VOLUME 31 · ISSUE 4 · APRIL 2017
Y O U R M O N T H LY A A N M E M B E R S H I P M A G A Z I N E
Emerging Science Program Presents Latest Research in Migraine, Epilepsy, Parkinson’s, and More The AAN is committed to presenting the best neuroscientific research at the 69 th Annual Meeting in Boston. A total of 21 abstracts will be presented as part of the Emerging Science program. This special session will emphasize ongoing neuroscience research of an extraordinary nature which warrants expedited presentation, key aspects of which must have taken place after the October 24, 2016, abstract submission deadline. Fourteen dual presentation abstracts will be featured in data blitz format during the first 45 minutes of the Emerging Science Platform Session on Tuesday, April 25, from 5:45 p.m. to 6:30 p.m., followed by poster presentations in the same room from 6:30 p.m. to 7:15 p.m. In addition, four poster presentations will be included in Poster Session IV on Wednesday, April 26, from 8:30 a.m. to 7:00 p.m. and four poster presentations will be included in Poster Session V on Thursday, April 27, from 8:30 a.m. to 7:00 p.m. And finally, one abstract will be presented during the Clinical Trials Plenary Session on Tuesday, April 25, from 9:15 a.m. to 11:00 a.m. Continued on page 10
Why Are Some Neurology Practices More Successful Than Others? Participate in Neurology Compensation and Productivity Survey and Find Out You work hard to maintain a successful neurology practice. But how do your efforts—and results—stack up against your peers? What are the more successful practices doing that you’re not? And how do their results compare to your bottom line?
Continued on page 11
Congratulations 2017 AAN Award Winners! The Academy congratulates these winners of the 2017 AAN awards. Most of these recipients will be celebrated with presentations of their awards during the Annual Meeting in Boston, and some will present papers at the times noted below.
THIS ISSUE 20 Hola! Neurology Now
Publishes Pilot Edition for Spanish Speakers
Alliance Awards Founders Sponsored by the American Academy of Neurology and endowed by the former American Academy of Neurology Alliance.
Recipient: Emer McGrath, MBChB Boston, MA S35: Aging and Dementia: Neuroimaging in Neurodegenerative Diseases Wednesday, April 26, 3:30 p.m. Continued on page 14
May Webinar Explores How Risk Is Calculated by Payers Early Adopters Share Experiences, Tips on MIPS Applications Open for New Women Leading in Neurology Program
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Table of Contents
President’s Column Official Publication of the American Academy of Neurology
PUBLICATION COVER Emerging Science Program Presents Latest Research in Migraine, Epilepsy, Parkinson’s, and More Why Are Some Neurology Practices More Successful Than Others? Congratulations 2017 AAN Award Winners!
5 Thank You for the Honor of Serving as Your President
MEET YOUR LEADERS
6 Thank These Departing AAN Board Members
7 Online and On-site Annual Meeting Registration Still Available
7 Shuttle Service Available from Selected Boston Hotels, But Plan Ahead
7 Abstracts Sought for July
Sports Concussion Conference, Registration Open
8 Annual Meeting Plenary Sessions to Feature More Than 40 Premier Researchers
11 Bring Your Unique, Challenging Cases to Annual Meeting Curbside Consults Sessions
12 Invited Science Programs
to Focus on Headache and Neuro-oncology
20 Hola! Neurology Now Publishes
The Vision of the AAN is to be indispensable to our members.
20 Check out What’s New in
The Mission of the AAN is to promote the highest quality patient-centered neurologic care and enhance member career satisfaction.
Pilot Issue for Spanish Speakers Neurology Now, Neurology: Clinical Practice
28 CMS Requires Claims on
Post-op Visits for Select Codes Beginning July 1
29 Get to Know the Axon Registry
Contact Information American Academy of Neurology 201 Chicago Avenue Minneapolis, MN 55415
29 May Webinar Explores How
Phone: (800) 879-1960 (toll free) (612) 928-6000 (international)
30 Early Adopters Share
at the Annual Meeting
Risk Is Calculated by Payers Experiences, Tips on MIPS
CME & MOC
32 New Continuum Explores
Outpatient Neurology Topics
32 Continuum Gains Canadian 33 Visit the UCNS Booth at the Annual Meeting
12 In Memoriam: Lewis P. (Bud) Rowland
34 Applications Open for New
Women Leading in Neurology Program
35 Enhance Your Practice with
AAN Membership Options for Your Whole Care Team—for as Little as $105
16 Get the Most out of Your Week:
17 ‘AAN Gives Back’ Helps Prepare
in Neurology Award Winners B. Smith and Dan Gasby at Commitment to Cures Event
Boston Public School Youth for Health and Science Careers
18 Capitol Hill Report
AANnews • April 2017
Website: AAN.com For advertising rates, contact: Eileen R. Henry Wolters Kluwer Health | Medical Research Lippincott, Williams & Wilkins Phone:
DATES AND DEADLINES | 35 AMERICAN BRAIN FOUNDATION
Download the Annual Meeting Mobile App Before You Head to Boston
36 Celebrate Public Leadership
CAREERS | 37
AAN Executive Director Catherine M. Rydell, CAE Editor-in-Chief: John D. Hixson, MD Managing Editor: Angela Babb, CAE Editor: Tim Streeter Writers: Ryan Knoke and Sarah Parsons Designers: Siu Lee and Jim Hopwood Email: aannews@AAN.com AANnews is published monthly by the American Academy of Neurology for its 32,000 members worldwide. Access this magazine and other AAN publications online at AAN.com/go/elibrary. The American Academy of Neurology’s registered trademarks and service marks are registered in the United States and various other countries around the world. “American Brain Foundation” is a registered service mark of the American Brain Foundation and is registered in the United States.
Thank You for the Honor of Serving as Your President The Academy’s leadership, from the Board of Directors to committee participants to executive staff, must strive to represent all members—adult and child neurologists, community neurologists, academics, those in small and solo practices, researchers, and international members—as much as possible. In my travels across the country and the world as the Academy’s president, I’ve had the chance to hear a very wide range of views and opinions from our members working in these diverse practice settings. Many have offered their perspectives about the type of health care system we should have. For example, there are members who feel a single-payer, governmentrun system would be best. There are others who feel just as passionately that government should not interfere with health care. And there are supporters for all possible combinations in between. What I have grown to realize is that the vast majority of members all want the same core things: fair reimbursement for the value we provide, reduced regulatory hassles that produce no value to our patients, appropriate funding for neuroscience research, patient access to neurologists, and preservation of a rich neurologist-patient relationship. In the past few weeks the Board of Directors approved Health Care Delivery Principles—available online at http://bit.ly/2mpggtz— which incorporates these member views. The AAN continues to be strong in delivering excellent innovative education, superb science, and first-rate scientific publications.
This must continue and become even better as we answer current and upcoming challenges. However, in order to provide our members the fullest support essential to practicing the highest quality neurology, the Academy has been active in additional areas.
easy way for you to submit data to CMS for quality reporting and help satisfy the MOC Part IV PIP Clinical Module activity requirement.
As I said, our practice settings are quite diverse. Yet, we need to do what we can to help all types. We began by concentrating on small and solo practices as Terrence L. Cascino, this group was under the Fair Reimbursement MD, FAAN most intense pressure from To help neurologists get external forces. An Academy fair reimbursement for the value we task force made up of individuals from deliver, we have increased our advocacy this demographic has developed a efforts with Congress and stepped number of recommendations, many of up our communications and direct which are being implemented now. meetings with CMS. No matter how we try though, this can go only so far. Reduction of Regulatory Burden We must now demonstrate value with Regulations that make patients safe data we don’t have. For this reason, we and improve quality are necessary. ® started the Axon Registry to help us Unfortunately, many regulations don’t improve patient care and at the same do that and are simply hassles that get time collect and produce the data to in the way of patient care and deeply demonstrate to payers something we frustrate physicians. The AAN’s task already know: We add great value to force on burnout published the first in a the care of neurologic patients. The roll series of member survey results in the out of the registry is going very well and February 21, 2017, issue of Neurology, I encourage all US members to learn also available online at AAN.com/ more about getting involved with it. LiveWell. The task force discovered that Not only does your practice data help 60 percent of neurologists surveyed are us make the case for neurology when experiencing some form of burnout. we advocate for you, it also provides an A key driver is the regulatory burden affecting all physicians. This must be changed or we will face a burnedout work force, which will not be in Continued on page 33
Meet Your Leaders
Thank These Departing AAN Board Members
Online and On-site Annual Meeting Registration Still Available
Five neurology leaders are rotating off the AAN’s Board of Directors in April. Please join us in thanking them for their years of service to our members and their dedication to furthering the goals of the Academy and the profession of neurology.
It’s not too late to attend the world’s largest gathering of neurology professionals this month in beautiful, historic Boston. Online registration is still available at AAN.com/view/AM17 and on-site registration will be available all week long in the Boston Convention and Exhibition Center between 6:30 a.m. and 5:30 p.m. beginning Saturday, April 22, through Friday, April 28. Remember: The meeting’s convenient all-inclusive registration rate means you don’t need to register for individual programs in advance and you have the freedom and flexibility to enjoy most everything the meeting has to offer, all week long, at no additional cost. •
Shuttle Service Available from Selected Boston Hotels, But Plan Ahead Neil A. Busis, MD, FAAN
Aaron E. Miller, MD, FAAN
Timothy A. Pedley, MD, FAAN
Stefan M. Pulst, MD, FAAN
Lisa M. Shulman, MD, FAAN
2011–2017 Board of Directors
2009–2017 Board of Directors
2002–2017 Board of Directors
2011–2017 Board of Directors
2007–2017 Board of Directors
2011–2013 President Elect
2009–2013 AAN Secretary
2013–2017 AAN Treasurer •
AANPage Secretary MEM: 17 FAAN Recruitment Campaign Ad—Half Horizontal> AN Placed in AANnews 8.25 x 5.25 +0.125 bleed, 4C
Founded in 1630, Boston is one of the oldest cities in the US and its streets are among the most history-filled avenues in the nation. They also are among the most congested! Even with mass
transportation, rush hour traffic can extend travel times to up to 40 minutes between the Boston Convention and Exhibition Center and outlying Annual Meeting hotels, so plan your time accordingly. Bring comfortable walking shoes if you are staying at one of these five hotels within a few blocks of the convention center: Westin Boston Waterfront, Renaissance Boston Waterfront, Seaport Boston Hotel, Aloft Boston Seaport, and the Element Boston Seaport.
2015–2017 Immediate Past President
Guests at the remaining hotels will have access to complimentary shuttle
service. However, because shuttle service will not be picking up at every hotel, attendees may have to walk a few blocks to their designated shuttle pick-up location at another nearby hotel. Shuttle schedules will be available at the Boston Convention and Exhibition Center and your hotel concierge also will be able to assist you. So, plan accordingly and relish the exercise and historic atmosphere if you are walking, or enjoy the shuttle for the chance to prep for your busy day at the meeting and decompress later on your way back to your hotel. •
Abstracts Sought for July Sports Concussion Conference, Registration Open
Get the recognition you deserve. Add the Fellow of the AAN (FAAN) designation to your already impressive credentials. Learn how at AAN.com/view/FAAN.
AANnews • April 2017
About the Conference Each year, 1.6 to 3.8 million concussions result from sports/ recreation injuries in the United States, with the issue attracting significant media attention in recent years. New science is emerging quickly and breakthrough therapies are helping athletes recover from injuries previously thought untreatable. The Sports Concussion Conference is designed specifically to help attendees stay up-to-date and discover the latest information on the prevention, diagnosis, and treatment of sports concussion through interactive hands-on workshops, debates, and other engaging formats. And beautiful,
cosmopolitan host city Jacksonville boasts 1,100 miles of shoreline, abundant parks and waterways, and a plethora of natural beauty just waiting to be explored. Money-saving early registration discounts end June 15, 2017. Visit AAN.com/view/ConcussionConference to secure your spot today. • 2O17
Set Yourself Apart
The AAN seeks abstracts on a variety of sports concussion topics—including treatment, prevention, and education—for presentation in a poster discussion session or during general poster sessions at the fourth annual Sports Concussion Conference, coming to Jacksonville, FL, July 14 through 16, 2017. The deadline to submit is May 8 and submission of previously presented work is encouraged if it is of interest to the field. Authors may submit online at AAN.com/view/ ConcussionConference or by contacting firstname.lastname@example.org.
–16 • Jacksonville,FL FL July 14 –16 July • 14Jacksonville,
Annual Meeting Plenary Sessions to Feature More Than 40 Premier Researchers More than 40 premier researchers have been selected to present during this year’s plenary sessions. Be sure to plan your Annual Meeting schedule to include these highly popular lectures on the most cutting-edge advances in neuroscience.
Hot Topics Plenary Session
H. Houston Merritt Lecture
Saturday, April 22 | 5:00 p.m.–6:30 p.m.
Nancy J. Newman, MD, FAAN
Features translational research related to clinical issues of importance. Four outstanding physician-scientists provide summaries of their recent research findings and describe the clinical implications of the results. Dimitri Krainc, MD, PhD Northwestern University Feinberg School of Medicine, Chicago, IL Lysosomal Proteins as a Therapeutic Target in Neurodegeneration Claudia Chiriboga, MD, MPH Columbia University Medical Center, New York, NY Antisense Oligonucleotide Treatment (ASO) and SMA: Results of Clinical Trials
Ophthalmoscopy in the 21st Century
Sidney Carter Award in Child Neurology J. Helen Cross, PhD UCL-Institute of Child Health, London, United Kingdom Improving Outcomes in Childhood Epilepsy Robert Wartenberg Lecture Ronald C. Petersen, PhD, MD
Jonathan Kipnis, PhD University of Virginia, Charlottesville, VA
Mayo Clinic, Rochester, MN
The Role of CNS-draining Lymphatics in Neurological Diseases
How Early Can We Diagnose Alzheimer’s Disease?
O. Carter Snead III, MD, FAAN Hospital for Sick Children, Toronto, ON, Canada Population-based Comprehensive Epilepsy Care in Ontario, Canada: A Model Network
Presidential Plenary Session Sunday, April 23 | 9:15 a.m.–12:00 p.m.
Features the AAN’s premier lecture awards for clinically relevant research and a presentation by a leading lecturer. Top researchers speak on some of the most significant findings in neurology in 2017.
Presidential Lecture Terrence L. Cascino, MD, FAAN Mayo Clinic, Rochester, MN Burnout, Wellness, and the Future of Our Profession
Emory University School of Medicine, Atlanta, GA
AANnews • April 2017
Contemporary Clinical Issues Plenary Session Monday, April 24 | 9:15 a.m.–11:30 a.m.
Highlights issues most critical to practicing neurologists, including abstracts related to new therapeutic developments, clinical applications of basic and translational research, and innovative technical developments. Commentary and discussion follow each presentation.
Abstract Presentations: Nusinersen in Infants Diagnosed with Spinal Muscular Atrophy (SMA): Study Design and Initial Interim Efficacy and Safety Findings from the Phase 3 International ENDEAR Study Presenter: Nancy L. Kuntz, MD Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL
Discussant: Charlotte J. Sumner, MD, Johns Hopkins Medical School, Baltimore, MD Resumption of Oral Anticoagulation After Intracerebral Hemorrhage Is Associated with Decreased Mortality and Favorable Functional Outcome Presenter: Alessandro Biffi, MD, Massachusetts General Hospital, Boston, MA Discussant: Daniel F. Hanley, MD, FAAN, Johns Hopkins Medical School, Baltimore, MD Targeting Neuronal Activity-regulated Neuroligin-3 Secretion for Glioma Therapy Presenter: Michelle Monje Deisseroth, MD, PhD, Stanford University, Stanford, CA Discussant: Tracy T. Batchelor, MD, MPH, Massachusetts General Hospital, Boston, MA
Invited Speakers: Louise D. McCullough, MD, PhD University of Texas Health Science Center, Houston, TX A Woman “Found Down” Amaal J. Starling, MD Mayo Clinic, Scottsdale, AZ The Era of Targeted Preventive Treatment for Migraine: CGRP Monocloncal Antibodies Dennis N. Bourdette, MD, FAAN Oregon Health and Science University, Portland, OR High Drug Prices: The Elephant in the Clinic
Clinical Trials Plenary Session Tuesday, April 25 | 9:15 a.m.–11:30 a.m.
Covers important clinical topics identified from other society meetings that affect patient care. The latest updates within several clinical trials conducted over the course of the last year will be presented with an open panel discussion at the conclusion.
Adnan I. Qureshi, MD Zeenat Qureshi Stroke Institute, Minneapolis, MN
Frontiers in Neuroscience Plenary Session
Effect of Intensive Systolic Blood Pressure Lowering on Hematoma Expansion in Patients with Intracerebral Hemorrhage: Analysis of Antihypertensive Treatment of Acute Cerebral Hemorrhage (ATACH) II Trial
Focuses on translational research related to clinical issues of importance. Six physician-scientists outline their recent research findings, along with the clinical implications.
