Tactful response to neurologist advice

[borne_before]

Hello,

I am set to start testing a kiddo, we haven't done intake yet, and just got a message that is basically like "EEG is supportive of absence seizures, and I (the neurologist) wants to start Ethosuximide, but parent is wondering should she wait prior till after the testing with youto start the medication. What are your thoughts?"

My thoughts are "WTF - start the freaking med. Testing aint that serious. I'd rather test a kid with controlled seizures. BTW - I'm just a psychologist - I am so out of my bounds."

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[borne_before]

Maybe this: "If starting the med is right medical move - then do it! I'll reach out to parent and explain something like "I'd rather have kid for testing with controlled seizures. In fact, we'd get more reliable data and if their are neurocognitive effects or side effects form the med, we can keep an eye for that. But, I wouldn't ever recommend a kiddo stops or delays meds for testing."

 

[PsyDr]

Because this is how medicine treats their peers, you thank them. Then you tell them that their proposed treatment should not interfere with testing.

"Dr. X, thank you for the additional clinical information. The proposed mediation would not interfere with testing. I will discuss this fact with the parent. I truly appreciate the professional courtesy."

 

[borne_before]

Maybe this:

"Hey Dr.X, thank you for taking the time to consult with me. I will defer any medical decision making to you and trust your expertise. If starting medication is your recommendation, I fully support that. I expect that testing will not be affected at all by the starting of the medication. In fact, I will probably get better data that is more generalizable to XXX and his learning/attentional processes, rather than measuring the impact of a seizure disorder learning and attention processes. I will keep an eye out for any absence seizures or side effects from medication. Would you like me to call his parent and explain his results?

 

[borne_before]

Because this is how medicine treats their peers, you thank them. Then you tell them that their proposed treatment should not interfere with testing.

"Dr. X, thank you for the additional clinical information. The proposed mediation would not interfere with testing. I will discuss this fact with the parent. I truly appreciate the professional courtesy."

I went with yours.

 

[FlowRate]

Ethosuximide is not an AED that we (psychiatrists) prescribe much so I'm not super familiar with the med. I did some brief reading and looks like it's usually somewhat better tolerated than some other AED's. As a very sweeping generalization, most AED's can have some degree of cognitive effects, especially at higher doses.

All that said, the neurologist should be the one informing you about whether a medication can potentially affect testing rather than asking for your opinion. Unless you subspecialize in testing kids with epilepsy, it would be weird to expect you to be an expert on testing with or without specific medications.

 

[Therapist4Chnge]

It’s collegial.

 

[WisNeuro]

Ethosuximide is not an AED that we (psychiatrists) prescribe much so I'm not super familiar with the med. I did some brief reading and looks like it's usually somewhat better tolerated than some other AED's. As a very sweeping generalization, most AED's can have some degree of cognitive effects, especially at higher doses.

All that said, the neurologist should be the one informing you about whether a medication can potentially affect testing rather than asking for your opinion. Unless you subspecialize in testing kids with epilepsy, it would be weird to expect you to be an expert on testing with or without specific medications.

I mean, a good deal of this research is done by neuropsychologists. We're the ones (assuming competence) that probably know best which meds affect cognition, and generally how much compared to others, particularly if we have experience with those populations. I've found neuropsych usually has a much better handle on this than neurology.

 

[dgdg]

Hello,

I am set to start testing a kiddo, we haven't done intake yet, and just got a message that is basically like "EEG is supportive of absence seizures, and I (the neurologist) wants to start Ethosuximide, but parent is wondering should she wait prior till after the testing with youto start the medication. What are your thoughts?"

My thoughts are "WTF - start the freaking med. Testing aint that serious. I'd rather test a kid with controlled seizures. BTW - I'm just a psychologist - I am so out of my bounds."

This is bread and butter stuff for primary care docs.
"I'm not a neurologist, but after reviewing everything they did, I think the neurologist made an accurate diagnosis which is supported by testing, and I recommend you follow their advice. Start the medication".
More questions can follow after that, but that is generally my main point when a specialist has a solid answer to a problem.

 

[FlowRate]

I mean, a good deal of this research is done by neuropsychologists. We're the ones (assuming competence) that probably know best which meds affect cognition, and generally how much compared to others, particularly if we have experience with those populations. I've found neuropsych usually has a much better handle on this than neurology.

Thanks, that's really interesting to hear and makes sense, especially as far as having a better handle as far as quantitative effects on testing. I'm actually a little surprised that it sounds like there are sufficient sample sizes to have good data on this.

 

[WisNeuro]

Thanks, that's really interesting to hear and makes sense, especially as far as having a better handle as far as quantitative effects on testing. I'm actually a little surprised that it sounds like there are sufficient sample sizes to have good data on this.

The epilepsy literature is fairly robust when it comes to med effects on cognition. Probably one of the best out there, other populations need some work, like different anti-cholinergics and cognition, among others.

 

[Freud’sMommy]

The epilepsy literature is fairly robust when it comes to med effects on cognition. Probably one of the best out there, other populations need some work, like different anti-cholinergics and cognition, among others.

Magellan scores and delirium risk + increased cognitive decline rate post-op in older adults is also robust IMO, though not as well characterized as AEDs.

 

[WisNeuro]

Magellan scores and delirium risk + increased cognitive decline rate post-op in older adults is also robust IMO, though not as well characterized as AEDs.

Yeah, the ACB and Megellan capture increased cognitive load, but as of now, there is only really data on differences in screening measures, which lacks a lot of precision and doesn't get at domain specific deficits, which is crucial.

 

[borne_before]

It’s collegial.

Yeah, I got the vibe that she was reaching out to be cool - like peers. But, I think it was kind of her way to ask "will you please tell mom to chill about this."

 

[singasongofjoy]

Yeah, I got the vibe that she was reaching out to be cool - like peers. But, I think it was kind of her way to ask "will you please tell mom to chill about this."

That was my initial take also. Sometimes parents just need to hear it from a second person too.

 

[smalltownpsych]

I would delay testing before I would delay treatment. In other words, sometimes a medication has a strong initial side effect that could lessen with time. I am assuming that the testing is more related to the long game anyway.

 

[borne_before]

I would delay testing before I would delay treatment. In other words, sometimes a medication has a strong initial side effect that could lessen with time. I am assuming that the testing is more related to the long game anyway.

Absolutely! But in this case, it's just to help the kid get services. I basically just need to document "functional impairment" in 3 of 6 activities of daily living that the bureaucracy of our state has identified, as epilepsy is a qualifying condition.