VOLUME 32 · ISSUE 6 · JUNE 2018
LAST CHANCE TO SAVE ON REGISTRATION Sport Concussion Conference Visit AAN.com/view/SCC today to book your hotel and register for the 2018 Sports Concussion Conference—early registration savings end June 14, and most attendees can save $200 by securing their spots early! Scheduled for July 20–22 at the JW Marriott in Indianapolis, IN—home to the National Collegiate Athletic Association (NCAA) and NCAA Sport Science Institute—this year’s conference presents a special opportunity for the AAN to collaborate with the NCAA on unique programming, including: Networking reception at the NCAA Hall of Champions Special session on the NCAA-DoD CARE Consortium In addition, attendees can expect to: Better understand the current state of concussion pathophysiology, diagnosis, and management Learn about the latest technologies for diagnosis and management Discover emerging issues in post-concussion syndrome diagnosis and advances in treatment approaches Discuss issues of long-term sequelae from athletic brain trauma Earn up to 20 CME/CE credits
Time Running out to Use Axon Registry for MIPS in 2018 AAN members are encouraged to sign up now for the Axon Registry® to be able to submit data for MIPS reporting year 2018. Getting in now will ensure your practice has enough time to complete integration before submission begins for the current reporting year. The Axon Registry has a dashboard that calculates performance rates on over 40 neurology-specific quality measures and gives you the option to manually attest to Advancing Care Information data and Improvement Activities. Continued on page 9
10 2018 Insights Report Is
Revealing Look at AAN Survey Data
Webinar Helps You Use Benchmarks for Stable, Prosperous Practice
Benchmarking data can seem cumbersome and unnecessary, but not prioritizing it can create financial inefficiencies that could break your practice. Understanding which measures to track, and how to use this data, can mean a more stable and prosperous
17 New AAN Publication Seeks ‘Negative, Inconclusive,’ and Confirmatory Studies
Continued on page 9
21 New Online Learning
Center Provides Convenient, Centralized Hub for Resources
In Multiple Sclerosis–
THE ART OF BRAIN PRESERVATION Adding Grey to the Palette Completes the Picture
GREY MATTERS, TOO
Learn more about Multiple Sclerosis at MSBrainPreservation.com/art © 2018 Celgene Corporation All rights reserved. 03/18 USII-CELG180067
AANnews · June 2018
Cover Last Chance to Save on Registration Time Running out to Use Axon Registry for MIPS in 2018 Webinar Helps You Use Benchmarks for Stable, Prosperous Practice President’s Column Good Vibrations and Record Attendance at the AAN 70th Anniversary Annual Meeting · · · · · · · · · · 4 Through Their Eyes Breaking Tradition for a New Class of Neurologists · · · ·6 Tools & Resources 2018 Insights Report Is Revealing Look at AAN Membership and Survey Data · · · · · · · · · · · · 10 Neurology: Clinical Practice Explores New Cyber Care Options · · · · · · · · · · · · · · 10 Actor, ALS Advocate Vance in New Brain & Life Issue · · · · 11 Podcast Central · · · · · · · · · 11 2018 Annual Meeting a Smash Hit! · · · · · · · · · · · · 13
Education & Research New AAN Publication Seeks ‘Negative, Inconclusive,’ and Confirmatory Studies · · · · · · 19 New Online Learning Center Provides Convenient, Centralized Hub for Resources · · · · · · · · · · · 19 Get Up-to-date on Assessment, Management of Behavioral Neurology and Psychiatry with New Continuum · · · · · · · · · 20 Apply Now to Recertify in Neurocritical Care Through UCNS · · · · · · · · · · 20 Conferences & Community · · 21 Leadership Programs Graduate Reflects on Being a Leader… and the Leader She’s Becoming · · · · · · · · · 21 The More You Participate, the More You Stand Out with New Synapse Badges · · · 24 Policy & Guidelines · · · · · · · 24 Capitol Hill Report · · · · · · · · 24 American Brain Foundation Researchers and Foundation Philanthropist Honored · · · · 25 Careers · · · · · · · · · · · · · · · 26 Dates & Deadlines · · · · · · · · 27
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AAN President Ralph L. Sacco, MD, FAAN, and American College of Rheumatology President David I. Daikh, MD, PhD, wrote an op-ed on our drug pricing advocacy efforts that was published in April in The Hill and mentioned in Kaiser Health News. The editorial, “Limiting Patient Choice Is the Wrong Way to Address High Drug Prices,” evaluated some of the Trump administration’s proposed actions the federal government should take to address rising drug prices. While Sacco and Daikh lauded some of these actions, they expressed their concern that several of the administration’s most prominent proposals would not only fail to lower drug prices, but also severely limit our Medicare patients’ access to critical therapies. Neurology Today® and Brain & Life™ recently won prestigious awards from the American Society of Healthcare Publication Editors. This well-respected competition— which draws nearly 3,000 entries annually—is judged by a panel of editors and graphics professionals in the publishing field. Neurology Today won the Silver Award for Best Conference/Trade Show Coverage for the Neurology Today Conference Reporter for the 2017 AAN Annual Meeting (https://bit.ly/2IbB2IP). Brain & Life won the Bronze Award for Best Profile, “Unforgettable,” (October/ November 2017), featuring fashion model B. Smith discussing the impact of her early-onset Alzheimer’s on her family’s life (AAN.com/view/ Unforgettable).
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: email@example.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.
