VOLUME 31 · ISSUE 7 · JULY 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
Neuro-ophthalmology/Neuro-otology Skills Workshop to Debut at Fall Conference in Las Vegas The AAN Fall Conference is always your year-end best bet for the latest clinical advances in neurology from top experts in the field—plus 15.75 CME—in a convenient three-day format. But this year the conference, which will be held October 20 through 22 at The Cosmopolitan of Las Vegas, will offer those interested in the latest neuro-ophthalmology and neuro-otology examination techniques a chance to learn via a special, interactive hands-on mini lab. Under the direction of Christopher Glisson, DO, the Neuroophthalmology/Neuro-otology Skills Workshop, which will be held on Saturday, October 21, from 1:00 p.m. to 5:00 p.m., will consist of stations to address individual components of the exam, including visual acuity (near and Snellen acuity), color vision, visual fields (confrontation and Amsler grid, including techniques to identify patients with functional vision loss), pupils (RAPD and anisocoria), ocular motility and alignment (prism and red Maddox rod), nystagmus, ophthalmoscopy (direct and panoptic ophthalmoscopes), assessment of the vestibular ocular reflex (head thrust and ophthalmoscopy), Hallpike testing, and repositioning treatments. Participants will visit each station for individualized instruction and troubleshooting with an expert on these essential examination skills. Space is limited and pre-registration and an additional fee is required to attend the workshop. Visit AAN.com/view/17FC to secure your spot.
Save $100+ with Early Fall Conference Registration Early Fall Conference registration savings and hotel reservations end September 8. Visit AAN.com/view/17FC today. •
Five New Awards Among 2018 AAN Research Program Opportunities Five new awards are among the 2018 AAN Research Program opportunities, as well as three large-scale awards that mark the AAN’s pledge to support all types of research across all career levels and discovery stages.
August Application Deadline: nn Clinician Scientist Development
Award in Multiple Sclerosis Funded by the American Brain Foundation and the National MS Society
Continued on page 7
Applications Now Open for New Practice Leadership Program
THIS ISSUE 8 12
In order to effectively navigate and manage today’s rapidly changing health care landscape, it is essential that neurologists are positioned and equipped to influence important decisions that stand to dramatically impact our field, our community, and our patients. The Practice Leadership Program, the AAN’s newest in its Continued on page 22
2017 Neurology Compensation and Productivity Report Available Soon Member Testifies on FAST Act: ‘Time Is Brain’ Neurology to Play Starring Role in Los Angeles Next April Safdieh Succeeds Ringel as Neurology Today Editor-in-Chief
SUPER-REFRACTORY STATUS EPILEPTICUS (SRSE) IS
A CRITICAL PUZZLE OF CLINICAL COMPLEXITY 1-3 SRSE is a life-threatening form of status epilepticus (SE) that continues or recurs for >24 hours despite multiple therapeutic interventions (first-, second-, and third-line agents).3,4
THE BURDEN OF SRSE IS HIGH5 Approximately 65% to 70% of patients with refractory SE or SRSE will die or be left with neurological deficits1,6 Outcomes of refractory seizures worsen with longer duration of uncontrolled seizure activity,7 including risk of neuronal death,7-9 neuronal injury,7-9 and alteration of neuronal networks3,4 Limited evidence exists to guide treatment decisions for patients with SRSE after third-line treatment failure3,4,10
Visit SRSE.com to learn more. References: 1. Delaj L, Novy J, Ryvlin P, Marchi NA, Rossetti AO. Refractory and super-refractory status epilepticus in adults: a 9-year cohort study. Acta Neurol Scand. 2017;135(1):92-99. 2. As reviewed in Bayrlee A, Ganeshalingam N, Kurczewski L, Brophy GM. Treatment of super-refractory status epilepticus. Curr Neurol Neurosci Rep. 2015;15(10):66. 3. As reviewed in Shorvon S, Ferlisi M. The treatment of super-refractory status epilepticus: a critical review of available therapies and a clinical treatment protocol. Brain. 2011;134(Pt 10):2802-2818. 4. As reviewed in Hocker S, Tatum WO, LaRoche S, Freeman WD. Refractory and super-refractory status epilepticus â€“ an update. Curr Neurol Neurosci Rep. 2014;14(6):452. 5. Beg JM, Anderson TD, Francis K, et al. Burden of illness for super-refractory status epilepticus patients. J Med Econ. 2017;20(1):45-53. 6. As reviewed in Ferlisi M, Shorvon S. The outcome of therapies in refractory and super-refractory convulsive status epilepticus and recommendations for therapy. Brain. 2012;135(Pt 8):2314-2328. 7. Scholtes FB, Renier WO, Meinardi H. Generalized convulsive status epilepticus: causes, therapy, and outcome in 346 patients. Epilepsia. 1994;35(5):1104-1112. 8. As reviewed in Payne TA, Bleck TP. Status epilepticus. Crit Care Clin. 1997;13(1):17-38. 9. As reviewed in Meldrum B. Excitotoxicity and epileptic brain damage. Epilepsy Res. 1991;10(1):55-61. 10. Glauser T, Shinnar S, Gloss D, et al. Evidence-based guideline: treatment of convulsive status epilepticus in children and adults: report of the Guideline Committee of the American Epilepsy Society. Epilepsy Curr. 2016;16(1):48-61.
ÂŠ 2017 Sage Therapeutics, Inc.
Official Publication of the American Academy of Neurology
Table of Contents
PUBLICATION The Vision of the AAN is to be indispensable to our members. The Mission of the AAN is to promote the highest quality patient-centered neurologic care and enhance member career satisfaction. Contact Information American Academy of Neurology 201 Chicago Avenue Minneapolis, MN 55415 Phone: (800) 879-1960 (toll free) (612) 928-6000 (international) Email:
Website: AAN.com For advertising rates, contact: Eileen R. Henry Wolters Kluwer Health | Medical Research Lippincott, Williams & Wilkins Phone:
COVER Neuro-ophthalmology/Neuro-otology Skills Workshop to Debut at Fall Conference in Las Vegas Five New Awards Among 2018 AAN Research Program Opportunities Applications Now Open for New Practice Leadership Program
4 Neurology Must Address Gender Disparity Issues
MEET YOUR LEADER
6 Brenda Banwell, MD, FAAN
8 Learn How to Use Teleneurology in Your Practice
8 2017 Neurology Compensation and Productivity Report Available Soon
9 New Quality Measures to Be 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.
Added to Axon Registry
10 MIPS and Quality: How to Get Started
11 Improve Your Patients’ Experience with Interactive Electronic Exam Room Posters
12 Member Testifies on FAST Act: ‘Time Is Brain’
12 Capitol Hill Report
20 Neurology to Play Starring Role in Los Angeles Next April
CME & MOC
20 Get Up-to-date on Sleep Disorders with Continuum Audio
21 Safdieh Succeeds Ringel as
Neurology Today Editor-in-Chief
22 Join New Consortium of
Neurology Advanced Practice Providers and Synapse Community
24 Member’s Passion, Participation Lead to Committee Assignment
AMERICAN BRAIN FOUNDATION
25 Commitment to Cures Event Raises Nearly $300,000
CAREERS | 26 DATES AND DEADLINES | 27
11 Podcast Central
NEWS BRIEFS The AAN Board of Directors approved to affirm the value of the National Collegiate Athletic Association’s Interassociation Consensus “Independent Medical Care for College Student-Athletes Best Practices.” Read the document online at http://on.ncaa.com/2qDyBoR. AAN Vice President Ann H. Tilton, MD, FAAN, recently gave a presentation at SUNY Downstate in Brooklyn, NY. More than 50 individuals attended her Grand Rounds lecture highlighting how the AAN can support its members throughout their careers. Smaller sessions were held throughout the day discussing opportunities and challenges with faculty and residents. •
AANnews • July 2017
Neurology Must Address Gender Disparity Issues According to the 2016 data in our most recent AAN Insights Report, women now comprise 36.8 percent of the AAN membership; among US neurologists, 31.5 percent are women. This is significant growth since 2008, when women were only 29 percent of all AAN members and 24.7 percent of US neurologists. Residency programs are training increasing numbers of Ralph L. Sacco, MD, MS, women in our profession. Despite FAHA, FAAN the increasing women among our neurology work force, some alarming statistics were published last year demonstrating gender disparities particularly among neurology. We evaluated the evidence in this article very seriously and acted swiftly. Last November, then-President Terrence Cascino reported to members that the Academy had formed a Gender Disparity Task Force, chaired by Board member Elaine C. Jones, MD, FAAN. The charge to the task force was to gather information and statistics on disparities in pay and other types of discrimination that women face in our profession and make recommendations to the AAN Board of how to address these issues. The 11-person task force convened four times in as many months to examine gender disparities as they play out in compensation, professional advancement, leadership opportunities, and work/life balance. I want to personally acknowledge their hard work in rapidly addressing this important problem.