Jerry R. Mendell, MD, FAAN The Research Institute at Nationwide Children’s Hospital, Columbus, OH Longitudinal Effect of Eteplirsen Versus Historical Control on Ambulation in Duchenne Muscular Dystrophy Scott Powers, PhD Cincinnati Children’s Hospital, Cincinnati, OH Kids Are Not Just Little Adults: The Childhood and Adolescent Migraine Prevention Trial (CHAMP) Ludwig Kappos, MD University Hospital Basel, Basel, Switzerland
Wednesday, April 26 | 9:15 a.m.–12:00 p.m.
Charles A. Gersbach, PhD Duke University, Durham, NC Genome and Epigenome Editing for Gene Therapy and Cell Programming Amy Brooks-Kayal, MD University of Colorado School of Medicine, Aurora, CO Epilepsy at the Cutting Edge: Using Novel Models for Therapeutic Advances Xandra O. Breakefield, PhD Massachusetts General Hospital, Charlestown, MA Vesicle Communication in the Tumor-bearing Brain
Efficacy of Siponimod in Secondary Progressive Multiple Sclerosis: Results of the Phase 3 Study
M. Elizabeth Ross, MD, PhD Weill Cornell Medical College, New York, NY
Miia Kivipelto, MD University of Kuopio, Kuopio, Finland
The Lives of a Gene: Diverse Roles in Diseases of Developing and Mature Brain
A 2-year Multidomain Intervention of Diet, Exercise, Cognitive Training, and Vascular Risk Monitoring Versus Control to Prevent Cognitive Decline in At-risk Elderly People (FINGER): A Randomized Controlled Trial Jerry R. Mendell, MD, FAAN The Research Institute at Nationwide Children’s Hospital, Columbus, OH AVXS-101 Phase 1 Gene Therapy Clinical Trial in SMA Type 1: Event Free Survival and Achievement of Developmental Milestones J. Helen Cross, PhD UCL-Institute of Child Health, London, United Kingdom Cannabidiol (CBD) Reduces Convulsive Seizure Frequency Gil I. Wolfe, MD, FAAN University at Buffalo, Buffalo, NY MGTX: Results of the Multinational Thymectomy Trial in Non-thymomatous Myasthenia Gravis
Mary Reilly, MD, FRCP, FRCPI National Hospital for Neurology and Neurosurgery, London, United Kingdom Axonopathies: What Next? Eliezer Masliah, MD University of California, San Diego, La Jolla, CA The Promise of Immunotherapy for Neurodegenerative Disorders: Progress and Challenges
Controversies in Neurology Plenary Session Thursday, April 27 | 9:15 a.m.–11:30 a.m.
Features experts discussing the most current and controversial issues in neuroscience. This debate format includes two speakers arguing one side of a single topic, followed by a rebuttal. Is Focused Ultrasound Better Than Deep Brain Stimulation? Pro: Paul S. Fishman, MD, PhD University of Maryland School of
Medicine, Baltimore, MD Con: Michael S. Okun, MD University of Florida, Gainesville, FL Should Disease-modifying Therapies Be Stopped in Progressive MS? Pro: John Corboy, MD, FAAN University of Colorado School of Medicine, Aurora, CO Con: Robert T. Naismith, MD, Washington University in St. Louis, St. Louis, MO Does Removal of Amyloid Improve Cognition in Alzheimer’s Disease? Pro: Reisa Sperling, MD Brigham Women’s Hospital and Massachusetts General Hospital, Boston, MA Con: George Perry, PhD University of Texas at San Antonio, San Antonio, TX
Neurology Year in Review Plenary Session Friday, April 28 | 9:15 a.m.–11:30 a.m.
Features six speakers, each focusing on the latest research that has happened in the last year within a specific subspecialty topic. Susan Fox, MD Toronto Western Hospital, Toronto, ON, Canada Movement Disorders Paul M. Vespa, MD, FAAN University of California Los Angeles, Los Angeles, CA Neurocritical Care Erika Augustine, MD, MS University of Rochester Medical Center, Rochester, NY Pediatric Neurology Peter A. Calabresi, MD, FAAN Johns Hopkins University, Baltimore, MD Multiple Sclerosis Cynthia L. Harden, MD Mount Sinai Beth Israel PACC, New York, NY Epilepsy Brett M. Kissela, MD, MS, FAAN University of Cincinnati Gardner Neuroscience Institute, Cincinnati, OH Stroke • AANnews • April 2017
Emerging Science Program Presents Latest Research in Migraine, Epilepsy, Parkinson’s, and More Continued from cover Emerging Science Platform Session
Tuesday, April 25 5:45 p.m.–7:15 p.m. 001 A Phase 3, Randomized, Doubleblind, Placebo-controlled Study to Evaluate the Efficacy and Safety of Erenumab in Migraine Prevention: Primary Results of the ARISE Trial | David W. Dodick, MD, FAAN, Phoenix, AZ 002 Non-invasive Vagus Nerve Stimulation for the Acute Treatment of Episodic and Chronic Cluster Headache: Findings from the Randomized, Double-blind, Sham-controlled ACT2 Study | Peter Goadsby, MD, PhD, San Francisco, CA 003 Double-blind, Randomized, Placebo-controlled, Phase III Study (TOLEDO) to Evaluate the Efficacy of Apomorphine Subcutaneous Infusion in Reducing OFF Time in Parkinson’s Disease Patients with Motor Fluctuations Not Well Controlled on Optimized Medical Treatment | Regina Katzenschlager, MD, Vienna, Austria 004 Intraputaminal AADC Gene Therapy for Advanced Parkinson’s Disease: Interim Results of a Phase 1b Trial | Chadwick W. Christine, MD, San Francisco, CA 005 Motor Effects and Safety of IPX203, an Investigational Extended-release Formulation of Carbidopa-Levodopa, in Advanced Parkinson’s Disease: A Single-dose Phase 2 Study | Mark Stacy, MD, FAAN, Durham, NC 006 Results of a Phase 1 Study of ABBV-8E12 in Patients with Progressive Supranuclear Palsy and Phase 2 Study Design in Alzheimer’s Disease and PSP | Hana Florian, North Chicago, IL 007 Sustained Seizure Reduction with Adjunctive Everolimus for Treatment-refractory Seizures Associated with Tuberous Sclerosis Complex (TSC): Long-term Results from the Phase 3 EXIST-3 Study | David N. Franz, MD, Cincinnati, OH 008 Cannabidiol (CBD) Significantly Reduces Drop Seizure Frequency in Lennox-Gastaut Syndrome (LGS): Results of a Dose-ranging, Multi-center, Randomized, Double-blind, Placebo-controlled
AANnews • April 2017
trial (GWPCARE3) | Anup D. Patel, MD, Columbus, OH 009 Efficacy and Safety of Nusinersen in Children with Later-onset Spinal Muscular Atrophy (SMA): Interim Results of the Phase 3 CHERISH Study | Richard S. Finkel, MD, Orlando, FL 010 Subcutaneous Immunoglobulin for Maintenance Treatment in Chronic Inflammatory Demyelinating Polyneuropathy (CIDP), a Multicenter Randomized Doubleblind Placebo-controlled Trial: The PATH Study | Ivo N. Van Schaik, MD, Amsterdam, Netherlands 011 Results of a Phase 1b/2 Study of ATYR1940 in Adult Patients with Limb Girdle Muscular Dystrophy Type 2B (LGMD2B) and Facioscapulohumeral Muscular Dystrophy (FSHD) (ATYR1940-C-004) | John Vissing, MD, Copenhagen, Denmark 012 Dual Responder Analyses of Both Muscle Strength and Activities of Daily Living, Eculizumab Versus Placebo, in Refractory Generalized Myasthenia Gravis (gMG) Patients: Results from the REGAIN Study | James F. Howard, Jr., MD, FAAN, Chapel Hill, NC 013 Comparison of Protein-coding and Long, Non-coding RNA Gene Expression Signatures to Classify Multiple Sclerosis | Charles Spurlock III, PhD, Nashville, TN 014 A ‘Surface-in’ Gradient of Thalamic Damage Is an Early and Diseasespecific Process in Pediatric-onset Multiple Sclerosis | Giulia Fadda, MD, Montreal, QC, Canada
Emerging Science Poster Presentations
Poster Session IV, Wednesday, April 26, 8:30 a.m.–7:00 p.m. P4.406 Delayed-release Dimethyl Fumarate Reduces the Formation of T2 Lesions in Pediatric Patients with Relapsing-remitting MS: Results From FOCUS, the First Clinical Trial to Evaluate the Neuroradiological Efficacy of an MS Disease-modifying Therapy in Pediatric Patients | Satish Eraly, MD, PhD, Cambridge, MA P4.407 Patients Who Received Alemtuzumab in CARE-MS I or II
Show a Low Rate of Conversion from Relapsing-remitting MS to Secondary Progressive MS Through 6 Years | Dana Horakova, MD, PhD, Prague, Czech Republic P4.408 Symptomatic and Objective Clinical Improvement in Progressive Multiple Sclerosis Patients Treated with Autologous Epstein-Barr Virus-specific T Cell Therapy: Interim Results of a Phase I Trial | Michael Pender, MD, PhD, Brisbane, Australia P4.409 Radiological Evidence for the Long-Term Effect of Fingolimod Treatment in Patients with Relapsing-Remitting Multiple Sclerosis | Jeffrey Allan Cohen, MD, Cleveland, OH Poster Session V, Thursday, April 27, 8:30 a.m.–7:00 p.m. P5.409 3D Mathematical Modeling of Glioblastoma Suggests that Transdifferentiated Vascular Endothelial Cells Promote Resistance to Current Standardof-care Therapy | Daniela Bota, MD, Orange, CA P5.410 Cholinesterase Inhibitor Use and Cognitive Decline in Mild Cognitive Impairment and Mild Dementia Due to Alzheimer Disease | Jee-young Han, St. Louis, MO P5.411 Seizures Are Locked to Long Time-scale Rhythms in Epilepsy | Maxime Baud, MD, PhD, San Francisco, CA P5.412 The Differential Effects of Eicosapentaenoic (EPA) and Docosahexaenoic (DHA) Acids on Seizure Frequency in Patients with Drug-resistant Epilepsy— A Randomized, Double-blind, Placebo-controlled Trial | Ahmed Daak, MD, PhD, Riviera Beach, FL
Clinical Trials Plenary Session Tuesday, April 25, 9:15 a.m.–11:30 a.m. Phase 3, Randomized, Double-blind, Placebo-controlled Study to Evaluate the Efficacy and Safety of Erenumab (AMG 334) in Migraine Prevention: Primary Results of the STRIVE Trial | Peter Goadsby, MD, PhD, San Francisco, CA •
Why Are Some Neurology Practices More Successful Than Others? Continued from cover
In this health care climate, you can’t afford to be uninformed. That’s why the AAN publishes the annual Neurology Compensation and Productivity Report. This is a $600 value for Academy members and a $1,200 value for nonmembers. But if you participate in the Neurology Compensation and Productivity Survey, you gain free access to the customizable dashboard, and access to current and past pdf reports. The survey is now open to AAN members. It only takes a short time to prepare for and complete, and your data is confidential and reported only in aggregate. And by participating, you will get the online 2017 Neurology Compensation and Productivity Report and customizable dashboard at no cost when it is available this summer, enabling you to compare your practice to those in your community, region, or nationwide. “The AAN’s Neurology Compensation and Productivity Report is an essential tool for our practice,” said David A. Evans, MBA, COO of Texas Neurology in Dallas and chair of the AAN’s Practice Management & Technology Subcommittee. “By having comparative data, we have been able to identify variances in several areas to include compensation, call pay, benefits, and RVUs. I also use it to
analyze the ratios between metrics, such as compensationto-RVUs and call pay-to-number of hospital beds. When I filter using varying criteria on the report’s online dashboard, I am always finding actionable data points.” For more information or to get started on the survey, visit AAN.com/view/benchmark or contact email@example.com. •
Free Complimentary Executive Summary Opens Window to Data You Can Use If you have not yet participated in the survey in order to receive our exclusive report, you now can receive the complimentary executive summary from the 2016 Neurology Compensation and Productivity Report containing valuable neurology benchmark statistics, such as the US median annual compensation by practice setting, median work RVU by practice setting, and much more! Check it out, and if you like what you see visit AAN.com/ view/benchmark to learn more and begin the survey. •
Bring Your Unique, Challenging Cases to Annual Meeting Curbside Consults Sessions Bring your unique and most challenging cases in specific topic areas to any one of this year’s Curbside Consults. Clinical Case Consults are available every day of the meeting—but Academic Consults are available Tuesday through Friday. These sessions offer a casual, walk-up opportunity to discuss your most demanding clinical and academic cases with experts in those areas. Even if you don’t have a case to discuss, Annual Meeting attendees are encouraged to stop by to listen and learn from other cases.
Clinical Case Consults nn nn nn nn
Movement Disorders | Cynthia L. Comella MD, FAAN Saturday, April 22, 1:30 p.m.–3:00 p.m. Neuro-oncology | Alan C. Carver, MD Sunday, April 23, 1:30 p.m.-3:00 p.m. Alzheimer’s Disease | Ronald C. Petersen, PhD, MD Monday, April 24, 1:30 p.m.–3:00 p.m. Multiple Sclerosis | Aaron E. Miller, MD, FAAN, and Stephen Krieger, MD, FAAN Tuesday, April 25, 1:30 p.m.–3:00 p.m. Headache | Peter Goadsby, MD, PhD, and Amaal J. Starling, MD Wednesday, April 26, 1:30 p.m.–3:00 p.m. Stroke | Natalia S. Rost, MD, FAAN Thursday, April 27, 1:30 p.m.–3:00 p.m. Neuromuscular Disorders | A. Gordon Smith, MD, FAAN, and Nicholas E. Johnson, MD Friday, April 28, 1:30 p.m.–3:00 p.m.
Academic Consults Program directors and clerkship directors are encouraged to bring their challenging “cases” or problems encountered in running their residency programs or clerkships. Each session will be co-led by a senior program director and a senior clerkship director. nn Tuesday, April 25, 1:30 p.m.–3:00 p.m.
Program Director: Charles F. Flippen II, MD— University of California Los Angeles
Clerkship Director: David Lee Gordon, MD, FAHA, FAAN— University of Oklahoma nn Wednesday, April 26, 1:30 p.m.–3:00 p.m. Program/Clerkship Director: Ralph F. Józefowicz, MD, FAAN—University of Rochester nn Thursday, April 27, 1:30 p.m.–3:00 p.m. Program/Clerkship Director: Frank W. Drislane, MD, FAAN— Beth Israel Deaconess, Boston nn Friday, April 28, 1:30 p.m.–3:00 p.m. Program Director: Steven L. Lewis, MD, FAAN— Rush University Medical Center Clerkship Director: Tracey Cho, MD—Massachusetts General Hospital • AANnews • April 2017
Invited Science Programs to Focus on Headache and Neuro-oncology
In Memoriam: Lewis P. (Bud) Rowland
Annual Meeting attendees won’t want to miss this year’s Invited Science sessions, where authors of top abstracts on headache and neuro-oncology that were previously presented at subspecialty meetings will take to the platform to present their findings.
Invited Science: Headache Monday, April 24 3:30 p.m.–5:30 p.m. nn 3:30 p.m. to 3:50 p.m.
Early Life Stress Increases Susceptibility to Cortical Spreading Depression and Anxiety in Rodents Stuart Collins, PhD Toledo, OH nn 3:50 p.m. to 4:10 p.m.
Posttraumatic Headache Five Years after Traumatic Brain Injury
Sylvia M. Lucas, MD, PhD Seattle, WA
nn 5:10 p.m. to 5:30 p.m.
Altered Pupillary Light Responses in Migrainous Photophobia
Melissa M. Cortez, DO Salt Lake City, UT
Invited Science: Neuro-oncology
nn 1:00 p.m.–1:20 p.m.
Ann Scher, PhD Bethesda, MD
nn 4:30 p.m. to 4:50 p.m.
Perspectives of Adolescents on the Burden of their Parent’s Migraine: Results from the Chronic Migraine Epidemiology and Outcomes Study
Richard B. Lipton, MD, FAAN Bronx, NY nn 4:50 p.m. to 5:10 p.m.
CRP and Migraine in Young Adults - Results from the Add Health Study
Gretchen E. Tietjen, MD Toledo, OH
Transformation of Tumor Endothelial Cells to Mesenchymal Stem Cell-like Cells Induces Therapy Resistance in Glioblastoma
Menggui Huang, PhD Philadelphia, PA nn 2:20 p.m.–2:40 p.m.
ACT IV: An International, Double-blind, Phase 3 Trial of Rindopepimut in Newly Diagnosed, EGFRvIII-expressing Glioblastoma Michael Weller, MD Zurich, Switzerland nn 1:20 p.m.–1:40 p.m.
Epidemiology of Migraine in Men: Results from the Chronic Migraine Epidemiology and Outcomes (CaMEO) Study
Tuesday, April 25 1:00 p.m.–3:00 p.m.
nn 4:10 p.m. to 4:30 p.m.
nn 2:00 p.m.–2:20 p.m.
Targeting Carcinoma–astrocyte Gap Junctions in Brain Metastasis
nn 1:40 p.m.–2:00 p.m.
