Neurology Today article

Excerpt from a 6 February 2007 article "Blogs, Wikis and Other Cutting Edge Technologies for Neurology" by Orly Avitzur MD in the American Academy of Neurology's publication "Neurology Today":

A sophisticated neurology wiki that helps doctors make clinical decisions is exactly what child neurologist Michael M. Segal, MD, PhD, had in mind when he created SimulConsult,  SimulConsult users input data into software that helps them arrive at a differential diagnosis of neurological syndromes. 

David J. Michelson, MD, assistant professor of neurology at Loma Linda University School of Medicine, said he has been amazed by SimulConsult's ability to generate perfect matches to single conditions. 

"The software is very user-friendly and intuitive," he said.  "It is designed to highlight metabolic and genetic syndromes which often only differ by certain specific findings."  ... a 7-year-old boy with a neurodegenerative disorder with dementia, cerebellar atrophy, and spastic quadriplegia - despite EMG and muscle biopsy results suggesting denervation - was a perfect match for neuroaxonal dystrophy.  He quipped, "Steven Ashwal made that diagnosis within five seconds of hearing me describe the child, which just proves that I need the program a lot more than he does."

The tool has matured and increased in accuracy through a collaborative effort of many neurologists.  In contrast to Wikipedia, all submissions to the SimulConsult database are reviewed by doctors following the existing norms for medical journals. Dr. Segal contends that wikis are more descriptive, providing details about findings in diseases, than prescriptive, providing rules tailored for particular clinical situations.  The descriptive information available through wikis is a good way to aggregate evidence-based medicine, Dr. Segal added.

"Our software addresses 1,400 inherited and congenital neurological diseases, and uses over 24,000 data points," said Dr. Segal.  "Since there are no clinical rules, adding new material is straightforward and can be done merely by changing individual data points."

SimulConsult also created a blog format for clinical cases in which medical terms from a case narrative are hyperlinked into the diagnostic software (  Physicians can click into the software with all patient findings already entered.  The cases blog format is being developed together with the Child Neurology Society for residents and other doctors in practice who want to keep their skills sharp and up-to-date with the latest advances in diagnostic knowledge.

The ability to click into information tools from narratives about patients has the potential for much wider application.  "In essence, a medical chart is a privacy-protected blog," Dr. Segal pointed out.  If data such as labs, tests, history and physical exam findings can be filtered into software, physicians can be easily assisted in medical decision-making."

"The cases blog illustrates the potential of a neurology wiki," Dr. Segal continued.  "As similar tools become an integral part of practice, opportunities for collecting the wisdom of the neurology community in these ways will increase."