These are the causes the Gender Disparity Task Force identified for disparities: 1. Lack of salary transparency, leading to female neurologists not being aware of their colleaguesâ€™ salaries and not having relevant data for negotiation. 2. Absence of negotiating and networking by women, rooted in a difference in how the genders approach both tasks. 3. Bias and, in particular, implicit bias which can color major decisions without being detected. 4. Penalty for work/life balance and family responsibility, based on the higher likelihood that women will assume caretaking roles in their personal lives. The Task force made these recommendations for the AAN to consider implementing as we address these issues: 1. Lead by example by reporting percentages of women involved in AAN leadership, and by continuing to promote gender-friendly work practices. Currently, 42 percent of the members on the AAN and AAN Institute Boards of Directors are women. Among the six AAN and AAN Institute officers, three are women. Of the seven members of the Academyâ€™s executive staff, three are women. 2. Continue to enhance leadership education options for female AAN members, such as the new Women Leading in Neurology Program that begins Fall of 2017. 3. Improve transparency by sharing neurology compensation and productivity data and developing resources that explain requirements for various career stages, while also leveraging relationships to encourage similar transparency from other medical associations and public institutions.
4. Address bias by making available survey tools that reveal implicit biases, as well as by writing articles for AAN publications on the topic.
whether because of their gender, ethnicity, sexual orientation, religion, or nationality—simply because of archaic thinking rooted in a prejudicial culture of the past.
5. Develop mentors by training men and women leaders to mentor women, by creating networking opportunities for women, and by highlighting female neurologists who have achieved leadership roles or professional success.
We must continue to be guided by the core values of our AAN that include leadership, integrity, professionalism, commitment, respect, and compassion. Last year, we added a new and critical core value: diversity and equality. We commit to building and sustaining an inclusive organization that respects and values the diversity of our membership and the communities we serve, and promotes equality in professional advancement and compensation.
6. Promote different practice options to support work/life balance. 7. Offer a scholarship or research fund to support relevant scholarship on the subject. 8. Explore legislative options that have been successful elsewhere while also updating the Code of Professional Conduct to reflect the AAN’s stance on gender disparity. 9. Conduct further investigation and publish the results. As the AAN works to implement the recommendations above, we ask that you take action and participate in these programs and resources to address disparity and bias in your workplace. It’s typically easier to spot the foibles of others than our own. But each of us should give some thought about how we may casually accept these disparities and perhaps even, consciously or subconsciously, perpetuate them. Our profession needs to attract and retain the best and brightest CHP: 16 Axon Registry Ad—Half Page Horizontal> AN and we can’t afford to deter or lose good people— Placed in minds AANnews
I hope you will join me in helping ensure our profession is open, welcoming, and provides equal opportunities on a level playing field where we all are judged solely by our skills, experience, and performance of our duties in service to our patients and all humanity. Let’s all work together to address and eliminate gender disparities. •
Ralph L. Sacco, MD, MS, FAHA, FAAN President, AAN firstname.lastname@example.org
8.25 x 5.25 +0.125 bleed, 4C
Driving quality improvement and demonstrating the value of neurology. The AAN’s new Axon Registry® provides a seamless, discrete collection of timely data that can show quality improvement by individual neurologists and collectively confirm the crucial value of neurologists in the care of patients with brain disease.
Learn more and participate: AAN.com/view/axon
AANnews • July 2017
Meet Your Leader
Brenda Banwell, MD, FAAN This is one of a series of profiles of members newly elected to the Board of Directors for the AAN and AAN Institute for the 2017–2019 term. Brenda Banwell, MD, FAAN, currently serves as the chief of child neurology and professor of neurology and pediatrics at The Children’s Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania. She also serves as the research chair of the International Pediatric Multiple Sclerosis Study Group. Banwell has been a member of the AAN since 1996, served on the Science Committee from 2005 to 2011, and the AAN Meeting Management Committee from 2011 to 2017. Banwell was a selected attendee at the AAN’s first Leadership Development Program in 2007 and 2008, and has more recently served as a mentor in the Emerging Leaders Program of the AAN. She serves on the Brain Health Fair Committee and has been an active participant in Brain Health Fair activities annually. How did you first get involved as a volunteer on committees/subcommittees and what moved you to participate?
From your experiences as an AAN leader, what is one of the more common misperceptions members may have about the Academy?
I attended my first AAN meeting in 1994 and, to my recollection, have missed none since. I first became involved when I was invited to join the Science Committee. It was an incredibly wonderful, collegial, and empowering experience. I knew joining the AAN in such a pivotal role would greatly enhance my ability to understand the organization and the Annual Meeting as well as to really have an impact on the science content.
I think neurologists that work in more niche areas may not view the AAN as being directly applicable to them. They do not realize the breadth and, importantly, the depth of the content, meeting areas of focus, resources, partnerships, and advocacy that are available through the AAN across all areas of neurology.
Why did you wish to be on the Board of Directors and what experiences and viewpoints do you bring to this role?
The AAN is, at its core, a voice for our field. This voice represents relevant views of experts; is the voice of academic, non-academic, and allied professionals; speaks loudly as an advocate; and, very importantly, speaks directly on behalf of individuals living with neurological disorders.
I have been honored to serve on AAN committees now for almost 13 years. As such, I wanted to now move to the next level. As a Board member, I can learn more about the highest level of organizational infrastructure and mission. I hope to contribute to important and timely discussions that will help frame AAN goals—at all levels (practice, science, meeting management, outreach, etc.).
In your view, how does the AAN benefit the field of neurology most?
How should members evaluate the success of the AAN and the Board of Directors in supporting their careers and in neurology in general? Being responsive to current advances and emerging priorities is key but not enough. The AAN is also anticipatory and visionary—to recognize new scientific, legal, regulatory, and care advances and bring this to members “ahead of the curve.” •
20 Minutes Pack a Punch! Download the latest podcast at Neurology.org. 6
AANnews • July 2017
Research & Awards
Five New Awards Among 2018 AAN Research Program Opportunities Continued from cover
October 1 Application Deadline: nn Two $450,000 Career Development Awards
nn Susan S. Spencer Clinical Research Training
Scholarship in Epilepsy
Funded by the American Academy of Neurology
Provides $150,000 per year for three years. Eligible applicants will have completed residency between five to 10 years prior to the start date of the Career Development Award.
Funded by the American Brain Foundation, the American Epilepsy Society, and the Epilepsy Foundation nn
Funded by the American Brain Foundation and the Society of Vascular and Interventional Neurology
nn $150,000 Neuroscience Research Training
Funded by the American Academy of Neurology
nn Clinical Research Training Scholarship in
Provides $75,000 over two years. The award is designed for basic and translational research proposals in neurology, and eligible applicants will have completed residency or a PhD no more than five years prior to the beginning of the award.