Single-cell Profiling of Glioblastoma Biopsies Identifies a Family of Activating PDGFreceptor Deletions
Soeren Mueller, PhD San Francisco, CA
David A. Reardon, MD Boston, MA nn 2:40 p.m.–3:00 p.m.
Adrienne Boire, MD New York, NY
Phase 2 Study to Evaluate the Clinical Efficacy and Safety of MEDI4736 (Durvalumab [ DUR]) in Patients with Glioblastoma (GBM): Results for Cohort B (DUR Monotherapy), Bevacizumab (BEV) Naïve Patients with Recurrent GBM
Redefining the Cellular Architecture of Adult and Pediatric Glioblastomas Through Largescale Single-cell Analyses Mariella Filbin, MD, PhD Boston, MA •
Lewis P. (Bud) Rowland, MD, FAAN
Neurology legend Lewis P. (Bud) Rowland, MD, FAAN, passed away on March 16, 2017, at age 91. Rowland served as AAN president from 1989 to 1991, and was editor-in-chief of Neurology ® from 1977 to 1986. He was the founding editor-in-chief of Neurology Today ® from 2001 through 2009, and was president of the AAN’s Education and Research Foundation (now the American Brain Foundation) from 1996 to 1999.
“The AAN and our profession has lost a true giant in neurology,” said President Elect Ralph L. Sacco, MD, MS, FAHA, FAAN. “Bud was a leader, advocate, teacher, mentor, and friend who personally touched so many of us. He inspired us to always do more for our patients and the field of neurology. We will miss his warmth, wit, and encouraging words, but he lives in our fond memories forever.” Steven P. Ringel, MD, FAAN, president at the time Neurology Today was launched, said, “It was an easy choice to select Bud Rowland as the first editor of Neurology Today. His stature, leadership, and breadth of knowledge guaranteed success. My admiration for him steadily grew in the nine years we worked together on the publication.” Rowland received his BA and MD degrees from Yale University and completed his residency under H. Houston Merritt at the New York Neurological Institute. He was a clinical associate at NINDS, focusing on neuromuscular disease, and taught neurology at Georgetown University. Rowland was a professor in neurology at Columbia University from 1957 to 1967, when he began a six-year stint as professor and chair of neurology at the University of Pennsylvania. He then returned to Columbia to chair the neurology department from 1973 to 1998. He was past president of the American Neurological Association, the New York Neurological Society, and the Association of University Professors of Neurology, The Parkinson’s Disease Foundation, and member of numerous NIH committees. His awards and honors, too numerous to mention in their entirety, include the AAN’s Presidential Award in 1993. •
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AANnews • April 2017
Rowland, with his wife Esther at his side, was honored at the 2008 Annual Meeting for his “unparalleled contributions” to the AAN’s publishing programs.
AANnews • April 2017
Congratulations 2017 AAN Award Winners! S. Weir Mitchell Sponsored by the American Academy of Neurology and endowed by the former American Academy of Neurology Alliance.
Recipient: Richard Ryan Darby, MD Boston, MA S18: Behavioral and Cognitive Neurology Monday, April 24, 3:30 p.m.
American Academy of Neurology President’s Award Recipient: Anthony G. Alessi, MD, FAAN Norwich, CT
American Brain Foundation Chair’s Award Sponsored by the American Brain Foundation.
Recipient: Francis I. Kittredge, Jr., MD, FAAN Bangor, ME
Association of Indian Neurologists in America (AINA) Lifetime Achievement Award Sponsored by the American Brain Foundation and endowed by the Association of Indian Neurologists in America (AINA).
Recipient: Kapil D. Sethi, MD, FRCP, FAAN Augusta, GA
Award for Creative Expression of Human Values in Neurology Sponsored by the Ethics, Law, and Humanities Committee, a joint committee of the American Academy of Neurology, the American Neurological Association, and the Child Neurology Society.
Recipient: Kathryn Rae Wagner, MD, PhD, Baltimore, MD
A.B. Baker Award for Lifetime Achievement in Neurologic Education Funded by an endowment created by matching funds from the A.B. Baker Family Trust and Novartis Pharmaceuticals.
Recipient: Harold P. Adams, Jr., MD, FAAN Iowa City, IA C74: Annual A.B. Baker Program: Focus on Professionalism Monday, April 24, 7:00 a.m–9:00 a.m.
Continued from cover
Recipients: Dr. Cyrus Escabillas Manila, Philippines
Enhanced Resident Leadership Program
John Dystel Prize for Multiple Sclerosis Research
The AAN is grateful to the following 2017 Enhanced Resident Leadership Program supporters: The Allergan Foundation and Lunbeck.
Sponsored by the AAN and National Multiple Sclerosis Society and made possible through a special contribution from the John Dystel Multiple Sclerosis Research Fund at the National Multiple Sclerosis Society.
Dr. Alagoma Iyagba Port Harcourt, Nigeria
Dr. Julia Pakpoor Oxford, United Kingdom
Gurmeen Kaur, MBBS Syracuse, NY
Recipient: Alan J. Thompson, MD, FRCP, FAAN London, United Kingdom
Balaji Krishnaiah, MD Hershey, PA
S33: Progressive MS Therapeutics Wednesday, April 26, 3:30 p.m.
Dr. Tan Lin Qingdao, Shandong, China
Steve O’Donnell, MD Salt Lake City, UT
Sheila Essey Award: An Award for ALS Research
Recipients: Jason L. Crowell, MD Charlottesville, VA
Weredeselam M. Olango, MD Newark, NJ Abby Lauren Olsen, MD Boston, MA Simy K. Parikh, MD Boston, MA William H. Roth, MD New York, NY Altaf Saadi, MD Boston, MA Elizabeth Silbermann, MD Saint Louis, MO Jennifer Cialone, MD Rochester, NY Anthony L. Fine, MD Rochester, MN
Presented by the AAN and the ALS Association and supported through the philanthropy of the Essey family and the ALS Association.
Recipient: John M. Ravits, MD, FAAN La Jolla, CA S3: ALS: Disease Mechanism and Therapeutics Sunday, April 23, 1:00 p.m.
Norman Geschwind Prize in Behavioral Neurology Sponsored by the American Academy of Neurology and endowed through Dr. Geschwind’s family, friends, and colleagues; Pfizer Inc; and the Society for Behavioral and Cognitive Neurology.
Ingo Helbig, MD Philadelphia, PA
Recipient: Peter Turkeltaub, MD, PhD Washington, DC
Lauren B. James, MD Columbus, OH
S18: Behavioral and Cognitive Neurology Monday, April 24, 3:30 p.m.
Audrey R. Nath, MD Boston, MA
Dreifuss-Penry Epilepsy Award Sponsored by the AAN and endowed by members of the AAN Epilepsy Section; Abbott Laboratories, Inc.; Cephalon, Inc.; Cyberonics, Inc.; Elan Pharmaceuticals, Inc.; GlaxoSmithKline; Novartis Neuroscience; Ortho-McNeil Neurologics; Pfizer Inc; Shire US, Inc; and UCB Pharma.
Recipient: William Stacey, MD Ann Arbor, MI S34: Epilepsy and Clinical Neurophysiology (EEG) II Wednesday, April 26, 3:30 p.m.
Wayne A. Hening Sleep Medicine Investigator Award Sponsored by the AAN and endowed by UCB Inc., Lilly USA, Elite Home Medical & Respiratory, Inc., Raleigh Neurology Associates, and friends of Dr. Wayne A. Hening.
Dr. Fabio Porto Sao Paulo, Brazil
Dr. Miguel Wilken Buenos Aires, Argentina
Dr. Imen Kacem La Manouba, Tunis, Tunisia
Dr. Roosevelt Francois Mirebalais, Haiti Dr. Janet Ebid Cairo, Egypt Dr. JieQiong Li Qingdao, Shandong, China Dr. Kiran Patil Puducherry, India Dr. Seid Gugssa Addis Ababa, Ethiopia Dr. Makoto Hara Tokyo, Japan Dr. Fei Han Beijing, China Dr. FeiFei Zhai Beijing, China
Mitchell B. Max Award for Neuropathic Pain Sponsored by the AAN and endowed by the United States Cancer Pain Relief Committee, the Mayday Fund, and friends of Dr. Mitchell Max.
Recipient: C Peter N Watson, MD Toronto, Ontario S38: Pain and Palliative Care Thursday, April 27, 1:00 p.m.
Lawrence C. McHenry Award: An Award for the History of Neurology
2017 Medical Student Diversity Scholarships The AAN is grateful to the following 2017 Medical Student Diversity Annual Meeting Scholarship supporters: The Allergan Foundation, Supernus Pharmaceuticals, Inc.
Recipients: Kamila Bond Rochester, MN
Reid Woods Washington, DC
Sponsored by the American Academy of Neurology.
Justin Williams Rochester, NY
Recipient: Chelsea Zhang Dallas, TX
Camilo Bermudez Noguera Nashville, TN Samantha Roman Halethorpe, MD Mikalei Gordon Silver Spring, MD Victor Ekuta San Diego, CA Gabriel Reynaldo Arismendi North Bergen, NJ
Medical Student Essay Awards Extended Neuroscience Award
P2.412: Quantitative Comparison of K-D Balance and Sway Balance™ System Mobile Device Applications
Monday, April 24, 8:30 a.m.
Movement Disorders Research Award Sponsored by the AAN, the Parkinson’s Disease Foundation, and the AAN Movement Disorders Section and endowed by the Parkinson’s Disease Foundation.
Sponsored by the American Academy of Neurology.
Recipient: Andrew Singleton, PhD Bethesda, MD
Recipient: Aaron Bowen Denver, CO
S22: Parkinson’s Disease: Observational Studies Tuesday, April 25, 1:00 p.m.
P2.409: Recycling Endosomes Mediate Local, Golgi-Independent Secretory Trafficking in Neuronal Dendrites Monday, April 24, 8:30 a.m.
G. Milton Shy Award in Clinical Neurology Sponsored by the American Academy of Neurology.
Recipient: Moon Jeong Lee Baltimore, MD
Recipient: Christopher J. Boes, MD, FAAN Rochester, MN
International Scholarship Award
S31: History of Neurology Wednesday, April 26, 1:00 p.m.
Roland P. Mackay Award in Historical Aspects
Sponsored by the American Academy of Neurology.
Monday, April 24, 8:30 a.m. Saul R. Korey Award in Experimental Neurology
S14: Highlights in Sleep Science Monday, April 24, 1:24 p.m.
Sponsored by the American Academy of Neurology.
P2.411: Patient or Participants? The 1977 National Bioethics Commission and Multidisciplinary Oversight of “Innovative” Psychosurgery
Jabari Bailey Washington, DC
P2.410: Utility of an Electronic Customizable Sleep Behavioral Software Program “MySleepScript” in Individuals with Acquired Brain Injury Monday, April 24, 8:30 a.m.
Recipient: Tiffany Braley, MD Ann Arbor, MI
Recipient: Bob Sun Cleveland, OH
Neuro-oncology Investigator Award Sponsored by the American Academy of Neurology and supported by friends of Dr. Jerome Posner.
Recipient: Michelle Monje, MD, PhD Stanford, CA S41: Neuro-oncology Thursday, April 27, 1:00 p.m.
Neuro-oncology Scientific Award Sponsored by the American Academy of Neurology and supported by friends of Dr. WK Alfred Yung.
Recipients: Mario Suva, MD, PhD Boston, MA S41: Neuro-oncology Thursday, April 27, 1:00 p.m.
Sponsored by the American Academy of Neurology.
Continued on page 16
AANnews • April 2017
AANnews • April 2017
Congratulations 2017 AAN Award Winners! Neuroendocrine Research Award
Continued from page 15
U-87 MG Cell Line Using Leaf Extract of Bacopa monnieri
Sponsored by the American Academy of Neurology and supported by friends of Dr. Andrew Herzog.
Sunday, April 23
Recipient: Gustavo Roman, MD, DrHC Houston, TX
Recipient: Gokul Kannan Highland, MD
Neuroendocrinology Section Meeting Sponsored by the American Academy of Neurology and the Child Neurology Society.
P1.410: Triggering the Brain to Heal Itself After Traumatic Brain Injury: Where Glia, Anesthesia and Nanomedicine Meet Sunday, April 23
Recipient: Pravin Ravishankar Sunnyvale, CA
Child Neurology Neuroscience Research Prize
Neuroscience Research Prize
P1.408: A LZCan: Predicting Future Onset of Alzheimer’s Using Polygenic Risk Scores, Cognitive Tests, CSF Biomarkers, and Multiple Neuroimaging Modalities Sunday, April 23 Recipient: Tejas Athni Macon, GA P1.409: Inhibiting the Proliferation of Patient-Derived Glioblastoma Multiforme (GBM) Cells and
Sponsored by the American Academy of Neurology and the Child Neurology Society.
Recipient: Lauren Singer Scarsdale, NY Transient Visually-evoked Potentials as a Novel Biomarker for Autism and Phelan-McDermid Syndrome Child Neurology Society Meeting
Michael S. Pessin Stroke Leadership Prize Sponsored by the AAN and endowed by Dr. Pessin’s family, friends, and colleagues.
Recipient: James F. Burke, MD, MS Ann Arbor, MI
S22: Parkinson’s Disease: Observational Studies Tuesday, April 25, 1:00 p.m.
Ensuring Adequate Nutrition Delivery in the Neurointensive Care Unit
Bruce S. Schoenberg International Award in Neuroepidemiology
H. Richard Tyler Award
Recipient: Preston Douglas, MD Maywood, IL
Sponsored by the American Academy of Neurology and endowed by GlaxoSmithKline, Inc.
Simulation-based Training in Brain Death Determination Incorporating Family Discussion
Potamkin Prize for Research in Pick’s, Alzheimer’s, and Related Diseases
Recipient: Raghav Govindarajan, MD Columbia, MO
Sponsored by the AAN and the American Brain Foundation and funded through the philanthropy of the Potamkin family.
Telephonic Single Breath Count Test Administered by Nurses in Diagnosing Myasthenia Exacerbation
Recipients: Carlos H. Schenck, MD Minneapolis, MN
Recipient: James E. Siegler III, MD Philadelphia, PA
Recipients: S. Claudia Kawas, MD Irvine, CA
Kristine Yaffe, MD San Francisco, CA
S7: Aging and Dementia: Clinical and Translational Studies in Neurodegenerative Diseases Sunday, April 23, 3:30 p.m.
Safety and Quality Award Sponsored by the American Academy of Neurology.
Download the 2017 AAN Annual Meeting Mobile App to help you plan and get the most out of your week in Boston. The handy app puts all the information you need to plan and customize your schedule on your smart phone or tablet. Browse and add education programs, scientific sessions, and other informational and social events quickly and easily, and much more. Features: nn Search the full Annual Meeting program schedule nn Locate rooms using the map nn View abstracts nn Access course syllabi and slides nn Submit course evaluations to earn CME nn Find out where all the fun social and networking events
are taking place
nn Get the latest meeting information and updates
The 2017 Annual Meeting Mobile App is sponsored by Novartis Pharmaceuticals. Visit AAN.com/view/AMApp to download the app in iOS and Android formats, also available at the Apple Store or Google Play Store. •
AANnews • April 2017
S11: Autonomic Disorders: Synucleinopathies Monday, April 24, 1:00 p.m.
S25: Cerebrovascular Disease and Interventional Neurology: Prehospital and Emergency Department Ischemic Stroke Care Tuesday, April 25, 3:30 p.m.
Get the Most out of Your Week: Download the Annual Meeting Mobile App Before You Head to Boston
Recipient: David Do, MD Philadelphia, PA
Inter-Provider Communication Using a Scheduled Provider Alert-Response Communication System (SPARCS) in 3 Inpatient Neurology Units
Irwin Schatz Award for Autonomic Disorders Sponsored by the American Academy of Neurology and endowed by Lundbeck, Inc.
Recipient: Phillip A. Low, MD, FAAN Rochester, MN
Recipient: Yogeshwar V. Kalkonde, MD Gadchiroli, Maharashtra, India S15: Neuroepidemiology Monday, April 24, 3:30 p.m.
Sleep Science Award
Mark W. Mahowald, MD Minneapolis, MN
S14: Highlights in Sleep Science Monday, April 24, 1:00 p.m.
Jon Stolk Award in Movement Disorders for Young Investigators Sponsored by the AAN and endowed by Kyowa Pharmaceutical, Inc., Lineberry Research, Quintiles, Dr. Dennis Gillings, and VelaPharma.
Recipient: Marios Politis, MD, MSC, DIC, PhD, FAAN London, United Kingdom
Sponsored by the American Academy of Neurology and the AAN History Section.
Recipient: Douglas Lanska, MD, FAAN Tomah, WI
Kenneth M. Viste Jr., MD Patient Advocate of the Year Award Sponsored by the American Academy of Neurology and endowed by gifts from Dr. Viste’s colleagues, friends, and patients.
Recipient: Elaine C. Jones, MD, FAAN Bristol, RI
Harold Wolff-John Graham Award: An Award for Headache/ Facial Pain Research Sponsored by the American Academy of Neurology and endowed by Endo Pharmaceuticals.
