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VOLUME 32  ·  ISSUE 2  ·  February 2018

BOOK YOUR HOTEL BY MARCH 2 Bring the Entire Family For the best rates and selection in the vibrant Los Angeles neighborhood of your choice, be sure to book your Annual Meeting accommodations by March 2. Choose from accommodations in neighborhoods such as Historic Downtown, the Fashion District, L.A. Live, Classic Hollywood, and others. The entertainment capital of the world is also a perfect family-friendly destination, brimming with activities you— and the whole family—won’t want to miss: ƒƒ Universal Studios Hollywood ƒƒ Disneyland ƒƒ Santa Monica Beach & Pier ƒƒ Marina Del Rey to see sea lions ƒƒ Getty Center art museum ƒƒ Travel Town Railroad Museum ƒƒ La Brea Tar Pits—famous Ice Age fossil excavation site ƒƒ Beverly Hills ƒƒ South Beach ƒƒ Hollywood ƒƒ More Visit AAN.com/view/AM18 today to learn more, book your hotel by March 2, and register by March 29 to get the early registration discount savings. Continued on page 6

New Continuum Updates Your Child Neurology Knowledge

Get Expert Advice on Participating in MIPS

Child neurology topics are the focus of the current issue of Continuum: Lifelong Learning in Neurology®.

Are you ready to participate in MIPS? This webinar will help you prepare to be measured in Quality, Advancing Care Information, and Improvement Activities. You will learn how to maximize your MIPS score, and understand how reporting tools will assist in the process. Get the information you need to improve your Quality score throughout the year.

Guest edited by James W. M. Owens, Jr., MD, PhD, and Shafali Jeste, MD, topics include: ƒƒ Genetic Diagnostics for Neurologists / Laura SilveiraMoriyama, MD, PhD; Alex R. Paciorkowski, MD ƒƒ Testing for Inborn Errors of Metabolism / Jennifer M. Kwon, MD, MPH, FAAN

Continued on page 24

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Discover the Impact of Research at Experiential Learning Area

9

What Did the AAN Do for You in 2017?

Fritz

Continued on page 11

12 AAN Can Help You Submit 2017 MIPS Reporting Data


AANnews · February 2018

CONTENTS

News Briefs

Book Your Hotel By March 2 New Continuum Updates Your Child Neurology Knowledge Get Expert Advice on Participating in MIPS President’s Column  Science Takes the Spotlight at Annual Meeting in Los Angeles · · · · · · · · · · · · · · ·3 Through Their Eyes  Recollections of Past AAN Presidents · · · · · · · · · · · · ·4 Conferences & Community  Discover the Impact of Research at Experiential Learning Area · · · · · · · · · · ·6 2018 Exhibit Hall Highlights— It’s More Than Just Lunch! · · · ·8 Submit Your Ideas for New Brainstorm: A Competition for the Innovator in All of Us · · · 9 What Did the AAN Do for You in 2017? · · · · · · · · 9 Don’t Put off Your Recognition as Fellow of the AAN · · · · · · · 10 Help Us Help You Better— Look for 2018 Needs Assessment Survey · · · · · · · ·11

Download New Issue of Neurology: Genetics · · · · · · · · ·12 What’s New in Neurology: Clinical Practice and Neurology Now? · · · · · · · · · 13 AAN Publications Win Editorial Awards · · · · · · · · · 13 Rural Neurologist Uses Free CMS Resource to Simplify MIPS Reporting · · · · · · · · · · 21 Podcast Central · · · · · · · · · 21 Policy & Guidelines  2018 Advocacy Efforts to Build on 2017 Successes · · · · 22 Education & Research  New, Special Pricing Available to APPs on Convenient Online Learning Program · · · · · · · · · · · · · · 23 Design Pioneer Lends Talents to New Covers · · · · · · 24 American Brain Foundation  Commitment to Cures Fundraiser Set to Take Place in Los Angeles · · · · · · 25 Careers · · · · · · · · · · · · · · · ·26 Dates & Deadlines  · · · · · · · · 27

Tools & Resources  AAN Can Help You Submit 2017 MIPS Reporting Data · · · · 12

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

For advertising rates, contact:

American Academy of Neurology 201 Chicago Avenue Minneapolis, MN 55415

Eileen R. Henry Wolters Kluwer Health | Medical Research Lippincott, Williams & Wilkins

Phone: (800) 879-1960 (toll free) (612) 928-6000 (international) Email:

memberservices@aan.com

Website: AAN.com

Phone: (732) 778-2261 Email: Eileen.Henry@wolterskluwer.com

Record RITE Registration A record number of registrations were received for the 2018 RITE® (Residency In-service Training Exam), which will be administered February 14 through 18.

Continuum and Continuum Audio Circulation for Continuum® increased in 2017, with 12,673 paid subscribers at year end, an eight-percent increase over 2016. Sales for the new package subscription of Continuum and Continuum® Audio have been strong, with 5,186 subscriptions sold as of December 18. The package subscription was phased in beginning in October with new and renewing subscribers. Starting in February, all current and new subscribers will have access to both Continuum and Continuum Audio.

New CPT Code A new CPT code for cognitive impairment assessment and care planning services, 99483, went into effect January 1, 2018, and is a positive step toward more widespread recognition by carriers of this important service. The AAN was one of many specialties that participated in the development of the code. A detailed list of the required elements to report 98943 is available on the Care Management Services Coding Table on AAN.com. 

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 34,000 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.


President’s Column 

Science Takes the Spotlight at Annual Meeting in Los Angeles Los Angeles is known as the entertainment capital of the world. But for a week in April, it will be the mecca of neurologic science at the Los Angeles Convention Center as well as at Universal Studios, where we’re thrilled to be hosting the AAN’s 70th Anniversary Celebration. We’ve held our meeting in LA twice before, in 1959 and 1978. But this gathering will be like no other, I can assure you. We’re building off exciting innovations from recent years and that includes the science program as well. Once again, we’ve broken records with more than 3,000 abstracts to be presented. Our Annual Meeting is the perfect place to learn about high-impact neuroscience, improve the quality of care for our neurological patients, get helpful advice to navigate our careers, achieve a better work life balance, connect with colleagues, and have some fun! The Science, Education, and Meeting Management Committees have worked tirelessly to make this Annual Meeting a true Academy award performance. Natalia S. Rost, MD, MPH, FAAN, FAHA, is chair of the Science Committee, and she shared these thoughts on what you will experience this April in LA. “I see science as the most dynamic element of the Annual Meeting. It’s exciting. Cutting edge. All-encompassing. Moreover, our vision for the science at the Annual Meeting is to deliver it in an effective and engaging way, as to maximize our reach to the community of neurologists and neuroscientists we serve. In this way, we strive to be indispensable to our membership, as clearly stated in the AAN’s vision. And the 2018 Annual Meeting promises to be the most exciting showcase of the best and the brightest in neurological science yet!”

The plenary sessions are always eagerly awaited. What’s in store this year? “I am always excited about the plenary sessions at the Annual Meeting, which offer an unprecedented breadth and depth of the premier neurological science. We are thrilled to welcome Dr. Francis Collins, director of the National Institutes of Health, at the Presidential Plenary this year. His presentation is both timely and significant, as he underlines the advances in neurosciences in the era of the BRAIN Initiative, the importance of support for public research funding, and the excitement

of what’s yet to come in neurological discoveries and the promise of precision medicine for our patients with neurological disorders. Along with the Presidential Plenary, these daily forums cover every subspecialty and present a comprehensive array of the latest and groundbreaking Sacco developments from contemporary clinical issues to clinical trials to controversies in neurology! I hope our attendees will join us in this ‘standing-room only’ experience!”

What other programs are at the top of your must-see list? “In addition to the plenaries, I am particularly proud of the Neuroscience in the Clinic (NIC) sessions, which first premiered in 2017 and received glowing reviews from the attendees. This session concept and format is a true testament to the nimble and innovative nature of science at the Annual Meeting—a session that has been developed in response to the feedback from our conference attendees and reflected on the best that the AAN science community has to offer: a unique blend of clinical application and dynamic dialogue with the neuroscience community. We begin with the burning clinical dilemmas that present to our neurology offices on a daily basis—like use of genetic testing in clinic, or managing a patient with suspected opioid abuse—and we dissect the scientific underpinnings of the current diagnosis and management of this clinical problem. The NICs were developed to encourage the dialogue between the clinicians and the scientists, the bi-directional flow of expertise and innovation, which brings meaning and purpose Continued on page 5


Through Their Eyes 

Recollections of Past AAN Presidents Nelson G. Richards, MD, FAAN / President 1983–1985 During 2018, AANnews celebrates the history of the Academy during its 70th anniversary with a series of interviews of past presidents. The following excerpt is from a 2017 correspondence interview between Nelson G. Richards, MD, FAAN, (NR) and AANnews editor Tim Streeter (TS). Richards, who joined the AAN in 1957, was the first practicing neurologist to be elected AAN president. He is retired and living in Virginia. TS: What motivated you to get involved in AAN leadership activities? NR: I had joined the American College of Physicians (ACP) and the practice management-oriented side by American Society of Medicine (ASIM). The Academy included both academic and practice management in one organization. The AAN was inviting participation. I started working with staff at the 1964 Annual Meeting in Denver and then became the local Annual Meeting chairman in Cleveland in 1965. I continued as chairman of this committee for a few years…. Dr. Foley, during his presidency in 1964, had talked with Dr. Herb Rosenbaum, from St. Louis, of the need for office-based neurologists at the AAN. Herb, with Dr. John Segerson of the Menninger Clinic, started organizing the Practice Committee. It was developed for the “grass-roots neurologist,” as Dr. Foley had suggested. I joined the committee. Education courses were developed for the Annual Meeting, including the Coding for Procedures (CPT) and diagnosis codes (ICD-9-CM) for the insurance companies and government Medicare/Medicaid “third-party” carrier programs. I borrowed experienced staff from the American Society of Internal Medicine to aid us in organizing and recording efficient committee meetings and the structure of the board…. I carried this experience to the Academy organization during my presidency. Advice from their membership, staff, and executive director was very supportive in my understandings of medical organizations and committees. Advice came along during difficult times at the Academy. The relationship of the ASIM, with the more academic ACP, was very similar to the Academy, where academics and practice are in our one organization. Indeed, the ACP and ASIM have joined each other. I used my observations at ASIM for the structure of the Academy.