Two $150,000 McKnight Clinical Translational Research Scholarships in Cognitive Aging and Age Related Memory Loss
Funded by the McKnight Brain Research Foundation, through the American Brain Foundation, and the American Academy of Neurology nn Clinical Research Training Scholarship
Funded by the American Academy of Neurology nn Practice Research Training Scholarship
Funded by the American Academy of Neurology
Clinician Scientist Development Award in Interventional Neurology
Funded by Lundbeck
Clinical Research Training Scholarship in Headache Funded by the American Brain Foundation and the International Headache Society
Clinical Research Training Scholarship in Neuromuscular Disease Funded by the American Brain Foundation and the Muscle Study Group
Clinical Research Training Scholarship in Dementia with Lewy Bodies Funded by the American Brain Foundation and The Mary E. Groff Charitable Trust
Look for applications to open this month. For more information, visit AAN.com/view/ResearchProgram. •
AANnews • July 2017
Learn How to Use Teleneurology in Your Practice Teleneurology offers many practical solutions to patient care, including improved access to neurologists. Hear from a teleneurology expert and learn what it takes to make it a part of your practice.
A Guide to Teleneurology: Use It in Your Practice August 1, 2017, from 12:00 p.m.–1:00 p.m. ET Deadline to Register: July 31 Director: Eric Anderson, MD, PhD
Upon completion, you should be able to: nn Describe the applications and delivery models for various
forms of telemedicine and mobile health
nn Learn how to code correctly for telemedicine for
Medicare, Medicaid, and private payers
nn Interpret legal and regulatory issues associated with
AAN practice management webinars provide the valuable insights and tools you need to navigate through the ever-changing 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 Eric Anderson, MD, PhD presentation slides and recordings if 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. •
Plan Ahead for September Webinar Register by September 11 at AAN.com/view/pmw17 for the upcoming webinar “Open Your Heart, Open Your Notes: A Guide to Patient Engagement,” offered on Tuesday, September 12, at 12:00 p.m. ET. •
2017 Neurology Compensation and Productivity Report Available Soon The AAN’s 2017 Neurology Compensation and Productivity Report and customizable results dashboard, based on 2016 data, will be available this month. US participants who completed the 2017 Neurology Compensation and Productivity Survey can access the online report and dashboard for free. Members who did not complete the survey may purchase access for $600. This is the fifth—and only—annual report exclusively detailing the neurology profession and gives you the power to
compare US neurologist salaries and practice characteristics by subspecialty, practice setting, and more! The report and customizable results dashboard will enable you to see what other practices are doing to more efficiently streamline their work and find new areas of growth. Whether you are a physician or practice administrator in a large or small practice setting, you can: nn Compare and customize your individual practice-related
data with your colleagues at local and national levels
nn Determine if you are being compensated fairly relative to
nn Use the data in demonstrating your value to payers and to
delivering quality patient care
nn Discover fair market value based on your subspecialty,
region, and practice type
nn Create charts and graphs and download them right to
nn Assess patient and practice management principles and
implement efficiencies that ultimately can help improve the quality of patient care
Access the 2017 Neurology Compensation and Productivity Report and customizable results dashboard at AAN.com/view/benchmark. To purchase the report, visit AAN.com/TheAANStore. •
AANnews • July 2017
New Quality Measures to Be Added to Axon Registry The Axon Registry ® is working to fulfill the needs of all neurologists, whether they are a solo practitioner, a general neurologist, or a subspecialist. In addition to the 24 quality measures already in the registry, the Registry Committee and AAN staff have selected up to 13 quality measures to be added into the registry by quarter three of 2017. Additionally, two patient reported outcome (PRO) measures will be implemented later in 2017. To create a well-rounded registry, quality measures selected for 2017 cover the areas of ALS, child neurology, dementia, essential tremor, multiple sclerosis, neuro-ophthalmology, and Parkinson’s disease. This is the full list of the new quality measures: nn ALS: Amyotrophic lateral sclerosis end of life planning
nn Child Neurology: Appropriate first line treatment for
nn Child Neurology: Screening for co-morbid conditions
of tic disorder or Tourette syndrome
nn Child Neurology: Botulinum Toxin Serotype (BoNT-A)
for spasticity and dystonia
nn Dementia: Education and support of caregivers for
patients with dementia
nn Dementia: Safety concern screening and follow-up for
patients with dementia
nn Essential Tremor: Annual assessment of essential
nn Multiple Sclerosis: Current multiple sclerosis disability
nn Neuro-ophthalmology: Giant Cell Arteritis: Absence of
fellow eye involvement after corticosteroid treatment
nn Neuro-ophthalmology: Ocular Myasthenia Gravis:
Improvement of ocular deviation or absence of diplopia or functional improvement of ptosis
Quality measures included in the registry are selected based on multiple criteria. Anup D. Patel, MD, co-chair for the Quality and Safety Subcommittee, explained, “Our subcommittee creates measures for the AAN and advises the Registry Committee on which measures to include in the registry. We consider the impact of the measure along with its capability to be implemented in an EHR and provide meaningful feedback to neurologists.”
Anup D. Patel, MD
Multiple subspecialties were included in the discussions not only to create the measures but to provide insight into adding them into the registry. Having all neurology-specific measures in the registry gives neurologists quality measure options that are relevant to their practice. This can be useful for quality improvement purposes, reporting quality measures for the new MIPS pathway under the Quality Payment Program, and receiving credit from the ABPN as an MOC Part IV PIP Clinical Module activity. For details about measures already in the Axon Registry, visit AAN.com/view/axon and scroll to the “Registry Quality Measures” tab. Note that the measures being added in 2017 were not a part of this year’s Qualified Clinical Data Registry application and therefore will not be eligible for the CMS reporting year 2017 for the quality component of MIPS. However, this will give neurologists time to work with the quality measures and improve their performance before consideration for MIPS 2018. If you would like to enroll in the registry or have questions, contact email@example.com. •
nn Parkinson’s Disease: Cognitive impairment or dysfunction
assessment for patients with Parkinson’s disease
nn Parkinson’s Disease: Fall rate for patients with
nn Parkinson’s Disease: Parkinson’s disease rehabilitative
AANnews • July 2017
MIPS and Quality: How to Get Started The Merit-based Incentive Payment System (MIPS) ties Medicare payments to performance. For participation in MIPS, eligible clinicians may submit 90 days or a complete year of 2017 data to possibly earn a bonus payment, which is based on performance data on the information submitted (not the amount of information or length of time submitted). Clinicians also may submit minimal data to avoid a penalty. The best way to earn the largest bonus payment is to submit data on the three MIPS performance categories: Advancing Care Information, Improvement Activities, and Quality—the latter being the focus of this article. Read on to learn how you can find out if you are eligible to participate in MIPS and how to integrate quality into your reporting.
How do I participate in the quality component of MIPS? The Centers for Medicare & Medicaid Services (CMS) has developed an online tool that is available to providers to review all available measures for the MIPS program. This tool allows participating physicians to filter measures by high priority, the submission method (claims, registry, Qualified Clinical Data Registry (QCDR), etc.), or specialty measure set. This allows participating providers to review the measures and select those that best fit their practice needs. The CMS tool can be accessed on the QPP website at QPP.cms.gov/measures/ quality. The quality component will account for 60 percent of a neurologist’s MIPS score in 2017.
What are the different reporting methods available for MIPS? The most common types of reporting used by neurologists are registry, claims, and QCDR. You will want to keep in mind the submission method you have chosen when selecting measures as not all methods are available for every measure. nn Claims-based submissions are done by submitting an
extra line for each measure performed on the applicable claim; this tells CMS that you have performed the necessary action performed during an encounter.
nn Registry-based submissions are typically done via an
online portal or submission through which a provider enters specific information regarding the quality measures; this information is then transmitted through a third-party vendor to CMS for consideration (for example, CE City).
nn QCDR is used by specialty societies that have
developed their own clinical data registry. There are measures from MIPS included but also additional measures which have been approved by CMS that apply to that specialty. Using a QCDR to report for MIPS may allow you to report on measures which apply to your specialty practice. The AAN’s Axon Registry® is a QCDR.