Recipient: Simple Futarmal Kothari Aarhus, Denmark S52: Headache: Clinical Trials and Disease Burden Friday, April 28, 1:00 p.m. •
‘AAN Gives Back’ Helps Prepare Boston Public School Youth for Health and Science Careers The AAN is proud to partner with The Center for Community Health and Health Equity at Brigham and Women’s Hospital to help give back to the Boston community during the 2017 AAN Annual Meeting. Your support will help send Boston public school ninth graders through the innovative Summer Science Academy program, exposing them to health care professions in a hospital setting, and providing hands-on science education that links to real-world professional—and personal—application. Donations will provide transportation, equipment, public health curriculum, and student funding. The AAN’s goal is to raise $5,000 and the Academy will match up to $2,500 in AAN Gives Back donations. To learn more and donate, visit AAN.com/conferences/2017-annualmeeting/aan-gives-back. • AANnews • April 2017
Capitol Hill Report Capitol Hill Report presents regular updates on legislative and regulatory actions and how the Academy ensures that the voice of neurology is heard on Capitol Hill. It is emailed to US members twice monthly and is posted at AAN.com/view/HillReport. Below are some recent highlights.
Neurology on the Hill Successes The recent 15th annual Neurology on the Hill set records with 216 AAN members from 42 states meeting their members of Congress in Washington, DC. Our advocates visited 272 congressional offices, created 2,072 tweets using #NOH17 which produced 1.8 million social media impressions, and took lots of pictures of everyone with members of the House and Senate. Once again, your colleagues were clad in AAN signature green bow ties and scarves that generated many conversations in congressional offices as well as in the halls and elevators about what our group was representing. The result is a significant increase in the profile of neurology to everyone on Capitol Hill. The primary goal was to carry four messages to lawmakers: nn Congress should ensure that any changes to the Affordable Care Act are in alignment with the AAN’s Principles for Health Care Delivery. nn Members of Congress should cosponsor the Furthering Access to Stroke Telemedicine Act (S 431/HR 1148) that will allow Medicare to pay for stroke telemedicine consultations in urban and suburban areas. nn Congress should support full funding for the NIH including the BRAIN Initiative. nn Congress should take steps to reduce drug prices that are impacting patients.
AANnews • April 2017
Neurology on the Hill is a two-day event. Advocates go to Capitol Hill after receiving a full day of training on the issues and updates from key people in government. This year’s program included an update on the amazing work of the BRAIN Initiative by AAN member Walter J. Koroshetz, MD, FAAN, who serves as the director of the National Institute of Neurological Disorders and Stroke (NINDS). This really encouraged AAN advocates to let their congressional offices know of the benefits of this incredible program. Staff from the powerful House Energy and Commerce (E&C) Committee, which has jurisdiction over many health care issues, gave an update on the FAST Act and encouraged us to cross the 218 cosponsor threshold, which represents a majority of the House. The AAN generated 172 cosponsors for the same legislation in the last Congress. Future Capitol Hill Reports will track our progress. During our event, the AAN’s federal political action committee, BrainPAC, collected $56,000 from more than 100 attendees. BrainPAC hosted a dinner for major donors Monday evening. This event featured a keynote address by E&C Committee Chair Greg Walden (R-OR), who discussed many of the major health care decisions being debated in Congress. AAN members also were strongly encouraged to promote their efforts publicly on social media using the hashtag #NOH17. Doing so helps raise awareness of the event and the issues with policy makers, the public, and the AAN membership. By the end of the day, over 200 participants had generated nearly 500 tweets, reaching more than a million people, including patients, colleagues, friends, coworkers, family, and many of
their associates, as well, as messages were forwarded and retweeted. Even seven legislators posted about their visits with the AAN members. They got to see a lot of enthusiasm and activism for neurology! After the long day of walking the halls of Congress, everyone was invited back to the AAN’s DC office for a reception to debrief and relax before heading back home. That is, all except Donn Dexter, MD, FAAN, of Wisconsin. Each member of Congress received one guest ticket to the Joint Session Address to Congress by President Trump that was held the evening
of NOH. Rep. Ron Kind (D-WI) gave his to Dexter, who is a member of the AAN’s Government Relations Committee. Dexter said, “It was a great honor to represent the AAN, our profession and our patients in Washington. It was also a thrill to be the guest of Rep. Kind at the presidential address. This is an NOH I’ll never forget.” View the 2017 Neurology on the Hill Photo Album on the American Academy of Neurology Facebook page to enjoy more pictures of our visit. You can see who you recognize, either AAN member, representative, or senator. •
Hola! Neurology Now Publishes Pilot Issue for Spanish Speakers The AAN is publishing a pilot issue of its patient magazine Neurology Now ® for Spanish speakers interested in brain health and those with neurologic conditions and their caregivers. The Spring 2017 issue, with its own exclusive content, is being mailed along with the April/May English issue to AAN members’ offices located in areas with high numbers of Spanish speakers. According to Editor-in-Chief Orly Avitzur, MD, MBA, FAAN, there is a strong need for high-quality and trustworthy medical information in the language of this community. About 53 million people living in the US today are Hispanic, making up one in five of the population. About a third of Hispanics are not proficient in English, although those numbers are rising. Moreover, non-white Hispanics also have a higher risk for neurologic problems including stroke, which is their fourthleading cause of death. Hispanics ALZANDO are also 1.5 times more likely LA VOZ La presentadora de TV to develop Alzheimer’s disease Elizabeth Espinosa habla por aquellos than whites. Research shows con necesidades especiales that fewer than 50 percent of Una vida entre letras Hispanics have a regular doctor, Esmeralda Santiago comparte su so access to trustworthy medical recuperación de un ataque cerebral information is further limited.
More Spanish Language Resources Available
LA FUENTE DE INFORMACIÓN MÁS CONFIABLE PARA LA SALUD DE SU CEREBRO
The AAN invites comments about this pilot issue and whether members and their patients would like to see future issues. After you receive the issue, please take a moment to complete a brief survey at AAN.com/survey/ NNSpanishIssue. •
¿Migraña? Una guía con lo último
Decisión informada Recomendaciones para tratar la esclerosis múltiple
The Neurology Now Spanish pilot issue is just one of a number of valuable resources that the AAN provides in the Spanish language. Others include: nn Selected clinical practice guidelines in Spanish at AAN.com/Guidelines/ Home/ByLanguage nn 2017 Annual Meeting—two-hour Hot Topics in Spanish on the HeadTalks stage. Topics include: §§ Neurocritical Care—Emergency Neurology Life Support §§ Zika Virus §§ Endovascular Treatment of Stroke nn 2017 Brain Health Fair—free resources and presentations in Spanish will be offered to the public attendees at the Boston event •
Check out What’s New in Neurology Now, Neurology: Clinical Practice The April/May 2017 issue of Neurology Now features actress Marcia Gay Harden (Pollock, God of Carnage, Code Black), whose mother was diagnosed with Alzheimer’s disease. That has motivated Harden to get involved with raising awareness about the disease, including identifying early symptoms and understanding the importance of getting an accurate diagnosis. The magazine also features a guide to summer camps for children with neurologic disorders. Share this information with your patients’ caregivers to help them find the perfect match for their children whether they have a neuromuscular disease, epilepsy, or developmental delays. Neurology Now is free for AAN members and their patients. AAN members may elect to receive multiple copies to distribute to their patients, who also can subscribe for free. Visit NeurologyNow.com to learn more or access your AAN member profile to adjust the number of copies you receive.
Neurology: Clinical Practice, published six times a year, is available in print (for US members only), online, and for the iPad and Android. Visit Neurology.org/cp for more information. •
YOUR TRUSTED RESOURCE FOR BRAIN HEALTH
IN THE MANAGEMENT OF RMS
BEYOND Ad Page
APRIL / MAY 2017
ROLE OF A LIFETIME
Actress Marcia Gay Harden Becomes Alzheimer’s Advocate after her Mom’s Diagnosis Off to Camp Sleepaway Camps for Kids with Neurologic Disorders Hit the Road 10 Tips for Making Travel Easier Caregivers How to get the Break You Need
In the new issue of Neurology ® Clinical Practice, neurology and its relationship to mental health is explored, including the effects of depression in patients living with epilepsy, migraine, and multiple sclerosis.
RMS=relapsing forms of multiple sclerosis. AANnews • April 2017
FOR PATIENTS WITH RELAPSING MS
Start or switch to AUBAGIO (teriflunomide) 14 mg—the only oral DMT with a proven impact on disability progression in 2 Phase III trials ®
The majority of patients remained free from disability progression* with AUBAGIO 14 mg1
80 84 AN ESTIMATED
OVER 108 WEEKS (P =0.03)1†
OVER 108 WEEKS (P <0.05)1†
TEMSO: A double-blind, placebo-controlled trial in patients with relapsing forms of MS (N=1088). Patients were randomized to receive AUBAGIO 14 mg (n=359), AUBAGIO 7 mg (n=366), or placebo (n=363) once daily for 108 weeks.4 TOWER: A double-blind, placebo-controlled trial in patients with relapsing forms of MS (N=1169). Patients were randomized to receive AUBAGIO 14 mg (n=372), AUBAGIO 7 mg (n=408), or placebo (n=389) once daily with results for up to 40 months of treatment.5
INDICATION AUBAGIO® (teriflunomide) is indicated for the treatment of patients with relapsing forms of multiple sclerosis.
—TEMSO: 20.2%, 21.7%, and 27.3% with AUBAGIO 14 mg, AUBAGIO 7 mg, and placebo, respectively1 —TOWER: 15.8%, 21.1%, and 19.7% with AUBAGIO 14 mg, AUBAGIO 7 mg, and placebo, respectively1 • AUBAGIO 7 mg did not achieve a statistically significant reduction in risk of sustained disability progression versus placebo in either trial1 • Sustained disability progression was defined as at least a 1-point increase from baseline EDSS score ≤5.5 (or at least a 0.5-point increase for those with a baseline EDSS score >5.5) sustained for at least 12 weeks1 • AUBAGIO 14 mg and 7 mg achieved a significant relative reduction in risk of relapse in TEMSO (31% for both doses; P<0.05) and TOWER (36% and 22%, respectively; P<0.05)1
CONTRAINDICATIONS • Patients with severe hepatic impairment. • Pregnant women and females of reproductive potential not using effective contraception. • Patients with a history of hypersensitivity reaction to teriflunomide, leflunomide, or to any of the inactive ingredients in AUBAGIO. • Co-administration with leflunomide.
(continued on back)
Please see additional Important Safety Information and Brief Summary of Full Prescribing Information, including boxed WARNING, on the following pages. ‡
• The estimated proportion of patients with sustained disability progression:
WARNINGS AND PRECAUTIONS • Hepatotoxicity: Patients with pre-existing acute or chronic liver disease, or those with serum ALT >2 times the upper limit of normal (ULN) before initiating treatment, should not normally be treated with AUBAGIO. In clinical trials, if ALT elevation was >3 times the ULN on 2 consecutive tests, patients discontinued AUBAGIO and underwent accelerated elimination. Consider additional monitoring if co-administering AUBAGIO with other potentially hepatotoxic drugs; monitor patients who develop symptoms suggestive of hepatic dysfunction (eg, unexplained nausea, vomiting, abdominal pain, fatigue, anorexia, or jaundice and/or dark urine). • Teratogenicity: AUBAGIO may cause fetal harm when administered in pregnant women. Teratogenicity and embryo-fetal lethality occurred in animal reproduction studies in multiple animal species at plasma teriflunomide exposures similar to or lower than that in humans at the maximum human recommended dose of 14 mg/day. AUBAGIO is contraindicated for use in pregnant women and females of reproductive potential not using effective contraception. Women who become pregnant while taking AUBAGIO may enroll in the AUBAGIO pregnancy registry by calling 1-800-745-4447, option 2. • Procedure for Accelerated Elimination of Teriflunomide: Teriflunomide is eliminated slowly from the plasma—it takes an average of 8 months, or up to 2 years, to reach plasma concentrations <0.02 mcg/mL. Elimination may be accelerated by administration of cholestyramine or activated charcoal, but this may cause disease activity to return in patients who were responding to AUBAGIO. • Bone Marrow Effects/Immunosuppression Potential/Infections: Decreases in white blood cell counts, mainly of neutrophils and lymphocytes, and platelets have been reported with AUBAGIO. Thrombocytopenia, including rare cases with platelet counts less than 50,000/mm3, has been reported in the postmarketing setting. Obtain a complete blood cell count within 6 months before starting treatment, with further monitoring based on signs and symptoms of bone marrow suppression. AUBAGIO is not recommended for patients with severe immunodeficiency, bone marrow disease, or severe uncontrolled infections. Tuberculosis (TB) has been observed in clinical studies of AUBAGIO. Before starting treatment, screen patients for latent TB infection with a tuberculin test. Treatment in patients with acute or chronic infections should not be started until the infection(s) is resolved. Administration of live vaccines is not recommended. The risk of malignancy, particularly lymphoproliferative disorders, or infection may be increased with the use of some medications with immunosuppressive potential, including teriflunomide.
IMPORTANT SAFETY INFORMATION WARNING: HEPATOTOXICITY AND RISK OF TERATOGENICITY • Severe liver injury including fatal liver failure has been reported in patients treated with leflunomide, which is indicated for rheumatoid arthritis. A similar risk would be expected for teriflunomide because recommended doses of teriflunomide and leflunomide result in a similar range of plasma concentrations of teriflunomide. Concomitant use of AUBAGIO with other potentially hepatotoxic drugs may increase the risk of severe liver injury. • Obtain transaminase and bilirubin levels within 6 months before initiation of AUBAGIO therapy. Monitor ALT levels at least monthly for 6 months after starting AUBAGIO. If drug-induced liver injury is suspected, discontinue AUBAGIO and start an accelerated elimination procedure with cholestyramine or activated charcoal. AUBAGIO is contraindicated in patients with severe hepatic impairment. Patients with pre-existing liver disease may be at increased risk of developing elevated serum transaminases when taking AUBAGIO. • AUBAGIO is contraindicated for use in pregnant women and in women of reproductive potential who are not using effective contraception because of the potential for fetal harm. Teratogenicity and embryolethality occurred in animals at plasma teriflunomide exposure lower than that in humans. Exclude pregnancy before the start of treatment with AUBAGIO in females of reproductive potential. Advise females of reproductive potential to use effective contraception during AUBAGIO treatment and during an accelerated drug elimination procedure after AUBAGIO treatment. Stop AUBAGIO and use an accelerated drug elimination procedure if the patient becomes pregnant.
for your patients with relapsing MS
*Disability progression was a secondary endpoint in TEMSO and TOWER.4,5 † Based on Kaplan-Meier estimates.1
DMT=disease-modifying therapy; EDSS=Expanded Disability Status Scale; MS=multiple sclerosis.
QUIETING MS Quietly
AUBAGIO is effective across key measures of disease activity: sustained disability progression (14 mg only), annualized relapse rate, and MRI activity. Overall discontinuation rates due to adverse events were 12.5% with AUBAGIO 14 mg, 11.2% with AUBAGIO 7 mg, and 7.5% with placebo, and treatment discontinuation rates due to common adverse events were ≤3.3% in the pooled clinical trials.1,6
Proven impact in newly diagnosed RMS patients1 In patients who had a first clinical event characteristic of RMS, AUBAGIO® (teriflunomide) provided freedom from relapses1
VS 62% WITH PLACEBO (P <0.05)1
• 71% of patients remained relapse free with AUBAGIO 7 mg in the TOPIC trial1 • TOPIC is the only trial of an oral RMS therapy that studied patients who had a first clinical event consistent with acute demyelination occurring within 90 days of randomization1-3 TOPIC: A double-blind, placebo-controlled trial in patients with relapsing forms of MS (N=618). Patients were randomized to receive AUBAGIO 14 mg (n=216), AUBAGIO 7 mg (n=205), or placebo (n=197) once daily for 108 weeks. Patients had a first clinical event consistent with acute demyelination occurring within 90 days of randomization with 2 or more T2 lesions at least 3 mm in diameter characteristic of RMS.7
MAKE AUBAGIO YOUR FIRST CHOICE FOR NEWLY DIAGNOSED RMS PATIENTS IMPORTANT SAFETY INFORMATION (continued) • Hypersensitivity and Serious Skin Reactions: AUBAGIO can cause anaphylaxis and severe allergic reactions. Signs and symptoms have included dyspnea, urticaria, and angioedema including lips, eyes, throat, and tongue. Cases of serious skin reactions, including Stevens-Johnson syndrome and a fatal case of toxic epidermal necrolysis, have been reported with AUBAGIO. Very rare cases of Drug Reaction with Eosinophilia and Systemic Symptoms have also been reported with leflunomide. If a severe skin reaction develops with AUBAGIO, stop treatment and begin accelerated elimination. In such cases, patients should not be re-exposed to teriflunomide. • Peripheral Neuropathy: Peripheral neuropathy, including polyneuropathy and mononeuropathy, has been reported with AUBAGIO. Age >60 years, concomitant neurotoxic medications, and diabetes may increase the risk. If peripheral neuropathy is suspected, consider discontinuing treatment and performing accelerated elimination. • Increased Blood Pressure: Blood pressure increases and hypertension have occurred with AUBAGIO. Measure blood pressure at treatment initiation and manage any elevations during treatment. • Respiratory Effects: Interstitial lung disease (ILD), including acute interstitial pneumonitis, has been reported with AUBAGIO. ILD may be fatal and may occur acutely at any time during therapy with a variable clinical presentation. If discontinuation of the drug is necessary, consider initiation of an accelerated elimination procedure. Adverse Reactions: The most frequent adverse reactions (≥10% and ≥2% greater than placebo) with AUBAGIO 7 mg and 14 mg and placebo, respectively, were headache (18% and 16% vs 15%), ALT increased (13% and 15% vs 9%), diarrhea (13% and 14% vs 8%), alopecia (10% and 13% vs 5%), and nausea (8% and 11% vs 7%). Drug Interactions: Monitor patients when teriflunomide is coadministered with warfarin, or with drugs metabolized by CYP1A2, CYP2C8, substrates of OAT3 transporters, substrates of BCRP, or OATP1B1/1B3 transporters. Use in Specific Populations: Women who wish to become pregnant should discontinue AUBAGIO and undergo an accelerated elimination procedure. Use of effective contraception should be continued until plasma concentrations of teriflunomide are <0.02 mcg/mL. Nursing mothers should not use AUBAGIO. AUBAGIO is detected in human semen. To minimize any possible fetal risk, men not wishing to father a child and their female partners should use effective contraception. Men wishing to father a child should discontinue therapy and either undergo accelerated elimination or verify plasma teriflunomide concentration is <0.02 mcg/mL.