Good Vibrations and Record Attendance at the AAN 70th Anniversary Annual Meeting The Annual Meeting in Los Angeles was by all accounts a great success! It literally featured a cast of thousands as we came together to share the latest advances and news in all areas of neurology, from the labs to the classrooms to the clinics to Congress. This was the third year for our new format and the meeting had something for everybody. California sunshine greeted more than 14,000 attendees at the Los Angeles Convention Center—a suitably epic stage for our epic production that broke attendance records. The meeting was preceded by our annual Brain Health Fair, a free public event that drew in more than 2,500 people from the LA area who sought more information on brain disorders. We promoted our new magazines Brain & Life™ and Brain & Life™ en Español. To encourage young minds to consider careers in neurology, we welcomed 115 high school students for a new program with hands-on activities and a panel on jobs in our profession. Of particular interest to all ages was a stroke mobile unit from the University of California, Los Angeles, made possible with the help of the American Brain Foundation Past Chair John C. Mazziotta, MD, PhD, FAAN. On Saturday, I was joined by AAN Treasurer Dr. Janis Miyasaki and Executive Director/CEO Cathy Rydell at our annual Business Meeting, where we reported to membership on the accomplishments of their Academy in 2017. Neurobowl again provided a spirited competition between three teams providing their snap diagnoses, but with an added visual flair of Hollywood in their creative, colorful costuming and the entry of the emcee. At Sunday’s Presidential Plenary Session, I awarded the Presidential Award to Dr. Lisa Shulman for her dedication to the academy, provided an update on the State of the AAN, and we heard from Dr. Doug Lanska about the founding of the AAN. The session was distinguished by the latest research of Dr. Lisa DeAngelis, Dr. Tallie Baram, Dr. Richard Finkel, and our special
AANnews • June 2018
Presidential Lecture guests Dr. Francis S. Collins, who spoke about what precision medicine and All of US means for neurology, and Dr. Walter Koroshetz, who addressed advances in neurologic research at the NIH and NINDS, particularly the BRAIN Initiative. The 70th Anniversary Opening Party at Universal Studios on Sunday night was a huge hit. We had the theme park to ourselves, and our members and guests had a great time. It was nice to set neurology aside for a few hours and connect with some of our favorite films and characters of the silver screen. As I mentioned to others the following day, who says neurologists don't know how to party! Our popular Controversies in Neurology Plenary Session used crowdsourcing for the first time this year to determine the topics debated—Would You Let Your Child Play Contact Sports? and Should the Neurologist Be Primarily Responsible for Taking Care of Patients with Functional Disorders? Throughout the seven plenary sessions, I was impressed by the diversity of speakers and topics—and especially proud to note that all of the four winners of the Neuroscience Research Prize for high school students were women. The energy in all of the sessions was terrific and the speakers did an outstanding job communicating the excitement in our field. Outside the Plenary Hall, attendees traced the growth of the AAN over 70 years with a history wall. We paid homage to the “Four Horsemen” with a display of autographed books they authored, as well as Dr. Francis Forster’s well-worn black leather medical bag. More recent AAN presidents shared their experiences via a series of brief videos. You can enjoy these videos and interviews with other luminaries at AAN.com/view/AANhistory. We made many media impressions throughout the meeting. We hosted two press conferences during the meeting. The first, moderated by Dr. Natalia Rost, highlighted some of the leading research announced by the AAN. The second press event was synced with the publication in Neurology® of the AAN's Practice
Guideline Recommendations Summary: Disease-modifying Therapies for Adults with Multiple Sclerosis. The guideline was endorsed by the Multiple Sclerosis Association of America and the National Multiple Sclerosis Society. The LA Convention Center was buzzing with information for every aspect of your profession and we utilized innovative ways to deliver essential advice to help navigate your career. The seven Experiential Learning Areas were always lively, offering the latest news on advocacy, wellness, practice management, research, careers, AAN membership, and our highly popular HeadTalks, where zombies stalked the stage, neurologists battled it out in Neuro-Jeopardy and Pictionary, and Dr. Joseph Sirven vividly demonstrated how to respond to medical conditions during a flight. As always, the meeting had many new facets, including the Hot Topics in Education—Implications of DAWN and DEFUSE-3 trials; the imaginative Innovation Hub in the always bustling Exhibit Hall; and jointly partnered programs with the ASA/AHA, MDS, and SVIN. The appearance of Dr. Bennet Omalu the day after he testified before Congress on concussion drew a great turnout as he passionately told his personal story. Attendees also enjoyed revamped ePoster “lounges”; a well-used Overflow Room with an enormous multichannel screen and personal headphones so more people were able to view heavily attended sessions; and satellite meeting registration at hotels. We had a special evening to raise funds to support the mission of the American Brain Foundation. I was pleased to join several hundred researchers and donors who help make their work possible at the Commitment to Cures fundraiser on Wednesday evening. I also had opportunities to meet with international colleagues and AAN partners, including the World Federation of Neurology. So much of the Annual Meeting—beyond the science and education—is about networking and bringing people together face-to-face. There were 37 section meetings held during the week. The Academy’s relationship with the subspecialties continues to strengthen with more than 15,000 members participating in sections and the Synapse online communities—the
highest number ever. There were numerous alumni receptions, and even the Run/Walk for Research brought together goodnatured competitors. Once again, the Faculty and Trainee Reception provided a relaxed venue for sharing information on new opportunities, and we hosted a new Medical Student Symposium and a Young Investigator Program to strengthen our offerings for medical students and residents to encourage and support their careers in neurology and research. Many students remarked how great it was to attend the meeting and how excited they were to consider a career in neurology. This is just what we need to expand our pipeline. All in all, this Annual Meeting provided 3,200 abstracts, 245 education courses, 54 platform sessions, seven plenary sessions, seven Neuroscience in the Clinic sessions, six poster sessions, and more than 300 experiential learning area presentations. If you were one of the more than 14,000 people who were on-site with us in Los Angeles, I want to personally thank you for your attendance and participation. And I thank our remarkable Board and committee chairs and all of the volunteer members and staff who put so much time and energy into making the 70th Annual Meeting one for the history books.