Can I integrate my quality reporting with my Improvement Activities (IAs)? Yes, participating providers can reduce their quality payment workload by choosing measures that incorporate IAs. There are several examples of activities that could sync up with quality measures and earn the provider credit for completing both the measure and the activity.
AANnews • July 2017
nn Chronic care and preventative care management §§ Potential measures: controlling high blood pressure,
screening for chronic depression, BMI screening, diabetes hemoglobin A1C, unhealthy alcohol use
nn Implementation of use of specialist reports back to
referring clinician §§ Potential measures: closing the referral loop
nn Implementation of condition-specific chronic disease self-
management support programs §§ Potential measures: screening for clinical depression, diabetes hemoglobin A1C
nn Implementation of fall screening and assessment programs §§ Potential measures: falls plan of care, falls risk
nn Implementation of medication management practice
improvements §§ Potential measures: documentation of current medications in the medical record, medication reconciliation
nn Depression screening §§ Potential measures: psychiatric symptoms
assessment for patients with Parkinson’s disease, screening for clinical depression and follow-up plan, depression utilization of the PHQ-9 tool
nn Tobacco use §§ Potential measures: tobacco use screening and
How are CMS benchmarks used? CMS uses data for individual measures from previous years’ submissions to calculate benchmarks for the quality measures included in MIPS. Benchmarks will differ depending on the submission method. CMS uses those benchmarks to determine how a participant will be scored for performance. Any MIPS measures that are not able to be benchmarked for 2017 will not be scored based on performance.
How do I find out more about the AAN’s QCDR? All email inquiries regarding the Axon Registry can be sent to firstname.lastname@example.org. Additional information, including an Axon participant interest form, is available at AAN.com/view/Axon. •
Improve Your Patients’ Experience with Interactive Electronic Exam Room Posters The AAN has partnered with Health Monitor Network, a patient education company, to offer free electronic touchscreen posters for US members’ exam rooms. The AAN will review content for the posters for medical accuracy. “The work group of physicians who tested out the digital posters were impressed by the content,” said Bert B. Vargas, MD, FAAN Bert B. Vargas, MD, FAAN, chair of the Digital Strategy Subcommittee. “They especially liked the graphics and felt they could be very useful as patient education tools. These posters could be an effective way to increase patient satisfaction and decrease their perceived wait time.”
by Health Monitor Network. Content is updated quarterly. The posters are available for all member practices in the US, excluding Alaska, Hawaii, and Puerto Rico. Health Monitor Network has partnerships with other medical organizations, such as the American Gastroenterological Association, as well as patient advocacy groups. To learn more about the electronic posters, visit http://bit.ly/HM_AAN. •
Each poster features educational charts, diagrams, and tips on managing neurologic conditions. The 21.5” screen silently rotates panels every 25 seconds, with no interaction needed from health care professionals, office staff, or patients. Clear, engaging videos play only when activated, with a suite of controls, including an easy-to-find pause button. Installation of the posters is free, and they do not require WiFi. They plug into the wall, and any maintenance is conducted
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Your Guide to New and Recent AAN Podcasts
Neurology Podcasts ®
Visit Neurology.org to listen to Neurology podcasts and earn 0.5 AMA PRA Category 1 CME Credits™ by answering the multiple-choice questions in the online podcast quiz. Interviews based on articles from Neurology ® Clinical Practice, Neurology ® Genetics, and Neurology ® Neuroimmunology & Neuroinflammation are excluded from the CME program.
Available by July 1 nn Neurology: Intake of Dairy Foods and Risk of Parkinson Disease Michelle E. Fullard, MD, and Katherine C. Hughes, BA nn Neurology: Diagnosis of DWI-negative Acute Ischemic Stroke: A Meta-analysis Kevin M. Barrett, MD, MSc, and Brian L. Edlow, MD nn Neurology: Discovering the Patient Within Ted M. Burns, MD, and Richard Morton, BSc, BM BCh nn Neurology: Neuroimmunology & Neuroinflammation: Microarray Screening of Guillain-Barré Syndrome Sera for
Antibodies to Glycolipid Complexes
Ted M. Burns, MD, and Hugh J. Willison, MBBS, PhD
nn Neurology: Neuroimmunology & Neuroinflammation: Next-generation Sequencing in Neuropathological Diagnosis of
Infections of the Nervous System
Heather D. Harle, MD, and Carlos A. Pardo, MD
AANnews • July 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.
Trump Proposed Budget Calls for Drastic Cuts to NIH, CDC nn The Trump administration released its FY2018 budget
proposal which calls for drastic cuts to the National Institutes of Health (NIH), the Center for Disease Control and Prevention, and other federal agencies tasked with health care research and safety.
nn We have had many conversations on Capitol Hill and
are finding no support for the Trump proposal. We continue to express our concern and advocate for research funding.
nn NIH Director Dr. Francis Collins, a major supporter of
the BRAIN Initiative, will maintain his position under the Trump administration.
BRAIN Initiative Letter Sent to Senate Appropriations Committee nn Funding for the BRAIN Initiate at NIH was a top
priority at the AAN’s Neurology on the Hill event if late February.
FAST Act CBO Score and Cosponsors nn The Congressional Budget Office (CBO) scored the
CHRONIC Care Act and attached a cost of $180 million to Medicare over 10 years for the Furthering Access to Stroke Telemedicine (FAST) Act.
nn The CBO score did not consider state Medicaid
savings and many other savings that will accompany increased access to tPA by stroke patients.
nn The FAST Act passed the Senate Finance Committee
as part of the CHRONIC Care Act, S. 870.
nn After securing an increase of $110 million for the
nn The Senate version of the FAST Act, S. 431, by Sen.
nn At the request of the AAN, a letter sent to the Senate
nn The House version of FAST, H.R. 1148, by Rep.
Initiative in FY2017 funding, the AAN has turned to securing funding for FY2018. Appropriations Committee last week supporting increased funding circulated through the Senate.
John Thune (R-SD) gained three cosponsors, bringing the total to nine. Morgan Griffith (R-VA) also gained three cosponsors, bringing the total to 90. •
Member Testifies on FAST Act: ‘Time Is Brain’ On May 16, AAN member Lee H. Schwamm, MD, FAHA, of Harvard Medical School and Massachusetts General Hospital, testified before the Senate Finance Committee in support of the FAST Act as part of the CHRONIC Care Act,
S. 870. Schwamm stated that he is a member of the AAN and the Academy has worked to expand telestroke access. He told senators that “telestroke is supported by a wealth of evidence” and that “the emergency department can use a telestroke network to get instant access to stroke expertise.” Citing the fact that “time is brain” when it comes to quickly accessing medical expertise, Schwann told the senators how tPA significantly reduces stroke disability and that those who receive tPA are three times more likely to recover with little or no disability. “tPA is a game-changing treatment in the field of stroke.” Committee Chairman Orrin Hatch (R-UT) thanked Utah AAN members Nicholas E. Johnson, MD, and Jennifer J. Majersik, MD, of the University of Utah, and Kevin D. Call, MD, of Intermountain Healthcare, for their work on telestroke. The Senate Finance Committee has since passed the CHRONIC Care Act out of committee on a unanimous vote, making the bill eligible for consideration on the floor of the Senate. •
AANnews • July 2017
QUIETING MS Quietly
for your patients with relapsing MS
*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.1,2
INDICATION AUBAGIO® (teriflunomide) is indicated for the treatment of patients with relapsing forms of multiple sclerosis. 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. Please see additional Important Safety Information and Brief Summary of Full Prescribing Information, including boxed WARNING, on the following pages.
THINK BEYOND RELAPSES IN THE MANAGEMENT OF RMS
MAKE AN IMPACT ON DISABILITY PROGRESSION NOW TRE
IMPORTANT SAFETY INFORMATION (continued) 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. 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.
Please see additional Important Safety Information and Brief Summary of Full Prescribing Information, including boxed WARNING regarding hepatotoxicity and use in pregnancy, on the following pages.