Please see additional Important Safety Information on the previous pages and Brief Summary of Full Prescribing Information, including boxed WARNING regarding hepatotoxicity and use in pregnancy, on the following pages. References: 1. AUBAGIO (teriflunomide) [package insert]. Cambridge, MA: Genzyme Corporation; November 2016. 2. Tecfidera (dimethyl fumarate) [package insert]. Cambridge, MA: Biogen Inc.; February 2016. 3. Gilenya (fingolimod) [package insert]. East Hanover, NJ: Novartis Pharmaceuticals Corporation; February 2016. 4. O’Connor P, Wolinsky JS, Confavreux C, et al; TEMSO Trial Group. Randomized trial of oral teriflunomide for relapsing multiple sclerosis. N Engl J Med. 2011;365(14):1293-1303. 5. Confavreux C, O’Connor P, Comi G, et al; for the TOWER Trial Group. Oral teriflunomide for patients with relapsing multiple sclerosis (TOWER): a randomised, double-blind, placebo-controlled, phase 3 trial. Lancet Neurol. 2014;13(3):247-256. 6. Data on file, Sanofi/Genzyme. Summary of safety HMR1726-teriflunomide. December 5, 2013. 7. Miller AE, Wolinsky JS, Kappos L, et al; for the TOPIC Study Group. Oral teriflunomide for patients with a first clinical episode suggestive of multiple sclerosis (TOPIC): a randomised, double-blind, placebo-controlled, phase 3 trial. Lancet Neurol. 2014;13(10):977-986.
©2016 Genzyme Corporation. All rights reserved. AUBAGIO, Sanofi, and Genzyme registered in U.S. Patent and Trademark Office. GZUS.AUBA.15.01.0245(3) December 2016
AUBAGIO® (teriflunomide) tablets, for oral use
Brief Summary of Prescribing Information WARNING: HEPATOTOXICITY and RISK OF TERATOGENICITY • Hepatotoxicity Severe liver injury including fatal liver failure has been reported in patients treated with leflunomide, which is indicated for rheumatoid arthritis. A similar risk would be expected for teriflunomide because recommended doses of teriflunomide and leflunomide result in a similar range of plasma concentrations of teriflunomide. Concomitant use of AUBAGIO with other potentially hepatotoxic drugs may increase the risk of severe liver injury. Obtain transaminase and bilirubin levels within 6 months before initiation of AUBAGIO therapy. Monitor ALT levels at least monthly for six months after starting AUBAGIO [see Warnings and Precautions (5.1)]. If drug induced liver injury is suspected, discontinue AUBAGIO and start an accelerated elimination procedure with cholestyramine or charcoal [see Warnings and Precautions (5.3)]. AUBAGIO is contraindicated in patients with severe hepatic impairment [see Contraindications (4)]. Patients with pre-existing liver disease may be at increased risk of developing elevated serum transaminases when taking AUBAGIO. • Risk of Teratogenicity AUBAGIO is contraindicated for use in pregnant women and in women of reproductive potential who are not using effective contraception because of the potential for fetal harm. Teratogenicity and embryolethality occurred in animals at plasma teriflunomide exposures lower than that in humans. Exclude pregnancy before the start of treatment with AUBAGIO in females of reproductive potential. Advise females of reproductive potential to use effective contraception during AUBAGIO treatment and during an accelerated drug elimination procedure after AUBAGIO treatment. Stop AUBAGIO and use an accelerated drug elimination procedure if the patient becomes pregnant [see Contraindications (4), Warnings and Precautions (5.2, 5.3), Use in Specific Populations (8.1), and Clinical Pharmacology (12.3) in the full prescribing information].
1 INDICATIONS AND USAGE AUBAGIO® is indicated for the treatment of patients with relapsing forms of multiple sclerosis. 2 DOSAGE AND ADMINISTRATION The recommended dose of AUBAGIO is 7 mg or 14 mg orally once daily. AUBAGIO can be taken with or without food. Monitoring to assess safety • Obtain transaminase and bilirubin levels within 6 months before initiation of AUBAGIO therapy. Monitor ALT levels at least monthly for six months after starting AUBAGIO [see Warnings and Precautions (5.1)]. • Obtain a complete blood cell count (CBC) within 6 months before the initiation of treatment with AUBAGIO. Further monitoring should be based on signs and symptoms of infection [see Warnings and Precautions (5.4)]. • Prior to initiating AUBAGIO, screen patients for latent tuberculosis infection with a tuberculin skin test or blood test for mycobacterium tuberculosis infection [see Warnings and Precautions (5.4)]. • Exclude pregnancy prior to initiation of treatment with AUBAGIO in females of reproductive potential [see Warnings and Precautions (5.2)]. • Check blood pressure before start of AUBAGIO treatment and periodically thereafter [see Warnings and Precautions (5.7)]. 4 CONTRAINDICATIONS AUBAGIO is contraindicated in/with: • Patients with severe hepatic impairment [see Warnings and Precautions (5.1)]. • Pregnant women and females of reproductive potential not using effective contraception. AUBAGIO may cause fetal harm [see Warnings and Precautions (5.2 and 5.3) and Use in Specific Populations (8.1)]. • Patients with a history of a hypersensitivity reaction to teriflunomide, leflunomide, or to any of the inactive ingredients in AUBAGIO. Reactions have included anaphylaxis, angioedema, and serious skin reactions [see Warnings and Precautions (5.5)]. • Coadministration with leflunomide [see Clinical Pharmacology (12.3) in the full prescribing information]. 5 WARNINGS AND PRECAUTIONS 5.1 Hepatotoxicity Severe liver injury including fatal liver failure and dysfunction has been reported in some patients treated with leflunomide, which is indicated for rheumatoid arthritis. A similar risk would be expected for teriflunomide because recommended doses of teriflunomide and leflunomide result in a similar range of plasma concentrations of teriflunomide. Patients with pre-existing liver disease may be at increased risk of developing elevated serum transaminases when taking AUBAGIO. Patients with pre-existing acute or chronic liver disease, or those with serum alanine aminotransferase (ALT) greater than two times the upper limit of normal (ULN) before initiating treatment, should not normally be treated with AUBAGIO. AUBAGIO is contraindicated in patients with severe hepatic impairment [see Contraindications (4)]. In placebo-controlled trials, ALT greater than three times the ULN occurred in 61/1045 (5.8%) and 62/1002 (6.2%) of patients receiving AUBAGIO 7 mg and 14 mg, respectively, and 38/997 (3.8%) of patients receiving placebo, during the treatment period. These elevations occurred mostly within the first year of treatment. Half of the cases returned to normal without drug discontinuation. In clinical trials, if ALT elevation was greater than three times the ULN on two consecutive tests, AUBAGIO was discontinued and patients underwent an accelerated elimi-
nation procedure [see Warnings and Precautions (5.3)]. Of the patients who underwent discontinuation and accelerated elimination in controlled trials, half returned to normal or near normal values within 2 months. One patient in the controlled trials developed ALT 32 times the ULN and jaundice 5 months after initiation of AUBAGIO 14 mg treatment. The patient was hospitalized for 5 weeks and recovered after plasmapheresis and cholestyramine accelerated elimination procedure. AUBAGIO-induced liver injury in this patient could not be ruled out. Obtain serum transaminase and bilirubin levels within 6 months before initiation of AUBAGIO therapy. Monitor ALT levels at least monthly for six months after starting AUBAGIO. Consider additional monitoring when AUBAGIO is given with other potentially hepatotoxic drugs. Consider discontinuing AUBAGIO if serum transaminase increase (greater than three times the ULN) is confirmed. Monitor serum transaminase and bilirubin on AUBAGIO therapy, particularly in patients who develop symptoms suggestive of hepatic dysfunction, such as unexplained nausea, vomiting, abdominal pain, fatigue, anorexia, or jaundice and/or dark urine. If liver injury is suspected to be AUBAGIO-induced, discontinue AUBAGIO and start an accelerated elimination procedure [see Warnings and Precautions (5.3)] and monitor liver tests weekly until normalized. If AUBAGIO-induced liver injury is unlikely because some other probable cause has been found, resumption of AUBAGIO therapy may be considered. 5.2 Teratogenicity AUBAGIO may cause fetal harm when administered to a pregnant woman. Teratogenicity and embryo-fetal lethality occurred in animal reproduction studies in multiple animal species at plasma teriflunomide exposures similar to or lower than that in humans at the maximum human recommended dose (MHRD) of 14 mg/day [see Use in Specific Populations (8.1)]. AUBAGIO is contraindicated for use in pregnant women and females of reproductive potential not using effective contraception [see Contraindications (4) and Warnings and Precautions (5.3)]. 5.3 Procedure for Accelerated Elimination of Teriflunomide Teriflunomide is eliminated slowly from the plasma [see Clinical Pharmacology (12.3) in the full prescribing information]. Without an accelerated elimination procedure, it takes on average 8 months to reach plasma concentrations less than 0.02 mg/L, although because of individual variations in drug clearance it may take as long as 2 years. An accelerated elimination procedure could be used at any time after discontinuation of AUBAGIO. Elimination can be accelerated by either of the following procedures: • Administration of cholestyramine 8 g every 8 hours for 11 days. If cholestyramine 8 g three times a day is not well tolerated, cholestyramine 4 g three times a day can be used. • Administration of 50 g oral activated charcoal powder every 12 hours for 11 days. If either elimination procedure is poorly tolerated, treatment days do not need to be consecutive unless there is a need to lower teriflunomide plasma concentration rapidly. At the end of 11 days, both regimens successfully accelerated teriflunomide elimination, leading to more than 98% decrease in teriflunomide plasma concentrations. Use of the accelerated elimination procedure may potentially result in return of disease activity if the patient had been responding to AUBAGIO treatment. 5.4 Bone Marrow Effects/Immunosuppression Potential/Infections Bone Marrow Effects A mean decrease compared to baseline in white blood cell (WBC) count of approximately 15% (mainly neutrophils and lymphocytes) and in platelet count of approximately 10% was observed in placebo-controlled trials with 7 mg and 14 mg of AUBAGIO. The decrease in mean WBC count occurred during the first 6 weeks and WBC count remained low during treatment. In placebo-controlled studies, neutrophil count <1.5×109/L was observed in 12% and 16% of patients receiving AUBAGIO 7 mg and 14 mg, respectively, compared with 7% of patients receiving placebo; lymphocyte count <0.8× 109/L was observed in 10% and 12% of patients receiving AUBAGIO 7 mg and 14 mg, respectively, compared with 6% of patients receiving placebo. No cases of serious pancytopenia were reported in premarketing clinical trials of AUBAGIO but rare cases of pancytopenia and agranulocytosis have been reported in the postmarketing setting with leflunomide. A similar risk would be expected for AUBAGIO [see Clinical Pharmacology (12.3) in the full prescribing information]. Cases of thrombocytopenia with AUBAGIO, including rare cases with platelet counts less than 50,000/mm3, have been reported in the postmarketing setting. Obtain a complete blood cell count (CBC) within 6 months before the initiation of treatment with AUBAGIO. Further monitoring should be based on signs and symptoms suggestive of bone marrow suppression. Risk of Infection / Tuberculosis Screening Patients with active acute or chronic infections should not start treatment until the infection(s) is resolved. If a patient develops a serious infection consider suspending treatment with AUBAGIO and using an accelerated elimination procedure. Reassess the benefits and risks prior to resumption of therapy. Instruct patients receiving AUBAGIO to report symptoms of infections to a physician. AUBAGIO is not recommended for patients with severe immunodeficiency, bone marrow disease, or severe, uncontrolled infections. Medications like AUBAGIO that have immunosuppression potential may cause patients to be more susceptible to infections, including opportunistic infections. In placebo-controlled studies of AUBAGIO, no overall increase in the risk of serious infections was observed with AUBAGIO 7 mg (2.2%) or 14 mg (2.7%) compared to placebo (2.2%). However, one fatal case of klebsiella pneumonia sepsis occurred in a patient taking AUBAGIO 14 mg for 1.7 years. Fatal infections have been reported in the postmarketing setting in patients receiving leflunomide, especially Pneumocystis jiroveci pneumonia and aspergillosis. Most of the reports were confounded by concomitant immunosuppressant therapy and/or comorbid illness which, in addition to rheumatoid disease, may predispose patients to infection. In clinical studies with AUBAGIO, cytomegalovirus hepatitis reactivation has been observed. In clinical studies with AUBAGIO, cases of tuberculosis have been observed. Prior to initiating AUBAGIO, screen patients for latent tuberculosis infection with a tuberculin skin test or with a blood test for mycobacterium tuberculosis infection. AUBAGIO has not been studied in patients with a positive tuberculosis screen, and the safety of AUBAGIO in individuals with latent tuberculosis infection is unknown. For patients testing positive in tuberculosis screening, treat by standard medical practice prior to therapy with AUBAGIO.