Ralph L. Sacco, MD, MS, FAHA, FAAN President, AAN firstname.lastname@example.org @DrSaccoNeuro on Twitter
Through Their Eyes
Breaking Tradition for a New Class of Neurologists AANnews® celebrates the history of the Academy during its 70th anniversary with a series of interviews of past presidents. This article looks back, through the eyes of AAN leaders, at events leading to the tumultuous June 1948 organizational meeting in Chicago that established the Academy.
The Need for the AAN Neurology was a very different field in the years leading up to the founding of the AAN. The American Board of Psychiatry and Neurology certified in both fields simultaneously. Most medical schools did not have separate departments of neurology. Neurology was typically a division of medicine, although in a few schools there was a single department of neurology and psychiatry. The American Neurological Association (ANA) represented academic neurologists and limited its membership to 250, thus effectively excluding many practicing neurologists. And most state societies had similar restrictions.
academic position? That would be his only way he might eventually be elected to the ANA. Resch, like a growing number of newly trained neurologists, sought a professional society that was inclusive and provided for his professional needs.
At the same time, there was an increasing demand for more neurologists, fueled in part by the growing number of VA hospitals that were required to treat injured veterans returning from World War II. Neurology residencies, which had been curtailed during the war, began to expand, and many new ones were created. Yet, there was no professional organization to meet the needs of the majority of these newly minted neurologists. Lt. Col. Joseph A. Resch, MD, who came home from the war in early 1946, was typical of many. The young doctor from Wisconsin had served seven years in the US Army Air Force and managed the hospital services for a fighter wing in New Guinea. Now, at age 32, he was working on his residency in neurology at the University of Minnesota under division chair Dr. A.B. Baker and eager Joseph A. Resch, MD, FAAN, circa 1947. to establish his career—as a neurologist. But Resch was told that he would probably have to practice psychiatry if he was to make a living and succeed in practice. He wanted to see patients who mainly had neurologic disorders. How would he stay current as neurologic research advanced? Would he need to find an
A.B. Baker, MD, FAAN, in the 1940s.
“I got in with Dr. Baker and [Joe] Brown, who were the best teachers in the world,” Resch shared in a 2008 interview. “They wanted to know how we were doing, and what do we think about things. That’s when I popped off, I guess, to the chief and said, ‘Well, neurology, in this situation, what do you do when you finish? There’s nothing that you can really belong to for a young neurologist.’ The ANA, a very old professional society, was really an organization for department heads or faculty people. They required that to be a member you had to have your boards, you had to have a list of publications and write a thesis. That’s pretty well not available for the fellows or brand-new neurologists…. So, Dr. Baker said, ‘Relax, we’re doing it.’ And they did, and it was really something.” Baker was sympathetic to Resch’s concerns. The times were changing. If neurology was to emerge from the shadow of psychiatry and stand as a distinct specialty of medicine, it must organize and grow.
AANnews • June 2018
Four Horsemen with a Plan Baker began developing the idea of a new organization, collaborating with Russell N. DeJong (University of Michigan), Francis M. Forster (then at Jefferson Medical College in Philadelphia), Adolph L. Sahs (University of Iowa), and Joe R. Brown (then at the University of Minnesota and Minneapolis Veterans Administration hospital).
Joe R. Brown, MD, FAAN, 1950.
“Abe Baker found a copy of a dental association constitution. We sat in his office over a few days’ time, copied large parts of this constitution with modifications to fit the principles of the Academy, and distributed the resulting document to the 52 original fellows for ratification.” The American Academy of Neurology was incorporated in the state of Minnesota on March 13, 1948.
“In planning the Academy, you must keep in mind that one was breaking with tradition,” said Baker later recalled. “The American neurological tradition at that time was the American Neurological Association, and to consider a new neurologic group on a broad democratic scale was not to be tolerated. Therefore, for two years, I spoke to many important leaders in the neurologic field trying to stimulate some support for this new idea. Therefore, it was fairly well known that such a society was being considered and I believe most people felt that no one would have the courage to start such a group.” Indeed, there were calls within the ANA to discipline the upstart Baker. Fortunately, he had allies who helped tamp down any retaliation, but friction between the two organizations existed well through the 1950s.
The Four Horsemen: DeJong, Baker, Sahs, and Forster
As Forster later recounted, “Abe gathered around him a number of disciples. Russ DeJong, Ady Sahs, and I were proud to be associated with him in these ventures. It was thus we became known as the Four Horsemen, a nickname derived from “the Four Horsemen of Notre Dame”—the legendary backfield for the 1920s college football team. Baker invited 52 key neurologists to become charter members and Fellows of the new American Academy of Neurology; two later declined after initially accepting the honor, having some skepticism that another society was necessary. In the meantime, organizational papers were drawn up. Brown, the AAN’s first secretary-treasurer, shared his story of the Academy’s launch in his 1973 Annual Meeting presidential address “The Early Years of the American Academy of Neurology,” later published in the January 1974 issue of Neurology ®.
