VOLUME 31 · ISSUE 10 · OCTOBER 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
Esteemed Lecturers Named for 2018 Presidential Plenary Sessions An impressive lineup of speakers has been confirmed for the 2018 Presidential Plenary Session at the 70 th Annual Meeting in Los Angeles, April 21 through 27. This premier session will be open to all registered attendees and take place on Sunday, April 22, from 9:15 a.m. to 12:00 p.m. Science Committee Chair Natalia S. Rost, MD, MPH, FAAN, FAHA, will moderate.
Presidential Plenary Session
Sunday, April 22 • 9:15 a.m. to 12:00 p.m. Presidential Lecture Francis S. Collins, MD, PhD National Institutes of Health, Bethesda, MD
Francis S. Collins, MD, PhD
Richard S. Finkel, MD
Tallie Z. Baram, MD, PhD
Lisa M. DeAngelis, MD, FAAN
George C. Cotzias Lecture Tallie Z. Baram, MD, PhD University of California-Irvine, Irvine, CA How Early-life Experiences Sculpt Your Brain: From Molecules to Circuits Sidney Carter Award in Child Neurology Richard S. Finkel, MD Nemours Children’s Hospital, Orlando, FL Spinal Muscular Atrophy Is a Treatable Neurodegenerative Disease Robert Wartenberg Lecture Lisa M. DeAngelis, MD, FAAN Memorial Sloan Kettering Cancer Center, New York, NY •
New Career Essentials Stand up for Neurology! Conference Helps Lay Apply for the 2018 Foundation for Success Neurology on the Hill A new AAN conference, Career Essentials: Foundation for Your Future, is set to take place January 13 and 15, 2018, at the Caribe Royale Orlando in Florida. It is offered concurrently with the popular Breakthroughs in Neurology Conference. Designed specifically for neurologists in private practice and academia who are no more than five years post-residency,
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Health care reform continues to influence our work as neurologists and the lives of our patients. Join your AAN colleagues at Neurology on the Hill from February 26 to 27, 2018, and help educate members of Congress so we can address critical health policy problems together. If selected, you will receive training to bring you up-to-date on key issues. Then, we will go to Capitol Hill for face-to-face meetings with congressional members and their staffs.
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THIS ISSUE 8 10 18 19
Submit Your Best Science by October 23 Deadline Apply by October 25 for Prestigious 2018 AAN Scientific Awards Learn How to Make Technology Work for You Use the Axon Registry to Prepare for MIPS in 2018
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
Ad Page 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
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:
Table of Contents
COVER Esteemed Lecturers Named for 2018 Presidential Plenary Sessions New Career Essentials Conference Helps Lay Foundation for Success Stand up for Neurology! Apply for the 2018 Neurology on the Hill
4 Growing Our Workforce to
Meet the Rising Demands for Neurological Care
5 AAN Gifts $50K for Members’
Hurricane Relief, Will You Join Us?
MEET YOUR LEADER
6 Jonathan P. Hosey, MD, FAAN
8 Submit Your Best Science by October 23 Deadline
RESEARCH & AWARDS
10 Apply by October 25 for Prestigious 2018 AAN Scientific Awards
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.
10 New Mridha Spirit of Neurology
Award Recognizes Compassion, Leadership
18 Learn How to Make Technology Work for You
18 Documenting Your Improvement Activities for MIPS
19 Use the Axon Registry to Prepare for MIPS in 2018
19 For Your Practice and Patients:
New Issues of Neurology Now and Neurology: Clinical Practice
20 Use New Quality Measurement Set for Essential Tremor
20 Apply for UCNS Accreditation by December 1
20 Update: ABPN Announces
Changes to Its MOC Program
22 Continuum and Continuum Audio Now Bundled Together for More Learning Options
23 Experience Personal and
Professional Growth at Palatucci Advocacy Leadership Forum
24 Capitol Hill Report
25 Distinguish Yourself with Premier FAAN Designation
25 Participate in Neurology Career Week, October 16 to 22
AMERICAN BRAIN FOUNDATION
27 As Foundation Evolves, Member
Support Remains Critical to Attract Public Dollars
CAREERS | 28 DATES AND DEADLINES | 29
NEWS BRIEFS The AAN submitted comments to the House Ways & Means Committee in response to a request entitled the “Medicare Red Tape Relief Project.” The AAN’s comments focused on prior authorization, documentation, EHR mandates, and several other issues that impact physicians. The FAST Act for telestroke continues to gain momentum. House Energy & Commerce (E&C) Committee staff have indicated that the bill, H.R. 1148, was “marked up” by the E&C Health Subcommittee in early September. This means it will be eligible for consideration by the full committee and then for passage by the full House. The language likely will be identical to language already passed by the Senate Finance Committee. •
AANnews • October 2017
Growing Our Workforce to Meet the Rising Demands for Neurological Care One in six people have some neurological condition, and as our population ages the number of people who need neurological care is rising. There are too few neurologists to meet these growing demands. For a number of years, and through several AAN presidencies, the Academy has been confronting the growing deficit of neurologists in the workforce with direct action. The AAN’s Workforce Task Force found that the United States is currently experiencing an 11-percent shortfall in the number of neurologists needed for patient care that will grow to 19 percent by 2025. We need to act quickly to fill this gap and ensure that our populations have access to high-quality patient-centered neurological care. I would like to take a moment to update you on two major initiatives to help strengthen and grow our profession. We need to more effectively engage advanced practice providers (APPs) as essential members of our neurology workforce and fully embrace the concept of the interdisciplinary patient care team. Whether in academic departments, subspecialty clinics, or in community practice, APPs are greatly helping to provide neurological care. The growing employment of APPs collaborating with neurologists and helping to alleviate workload prompted the AAN to establish two APP membership categories. In just four years, I’m happy to report that we have crossed the 1,000-member threshold and APPs are the fastest growing segment of our organization. A high priority for the Academy is to do everything we can to increase APP participation both within the organization and in the field of neurology generally. Collaborating across its committees and work groups, the AAN is committed to addressing the unique professional and educational needs of APPs in neurology to ensure high-quality patient care; member career satisfaction; and efficient, costeffective practices. The AAN is working to meet four goals: nn Increase APP membership and engagement of APPs in the AAN nn Ensure standardized, quality clinical education for APPs nn Ensure standardized, quality online practice education for APPs nn Improve neurology environment to one that is receptive to APPs in practice The Academy recently created the Consortium of Neurology APPs (CNAPP) to provide a highly visible home for APPs within our organization. AAN leadership has made it a priority to appoint a number of APPs on our major committees, such as the Member Engagement Committee, the Practice Committee, and the newly created Drug Pricing Task Force. We are pleased with the high engagement of APPs at our conferences, inperson meetings, and through our Synapse online communities.
And every day, we are focused on making sure they’re valued, and that our programs, products, and services keep the APP in mind. Our strategic plan addresses the AAN vision, “to be indispensable to our members,” both for physician members and new APP members. APPs are essential members of our workforce who will enable us to fully address the AAN mission, “to promote the highest quality patient-centered neurologic Ralph L. Sacco, MD, MS, care and enhance member career FAHA, FAAN satisfaction.” Neurologist-led interdisciplinary teams will allow all health care professionals to practice together and more efficiently serve the growing number of neurology patients. While APPs can help alleviate the “here and now” pressures on our neurology workforce, the second major initiative for our Academy is to enhance the pipeline of medical students choosing careers in neurology. We need to grow the number of future neurologists to reduce that projected 19-percent shortage we face. For too long, the proportion of US medical school graduates has remained stable at 2.5 percent annually choosing to enter a neurology residency. With a goal of increasing this number, we received a grant from the Conrad N. Hilton Foundation and created a special work group under our Education Committee. Our Medical Student Pipeline/Hilton Grant Work Group is diligently working to explore, develop, and enhance opportunities to engage medical students and increase their interest in choosing a career in neurology. Like everything we do as an organization, we are generating data to provide evidence-informed approaches to address this issue. To better understand the challenges we face engaging students to go into neurology, the Exploration Sub Group has focused on analyzing survey and interview data. The Implementation Sub Group is focused on identifying and implementing activities and programs to raise awareness about neurology at the medical school level and attract high-quality medical students into neurology. At the 2017 Annual Meeting, we held focus groups of Year 1 and Year 2 medical students, a group of Year 4 medical students planning to enter neurology, a group of Year 4 medical students not entering neurology, and a group of adult and child neurology trainees. In addition, AAN staff has been conducting phone interviews with medical students at institutions from a variety of locations and with varying demographics. There are three interview subjects at each institution: a student who chose neurology, a student
who considered neurology but chose another specialty, and a student who never considered neurology. All of this data will be incredibly helpful as we design better ways to excite medical students about our field and grow the neurology professional pipeline. Remember that the Academy is home for our neurology clerkship directors and the Student Interest Group in Neurology (SIGN) that are a medical student’s “first contact” with neurology. We plan to capitalize on that moment and provide our ambassadors with enhanced tools to bend the curve and increase the proportion of students choosing careers in neurology. Furthermore, at the 2017 Annual Meeting: nn Eight talks in the Navigating Your Career Area were about
SIGN or geared toward medical students.
nn Of the 92 talks in the Navigating Your Career Area, 66
contained content applicable to medical student attendees.
nn There were 65 one-on-one mentoring sessions with
medical students, with neurology faculty and practitioner volunteers serving as mentors.
nn Four neurologist-led poster hall tours were offered
nn The meetings of our Consortium of Program Directors
and Consortium of Neurology Clerkship Directors hosted presentations about the medical student pipeline work. The consortiums were asked for feedback as well as interest in piloting our new, reformed SIGN program at institutions.
Growing our neurology workforce of APPs and neurologists is of paramount importance to AAN leadership and remains a top strategic priority. I am confident that our strategy and these, and other, tactics will be successful. Our “Neuroscience Is...TM” campaigns and even our yearly Brain Health Fair held in our Annual Meeting host cities have the potential to inspire young minds to join us in our work to prevent, treat and cure neurological diseases. You can help, too. Think back to what sparked your interest in neurology, and if you have the opportunity, share that spark with a child or a fresh-faced med student. You may help launch the career of a practitioner who brings tremendous skill and compassion to his or her patients, or a researcher who makes a great discovery or cure. Let’s all be part of the solution to growing the workforce to meet the rising demands for neurology care. •
to medical students on three days, and 22 students participated.
nn A digital scavenger hunt was piloted to help improve
medical student engagement. Held Saturday to Wednesday, the hunt drew medical students to different areas and talks at the meeting, with up to three winners each day.
Ralph L. Sacco, MD, MS, FAHA, FAAN President, AAN email@example.com @DrSaccoNeuro on Twitter
AAN Gifts $50K for Members’ Hurricane Relief, Will You Join Us? The recent hurricanes that have devastated the south and southeastern regions of the United States have severely affected AAN member neurologists and their patients, and they need your help! Please join us in making a generous gift to the recovery efforts of affected AAN members through the AAN Hurricane Relief Fund for Affected Neurology Practices at AAN.com/view/HurricaneRelief. The AAN has given a $50,000 gift to this fund, as well as a donation to the American Red Cross. The YouCaring website is a safe and secure site, and your non-tax deductible gift will help our members get back on their feet again and provide the quality care their patients rely on. AAN member neurology practices affected by the recent hurricanes are encouraged to contact the AAN for assistance at firstname.lastname@example.org. Thank you for your generosity and compassion during this very difficult time. • AAN member Amrou Sarraj, MD, wades through Houston’s murky floodwaters following Hurricane Harvey.