Vaccination No clinical data are available on the efficacy and safety of live vaccinations in patients taking AUBAGIO. Vaccination with live vaccines is not recommended. The long half-life of AUBAGIO should be considered when contemplating administration of a live vaccine after stopping AUBAGIO. Malignancy The risk of malignancy, particularly lymphoproliferative disorders, is increased with the use of some immunosuppressive medications. There is a potential for immunosuppression with AUBAGIO. No apparent increase in the incidence of malignancies and lymphoproliferative disorders was reported in the AUBAGIO clinical trials, but larger and longer-term studies would be needed to determine whether there is an increased risk of malignancy or lymphoproliferative disorders with AUBAGIO. 5.5 Hypersensitivity and Serious Skin Reactions AUBAGIO can cause anaphylaxis and severe allergic reactions [see Contraindications (4)]. Signs and symptoms have included dyspnea, urticaria, and angioedema including lips, eyes, throat, and tongue. Cases of serious skin reactions, including cases of Stevens-Johnson syndrome (SJS) and a fatal case of toxic epidermal necrolysis (TEN), have been reported with AUBAGIO. In patients treated with leflunomide, the parent compound, very rare cases of Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) have also been reported. Inform patients of the signs and symptoms of anaphylaxis and angioedema and signs and symptoms that may signal a serious skin reaction. Inform patients that a fever associated with signs of other organ system involvement (e.g., rash, lymphadenopathy, or hepatic dysfunction) may be drug-related. Instruct patients to discontinue AUBAGIO and seek immediate medical care should these signs and symptoms occur. Discontinue AUBAGIO, unless the reactions are clearly not drug-related, and begin an accelerated elimination procedure immediately [see Warnings and Precautions (5.3)]. In such cases, patients should not be re-exposed to teriflunomide [see Contraindications (4)]. 5.6 Peripheral Neuropathy In placebo-controlled studies, peripheral neuropathy, including both polyneuropathy and mononeuropathy (e.g., carpal tunnel syndrome), occurred more frequently in patients taking AUBAGIO than in patients taking placebo. The incidence of peripheral neuropathy confirmed by nerve conduction studies was 1.4% (13 patients) and 1.9% (17 patients) of patients receiving 7 mg and 14 mg of AUBAGIO, respectively, compared with 0.4% receiving placebo (4 patients). Treatment was discontinued in 0.7% (8 patients) with confirmed peripheral neuropathy (3 patients receiving AUBAGIO 7 mg and 5 patients receiving AUBAGIO 14 mg). Five of them recovered following treatment discontinuation. Not all cases of peripheral neuropathy resolved with continued treatment. Peripheral neuropathy also occurred in patients receiving leflunomide. Age older than 60 years, concomitant neurotoxic medications, and diabetes may increase the risk for peripheral neuropathy. If a patient taking AUBAGIO develops symptoms consistent with peripheral neuropathy, such as bilateral numbness or tingling of hands or feet, consider discontinuing AUBAGIO therapy and performing an accelerated elimination procedure [see Warnings and Precautions (5.3)]. 5.7 Increased Blood Pressure In placebo-controlled studies, the mean change from baseline to the end of study in systolic blood pressure was +2.3 mmHg and +2.7 mmHg for AUBAGIO 7 mg and 14 mg, respectively, and -0.6 mmHg for placebo. The change from baseline in diastolic blood pressure was +1.4 mmHg and +1.9 mmHg for AUBAGIO 7 mg and 14 mg, respectively, and -0.3 mmHg for placebo. Hypertension was an adverse reaction in 3.1% and 4.3% of patients treated with 7 mg or 14 mg of AUBAGIO compared with 1.8% for placebo. Check blood pressure before start of AUBAGIO treatment and periodically thereafter. Elevated blood pressure should be appropriately managed during treatment with AUBAGIO. 5.8 Respiratory Effects Interstitial lung disease, including acute interstitial pneumonitis, has been reported with AUBAGIO in the postmarketing setting. Interstitial lung disease and worsening of pre-existing interstitial lung disease have been reported during treatment with leflunomide. Interstitial lung disease may be fatal and may occur acutely at any time during therapy with a variable clinical presentation. New onset or worsening pulmonary symptoms, such as cough and dyspnea, with or without associated fever, may be a reason for discontinuation of therapy and for further investigation as appropriate. If discontinuation of the drug is necessary, consider initiation of an accelerated elimination procedure [see Warnings and Precautions (5.3)]. 5.9 Concomitant Use with Immunosuppressive or Immunomodulating Therapies Coadministration with antineoplastic, or immunosuppressive therapies used for treatment of multiple sclerosis has not been evaluated. Safety studies in which AUBAGIO was concomitantly administered with other immune modulating therapies for up to one year (interferon beta, glatiramer acetate) did not reveal any specific safety concerns. The long term safety of these combinations in the treatment of multiple sclerosis has not been established. In any situation in which the decision is made to switch from AUBAGIO to another agent with a known potential for hematologic suppression, it would be prudent to monitor for hematologic toxicity, because there will be overlap of systemic exposure to both compounds. Use of an accelerated elimination procedure may decrease this risk, but may also potentially result in return of disease activity if the patient had been responding to AUBAGIO treatment [see Warnings and Precautions (5.3)]. 6 ADVERSE REACTIONS The following serious adverse reactions are described elsewhere in the prescribing information: • Hepatotoxicity [see Contraindications (4) and Warnings and Precautions (5.1)] • Bone Marrow Effects/Immunosuppression Potential/Infections [see Warnings and Precautions (5.4)] • Hypersensitivity and Serious Skin Reactions [see Contraindications (4) and Warnings and Precautions (5.5)] • Peripheral Neuropathy [see Warnings and Precautions (5.6)] • Increased Blood Pressure [see Warnings and Precautions (5.7)]
AUBAGIO® (teriflunomide) tablets, for oral use • Respiratory Effects [see Warnings and Precautions (5.8)] 6.1 Clinical Trials Experience Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in clinical practice. A total of 2047 patients receiving AUBAGIO (7 mg or 14 mg once daily) constituted the safety population in the pooled analysis of placebo controlled studies in patients with relapsing forms of multiple sclerosis; of these, 71% were female. The average age was 37 years. Table 1 lists adverse reactions in placebo-controlled trials with rates that were at least 2% for AUBAGIO patients and also at least 2% above the rate in placebo patients. The most common were headache, an increase in ALT, diarrhea, alopecia, and nausea. The adverse reaction most commonly associated with discontinuation was an increase in ALT (3.3%, 2.6%, and 2.3% of all patients in the AUBAGIO 7 mg, AUBAGIO 14 mg, and placebo treatment arms, respectively). Table 1. Adverse Reactions in Pooled Placebo-Controlled Studies in Patients with Relapsing Forms of Multiple Sclerosis AUBAGIO AUBAGIO 7 mg 14 mg Placebo Adverse Reaction (N=1045) (N=1002) (N=997) Headache 18% 16% 15% Increase in Alanine aminotransferase 13% 15% 9% Diarrhea 13% 14% 8% Alopecia 10% 13% 5% Nausea 8% 11% 7% Paresthesia 8% 9% 7% Arthralgia 8% 6% 5% Neutropenia 4% 6% 2% Hypertension 3% 4% 2% Cardiovascular Deaths Four cardiovascular deaths, including three sudden deaths, and one myocardial infarction in a patient with a history of hyperlipidemia and hypertension were reported among approximately 2600 patients exposed to AUBAGIO in the premarketing database. These cardiovascular deaths occurred during uncontrolled extension studies, one to nine years after initiation of treatment. A relationship between AUBAGIO and cardiovascular death has not been established. Acute Renal Failure In placebo-controlled studies, creatinine values increased more than 100% over baseline in 8/1045 (0.8%) patients in the 7 mg AUBAGIO group and 6/1002 (0.6%) patients in the 14 mg AUBAGIO group versus 4/997 (0.4%) patients in the placebo group. These elevations were transient. Some elevations were accompanied by hyperkalemia. AUBAGIO may cause acute uric acid nephropathy with transient acute renal failure because AUBAGIO increases renal uric acid clearance. Hypophosphatemia In clinical trials, 18% of AUBAGIO-treated patients had hypophosphatemia with serum phosphorus levels of at least 0.6 mmol/L, compared to 7% of placebo-treated patients; 4% of AUBAGIO-treated patients had hypophosphatemia with serum phosphorus levels at least 0.3 mmol/L but less than 0.6 mmol/L, compared to 0.8% of placebo-treated patients. No patient in any treatment group had a serum phosphorus below 0.3 mmol/L. 6.2 Postmarketing Experience The following adverse reactions have been identified during postapproval use of AUBAGIO. Because these reactions are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure. • Hypersensitivity reactions, some of which were severe, such as anaphylaxis and angioedema [see Warnings and Precautions (5.5)] • Severe skin reactions, including toxic epidermal necrolysis and Stevens-Johnson syndrome [see Warnings and Precautions (5.5)] • Thrombocytopenia [see Warnings and Precautions (5.4)] • Interstitial lung disease [see Warnings and Precautions (5.8)] • Pancreatitis 7 DRUG INTERACTIONS Effect of AUBAGIO on CYP2C8 substrates Teriflunomide is an inhibitor of CYP2C8 in vivo. In patients taking AUBAGIO, exposure of drugs metabolized by CYP2C8 (e.g., paclitaxel, pioglitazone, repaglinide, rosiglitazone) may be increased. Monitor these patients and adjust the dose of the concomitant drug(s) metabolized by CYP2C8 as required [see Clinical Pharmacology (12.3) in the full prescribing information]. Effect of AUBAGIO on warfarin Coadministration of AUBAGIO with warfarin requires close monitoring of the international normalized ratio (INR) because AUBAGIO may decrease peak INR by approximately 25%. Effect of AUBAGIO on oral contraceptives AUBAGIO may increase the systemic exposures of ethinylestradiol and levonorgestrel. Consideration should be given to the type or dose of contraceptives used in combination with AUBAGIO [see Clinical Pharmacology (12.3) in the full prescribing information]. Effect of AUBAGIO on CYP1A2 substrates Teriflunomide may be a weak inducer of CYP1A2 in vivo. In patients taking AUBAGIO, exposure of drugs metabolized by CYP1A2 (e.g., alosetron, duloxetine, theophylline, tizanidine) may be reduced. Monitor these patients and adjust the dose of the concomitant drug(s) metabolized by CYP1A2 as required [see Clinical Pharmacology (12.3) in the full prescribing information].
Effect of AUBAGIO on organic anion transporter 3 (OAT3) substrates Teriflunomide inhibits the activity of OAT3 in vivo. In patients taking AUBAGIO, exposure of drugs which are OAT3 substrates (e.g., cefaclor, cimetidine, ciprofloxacin, penicillin G, ketoprofen, furosemide, methotrexate, zidovudine) may be increased. Monitor these patients and adjust the dose of the concomitant drug(s) which are OAT3 substrates as required [see Clinical Pharmacology (12.3) in the full prescribing information]. Effect of AUBAGIO on BCRP and organic anion transporting polypeptide B1 and B3 (OATP1B1/ 1B3) substrates Teriflunomide inhibits the activity of BCRP and OATP1B1/1B3 in vivo. For a patient taking AUBAGIO, the dose of rosuvastatin should not exceed 10 mg once daily. For other substrates of BCRP (e.g., mitoxantrone) and drugs in the OATP family (e.g., methotrexate, rifampin), especially HMG-Co reductase inhibitors (e.g., atorvastatin, nateglinide, pravastatin, repaglinide, and simvastatin), consider reducing the dose of these drugs and monitor patients closely for signs and symptoms of increased exposures to the drugs while patients are taking AUBAGIO [see Clinical Pharmacology (12.3) in the full prescribing information]. 8 USE IN SPECIFIC POPULATIONS 8.1 Pregnancy Pregnancy Exposure Registry There is a pregnancy exposure registry that monitors pregnancy outcomes in women exposed to AUBAGIO during pregnancy. Healthcare providers and patients are encouraged to report pregnancies by calling 1-800-745-4447, option 2 Risk Summary AUBAGIO is contraindicated for use in pregnant women and females of reproductive potential not using effective contraception because of the potential for fetal harm based on animal data. Human data are not available at this time to inform the presence or absence of drug-associated risk with the use of AUBAGIO during pregnancy. In animal reproduction studies in rat and rabbits, oral administration of teriflunomide during organogenesis caused teratogenicity and embryolethality at plasma exposures (AUC) lower than that at the maximum human recommended dose (MHRD) of 14 mg/day [see Data]. In the US general population, the estimated background risk of major birth defects and miscarriage in clinically recognized pregnancies is 2%–4% and 15%–20%, respectively. The background risk of major birth defects and miscarriage in the indicated population is unknown. Clinical Considerations Women who wish to become pregnant should discontinue use of AUBAGIO and undergo an accelerated elimination procedure to decrease the plasma concentration of teriflunomide to less than 0.02 mg/L (0.02 mcg/mL). Effective contraception should be used until is it verified that plasma concentrations of teriflunomide are less than 0.02 mg/L (0.02 mcg/mL) [see Warnings and Precautions (5.3)]. Human plasma concentrations of teriflunomide less than 0.02 mg/L (0.02 mcg/mL) are expected to have minimal embryofetal risk [see Contraindications (4) and Warnings and Precautions (5.3)]. If the patient becomes pregnant while taking this drug, stop treatment with AUBAGIO, inform the patient of the potential risk to the fetus, and perform the accelerated drug elimination procedure to achieve plasma concentrations of less than 0.02 mg/L (0.02 mcg/mL) [see Warnings and Precautions (5.3) and Clinical Pharmacology (12.3) in the full prescribing information]. Refer the patient to an obstetrician/gynecologist, preferably experienced in reproductive toxicity, for further evaluation and counseling [see Warnings and Precautions (5.2, 5.3)]. Data Animal Data When teriflunomide (oral doses of 1, 3, or 10 mg/kg/day) was administered to pregnant rats throughout the period of organogenesis, high incidences of fetal malformation (primarily craniofacial, and axial and appendicular skeletal defects) and embryofetal death were observed at doses not associated with maternal toxicity. Adverse effects on embryofetal development were observed following dosing at various stages throughout organogenesis. Maternal plasma exposure at the no-effect level (1.0 mg/kg/day) for embryofetal developmental toxicity in rats was less than that in humans at the maximum recommended human dose (MRHD, 14 mg /day). Administration of teriflunomide (oral doses of 1, 3.5, or 12 mg/kg/day) to pregnant rabbits throughout organogenesis resulted in high incidences of fetal malformation (primarily craniofacial, and axial and appendicular skeletal defects) and embryofetal death at doses associated with minimal maternal toxicity. Maternal plasma exposure at the no-effect dose (1.0 mg/kg/day) for embryofetal developmental toxicity in rabbits was less than that in humans at the MRHD. In studies in which teriflunomide (oral doses of 0.05, 0.1, 0.3, 0.6, or 1.0 mg/kg/day) was administered to rats during gestation and lactation, decreased growth, eye and skin abnormalities, and high incidences of malformation (limb defects) and postnatal death were observed in the offspring at doses not associated with maternal toxicity. Maternal plasma exposure at the no-effect dose for pre- and postnatal developmental toxicity in rats (0.10 mg/kg/day) was less than that in humans at the MRHD. In animal reproduction studies of leflunomide, embryolethality and teratogenic effects were observed in pregnant rat and rabbit at or below clinically relevant plasma teriflunomide exposures (AUC). In published reproduction studies in pregnant mice, leflunomide was embryolethal and increased the incidence of malformations (craniofacial, axial skeletal, heart and great vessel). Supplementation with exogenous uridine reduced the teratogenic effects in pregnant mice, suggesting that the mode of action (inhibition of mitochondrial enzyme dihydroorotate dehydrogenase) is the same for therapeutic efficacy and developmental toxicity. At recommended doses in humans, teriflunomide and leflunomide result in a similar range of plasma concentrations of teriflunomide. 8.2 Lactation Risk Summary It is not known whether this drug is excreted in human milk. Teriflunomide was detected in rat milk following a single oral dose. The developmental and health benefits of breastfeeding should be considered along with the mother’s clinical need for AUBAGIO and any potential adverse effects on the breastfed infant from AUBAGIO or from the underlying maternal condition.
AUBAGIO® (teriflunomide) tablets, for oral use 8.3 Females and Males of Reproductive Potential Pregnancy Testing Exclude pregnancy prior to initiation of treatment with AUBAGIO in females of reproductive potential. Advise females to notify their healthcare provider immediately if pregnancy occurs or is suspected during treatment [see Warnings and Precautions (5.2, 5.3) and Use in Specific Populations (8.1)]. Contraception Females Females of reproductive potential should use effective contraception while taking AUBAGIO. If AUBAGIO is discontinued, use of contraception should be continued until is it verified that plasma concentrations of teriflunomide are less than 0.02 mg/L (0.02 mcg/mL). Females of reproductive potential who wish to become pregnant should undergo an accelerated elimination procedure. Effective contraception should be used until it is verified that plasma concentrations of teriflunomide are less than 0.02 mg/L (0.02 mcg/mL) [see Warnings and Precautions (5.3)]. Males AUBAGIO is detected in human semen. Animal studies to specifically evaluate the risk of male-mediated fetal toxicity have not been conducted. To minimize any possible risk, men not wishing to father a child and their female partners should use effective contraception. Men wishing to father a child should discontinue use of AUBAGIO and either undergo an accelerated elimination procedure or wait until verification that the plasma teriflunomide concentration is less than 0.02 mg/L (0.02 mcg/mL) [see Warnings and Precautions (5.3)]. Infertility Administration of teriflunomide to male rats resulted in no adverse effects on fertility. However, reduced epididymal sperm count was observed [see Nonclinical Toxicology (13.1) in the full prescribing information]. Effects of AUBAGIO on fertility in humans have not been evaluated. 8.4 Pediatric Use Safety and effectiveness in pediatric patients have not been established. 8.5 Geriatric Use Clinical studies of AUBAGIO did not include patients over 65 years old. 8.6 Hepatic Impairment No dosage adjustment is necessary for patients with mild and moderate hepatic impairment. The pharmacokinetics of teriflunomide in severe hepatic impairment have not been evaluated. AUBAGIO is contraindicated in patients with severe hepatic impairment [see Contraindications (4), Warnings and Precautions (5.1), and Clinical Pharmacology (12.3) in the full prescribing information]. 8.7 Renal Impairment No dosage adjustment is necessary for patients with mild, moderate, and severe renal impairment [see Clinical Pharmacology (12.3) in the full prescribing information]. 10 OVERDOSAGE There is no experience regarding teriflunomide overdose or intoxication in humans. Teriflunomide 70 mg daily up to 14 days was well tolerated by healthy subjects. In the event of clinically significant overdose or toxicity, cholestyramine or activated charcoal is recommended to accelerate elimination [see Warnings and Precautions (5.3)].
Genzyme Corporation 500 Kendall Street Cambridge, MA 02142 A SANOFI COMPANY November 2016 TER-BPLR-SA-NOV16
CMS Requires Claims on Post-op Visits for Select Codes Beginning July 1
Get to Know the Axon Registry at the Annual Meeting
The Centers for Medicare & Medicaid Services (CMS) has stated that beginning July 1, 2017, practitioners in Florida, Kentucky, Louisiana, Nevada, New Jersey, North Dakota, Ohio, Oregon, and Rhode Island will be required to submit claims for postoperative visits furnished during the global period of select codes.
The AAN’s Axon Registry ® is your solution to fulfilling multiple regulatory requirements and you can get a preview of the registry at the 2017 Annual Meeting in Boston. The Axon Registry, a quality-improvement and clinical data registry (QCDR), has successfully completed its pilot phase. Now, Axon Registry is accepting more practices to join in 2017. When you’re at the Annual Meeting, come talk with registry staff, learn more about the Axon Registry, and see a registry User Dashboard demonstration.