TS: Dr. John Conomy said that you “brought the community of practicing neurologists into the mainstream of the organization and eventually into the leadership and conscience of the AAN.” What were the obstacles you faced? Who were some of the leaders who held differing views? NR: I did not feel any obstacles and found much support in changes I suggested. Academic neurologists were helpful in the understanding of our objectives not to replace but complement academic and private practices’ relationships. Some of the eastern neurologists did express some reservation in the need of an additional society in the middle of America. I asked five of the recent presidents to be available to give me suggestions and advice when needed. Maynard Cohen, the immediate past president, was very helpful and became a good friend. TS: What were the challenges of being a practicing neurologist in those days? NR: There were few referrals for the office-based neurologist. Neurological consultations were felt to be “diagnose and adios.” Detailed neurological examination was needed and the formulation of the problem, but few neurodiagnostic procedures were available. Previous neurological education had usually been minimal for most doctors… TS: Was it a challenge to get the first practice management course into the Annual Meeting in 1981?

Richards in 2003 with Executive Director and CEO Catherine M. Rydell, CAE.

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AANnews  •  February 2018

Nelson G. Richards, MD, FAAN, in 1970.


President’s Column 

NR: There was some resistance to include practice management within the Annual Meeting. Documentation of practice was related to the proper coding numbers for the patient’s insurance. Medicare/Medicaid were the “third-party payers.” The need of coding by ICD-9 and CPT were poorly understood in many practices. Efficient office management was needed, usually with the additional employment of personnel. The challenge was there. Budgets were tight with additional help being needed. TS: You were the first practicing neurologist to become AAN president in 1983. How did that come about? NR: The Academy was for all neurologists, including those in office-based practice. The courses in practice were popular. An office-based neurologist was needed. The activity of the Practice Committee may have been a source for a practicing neurologist. TS: Was it difficult to get the Executive Board to adjust the schedule of the Annual Meeting to better accommodate practitioners? NR: No, I had great support from the previous presidents and chairmen of the Education Committee. When we placed the courses at both ends of the scientific papers presentation it was based on the desire that all partners at home should get access to the meeting. This was developed to make it possible for those members who came to the meeting to return home and allow their associates, who were at home in their active practice, to come to meetings. TS: Can you talk about Stanley Nelson when he was executive director? What was his style and his contribution to the success of the AAN? NR: He was working with a very small staff and had little contact with the membership for doing a difficult job. The AAN was growing in membership and organizational activities. He, and his small staff, organized and set up the conventions. He was always pleasant with the various problems. He needed help. He was basically a CPA. TS: There were only a dozen or so employees on staff when you were president. Did that impede the Academy’s efforts to serve its members, or was that a “simpler time” back then? NR: It was a simpler time. I had a new basic change in the Academy to one similar to the ASIM in function and activity. Staff and members worked together with almost no resistance. With the two-year president’s appointment, the first year was involved with structure and committee selection, and the second year, there was the application of the action of the appointed committee. It was really a great time. Visit AAN.com/view/AANhistory to read the complete transcript of Richard’s interview and learn more about how the AAN evolved in the 1960s and 1970s. 

Science Takes the Spotlight at Annual Meeting in Los Angeles  continued from 3 to the clinical applications of scientific discoveries—and, ultimately, benefits our patients. This type of exchange is only possible at the AAN Annual Meeting, where the clinical neurology and neuroscience worlds come together. Other highlights of the meeting include the “Best Of” scientific platforms, Poster Neighborhoods, and Emerging Science.

One of the most exciting innovations of the last two Annual Meetings are the Experiential Learning Areas, or ELAs, that appear throughout the venues. Will science play a part in these presentations? “Certainly. Another particular science program feature that I am excited about at the Annual Meeting is the return of our Research Corner, one of the seven Experiential Learning Areas. You have not fully experienced the Annual Meeting if you have not attended one of the most dynamic, motivating, and innovative ‘open’ formats that the Annual Meeting has to offer at the ELAs. It’s young, it’s interactive, it’s literally buzzing with excitement! Our Research Corner has been a particular hit with the neurology trainees and junior faculty, who gained advice from our colleagues in the NINDS Career Development program, learned about the tricks of grant writing, contemplated on the complexity of the FDA regulations, and cheered for their colleagues presenting prize-winning abstracts! I will be stopping by Research Corner daily—and I encourage my colleagues to join us there as well.” Along with an abundance of science programming, this year’s meeting also includes 235 expert-led education courses in a variety of formats. And to mark our 70th anniversary, on Sunday, April 22, the AAN will host a special celebration as we take over Universal Studios. The first 4,000 Annual Meeting registered attendees will receive free tickets to this spectacular event. I look forward to celebrating with many of you in Tinseltown. You can learn more at AAN.com/view/AM18, as well as make your travel and hotel arrangements. The deadline for discounted hotel rates is March 2, and the final day to get the early registration discount is March 29. I encourage you to move quickly, as this could be the AAN’s biggest and most popular Annual Meeting ever! 

Ralph L. Sacco, MD, MS, FAHA, FAAN President, AAN rsacco@aan.com @DrSaccoNeuro on Twitter

AANnews  •  February 2018 5


Conferences & Community 

Discover the Impact of Research at Experiential Learning Area Research is vital to the future of neurology. Find out how it’s making a significant impact on patient care, discover new and valuable resources to start a career in research, and learn about opportunities to accelerate your research at the Research Corner: Moving Neurology Forward Experiential Learning Area at the 2018 Annual Meeting. The informative, interactive area will feature themed days of programming throughout the week, including: ƒƒ Spotlighting the AAN Research Program and the 2018 grant recipients ƒƒ Learn more about research funding opportunities from the American Brain Foundation

ƒƒ Bridge Research Recommendations for Residents and Fellows ƒƒ Finding Collaborators ƒƒ How to Get a K-Award ƒƒ Recruiting Difficult and Underrepresented Populations in Research ƒƒ Working with an Epidemiologist For the full presentation schedule and descriptions, visit AAN.com/view/ELA. Register today to attend the Annual Meeting at AAN.com/view/AM18. 

ƒƒ Highlighting the careers of women in research ƒƒ Collaboration with the National Institute of Neurological Disorders and Stroke (NINDS) ƒƒ Recognition of 2018 scientific award winners ƒƒ Scientific platform sessions featuring abstract presenters discussing their recent research findings

NEW! Office Hours Stop in throughout the week to get your questions answered by leading researchers and mentors and to work in a small group setting on the following topics: ƒƒ Surviving as a Clinician Researcher

Book Your Hotel By March 2  continued from cover Please be advised of unofficial solicitations to secure housing for Annual Meeting that may target you. Convention Management Resources, Inc., is the only official housing company for the AAN. Companies such as Congress Makers and HICORD, along with other third-party housing and travel companies, are not affiliated with the AAN in any way, nor are they authorized to represent the AAN, and should be avoided. For your own protection, please do not make reservations through any unknown housing or travel company.  A legitimate company would not call or contact you unless you had initiated contact with it first. If you receive a

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AANnews  •  February 2018

call or email from any company that is not our official housing provider, please contact the AAN immediately. Look for this seal to ensure you are booking through the AAN’s official housing vendor, CMR, and only book on sites where you see this seal.

Submit Abstracts by February 8 for Emerging Science Program If you conducted major research since the October 23, 2017, AAN Annual Meeting abstract deadline, then be sure and submit your abstracts by no

later than February 8 to be considered for the 2018 meeting’s Emerging Science program. Visit AAN.com/ view/18emergingscience for eligibility requirements and to conveniently submit online. For more information, contact science@aan.com or (612) 928-6103.

Watch Your Mailbox for 2018 Annual Meeting Scientific Program The 2018 Annual Meeting Scientific Program will come to your mailbox in March and showcase more than 3,000 abstracts in a wide variety of formats. 


Bring the Entire Family! Why make the trip to the Annual Meeting alone? Vibrant and exciting Los Angeles is the perfect family-friendly destination—full of activities for you to share with your family. Enjoy the enhanced Family Room in the Los Angeles Convention Center: • Private mothers’ area for nursing mothers • Changing stations • Special lounge area where everyone in the family can come and relax • Livestreams of courses, Plenary Sessions, and more

Check with your hotel concierge on or before arrival for details on child care options throughout the city. Take the whole family to some of the best fun and entertainment Los Angeles has to offer, including: • Universal Studios Hollywood • Disneyland • Santa Monica Beach & Pier • Marina Del Rey beaches and water sports • Getty Center Art Museum for Kids • California Science Center • La Brea Tar Pits • Much more!

Visit AAN.com/view/FamilyFriendly to learn more about all the fun opportunities awaiting your family!

ADVANCING NEUROLOGY. ADVANCING YOU.


Conferences & Community 

2018 Exhibit Hall Highlights—It’s More Than Just Lunch! The Annual Meeting Exhibit Hall has always offered valuable opportunities for attendees to meet organizations and learn about exciting new products and services that can help you do your job better and provide the best possible care for patients. It’s also always provided popular and much-appreciated lunches. But the Exhibit Hall is much more. As it continues to grow and expand, so too does the breadth of its offerings: ƒƒ AAN’s Innovation Hub Stretch your brain in new directions at this creative and interactive area featuring unique physician-lead presentations, teleneurology demonstrations, daily paint and wine sessions, and more!

ƒƒ Technology Pavilion Experience cutting-edge technology that can change the way you care for patients. ƒƒ Charging Hubs Charge your devices while you check in with your office, catch up on emails, or just relax in these comfortable areas. 

ƒƒ Association Neighborhood Visit with our association partners who are fighting to further disease awareness and help raise funds to find cures. ƒƒ Career Fair Neighborhood Learn about career opportunities available nationwide. ƒƒ Buzz Café This new area is a great spot to reconnect with colleagues while enjoying a complimentary caffeinated beverage.

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AANnews  •  February 2018


Submit Your Ideas for New Brainstorm: A Competition for the Innovator in All of Us The AAN is seeking innovative idea submissions for a new event at the 2018 Annual Meeting on Monday, April 23, from 4:30 p.m. to 6:00 p.m. at the Innovation Hub presentation stage in the Exhibit Hall. Brainstorm: A Competition for the Innovator in All of Us will be a game-style event judged by AAN members that allows participants to

present inventive solutions to challenges related to patients, practice, or any other medical-related issue.

and submit your video at AAN.informz. net/AAN/pages/18_AM_Exhibit_Hall_ Submission. Those submitters who are selected will have the opportunity to present on stage before the judges for discussion and critique. All Annual Meeting attendees are invited to come and watch their trailblazing colleagues. Learn more at AAN.com/view/AM18. 

Members who are interested in presenting highly original ideas at the event are encouraged to submit a video, no more than 1.5 minutes long, giving a brief description of the challenge and solution. Learn more about the event

What Did the AAN Do for You in 2017? If you are wondering what the AAN has done for you recently, you’re invited to take a look at the 2017 Annual Report, posted online later this month at AAN.com/view/annualreport.

continues to challenge our superb staff with higher goals and expectations. And last year, like always, our outstanding staff continued to help us be indispensable to our members.”