AANnews • October 2017
Meet Your Leader
Jonathan P. Hosey, MD, FAAN Jonathan P. Hosey, MD, FAAN, of the AAN and AAN Institute Board of Directors, is currently the chairman of neuroscience for the St. Luke’s University Health Network in Bethlehem, PA, which is composed of seven hospitals in two states. He has been involved with the development of neurology residency programs at the Madigan Army Medical Center in Tacoma in 1990, and as the founding director of the Geisinger Health System program in 2010. He is a professor of neurology at the Lewis Katz School of Medicine at Temple University. Hosey has served on numerous American Academy of Neurology subcommittees and committees, including the Practice Committee, the Medical Economics and Management Subcommittee, Patient Safety Subcommittee, the American Brain Foundation Development Committee, and the Guidelines and Publication/Dissemination Task Force. He is currently on the Meeting Management Committee and Neurology Drug Pricing Task Force. Hosey also is active in his community, having served as a past president of the American Heart Association/American Stroke Association (AHA/ASA) of Pennsylvania/Delaware chapter. How did you first get involved as a volunteer on committees/ subcommittees and what moved you to participate? My first experience with the AAN came from an invitation from the late Dr. Elliott Mancall, who was the motivation for me to enter neurology. He initially asked me to review several Continuum chapters, which led to an appointment to the Continuum editorial board. Dr. Mancall was a career-long mentor and sponsor. His love of neurology made an indelible mark on me. He was a lifelong advocate of neurologic practice and education. I applied for, and was accepted into the first class of the Palatucci Advocacy Leadership Forum in 2003. The passion and commitment of my classmates also contributed to my commitment to the mission of the AAN. Why did you wish to be on the Board of Directors? The AAN and its leaders have greatly invested in my career, allowing me the privilege of serving on numerous committees and work groups. Meeting innumerable members and hearing their stories motivated me to represent them on our board. AAN members are a diverse, exceptionally talented, and passionate group of physicians whose relatively small numbers impact a large proportion of our patients in America. The honor to be a board member is a way to pay back the members and volunteers that I have been fortunate to work with since becoming a member in 1984.
AANnews • October 2017
What experiences and viewpoints do you bring to this role? As a prior chair of the Practice Committee and member of the Education Committee, it is critical that we continue to “secure our legacy” of providing information of the highest quality and value for our members. From impactful guidelines to practiceenhancing tools, the AAN needs to be ahead of the curve for trustworthy, reliable information to enhance their practices. Critical to this is the absolutely vital recruitment and preparation of neurology residents and early career providers, including advanced practitioners, ensuring the future health of our specialty. In addition, there is no greater urgency than to act as role models for students who hopefully will pursue a career in neurology. From your experiences as an AAN leader, what is one of the more common misperceptions members may have about the Academy? The AAN of 2017 is unrecognizable from the society that I joined in 1984. We are now representative of the majority of neurologists, not just in North America, but worldwide. However, some members may perceive that our current organization has not evolved from our more traditional roots. Very purposefully, the AAN has conceptualized and developed leadership programs to bring great talent from all constituencies in the AAN. We now are seeing these young and mid-career members leading committees and programs, including
having a substantial presence on our board. These programs have been the most transformational area of the AAN in the past 20 years. I hope our members appreciate the dynamic nature of our current society. In your view, how does the AAN benefit the field of neurology most? Over 80 percent of our current residents enter a neurologic subspecialty and we continue to see our members practice from single and small groups to large integrated health systems and academic centers. The AAN has followed this trend and has adjusted to being a fully inclusive organization. The AAN serves to be the “glue” to enable and represent all neurologists to practice in ways that serve their patients and community. In addition, strength comes in numbers, and the AAN is uniquely equipped to advocate for our members at all points of influence in our increasing complex health care system. How should members evaluate the success of the AAN and the Board of Directors in supporting their careers and in neurology in general? I would call on all our members, if their situation permits, to become involved by attending our meetings, volunteering, and being “present” to make their opinions known. This is a critical measure of our success and to secure the future of our profession. I feel we can best judge our success by the level of engagement in our membership. •
New Career Essentials Conference Helps Lay Foundation for Success Continued from cover
the family-friendly Career Essentials Conference will offer an excellent opportunity for early career neurologists to learn things they weren’t taught in residency that can help lay the foundation for a successful career, as well as earn up to 8.5 valuable CME credits. The conference’s concurrence with Breakthroughs in Neurology also makes it easy for attendees to participate in both, if they wish.
nn Financial Planning: Learn about
“The new Career Essentials Conference will provide tangible, practical information for neurologists in the early stages of their career—all the things they didn’t teach in medical school and residency!” said Conference Director Carlayne E. Jackson, MD, FAAN. She chaired the physician work group that created the course topics after carefully considering the information they felt would have most benefited them early in their own careers. The work group also used evaluation data and needs assessment info collected from other programs. “The course material is applicable to both private practitioners and academicians. The conference will create fun opportunities for families to spend quality time together as well as to network with other neurologists facing similar challenges.”
Experience 30-minute activities to reinforce the importance of maintaining health, self-care, and stress management—for you and your patients.
Why should you attend? nn Family Friendly: With programming running only
half-days, there will be plenty of time to enjoy the thrill of Orlando with the family! In addition, everyone is invited to a special kick-off reception on Saturday, January 13, with food, beverages, and a variety of games and activities for all ages.
nn Business Basics: Get the foundation you need to
succeed, from effective negotiation tactics to application of sound business strategies, and tools to maintain and grow income in current and future financial models.
nn Effective Communication: Discover techniques to
improve daily—and difficult—patient encounters, and hone effective communication skills with colleagues, employees, supervisors, and practice administrators.
nn Teleneurology: Find what you need to know about
this in-demand and growing practice that improves access to neurology.
everything from student loan management and repayment strategies to maximizing employer-sponsored benefits, to long-term financial planning decision-making.
nn Wellness Presentations:
nn CME: Earn up to 8.5 CME.
Carlayne E. Jackson, MD, FAAN
nn Expert Faculty: Get ready access to top experts.
The early registration deadline is January 3, 2018, and the housing deadline is December 8, 2017. Visit AAN.com/view/careeressentials to learn more and to reserve your spot today. •
Get a Year in Review of the Best in Neurology at January Breakthroughs Conference Experience top neurology programming led by more than 14 experts in the field, earn up to 25.25 CME (11.25 of which qualify for self-assessment CME), and receive ample opportunities to interact with faculty and colleagues the weekend of January 12 through 15 at the beautiful Caribe Royale Orlando in Florida. From the latest practice management advice to help preparing for ABPN board recertification—and the latest science and education from top experts—Breakthroughs in Neurology has you covered. Early registration ends January 3, 2018, and the housing deadline is December 8, 2017. Learn more at AAN.com/view/breakthroughs. •
nn MACRA/MIPS: Gain an understanding of the Medicare
Access and CHIP Reauthorization Act (MACRA), its impact on care, costs, and increased administrative burden, and how to implement it into your practice.
January 12–15, 2018 • Orlando, FL
AANnews • October 2017
Submit Your Best Science by October 23 Deadline The deadline is fast approaching to submit abstracts for the 2018 AAN Annual Meeting. Abstracts are accepted in all areas of neurology and neuroscience and submissions are due by 11:59 p.m. CT on October 23.
General Topics Abstracts are sought for the following general topics: nn Aging and Dementia nn Autonomic Disorders nn Behavioral and Cognitive Neurology nn Cerebrovascular Disease and Interventional Neurology nn Child Neurology and Developmental Neurology nn Epilepsy/Clinical Neurophysiology (EEG) nn General Neurology nn Global Health nn Headache nn Infectious Disease nn History of Neurology nn Movement Disorders nn MS and CNS Inflammatory Disease nn Neurocritical Care nn Neuroepidemiology nn Neuro Trauma and Sports Neurology nn Neuromuscular and Clinical Neurophysiology (EMG)
nn Neuro-oncology nn Neuro-ophthalmology/
nn Neuro-rehabilitation nn Pain and Palliative Care nn Practice, Policy, and Ethics nn Research Methodology and
Neuroscience in the Clinic Sessions Abstracts are specifically sought for the Neuroscience in the Clinic sessions, which will feature a mix of scientists and clinicians actively engaged in lively case discussions to integrate scientific research with clinical application. A moderator will introduce and provide background on a case and an invited speaker will frame the case in scientific and clinical context. Thematic abstract presentations will provide additional framework. Each session will conclude with panel discussion. Topics sought include: nn Antisense Oligonucleotide (ASO)
Therapy nn Opioid Abuse nn Challenges in Genetic Diagnoses in Neurology
nn Treatment of Progressive
nn REM Sleep Behavior Disorder nn Immunotherapy nn Autism and Neurodevelopmental
To submit your abstract(s), complete the online form at AAN.com/view/18Abstracts. For more information, contact email@example.com or (800) 879-1960 or (612) 928-6088.
5 Steps to Abstract Acceptance 1. Beat the Deadline: The deadline for abstract submission is 11:59 p.m. CT, October 23, 2017. Be sure to allow plenty of time for writing, proofing by other authors, revision, and submission logistics. 2. Submit Your Best Science, Regardless if Presented Elsewhere First: The Annual Meeting brings together top scientists and neurologists from around the world across a wide range of subspecialties to network and discuss advances in the field. While original research is emphasized, submission of previously presented work is encouraged if it is of interest to the field of neurology. 3. Submit Online: All abstracts should be submitted online. The body of the abstract must be 300 words or less. A maximum of two abstracts per first author may be submitted (excluding practice, policy, and ethics; research methodology and education; and history of neurology topics). 4. Plan to Show up: All accepted abstracts must be presented by either the first author or co-author at the Annual Meeting. 5. Deliver the Data: With few exceptions, authors should be prepared to have results available at the time of presentation. • Note: Successful submission of your abstract is not a guarantee of acceptance.
AANnews • October 2017
Annual Meeting Registration Opening Next Month Keep your eye open for when registration goes live next month for the exciting 2018 Annual Meeting, set to take place in the equally exciting film and entertainment capital of Los Angeles. Whether you’re a student, resident, clinician, or researcher—and no matter what your subspecialty area of interest—the 2018 Annual Meeting will shine the spotlight on the latest science, education, and the things you need to make your career shine by offering choices you won’t find at any other neurology meeting in the world, and the flexibility to make the experience all your own. Get ready to experience: nn Value: Our single registration rate eliminates pre-
registration for individual courses and gives you the flexibility to explore courses, talks, sessions, and more to maximize your meeting experience.
nn Choice: You can choose from 200+ expert-led
education courses for the latest updates in your subspecialty field and other topics of interest such as practice management, advocacy, the growing field of telemedicine, and much more.
nn Customization: We like to think of it as learning
without boundaries. Create your own fluid, customized schedule with options both inside and outside the classroom, in your specific subspecialty area of interest, and for your specific career—and MEM: 17 FAAN Recruitment Campaign Ad—Half Page Horizontal> AN personal—needs. Placed in AANnews 8.25 x 5.25 +0.125 bleed, 4C
Set Yourself Apart Get the recognition you deserve. Add the Fellow of the AAN (FAAN) designation to your already impressive credentials. Learn how at AAN.com/view/FAAN.
nn Innovation: We’re serving up exciting new ways
to learn and engage at our dynamic, interactive Experiential Learning Areas that expand education outside the traditional classroom and offer enriching and thought-provoking topics.
nn Los Angeles: 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 excitement of Hollywood. •
Research & Awards
Apply by October 25 for Prestigious 2018 AAN Scientific Awards Since 1955, AAN scientific awards have recognized those who shine the light on new breakthroughs in the understanding, treatment, and potential future cures of neurologic disorders—paving the way for a world free of brain disease. AAN awards honor the best research and achievements by neurologists and neuroscientists around the globe, at all stages of their career.