In a January 1951 letter from then-AAN President Pearce Bailey [himself the son of a famed New York City neurologist] published in the first issue of Neurology®, framed the situation in blunt terms: “The scope of the Academy is nationwide and hence antagonistic to the geographic sectionalism which always has hemmed in the neurology of the past. Pearce Bailey, MD, FAAN, 1950. It should be recalled that the early American neurologists were all aristocrats, originating for the most part from the northeastern section of the United States and guided by the principles of rugged individualism. There were no middle or lower classes in the neurology of the early days.... Neurology needs a progressive middle class and the Academy, by virtue of its organizational plan, is equipped to help develop such a group.” For Joe Resch, with a wife and three children to support, and hundreds of other young neurologists like him, such a change would be most welcome. Continued on page 8
AANnews • June 2018 7
Through Their Eyes
Breaking Tradition for a New Class of Neurologists
Continued from page 7
June 1948: The Organizational Meeting Baker invited leading neurologists to Chicago for an organizational summit on June 3, 1948, that coincided with the annual meeting of the American Medical Association. Some 70 or so neurologists convened in the stately Stevens Hotel (now the Conrad Hilton Hotel), the world’s largest. According to Brown, it started out with a linguistic quagmire. “The first item of business was the presentation of the constitution and bylaws. This stirred extensive responses in the group, not to the principles involved but to the wordings used. Almost every neurologist present seemed to have an opinion as to how each phrase should be worded and where each punctuation mark should be placed. The discussion went on almost unendingly until it became necessary to stop it. This was accomplished by pointing out that the constitution had already been accepted and that any recommendations for change would have to be referred to a committee on constitution and bylaws.” And then it got worse, according to Brown. “The final item of business for the day was the election of officers. It was planned to have one organizational year with a president [Baker], vice president [Bailey], and secretarytreasurer [Brown], followed by a regular two-year term for the officers. For this reason, the nominating committee did not propose a candidate for president-elect, a failure that soon demonstrated our naivete. After the slate of three officers was presented, one member of the audience noted that no one had been named for the office of president-elect. He jumped up and nominated Walter Freeman for the office. Then someone else jumped up and moved that the nominations be closed.” Dr. Walter J. Freeman, a prominent neurologist from Washington, DC, had played no role in forming the association. He was a controversial figure who would become even more so in the future for his promotion of lobotomies. His apparent coup provoked talk of disbanding the new Academy and starting over.
Sahs, DeJong, Baker, and Forster at the ABPN 50th Anniversary dinner, 1984.
As Brown related, “Dr. Freeman was known as a very influential and strong-willed person. His becoming president-elect was looked on by the organizers of the Academy as a real threat to the future of the organization. After the meeting and the election were over, there was a discussion about what could be done. One suggestion made was that everyone resign and start a new organization. On returning home, however, I reviewed the records and found out that Dr. Freeman not only was not a fellow but also had not joined the Academy and had not paid his dues. Consequently, he was not eligible to be an officer. It became my task to write him of this fact. He returned a letter graciously withdrawing his name. He attended future meetings of the Academy and always was friendly during that time.” Baker gained his full term as president through a mail vote of the new membership and served in this role until 1951. Afterward, he continued to be actively involved with the AAN for the rest of his career, particularly in guiding special courses for the Annual Meetings through the 1950s. Forster and Sahs later had terms as AAN president. DeJong became the founding editor-in-chief of the journal Neurology, which began publication in 1951; it was a position he held for 26 years. Resch completed his residency at the University of Minnesota and was accepted as a Junior member of the AAN in 1949. He was one of the first neurologists in the Twin Cities to make a living without seeing psychiatric patients (to show skeptics it could be done, he carried a card with his appointments noted on it). He helped found the Minneapolis Clinic of Neurology in 1955 with Harold Noran. Resch was persuaded by Baker to return to the university in 1962, and became chair of the neurology department upon Baker’s retirement in 1976 and served until 1982. He was an active AAN board member (or “councilor,” as they were known then) in the 1970s, and returned to the AAN office in 2008 to help celebrate the 60th anniversary. He died the following year at age 94.
Resch celebrated the 60th anniversary of the AAN with Executive Director Catherine M. Rydell, CAE, and staff in 2008.
AANnews • June 2018
To learn more about the AAN’s remarkable history, visit AAN.com/view/AANhistory.
Tools & Resources
Time Running out to Use Axon Registry for MIPS in 2018 Continued from cover
Other benefits to joining the Axon Registry include the ability to benchmark performance nationally against your peers and use data driven results to implement quality improvement. Once using the dashboard for quality improvement purposes, providers also can receive credit for MOC part IV clinical module activity and waive eight credits of part II Selfassessment. Benchmarking your quality performance data against your peers nationally can be a powerful negotiation tool with private payers as well. Practices joining the Axon Registry after June 30, 2018, will only be able to integrate to use data for the 2019 reporting year. Joining prior to that date will give you the opportunity to collect and submit data for the 2018 reporting year. Generally, it takes three to six months to fully integrate with Axon, depending on the practice’s access to its data through their EMR. To accommodate for this, Axon has set deadlines for integration and MIPS submission. A practice must sign up by June 30 and be fully integrated by December 1 of the reporting year. If you have questions or would like to sign up for Axon, visit AAN.com/view/Axon or email Axon staff at email@example.com. Get real-time access to your quality data by signing up today with the Axon Registry!
Webinar Helps You Use Benchmarks for Stable, Prosperous Practice Continued from cover
practice. This webinar will help you develop strategies for becoming a benchmarking expert, and build tracking these metrics directly into your practice.