The codes relevant to neurology for which reporting on post-operative visits is required include: nn 64612 Chemodenervation of
muscle(s); muscle(s) innervated by facial nerve, unilateral (e.g., for blepharospasm, hemifacial spasm)
nn 64615 Chemodenervation of
muscle(s); muscle(s) innervated by facial, trigeminal, cervical spinal and accessory nerves, bilateral (e.g., for chronic migraine)
nn 64616 Chemodenervation of
muscle(s); neck muscle(s), excluding muscles of the larynx, unilateral (e.g., for cervical dystonia, spasmodic torticollis)
nn 64617 Chemodenervation of
muscle(s); larynx, unilateral, percutaneous (e.g., for spasmodic dysphonia), includes guidance by needle electromyography, when performed
What Is a Global Package? “Under the Physician Fee Schedule (PFS), certain services, such as surgery, are valued and paid for as part of global packages that include the procedure and the services typically furnished in the periods immediately before and after the procedure. For each of these global packages, we establish a single PFS payment that includes payment for particular services that we assume to be typically furnished during the established global period. There are three primary categories of global packages that are labeled based on the number of post-operative days included in the global period: 0-day; 10-day; and 90-day.” —2017 Federal Register nn 64633 Destruction by neurolytic
agent, paravertebral facet joint nerve(s), with imaging guidance (fluoroscopy or CT); cervical or thoracic, single facet joint
nn 64635 Destruction by neurolytic
agent, paravertebral facet joint nerve(s), with imaging guidance (fluoroscopy or CT); lumbar or sacral, single facet joint
nn 64640 Destruction by neurolytic
agent; other peripheral nerve or branch
Practitioners in these states who only practice in settings with fewer than 10 practitioners are exempted from required reporting, but they are encouraged to report if feasible. Although reporting is required for global procedures furnished on or after July 1, 2017, CMS encourages all practitioners to begin reporting as soon as possible. The exercise is part of a CMS initiative outlined in the 2017 Federal Register to gather data on services furnished during a global period. Learn more at AAN.com/view/CMSG. •
The Axon Registry booth, located in the Maximize Your Value: Improve Your Neurology Practice Experiential Learning Area on the main floor of the convention center, will have experts available for the entire meeting. Additionally, from April 22 through 25, a representative from registry vendor FIGMD will be available to answer technical questions and share information about the sign-up process. Stop by to see demonstrations
of the dashboard and learn how having registry data at your fingertips can be a valuable resource for your practice.
for the Improvement Activity requirements. Also, the Axon Registry is approved by the American Board of Psychiatry and Neurology as an MOC Part IV PIP Clinical Module activity.”
“With the release of the MACRA final rule in October 2016, now is the If you’re looking for how Axon time to assess how you Registry participation will help will fulfill Quality Payment your practice save time and Program requirements,” be more efficient in handling Lyell K. Jones, MD, FAAN said Lyell K. Jones, reporting requirements MD, FAAN, chair of the and implement quality Registry Committee. “The improvement initiatives, stop Axon Registry will help neurologists by the booth and get all your questions satisfy the Quality component of MIPS, answered. Don’t miss this opportunity will attest to engaging with a QCDR to learn how to successfully maximize for Advancing Care Information and the value of your practice. •
May Webinar Explores How Risk Is Calculated by Payers What do you risk when you don’t know about risk? Plenty. That’s why you should attend this webinar to learn how payers calculate risk and what that means to your practice.
Coding for Risk: How It Impacts Payment May 2, 2017 | 12:00 p.m.–1:00 p.m. ET Deadline to Register: May 1 Directors: Eric M. Cheng, MD, MS, FAAN Joseph V. Fritz, PhD Upon completion, you should be able to: nn Understand how medical severity (risk) is calculated
by the government and insurance companies
nn Understand how that risk calculation is used to
evaluate your performance
nn Learn strategies so that your risk is calculated accurately nn Effectively use ICD-10 codes to communicate patient risk
AAN practice management webinars provide the valuable insights and tools you need to navigate through the everchanging health care landscape. Single webinars are $99 but AAN members get the greatest value with the $189 subscription to all 10 live one-hour webinars. All webinars include access to presentation slides and recordings if
Eric M. Cheng, MD, MS, FAAN
Joseph V. Fritz, PhD
you miss the live event. Physicians receive 1 AMA PRA Category 1 Credit ™ per webinar; non-physicians receive a certificate of completion. Visit AAN.com/view/pmw17 to learn more and register. •
AANnews • April 2017
Early Adopters Share Experiences, Tips on MIPS The passage of MACRA led the Centers for Medicare & Medicaid Services to create a new payment structure, the Quality Payment Program (QPP). Within this new program, CMS provides two pathways by which physician payments will be based: Merit-based Incentive Payment System (MIPS) or Alternative Payment Models (APMs).
Background Most neurologists, particularly those in solo or small practice, will participate in MIPS. Physicians will be considered participating in MIPS unless: nn You participate in an APM nn You are new to Medicare nn You see fewer than 100 Medicare beneficiaries or
receive less than $30,000 in Part B payments
In MIPS, how you perform in 2017 will affect your payments in 2019. However, under CMS’s pick your pace plan, choosing any one of these four options in 2017 will ensure that you do not receive a payment penalty in 2019: nn Full-year Reporting: Start January 1, 2017, possibly
earn a moderate positive payment bonus
nn Partial-year Reporting: Collect and submit data for
any 90 continuous days during the 2017 calendar year (January 1 through December 31), possibly earn a small payment bonus
nn Test-option Reporting: Submit minimal data—one
quality measure or one improvement activity or the required base measures on EHR usage—at any point in 2017, avoid a payment penalty
nn Advanced APM: Participate in an Advanced APM,
exempt from MIPS, earn a 5-percent payment bonus
Also, when participating in MIPS, you can implement the AAN quality measurement sets pertinent to neurology. To help alleviate reporting burdens, you should consider signing up to participate in the Axon Registry ®.
Experiences and Tips Three clinics that are participating in MIPS share their experiences and insights on the process:
Noran Neurological Clinic Sara Valentine, director of Health Information and Quality, said Noran Neurological Clinic plans to participate in MIPS for a full year beginning in 2017. “For several years, the clinic has participated in the meaningful use and Physician Quality Reporting System (PQRS) programs and has specifically focused on the AAN’s quality measurement sets. Our clinic began participation with the AAN’s Axon Registry in pilot cohort group #1 and has been in active engagement with the registry since mid-2015. We have worked collaboratively with the AAN registry team, providing regular provider input, feedback, and insight into the quality measures that are a part of the Axon Registry. We plan to report the AAN/Axon
AANnews • April 2017
Registry measures for the quality component of the MIPS program as well as use our registry participation to meet portions of the performance improvement category in the MIPS program.” Valentine provided these tips for AAN members: “Develop a quality champion and team to ensure understanding and interest in clinic quality initiatives. Inform, collaborate, and educate providers on the measures and requirements to meet the measures. Provide updates to providers on their performance, potential areas of improvement, and make available tools for understanding and best documentation practices.”
Abington Neurological Associates, Ltd. Brad Klein, MD, MBA, is a neurologist at Abington Neurological Associates, Ltd., a small practice in Willow Grove, PA. He says his clinic has been reporting meaningful use and PQRS in prior years. “However, this is the first year we are looking at reporting a full year of data. Because CMS does not require reporting until March 31, 2018, for 2017, we Brad Klein, MD, MBA thankfully still have time to decide reporting for the full year versus 90 days. We are trying to figure out how to put our best foot forward to report quality and maximize our potential future reimbursements from CMS. Using the AAN Axon Registry, our data on our quality reporting is almost real time so we can better judge what is best for our practice. Our hope is that we will nonetheless be able to use this system to report a full year of data.” So, what might stop them from doing the full year reporting? “We strive for the highest quality care with all our patients. However, because our focus is on the patient in front of us, we may inadvertently miss documenting a particular quality measure despite asking the relevant questions or providing the necessary treatment and/or counseling. As a result, there is worry we may appear like we are not providing quality and there will be decreased performance bonuses. Further, some physicians feel the added burdens of reporting may distract them from the needs of the patient sitting in front of them. By using the 90-day reporting, we have the flexibility in 2017
to find a period of time when our documentation best matches our patient care practice.” While the staff at Abington Neurological Associates is addressing the requirements necessary for 2017, they are keeping an eye on full reporting in 2018, according to Klein. “The process of quality reporting is clearly an evolution not just for us, but for everyone in the country—including CMS. We see 2017 as an opportunity to continue to lay more ground work, tweak our system, and increase our automation. While we plan to be ready by 2018, we suspect we will continue to tweak far beyond next year. We hope that there will be continued actions by our new government leadership to decrease the administrative burden we face in our practices, make it easier to care for our patients, and report for a full year.” Klein, whose clinic includes AAN measures in its reporting, offered these insights to Academy members. “For those who may be beginning this process, it is still not too late. However, waiting will result in significant adverse financial outcomes for providers who accept Medicare. Developing a quality reporting system is not a sprint, but a marathon. It cannot be solved over a weekend in just EMR tweaks. Quality reporting can affect your EMR system, workflow, efficiency, and culture. For some physicians, it will be seen as yet another administrative burden on providers and increase a sense of further lost autonomy and burnout. Each practice needs a champion who will take on the responsibility and accountability to ensure not only the reporting is done but these additional concerns. Lastly, I would suggest reaching out to the AAN and see if you may be able to join the Axon Registry. This may alleviate some reporting burdens, saving time and money.”
DENT Neurologic Institute “We are still working this out,” said Joseph V. Fritz, PhD, CEO of the Dent Neurologic Institute in Amherst, NY. “We are in an accountable care organization (ACO), and they say it will count as an Advanced APM” in the new Quality Payment Program. Nonetheless, Fritz said his clinic, which participated in the pilot testing of the Axon Joseph V. Fritz, PhD, CEO Registry, is hedging its bets. “We are aggressively working to improve our registry scores, completeness of ICD-10 coding (detailed primary diagnosis plus comorbidities), and justifications for resource ordering through a ‘workflow innovations team.’ This team consists of a ‘field’ person who shadows each provider and helps them with documentation, productivity, and reference materials.
She is supported by EMR and billing experts who help her optimize solutions. We will then rely on the Axon Registry upgrades that will enable us to select, attest, and push quality and improvement data to CMS. Thus, we are doubling up and ensuring that we hit both MIPS and Advanced APM requirements.” Despite his group’s active involvement, Fritz said, “I confess we still feel unsure whether we are hitting all the MACRA requirements to score well. Part of the reason is that being in an ACO so long makes us lazy on the detailed subtleties of MIPS. But reality hit when we noted our Axon dashboards didn’t grade out where we expected, and local payer hierarchical condition classifications (HCC) audits suggested also that we need to pay more attention to coding the details contained in our clinical notes. So we have decided to go all-in with the MIPS. I don’t know what happens when you do both, but we’ll figure it out as we go.”
Metropolitan Neurology Gabriella C. Gerstle, MD, is in solo practice at Metropolitan Neurology in Boynton Beach, FL. “As a solo practitioner, it has been very challenging to comply with all the government mandated programs,” she said. “This is now magnified with MACRA. My practice approach to compliance Gabriella C. Gerstle, MD incorporates a variety of strategies: Understanding and implementing MIPS, and exploring for APMs. Unfortunately, these require a lot of time and detract from the practice of medicine.” The AAN is committed to helping all our members maximize success under the sweeping changes to physician payment. We are your partner as you prepare to maximize your payments under value-based reimbursement models. Power your practice by using the tools and resources developed by the AAN to help you navigate the evolving health care environment. Learn more at AAN.com/view/MACRA or send your questions to firstname.lastname@example.org. Also, the Axon Registry, a free member benefit, can be an integral—and time-saving—part of your reporting. Visit AAN.com/view/Axon and fill out the Axon Registry interest form. You will be placed on a wait list and contacted to enroll when your number is reached. To check whether your EHR vendor is successfully working with the registry, review the EHR list online at http://bit.ly/2heFB8G. For information about the registry process, contact email@example.com. •
AANnews • April 2017
CME & MOC
New Continuum Explores Outpatient Neurology Topics nn Trigeminal Neuralgia, by Giorgio Cruccu, MD
Outpatient neurology is the focus of the latest issue of Continuum: Lifelong Learning in Neurology®. Participants in the US can earn up to 14 hours of AMA PRA Category 1 Credit™ (12 of which apply to MOC Self-assessment credit). Starting with the April 2017 issue, Canadian participants can claim a maximum of 14 hours. “Selected Topics in Outpatient Neurology reviews questions encountered in a neurology office every day,” said Charles A. Zollinger, MD, FAAN, general neurologist at the Neurocare Center, Inc, in Canton, OH, and at NEOMED, Rootstown, OH. “These are common problems brought to the general neurologist that may not be captured in Continuum’s subspecialty-based reviews. This ‘potpourri’ of fundamental neurology will enhance the clinical skills and knowledge of our readership.”
nn Disorders of Taste and Smell, by Ronald DeVere,
nn Bell’s Palsy, by Stephen G. Reich, MD, FAAN nn Low Back Pain, by Jinny O. Tavee, MD;
Kerry H. Levin, MD, FAAN
nn Common Entrapment Neuropathies, by Lisa D.
Hobson-Webb, MD; Vern C. Juel, MD, FAAN
nn Neuropathic Pain, by Lindsay A. Zilliox, MD, MS nn Urogenital Symptoms in Neurologic Patients,
Charles A. Zollinger, MD, FAAN
Articles in this issue include: nn Syncope, by William P. Cheshire, Jr., MD, FAAN nn Dizziness in the Outpatient Care Setting,
by Terry D. Fife, MD, FAAN
AANnews • April 2017
If you have questions about UCNS certification or accreditation, Riggott and her staff will be present to share their expertise. • Brenda Riggott
nn Mitigating Cybersecurity Risks, by Rachel V. Rose,
JD, MBA; Joseph S. Kass, MD, JD, FAAN
nn Practical Considerations in Addressing Physician
nn Use of the Electronic Health Record for Coding in
Thank You for the Honor of Serving as Your President
Burnout, by Anindita Deb, MD
Outpatient Neurology, by Allison L. Weathers, MD, FAAN
Continuum® is published six times per year. Subscribe to Continuum by contacting Wolters Kluwer at (800) 361-0633, (301) 223-2300 (international), or LWW.com/continuum. Junior members who are transitioning to Active or Associate memberships can receive a 50-percent discount on the already low member rate for Continuum subscriptions. •
of Continuing Medical Education and Professional Development, University of Calgary, beginning April 1, 2017. “This approval is great news for Canadian neurologists” said Hannah R. Briemberg, MD, FRCPC, a member of the board of directors of the Royal
College of Physicians and Surgeons of Canada and the Continuum Editorial Board. “Continuum is a fantastic educational resource, and now Canadian participants will be able to utilize this resource to help fulfill Section 3 MOC requirements of the Royal College of Physicians and Surgeons of Canada.” Beginning with the April 2017 issue of Continuum, Canadian participants may claim a maximum of 12 hours for completion of the Postreading Selfassessment and CME Test and two hours for completion of the Patient Management Problem for a total of 14 credits (credits are automatically calculated). Participants will be able to download a Continuum-specific reflective tool from the CME website. Canadian participants should visit MAINPORT at MAINPORT.org/mainport to record learning and outcomes. •
Did you know the United Council on Neurologic Subspecialties has a new leader? You can meet Executive Director Brenda Riggott at the UCNS booth at the Annual Meeting. Riggott joined UCNS in November after serving as corporate relations and foundation director for the American Association of Neuromuscular & Electrodiagnostic Medicine in Rochester, MN.
by Jalesh N. Panicker, MD, DM, FRCP
Continuum Gains Canadian Accreditation The AAN’s official continuing medical education journal Continuum has been designated an Accredited SelfAssessment Program (Section 3) as defined by the Maintenance of Certification Program of the Royal College of Physicians and Surgeons of Canada, and approved by the Office
Visit the UCNS Booth at the Annual Meeting
anyone’s best interest and will result in poorer value of care. This trend also is occurring in many areas internationally. The AAN is working to improve the situation. Our message and those of other medical societies to Congress, CMS, third-party payers, certification and licensure agencies is clear: We must reduce regulatory hassles which produce no value where possible. We hope they are listening. In the meantime, burnout can be mitigated by making our practices more efficient in areas such as more effective EHR usage and other ideas. Our committees are working on ways we might help members who are interested in using best practices to mitigate some of the causes of burnout. Finally, helping people become more “resilient” in dealing with burnout issues has been shown to help selected individuals. We are offering a menu of tools for members who are interested to try at AAN.com/LiveWell, with an eye to expanding these in the future.
Support for Research Without robust investment in neuroscience research funding, we may not have the type of innovative treatments we all want for our patients. An important focus of our advocacy efforts has been to increase funding for the National Institutes of Health (NIH) and the Brain Research through Advancing Innovative Neurotechnologies (BRAIN) Initiative, which seeks to accelerate the development and application of innovative technologies for brain research. Our hard work in 2016 helped persuade Congress to pass the 21st Century Cures Act, which contains a $4.8 billion increase in funding over 10 years for NIH, of which $1.51 billion will go toward the BRAIN Initiative, subject to annual appropriations. We also continue to look to the American Brain Foundation to enjoy increased success in raising dollars toward its mission to “cure brain disease.”