The report covers last year’s accomplishments of Academy member volunteers and staff in the areas of practice, public policy, conferences, continuing education, and more. The organization’s successful financial results for the year are reviewed as well. The report looks forward to a challenging 2018 with an outline of the AAN’s strategic plan.

Stay connected to what the AAN is doing for you by reading your monthly issue of AANnews, checking your inbox for AANe-news® and other Academy emails, and regularly visiting AAN.com. 

In their introduction to the report, President Ralph L. Sacco, MD, MA, FAHA, FAAN, and Executive Director and CEO Catherine M. Rydell, CAE, noted the collaborative efforts of members and staff. “These top successes—and the countless other accomplishments across the Academy—were made possible only by thousands of volunteer members who gave of their time and energy in innumerable ways, from serving on committees to creating quality measures, reviewing journal papers, or directing conference programs. The Academy enjoyed a smooth and successful transition last April from the presidency of Terrence L. Cascino, MD, FAAN, who continues to share his insights as immediate past president. Membership elected a dynamic and ambitious Board of Directors that

E P O RT ANNUAL R

Neurology ® Podcasts:

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AANnews  •  February 2018 9


Conferences & Community 

Don’t Put off Your Recognition as Fellow of the AAN The AAN Board of Directors recently elevated 62 members to Fellows of the American Academy of Neurology, bringing the total to 196 for 2017. And it’s possible several thousand more members are eligible—without even knowing it! “It’s very easy to overlook the fact that you may have already fulfilled the requirements to become a Fellow of the American Academy of Neurology,” suggested David J. Capobianco, MD, FAAN, chair of the Member Application Review Subcommittee. “Over the years of your AAN membership, you may have attended the necessary number of Annual Meetings, or have distinguished yourself in an academic or clinical setting or through community service. You may be very close to meeting the criteria—or you may have surpassed it! It’s certainly worth taking a couple minutes to go online and find out.”

Capobianco

Members can track their FAAN eligibility status within their AAN member profile or view the qualification information and apply or nominate a colleague by visiting AAN.com/view/FAAN. “There is no deadline, so it’s one of those things that might be easy to put off or forget about,” Capobianco said. “But it does give you recognition among your peers and your community for your contributions to the field of neurology. It also makes you eligible to serve on the AAN Board of Directors, if you aspire to that leadership role. The application process is simple and not time-consuming, and the Board makes its decisions quarterly. In just a matter of months, you could appear in an AANnews article celebrating your new FAAN designation.” If you have questions about the Fellow status, how to nominate a colleague, or the application process, contact FAAN@aan.com or (800) 879-1960.

Congratulate These New FAANs! The AAN congratulates the following members who were named Fellows between October and December 2017.

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Robert H. Baloh, MD, PhD, FAAN

Justin Y. Kwan, MD, FAAN

David P. Richman, MD, FAAN

Selim R. Benbadis, MD, FAAN

Kathrin LaFaver, MD, FAAN

Eva K. Ritzl, MD, FAAN

Eugene Benjamin, MD, FAAN

Oscar L. Lopez, MD, FAAN

Jose Gabriel Romano, MD, FAAN

Elinor Ben-Menachem, MD, FAAN

Jean K. Mah, MD, FRCPC, FAAN

Rebecca Romero, MD, FAAN

James H. Bower, MD, MSc, FAAN

E.E. Marsh III, MD, FAAN

Philip Scheltens, MD, PhD, FAAN

Laura S. Boylan, MD, FAAN

Lora J. McGill, MD, FAAN

Holly A. Shill, MD, FAAN

Michael Chez, MD, FAAN

Yahya M. Mousali, MD, FAAN

Jason J. Sico, MD, FAAN

Felix Chukwudelunzu, MD, FAAN

Maciej M. Mrugala, MD, FAAN

Ericka P. Simpson, MD, FAAN

Robert Coni, DO, FAAN

Andrew M. Naidech, MD, FAAN

Carlos Cosentino, MD, FAAN

Sreekumaran Nair, MD, FAAN

Mamta Bhushan Singh, MBBS, MD, DM, FAAN

Bruce A.C. Cree, MD, PhD, MCR, FAAN

Shinji Ohara, MD, FAAN

Chaouki K. El-Khoury, MD, FAAN

Jyoti Pillai, MD, MBBS, MR, FAAN

Todd D. Elmore, MD, FAAN

Silva Markovic Plese, MD, FAAN

Briseida E. Feliciano-Astacio, MD, FAAN

Mary Jo Pugh, PhD, RN, FAAN

Oscar Gonzales Gamarra, MD, FAAN

Alexander D. Rae-Grant, MD, FAAN

Georges A. Ghacibeh, MD, FAAN

James B. Ragland, MD, FAAN

Padma S. Gunaratne, MD, FAAN

Kishore N. Ranade, MD, FAAN

H. Huntley Hardison, MD, FAAN

Lakshmi N. Ranganathan, MD, FAAN

Bahaa Hassan, MD, FAAN

Mary R. Rensel, MD, FAAN

Ging-Yuek R. Hsiung, MD, FAAN

Kourosh Rezania, MD, FAAN

Nicholas Elwood Johnson, MD, FAAN

Irene Richard, MD, FAAN

Pooja Khatri, MD, FAAN

Sarah Pirio Richardson, MD, FAAN

AANnews  •  February 2018

Albert Z. Szabo, MD, FAAN Tania F. Tayah, MD, FAAN Brian A. Trimble, MD, FAAN Bhargava Arvindbabu Trivedi, MD, FAAN Charles J. Vecht, MD, PhD, FAAN Guha Venkatraman, MD, FAAN James Wang, MD, PhD, FAAN Daniel Woo, MD, FAAN Lawrence A. Zumo, MD, FAAN 


Help Us Help You Better—Look for 2018 Needs Assessment Survey Hearing from members is the best way for AAN leadership to ensure your Academy is most relevant to you. The AAN will be sending out its 2018 AAN Needs Assessment Survey this month via email and mail to select members. If selected, we hope you will consider completing this important survey, so we can continue to improve our understanding of your unique needs. The survey should only take about 15 minutes to complete and the deadline is March 30. Your individual responses will be kept confidential and will be reported only in aggregate form. If you have any questions about the survey, contact Chris Keran, Senior Director, Member Insights, at ckeran@aan.com or (612) 928-6116. We are continually working to improve the value of your AAN membership, and feedback from this survey is critical in setting direction. Some recent examples include:

ƒƒ Updating AAN.com to offer a more personalized and relevant user experience with expanded and updated search functionality ƒƒ Offering MOC resources free with membership in response to members asking us to charge less for these resources ƒƒ Customizing membership for nurse practitioners, physician assistants, and business administrators to meet their needs ƒƒ Expanding representation on the Board of Directors in response to members asking for more diversified leadership 

Get Expert Advice on Participating in MIPS  continued from cover Successfully Participating in MIPS February 20, 2018 12:00 p.m.–1:00 p.m. ET Deadline to Register: February 19 Faculty: Joseph V. Fritz, PhD Remember, many of the 2018 practice management webinars will include a panel to provide more perspectives on the information presented. Also, members who subscribe to the complete

series of webinars can access a Synapse online community page to ask further questions, whether they participate live or watch the recorded webinar.

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. Physicians receive 1 AMA PRA Category 1 Credit™ per webinar; non-physicians receive a certificate of completion. Visit AAN.com/view/pmw18 to learn more and register, or contact Jessica Nickrand at jnickrand@aan.com. 

Subscribe to All Webinars for Best Member Value The AAN’s practice management webinars provide the valuable insights and tools you need to navigate through the ever-changing health care landscape—and receive year-end CME credits! Single webinars are $99 but

AANnews  •  February 2018 11


Tools & Resources 

AAN Can Help You Submit 2017 MIPS Reporting Data

Download New Issue of Neurology: Genetics

The 2018 performance year for the Merit-based Incentive Payment System (MIPS) may be underway, but you still have time to submit data to avoid a negative payment adjustment for the 2017 reporting year. MIPS has deadlines quickly approaching, so now is the time to submit your data to avoid a negative payment adjustment on your 2019 Medicare reimbursements for reporting year 2017.

A new issue of Neurology ® Genetics is available for downloading. The issue provides a compilation of more than a dozen articles and clinical/scientific notes on an array of brain research topics, including “Alzheimer Risk Loci and Associated Neuropathology in a Populationbased Study (Vantaa 85+),” “1q21.1 Duplication Syndrome and Epilepsy—Case Report and Review,” and “Late Onset and Acute Presentation of Brown-Vialetto-Van Laere Syndrome in a Brazilian Family.”

If you still need a way to submit, the AAN has a solution for you! The AAN partners with a registry vendor, Premier, that has a manual submission registry called MIPSwizard®. This product is provided at a reduced cost to AAN members and can be used to submit any or all of the three components of the MIPS program required in 2017: Quality, Advancing Care Information, and Improvement Activities. The deadline for submitting data through Premier is February 28, so you have just a few more weeks to take advantage of this opportunity. For those looking to establish a long-term plan for meeting MIPS requirements, check out the AAN’s Axon Registry ®. The Axon Registry is a Qualified Clinical Data Registry that can calculate quality measures using data from your EHR and can be used to satisfy all three components of MIPS. It’s a free benefit for AAN US members and can be used for much more than just MIPS requirements: It gives providers the ability to implement quality improvement in their practice, meets the MOC Part IV PIP clinical module activity, and waives eight credits of Part II Self-assessment.

Access this issue at NG.neurology.org/content/by/year. 

It can take three to six months to integrate a practice with the Axon Registry, so completing enrollment now is important to stay on track for the reporting year. Visit AAN.com/view/Axon for more information about measures in the registry, ways to transfer data, and how to enroll. To learn more about MIPSwizard and MIPS, contact MACRA@aan.com. 

Neurology Disputes & Debates:

Join the Discussion! Comment on Neurology® journal articles and read what others are saying at Neurology.org/N 12

AANnews  •  February 2018


What’s New in Neurology: Clinical Practice and Neurology Now? 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 receive for your patients or to update your clinic address. 

Sporting a new, vibrant cover design, this month’s Neurology ® Clinical Practice offers research papers including “Wake-up Stroke Is Not Associated with Sleep-Disordered Breathing in Women,” “Neuroradiologic Manifestations of Erdheim-Chester Disease,” and “A Pilot Study of Volume Contracted State and Hospital Outcome After Stroke.” Of note to practitioners who treat patients with concussion is the editorial “Calling It Quits: Abandoning a Sport You Love After Concussion.” 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. In the cover story of the February/March 2018 issue of Neurology Now ®, TV broadcaster Soledad O’Brien talks about her son Jackson, who was diagnosed with sensorineural hearing loss when he was in first grade. Now age 12 and in 7th grade, Jackson is thriving thanks to hearing aids and learning to advocate for himself.