5 Benchmarks That Can Make or Break Your Practice June 19, 2018 2:00 p.m.–1:00 p.m. ET Deadline to Register: June 18 Faculty: Brad C. Klein, MD, MBA, FAAN
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 AAN members get the greatest value with the $189 subscription to all 10 live onehour 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 firstname.lastname@example.org.
5 Benchmarks That Can Make or Break Your Practice
AANnews • June 2018 9
Tools & Resources
Neurology: Clinical Practice Explores New Cyber Care Options The June/July issue of Neurology ® Clinical Practice looks at new opportunities care for patients by use of telecommunications technology with “Providing Patient-centered Care in the Digital Era,” by Editor John R. Corboy, MD, FAAN, as well as “Ask a Neurologist: What Primary Care Providers ask, and Reducing Referrals Through eConsults” and “Curbside Consults Join the Telemedicine Era.” Other articles of interest include “Exercise for Cognitive Brain Health in Aging: A Systematic Review for an Evaluation of Dose” and “What Predicts Falls in Parkinson disease? Observations from the Parkinson Foundation Registry.” 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.
2018 Insights Report Is Revealing Look at AAN Membership and Survey Data What influences the decisions made by AAN leadership? A number of factors are involved, of course, but key among them are responses from members to Academy surveys and focus groups. This input can help gauge interest in a possible new program or evaluate the success of existing programs. The data can confirm or dispel issues of concern or point to new member needs that would enhance their work and the value of their AAN membership. Published annually since 2013, the AAN’s new 2018 Insights Report is a summary of the member research done by the Academy last year, mostly through surveys and focus groups considering a variety of topics. The Insights Report is a product of the Member Research Subcommittee, chaired by Thomas R. Vidic, MD, FAAN, who also serves on the AAN Board of Directors. This subcommittee reports to the Board Planning Committee, chaired by Board Secretary Carlayne E. Jackson, MD, FAAN. The report is provided to the Board as one of the resources for the strategic planning meeting each February. “The Member Research Subcommittee helps all the various committees and sections gather data about our members,” said Vidic. “The Insights Report is a compilation of all this information that is arranged in a manner to address the
AANnews • June 2018
priorities of the AAN. We highlight areas that are surprising, troublesome, or different than we would have predicted. Members can gain their own ‘insights’ into the AAN and our profession by reviewing this summary.” Members can learn from the report what the Vidic research found and how data from surveys and focus groups were used. For example, three publications helped better define neurologist well-being and are being used to shape burnout mitigation efforts. In another instance, focus groups results helped Neurology® journal staff decide to move forward with a one-year pilot of the “electronic long, print short” formats for publishing papers online and in print. Members can access these reports on AAN at AAN.com/view/18Insights. The Academy thanks past survey and focus group participants who provided their insights, and encourages members to respond to survey requests for future research projects to help move the Academy forward.
Also in the new Brain & Life, we look at the risks and benefits of surgery for several neurologic disorders, including Parkinson’s disease, myasthenia gravis, and epilepsy, to help readers make informed decisions about deep brain stimulation, thymectomy, and temporal lobe surgery. In our third feature, “Cultural Perceptions of Disease,” we examine how different cultures perceive and experience neurologic diseases and symptoms and provide advice for families about how they can overcome these differences if they get in the way of proper care. Brain & Life and its companion patient and caregiver website BrainandLife.org made their debut in April. The magazine and website provide the same trusted, expert information for patients, families, and caregivers as Neurology Now did. Brain & Life is a FREE resource to AAN members in the United States to distribute to patients, who also can subscribe for free. If you need to adjust the number of copies you receive for your patients or update your clinic address, visit BrainandLife.org or email BeGreen@WasteFreeMail.com.
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In the June/July issue of Brain & Life™ (formerly Neurology Now ®), actor Courtney B. Vance (Law & Order: Criminal Intent, People vs OJ Simpson) describes his mother’s experience with amyotrophic lateral sclerosis and how it affected him and his family in the hopes of raising awareness about the disease.
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Actor, ALS Advocate Vance in New Brain & Life Issue
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 June 1 Disease-specific Quality of Life Measure for Diabetic Polyneuropathy: the CAPPRI Alexander J. Menze, MD, and Kelly Graham Gwathmey, MD Neurology: Reflections on Translation: Views of Participants in a Multi-site Canadian CCSVI Clinical Trial Stacey Lynn Clardy, MD, PhD, and Judy Illes, CM, PhD, FRSC, FCAHS Neurology: Clinical Practice: Ask a Neurologist: What Primary Care Providers Ask, and Reducing Referrals Through eConsults Heather D. Harle, MD, and Ana C. Bradi, MD
Neurology: Neuroimmunology & Neuroinflammation: IgLON5 antibody: Neurological Accompaniments & Outcomes in 20 Patients Stacey Lynn Clardy, MD, PhD, and Andrew McKeon, MD, MB, BCh
AANnews • June 2018 11
Conferences & Communityâ€‚
2018 Annual Meeting a Smash Hit!
Everyone was a star at the Annual Meeting in Los Angeles, which attracted more than 14,000 attendees seeking the latest information in research, education, clinical practice, and advocacy.
AANnews • June 2018 13
BECAUSE RELAPSING MS AFFECTS MORE THAN HER. . .
NEWLY DIAGNOSED PATIENTS DESERVE THE #1 PRESCRIBED ORAL RMS THERAPY 1,2*†
Tecfidera® (dimethyl fumarate) is indicated for adults with relapsing forms of multiple sclerosis.