Apply or nominate a colleague today: AAN.com/view/18Awards. 2018 Scientific Awards; Application Deadline October 25
Senior Investigator nn Potamkin Prize for Research
nn nn nn nn nn nn nn nn nn
in Pick’s, Alzheimer’s, and Related Diseases Neuroendocrine Research Award John Dystel Prize for Multiple Sclerosis Research Sleep Science Award Sheila Essey Award: An Award for ALS Research Mitchell B. Max Award for Neuropathic Pain Movement Disorders Research Award Lawrence C. McHenry: An Award for the History of Neurology The Irwin Schatz Award for Autonomic Disorders Neuro-oncology Scientific Award
Young Investigator nn Bruce S. Schoenberg International Award in Neuroepidemiology nn Dreifuss-Penry Epilepsy Award nn Jon Stolk Award in Movement Disorders for Young Investigators nn The Irwin Schatz Award for Autonomic Disorders nn Michael S. Pessin Stroke Leadership Prize nn Wayne A. Hening Sleep Medicine Investigator Award nn Harold Wolff-John Graham Award: An Award for Headache/Facial Pain Research nn Neuro-oncology Investigator Award nn Neuro-oncology Scientific Award nn Norman Geschwind Prize in Behavioral Neurology
Resident nn Alliance Awards: Founders nn Alliance Awards: S. Weir Mitchell Medical Student nn Medical Student Essay Award— Extended Neuroscience Award nn Medical Student Essay Award— G. Milton Shy Award nn Medical Student Essay Award— Roland P. Mackay Award nn Medical Student Essay Award— Saul R. Korey Award High School Student; Application Deadline October 9 nn Neuroscience Research Prize •
New Mridha Spirit of Neurology Award Recognizes Compassion, Leadership A new award, sponsored by the American Brain Foundation and endowed by gifts from AAN member Debasish Mridha, MD, and his wife, Chinu, has been established in honor of the Mridhas’ dedication to improving the lives of others. The Dr. Debasish and Chinu Mridha Spirit of Neurology Humanitarian Award will be presented for the first Debasish Mridha, MD time during the 2018 AAN Annual Meeting in Los Angeles, and recognize the work of a neurologist or neuroscientist who has demonstrated altruism, compassion, integrity, and leadership while providing quality neurologic care to a destitute, distressed, or marginalized population or in impoverished communities of the world. In addition to recognition during the Annual Meeting, the recipient will receive a $1,000 honorarium.
AANnews • October 2017
The award is open to all current AAN members in practice, academics, or who are retired. Members may apply themselves, nominate another current member, or be nominated by a current member. The deadline to apply is October 25, 2017. For application and nomination instructions and to apply, visit AAN.com/view/MridhaAward. •
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PROGRESSION NOW DMT=disease-modifying therapy; EDSS=Expanded Disability Status Scale; MS=multiple sclerosis.
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. 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.
QUIETING MS Quietly for your patients with relapsing MS
Start or switch to AUBAGIO (teriflunomide) 14 mg—the only oral DMT with a proven impact on disability progression in 2 Phase III trials ®
The majority of patients remained free from disability progression* with AUBAGIO 14 mg1
80 84 AN ESTIMATED
OVER 108 WEEKS (P =0.03)1†
OVER 108 WEEKS (P <0.05)1†
*Disability progression was a secondary endpoint in TEMSO and TOWER.4,5 † 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.4 TOWER: A double-blind, placebo-controlled trial in patients with relapsing forms of MS (N=1169). Patients were randomized to receive AUBAGIO 14 mg (n=372), AUBAGIO 7 mg (n=408), or placebo (n=389) once daily with results for up to 40 months of treatment.5
• 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
WARNINGS AND PRECAUTIONS • Hepatotoxicity: Patients with pre-existing acute or chronic liver disease, or those with serum ALT >2 times the upper limit of normal (ULN) before initiating treatment, should not normally be treated with AUBAGIO. In clinical trials, if ALT elevation was >3 times the ULN on 2 consecutive tests, patients discontinued AUBAGIO and underwent accelerated elimination. Consider additional monitoring if co-administering AUBAGIO with other potentially hepatotoxic drugs; monitor patients who develop symptoms suggestive of hepatic dysfunction (eg, unexplained nausea, vomiting, abdominal pain, fatigue, anorexia, or jaundice and/or dark urine). • Teratogenicity: AUBAGIO may cause fetal harm when administered in pregnant women. Teratogenicity and embryo-fetal lethality occurred in animal reproduction studies in multiple animal species at plasma teriflunomide exposures similar to or lower than that in humans at the maximum human recommended dose of 14 mg/day. AUBAGIO is contraindicated for use in pregnant women and females of reproductive potential not using effective contraception. Women who become pregnant while taking AUBAGIO may enroll in the AUBAGIO pregnancy registry by calling 1-800-745-4447, option 2. • Procedure for Accelerated Elimination of Teriflunomide: Teriflunomide is eliminated slowly from the plasma—it takes an average of 8 months, or up to 2 years, to reach plasma concentrations <0.02 mcg/mL. Elimination may be accelerated by administration of cholestyramine or activated charcoal, but this may cause disease activity to return in patients who were responding to AUBAGIO. • Bone Marrow Effects/Immunosuppression Potential/Infections: Decreases in white blood cell counts, mainly of neutrophils and lymphocytes, and platelets have been reported with AUBAGIO. Thrombocytopenia, including rare cases with platelet counts less than 50,000/mm3, has been reported in the postmarketing setting. Obtain a complete blood cell count within 6 months before starting treatment, with further monitoring based on signs and symptoms of bone marrow suppression. AUBAGIO is not recommended for patients with severe immunodeficiency, bone marrow disease, or severe uncontrolled infections. Tuberculosis (TB) has been observed in clinical studies of AUBAGIO. Before starting treatment, screen patients for latent TB infection with a tuberculin test. Treatment in patients with acute or chronic infections should not be started until the infection(s) is resolved. Administration of live vaccines is not recommended. The risk of malignancy, particularly lymphoproliferative disorders, or infection may be increased with the use of some medications with immunosuppressive potential, including teriflunomide.
(continued on back)
Please see additional Important Safety Information and Brief Summary of Full Prescribing Information, including boxed WARNING, on the following pages. ‡
AUBAGIO is effective across key measures of disease activity: sustained disability progression (14 mg only), annualized relapse rate, and MRI activity. Overall discontinuation rates due to adverse events were 12.5% with AUBAGIO 14 mg, 11.2% with AUBAGIO 7 mg, and 7.5% with placebo, and treatment discontinuation rates due to common adverse events were ≤3.3% in the pooled clinical trials.1,6
Proven impact in newly diagnosed RMS patients1 In patients who had a first clinical event characteristic of RMS, AUBAGIO® (teriflunomide) provided freedom from relapses1
VS 62% WITH PLACEBO (P <0.05)1
• 71% of patients remained relapse free with AUBAGIO 7 mg in the TOPIC trial1 • TOPIC is the only trial of an oral RMS therapy that studied patients who had a first clinical event consistent with acute demyelination occurring within 90 days of randomization1-3 TOPIC: A double-blind, placebo-controlled trial in patients with relapsing forms of MS (N=618). Patients were randomized to receive AUBAGIO 14 mg (n=216), AUBAGIO 7 mg (n=205), or placebo (n=197) once daily for 108 weeks. Patients had a first clinical event consistent with acute demyelination occurring within 90 days of randomization with 2 or more T2 lesions at least 3 mm in diameter characteristic of RMS.7
MAKE AUBAGIO YOUR FIRST CHOICE FOR NEWLY DIAGNOSED RMS PATIENTS IMPORTANT SAFETY INFORMATION (continued) • Hypersensitivity and Serious Skin Reactions: AUBAGIO can cause anaphylaxis and severe allergic reactions. Signs and symptoms have included dyspnea, urticaria, and angioedema including lips, eyes, throat, and tongue. Cases of serious skin reactions, including Stevens-Johnson syndrome and a fatal case of toxic epidermal necrolysis, have been reported with AUBAGIO. Very rare cases of Drug Reaction with Eosinophilia and Systemic Symptoms have also been reported with leflunomide. If a severe skin reaction develops with AUBAGIO, stop treatment and begin accelerated elimination. In such cases, patients should not be re-exposed to teriflunomide. • Peripheral Neuropathy: Peripheral neuropathy, including polyneuropathy and mononeuropathy, has been reported with AUBAGIO. Age >60 years, concomitant neurotoxic medications, and diabetes may increase the risk. If peripheral neuropathy is suspected, consider discontinuing treatment and performing accelerated elimination. • Increased Blood Pressure: Blood pressure increases and hypertension have occurred with AUBAGIO. Measure blood pressure at treatment initiation and manage any elevations during treatment. • Respiratory Effects: Interstitial lung disease (ILD), including acute interstitial pneumonitis, has been reported with AUBAGIO. ILD may be fatal and may occur acutely at any time during therapy with a variable clinical presentation. If discontinuation of the drug is necessary, consider initiation of an accelerated elimination procedure. Adverse Reactions: The most frequent adverse reactions (≥10% and ≥2% greater than placebo) with AUBAGIO 7 mg and 14 mg and placebo, respectively, were headache (18% and 16% vs 15%), ALT increased (13% and 15% vs 9%), diarrhea (13% and 14% vs 8%), alopecia (10% and 13% vs 5%), and nausea (8% and 11% vs 7%). Drug Interactions: Monitor patients when teriflunomide is coadministered with warfarin, or with drugs metabolized by CYP1A2, CYP2C8, substrates of OAT3 transporters, substrates of BCRP, or OATP1B1/1B3 transporters. Use in Specific Populations: Women who wish to become pregnant should discontinue AUBAGIO and undergo an accelerated elimination procedure. Use of effective contraception should be continued until plasma concentrations of teriflunomide are <0.02 mcg/mL. Nursing mothers should not use AUBAGIO. AUBAGIO is detected in human semen. To minimize any possible fetal risk, men not wishing to father a child and their female partners should use effective contraception. Men wishing to father a child should discontinue therapy and either undergo accelerated elimination or verify plasma teriflunomide concentration is <0.02 mcg/mL.
Please see additional Important Safety Information on the previous pages and Brief Summary of Full Prescribing Information, including boxed WARNING regarding hepatotoxicity and use in pregnancy, on the following pages. References: 1. AUBAGIO (teriflunomide) [package insert]. Cambridge, MA: Genzyme Corporation; November 2016. 2. Tecfidera (dimethyl fumarate) [package insert]. Cambridge, MA: Biogen Inc.; February 2016. 3. Gilenya (fingolimod) [package insert]. East Hanover, NJ: Novartis Pharmaceuticals Corporation; February 2016. 4. O’Connor P, Wolinsky JS, Confavreux C, et al; TEMSO Trial Group. Randomized trial of oral teriflunomide for relapsing multiple sclerosis. N Engl J Med. 2011;365(14):1293-1303. 5. Confavreux C, O’Connor P, Comi G, et al; for the TOWER Trial Group. Oral teriflunomide for patients with relapsing multiple sclerosis (TOWER): a randomised, double-blind, placebo-controlled, phase 3 trial. Lancet Neurol. 2014;13(3):247-256. 6. Data on file, Sanofi/Genzyme. Summary of safety HMR1726-teriflunomide. December 5, 2013. 7. Miller AE, Wolinsky JS, Kappos L, et al; for the TOPIC Study Group. Oral teriflunomide for patients with a first clinical episode suggestive of multiple sclerosis (TOPIC): a randomised, double-blind, placebo-controlled, phase 3 trial. Lancet Neurol. 2014;13(10):977-986.
©2016 Genzyme Corporation. All rights reserved. AUBAGIO, Sanofi, and Genzyme registered in U.S. Patent and Trademark Office. GZUS.AUBA.15.01.0245(3) December 2016
AUBAGIO® (teriflunomide) tablets, for oral use
Brief Summary of Prescribing Information WARNING: HEPATOTOXICITY and RISK OF TERATOGENICITY • Hepatotoxicity Severe liver injury including fatal liver failure has been reported in patients treated with leflunomide, which is indicated for rheumatoid arthritis. A similar risk would be expected for teriflunomide because recommended doses of teriflunomide and leflunomide result in a similar range of plasma concentrations of teriflunomide. Concomitant use of AUBAGIO with other potentially hepatotoxic drugs may increase the risk of severe liver injury. Obtain transaminase and bilirubin levels within 6 months before initiation of AUBAGIO therapy. Monitor ALT levels at least monthly for six months after starting AUBAGIO [see Warnings and Precautions (5.1)]. If drug induced liver injury is suspected, discontinue AUBAGIO and start an accelerated elimination procedure with cholestyramine or charcoal [see Warnings and Precautions (5.3)]. AUBAGIO is contraindicated in patients with severe hepatic impairment [see Contraindications (4)]. Patients with pre-existing liver disease may be at increased risk of developing elevated serum transaminases when taking AUBAGIO. • Risk of Teratogenicity AUBAGIO is contraindicated for use in pregnant women and in women of reproductive potential who are not using effective contraception because of the potential for fetal harm. Teratogenicity and embryolethality occurred in animals at plasma teriflunomide exposures lower than that in humans. Exclude pregnancy before the start of treatment with AUBAGIO in females of reproductive potential. Advise females of reproductive potential to use effective contraception during AUBAGIO treatment and during an accelerated drug elimination procedure after AUBAGIO treatment. Stop AUBAGIO and use an accelerated drug elimination procedure if the patient becomes pregnant [see Contraindications (4), Warnings and Precautions (5.2, 5.3), Use in Specific Populations (8.1), and Clinical Pharmacology (12.3) in the full prescribing information].