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Another feature looks at the high cost of prescription drugs and what patients and neurologists can do about it. The third feature chronicles the remarkable story of Alfredo Quinones-Hinojosa—from migrant farm worker in California to renowned brain surgeon at the Mayo Clinic— and how he’s working to address disparities in health care between Latinos and Caucasians for brain tumors and aneurysms.

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AAN Publications Win Editorial Awards In October, Neurology Today ® and Neurology Now ® each won honorable mentions in the 2017 FOLIO: Eddie & Ozzie Awards competition, which recognizes excellence in magazine editorial and design for both trade and consumer publications. The AAN publications were selected by a panel of judges from more than 2,500 entries.

Neurology Today won for its series of articles on salary disparities between men and women in neurology: “Salary Disparities Reported Between Men and Women Academic Physicians—The Widest Gap Is in Neurology” (http://bit.ly/NT-salarydisparities); “Gender Salary Inequality

Worst in Neurology: What Can Be Done to Remedy the Matter?” (http://bit.ly/NT-gendersalarygap); “The Leakiest Pipeline: All Too Few Women Get to Run Their Own Neuroscience Labs” (http://bit.ly/NT-leakiestpipeline).

Neurology Now won for the single article, “Going on Record: Patients have a right to their medical records but often don't know how to access them” (http://bit.ly/NN-goingonrecord). 

AANnews  •  February 2018 13


For the treatment of partial-onset seizures in patients 4 years of age and older.

ANTISEIZURE THERAPY FINE-TUNED FOR YOUR PATIENTS


ED AND INDI P X

NEW E

TION CA

FOR PATIENTS 4 YEARS AND OLDER

APTIOM® (eslicarbazepine acetate) IS A ONCE-DAILY CRUSHABLE AED FDA APPROVED FOR ADULT AND PEDIATRIC PATIENTS APTIOM is indicated for the treatment of partial-onset seizures in patients 4 years of age and older. • Once-daily immediate-release AED therapy—can be taken either whole or crushed, with or without food

Important Safety Information for APTIOM Contraindications: APTIOM is contraindicated in patients with a hypersensitivity to eslicarbazepine acetate or oxcarbazepine. Suicidal Behavior and Ideation: Antiepileptic drugs (AEDs), including APTIOM, increase the risk of suicidal thoughts or behavior. Anyone considering prescribing APTIOM or any other AED must balance this risk with the risk of untreated illness. Epilepsy and many other illnesses for which AEDs are prescribed are themselves associated with morbidity and mortality and an increased risk of suicidal thoughts and behavior. Patients treated with any AED for any indication should be monitored for the emergence or worsening of depression, suicidal thoughts or behavior, and/or any unusual changes in mood or behavior. Patients and caregivers should also be advised to be alert to these behavioral changes and to immediately report them to the health care provider. Serious Dermatologic Reactions, including Stevens-Johnson Syndrome (SJS) and toxic epidermal necrolysis (TEN), have been reported in association with APTIOM use. Serious and sometimes fatal dermatologic reactions, including TEN and SJS, have also been reported in patients using oxcarbazepine or carbamazepine, which are chemically related to APTIOM. Should a patient develop a dermatologic reaction while using APTIOM, discontinue APTIOM use unless it is clearly not drug related.

Please see additional Important Safety Information and Brief Summary of Full Prescribing Information on adjacent pages.

Dosing Considerations Some adverse reactions occur more frequently when patients take APTIOM adjunctively with carbamazepine. When APTIOM and carbamazepine are taken concomitantly, the dose of APTIOM or carbamazepine may need to be adjusted based on efficacy and tolerability. APTIOM should not be taken as an adjunctive therapy with oxcarbazepine. For patients taking other enzymeinducing AEDs (i.e., phenobarbital, phenytoin, and primidone), higher doses of APTIOM may be needed. A dose reduction is recommended in patients with moderate and severe renal impairment (i.e., creatinine clearance <50 mL/min). Dose adjustments are not required in patients with mild to moderate hepatic impairment. Use of APTIOM in patients with severe hepatic impairment has not been studied, and use in these patients is not recommended. Concomitant use of APTIOM and oral contraceptives containing ethinylestradiol and levonorgestrel is associated with lower plasma levels of these hormones. Patients should use additional or alternative non-hormonal birth control during APTIOM treatment and after discontinuation of APTIOM for one menstrual cycle, or until otherwise instructed.

For more information, visit www.AptiomHCP.com.


Important Safety Information Indications and Usage Aptiom® (eslicarbazepine acetate) is indicated for the treatment of partial-onset seizures in patients 4 years of age and older. Important Safety Information for APTIOM Contraindications: APTIOM is contraindicated in patients with a hypersensitivity to eslicarbazepine acetate or oxcarbazepine. Suicidal Behavior and Ideation: Antiepileptic drugs (AEDs), including APTIOM, increase the risk of suicidal thoughts or behavior. Anyone considering prescribing APTIOM or any other AED must balance this risk with the risk of untreated illness. Epilepsy and many other illnesses for which AEDs are prescribed are themselves associated with morbidity and mortality and an increased risk of suicidal thoughts and behavior. Patients treated with any AED for any indication should be monitored for the emergence or worsening of depression, suicidal thoughts or behavior, and/or any unusual changes in mood or behavior. Patients and caregivers should also be advised to be alert to these behavioral changes and to immediately report them to the health care provider. Serious Dermatologic Reactions, including Stevens-Johnson Syndrome (SJS) and toxic epidermal necrolysis (TEN), have been reported in association with APTIOM use. Serious and sometimes fatal dermatologic reactions, including TEN and SJS, have also been reported in patients using oxcarbazepine or carbamazepine, which are chemically related to APTIOM. Should a patient develop a dermatologic reaction while using APTIOM, discontinue APTIOM use unless it is clearly not drug related. Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS), also known as Multiorgan Hypersensitivity, has been reported in patients taking APTIOM. DRESS typically, although not exclusively, presents with fever, rash, and/or lymphadenopathy, in association with other organ system involvement. If this reaction is suspected, treatment with APTIOM should be discontinued. Anaphylactic Reactions and Angioedema: Rare cases of anaphylaxis and angioedema have been reported in patients taking APTIOM. Anaphylaxis and angioedema associated with laryngeal edema can be fatal. If a patient develops any of these reactions, the drug should be discontinued. Patients with a prior anaphylactic-type reaction after treatment with either oxcarbazepine or APTIOM should not be treated with APTIOM. Hyponatremia: Clinically significant hyponatremia (sodium <125 mEq/L) and syndrome of inappropriate antidiuretic hormone secretion (SIADH) can develop in patients taking APTIOM. Measurement of serum sodium and chloride levels should be considered during maintenance treatment with APTIOM, particularly if the patient is receiving other medications known to decrease serum sodium levels. Depending on the severity of hyponatremia, the dose of APTIOM may need to be reduced or discontinued. Neurological Adverse Reactions: APTIOM causes dose-dependent increases in the following reactions (dizziness, disturbance in gait and coordination, somnolence, fatigue, and visual changes). There was an increased risk of dizziness, disturbance in gait and coordination, and visual changes during the titration period (compared to maintenance treatment), and there may be an increased risk of these adverse reactions in patients 60 years of age and older compared to younger adults. APTIOM causes dose-dependent increases in cognitive dysfunction-related events in adults (memory impairment, disturbance in attention, amnesia, confusional state, aphasia, speech disorder, slowness of thought, disorientation, and psychomotor retardation). The incidences of dizziness and diplopia were greater with concomitant use of APTIOM and carbamazepine compared to the use of APTIOM without carbamazepine.

APTIOM is a registered trademark of , used under license. SUNOVION and are registered trademarks of Sumitomo Dainippon Pharma Co., Ltd. Sunovion Pharmaceuticals Inc. is a U.S. subsidiary of Sumitomo Dainippon Pharma Co., Ltd. ©2017 Sunovion Pharmaceuticals Inc. All rights reserved. 12/17 APT219-17

Prescribers should advise patients against engaging in hazardous activities requiring mental alertness, such as operating motor vehicles or dangerous machinery, until the effect of APTIOM is known. Withdrawal of AEDs: As with all AEDs, APTIOM should be withdrawn gradually because of the risk of increased seizure frequency and status epilepticus, but if withdrawal is needed because of a serious adverse event, rapid discontinuation can be considered. Drug Induced Liver Injury: Hepatic effects, ranging from mild to moderate elevations in transaminases (>3 times the upper limit of normal) to rare cases with concomitant elevations of total bilirubin (>2 times the upper limit of normal) have been reported with APTIOM use. Baseline evaluations of liver laboratory tests are recommended. APTIOM should be discontinued in patients with jaundice or other evidence of significant liver injury. Abnormal Thyroid Function Tests: Dose-dependent decreases in serum T3 and T4 (free and total) values have been observed in patients taking APTIOM. These changes were not associated with other abnormal thyroid function tests suggesting hypothyroidism. Abnormal thyroid function tests should be clinically evaluated. Hematologic Adverse Reactions: Rare cases of pancytopenia, agranulocytosis, and leukopenia have been reported during postmarketing use in patients treated with APTIOM. Discontinuation of APTIOM should be considered in patients who develop pancytopenia, agranulocytosis, or leukopenia. Most Common Adverse Reactions: The most common adverse reactions in adult patients receiving APTIOM (≥4% and ≥2% greater than placebo) were dizziness, somnolence, nausea, headache, diplopia, vomiting, fatigue, vertigo, ataxia, blurred vision, and tremor. Adverse reactions in pediatric patients are similar to those seen in adult patients. Safety and Efficacy in Patients <4 Years of Age: Safety and effectiveness in patients below 4 years of age have not been established. Dosing Considerations Some adverse reactions occur more frequently when patients take APTIOM adjunctively with carbamazepine. When APTIOM and carbamazepine are taken concomitantly, the dose of APTIOM or carbamazepine may need to be adjusted based on efficacy and tolerability. APTIOM should not be taken as an adjunctive therapy with oxcarbazepine. For patients taking other enzyme-inducing AEDs (i.e., phenobarbital, phenytoin, and primidone), higher doses of APTIOM may be needed. A dose reduction is recommended in patients with moderate and severe renal impairment (i.e., creatinine clearance <50 mL/min). Dose adjustments are not required in patients with mild to moderate hepatic impairment. Use of APTIOM in patients with severe hepatic impairment has not been studied, and use in these patients is not recommended. Concomitant use of APTIOM and oral contraceptives containing ethinylestradiol and levonorgestrel is associated with lower plasma levels of these hormones. Patients should use additional or alternative non-hormonal birth control during APTIOM treatment and after discontinuation of APTIOM for one menstrual cycle, or until otherwise instructed. Please see Brief Summary of Full Prescribing Information on adjacent pages.