Important Safety Information
TECFIDERA is contraindicated in patients with known hypersensitivity to dimethyl fumarate or any of the excipients of TECFIDERA. TECFIDERA can cause anaphylaxis and angioedema after the first dose or at any time during treatment. Patients experiencing signs and symptoms of anaphylaxis and angioedema (which have included difficulty breathing, urticaria, and swelling of the throat and tongue) should discontinue TECFIDERA and seek immediate medical care. Progressive multifocal leukoencephalopathy (PML) has occurred in patients with MS treated with TECFIDERA. PML is an opportunistic viral infection of the brain caused by the JC virus (JCV) that typically only occurs in patients who are immunocompromised, and that usually leads to death or severe disability. A fatal case of PML occurred in a patient who received TECFIDERA in a clinical trial. PML has also occurred in the postmarketing setting in the presence of lymphopenia (<0.8x109/L) persisting for more than 6 months. While the role of lymphopenia in these cases is uncertain, the majority of cases occurred in patients with lymphocyte counts <0.5x109/L. The symptoms associated with PML are diverse, progress over days to weeks, and include progressive weakness on one side of the body or clumsiness of limbs, disturbance of vision, and changes in thinking, memory, and orientation leading to confusion and personality changes. At the first sign or symptom suggestive of PML, withhold
TECFIDERA and perform an appropriate diagnostic evaluation. MRI findings may be apparent before clinical signs or symptoms. TECFIDERA may decrease lymphocyte counts; in clinical trials there was a mean decrease of ~30% in lymphocyte counts during the first year which then remained stable. Four weeks after stopping TECFIDERA, mean lymphocyte counts increased but not to baseline. Six percent of TECFIDERA patients and <1% of placebo patients had lymphocyte counts <0.5x109/L. TECFIDERA has not been studied in patients with pre-existing low lymphocyte counts. There was no increased incidence of serious infections observed in patients with lymphocyte counts <0.8x109/L or ≤0.5x109/L in controlled trials, although one patient in an extension study developed PML in the setting of prolonged lymphopenia (lymphocyte counts predominantly <0.5x109/L for 3.5 years). In controlled and uncontrolled clinical trials, 2% of patients experienced lymphocyte counts <0.5x109/L for at least six months. In these patients, the majority of lymphocyte counts remained <0.5x109/L with continued therapy. A complete blood count including lymphocyte count should be obtained before initiating treatment, 6 months after starting, every 6 to 12 months thereafter and as clinically indicated. Consider treatment interruption if lymphocyte counts <0.5x109/L persist for more than six months and follow lymphocyte counts until lymphopenia is resolved. Consider withholding treatment in patients with serious infections until resolved. Decisions about whether or not to restart TECFIDERA should be based on clinical circumstances. Clinically significant cases of liver injury have been reported in
IN THE DEFINE‡ CLINICAL TRIAL, PATIENTS WERE:
LESS LIKELY TO EXPERIENCE
A RELAPSE3§ TECFIDERA: 27% (n=410) Placebo: 46% (n=408) [P<0.0001] Based on proportion of patients relapsed (PPR)||
LESS LIKELY TO EXPERIENCE
TECFIDERA: 16% (n=410) Placebo: 27% (n=408) [P=0.0050]
84% OF PATIENTS IN THE DEFINE TRIAL WERE FREE OF DISABILITY PROGRESSION VS 73% OF PLACEBO PATIENTS3
IN A SEPARATE ANALYSIS, THE NEWLY DIAGNOSED PATIENTS FROM THE PIVOTAL TRIALS WERE:
LESS LIKELY TO EXPERIENCE
TECFIDERA: 0.073 (n=221) Placebo: 0.233 (n=223) [P<0.0001]
STUDY DESIGN: This post hoc analysis of integrated data from DEFINE and CONFIRM# was conducted to examine the efficacy and safety of TECFIDERA in 678 newly diagnosed patients (59% of patients in DEFINE and 71% in CONFIRM were treatment-naive4,5). The newly diagnosed population included patients who had been diagnosed with RRMS within 1 year prior to study entry and were naive to MS disease-modifying therapy. The analysis included clinical and neuroradiological efficacy endpoints as well as basic safety data, or adverse events. This study was not designed in advance to analyze the endpoints presented in the subgroup of newly diagnosed patients.1 Most common adverse events reported in patients receiving TECFIDERA compared with placebo included flushing, nasopharyngitis, headache, diarrhea, nausea, upper abdominal pain, and abdominal pain.3
Important Safety Information (cont’d)
patients treated with TECFIDERA in the postmarketing setting. The onset has ranged from a few days to several months after initiation of treatment. Signs and symptoms of liver injury, including elevation of serum aminotransferases to greater than 5-fold the upper limit of normal and elevation of total bilirubin to greater than 2-fold the upper limit of normal have been observed. These abnormalities resolved upon treatment discontinuation. Some cases required hospitalization. None of the reported cases resulted in liver failure, liver transplant, or death. However, the combination of new serum aminotransferase elevations with increased levels of bilirubin caused by drug-induced hepatocellular injury is an important predictor of serious liver injury that may lead to acute liver failure, liver transplant, or death in some patients. Elevations of hepatic transaminases (most no greater than 3 times the upper limit of normal) were observed during controlled trials. Obtain serum aminotransferase, alkaline phosphatase, and total bilirubin levels before initiating TECFIDERA and during treatment, as clinically indicated. Discontinue TECFIDERA if clinically significant liver injury induced by TECFIDERA is suspected. TECFIDERA may cause flushing (e.g. warmth, redness, itching, and/or burning sensation). 40% of patients taking TECFIDERA reported flushing, which was mostly mild to moderate in severity. Three percent of patients discontinued TECFIDERA for flushing and <1% had serious flushing events that led to hospitalization. Taking TECFIDERA with food may reduce flushing. Alternatively, administration of non-enteric coated aspirin prior to dosing may reduce the incidence or severity of flushing. TECFIDERA may cause gastrointestinal (GI) events (e.g., nausea, vomiting, diarrhea, abdominal pain, and dyspepsia). Four percent of TECFIDERA patients and <1% of placebo patients discontinued due to GI events. The incidence of serious GI events was 1%. The most common adverse reactions associated with TECFIDERA