1 INDICATIONS AND USAGE AUBAGIO® is indicated for the treatment of patients with relapsing forms of multiple sclerosis. 2 DOSAGE AND ADMINISTRATION The recommended dose of AUBAGIO is 7 mg or 14 mg orally once daily. AUBAGIO can be taken with or without food. Monitoring to assess safety • Obtain transaminase and bilirubin levels within 6 months before initiation of AUBAGIO therapy. Monitor ALT levels at least monthly for six months after starting AUBAGIO [see Warnings and Precautions (5.1)]. • Obtain a complete blood cell count (CBC) within 6 months before the initiation of treatment with AUBAGIO. Further monitoring should be based on signs and symptoms of infection [see Warnings and Precautions (5.4)]. • Prior to initiating AUBAGIO, screen patients for latent tuberculosis infection with a tuberculin skin test or blood test for mycobacterium tuberculosis infection [see Warnings and Precautions (5.4)]. • Exclude pregnancy prior to initiation of treatment with AUBAGIO in females of reproductive potential [see Warnings and Precautions (5.2)]. • Check blood pressure before start of AUBAGIO treatment and periodically thereafter [see Warnings and Precautions (5.7)]. 4 CONTRAINDICATIONS AUBAGIO is contraindicated in/with: • Patients with severe hepatic impairment [see Warnings and Precautions (5.1)]. • Pregnant women and females of reproductive potential not using effective contraception. AUBAGIO may cause fetal harm [see Warnings and Precautions (5.2 and 5.3) and Use in Specific Populations (8.1)]. • Patients with a history of a hypersensitivity reaction to teriflunomide, leflunomide, or to any of the inactive ingredients in AUBAGIO. Reactions have included anaphylaxis, angioedema, and serious skin reactions [see Warnings and Precautions (5.5)]. • Coadministration with leflunomide [see Clinical Pharmacology (12.3) in the full prescribing information]. 5 WARNINGS AND PRECAUTIONS 5.1 Hepatotoxicity Severe liver injury including fatal liver failure and dysfunction has been reported in some patients treated with leflunomide, which is indicated for rheumatoid arthritis. A similar risk would be expected for teriflunomide because recommended doses of teriflunomide and leflunomide result in a similar range of plasma concentrations of teriflunomide. Patients with pre-existing liver disease may be at increased risk of developing elevated serum transaminases when taking AUBAGIO. Patients with pre-existing acute or chronic liver disease, or those with serum alanine aminotransferase (ALT) greater than two times the upper limit of normal (ULN) before initiating treatment, should not normally be treated with AUBAGIO. AUBAGIO is contraindicated in patients with severe hepatic impairment [see Contraindications (4)]. In placebo-controlled trials, ALT greater than three times the ULN occurred in 61/1045 (5.8%) and 62/1002 (6.2%) of patients receiving AUBAGIO 7 mg and 14 mg, respectively, and 38/997 (3.8%) of patients receiving placebo, during the treatment period. These elevations occurred mostly within the first year of treatment. Half of the cases returned to normal without drug discontinuation. In clinical trials, if ALT elevation was greater than three times the ULN on two consecutive tests, AUBAGIO was discontinued and patients underwent an accelerated elimi-
nation procedure [see Warnings and Precautions (5.3)]. Of the patients who underwent discontinuation and accelerated elimination in controlled trials, half returned to normal or near normal values within 2 months. One patient in the controlled trials developed ALT 32 times the ULN and jaundice 5 months after initiation of AUBAGIO 14 mg treatment. The patient was hospitalized for 5 weeks and recovered after plasmapheresis and cholestyramine accelerated elimination procedure. AUBAGIO-induced liver injury in this patient could not be ruled out. Obtain serum transaminase and bilirubin levels within 6 months before initiation of AUBAGIO therapy. Monitor ALT levels at least monthly for six months after starting AUBAGIO. Consider additional monitoring when AUBAGIO is given with other potentially hepatotoxic drugs. Consider discontinuing AUBAGIO if serum transaminase increase (greater than three times the ULN) is confirmed. Monitor serum transaminase and bilirubin on AUBAGIO therapy, particularly in patients who develop symptoms suggestive of hepatic dysfunction, such as unexplained nausea, vomiting, abdominal pain, fatigue, anorexia, or jaundice and/or dark urine. If liver injury is suspected to be AUBAGIO-induced, discontinue AUBAGIO and start an accelerated elimination procedure [see Warnings and Precautions (5.3)] and monitor liver tests weekly until normalized. If AUBAGIO-induced liver injury is unlikely because some other probable cause has been found, resumption of AUBAGIO therapy may be considered. 5.2 Teratogenicity AUBAGIO may cause fetal harm when administered to a pregnant woman. Teratogenicity and embryo-fetal lethality occurred in animal reproduction studies in multiple animal species at plasma teriflunomide exposures similar to or lower than that in humans at the maximum human recommended dose (MHRD) of 14 mg/day [see Use in Specific Populations (8.1)]. AUBAGIO is contraindicated for use in pregnant women and females of reproductive potential not using effective contraception [see Contraindications (4) and Warnings and Precautions (5.3)]. 5.3 Procedure for Accelerated Elimination of Teriflunomide Teriflunomide is eliminated slowly from the plasma [see Clinical Pharmacology (12.3) in the full prescribing information]. Without an accelerated elimination procedure, it takes on average 8 months to reach plasma concentrations less than 0.02 mg/L, although because of individual variations in drug clearance it may take as long as 2 years. An accelerated elimination procedure could be used at any time after discontinuation of AUBAGIO. Elimination can be accelerated by either of the following procedures: • Administration of cholestyramine 8 g every 8 hours for 11 days. If cholestyramine 8 g three times a day is not well tolerated, cholestyramine 4 g three times a day can be used. • Administration of 50 g oral activated charcoal powder every 12 hours for 11 days. If either elimination procedure is poorly tolerated, treatment days do not need to be consecutive unless there is a need to lower teriflunomide plasma concentration rapidly. At the end of 11 days, both regimens successfully accelerated teriflunomide elimination, leading to more than 98% decrease in teriflunomide plasma concentrations. Use of the accelerated elimination procedure may potentially result in return of disease activity if the patient had been responding to AUBAGIO treatment. 5.4 Bone Marrow Effects/Immunosuppression Potential/Infections Bone Marrow Effects A mean decrease compared to baseline in white blood cell (WBC) count of approximately 15% (mainly neutrophils and lymphocytes) and in platelet count of approximately 10% was observed in placebo-controlled trials with 7 mg and 14 mg of AUBAGIO. The decrease in mean WBC count occurred during the first 6 weeks and WBC count remained low during treatment. In placebo-controlled studies, neutrophil count <1.5×109/L was observed in 12% and 16% of patients receiving AUBAGIO 7 mg and 14 mg, respectively, compared with 7% of patients receiving placebo; lymphocyte count <0.8× 109/L was observed in 10% and 12% of patients receiving AUBAGIO 7 mg and 14 mg, respectively, compared with 6% of patients receiving placebo. No cases of serious pancytopenia were reported in premarketing clinical trials of AUBAGIO but rare cases of pancytopenia and agranulocytosis have been reported in the postmarketing setting with leflunomide. A similar risk would be expected for AUBAGIO [see Clinical Pharmacology (12.3) in the full prescribing information]. Cases of thrombocytopenia with AUBAGIO, including rare cases with platelet counts less than 50,000/mm3, have been reported in the postmarketing setting. Obtain a complete blood cell count (CBC) within 6 months before the initiation of treatment with AUBAGIO. Further monitoring should be based on signs and symptoms suggestive of bone marrow suppression. Risk of Infection / Tuberculosis Screening Patients with active acute or chronic infections should not start treatment until the infection(s) is resolved. If a patient develops a serious infection consider suspending treatment with AUBAGIO and using an accelerated elimination procedure. Reassess the benefits and risks prior to resumption of therapy. Instruct patients receiving AUBAGIO to report symptoms of infections to a physician. AUBAGIO is not recommended for patients with severe immunodeficiency, bone marrow disease, or severe, uncontrolled infections. Medications like AUBAGIO that have immunosuppression potential may cause patients to be more susceptible to infections, including opportunistic infections. In placebo-controlled studies of AUBAGIO, no overall increase in the risk of serious infections was observed with AUBAGIO 7 mg (2.2%) or 14 mg (2.7%) compared to placebo (2.2%). However, one fatal case of klebsiella pneumonia sepsis occurred in a patient taking AUBAGIO 14 mg for 1.7 years. Fatal infections have been reported in the postmarketing setting in patients receiving leflunomide, especially Pneumocystis jiroveci pneumonia and aspergillosis. Most of the reports were confounded by concomitant immunosuppressant therapy and/or comorbid illness which, in addition to rheumatoid disease, may predispose patients to infection. In clinical studies with AUBAGIO, cytomegalovirus hepatitis reactivation has been observed. In clinical studies with AUBAGIO, cases of tuberculosis have been observed. Prior to initiating AUBAGIO, screen patients for latent tuberculosis infection with a tuberculin skin test or with a blood test for mycobacterium tuberculosis infection. AUBAGIO has not been studied in patients with a positive tuberculosis screen, and the safety of AUBAGIO in individuals with latent tuberculosis infection is unknown. For patients testing positive in tuberculosis screening, treat by standard medical practice prior to therapy with AUBAGIO.