Continued from page 5
So the issues we face are complicated and the challenges are numerous as an aging population—and society at large—confronts the increasing physical and financial burden of neurologic diseases. Even as our services and skills are needed now more than ever, it has never been more necessary to justify them to skeptical or unaware policymakers and regulators. Despite this, I remain optimistic about our future. My advice is to concentrate on doing what is best for our patients and this will aid us in providing high-quality care. These are things the vast majority of our members can agree. It is quite obvious we have a love for neurology and great compassion for our patients. This will serve us well as we move forward, but it won’t be enough. We need to take control of our futures. The AAN is doing what we can, but it will take work from all of us to assure a bright future for our profession. It has been a high point in my career to serve as AAN president. Any kudos that come my way were earned by my colleagues on the Board of Directors, the hundreds of volunteer members who have participated on committees and task forces, those who have given their time and energies to educating us at the Annual Meeting and conferences, our impassioned advocates who champion neurology in their communities and throughout the world, and our amazing staff led by Executive Director Cathy Rydell. Thank you all for the privilege of serving as president of this great association.
Terrence L. Cascino, MD, FAAN President, American Academy of Neurology firstname.lastname@example.org
AANnews • April 2017
Applications Open for New Women Leading in Neurology Program Applications are now open for a new AAN Leadership Program designed specifically for mid-career women neurologists seeking to improve their leadership and management skills. Women Leading in Neurology is an intensive 10-month program that provides a forum to address controversial topics in medicine and provides participants with skills based in authentic leadership theory, communication strategies to strengthen skills as a provider and a team member, and negotiating busy careers and personal lives. “Due to the popularity of AAN’s day-long Leadership for Women workshops, the AAN Leadership Development Committee (LDC) determined that a more intensive opportunity was in order,” said Cynthia L. Comella, MD, FAAN, chair of the Leadership for Women Subcommittee. Participants of this elite new program will: nn Hone their leadership skills through customized
in-depth training on negotiation, conflict resolution, mentoring, public speaking, team leadership, persuasion, effective meeting administration, association and community leadership and engagement, and more
nn Address sensitive topics of gender bias and
discrimination in medicine and learn skills to combat bias and mentor other women
nn Focus on a self-identified development goal
and receive personalized coaching
nn Expand their networks and accelerate professional
nn Gain exposure to AAN leadership, executive staff,
and the roles and mission of the Academy
“Women in academic medicine are not treated equitably compared to their male counterparts. On average, they receive less compensation, and less representation and recognition as academic leaders. This innovative program is designed to address these disparities, providing women with the skills needed to realize their potential as leaders in neurology.” Eligible applicants must be US female AAN member neurologist 10 or more years out of neurology training, have demonstrated effective leadership skills and are interested in future roles of responsibility within the AAN and the field of neurology, and be available to attend all required in-person meetings. The application deadline is June 5, 2017. Visit AAN.com/view/WLN for additional eligibility requirements and to apply.
Enhance Your Practice with AAN Membership Options for Your Whole Care Team—for as Little as $105 The true strength of a neurology practice relies on the ability of the entire care team. With the proper training resources, an efficient care team can help expand services through increased patient volume, quality of care, and enhanced physician focus— all of which can help reduce neurologist burnout as well. This is why the AAN offers valuable membership options for advanced practice providers and business administrators. When you sign up your care team members for AAN membership, they, too, can experience all the career-enhancing training resources and opportunities designed to help them stay up-to-date on the latest advances in patient care. nn Access to SynapseSM Online Communities to connect
$105 membership level includes:
with peers and neurology’s leaders
nn Publications like Neurology ® Clinical Practice (digital
nn Big savings on registration to the 2017 AAN Annual
only for international members) and Neurology Today ® (digital access) nn Access to AAN Practice Guidelines—now on smart phone nn Deep discounts on Continuum: Lifelong Learning in Neurology ® nn Member-only tools on AAN.com, the leading online resource for neurology information worldwide
Meeting in Boston, with programs and events geared specifically toward advanced practice providers nn Access to the world’s largest professional association of neurologists and neurology professionals
$255 includes everything above plus: nn Free AAN online education resources: NeuroSAE®,
NeuroPISM, and NeuroLearnSM nn Print subscription to Neurology Today nn Print and digital subscription to Neurology ® for Advanced Practice Provider membership category nn Free registration to the AAN’s 2017 Practice Management Webinar series for Business Administrator membership category
Emerging Leaders Program Applications Now Open Applications are also being accepted for the next class of the AAN’s popular Emerging Leaders Program, an intensive leadership training program for US member neurologists who are less than 10 years out of residency. Learn more and apply by the July 1 deadline at AAN.com/view/ELP. •
Enhance your practice’s quality and efficiency by giving your care team members access to exclusive AAN training resources today at AAN.com/MemberDues. •
Dates and Deadlines SUN
APRIL 2017 WED
JUNE 2017 WED 7
AAN Brain Health Fair Boston BrainHealthFair.com
Webinar: Coding for Risk: How It Impacts Payment (Register by May 1) AAN.com/view/pmw17
Deadline: UCNS Accreditation UCNS.org
Webinar: Break the Code, or It Will Break Your Practice: Coding for Neurodiagnostic Procedures (Register by June 5) AAN.com/view/pmw17
AAN Business Meeting Boston AAN.com/view/AM17
APRIL 22–28 AAN Annual Meeting Boston AAN.com/view/AM17 AANnews • April 2017
Deadline: Neurology Compensation and Productivity Survey AAN.com/view/benchmark
JUNE 15 Early Registration Deadline: Sports Concussion Conference AAN.com/view/ConcussionConference
AAN.com/careers Visit the AAN’s Neurology Career Center to view hundreds of additional jobs and sign up for customized, confidential notifications when positions of interest are added.
General Neurologist in Beautiful Northeast Wisconsin Bay Area Medical Center has an excellent opportunity for a motivated Neurologist looking to make a difference. Outpatient clinic with procedure room for EMGs. Inpatient hospital consults. Lumbar punctures, EEGs, EMGs, nerve conduction studies, tPA. Currently staffed with one fulltime neurologist, two full-time LPNs and one receptionist. Hospital employed with annual salary plus incentive compensation. Full range of benefits including: sign-on bonus, relocation, health, dental, vision, long and short term disability, life insurance, 401k plan, 36 days pto, 5 days plus $5,500 CME, paid for licenses and malpractice insurance. Required call of 10, 24 hour shifts per month; call bonus for providing additional call. Start upon credentialing. Open to J-1 and H-1B visa candidates. Bay Area Medical Center in a 99-bed, non-profit medical center in Marinette, Wisconsin. We are located one-hour north of Green Bay on scenic Lake Michigan and an easy drive to major metropolitan areas and international airports. There’s no limit to the possibilities for family recreation in all four seasons. We are in the process of building a brand new, state-of-the-art facility due to be completed in the summer of 2018. Come grow with us. Please send CV and direct all questions to Becky Beal, Medical Staff Recruiter, at email@example.com
Celebrate Public Leadership in Neurology Award Winners B. Smith and Dan Gasby at Commitment to Cures Event B. Smith and Dan Gasby will receive the Public Leadership in Neurology Award at the AAN Annual Meeting during the Commitment to Cures event, a fundraiser for the American Brain Foundation. Gasby recently joined the American Brain Foundation Board to help the Foundation make curing brain disease a public cause. Gasby’s wife, B. Smith, a nationally recognized celebrity chef, restaurateur, supermodel, and lifestyle maven, was diagnosed with early-onset Alzheimer’s in 2013. The moment Smith received her diagnosis, the couple decided that they would not hide; they would go public and advocate for Alzheimer’s patients and caregivers. Since then, they have crisscrossed the country, making more than 25 appearances at Alzheimer’s-related events. They co-authored the book Before I Forget: Love, Hope, and Acceptance in our Fight Against Alzheimer’s, released by Random House in January 2016.
AANnews • April 2017
In their book, which includes a forward by Rudolph Tanzi, PhD, of Harvard University and 1996 recipient of the Potamkin Prize for Research in Pick’s, Alzheimer’s, and Related Diseases, Smith and Gasby share their compelling personal journey with Alzheimer’s disease and make a strong case for research funding. They detail the particularly devastating impact of the disease on African Americans, who are twice as likely as nonHispanic whites to develop late onset Alzheimer’s and less likely to have a diagnosis of their condition, which often results in little time for treatment and planning. Commitment to Cures will be on Wednesday, April 26, at the Westin Boston Waterfront and includes a cocktail hour, dinner, and program with speakers Gasby and Smith and entertainment from the Delfeayo Jazz Quartet. For tickets, visit AmericanBrainFoundation.org/Commitment2Cures or call (866) 770-7570.
Chicago: Multiple Neurology Openings Available The Department of Neurological Sciences at Rush University Medical Center is seeking to fill several open positions within its growing divisions. This recruitment is part of a key strategic growth initiative within the Department of Neurological Sciences. Brief profiles are found below. For more information on Rush University Medical Center, and to apply, visit JoinRush.org. Neuro Critical Care: The Department of Neurological Sciences is seeking a Neurointensivist to join its distinguished Neurocritical Care program. The current recruitment will fulfill a collaborative team of six fellowship trained Neurointensivists. This position is a full time faculty position. Candidate should be eligible for faculty appointment in Rush Medical College at the rank of Assistant or Associate Professor. General Neurology: the Department of Neurological Sciences is seeking an additional academic general neurologist clinician educator to join its current team of eight academic clinical neurologists and two nurse clinicians. The general neurology faculty have a variety of clinical and academic interests, each with extensive experience caring for patients with a wide range of neurological problems in both outpatient and inpatient settings. Opportunities are available on Rush’s main campus, Oak Park and in the western suburbs of Chicago. Movement Disorders: the Parkinson’s Disease and Movement Disorders Program is expanding its program with three positions: an Associate/Professor Senior position and an Assistant Professor position both with opportunities for research and a pure clinical position open to all faculty ranks. The ideal candidate for the senior position will have a well-identified research area of focus and funding. Candidates for the junior position should have a clear research path that will lead to independent funding within three years. The clinical position will be divided between direct clinical
care, education and study protocol conduct. Multiple Sclerosis: the Department of Neurological Sciences is seeking a specialist for one of the largest Multiple Sclerosis Centers in the Midwest. This is part of a strategic recruitment for the continual expansion of our comprehensive treatment center. The team includes collaborative efforts with Rush’s psychologists and physical occupational therapists. Neuro-oncology: the Section of Neuro-Oncology and Comprehensive Brain and Spine Tumor Center is seeking a full-time neuro-oncologist to join its expanding program. The Neuro-Oncology Program at Rush is one of the largest and busiest in the Midwest. The Coleman Foundation Comprehensive Brain Tumor Clinic provides a multidisciplinary approach that ensures every patient receives state-of-the-art care, tailored to the specific patient and designed by the most experienced and qualified specialists in the area. Candidates must also be UCNS certified in Neuro-Oncology and have experience in clinical trials. Candidates should be eligible for faculty appointment in Rush Medical College at the rank of Assistant, Associate or Professor level depending on qualifications. Rush is an Equal Opportunity Employer. Northwest Pennsylvania Seeks General Neurologist – Starting Bonus and Student Loan Repayment Saint Vincent Hospital, part of the Allegheny Health Network is actively recruiting a board-certified or board eligible neurologist to join a group of two highly-experienced neurologists. Position includes general neurology such as stroke, epilepsy, dementia, deep brain stimulation, EMG, EEG and sleep studies. Excellent salary, benefits and incentives offered such as starting bonus and student loan repayment. Position Highlights: Busy outpatient practice. Average 16 patients per day. Start-up loan, moving expenses, and student loan repayment available. Inpatients admitted to Saint Vincent Hospital. 24/7 Stroke Alert Team. Certified Stroke Center. State-of-the-art equipment. Call coverage is 1:3. Hospital employed position. Close proximity to major cities such as Cleveland, Pittsburgh and Buffalo. About Our Practice: Full-service, highly respected neurology group that has been in practice for nearly 40 years. Two well-trained, experienced neurologist who provide inpatient work at local tertiary hospital and have a thriving outpatient practice. Competitive salary with bonus incentives offered. Contact: Rose Panko firstname.lastname@example.org; phone: (814) 452-5634. Maine Central Maine Medical Group is seeking a BE/BC neurologist to join an established adult neurology practice primarily associated with Central Maine Medical Center. A focused interest in stroke, muscle disease, headache/migraine, epilepsy, or movement disorder would be a welcome addition, but is not required. Our diagnostic capabilities include: 1.5 T MRI, CT angio, EMG, Evoked Potentials, EEG, and 24–72 Hour Ambulatory EEG. We also have an active Teleneurology service that is affiliated with Massachusetts General Hospital. Central Maine Medical Center is the flagship hospital of Central Maine Healthcare. The medical center has 250 inpatient beds and offers a broad range of services that include, among many, neurosurgery, a Level II trauma center, cardiovascular medicine,
vascular and cardiac surgery, and medical and radiation oncology. The Central Maine Medical Group comprises of approximately 350 providers, approximately half of which are in primary care. The group delivers care across almost 2500 square miles at numerous outpatient sites and four hospitals. A competitive salary and attractive benefits package are enhanced by the scenic beauty and abundant outdoor adventure found in Maine. Interested candidates, please send CV to Gina Mallozzi, Central Maine Medical Center, 300 Main Street, Lewiston, ME 04240. Fax: (207) 795-5696, email: MallozGi@cmhc.org, or call: (800) 445-7431. Not a J1 opportunity. General Neurologist Practice Opportunity Exceptional Quality of Life & Practice Environment in Beautiful Hendersonville, Western NC. UNC Health Care Affiliated Hospital Hospital-employed position with competitive benefits and incentives Large number of medical specialists on-site for consults Join busy, established neurologist in outpatient practice at Pardee Neurology Associates. Opportunity for team-oriented BC/BE Neurologist. EEG/EMG, state-of-theart radiology center with carotid duplex ultrasound, 64 Slice CT Angiography, MRI Angiography, PET/CT and Neuroradiologist availability. Full spectrum inpatient & outpatient rehab for neurological conditions. Opportunity for participation in regional and state stroke collaboratives. Area offers excellent practice growth potential. Employed position with production incentive bonus, competitive compensation, full benefits package, excellent referral network, established Hospitalist program, relocation assistance. Thirteen-minute flight time access to regional neurotrauma center via medical air ambulance. Sorry, No Visa sponsorships available. No Recruitment or Placement Firm Inquiries. For consideration send CV to: Lilly Bonetti, FASPR (828) 694-7687 lillian.bonetti@unchealth. unc.edu www.pardeehospital.org
AANnews® Classified Advertising T he AAN offers a complete package of print, online, and in-person recruitment advertising opportunities. Visit AAN.com/careers for all AAN options, rates, and deadlines.
d copy for the June 2017 print edition of AANnews A must be submitted by May 1, 2017. The same deadline applies to changes/cancellations. he American Academy of Neurology reserves the T right to decline, withdraw, or edit advertisements at its discretion. Every care is taken to avoid mistakes, but the responsibility for clerical or printer errors does not exceed the cost of the ad.
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AANnews • April 2017
Are you seeing the whole picture?
Migraine is a common and debilitating neurological disease.1-3 Uncover its true impact on the lives of patients, and see how the neuropeptide CGRP can play a key role in migraine’s complex pathophysiology. 2,4-9 References: 1. Barbanti P, Aurilia C, Egeo G, Fofi L. Future trends in drugs for migraine prophylaxis. Neurol Sci. 2012;33(suppl 1):S137-S140. 2. Edmeads J, Findlay H, Tugwell P, Pryse-Phillips W, Nelson RF, Murray TJ. Impact of migraine and tension-type headache on life-style, consulting behaviour, and medication use: a Canadian population survey. Can J Neurol Sci. 1993;20:131-137. 3. Munakata J, Hazard E, Serrano D, et al. Economic burden of transformed migraine: results from the American Migraine Prevalence and Prevention (AMPP) Study. Headache. 2009;49:498-508. 4. Lipton RB, Bigal ME, Diamond M, et al; for AMPP Advisory Group. Migraine prevalence, disease burden, and the need for preventative therapy. Neurology. 2007;68:343-349. 5. Hu XH, Markson LE, Lipton RB, Stewart WF, Berger ML. Burden of migraine in the United States. Arch Intern Med. 1999;159:813-818. 6. Buse DC, Rupnow MFT, Lipton RB. Assessing and managing all aspects of migraine: migraine attacks, migraine-related functional impairment, common comorbidities, and quality of life. Mayo Clin Proc. 2009;84:422-435. 7. Russo AF. Calcitonin gene-related peptide (CGRP): a new target for migraine. Annu Rev Pharmacol Toxicol. 2015;55:533-552. 8. Russell FA, King R, Smillie S-J, Kodji X, Brain SD. Calcitonin gene-related peptide: physiology and pathophysiology. Physiol Rev. 2014;94:1099-1142. 9. Goadsby PJ, Edvinsson L, Ekman R. Release of vasoactive peptides in the extracerebral circulation of humans and the cat during activation of the trigeminovascular system. Ann Neurol. 1988;23:193-196.
Learn more about the impact of migraine and the science behind it at
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Published on Mar 27, 2017