versus placebo are flushing (40% vs 6%) and GI events: abdominal pain (18% vs 10%), diarrhea (14% vs 11%), nausea (12% vs 9%). A transient increase in mean eosinophil counts was seen during the first two months. TECFIDERA should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. Encourage patients who become pregnant while taking TECFIDERA to enroll in the TECFIDERA pregnancy registry by calling 1-866-810-1462 or visiting www.TECFIDERApregnancyregistry.com. For additional Important Safety Information, please see adjacent Brief Summary of full Prescribing Information. *TECFIDERA is approved for adult patients only. † Based on prescriptions. ‡ Determination of Efficacy and Safety of Oral Fumarate in RelapsingRemitting MS.4 § Relapses were defined as new or recurrent neurologic symptoms not associated with fever or infection that lasted for at least 24 hours and were accompanied by new objective neurologic findings.4 || PPR is the percentage of patients who had one or more relapses over the course of the trial.4 ¶ Disability progression is defined as at least a 1-point increase from baseline EDSS of ≥1.0, OR at least a 1.5-point increase for patients with baseline EDSS of 0 sustained for 12 weeks.3 # Comparator and an Oral Fumarate in Relapsing-Remitting Multiple Sclerosis.5 References: 1. Gold R, Giovannoni G, Phillips JT, et al. Mult Scler. 2015;21(1):57-66. 2. IMS data September 27, 2013-December 8, 2017. 3. TECFIDERA Prescribing Information, Biogen, Cambridge, MA. 4. Gold R, Kappos L, Arnold DL, et al. N Engl J Med. 2012;367:10981107. Erratum in: N Engl J Med. 2012;367:2362. 5. Fox RJ, Miller DH, Phillips JT, et al. N Engl J Med. 2012;367:1087-1097. Erratum in: N Engl J Med. 2012;367:1673. © 2018 Biogen. All rights reserved. 02/18 TEC-US-2505
Tecfidera® (dimethyl fumarate) delayed-release capsules, for oral use Brief Summary of Full Prescribing Information 1 INDICATIONS AND USAGE TECFIDERA is indicated for the treatment of patients with relapsing forms of multiple sclerosis. 2 DOSAGE AND ADMINISTRATION 2.1 Dosing Information The starting dose for TECFIDERA is 120 mg twice a day orally. After 7 days, the dose should be increased to the maintenance dose of 240 mg twice a day orally. Temporary dose reductions to 120 mg twice a day may be considered for individuals who do not tolerate the maintenance dose. Within 4 weeks, the recommended dose of 240 mg twice a day should be resumed. Discontinuation of TECFIDERA should be considered for patients unable to tolerate return to the maintenance dose. The incidence of flushing may be reduced by administration of TECFIDERA with food. Alternatively, administration of non-enteric coated aspirin (up to a dose of 325 mg) 30 minutes prior to TECFIDERA dosing may reduce the incidence or severity of flushing [see Clinical Pharmacology (12.3)]. TECFIDERA should be swallowed whole and intact. TECFIDERA should not be crushed or chewed and the capsule contents should not be sprinkled on food. TECFIDERA can be taken with or without food. 2.2 Blood Tests Prior to Initiation of Therapy Obtain a complete blood cell count (CBC) including lymphocyte count before initiation of therapy [see Warnings and Precautions (5.3)]. Obtain serum aminotransferase, alkaline phosphatase, and total bilirubin levels prior to treatment with TECFIDERA [see Warnings and Precautions (5.4)]. 3 DOSAGE FORMS AND STRENGTHS TECFIDERA is available as hard gelatin delayed-release capsules containing 120 mg or 240 mg of dimethyl fumarate. The 120 mg capsules have a green cap and white body, printed with “BG-12 120 mg” in black ink on the body. The 240 mg capsules have a green cap and a green body, printed with “BG-12 240 mg” in black ink on the body. 4 CONTRAINDICATIONS TECFIDERA is contraindicated in patients with known hypersensitivity to dimethyl fumarate or to any of the excipients of TECFIDERA. Reactions have included anaphylaxis and angioedema [see Warnings and Precautions (5.1)]. 5 WARNINGS AND PRECAUTIONS 5.1 Anaphylaxis and Angioedema TECFIDERA can cause anaphylaxis and angioedema after the first dose or at any time during treatment. Signs and symptoms have included difficulty breathing, urticaria, and swelling of the throat and tongue. Patients should be instructed to discontinue TECFIDERA and seek immediate medical care should they experience signs and symptoms of anaphylaxis or angioedema. 5.2 Progressive Multifocal Leukoencephalopathy Progressive multifocal leukoencephalopathy (PML) has occurred in patients with MS treated with TECFIDERA. PML is an opportunistic viral infection of the brain caused by the JC virus (JCV) that typically only occurs in patients who are immunocompromised, and that usually leads to death or severe disability. A fatal case of PML occurred in a patient who received TECFIDERA for 4 years while enrolled in a clinical trial. During the clinical trial, the patient experienced prolonged lymphopenia (lymphocyte counts predominantly <0.5x109/L for 3.5 years) while taking TECFIDERA [see Warnings and Precautions (5.3)]. The patient had no other identified systemic medical conditions resulting in compromised immune system function and had not previously been treated with natalizumab, which has a known association with PML. The patient was also not taking any immunosuppressive or immunomodulatory medications concomitantly. PML