Vaccination No clinical data are available on the efficacy and safety of live vaccinations in patients taking AUBAGIO. Vaccination with live vaccines is not recommended. The long half-life of AUBAGIO should be considered when contemplating administration of a live vaccine after stopping AUBAGIO. Malignancy The risk of malignancy, particularly lymphoproliferative disorders, is increased with the use of some immunosuppressive medications. There is a potential for immunosuppression with AUBAGIO. No apparent increase in the incidence of malignancies and lymphoproliferative disorders was reported in the AUBAGIO clinical trials, but larger and longer-term studies would be needed to determine whether there is an increased risk of malignancy or lymphoproliferative disorders with AUBAGIO. 5.5 Hypersensitivity and Serious Skin Reactions AUBAGIO can cause anaphylaxis and severe allergic reactions [see Contraindications (4)]. Signs and symptoms have included dyspnea, urticaria, and angioedema including lips, eyes, throat, and tongue. Cases of serious skin reactions, including cases of Stevens-Johnson syndrome (SJS) and a fatal case of toxic epidermal necrolysis (TEN), have been reported with AUBAGIO. In patients treated with leflunomide, the parent compound, very rare cases of Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) have also been reported. Inform patients of the signs and symptoms of anaphylaxis and angioedema and signs and symptoms that may signal a serious skin reaction. Inform patients that a fever associated with signs of other organ system involvement (e.g., rash, lymphadenopathy, or hepatic dysfunction) may be drug-related. Instruct patients to discontinue AUBAGIO and seek immediate medical care should these signs and symptoms occur. Discontinue AUBAGIO, unless the reactions are clearly not drug-related, and begin an accelerated elimination procedure immediately [see Warnings and Precautions (5.3)]. In such cases, patients should not be re-exposed to teriflunomide [see Contraindications (4)]. 5.6 Peripheral Neuropathy In placebo-controlled studies, peripheral neuropathy, including both polyneuropathy and mononeuropathy (e.g., carpal tunnel syndrome), occurred more frequently in patients taking AUBAGIO than in patients taking placebo. The incidence of peripheral neuropathy confirmed by nerve conduction studies was 1.4% (13 patients) and 1.9% (17 patients) of patients receiving 7 mg and 14 mg of AUBAGIO, respectively, compared with 0.4% receiving placebo (4 patients). Treatment was discontinued in 0.7% (8 patients) with confirmed peripheral neuropathy (3 patients receiving AUBAGIO 7 mg and 5 patients receiving AUBAGIO 14 mg). Five of them recovered following treatment discontinuation. Not all cases of peripheral neuropathy resolved with continued treatment. Peripheral neuropathy also occurred in patients receiving leflunomide. Age older than 60 years, concomitant neurotoxic medications, and diabetes may increase the risk for peripheral neuropathy. If a patient taking AUBAGIO develops symptoms consistent with peripheral neuropathy, such as bilateral numbness or tingling of hands or feet, consider discontinuing AUBAGIO therapy and performing an accelerated elimination procedure [see Warnings and Precautions (5.3)]. 5.7 Increased Blood Pressure In placebo-controlled studies, the mean change from baseline to the end of study in systolic blood pressure was +2.3 mmHg and +2.7 mmHg for AUBAGIO 7 mg and 14 mg, respectively, and -0.6 mmHg for placebo. The change from baseline in diastolic blood pressure was +1.4 mmHg and +1.9 mmHg for AUBAGIO 7 mg and 14 mg, respectively, and -0.3 mmHg for placebo. Hypertension was an adverse reaction in 3.1% and 4.3% of patients treated with 7 mg or 14 mg of AUBAGIO compared with 1.8% for placebo. Check blood pressure before start of AUBAGIO treatment and periodically thereafter. Elevated blood pressure should be appropriately managed during treatment with AUBAGIO. 5.8 Respiratory Effects Interstitial lung disease, including acute interstitial pneumonitis, has been reported with AUBAGIO in the postmarketing setting. Interstitial lung disease and worsening of pre-existing interstitial lung disease have been reported during treatment with leflunomide. Interstitial lung disease may be fatal and may occur acutely at any time during therapy with a variable clinical presentation. New onset or worsening pulmonary symptoms, such as cough and dyspnea, with or without associated fever, may be a reason for discontinuation of therapy and for further investigation as appropriate. If discontinuation of the drug is necessary, consider initiation of an accelerated elimination procedure [see Warnings and Precautions (5.3)]. 5.9 Concomitant Use with Immunosuppressive or Immunomodulating Therapies Coadministration with antineoplastic, or immunosuppressive therapies used for treatment of multiple sclerosis has not been evaluated. Safety studies in which AUBAGIO was concomitantly administered with other immune modulating therapies for up to one year (interferon beta, glatiramer acetate) did not reveal any specific safety concerns. The long term safety of these combinations in the treatment of multiple sclerosis has not been established. In any situation in which the decision is made to switch from AUBAGIO to another agent with a known potential for hematologic suppression, it would be prudent to monitor for hematologic toxicity, because there will be overlap of systemic exposure to both compounds. Use of an accelerated elimination procedure may decrease this risk, but may also potentially result in return of disease activity if the patient had been responding to AUBAGIO treatment [see Warnings and Precautions (5.3)]. 6 ADVERSE REACTIONS The following serious adverse reactions are described elsewhere in the prescribing information: • Hepatotoxicity [see Contraindications (4) and Warnings and Precautions (5.1)] • Bone Marrow Effects/Immunosuppression Potential/Infections [see Warnings and Precautions (5.4)] • Hypersensitivity and Serious Skin Reactions [see Contraindications (4) and Warnings and Precautions (5.5)] • Peripheral Neuropathy [see Warnings and Precautions (5.6)] • Increased Blood Pressure [see Warnings and Precautions (5.7)]
AUBAGIO® (teriflunomide) tablets, for oral use • Respiratory Effects [see Warnings and Precautions (5.8)] 6.1 Clinical Trials Experience Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in clinical practice. A total of 2047 patients receiving AUBAGIO (7 mg or 14 mg once daily) constituted the safety population in the pooled analysis of placebo controlled studies in patients with relapsing forms of multiple sclerosis; of these, 71% were female. The average age was 37 years. Table 1 lists adverse reactions in placebo-controlled trials with rates that were at least 2% for AUBAGIO patients and also at least 2% above the rate in placebo patients. The most common were headache, an increase in ALT, diarrhea, alopecia, and nausea. The adverse reaction most commonly associated with discontinuation was an increase in ALT (3.3%, 2.6%, and 2.3% of all patients in the AUBAGIO 7 mg, AUBAGIO 14 mg, and placebo treatment arms, respectively). Table 1. Adverse Reactions in Pooled Placebo-Controlled Studies in Patients with Relapsing Forms of Multiple Sclerosis AUBAGIO AUBAGIO 7 mg 14 mg Placebo Adverse Reaction (N=1045) (N=1002) (N=997) Headache 18% 16% 15% Increase in Alanine aminotransferase 13% 15% 9% Diarrhea 13% 14% 8% Alopecia 10% 13% 5% Nausea 8% 11% 7% Paresthesia 8% 9% 7% Arthralgia 8% 6% 5% Neutropenia 4% 6% 2% Hypertension 3% 4% 2% Cardiovascular Deaths Four cardiovascular deaths, including three sudden deaths, and one myocardial infarction in a patient with a history of hyperlipidemia and hypertension were reported among approximately 2600 patients exposed to AUBAGIO in the premarketing database. These cardiovascular deaths occurred during uncontrolled extension studies, one to nine years after initiation of treatment. A relationship between AUBAGIO and cardiovascular death has not been established. Acute Renal Failure In placebo-controlled studies, creatinine values increased more than 100% over baseline in 8/1045 (0.8%) patients in the 7 mg AUBAGIO group and 6/1002 (0.6%) patients in the 14 mg AUBAGIO group versus 4/997 (0.4%) patients in the placebo group. These elevations were transient. Some elevations were accompanied by hyperkalemia. AUBAGIO may cause acute uric acid nephropathy with transient acute renal failure because AUBAGIO increases renal uric acid clearance. Hypophosphatemia In clinical trials, 18% of AUBAGIO-treated patients had hypophosphatemia with serum phosphorus levels of at least 0.6 mmol/L, compared to 7% of placebo-treated patients; 4% of AUBAGIO-treated patients had hypophosphatemia with serum phosphorus levels at least 0.3 mmol/L but less than 0.6 mmol/L, compared to 0.8% of placebo-treated patients. No patient in any treatment group had a serum phosphorus below 0.3 mmol/L. 6.2 Postmarketing Experience The following adverse reactions have been identified during postapproval use of AUBAGIO. Because these reactions are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure. • Hypersensitivity reactions, some of which were severe, such as anaphylaxis and angioedema [see Warnings and Precautions (5.5)] • Severe skin reactions, including toxic epidermal necrolysis and Stevens-Johnson syndrome [see Warnings and Precautions (5.5)] • Thrombocytopenia [see Warnings and Precautions (5.4)] • Interstitial lung disease [see Warnings and Precautions (5.8)] • Pancreatitis 7 DRUG INTERACTIONS Effect of AUBAGIO on CYP2C8 substrates Teriflunomide is an inhibitor of CYP2C8 in vivo. In patients taking AUBAGIO, exposure of drugs metabolized by CYP2C8 (e.g., paclitaxel, pioglitazone, repaglinide, rosiglitazone) may be increased. Monitor these patients and adjust the dose of the concomitant drug(s) metabolized by CYP2C8 as required [see Clinical Pharmacology (12.3) in the full prescribing information]. Effect of AUBAGIO on warfarin Coadministration of AUBAGIO with warfarin requires close monitoring of the international normalized ratio (INR) because AUBAGIO may decrease peak INR by approximately 25%. Effect of AUBAGIO on oral contraceptives AUBAGIO may increase the systemic exposures of ethinylestradiol and levonorgestrel. Consideration should be given to the type or dose of contraceptives used in combination with AUBAGIO [see Clinical Pharmacology (12.3) in the full prescribing information]. Effect of AUBAGIO on CYP1A2 substrates Teriflunomide may be a weak inducer of CYP1A2 in vivo. In patients taking AUBAGIO, exposure of drugs metabolized by CYP1A2 (e.g., alosetron, duloxetine, theophylline, tizanidine) may be reduced. Monitor these patients and adjust the dose of the concomitant drug(s) metabolized by CYP1A2 as required [see Clinical Pharmacology (12.3) in the full prescribing information].
Effect of AUBAGIO on organic anion transporter 3 (OAT3) substrates Teriflunomide inhibits the activity of OAT3 in vivo. In patients taking AUBAGIO, exposure of drugs which are OAT3 substrates (e.g., cefaclor, cimetidine, ciprofloxacin, penicillin G, ketoprofen, furosemide, methotrexate, zidovudine) may be increased. Monitor these patients and adjust the dose of the concomitant drug(s) which are OAT3 substrates as required [see Clinical Pharmacology (12.3) in the full prescribing information]. Effect of AUBAGIO on BCRP and organic anion transporting polypeptide B1 and B3 (OATP1B1/ 1B3) substrates Teriflunomide inhibits the activity of BCRP and OATP1B1/1B3 in vivo. For a patient taking AUBAGIO, the dose of rosuvastatin should not exceed 10 mg once daily. For other substrates of BCRP (e.g., mitoxantrone) and drugs in the OATP family (e.g., methotrexate, rifampin), especially HMG-Co reductase inhibitors (e.g., atorvastatin, nateglinide, pravastatin, repaglinide, and simvastatin), consider reducing the dose of these drugs and monitor patients closely for signs and symptoms of increased exposures to the drugs while patients are taking AUBAGIO [see Clinical Pharmacology (12.3) in the full prescribing information]. 8 USE IN SPECIFIC POPULATIONS 8.1 Pregnancy Pregnancy Exposure Registry There is a pregnancy exposure registry that monitors pregnancy outcomes in women exposed to AUBAGIO during pregnancy. Healthcare providers and patients are encouraged to report pregnancies by calling 1-800-745-4447, option 2 Risk Summary AUBAGIO is contraindicated for use in pregnant women and females of reproductive potential not using effective contraception because of the potential for fetal harm based on animal data. Human data are not available at this time to inform the presence or absence of drug-associated risk with the use of AUBAGIO during pregnancy. In animal reproduction studies in rat and rabbits, oral administration of teriflunomide during organogenesis caused teratogenicity and embryolethality at plasma exposures (AUC) lower than that at the maximum human recommended dose (MHRD) of 14 mg/day [see Data]. In the US general population, the estimated background risk of major birth defects and miscarriage in clinically recognized pregnancies is 2%–4% and 15%–20%, respectively. The background risk of major birth defects and miscarriage in the indicated population is unknown. Clinical Considerations Women who wish to become pregnant should discontinue use of AUBAGIO and undergo an accelerated elimination procedure to decrease the plasma concentration of teriflunomide to less than 0.02 mg/L (0.02 mcg/mL). Effective contraception should be used until is it verified that plasma concentrations of teriflunomide are less than 0.02 mg/L (0.02 mcg/mL) [see Warnings and Precautions (5.3)]. Human plasma concentrations of teriflunomide less than 0.02 mg/L (0.02 mcg/mL) are expected to have minimal embryofetal risk [see Contraindications (4) and Warnings and Precautions (5.3)]. If the patient becomes pregnant while taking this drug, stop treatment with AUBAGIO, inform the patient of the potential risk to the fetus, and perform the accelerated drug elimination procedure to achieve plasma concentrations of less than 0.02 mg/L (0.02 mcg/mL) [see Warnings and Precautions (5.3) and Clinical Pharmacology (12.3) in the full prescribing information]. Refer the patient to an obstetrician/gynecologist, preferably experienced in reproductive toxicity, for further evaluation and counseling [see Warnings and Precautions (5.2, 5.3)]. Data Animal Data When teriflunomide (oral doses of 1, 3, or 10 mg/kg/day) was administered to pregnant rats throughout the period of organogenesis, high incidences of fetal malformation (primarily craniofacial, and axial and appendicular skeletal defects) and embryofetal death were observed at doses not associated with maternal toxicity. Adverse effects on embryofetal development were observed following dosing at various stages throughout organogenesis. Maternal plasma exposure at the no-effect level (1.0 mg/kg/day) for embryofetal developmental toxicity in rats was less than that in humans at the maximum recommended human dose (MRHD, 14 mg /day). Administration of teriflunomide (oral doses of 1, 3.5, or 12 mg/kg/day) to pregnant rabbits throughout organogenesis resulted in high incidences of fetal malformation (primarily craniofacial, and axial and appendicular skeletal defects) and embryofetal death at doses associated with minimal maternal toxicity. Maternal plasma exposure at the no-effect dose (1.0 mg/kg/day) for embryofetal developmental toxicity in rabbits was less than that in humans at the MRHD. In studies in which teriflunomide (oral doses of 0.05, 0.1, 0.3, 0.6, or 1.0 mg/kg/day) was administered to rats during gestation and lactation, decreased growth, eye and skin abnormalities, and high incidences of malformation (limb defects) and postnatal death were observed in the offspring at doses not associated with maternal toxicity. Maternal plasma exposure at the no-effect dose for pre- and postnatal developmental toxicity in rats (0.10 mg/kg/day) was less than that in humans at the MRHD. In animal reproduction studies of leflunomide, embryolethality and teratogenic effects were observed in pregnant rat and rabbit at or below clinically relevant plasma teriflunomide exposures (AUC). In published reproduction studies in pregnant mice, leflunomide was embryolethal and increased the incidence of malformations (craniofacial, axial skeletal, heart and great vessel). Supplementation with exogenous uridine reduced the teratogenic effects in pregnant mice, suggesting that the mode of action (inhibition of mitochondrial enzyme dihydroorotate dehydrogenase) is the same for therapeutic efficacy and developmental toxicity. At recommended doses in humans, teriflunomide and leflunomide result in a similar range of plasma concentrations of teriflunomide. 8.2 Lactation Risk Summary It is not known whether this drug is excreted in human milk. Teriflunomide was detected in rat milk following a single oral dose. The developmental and health benefits of breastfeeding should be considered along with the mother’s clinical need for AUBAGIO and any potential adverse effects on the breastfed infant from AUBAGIO or from the underlying maternal condition.