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†
DMT=disease-modifying therapy; EDSS=Expanded Disability Status Scale; RMS=relapsing forms of MS. *Disability progression was a secondary endpoint in TEMSO and TOWER.6,7 † Based on Kaplan-Meier estimates.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.6 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.7
• The estimated proportion of patients with sustained disability progression: —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
• 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. • 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. (continued on back)
MAKE AN IMPACT ON DISABILITY PROGRESSION—START OR SWITCH TO AUBAGIO 1
The only oral DMT with a proven impact on disability progression in 2 Phase III trials1,4,5 • An estimated 80% of patients in TEMSO and 84% of patients in TOWER remained free from disability progression over 108 weeks with AUBAGIO® (teriflunomide) 14 mg1 • 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 kept a range of RMS patients free from relapse1 • 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)
One pill, once a day, taken with or without food1 • Health care professionals should run certain tests before prescribing AUBAGIO and should monitor patient liver enzyme levels monthly for the first 6 months 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.1,2
IMPORTANT SAFETY INFORMATION (continued) 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. Data on file, Sanofi/Genzyme. Summary of safety HMR1726teriflunomide. December 5, 2013. 3. Ziemssen T, De Stefano N, Pia Sormani M, Van Wijmeersch B, Wiendl H, Kieseier BC. Optimizing therapy early in multiple sclerosis: An evidence-based view. Mult Scler Relat Disord. 2015;4(5):460-469. 4. Tecfidera (dimethyl fumarate) [package insert]. Cambridge, MA: Biogen Inc.; February 2016. 5. Gilenya (fingolimod) [package insert]. East Hanover, NJ: Novartis Pharmaceuticals Corporation; February 2016. 6. O’Connor P, Wolinsky JS, Confavreux C, et al; for the TEMSO Trial Group. Randomized trial of oral teriflunomide for relapsing multiple sclerosis. N Engl J Med. 2011;365(14):1293-1303. 7. 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.
©2017 Genzyme Corporation. All rights reserved. AUBAGIO, Sanofi, and Genzyme registered in U.S. Patent and Trademark Office. GZUS.AUBA.15.01.0246(4) February 2017
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
Neurology to Play Starring Role in Los Angeles Next April The AAN Annual Meeting—the place to see and be seen in the world of neurology— is gearing up to steal the spotlight next April in Los Angeles, the film and entertainment capital in which to see and be seen. A destination like no other, sunny Los Angeles boasts 75 miles of coastline, endless dining and nightlife options, family-friendly activities, rich cultural diversity, and the famous glamour and glitz of Hollywood. Los Angeles will provide the perfect backdrop to an equally vibrant Annual Meeting when all the biggest names in neurology and neuroscience convene at the Los Angeles Convention Center April 21 through 27. Attendees will be treated to a week of world-class science offering the latest research from across the spectrum of neurology, top education led by expert faculty from around the globe, and unparalleled networking and collaboration to further the field of neurology.
APRIL 21–27, 2018 • LOS ANGELES, CA
Registration will open in fall 2017. Visit AAN.com/view/AM18 to sign up for notification when registration goes live. •
CME & MOC
Get Up-to-date on Sleep Disorders with Continuum Audio From the brain circuitry controlling sleep and wakefulness to making decisions about driving safety with sleep disorders, the latest Continuum® Audio series will cover the breadth of the topic in a format convenient for listening during your commute or workout. “Members can use this series to delve into the many disorders that cause sleepiness and sleeplessness,” said Steven L. Lewis, MD, FAAN, host of the issue and Continuum editor-in-chief. “They will benefit from discussions of parasomnias, comorbid sleep issues in neurologic disorders, and sleep-wake disorders of childhood, among many others.” The first two hours of the series are currently available; the second two hours will be available in August. HOUR 1 nn Brain Circuitry Controlling Sleep and Wakefulness /
Richard L. Horner, PhD
nn Diagnostic Approach and Investigation in Sleep
Medicine / Michael H. Silber, MBChB, FAAN
nn Comorbid Sleep Disturbances in Neurologic
Disorders / Yo-El S. Ju, MD, MSCI
HOUR 2 nn Restless Leg Syndrome and Sleep-related Movement
Disorders / Lynn Marie Trotti, MD, MSc
nn Rapid Eye Movement Sleep Behavior Disorders and Other
Rapid Eye Movement Parasomnias / Birgit Högl, MD
nn Non-rapid Eye Movement and Overlap Parasomnias /
Michael J. Howell, MD, FAAN
HOUR 3 nn Sleep-disordered Breathing / Nancy R. Foldvary-
Schaeffer, DO, MS
nn Circadian Rhythm Sleep-wake Disorders /
Milena Pavlova, MD, FAASM
AANnews • July 2017
nn Chronic Insomnia Disorder /
Alon Y. Avidan, MD, MPH, FAAN
Steven L. Lewis, MD, FAAN
HOUR 4 nn Sleep-wake Disorders of Childhood /
Suresh Kotagal, MD, FAAN
nn Shared Medical Decision-Making in Consideration
of Opioid Therapy in a Patient with Restless Legs Syndrome / Michael Rubin, MD, MA
nn Driving Safety and Fitness to Drive in Sleep Disorders /
Jon Tippin, MD, FAAN, FAASM
Continuum Audio is a biweekly audio CME program based on discussions with the authors of articles published in Continuum: Lifelong Learning in Neurology ®, the official CME journal of the AAN. Continuum Audio is available in multiple formats, including apps for iOS and Android devices. This program may be used to meet self-assessment and CME requirements for maintenance of certification as mandated by the American Board of Psychiatry and Neurology. To learn more and subscribe, visit Audio-digest.org/Continuum. •
Safdieh Succeeds Ringel as Neurology Today Editor-in-Chief Joseph E. Safdieh, MD, FAAN, begins his role as editor-in-chief of Neurology Today ® on July 1, 2017, after a transition period with outgoing Editor-in-Chief Steven P. Ringel, MD, FAAN. Safdieh will serve an initial five-year term, eligible for reappointment for up to five additional years. AAN President Ralph L. Sacco, MD, MS, FANA, FAAN, welcomed Joseph E. Safdieh, the new editor. “Dr. Safdieh is an MD, FAAN outstanding choice to lead one of our most successful publications and build upon the strong foundation of the past Neurology Today editors. His talents and experience with innovative ways to rapidly bring information to our members will advance Neurology Today to new levels of excellence.” “I am very enthusiastic to take on the role as editor-in-chief,” Safdieh said. “I know just how valuable Neurology Today is to AAN members, and I have heard from many members that this is their main source for learning what they need to know about recent clinical and scientific advances in the medical literature. It is my hope that Neurology Today remains a critically important, high-quality, and well-balanced resource for neurologists to stay abreast of important advances in the field.” Safdieh, an AAN member since 2003, is associate attending neurologist at New York Presbyterian Hospital-Weill Cornell Center and is vice chairman of neurology for education and Louis and Rachel Rudin Foundation Education Scholar at Weill Medical College of Cornell University. He earned his BS degree from New York University College of Arts and Science and MD from New York University School of Medicine. Since 2015, Safdieh has been associate editor of CME and self-assessment for the AAN’s Continuum: Lifelong Learning in Neurology ®. Also for the AAN, he has served as Fall Conference director for the Neurology Update program since 2013, and has chaired the Distance Learning Subcommittee, the Consortium of Neurology Clerkship Directors, and the Medical Student Self-Assessment Exam Work Group. He has been a member of the Academy’s Undergraduate Education Subcommittee, Education Committee, and has participated in topic planning and as course director for several AAN Annual Meetings. Among Safdieh’s many honors are two from the AAN: He received the 2015 Clerkship Director Teaching Award and was a 2006 Annual Meeting Resident Scholarship Recipient. As Ringel states in his valedictory editorial, “The primary mission of Neurology Today has always been to reduce information overload as we provide a balanced analysis of neurological research discoveries and practice innovations.”