The relative risk for suicidal thoughts or behavior was higher in clinical trials in patients with epilepsy than in clinical trials in patients with psychiatric or other conditions, but the absolute risk differences were similar for epilepsy and psychiatric indications.

BRIEF SUMMARY OF FULL PRESCRIBING INFORMATION INDICATIONS AND USAGE Partial-Onset Seizures APTIOM (eslicarbazepine acetate) is indicated for the treatment of partial-onset seizures in patients 4 years of age and older.

CONTRAINDICATIONS APTIOM is contraindicated in patients with a hypersensitivity to eslicarbazepine acetate or oxcarbazepine.

WARNINGS AND PRECAUTIONS Suicidal Behavior and Ideation Antiepileptic drugs (AEDs), including APTIOM, increase the risk of suicidal thoughts or behavior in patients taking these drugs for any indication. Patients treated with any AED for any indication should be monitored for the emergence or worsening of depression, suicidal thoughts or behavior, and/or any unusual changes in mood or behavior. Pooled analyses of 199 placebo-controlled clinical trials (mono- and adjunctive therapy) of 11 different AEDs showed that patients randomized to one of the AEDs had approximately twice the risk (adjusted Relative Risk 1.8, 95% confidence interval [CI]: 1.2, 2.7) of suicidal thinking or behavior compared to patients randomized to placebo. In these trials, which had a median treatment duration of 12 weeks, the estimated incidence of suicidal behavior or ideation among 27,863 AED-treated patients was 0.43%, compared to 0.24% among 16,029 placebo-treated patients, representing an increase of approximately one case of suicidal thinking or behavior for every 530 patients treated. There were four suicides in drugtreated patients in the trials and none in placebotreated patients, but the number of events is too small to allow any conclusion about drug effect on suicide. The increased risk of suicidal thoughts or behavior with AEDs was observed as early as one week after starting treatment with AEDs and persisted for the duration of treatment assessed. Because most trials included in the analysis did not extend beyond 24  weeks, the risk of suicidal thoughts or behavior beyond 24 weeks could not be assessed. The risk of suicidal thoughts or behavior was generally consistent among drugs in the data analyzed. The finding of increased risk with AEDs of varying mechanisms of action and across a range of indications suggests that the risk applies to all AEDs used for any indication. The risk did not vary substantially by age (5-100 years) in the clinical trials analyzed. Table 3 shows absolute and relative risk by indication for all evaluated AEDs. Table 3: Risk of Suicidal Thoughts or Behaviors by Indication for Antiepileptic Drugs in the Pooled Analysis

Indication

Placebo Drug Relative Risk: Patients Patients Incidence of with with Events in Events Events Drug Patients/ Per 1000 Per 1000 Incidence in Patients Patients Placebo Patients

Risk Differences: Additional Drug Patients with Events Per 1000 Patients

Epilepsy

1.0

3.4

3.5

2.4

Psychiatric

5.7

8.5

1.5

2.9

Other

1.0

1.8

1.9

0.9

Total

2.4

4.3

1.8

1.9

Anyone considering prescribing APTIOM or any other AED must balance this risk with the risk of untreated illness. Epilepsy and many other illnesses for which AEDs are prescribed are themselves associated with morbidity and mortality and an increased risk of suicidal thoughts and behavior. Should suicidal thoughts and behavior emerge during treatment, the prescriber needs to consider whether the emergence of these symptoms in any given patient may be related to the illness being treated. Patients, their caregivers, and families should be informed that AEDs increase the risk of suicidal thoughts and behavior and should be advised of the need to be alert for the emergence or worsening of the signs and symptoms of depression; any unusual changes in mood or behavior; or the emergence of suicidal thoughts, behavior, or thoughts about selfharm. Behaviors of concern should be reported immediately to healthcare providers. Serious Dermatologic Reactions Serious dermatologic reactions including StevensJohnson Syndrome (SJS) and toxic epidermal necrolysis (TEN) have been reported in association with APTIOM use. Serious and sometimes fatal dermatologic reactions, including TEN and SJS, have also been reported in patients using oxcarbazepine or carbamazepine which are chemically related to APTIOM. The reporting rate of these reactions associated with oxcarbazepine use exceeds the background incidence rate estimates by a factor of 3- to 10-fold. The reporting rates for APTIOM have not been determined. Risk factors for the development of serious and potentially fatal dermatologic reactions with APTIOM use have not been identified. If a patient develops a dermatologic reaction while taking APTIOM, discontinue APTIOM use, unless the reaction is clearly not drug-related. Patients with a prior dermatologic reaction with oxcarbazepine, carbamazepine, or APTIOM should ordinarily not be treated with APTIOM. Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS)/Multiorgan Hypersensitivity Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS), also known as Multiorgan Hypersensitivity, has been reported in patients taking APTIOM. DRESS may be fatal or life-threatening. DRESS typically, although not exclusively, presents with fever, rash, and/or lymphadenopathy, in association with other organ system involvement, such as hepatitis, nephritis, hematological abnormalities, myocarditis, or myositis sometimes resembling an acute viral infection. Eosinophilia is often present. Because this disorder is variable in its expression, other organ systems not noted here may be involved. It is important to note that early manifestations of hypersensitivity, such as fever or lymphadenopathy, may be present even though rash is not evident. If such signs or symptoms are present, the patient should be evaluated immediately. APTIOM should be discontinued and not be resumed if an alternative etiology for the signs or symptoms cannot be established. Patients with a prior DRESS reaction with either oxcarbazepine or APTIOM should not be treated with APTIOM. Anaphylactic Reactions and Angioedema Rare cases of anaphylaxis and angioedema have been reported in patients taking APTIOM. Anaphylaxis and angioedema associated with laryngeal edema can be fatal. If a patient develops any of these reactions

after treatment with APTIOM, the drug should be discontinued. Patients with a prior anaphylactic-type reaction with either oxcarbazepine or APTIOM should not be treated with APTIOM. Hyponatremia Clinically significant hyponatremia (sodium <125 mEq/L) can develop in patients taking APTIOM. Measurement of serum sodium and chloride levels should be considered during maintenance treatment with APTIOM, particularly if the patient is receiving other medications known to decrease serum sodium levels, and should be performed if symptoms of hyponatremia develop (e.g., nausea/vomiting, malaise, headache, lethargy, confusion, irritability, muscle weakness/ spasms, obtundation, or increase in seizure frequency or severity). Cases of symptomatic hyponatremia and syndrome of inappropriate antidiuretic hormone secretion (SIADH) have been reported during postmarketing use. In clinical trials, patients whose treatment with APTIOM was discontinued because of hyponatremia generally experienced normalization of serum sodium within a few days without additional treatment. In the controlled adult adjunctive epilepsy trials, 4/415 patients (1.0%) treated with 800 mg and 6/410 (1.5%) patients treated with 1200 mg of APTIOM had at least one serum sodium value less than 125 mEq/L, compared to none of the patients assigned to placebo. A higher percentage of APTIOM-treated patients (5.1%) than placebo-treated patients (0.7%) experienced decreases in sodium values of more than 10 mEq/L. These effects were dose-related and generally appeared within the first 8 weeks of treatment (as early as after 3 days). Serious, life-threatening complications were reported with APTIOM-associated hyponatremia (as low as 112 mEq/L) including seizures, severe nausea/vomiting leading to dehydration, severe gait instability, and injury. Some patients required hospitalization and discontinuation of APTIOM. Concurrent hypochloremia was also present in patients with hyponatremia. Hyponatremia was also observed in adult monotherapy trials and in pediatric trials. Depending on the severity of hyponatremia, the dose of APTIOM may need to be reduced or discontinued. Neurological Adverse Reactions Dizziness and Disturbance in Gait and Coordination APTIOM causes dose-related increases in adverse reactions related to dizziness and disturbance in gait and coordination (dizziness, ataxia, vertigo, balance disorder, gait disturbance, nystagmus, and abnormal coordination). In controlled adult adjunctive epilepsy trials, these events were reported in 26% and 38% of patients randomized to receive APTIOM at doses of 800 mg and 1200 mg/day, respectively, compared to 12% of placebo-treated patients. Events related to dizziness and disturbance in gait and coordination were more often serious in APTIOM-treated patients than in placebo-treated patients (2% vs. 0%), and more often led to study withdrawal in APTIOM-treated patients than in placebo-treated patients (9% vs. 0.7%). There was an increased risk of these adverse reactions during the titration period (compared to the maintenance period) and there also may be an increased risk of these adverse reactions in patients 60 years of age and older compared to younger adults. Nausea and vomiting also occurred with these events. Adverse reactions related to dizziness and disturbance in gait and coordination were also observed in adult monotherapy trials and pediatric trials. The incidence of dizziness was greater with the concomitant use of APTIOM and carbamazepine compared to the use of APTIOM without carbamazepine in adult and pediatric trials. Therefore, consider dosage modifications of both APTIOM and carbamazepine if these drugs are used concomitantly.


Somnolence and Fatigue APTIOM causes dose-dependent increases in somnolence and fatigue-related adverse reactions (fatigue, asthenia, malaise, hypersomnia, sedation, and lethargy). In the controlled adult adjunctive epilepsy trials, these events were reported in 13% of placebo patients, 16% of patients randomized to receive 800 mg/day APTIOM, and 28% of patients randomized to receive 1200 mg/day APTIOM. Somnolence and fatigue-related events were serious in 0.3% of APTIOM-treated patients (and 0 placebo patients) and led to discontinuation in 3% of APTIOMtreated patients (and 0.7% of placebo-treated patients). Somnolence and fatigue-related reactions were also observed in adult monotherapy trials and in pediatric trials.

patients with jaundice or other evidence of significant liver injury (e.g., laboratory evidence).

Cognitive Dysfunction APTIOM causes dose-dependent increases in cognitive dysfunction-related events in adults (memory impairment, disturbance in attention, amnesia, confusional state, aphasia, speech disorder, slowness of thought, disorientation, and psychomotor retardation). In the controlled adult adjunctive epilepsy trials, these events were reported in 1% of placebo patients, 4% of patients randomized to receive 800 mg/day APTIOM, and 7% of patients randomized to receive 1200 mg/day APTIOM. Cognitive dysfunction-related events were serious in 0.2% of APTIOM-treated patients (and 0.2% of placebo patients) and led to discontinuation in 1% of APTIOMtreated patients (and 0.5% of placebo-treated patients). Cognitive dysfunction events were also observed in adult monotherapy trials.