AUBAGIO® (teriflunomide) tablets, for oral use 8.3 Females and Males of Reproductive Potential Pregnancy Testing Exclude pregnancy prior to initiation of treatment with AUBAGIO in females of reproductive potential. Advise females to notify their healthcare provider immediately if pregnancy occurs or is suspected during treatment [see Warnings and Precautions (5.2, 5.3) and Use in Specific Populations (8.1)]. Contraception Females Females of reproductive potential should use effective contraception while taking AUBAGIO. If AUBAGIO is discontinued, use of contraception should be continued until is it verified that plasma concentrations of teriflunomide are less than 0.02 mg/L (0.02 mcg/mL). Females of reproductive potential who wish to become pregnant should undergo an accelerated elimination procedure. Effective contraception should be used until it is verified that plasma concentrations of teriflunomide are less than 0.02 mg/L (0.02 mcg/mL) [see Warnings and Precautions (5.3)]. Males AUBAGIO is detected in human semen. Animal studies to specifically evaluate the risk of male-mediated fetal toxicity have not been conducted. To minimize any possible risk, men not wishing to father a child and their female partners should use effective contraception. Men wishing to father a child should discontinue use of AUBAGIO and either undergo an accelerated elimination procedure or wait until verification that the plasma teriflunomide concentration is less than 0.02 mg/L (0.02 mcg/mL) [see Warnings and Precautions (5.3)]. Infertility Administration of teriflunomide to male rats resulted in no adverse effects on fertility. However, reduced epididymal sperm count was observed [see Nonclinical Toxicology (13.1) in the full prescribing information]. Effects of AUBAGIO on fertility in humans have not been evaluated. 8.4 Pediatric Use Safety and effectiveness in pediatric patients have not been established. 8.5 Geriatric Use Clinical studies of AUBAGIO did not include patients over 65 years old. 8.6 Hepatic Impairment No dosage adjustment is necessary for patients with mild and moderate hepatic impairment. The pharmacokinetics of teriflunomide in severe hepatic impairment have not been evaluated. AUBAGIO is contraindicated in patients with severe hepatic impairment [see Contraindications (4), Warnings and Precautions (5.1), and Clinical Pharmacology (12.3) in the full prescribing information]. 8.7 Renal Impairment No dosage adjustment is necessary for patients with mild, moderate, and severe renal impairment [see Clinical Pharmacology (12.3) in the full prescribing information]. 10 OVERDOSAGE There is no experience regarding teriflunomide overdose or intoxication in humans. Teriflunomide 70 mg daily up to 14 days was well tolerated by healthy subjects. In the event of clinically significant overdose or toxicity, cholestyramine or activated charcoal is recommended to accelerate elimination [see Warnings and Precautions (5.3)].
Genzyme Corporation 500 Kendall Street Cambridge, MA 02142 A SANOFI COMPANY November 2016 TER-BPLR-SA-NOV16
Learn How to Make Technology Work for You Frustrated by electronic health records and other information technology involved in your work? Register for this webinar to see how you can more effectively use these tools and gain greater efficiency.
iNeurology: Best IT Practices November 7, 2017, from 12:00 p.m.–1:00 p.m. ET Deadline to Register: November 6 Director: Melissa Yu, MD Upon completion, you should be able to: nn Understand the core functionalities of electronic health records nn Use health information technology to effectively report on payer programs nn Identify tools to improve patient care 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 presentation slides and recordings if you miss the live event. Melissa Yu, MD 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. •
Still Time to Register for October 10 Webinar! Register by October 9 at AAN.com/view/pmw17 for the upcoming webinar “Using the EHR or Axon Registry to Drive Quality Improvement” offered on October 10, from 12:00 p.m. to 1:00 p.m. ET. •
Documenting Your Improvement Activities for MIPS In the Merit-based Incentive Program (MIPS), a new performance category is Improvement Activities (IA), for which clinicians are rewarded for care focused on care coordination, beneficiary engagement, and patient safety. Up to 40 points are available, and most participants must complete up to four activities for a minimum of 90 days. (Participants in a patient-centered medical home or MIPS APM will receive automatic full and partial credit, respectively.)
Why You Should Document IA Because physicians attest to IA, it’s not necessary to submit documentation or evidence. However, the Centers for Medicare & Medicaid Services has audited similar attestationbased programs in the past. In June, the US Department of Health and Human Services’ Office of Inspector General reported that a recent audit of meaningful use programs found CMS overpaid physicians by about $730 million, or 12 percent of total payments. While it’s likely that some of these providers likely DID do the required work, they did NOT maintain the required documentation. The report recommended that those who were audited and were overpaid be required to return the overpayments. Consequently, it is crucial to keep evidence of improvement activity
AANnews • October 2017
completion on file on the off chance that you may face an audit. Eligible clinicians are encouraged to retain documentation for up to 10 years per the False Claims Act; on the other hand, the CMS document retention policy final rule indicates that documentation or data must be retained for at least six years as required.
How to Document The easiest route for many providers is to use their EHR to maintain documentation, and MIPS provides a bonus for those who do use certified EHR technology (CHERT) to submit. But this is not the only way to keep records. The following are appropriate ways to document IA: nn Meeting notes nn Improvement plans that document
activities in a specific area (e.g., access to care in the clinic)
nn Survey results (e.g., CAHPS) nn Patient encounters nn Claims
How the AAN Is Helping You A benefit of participating for free in the AAN’s Axon Registry ® is that US members can leverage feedback reports to demonstrate use of QCDR data to promote use of standard practices, tools, and processes for quality improvement, including, for example, preventative screenings. The AAN provides a helpful IA fact sheet that can be accessed at AAN.com/view/ImprovementActivities. The Academy also has been proposing to CMS new neurology-specific IAs, and one on continuing medical education is included in CMS’s proposed rule for 2018. •
Use the Axon Registry to Prepare for MIPS in 2018 Have you considered how you are going to report for the Merit-based Incentive Payment System (MIPS) pathway of CMS’s Quality Payment Program in 2018? If your answer is no, now is the time to begin looking at ways to be prepared for the coming year. The Axon Registry ® is a free benefit for AAN members in the US that allows providers to assess their practice with quality measures and to report three MIPS components: Quality, Advancing Care Information, and Improvement Activities. The Axon Registry gives providers an up-to-date dashboard with a visual representation of performance on quality measures. This is an opportunity for physicians to initiate quality improvement projects, meet government reporting requirements, receive credit for MOC part IV PIP clinical activity, and show value to payers.
the enrollment process. There is a wait list to be a part of the Axon Registry that works on a firstcome, first-served basis. However, enrolling your practice now will ensure integration early enough Lyell K. Jones, MD, FAAN in the year to be prepared for the necessary submission deadlines. For more information about how your EMR system will impact your integration timeline, check out our EHR Compatibility Document on our website.
Lyell K. Jones, MD, FAAN, chair of the Registry Committee, explains, “Getting your practice enrolled in the registry now gives you time to understand and improve your performance on the registry quality measures, and be prepared for submission in the coming year.”
As practices sign up, they will be placed on a wait list and contacted when their number is reached. For more information about the process, contact firstname.lastname@example.org. •
US members of the AAN interested in joining the Axon Registry should go to AAN.com/view/Axon and complete
For Your Practice and Patients: New Issues of Neurology Now and Neurology: Clinical Practice The October/November issue of Neurology Now ® features the story of restauranteur B. Smith and her husband Dan Gasby, who were recipients of this year’s Public Leadership in Neurology Award from the American Brain Foundation. Smith was diagnosed with early-onset Alzheimer’s disease at age 62, and since then she and Gasby have worked hard to raise awareness about the disease, especially as it relates to African-Americans and women. They’ve urged African-Americans to participate in research and take responsibility for their own health. The couple has also pointed out the cultural and societal pressures that increase the risk of Alzheimer’s disease among the AfricanAmerican community. Another article explains the importance of patient registries in helping to gather important data about neurologic disease. It also describes how registries foster patient engagement in research and, generate discussion about important topics such as cost of care, side effects, and views on treatments such as cannabis.
receive for your patients or to update your clinic address.
AAN members may elect to receive multiple copies of Neurology Now to distribute to their patients, who also can subscribe for free. Visit NeurologyNow.com to learn more or email BeGreen@WasteFreeMail.com to adjust the number of copies you
In the Special Cases issue of Neurology ® Clinical Practice, authors present cases that provide glimpses into diagnosis, therapeutics, semiology, and pathophysiology of neurologic disease. The focus includes cases on a specific RT-PCR protocol with an enhanced sensitivity and specificity to identify enterovirus D68 in CSF; the importance of recognizing signs of chronic diphenhydramine abuse to ue s s I l provide timely and effective ia Spec treatment; and brain sagging secondary to cerebrospinal fluid hypovolemia in a patient BEFORE W E FORGE presenting with chorea. Restaura T teur B. Hu mber
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Neurology: Clinical Practice, published six times a year, is available in print (for US members only), online, and for the iPad and Android. Visit Neurology.org/cp for more information. •
AANnews • October 2017
Use New Quality Measurement Set for Essential Tremor A new quality measurement set was developed to meet the needs of patients with essential tremor and published online ahead of print in Neurology ® on August 23, 2017. Six measures were created by a multidisciplinary workgroup.