The publication was the brainchild of Ringel, who also led the Academy as president from 1997 to 1999 and chaired the for-profit subsidiary AAN Enterprises, Inc. from 2002 to 2009. He served as the newspaper’s associate editor under founding Editor-in-Chief Lewis P. (Bud) Rowland and succeeded him in 2010. The publication has gone from four print issues in Steven P. Ringel, 2001 to 24 issues annually in print MD, FAAN and electronic formats. Over the years, Neurology Today has added podcasts, video interviews, and rapid electronic reporting from major meetings featured in the Conference Reporter. “In my tenure with Neurology Today, I have learned something new almost every day that improves the health and well-being of my patients with neurologic diseases.” “Steve Ringel brought keen intelligence, a superb background in medical science, and his own experience as a writer to the editorship of Neurology Today,” said Publications Committee Chair and Neurology Editor-inChief Robert A. Gross, MD, PhD, FAAN. “His ability to identify the newsworthy topics that would appeal to a broad array of readers interested in neurology, and his enviable skill at separating out the most salient, important findings, contributed to making Neurology Today the wonderful, relevant, and interesting newspaper it is. Finally, his ability to assemble a superb group of editors and staff is peerless: As we all know, producing a publication of consistently high quality takes a team approach and effort.” •
FIVE FAST FACTS About Neurology Today Circulation: 24,598 Social media followers: Twitter: 29,800 Facebook: 6,042 New feature: Neurology Today Conference Reporter launched in 2015 Distribution: Print edition: May 2001; online edition: 2004; iPad® app: April 2012; Android app: April 2016 Awards won since 2010: 15
AANnews • July 2017
Join New Consortium of Neurology Advanced Practice Providers and Synapse Community In March, the AAN Board of Directors approved the creation of a Consortium of Neurology Advanced Practice Providers (CNAPP). CNAPP members have the opportunity to meet once per year during the Annual Meeting, and have access to Synapse Online Communities for year-round engagement. The consortium’s purpose is to address the unique professional and educational needs of nurse practitioners, physician assistants, and clinical nurse specialists in neurology. CNAPP serves as a site for networking and collaboration between the AAN’s 600+ APPs and other allied health professionals. CNAPP is open to all members, so consider joining to: nn Network with APPs and other colleagues nn Share educational resources related to onboarding
nn Ask and answer questions related to APPs in practice nn Exchange insights on professional topics and issues nn Share expertise on patient care
nn Find answers to tough questions nn Share the realities—and offer solutions—to issues in
practice, patient care, academia, and other areas of the neurology profession
To join the Consortium of Neurology Advanced Practice Providers and participate in Synapse conversations, visit AAN.com/synapse. •
nn Discuss timely news and science affecting the field
Applications Now Open for New Practice Leadership Program Continued from cover
lineup of quality leadership programs, seeks to address the unique needs and challenges of practicing neurologists by helping them develop and hone the kind of leadership skills needed not only to succeed, but to flourish. Applications are now open at AAN.com/view/PracticeLeadership and the deadline to apply is July 31. Eligible applicants must be US neurologists employed in a solo or small group neurology specialty practice with no more than 10 members. The program will kick off in November of 2017 with a convenient format designed specifically with those in mind who may have concerns about coverage and time away from their practice. Selected participants will: nn Begin the program with a face-to-face meeting November 17
through 19, 2017, at the AAN headquarters in Minneapolis
nn Participate in monthly conference calls December through
March with AAN leader mentors
nn Receive an introduction to AAN structure and interact with
leadership at the April Annual Meeting in Los Angeles
nn Learn more about how to transition to leadership, manage
staff and employees, code/reimburse in solo or single specialty practices, run efficient offices hours, negotiate contracts, understand the changing regulatory burden to practices, and discover tactics to survive and thrive •
AANnews • July 2017
Solve the case of his lifetime Identifying the link can lead to a crucial diagnosis1-5 Hereditary ATTR amyloidosis is an inherited, rapidly progressive disease that causes sensory-motor polyneuropathy that may be accompanied by autonomic or cardiac symptoms, eventually robbing patients of function—and even their lives. With increased research and development in hATTR amyloidosis, now it is more critical than ever to be aware of red-flag symptom clusters and investigate potential cases.
See the connections at: InvestigateRedFlagSymptoms.com
Not an actual patient.
References: 1. Conceição I, González-Duarte A, Obici L, et al. “Red-flag” symptom clusters in transthyretin familial amyloid polyneuropathy. J Peripher Nerv Syst. 2016;21(1):5-9. 2. Hanna M. Novel drugs targeting transthyretin amyloidosis. Curr Heart Fail Rep. 2014;11(1):50-57. 3. Adams D, Coelho T, Obici L, et al. Rapid progression of familial amyloidotic polyneuropathy: a multinational natural history study. Neurology. 2015;85(8):675-682. 4. Damy T, Judge DP, Kristen AV, et al. Cardiac findings and events observed in an open-label clinical trial of tafamidis in patients with non-Val30Met and non-Val122lle hereditary transthyretin amyloidosis. J Cardiovasc Transl Res. 2015;8(2):117-127. 5. Mohty D, Damy T, Cosnay P, et al. Cardiac amyloidosis: updates in diagnosis and management. Arch Cardiovasc Dis. 2013;106(10):528-540.
© 2017 Alnylam Pharmaceuticals, Inc. All rights reserved. 05.2017
Member’s Passion, Participation Lead to Committee Assignment The ways for AAN members to get more involved with the Academy are innumerable, from presenting research at the Annual Meeting, teaching a course at a conference, reviewing journal articles, or serving on a guidelines panel. Even joining one of the AAN’s 37 sections can lead to unexpected and professionally fulfilling places. Take Partha Thirumala, MD, FAAN, who recently was appointed to the Government Relations Committee (GRC). His path began in 2008, when he became a member of the Clinical Neurophysiology Section, which provided an opportunity to network with colleagues. In 2010—and again in 2015—Thirumala went to Washington, DC, “to advocate and educate” members of Congress on key issues during the AAN’s Neurology on the Hill. Not surprisingly, he is a donor to BrainPAC, the AAN’s federal political action committee. “BrainPAC provides our advocacy team with access to the lawmakers in DC. I still remember the saying from my first NOH, ‘If you are not at the table, you are on the menu.’” Thirumala, who was involved in advocacy in his state of Pennsylvania, wanted to strengthen his abilities to stop legislation affecting his practice of neurology. “I was fighting a scope of practice bill in Pennsylvania,” he said, “which would let audiologists provide intraoperative neurophysiological monitoring and perioperative neurological evaluation without physician supervision.” He successfully applied for the Palatucci Advocacy Leadership Forum in 2013, and his passion for change and newly honed advocacy skills helped him successfully lobby for defeat of the legislation. He’s now sharing the knowledge of that experience with AAN colleagues in Illinois who are battling a similar bill. At the suggestion of AAN staff, Thirumala became involved with the nascent Pennsylvania Neurological Society, eventually becoming its president from 2013 to 2015. “It is important to get involved with your state neurosociety to educate, connect, and advocate.” And he broadened his participation with the AAN, joining the Sports Neurology Section in 2014. Also that year, Thirumala was nominated and accepted as a participant in the Emerging Leaders Forum, one of the Academy’s 11 customized leadership training programs. “This gave me the opportunity to sit with a group of highly motivated individuals with different viewpoints and come up with a consensus for our assignment. The experience also strengthened my skills in networking, leadership, and conflict management.” That’s where it was suggested to him that he consider applying for the Government Relations Committee, which recommends priorities for the Academy’s federal and state advocacy agendas and directs member efforts to influence health policy. “This is a role I am passionate about, and a group I can work with. The GRC seemed to be the obvious choice.”
