Improving in Clinical Neurology" have included topics such as:
- Pediatric Neurology Updates
- Stroke updates
- Paroxysmal Movement Disorders
- Status Epilepticus Management
- Neurosarcoidosis
- Tremor Electrophysiology