ADVERSE REACTIONS

Visual Changes APTIOM causes dose-dependent increases in events related to visual changes including diplopia, blurred vision, and impaired vision. In the controlled adult adjunctive epilepsy trials, these events were reported in 16% of patients randomized to receive APTIOM compared to 6% of placebo patients. Eye events were serious in 0.7% of APTIOM-treated patients (and 0 placebo patients) and led to discontinuation in 4% of APTIOM-treated patients (and 0.2% of placebotreated patients). There was an increased risk of these adverse reactions during the titration period (compared to the maintenance period) and also in patients 60 years of age and older (compared to younger adults). The incidence of diplopia was greater with the concomitant use of APTIOM and carbamazepine compared to the use of APTIOM without carbamazepine (up to 16% vs. 6%, respectively). Similar adverse reactions related to visual changes were also observed in adult monotherapy trials and in pediatric trials. Hazardous Activities Prescribers should advise patients against engaging in hazardous activities requiring mental alertness, such as operating motor vehicles or dangerous machinery, until the effect of APTIOM is known. Withdrawal of AEDs As with all antiepileptic drugs, APTIOM should be withdrawn gradually because of the risk of increased seizure frequency and status epilepticus, but if withdrawal is needed because of a serious adverse event, rapid discontinuation can be considered. Drug Induced Liver Injury Hepatic effects, ranging from mild to moderate elevations in transaminases (>3 times the upper limit of normal) to rare cases with concomitant elevations of total bilirubin (>2 times the upper limit of normal) have been reported with APTIOM use. Baseline evaluations of liver laboratory tests are recommended. The combination of transaminase elevations and elevated bilirubin without evidence of obstruction is generally recognized as an important predictor of severe liver injury. APTIOM should be discontinued in

Abnormal Thyroid Function Tests Dose-dependent decreases in serum T3 and T4 (free and total) values have been observed in patients taking APTIOM. These changes were not associated with other abnormal thyroid function tests suggesting hypothyroidism. Abnormal thyroid function tests should be clinically evaluated. Hematologic Adverse Reactions Rare cases of pancytopenia, agranulocytosis, and leukopenia have been reported during postmarketing use in patients treated with APTIOM. Discontinuation of APTIOM should be considered in patients who develop pancytopenia, agranulocytosis, or leukopenia. 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 practice. Adult Patients In monotherapy trials in patients with partial-onset seizures [Study 1 and Study 2], 365 patients received APTIOM, of whom 225 were treated for longer than 12 months and 134 for longer than 24 months. Of the patients in those trials, 95% were between 18 and 65  years old; 48% were male, and 84% were Caucasian. Across controlled and uncontrolled trials in patients receiving adjunctive therapy for partial-onset seizures, 1195 patients received APTIOM, of whom 586 were treated for longer than 6 months and 462 for longer than 12 months. In the placebo controlled adjunctive therapy trials in patients with partial-onset seizures (Study 3, Study 4 and Study 5), 1021 patients received APTIOM. Of the patients in those trials, approximately 95% were between 18 and 60 years old, approximately 50% were male, and approximately 80% were Caucasian. Monotherapy Historical Control Trials In the monotherapy epilepsy trials (Study 1 and Study  2), 13% of patients randomized to receive APTIOM at the recommended doses of 1200 mg and 1600 mg once daily discontinued from the trials as a result of an adverse event. The adverse reaction most commonly (≥1% on APTIOM) leading to discontinuation was hyponatremia. Adverse reactions observed in these studies were generally similar to those observed and attributed to drug in adjunctive placebo-controlled studies. Because these studies did not include a placebo control group, causality could not be established. Dizziness, nausea, somnolence, and fatigue were all reported at lower incidences during the AED Withdrawal Phase and Monotherapy Phase compared with the Titration Phase. Adjunctive Therapy Controlled Trials In the controlled adjunctive therapy epilepsy trials (Study 3, Study 4, and Study 5), the rate of discontinuation as a result of any adverse reaction was 14% for the 800 mg dose, 25% for the 1200 mg dose, and 7% in subjects randomized to placebo. The adverse reactions most commonly (≥1% in any APTIOM treatment group, and greater than placebo) leading to discontinuation, in descending order of frequency, were dizziness, nausea, vomiting, ataxia, diplopia, somnolence, headache, blurred vision, vertigo, asthenia, fatigue, rash, dysarthria, and tremor. The most frequently reported adverse reactions in patients receiving APTIOM at doses of 800 mg or 1200 mg (≥4% and ≥2% greater than placebo) were dizziness, somnolence, nausea, headache, diplopia, vomiting, fatigue, vertigo, ataxia, blurred vision, and tremor.

Table 4 gives the incidence of adverse reactions that occurred in ≥2% of subjects with partial-onset seizures in any APTIOM treatment group and for which the incidence was greater than placebo during the controlled clinical trials. Adverse reactions during titration were less frequent for patients who began therapy at an initial dose of 400 mg for 1 week and then increased to 800 mg compared to patients who initiated therapy at 800 mg. Table 4: Adverse Reactions Incidence in Pooled Controlled Clinical Trials of Adjunctive Therapy in Adults (Events ≥2% of Patients in the APTIOM 800 mg or 1200 mg Dose Group and More Frequent Than in the Placebo Group) APTIOM

Placebo

800 mg 1200 mg (N=426) (N=415) (N=410) % % % Ear and labyrinth disorders Vertigo

<1

2

6

Eye disorders Diplopia Blurred vision Visual impairment

2 1 1

9 6 2

11 5 1

Gastrointestinal disorders Nausea Vomiting Diarrhea Constipation Abdominal pain Gastritis

5 3 3 1 1 <1

10 6 4 2 2 2

16 10 2 2 2 <1

General disorders and administration site conditions Fatigue Asthenia Gait disturbance Peripheral edema

4 2 <1 1

4 2 2 2

7 3 2 1

Infections and Infestations Urinary tract infections

1

2

2

Injury, poisoning and procedural complications Fall

1

3

1

Metabolism and nutrition disorders Hyponatremia

<1

2

2

Nervous system disorders Dizziness Somnolence Headache Ataxia Balance disorder Tremor Dysarthria Memory impairment Nystagmus

9 8 9 2 <1 1 0 <1 <1

20 11 13 4 3 2 1 1 1

28 18 15 6 3 4 2 2 2

Psychiatric disorders Depression Insomnia

2 1

1 2

3 2

Respiratory, thoracic and mediastinal disorders Cough

1

2

1

Skin and subcutaneous tissue disorders Rash

1

1

3

Vascular disorders Hypertension

1

1

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Pediatric Patients (4 to 17 Years of Age) Clinical studies of pediatric patients 4 to 17 years of age were conducted which support the safety and tolerability of APTIOM for the treatment of partialonset seizures. Across studies in pediatric patients


with partial-onset seizures, 393 patients ages 4 to 17 years received APTIOM, of whom 265 received APTIOM for at least 1 year. Adverse reactions reported in clinical studies of pediatric patients 4 to 17 years of age were similar to those seen in adult patients. Other Adverse Reactions with APTIOM Use Compared to placebo, APTIOM use was associated with slightly higher frequencies of decreases in hemoglobin and hematocrit, increases in total cholesterol, triglycerides, and LDL, and increases in creatine phosphokinase. Adverse Reactions Based on Gender and Race No significant gender differences were noted in the incidence of adverse reactions. Although there were few non-Caucasian patients, no differences in the incidences of adverse reactions compared to Caucasian patients were observed. Postmarketing Experience The following adverse reactions have been identified during postapproval use of APTIOM. 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: Hematologic and Lymphatic Systems: leukopenia, agranulocytosis, thrombocytopenia, megaloblastic anemia, and pancytopenia Metabolism and Nutrition Disorders: syndrome of inappropriate antidiuretic hormone secretion (SIADH)

DRUG INTERACTIONS Other Antiepileptic Drugs Several AEDs (e.g., carbamazepine, phenobarbital, phenytoin, and primidone) can induce enzymes that metabolize APTIOM and can cause decreased plasma concentrations of eslicarbazepine. Higher doses of Aptiom may be needed. CYP2C19 Substrates APTIOM can inhibit CYP2C19, which can cause increased plasma concentrations of drugs that are metabolized by this isoenzyme (e.g., phenytoin, clobazam, and omeprazole). Dose adjustment may be needed. CYP3A4 Substrates In vivo studies suggest that APTIOM can induce CYP3A4, decreasing plasma concentrations of drugs that are metabolized by this isoenzyme (e.g., simvastatin, lovastatin). Dose adjustment of simvastatin and lovastatin may be needed if a clinically significant change in lipids is noted. Oral Contraceptives Because concomitant use of APTIOM and ethinylestradiol and levonorgestrel is associated with lower plasma levels of these hormones, females of reproductive potential should use additional or alternative non-hormonal birth control.

USE IN SPECIFIC POPULATIONS Pregnancy Pregnancy Exposure Registry There is a pregnancy exposure registry that monitors pregnancy outcomes in women exposed to AEDs, such as APTIOM, during pregnancy. Encourage women who are taking APTIOM during pregnancy to enroll in the North American Antiepileptic Drug (NAAED) Pregnancy Registry by calling 1-888-233-2334 or visiting http:// www.aedpregnancyregistry.org. Risk Summary Limited available data with APTIOM use in pregnant women are insufficient to inform a drug-associated risk of adverse developmental outcomes. In oral studies conducted in pregnant mice, rats, and rabbits, eslicarbazepine acetate demonstrated developmental toxicity, including increased incidence of malformations

(mice), embryolethality (rats), and fetal growth retardation (all species), at clinically relevant doses. Advise a pregnant woman of the potential risk to a fetus. In the U.S. 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 for the indicated population is unknown. Data Animal Data When eslicarbazepine acetate was orally administered (150, 350, 650 mg/kg/day) to pregnant mice throughout organogenesis, increased incidences of fetal malformations was observed at all doses and fetal growth retardation was observed at the mid and high doses. A no-effect dose for adverse developmental effects was not identified. At the lowest dose tested, plasma eslicarbazepine exposure (Cmax, AUC) is less than that in humans at the maximum recommended human dose (MRHD, 1600 mg/day). Oral administration of eslicarbazepine acetate (40, 160, 320 mg/kg/day) to pregnant rabbits throughout organogenesis resulted in fetal growth retardation and increased incidences of skeletal variations at the mid and high doses. The no-effect dose (40 mg/kg/day) is less than the MRHD on a mg/m2 basis. Oral administration to pregnant rats (65, 125, 250 mg/ kg/day) throughout organogenesis resulted in embryolethality at all doses, increased incidences of skeletal variations at the mid and high doses, and fetal growth retardation at the high dose. The lowest dose tested (65 mg/kg/day) is less than the MRHD on a mg/m2 basis. When eslicarbazepine acetate was orally administered to female mice during pregnancy and lactation (150, 350, 650 mg/kg/day), the gestation period was prolonged at the highest dose tested. In offspring, a persistent reduction in offspring body weight and delayed physical development and sexual maturation were observed at the mid and high doses. The lowest dose tested (150 mg/kg/day) is less than the MRHD on a mg/m2 basis. When eslicarbazepine acetate was orally administered (65, 125, 250 mg/kg/day) to rats during pregnancy and lactation, reduced offspring body weight was seen at the mid and high doses. Delayed sexual maturation and a neurological deficit (decreased motor coordination) were observed at the highest dose tested. The no-effect dose for adverse developmental effects (65 mg/kg/day) is less than the MRHD on a mg/m2 basis. The rat data are of uncertain relevance to humans because of differences in metabolic profile between species. Lactation Eslicarbazepine is present in human milk. The effects of APTIOM on the breastfed infant or on milk production are unknown. The developmental and health benefits of breastfeeding should be considered along with the mother’s clinical need for APTIOM and any potential adverse effects on the breastfed infant from APTIOM or from the underlying maternal condition. Females and Males of Reproductive Potential Contraception Use of APTIOM with hormonal contraceptives containing ethinylestradiol or levonorgestrel is associated with lower plasma levels of these hormones. Advise women of reproductive potential taking APTIOM who are using a contraceptive containing ethinylestradiol or levonorgestrel to use additional or alternative non-hormonal birth control.