AANnews • July 2017
Partha Thirumala, MD, FAAN
Nicholas E. Johnson, MD
Gregory D. Cascino, MD, FAAN
When considering applying for a committee or subcommittee assignment, both knowledge and experience can be essential qualifications. In the case of the GRC, “When looking at ideal candidates, we are looking for AAN members who have a clear passion for advocacy, and have been engaged in our efforts,” said Chair Nicholas E. Johnson, MD. “Ideally, committee members have a familiarity with health care policy issues. We are excited to have Dr. Thirumala on the GRC because of his outstanding track record working on issues of importance at the state level and his passion for advocacy.” Thirumala feels he can contribute to the GRC and future success of the AAN. “I am passionate about advocacy, and I feel it is critical to improve patient care, research funding, and the environment for practice. I also feel this will improve member satisfaction, engagement, and help reduce burn out. Federal advocacy works, we just have to persistently follow up.” In 2015, Thirumala successfully applied to become a Fellow of the AAN. “It recognizes members who have made a significant contribution, so I thought it will boost my confidence, and will provide a source of inspiration for others to follow the path.” “As Dr. Thirumala’s experiences show, the AAN provides a great number of opportunities to not only get involved, but to take on increasingly visible leadership roles,” said Gregory D. Cascino, MD, FAAN, chair of the Membership Engagement Committee. “The Academy relies on its multitalented, diverse membership to not only provide input, but to help successfully move our organization forward. This participation benefits both the AAN and the individual members who gain by giving of themselves.” Given Thirumala’s experience, it’s not surprising that he would recommend Neurology on the Hill and the Palatucci Forum to members who want to get more involved with the AAN. Considering that nine of the current members of the Board of Directors are graduates of the Palatucci Forum, that’s a good thing to have on your CV if your AAN involvement has high aspirations! But clearly, there are a multitude of opportunities the Academy offers to members to enhance their career professionalism and personal satisfaction. Visit AAN.com/membership to find the path that is right for you. •
Francis I. Kittredge, MD, FAAN
Commitment to Cures Event Raises Nearly $300,000 The American Brain Foundation’s Commitment to Cures event during the recent Annual Meeting in Boston made the Foundation’s 25th anniversary one to remember. More than 220 people gathered to honor the organization’s founders, celebrate its supporters, and share new initiatives to move the Foundation into the future. Through the generosity of sponsors, major donors, and attendees, the Foundation raised nearly $300,000 to support its mission of bringing researchers and donors together to defeat brain disease. Seven individuals donated $25,000 in honor of the Foundation’s anniversary, with many others recognizing the occasion with gifts of $2,500. Past AAN President Robert C. Griggs, MD, FAAN, paid special tribute to the late Lewis P. “Bud” Rowland, MD, FAAN, whose wife and daughter were in attendance. Griggs announced the
Foundation’s new leadership giving circle—the Rowland Circle—which was named in honor of Rowland’s longtime commitment to supporting and advancing the Foundation’s work, and those who continue Rowland’s impact. Any donor giving $2,500 or more in 2017 will be recognized as a Charter Member. Attendees honored former AAN president Francis I. Kittredge, MD, FAAN, who was the first chair of the Foundation 25 years ago and remains one of its most generous donors and strongest champions. The successful event also recognized nationally known celebrity chef, restaurateur, supermodel, and lifestyle maven B. Smith and her husband, Dan Gasby, who received the Public Leadership in Neurology Award for their efforts in raising awareness of Alzheimer’s and their help in partnering with the Foundation to make curing brain disease a public cause.
Outsmarting Brain Disease With Jenga GIANT, Annual Meeting attendees were inspired to outsmart brain disease at the American Brain Foundation booth. Brain diseases were inscribed on the Jenga pieces to figuratively illustrate the guiding philosophy of the Foundation to “Cure One, Cure Many,” a science-based outlook that gives hope that a cure for one brain disease could lead to cures for others. The Foundation also presented the world’s first neuroscience crowdfunding platform that allows investigators to seek research dollars and donors to fund specific projects that most interest and motivate them. Visit AmericanBrainFoundation.org for more information or to submit research to be funded. •
AANnews • July 2017
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. Ochsner Neuroscience Institute is actively recruiting two NEUROCRITICAL CARE SPECIALISTS to join our growing department and practice at Ochsner Medical Center in New Orleans, Louisiana Candidates must be BC/BE in Anesthesiology or Neurology with fellowship training in Neurocritical Care. Subspecialty interest in vascular neurology can be accommodated. Practice in a collegial, patient-focused, and academic environment in a state-ofthe-art unit with 30 neurological beds. Academic appointments are available at any of our affiliated institutions, including Tulane, LSU, and the University of Queensland. Both newly trained and experienced physicians are encouraged to apply. Ochsner Health System Neurocritical Care physicians are part of a comprehensive team of physicians trained in both anesthesiology and neurology, and work closely with the departments of anesthesiology, neurology, and neurosurgery. Ochsner’s TeleStroke Program has become one of the fastest growing networks in the country with 30 active spoke hospitals. Ochsner Health System is Louisiana’s largest non-profit, academic, healthcare system with 30 owned, managed and affiliated hospitals and more than 60 health centers. Ochsner employs 17,000 employees and over 1,000 physicians in over 9 0 medical specialties and subspecialties, and conducts more than 600 clinical research studies. Ochsner is the only Louisiana hospital recognized by U.S. News & World Report as a “Best Hospital” across three specialty categories caring for patients from all 50 states and more than 80 countries worldwide each year. For more information, please visit www.ochsner.org. Please email CV to profrecruiting@ ochsner.org or call (800) 422-2240 for more information. Reference # AAN-NCC. Sorry, no J1 visa opportunities. Wheaton Franciscan Healthcare, a part of Ascension Wisconsin has an exciting opportunity for a General Neurologist in Racine, Wisconsin Join a well-established practice in Racine, Wisconsin consisting of Four Neurologists and Three Advanced Practice Providers. Coverage will be for One Hospital with a 24/7 Hospitalist Team. Call: Weekday call, evenings only—primarily pager call; weekends 1:4. Approximately 10-15 patients per day. Multispecialty group with strong referral patterns. Highly competitive compensation package. Excellent benefits, including a great retirement plan. Facility: EEG-Routine inpatient/outpatient, continuous inpatient video EEG monitoring. EMG/Nerve Conduction. EP Polysomnography. Sleep Disorder studies with New 6 bed Sleep Lab. CT: 3 scanners including a 64 slice all helical capability. MRI: 2 Scanners including GE 450W wide bore in 2011. PET/CT. US: 6 Siemens S2000 with 3D/4D and MSK capability. Email: email@example.com Neuroscience Institute at Mercy Health Seeks Advanced Practice Providers Mercy Health northern Ohio (Toledo Ohio) market is a seven-hospital market and a preferred provider of healthcare services for a 20-county area in Northwest Ohio and Southeast Michigan. As a faith-based healthcare system, Mercy Health continues to honor its long-standing Mission to extend the healing ministry of Jesus by improving the health of our communities, with an emphasis on the underserved. Mercy demonstrates behaviors reflecting its core values of compassion, excellence, human dignity, justice, service, and sacredness of life. Mercy Health based in Cincinnati, the largest healthcare system in Ohio and ranked nationally in the top 20% of health systems for clinical quality and efficiency. As the only Joint Commission Designated Comprehensive Stroke Center within Mercy Health, St. Vincent Medical Center provides an excellent opportunity for an energetic Neuro Intensivist or potentially Neuro Critical Care Director to work with the Neuroscience Institute team led by Osama O. Zaidat, MD, MS. Our Services: Dedicated team of employed neurosurgeons with experience in the full aspects of neurosurgical care and procedures including clipping and hemi-craniotomy for large hemispheric strokes and intracranial bleeds. Dedicated Endovascular Neurosurgery service provided by two experienced full time interventional and stroke neurologists. Great support,