These measures use the following formula to identify quality of care performance: Quality of Patient Care =
patients who meet criterion (eligible population – exclusions)
2016 Essential Tremor Measurement (ET) Set Pharmacological Treatment for Patients with ET Surgical Evaluation for Patients with ET Annual Assessment of Essential Tremor Severity Annual Screening of Depression and Anxiety for Patients with ET Annual Assessment of Quality of Life for Patients with ET Promotion of ET Resources
For example, to determine performance on the pharmacological treatment measure, physicians would first identify all patients aged 18 years and older with a diagnosis of essential tremor. Using this number as a denominator, performance would then be calculated by identifying the patients who met the numerator criteria of having had pharmacological treatment options discussed at least once in the 12-month measurement period and dividing by the denominator. View the executive summary at Neurology and the full measure set on AAN.com. For more information, contact Amy Bennett at email@example.com or (612) 928-6072. •
Apply for UCNS Accreditation by December 1 Programs interested in accreditation from the United Council for Neurologic Subspecialties (UCNS) for their fellowship training programs should apply by December 1, 2017. Programs applying by December 1 will be reviewed at the spring 2018 UCNS meeting, with successful program actions effective June 1, 2018. UCNS accredits programs in nine neurologic subspecialty areas. Accreditation is a voluntary process of evaluation and peer-review based on UCNS accreditation standards. Programs that attain accreditation status offer the core content established by the subspecialty and meet the required quality standards established by UCNS. Residents seeking fellowships in UCNS subspecialty areas know that the UCNS training programs offer the training defined by experts in that subspecialty and the programs have the oversight of the UCNS Accreditation Council. Fellows graduating from
UCNS-accredited training programs meet the training eligibility requirements for certification in their respective UCNS-recognized subspecialty, creating a strong career path for fellow graduates. Join the 187 programs with UCNS accreditation. For more information, visit UCNS.org. •
Update: ABPN Announces Changes to Its MOC Program The American Board of Psychiatry and Neurology has announced plans for changes to its maintenance of certification program, including an MOC pilot alternative to the 10-year examination. Significant changes in Parts II and III in the next year include: nn Self-Assessment (Part II): Eight Self-Assessment CME credits in a three-year CMOC block waived if participating in the
AAN’s Axon Registry ® or other approved registry
nn MOC Exam (Part III): piloting an alternative based on peer-selected literature and self-assessment
To learn more about the changes ABPN is making to its MOC program, visit ABPN.com/wp-content/uploads/2017/09/ABPNChanges-in-MOC-Program.pdf. •
AANnews • October 2017
Approximately one-third of people with Parkinson’s in the U.S. experience OFF periods.1-3 For people with Parkinson's, unexpected symptoms can affect their ability to move and engage in usual activities.4 In a 2014 survey of > 3,000 people with Parkinson's, two-thirds of respondents reported having more than two hours of OFF time per day.5
1. Statistics on Parkinson’s. Parkinson's Disease Foundation. http://www.pdf.org/en/parkinson_ statistics. Accessed July 2017. 2. Ahlskog JE et al. Mov Disord. 2001;16(3):448-458. 3. Decision Resources. Parkinson’s Disease (Report: January 2015). 4. Hechtner MC et al. Parkinsonism Relat Disord. 2014;20:969-974. 5. The Michael J. Fox Foundation Survey of Parkinson’s Patients’ Off Time Experience, July 2014. ACORDA THERAPEUTICS® and the stylized ACORDA THERAPEUTICS® logo are registered trademarks of Acorda AANnews Therapeutics, Inc. ©2017 Acorda Therapeutics,• Inc.October All rights reserved. 2017
Continuum and Continuum Audio Now Bundled Together for More Learning Options AAN members can now receive both the definitive text of Continuum® and the in-depth audio conversations of Continuum® Audio all in one subscription. “These two products that are highly valued by AAN members are now bundled together to provide you the education essential for your practice in a variety of learning formats,” said Continuum Editor-in-Chief Steven L. Lewis, MD, FAAN. “You can lean back with the Continuum journal for up-to-date information about diagnosis, treatment, and management of a subspecialty area, Steven L. Lewis, MD, FAAN and you can make use of your commute or workout time to listen to fascinating interviews with leaders in their fields with Continuum Audio.” The new product bundle is available now for new subscribers and will be phased in for current subscribers as they renew their subscriptions. Starting in February 2018, all current and new subscribers will have access to both Continuum and Continuum Audio. The two products will continue to provide high-quality education, as well as CME credits:
Continuum nn Comprehensive curriculum of single-topic issues,
each covering a core neurologic subspecialty area.
nn Clinical applications of the latest research and
up-to-date information about diagnosis, treatment, and management. nn Subscription includes print, online, iPad, and Android. nn Opportunity to earn up to 14 AMA PRA Category 1 CreditsTM per issue (12 can apply to ABPN MOC Self-Assessment credit).
Continuum Audio nn In-depth conversations with expert authors of articles
from the Continuum journal.
nn Ability to listen to any interview of interest on any topic,
from the entire library of Continuum Audio content.
nn Subscription includes online, MP3 files, and iOS/Android. nn Opportunity to earn CME credits for each interview. Once
8 AMA PRA Category 1 Credits have been earned, they and all subsequent credits may apply toward ABPN MOC Self-Assessment credit.
AAN members who subscribe now gain access to both products for only $349. Learn more at Shop.LWW.com/ Continuum and subscribe today! Already a subscriber? Renew now for $349 and receive access to the full bundle. Coming in February 2018: Continuum gets an update, both in print and online! Enjoy the same expert content with a fresh, modern look. In addition, enhancements to both Continuum and Continuum Audio will make it easier to jump from an interview to the corresponding article or link quickly from the online Continuum article to the audio interview. •
Peripheral Nerve and Motor Neuron Disorders Reviewed in October Continuum Get up-to-date on peripheral nerve and motor neuron disorders with the current issue of Continuum: Lifelong Learning in Neurology ®.
Guest edited by Kerry H. Levin, MD, FAAN, the issue’s articles include: nn General Approach to Peripheral Nerve Disorders nn Neurophysiologic Kerry H. Levin, MD, FAAN Studies in the Evaluation of Polyneuropathy nn Ultrasonography in Peripheral Nervous System Diagnosis nn Guillain-Barré Syndrome nn Chronic Demyelinating Polyneuropathies nn Diagnosis and Clinical Management of Amyotrophic Lateral Sclerosis and Other Motor Neuron Disorders nn Charcot-Marie-Tooth Disease and Other Genetic Polyneuropathies nn Axonal Sensorimotor Polyneuropathies nn Immune Axonal Polyneuropathy nn Sensory Polyneuropathies nn Peripheral Nerve Hyperexcitability Syndromes nn Right-to-Try Investigational Therapies for Incurable Disorders nn The Implication of Diagnostic Errors Subscribe to the new Continuum bundle by contacting Wolters Kluwer at (800) 361-0633, (301) 223-2300 (international), or Shop.LWW.com/continuum. Junior members who are transitioning to Neurologist memberships can receive a 50-percent discount on the already low member rate for Continuum subscriptions. •
AANnews • October 2017
Experience Personal and Professional Growth at Palatucci Advocacy Leadership Forum Darrah Haffner, MD, was quick to take advantage of one of the AAN’s signature benefits for members. Haffner, a neurodevelopmental disabilities resident at the University of Texas Southwestern Medical School who joined the AAN in 2016, applied and was accepted for advocacy training at the 2017 Palatucci Advocacy Leadership Forum (PALF). She sought this training to help her promote an autism therapy program. But seizing the opportunity paid off personally as well as professionally. “Before arriving at PALF I was both excited but definitely apprehensive,” said Haffner. “I didn’t know what to expect but I thought that as a resident I would be highly underqualified compared to everyone else who would be full-fledged neurologists, well established in their careers, and entirely confident in their advocacy topic and plan. My fears could not have been more unfounded. PALF was a great combination of neurologists in all career levels from all different practice settings. Despite our differences, everyone was so passionate about their own advocacy topics and in supporting others in succeeding with their plans.” PALF not only prepares participants for success, but also provides encouragement and support—at the training and throughout the year as advisors continue to help coach the new advocates. “The most important thing I learned about advocacy was to have a plan and then not to be discouraged when things don’t go according to plan. The unofficial recurring theme at PALF seemed to be that most people don’t finish their exact plan but they find aspects or other avenues that were equally important. I guess that boils down to being persistent and open to new avenues.” Haffner is quick to display her newly learned skills whenever she has the opportunity. “Always have your 10-second sound bite ready and push your action plan whenever you can. So here goes: Applied Behavioral Analysis or ABA therapy is an intensive behavioral program that is a positive, life-changing treatment, and all children with autism deserve access to it. In all seriousness,
though, at PALF I learned how to effectively talk about my plan to different groups of people and it also gave me a foundation in how government, especially the legislature, works. Since PALF, I talk about autism and ABA therapy all the time to anyone who will listen. And that includes to patients and their families. Previously, I used to just prescribe ABA therapy to my patients and then give lists of grant programs to Medicaid families who can’t access services otherwise. Now, we discuss the current legislation and what we both can do to advocate for better services.” PALF also gave her a new sense of personal confidence and self-awareness, both professionally and personally. “I have never been a big public speaker, but I found that if I was passionate enough about the topic that I really could get up in front of a group and be coherent. The biggest impact PALF had on my personal life was to make me pay attention to my own work-life balance. At the Forum, a few fellow advocates were working on physician burnout and well-being and their action plans really hit home. When I arrived at PALF, I personally was feeling burnt out, but I left feeling inspired professionally and personally. I have my action plan to work on but have also started running, and will run in my first 5K in October to support adults with disabilities!” What would Haffner tell a colleague who might have an interest in applying for PALF? “Absolutely go for it! If you have an issue that is important to you, either something well fleshed out or just an idea, PALF can really help you overcome the hurdles to getting started. PALF is designed so that you work on designing your advocacy plan but also is a skills boot camp for learning how to talk to colleagues, the media, and even government officials. I left PALF inspired and feeling like I’m doing something really worthwhile.” •
Darrah Haffner, MD, (right) at the 2017 Palatucci Advocacy Leasdership Forum.
Apply for 2018 Palatucci Advocacy Leadership Forum The weekend of May 17 through 20, 2018, is the weekend that will change your life. Learn how to become an advocacy leader in your clinic, institution, or community. Acquire skills that you can apply both professionally and personally to enrich your work and reinvigorate your sense of purpose. Visit AAN.com/view/PALF to learn more and apply by December 11. •
AANnews • October 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. During the August congressional recess, several AAN members made “Neurology off the Hill” visits to members of Congress in their district offices. Here are some of their experiences. Neal Parikh, MD—New York “I, along with Dr. Janice Weisman, had the pleasure of visiting with Rep. Carolyn Maloney in her district office as part of the Neurology off the Hill initiative. The AAN’s efforts gave us nearly 30 minutes of direct contact with our representative, her chief-of-staff, and even some summer interns! We discussed the FAST Act and NIH funding in great detail and continued the conversation by email after the meeting. The intimate meeting also allowed us a unique window into Rep. Maloney’s passions in a way that will hopefully allow us to more effectively align our priorities with hers.” Kara Stavros, MD—Rhode Island “Participating in Neurology off the Hill was a valuable and empowering experience. My colleagues and I visited Rep. Langevin at his local office in RI. The local visit was longer and more intimate than meeting in his DC office, and it provided us the flexibility to discuss a variety of issues and to bond over our local connections. It was a great way to follow up on the issues we discussed in DC earlier this year (in particular, support for the BRAIN Initiative and the FAST Act) and to continue to build a relationship with Rep. Langevin and his office going forward. Plus, meeting locally allowed more of my colleagues to attend, giving us a more robust delegation and more supportive voices for the issues that matter to us and our patients! This was an invaluable opportunity to speak directly to a member of Congress.” Sarah Song, MD—Illinois “Our in-district visit ‘off the Hill’ was fantastic! A group of stroke neurologists from Rush University Medical Center, Drs. Laurel Cherian, Alex Vargas, Nick Osteraas, and I went to visit Rep. Quigley’s office, located in the Lakeview neighborhood of Chicago, IL. I was the only one with experience doing in-person advocacy, but my three colleagues were excited and eager to participate. Beforehand, we discussed the different issues, and decided to focus on the FAST Act, funding for the BRAIN initiative, and support for any health care legislation that advocated for the most Americans covered. We practiced several times, starting with introductions, and leading from issue to issue. On the day of our meeting, we met with Erica Reardon, the district policy advisor. She was very receptive to our conversation, and the newbies did great! I was so impressed with how well they were able to shift talking points and emphasize our asks. Since Rush does quite a bit of telestroke, we also pulled out our cell phones to show her a mock telestroke patient by using mobile technology, so Erica really understood how valuable and timely telestroke could be used. Overall, our meeting was encouraging and promising!” •
Stand up for Neurology! Apply for the 2018 Neurology on the Hill Continued from cover The Academy will cover airfare expenses and hotel accommodations. There is a general registration fee of $150, or $50 for residents, fellows, and members residing in the Washington, DC, area. Encourage your colleagues to apply, as well. Space is limited and fills quickly. Learn more and apply by November 3, 2017, at AAN.com/view/NOH. •
AANnews • October 2017
Distinguish Yourself with Premier FAAN Designation If you wish to elevate your status and distinguish yourself from your peers, apply now—or nominate a colleague—to become an esteemed Fellow of the American Academy of Neurology (FAAN). Gain the recognition you deserve for your exemplary contributions to the field of neurology and become eligible to serve on the AAN Board of Directors. This offers a unique opportunity that could allow you to have a significant impact on the future direction of the AAN and the field of neurology. Learn more and apply or nominate by visiting AAN.com/view/FAAN. For more information, contact FAAN@aan.com or (800) 879-1960.