Infertility Eslicarbazepine acetate was evaluated in rats and mice for potential adverse impact on fertility of the parental and first generation. In a fertility study in male and female mice, adverse developmental outcomes were observed in embryos. In a fertility study in male and female rats, impairment of female fertility by eslicarbazepine acetate was shown. Pediatric Use Safety and effectiveness of APTIOM have been established in the age groups 4 to 17 years. Use of APTIOM in these age groups is supported by evidence from adequate and well-controlled studies of APTIOM in adults with partial-onset seizures, pharmacokinetic data from adult and pediatric patients, and safety data from clinical studies in 393 pediatric patients 4 to 17 years of age. Safety and effectiveness in pediatric patients below the age of 4 years have not been established. Animal Data In a juvenile animal study in which eslicarbazepine acetate (40, 80, 160 mg/kg/day) was orally administered to young dogs for 10 months starting on postnatal day 21, adverse effects on bone growth (decreased bone mineral content and density) were seen in females at all doses at the end of the dosing period, but not at the end of a 2-month recovery period. Convulsions were seen at the highest dose tested. A no-effect dose for adverse effects in juvenile dogs was not identified. The lowest dose tested is less than the maximum recommended pediatric dose (1200 mg/day) on a body surface area (mg/m2) basis. A separate juvenile animal study was conducted to assess possible adverse effects on the immune system. Eslicarbazepine acetate (10, 40, 80 mg/kg/day) was orally administered to young dogs for 17 weeks starting on postnatal day 21. No effects on the immune system were observed. Geriatric Use There were insufficient numbers of patients ≥65 years old enrolled in the controlled adjunctive epilepsy trials (N=15) to determine the efficacy of APTIOM in this patient population. The pharmacokinetics of APTIOM were evaluated in elderly healthy subjects (N=12). Although the pharmacokinetics of eslicarbazepine are not affected by age independently, dose selection should take in consideration the greater frequency of renal impairment and other concomitant medical conditions and drug therapies in the elderly patient. Dose adjustment is necessary if CrCl is <50 mL/min. Patients with Renal Impairment Clearance of eslicarbazepine is decreased in patients with impaired renal function and is correlated with creatinine clearance. Dosage adjustment is necessary in patients with CrCl<50 mL/min. Patients with Hepatic Impairment Dose adjustments are not required in patients with mild to moderate hepatic impairment. Use of APTIOM in patients with severe hepatic impairment has not been evaluated, and use in these patients is not recommended.

DRUG ABUSE AND DEPENDENCE Controlled Substance APTIOM is not a controlled substance. Abuse Prescription drug abuse is the intentional nontherapeutic use of a drug, even once, for its rewarding psychological or physiological effects. Drug addiction, which develops after repeated drug abuse, is characterized by a strong desire to take a drug despite harmful consequences, difficulty in controlling its use, giving a higher priority to drug use than to obligations, increased tolerance, and sometimes physical withdrawal. Drug abuse and drug addiction are


separate and distinct from physical dependence (for example, abuse may not be accompanied by physical dependence). In a human abuse study in recreational sedative abusers APTIOM showed no evidence of abuse. In Phase 1, 1.5% of the healthy volunteers taking APTIOM reported euphoria compared to 0.4% taking placebo. Dependence Physical dependence is characterized by withdrawal symptoms after abrupt discontinuation or a significant dose reduction of a drug. The potential for APTIOM to produce withdrawal symptoms has not been adequately evaluated. In general, AEDs should not be abruptly discontinued in patients with epilepsy because of the risk of increased seizure frequency and status epilepticus.

OVERDOSAGE Signs, Symptoms, and Laboratory Findings of Acute Overdose in Humans Symptoms of overdose are consistent with the known adverse reactions of APTIOM and include hyponatremia (sometimes severe), dizziness, nausea, vomiting, somnolence, euphoria, oral paraesthesia, ataxia, walking difficulties, and diplopia. The maximum dosage studied in open-label adult monotherapy treatment following withdrawal of concomitant AEDs was 2400 mg once daily. Treatment or Management of Overdose There is no specific antidote for overdose with APTIOM. Symptomatic and supportive treatment should be administered as appropriate. Removal of the drug by gastric lavage and/or inactivation by administering activated charcoal should be considered. Standard hemodialysis procedures result in partial clearance of APTIOM. Hemodialysis may be considered based on the patient’s clinical state or in patients with significant renal impairment.

PATIENT COUNSELING INFORMATION See FDA-approved patient labeling (Medication Guide).

Manufactured for: Sunovion Pharmaceuticals Inc. Marlborough, MA 01752 USA APTIOM is a registered trademark of

, used under license.

SUNOVION and are registered trademarks of Sumitomo Dainippon Pharma Co., Ltd. Sunovion Pharmaceuticals Inc. is a U.S. subsidiary of Sumitomo Dainippon Pharma Co., Ltd. ©2017 Sunovion Pharmaceuticals Inc. All rights reserved. October 2017 10/17 APT266-17


Tools & Resources 

“If other small providers are paying consultants to help them understand MIPS, they are wasting their money!” said a satisfied Frigon. Frigon first learned about QPP-SURS through a CMS webinar. She was seeking help selecting measures. Her office was planning to report five measures it was already collecting. Through support and encouragement from the QPP-SURS provider, Frigon identified an additional quality measure to report in order maximize her score in the Quality category. The QPP-SURS provider also helped her to select Improvement Activities and identify documentation requirements for improvement activities, and sends reminders of events and upcoming deadlines. This helps Frigon stay on top of reporting requirements. Many small practices may struggle to fulfill MIPS requirements without support from a practice manager. QPP-SURS helps to fill that gap. This assistance is available to practices with 15 or fewer clinicians. Priority is given to those small practices: ƒƒ Located in a rural area ƒƒ Located in designated health professional shortage areas ƒƒ Located in designated medically underserved areas But any small practice can call and receive services. The service connects these small practices with assistance providers who can help them determine what MIPS measures to choose and report. The providers offer direct education and outreach, as well as guidance with all aspects of the program, including strategic planning and helping practices adapt to the new QPP processes. Physicians can get support for optimizing health information technology, such as Certified Electronic Health Record Technology (CEHRT). “This is a blessing!” said Frigon. To learn more about this program, visit QPP.cms.gov/about/ small-underserved-rural-practices, call (866) 288-8292, or email qppsurs@impaqint.com. 

downloads... a n o nd illi g m

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AAN member Sue Frigon, MD, sees 2,000 to 2,500 patients a year in her Pine Bluff solo practice in rural Arkansas. Like many neurologists, she was perplexed about how to choose and report measures for the Quality Payment Program (QPP). That changed when she heard about Frigon free assistance through QPP Small, Underserved, and Rural Support (QPPSURS), a program offered by the Centers for Medicare & Medicaid Services (CMS).

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Rural Neurologist Uses Free CMS Resource to Simplify MIPS Reporting

PODCAST CENTRAL 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 February 1 ƒƒ Neurology: Burnout, Wellness, and the Future of Our Profession Ted M. Burns, MD, and Terrence L. Cascino, MD, FAAN ƒƒ Neurology: Intravenous Thrombolysis and Platelet Count Kevin M. Barrett, MD, MSc, and Henrik Gensicke, MD ƒƒ Neurology: An Interdisciplinary Response to Contemporary Concerns About Brain Death Determination Andrew C. Schomer, MD, and Ariane K. Lewis, MD ƒƒ Neurology: Clinical Practice: Medical Retirement from Sport After Concussions: A Practical Guide for a Difficult Discussion Jason Crowell, MD, and James McCallum Noble, MD, MS, CPH

AANnews  •  February 2018 21


Policy & Guidelines 

2018 Advocacy Efforts to Build on 2017 Successes Thanks to the passion of thousands of neurology advocates who participated in advocacy events or contacted their members of Congress regarding key health care legislation, the AAN enjoyed a number of victories on the federal level. These accomplishments help set the stage for what we are sure will be a very busy 2018. Last year’s 15th annual Neurology on the Hill was a recordbreaking event with 216 AAN member advocates making 272 congressional office visits, sending out 2,072 tweets, and generating 1.8 million social media impressions. We also launched a new Neurology off the Hill program. This conveniently involved AAN members on a local basis as they engaged with their senators or representatives when they were in their districts during the August recess. Most of our advocacy efforts and messaging were focused on these 2017 priorities: ƒƒ Research Funding The BRAIN Initiative received $260 million in funding for fiscal year 2017, an increase of $110 million. Despite proposed cuts by the administration, the Senate approved a budget that increases NIH funding by $2 billion in fiscal year 2018, and the House approved an increase of $1.1 billion. ƒƒ Health Care Reform We developed our Principles for Health Care Delivery and successfully opposed efforts by Congress to pass legislation that would have left neurology patients with less access to health care coverage and weakened key consumer protections.

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AANnews  •  February 2018

ƒƒ Drug Pricing We created our position statement to urge legislative action on affordable, accessible prescription medications for patients with neurologic conditions. We are advocating for giving federal agencies the authority to negotiate contracts with manufacturers of covered Medicare Part D drugs; transparency in prescription drug pricing; and reimportation of the same safe, high-quality prescriptions from Canada when they are less expensive than in the US. ƒƒ Telestroke AAN Board Member Brett M. Kissela, MD, MS, FAAN, testified before the House Energy & Commerce Health Subcommittee in support of the Furthering Access to Stroke Telemedicine (FAST) Act, which would permit telestroke consultations to be reimbursed under Medicare no matter where a patient is located. The FAST Act passed the Senate as a part of the CHRONIC Care Act, and passed the House Energy & Commerce Committee.

2018 Strategy and Priorities This is an election year, so not only will Washington be bustling with activity, but there will be crucial elections across the country. We again will demonstrate our advocacy power during Neurology on the Hill later this month, and expand our program to connect federal lawmakers with neurologists in their districts during Neurology off the Hill events.