AANnews • July 2017
relationship and interaction with Pulmonary and surgical/ trauma critical care teams with moving toward 24/7 block models. Tele-NeuroICU robot in the neuro-critical care unit for 24/7 communication via your smart device. Dedicated Neocritical Care nurse practitioners. Academic pursuit with resident’s rotation from emergency medicine, preliminary medicine, family practice, internal medicine and surgical residents and fellows. 24 hrs EEG monitoring. Video EEG monitoring. 24/7 TCD transcranial ultrasound. Clinical research infra-structure support. Mercy Health is a recognized leader in providing quality, cost-effective healthcare and is a regional leader in collaboration with other community organizations to meet community needs. Mercy is a preferred provider in the majority of health insurance plans, we actively work to control healthcare costs through managed care contracts and insurance initiatives. We offer highly competitive compensation plus unparalleled benefits. A culturally prosperous city, Toledo is home to a nationally renowned art museum and zoo, the Toledo Symphony, as well as the newly renovated Valentine Theater. The community is home to the Toledo Mud Hens, the Triple A affiliate of the Detroit Tigers. The Mud Hens play in their downtown stadium, Fifth Third Field, which was named as one of the top minor league baseball stadiums in the country. Toledo also offers an ECHL hockey team, NCAA sports at the University of Toledo, and an annual LPGA golf tournament. Nature and outdoors lovers enjoy the close proximity to Lake Erie. Outstanding schools coupled with affordable housing give northwest Ohio families a great lifestyle. Toledo boasts of having 33 colleges and universities within a 60-mile radius, including a medical college within the metro area. Additionally, Ann Arbor, Chicago, Cleveland, Columbus and Detroit are all within a short driving distance. Inquiries, including curriculum vitae should be addressed to: Tom Leeds, Director Medical Staff Recruitment, Mercy Health Partners, 2200 Jefferson Avenue, Toledo, Ohio 43604, or via email: firstname.lastname@example.org Pediatric Neurologist Kids Neuro Care is seeking a full-time BC/BE Pediatric Neurologist to join an established Pediatric Neurology practice. We currently have two Pediatric Neurologists and one Physician Assistant. Our diagnostic capabilities include: EEG, Ambulatory EEG, Video EEG, and EMG. We are based in Orlando, Florida, where residents enjoy a high standard of living combined with a low cost of living. Limitless recreational opportunities and spectacular scenery is all accessible in a community with abundant affordable housing! While there is much to see and do in East Orlando, the city is ideally located for fast convenient getaways to Disney and Universal, Winter Park, and in close proximity to beautiful Cocoa Beach, Daytona Beach, and Wekiwa Springs. Kids Neuro Care has academic affiliation with the University of Central Florida Medical School, and has privileges with the local children’s hospitals. We offer a competitive salary and attractive benefits package. Salary will be negotiable commensurate with experience. The applicant should hold an M.D. degree, and have Board Certification in Neurology with Special Qualification in Child Neurology. Applicants must include: Current CV, list of publications, and a list of 3–4 references. Please email to Anarathinam@Yahoo.com or mail to: Eric Marcus, Kids Neuro Care, 10931 Dylan Loren Circle, Orlando, FL 32825. Please visit our website for more information at www.KidsNeuroCare.com General Outpatient Neurologist Practice Opportunity (Asheville, NC area) Join busy, established neurologist, and PA-C, in hospital-employed outpatient practice at Pardee Neurology Associates. Opportunity for team-oriented BC/ BE Neurologist. EEG/EMG, state-of-the-art 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. Employed position with competitive base salary with w/ RVU incentive plus annual bonus with attainment of quality measures. Comprehensive benefits package, matching
retirement plan, Paid Time Off, CME & Dues allowances, relocation and sign-on. Over 270 physicians on our medical staff offer an excellent referral network, established Hospitalist program for inpatient admissions, and large number of medical specialists on-site for consults at our 222-bed not-for-profit UNC Health Care affiliated hospital. Access to regional neurotrauma center via medical air or ground ambulance. Discover an exceptional quality of life and practice environment in beautiful Hendersonville, Western NC. Our growing area offers excellent practice growth potential as well as a safe and friendly community. No Visa sponsorship. No Recruitment or Placement Firm Inquiries. For consideration send CV to: Lilly Bonetti, Physician Recruiter, Pardee UNC Health Care, 800 N. Justice Street, Hendersonville, NC. (828) 694-7687; email@example.com; http:// w w w. pardeehospital.org Neurologist One Hour from Boston, MA—No State Income/Sales Tax Elliot Health System (EHS) is seeking an additional Neurologist or specialized Neurologist to join our collaborative and dynamic outpatient practice, Elliot Neurology Associates. The practice is located at our new state-of-the-art facility, the Elliot at the River’s Edge, just 3 miles from the main Hospital campus in Manchester, NH. Our Neurology team specializes in epilepsy/seizure disorders, stroke, chronic headaches/ migraines, multiple sclerosis, Parkinson’s and Alzheimer disease, as well as movement and neuromuscular disorders. Subspecialty interest are welcomed and supported. Some of the advantages at our outpatient practice include: On-site infusion center, Office MRI, 24/7 telestroke coverage, Neuro hospitalist coverage. EHS is the largest provider of comprehensive healthcare services in Southern New Hampshire. The cornerstone of EHS is Elliot Hospital, a 296-bed acute care facility, Level II Trauma Center, and one of the Top 100 Most Wired Hospitals in the country. Elliot’s commitment to Team STEPPS (a patient safety initiative to ensure the highest quality care for patients for the best possible patient outcome), along with its fully integrated EMR system (EPIC) make it a great place for physicians to Live Better – Work Better. The Manchester, New Hampshire, area is a thriving metropolitan community, located within an hour’s drive of Boston, Massachusetts, the seacoast, and White Mountains region of New England. It is also home to the Manchester-Boston Regional airport. We invite you to explore the rich heritage, breathtaking beauty and fourseason attractions of (tax free) New Hampshire. Come see why Money magazine annually ranks the area one of the nation’s “Best Places to Live.”To apply, email Fran Lannan at: Flannan@elliot-hs.org or online at ElliotPhysicians.org. You can interact with us socially at facebook.com/elliotphysicians or on Twitter @ElliotPhysician. We are an equal opportunity employer embracing the strength that diversity brings to the workplace. We provide a welcoming and supportive environment for employees of all ethnic backgrounds, cultures, ages, lifestyles and physical abilities. 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 September 2017 print edition of A AANnews must be submitted by August 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.
Dates and Deadlines
SAVE THE DATES! JULY 14–16, 2017 • SPORT CONCUSSION CONFERENCE
OCTOBER 20–22, 2017 • FALL CONFERENCE
JULY 2017 WED
AUGUST 2017 WED
Application Deadline: Emerging Leaders AAN.com/view/ELP
Webinar: A Guide to Teleneurology: Use It in Your Practice (Register by July 31) AAN.com/view/pmw17
Early Registration Deadline: Fall Conference AAN.com/view/Fall
JULY 14–16 Sports Concussion Conference Jacksonville, FL AAN.com/view/ConcussionConference
JULY 17 Application Deadline: UCNS Neurocritical Care Certification MEM: 17 FAAN Recruitment Campaign Ad 7—Half Page Horizontal> AANnews and Recertification PlacedUCNS.org/go/subspecialty/neurocritical/ in AANnews 8.25 x 5.25 +0.125 bleed, 4C certification
SEPTEMBER 12 Webinar: Open Your Heart, Open Your Notes: A Guide to Patient Engagement (Register by September 11) AAN.com/view/pmw17
JULY 31 Application Deadline: Practice Leadership Program AAN.com/view/PracticeLeadership
Set Yourself Apart Get the recognition you deserve. Add the esteemed Fellow of the AAN (FAAN) designation to your already impressive credentials.
Learn how at AAN.com/view/FAAN.
AANnews • July 2017
A deeper look at the science behind migraine
Beyond the actual pain of migraine is the everyday impact on patientsâ€™ lives. Today, a growing understanding of the CGRP neuropeptide brings new insights to the science behind the migraine experience. CGRP = calcitonin gene-related peptide.
Le a rn m o re a t
scienceofm ig ra i ne.co m ÂŠ 2017 Amgen Inc. All rights reserved. USA-334-049371
Published on Jun 21, 2017