Congratulate These New FAANs! The AAN congratulates the following members who were named Fellows between April and June 2017. Baha Abu-Esheh, MD, FAAN Anat Achiron, MD, PhD, FAAN Abdulmuttaleb A. Al Sheikhly, MD, FAAN Sankar Bandyopadhyay, MD, FAAN Gurdesh Bedi, MD, FAAN Samir Belagaje, MD, FAAN Jennifer Bickel, MD, FAAN Nilton Custodio Capunay, MD, FAAN Francisco Javier Carod-Artal, MD, FAAN Marcello Cherchi, MD, PhD, FAAN Tracey Cho, MD, FAAN Anne M. Connolly, MD, FAAN Joel M. Dean, DO, FAAN John J. Doyle, MD, FAAN
Deniz Erten-Lyons, MD, FAAN Patricio S. Espinosa, MD, MPH, FAAN Ajay S. Gupta, MD, FAAN Cynthia M. Hingtgen, MD, FAAN Andres M. Kanner, MD, FAAN Eugene C. Lai, MD, PhD, FAAN Ruple S. Laughlin, MD, FAAN Adena Leder, DO, FAAN David Lira, MD, FAAN Lynn Liu, MD, FAAN Jyh-Haur Lu, MD, FAAN Nicholas J. Maragakis, MD, FAAN M. Sean Marquez, MBBS, FRCPC, FAAN Katherine D. Mathews, MD, FAAN
Nikolaus McFarland, MD, PhD, FAAN Mark Milstein, MD, FAAN Scott Douglas Newsome, DO, FAAN Katherine C. Nickels, MD, FAAN Alvaro Pascual-Leone, MD, PhD, FAAN Madan Prasad, MD, MBBS, FAAN Rachel Marie E. Salas, MD, FAAN Robert W. Schabbing, MD, FAAN Nawfal Madhi Sheaheed, MD, FAAN Ron Tintner, MD, FAAN Elaine C. Wirrell, MD, FAAN Marcus Yountz, MD, FAAN Fenny L. Yudiarto, MD, PhD, FAAN •
Participate in Neurology Career Week, October 16 to 22 The always popular Neurology Career Week is being held October 16 through 22, and you can access hundreds of open positions from leading employers across the country. Create or update your job seeker profile by October 22 and you will be entered in a drawing for a chance to win $500. Visit AAN.com/careers/career-events for more information. Don’t forget to check out helpful articles and tools to advance your career at AAN.com/careers. •
“The Neurology Career Center is the only site where we consistently source eligible candidates.” —Beth Dery Recruiting and Operations Manager, RosmanSearch
Notice If you receive a suspicious email purporting to be from the AAN, please report it to Member Services at firstname.lastname@example.org, so we can investigate. The AAN will never send you an unsolicited email asking for donations to individuals. •
AANnews • October 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
AANnews • October 2017
American Academy of Neurology Education and Research Foundation American Academy of Neurology Foundation
As Foundation Evolves, Member Support Remains Critical to Attract Public Dollars AAN leadership saw a unique opportunity when the 1990s were branded the “Decade of the Brain.” Neurology was at the threshold of great advancement, but research funding was threatened. Under the direction of then President Lewis P. “Bud” Rowland, MD, FAAN, leadership decided to harness the decade-long awareness initiative to raise much-needed research dollars. A fundraising task force was quickly developed, from which sprang the idea of the American Academy of Neurology Education and Research Foundation, which later became the American Academy of Neurology Foundation, and in 2012 grew into what we know today as the American Brain Foundation. While the name has changed, the mission has not. The American Brain Foundation continues to work closely with the AAN and its members to fund innovative research in the quest to discover better treatments, prevention, and cures for diseases of the brain and nervous system. The most recent name change signifies the American Brain Foundation’s desire to be known
Join the Rowland Circle!
Donors who give $2,500 or more cumulatively in a year will be recognized and honored in the Rowland Circle, named after AAN and Foundation Past President Lewis P. “Bud” Rowland, MD, FAAN, in memory of his generous, long-time support of the Foundation. 2017 Rowland Circle donors will be named as Charter Members and will be included in a special reception on April 25 during the 2018 Annual Meeting in Los Angeles. For more information or to become a member, contact Shelly Rucks at email@example.com or (612) 928-6318. as the Foundation for brain disease research. Just as the American Cancer Society has become known for unifying all types of cancer, it is the American Brain Foundation’s goal to be known as the organization for unifying, connecting, and funding research for all forms of brain disease and reinforcing within the public’s perception the critical relationship between all brain-related illnesses and their devastating impacts. As the Foundation becomes more publicly recognizable, charitable donations from Academy members become even more critical. Members
of the general public frequently ask about AAN member commitment; it’s important to them to know that the American Brain Foundation has the support of neurologists. As you receive your 2018 AAN membership dues renewal invoice in the mail later this month, please take special notice of the option to make an additional gift of support to the American Brain Foundation. Your investment in the Foundation speaks volumes and is critical to securing broad support and increasing reach. You may also make a gift online anytime by visiting CureBrainDisease.org. •
AANnews • October 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. Duke School of Medicine - Department of Neurology seeks Division Chief in Parkinson’s Disease and Movement Disorders Merritt Hawkins’ Department of Academics has partnered with Duke University School of Medicine and its Department of Neurology for this key recruitment. This is a rare opportunity for an outside hire to come in and lead the Division of Movement Disorders within the Department of Neurology. The school has an incredibly rich academic environment with robust clinical and surgical programs in movement disorders. This new Division Chief would be one who, not only ascribes to the same values and vision as defined by the department but also aspires to align this vision with those outside their department, including all the specialists, scientists and staff that partner in a multi-disciplinary approach to patient care. This will further the goals to develop a regional, national, and international presence in the care and science of Parkinson’s disease and other movement disorders. Background in clinical-based research, with a proven record of excellence. Visionary to support and grow current translational and basic science research. Values that align with our department, which is built on generosity, learning, and excellence. Ability to develop a business plan and have a broad understanding of all clinical based programs that can be expanded within the division. Duke University Hospital is consistently ranked near the top in the nation by US News and World Report. Furthermore, the School of Medicine is especially noted for its groundbreaking biomedical research, bringing in nearly $700 million in NIH-sponsored projects in 2016, putting it in the top 10 in NIH funding. The Duke Clinical Research Institute is the oldest and largest academic organization of its kind and is known for conducting groundbreaking multinational clinical trials, managing major national patient registries, and performing landmark outcomes research. Highlights: National Parkinson’s Foundation Center of Excellence,
Movement Disorder’s Fellowship, Parkinson’s Rehab Clinic offers patients access to a multi-disciplinary rehab evaluation, offer both conventional surgical procedures like DBS, as well as optional experimental treatments such as gene therapies, growth factor treatment, stem cells, etc., established basic science laboratories in basal ganglia physiology in the Departments of Neurology, Neuroscience and Biomedical Engineering, participate in a variety of clinical trials focused on improving the management and treatment of Parkinson’s disease, Huntington’s disease, and dystonia. The Department currently has over 80 active clinical trials, top 5 location in the nation for DBS, current research and funding in dystonia, Parkinson’s, and Huntington’s Disease, generous start-up package, top 10 NIH funding, #1 Biomedical engineering department in the nation, the Duke Clinical Research Institute is the world’s largest academic clinical research organization. Durham, the “city of medicine,” is a vibrant, welcoming, and affordable community. Durham is home to more than 300 restaurants and 40 annual festivals. Raleigh, Durham, and Chapel Hill are known for their research/technology roots and collegiate rivalries. This tri-city region (known as the Triangle) is luring nearly 80 new residents a day with strong job growth and a high quality of life. It has a combined population of more than one million, and boasts a robust intellectual climate and broad cultural diversity. Many people who call the Raleigh and Durham metro areas home are young, friendly, diverse, and educated. Housing options are plentiful and affordable—new apartment complexes, renovated mill-village houses, wonderful old houses in turn-of-the-century neighborhoods, modern condominiums, and suburban choices. Email tracy. firstname.lastname@example.org Fellowship in Neuroimaging Winchester Neurological Consultants, Inc., in conjunction with Virginia
Commonwealth University and Winchester Medical Center, is offering a clinical Neuroimaging Fellowship for BC/BE neurology graduates that can be completed in one or two years. Located approximately an hour from Washington, D.C., our United Council of Neurologic Subspecialties fully accredited fellowship offers extensive training in the performance and interpretation of diagnostic inpatient and outpatient MRI, CT, Doppler, TCD, and myelography -- utilizing four state of the art MRI scanners and four multi-slice CT units. Responsibilities include supervision and interpretation of imaging, assisting with acute stroke protocols, and direct patient care. Availability: immediate. Research interests are encouraged. Salary is $60,000.00 per year plus benefits. CV’s should be emailed to email@example.com
AANnews ® Classified Advertising he AAN offers a complete package of print, online, T and in-person recruitment advertising opportunities. Visit AAN.com/careers for all AAN options, rates, and deadlines. d copy for the December 2017 print edition of A AANnews must be submitted by November 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.
14 mi lli Ov an on d er d g ow row nlo ing ads ... !
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 October 1 nn Neurology: Functional impairments for Outcomes in a Randomized Trial of Unruptured Brain AVMs Andrew M. Southerland, MD, MSc, and Jay P. Mohr, MD nn Neurology: Quality Improvement in Neurology: Stroke and Stroke Rehabilitation Quality Measurement Set Update Daniel J. Ackerman, MD, and Julius Gene Silva Latorre, MD, MPH nn Neurology: Burnout, Career Satisfaction, and Well-being Among US Neurologists in 2016: A Qualitative Study Pearce J. Korb, MD, and Hugh Stephen Markus, DM, FRCP nn Neurology: Genetics: ExACtly Zero or Once: A Clinically Helpful Guide to Assessing Genetic Variants in Mild Epilepsies James Kiely, MD, PhD, and Samuel F. Berkovic, AM, MD, FAAN, FRACP, FRS nn Neurology: Genetics: Phenotypic and Molecular Analyses of Primary Lateral Sclerosis Elliot Dimberg, MD, and Hiroshi Mitsumoto, MD, DSc
AANnews • October 2017
Dates and Deadlines OCTOBER 2017
Application Deadline: 2018 Clinical Research Training Scholarships AAN.com/view/ResearchProgram
Application Deadline: Neurology on the Hill
Registration Deadline: RITE (Residency In-service Training Examination) AAN.com/view/rite
Webinar: Using the EHR or Axon Registry® to Drive Quality Improvement (Register by October 9) AAN.com/view/pmw17
OCTOBER 16–22 Neurology Career Week AAN.com/careers
OCTOBER 20–22 2017 AAN Fall Conference Las Vegas, NV AAN.com/view/fall
OCTOBER 23 Deadline: Call for Abstracts
OCTOBER 25 Application Deadline: AAN Awards
Webinar: iNeurology: Best IT Practices
(Register by November 6) AAN.com/view/pmw17
Submission Deadline: Resident Scholarship to the Annual Meeting AAN.com/view/ResidentScholarship
Submission Deadline: A.B. Baker Teacher Recognition Award AAN.com/view/ABBaker
Submission Deadline: Fellow Scholarship to the Annual Meeting AAN.com/view/FellowshipScholarship
Submission Deadline: Clerkship Coordinator Recognition Award AAN.com/view/ClerkshipCoordinator
Submission Deadline: Program Director Recognition Award AAN.com/view/ProgramDirectorAward
Submission Deadline: Clerkship Director Innovation Award AAN.com/view/ClerkshipInnovation
Submission Deadline: Program Coordinator Recognition Award AAN.com/view/ ProgramCoordinatorAward
Submission Deadline: Medical Student Scholarship to the Annual Meeting AAN.com/view/MedStudentScholarship
Submission Deadline: Frank A. Rubino Award for Excellence in Clinical Neurology Teaching AAN.com/view/frankrubino
Submission Deadline: Clerkship Director Teaching Award AAN.com/view/ClerkshipTeaching
Find Your Next Job
Application Deadline: UCNS Fellowship Training Program Accreditation UCNS.org/index.cfm
DECEMBER 11 Application Deadline: Palatucci Advocacy Leadership Forum AAN.com/view/PALF
Fill Your Open Job The hottest jobs meet the top candidates at the AAN Neurology Career Center.
AANnews • October 2017
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Published on Sep 21, 2017