Education & Research 

We also will renew our efforts on priority issues that can be addressed through federal legislation: ƒƒ Regulatory Burden We will advocate for legislative solutions that can ease MACRA implementation and the growing administrative challenges of running a practice. ƒƒ Drug Pricing We will continue to highlight the burden of high-cost neurologic drugs and move forward on recommendations from the AAN’s Drug Pricing Task Force. ƒƒ Research Funding We will continue our push for strong federal funding for basic research, neurologic research, and other concerns, including non-opioid pain relief research.

We Seek Your Input We are eager to hear your feedback on these issues so we can strengthen our story on Capitol Hill. Are we on the right track? Do you have particular issues or concerns we should be aware of? Have you personally engaged with your legislators to advocate for neurology? Please send an email to advocacy@aan.com or visit us at the Advocacy Experiential Learning Area at the Annual Meeting in Los Angeles. 

New, Special Pricing Available to APPs on Convenient Online Learning Program As crucial members of the neurology care team, advanced practice providers (APPs) can benefit from the same reviews and updates in neurology as their neurologist colleagues. And now these valuable care team members can get special pricing on the AAN’s Neurology MOC Prep Course, Cook which provides a review and update on 14 topics most heavily weighted on the ABPN MOC exam. APPs can benchmark their knowledge based on competency standards for neurologists preparing for board recertification. Advanced practice providers who are AAN members now can access the convenient online Neurology MOC Prep Course for only $299 (a $150 savings from regular member pricing), and nonmember APPs can purchase it for $499 (a $70 savings from regular nonmember pricing). “The Neurology MOC prep course is a helpful overview of various neurology topics,” said Calli Leighann Cook, FNP-C, chair of the Consortium of Neurology Advanced Practice Providers, who recently completed the program. “The course could benefit APPs as a review or as an overview of neurology for APPs just beginning their careers in neurology. I strongly recommend this course for APPs, as it provides a valuable educational resource for multiple neurologic topics relevant to the APP.” Features: ƒƒ Materials written by neurologists based on the ABPN content outline for the cognitive expertise component (Part III) of maintenance of certification ƒƒ Syllabi that cover new and updated science and therapies to bring you up-to-date ƒƒ Audio interviews that allow for on-the-go listening ƒƒ 100 multiple-choice questions to help you determine your strengths and areas for improvement ƒƒ Exam feedback by subspecialty areas and suggestions for further reading ƒƒ Performance results compared to others who took the exam ƒƒ Convenient online format—take on your own time, at your own pace Visit AAN.com/view/MOCPrep to get started. 

AANnews  •  February 2018 23


Education & Research 

New Continuum Updates Your Child Neurology Knowledge  continued from cover ƒƒ Hypoxic-ischemic Encephalopathy and Other Neonatal Encephalopathies / Hannah C. Glass, MDCM, MAS ƒƒ Nervous System Malformations / John Gaitanis, MD; Tomo Tarui, MD ƒƒ Neurocutaneous Disorders / Tena Rosser, MD

Jeste

Owens

ƒƒ Leukodystrophies / Amy T. Waldman, MD, MSCE ƒƒ Evaluation and Acute Management of Ischemic Stroke in Infants and Children / Catherine Amlie-Lefond, MD ƒƒ Epileptic Encephalopathies / Shaun A. Hussain, MD, MS ƒƒ Epilepsy Syndromes in Childhood / Phillip L. Pearl, MD, FAAN ƒƒ Pediatric Sleep Disorders / Kiran Maski, MD, MPH; Judith Owens, MD, MPH ƒƒ Evaluation of the Child with Developmental Impairments / Clara D. M. van Karnebeek, MD, PhD ƒƒ Evaluation and Management of the Child with Autism Spectrum Disorder / Nicole Baumer, MD, MEd; Sarah J. Spence, MD, PhD ƒƒ Transition from Pediatric to Adult Neurologic Care / Ann H. Tilton, MD, FAAN; Claudio Melo de Gusmao, MD ƒƒ Neurologic Complications in the Pediatric Intensive Care Unit / Mark S. Wainwright, MD, PhD ƒƒ Pediatric Traumatic Brain Injury and Concussion / Meeryo Choe, MD; Karen M. Barlow, MD ƒƒ How the International Classification of Diseases, Tenth Revision, Clinical Modification Affects Coding for Pediatric Diagnoses / Korwyn Williams, MD, PhD Starting this month, all current and new subscribers will have access to both Continuum and Continuum® Audio. Subscribe to Continuum and Continuum Audio 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 the Continuum and Continuum Audio subscription. 

Design Pioneer Lends Talents to New Covers Peter Grundy, the artist selected to produce a series of Continuum covers beginning with the February 2018 issue, is one of the world’s leading information illustrators. Since 1980, he has evolved a simple, elegant combination of ideas and iconography to form inventive infographics for clients and institutions around the world including the Imperial War Museum, Shell International, the World Bank and the United Nations. In 2013, he illustrated The Human Body, a book for children and adults (Big Picture Press) which gave medical illustration a refreshing new look. About the process of designing the Continuum series, on which Grundy worked with Editor-in-Chief Steven L. Lewis, MD, FAAN, to both accurately and whimsically convey the topic of each of the next 18 issues, Grundy said, “I set out to create a look and feel for Continuum that was firstly distinctive, secondly medically informative but at the same fresh and friendly. I wanted to break away from traditional medical illustration and do something elegant and beautiful. Something worthy of cover art that could become a new look for Continuum.” The process involved ideas, development, and implementation working closely with the Continuum editorial team to distill complex messages into simple graphic images. 

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AANnews  •  February 2018


American Brain Foundation 

Commitment to Cures Fundraiser Set to Take Place in Los Angeles Comedian Michael Pritchard, friend of the late Robin Williams, will serve as the program emcee at the American Brain Foundation’s 2018 Commitment to Cures. The popular annual dinner and fundraiser is set for April 25 at the JW Marriott Los Angeles, in conjunction with the AAN’s Annual Meeting. Pritchard will entertain attendees with his unique comedic style while underscoring the importance of finding cures and treatments for brain disease. He will be joined via video by 2018 Public Leadership in Neurology Award recipient Mary Temple Grandin, PhD, an American professor of animal science at Colorado State University, consultant to the livestock industry on animal behavior,

and well-known autism spokesperson. Acoustic guitarist, singer, composer, and American Brain Foundation Honorary Board Member Billy McLaughlin will provide a memorable performance. McLaughlin was diagnosed with focal dystonia in 2001, but his passion and drive sent him on an unlikely journey of teaching himself to play in what has now become his own signature left-handed style. Individual tickets are $125, and tables for 10 are available for $1,500. Visit AmericanBrainFoundation.org/newsevents to secure your spot for this special evening, or contact info@ AmericanBrainFoundation.org or (866) 770-7570 for more information. 

McLaughlin


„ 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.

NeuroHospitalist positions in Eugene, Oregon PeaceHealth Sacred Heart Medical Center at RiverBend is seeking a Neurologist and a Nurse Practitioner for their Neurohospitalist program. This position is to join their established and robust Stroke Program. PeaceHealth offers infrastructure, support and vision to develop this Primary Stroke Center into a Comprehensive Stroke Program. Comprehensive support including Neurointervention, Neurosurgery, Intensivists, 24/7 Hospitalist support and 3 full time Diagnostic Neuroradiologists. PeaceHealth at RiverBend will see approximately 600 strokes per year, serves a large catchment area, and is the dominant Stroke Program in the Willamette Valle. Patient volume encompasses the whole spectrum of neurologic disease. PeaceHealth offers H1B/J1 Visa support with over 15 years of experience. Eugene/Springfield is located at the south end of the Willamette Valley, near the confluence of the McKenzie and Willamette rivers, about 50 miles east of the Oregon Coast. Fantastic place for outdoor enthusiast. With everything from hiking, biking, kayaking, swimming, running and water sports, there is no shortage of things to do outside. Check out Spencer’s Butte which

provides some spectacular views of the city. The Hult Center for the Performing Arts features all kinds of entertainment including jazz, opera, ballet, the Eugene symphony and choir. In addition, the center also features a permanent art collection. Go shopping at the 5th Street Public Market. Spend an afternoon visiting the shops and enjoy a multitude of international cuisine while local musicians provide live entertainment at the market. Sports fanatic? Eugene is home to the University of Oregon (Mighty Ducks) where you can catch professional, Olympic and collegiate sporting events. Home to very strong and diverse school districts. For more information contact: Grace Riggs, Phone: (541) 335-2069; Email: GRiggs@peacehealth.org. PeaceHealth, based in Vancouver, Washington, is a not-for-profit Catholic health system offering care to communities in Washington, Oregon, and Alaska. PeaceHealth has approximately 16,000 caregivers, a multi-specialty medical group practice with more than 900 physicians and providers, a comprehensive laboratory system, and ten medical centers serving both urban and rural communities throughout the Northwest. In 1890, Sisters of St. Joseph of Peace founded what has

become PeaceHealth. Today, PeaceHealth is the legacy of its founding Sisters and continues to serve communities when invited to do so with a spirit of collaboration and stewardship. This is The Spirit of Health. AANnews® Classified Advertising  he AAN offers a complete package of print, online, T and in-person recruitment advertising opportunities. Visit careers.AAN.com for all AAN options, rates, and deadlines.  d copy for the April 2018 print edition of AANnews A must be submitted by March 1, 2018. The same deadline applies to changes/cancellations.  he American Academy of Neurology reserves the T right to decline, withdraw, or edit advertisements at its discretion. Every care is taken to avoid mistakes, but the responsibility for clerical or printer errors does not exceed the cost of the ad.

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Dates & Deadlines 

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FEBRUARY 14–18

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RITE Administration

Deadline: 2018 Annual Meeting Hotel Reservation AAN.com/view/AM18

Deadline: UCNS Headache Medicine Certification and Recertification Applications UCNS.org/go/subspecialty/headache/ certification

®

FEBRUARY 20 Webinar: Successfully Participating in MIPS (Register by February 19) AAN.com/view/pmw18

MARCH 2 2018 Neuro Film Festival Video Submission Deadline NeuroFilmFestival.com

APRIL 20 2018 Brain Health Fair Los Angeles, CA BrainHealthFair.com

MARCH 20 Webinar: Getting Paid for Your Time, All of the Time (Register by March 19) AAN.com/view/pmw18

APRIL 21–27 AAN Annual Meeting Los Angeles, CA AAN.com/view/AM18

MARCH 29

APRIL 21

Deadline: Annual Meeting Early Registration AAN.com/view/AM18

AAN Business Meeting Los Angeles Convention Center Los Angeles, CA AAN.com/view/AM18

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AANnews  •  February 2018 27


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