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Reply from the author

  • Mauricio R. Delgado, MD, FRCPC, FAAN, University of Texas Southwestern Medical Center, Harry Hines Blvd, Dallas, TexasGuidelines@aan.com
Submitted May 17, 2010

We thank Dr. Whelan for the opportunity to respond to her queries. The article to which she refers is a Cochrane article, which is a review article. [2] During the guideline development process, we look at review articles for references to ensure the completeness of our search, but we do not use them as evidence, as they do not contain primary data.

Dr. Whelan's concern about the authors’ conflicts of interest and possible bias is valid. However, the AAN’s clinical practice guideline conflict of interest policy does not automatically exclude those with a potential conflict of interest: "The goal is to balance interests and to minimize the impact of bias in the guideline development process. When it is not feasible to form an expert panel devoid of potential conflict, it is essential to balance the panel between those with and without conflicts." [3]

Five of the 10 authors on this panel (DH, MA, SA, LAM, and MWS) have no significant conflicts of interest related to the topic of this guideline. Other panel members have conflicts that account for 20% or less of their clinical practice and 2 panel members could be considered to have significant relationships with corporate sponsors or 50% or more of their clinical effort spent treating this condition.

In addition, this Practice Parameter was extensively reviewed by several AAN committees and outside organizations. It was finally reviewed and approved by the AAN Board of Directors and Neurology's peer reviewers. In my opinion, the review process was as thorough as can be obtained.

We hope this letter satisfies the concerns.

Reference

3. AAN Clinical Practice Guideline Conflict of Interest Policy. http://www.aan.com/globals/axon/assets/4206.pdf

Disclosures: See original article for full disclosure list.

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