has also occurred in the postmarketing setting in the presence of lymphopenia (<0.8x109/L) persisting for more than 6 months. While the role of lymphopenia in these cases is uncertain, the majority of cases occurred in patients with lymphocyte counts <0.5x109/L. At the first sign or symptom suggestive of PML, withhold TECFIDERA and perform an appropriate diagnostic evaluation. Typical symptoms associated with PML are diverse, progress over days to weeks, and include progressive weakness on one side of the body or clumsiness of limbs, disturbance of vision, and changes in thinking, memory, and orientation leading to confusion and personality changes. MRI findings may be apparent before clinical signs or symptoms. Cases of PML, diagnosed based on MRI findings and the detection of JCV DNA in the cerebrospinal fluid in the absence of clinical signs or symptoms specific to PML, have been reported in patients treated with
other MS medications associated with PML. Many of these patients subsequently became symptomatic with PML. Therefore, monitoring with MRI for signs that may be consistent with PML may be useful, and any suspicious findings should lead to further investigation to allow for an early diagnosis of PML, if present. Lower PML-related mortality and morbidity have been reported following discontinuation of another MS medication associated with PML in patients with PML who were initially asymptomatic compared to patients with PML who had characteristic clinical signs and symptoms at diagnosis. It is not known whether these differences are due to early detection and discontinuation of MS treatment or due to differences in disease in these patients. 5.3 Lymphopenia TECFIDERA may decrease lymphocyte counts. In the MS placebo controlled trials, mean lymphocyte counts decreased by approximately 30% during the first year of treatment with TECFIDERA and then remained stable. Four weeks after stopping TECFIDERA, mean lymphocyte counts increased but did not return to baseline. Six percent (6%) of TECFIDERA patients and <1% of placebo patients experienced lymphocyte counts <0.5x109/L (lower limit of normal 0.91x109/L). The incidence of infections (60% vs 58%) and serious infections (2% vs 2%) was similar in patients treated with TECFIDERA or placebo, respectively. There was no increased incidence of serious infections observed in patients with lymphocyte counts <0.8x109/L or ≤0.5x109/L in controlled trials, although one patient in an extension study developed PML in the setting of prolonged lymphopenia (lymphocyte counts predominantly <0.5x109/L for 3.5 years) [see Warnings and Precautions (5.2)]. In controlled and uncontrolled clinical trials, 2% of patients experienced lymphocyte counts <0.5x109/L for at least six months, and in this group the majority of lymphocyte counts remained <0.5x109/L with continued therapy. TECFIDERA has not been studied in patients with pre-existing low lymphocyte counts. Obtain a CBC, including lymphocyte count, before initiating treatment with TECFIDERA, 6 months after starting treatment, and then every 6 to 12 months thereafter, and as clinically indicated. Consider interruption of TECFIDERA in patients with lymphocyte counts less than 0.5x109/L persisting for more than six months. Given the potential for delayed recovery of lymphocyte counts, continue to obtain lymphocyte counts until their recovery if TECFIDERA is discontinued or interrupted due to lymphopenia. Consider withholding treatment from patients with serious infections until resolution. Decisions about whether or not to restart TECFIDERA should be individualized based on clinical circumstances. 5.4 Liver Injury Clinically significant cases of liver injury have been reported in patients treated with TECFIDERA in the postmarketing setting. The onset has ranged from a few days to several months after initiation of treatment with TECFIDERA. Signs and symptoms of liver injury, including elevation of serum aminotransferases to greater than 5-fold the upper limit of normal and elevation of total bilirubin to greater than 2-fold the upper limit of normal have been observed. These abnormalities resolved upon treatment discontinuation. Some cases required hospitalization. None of the reported cases resulted in liver failure, liver transplant, or death. However, the combination of new serum aminotransferase elevations with increased levels of bilirubin caused by drug-induced hepatocellular injury is an important predictor of serious liver injury that may lead to acute liver failure, liver transplant, or death in some patients. Elevations of hepatic transaminases (most no greater than 3 times the upper limit of normal) were observed during controlled trials [see Adverse Reactions (6.1)]. Obtain serum aminotransferase, alkaline phosphatase (ALP), and total bilirubin levels prior to treatment with TECFIDERA and during treatment, as clinically indicated. Discontinue TECFIDERA if clinically significant liver injury induced by TECFIDERA is suspected. 5.5 Flushing TECFIDERA may cause flushing (e.g., warmth, redness, itching, and/or burning sensation). In clinical trials, 40% of TECFIDERA treated patients experienced flushing. Flushing symptoms generally began soon after initiating TECFIDERA and usually improved or resolved over time. In the majority of patients who experienced flushing, it was mild or moderate in severity. Three percent (3%) of patients discontinued TECFIDERA for flushing and <1% had serious flushing symptoms that were not lifethreatening but led to hospitalization. Administration of TECFIDERA with food may reduce the incidence of flushing. Alternatively, administration of non-enteric coated aspirin (up to a dose of 325 mg) 30 minutes prior to TECFIDERA dosing may reduce the incidence or severity of flushing [see Dosing and Administration (2.1) and Clinical Pharmacology (12.3)]. 6 ADVERSE REACTIONS The following important adverse reactions are described elsewhere in labeling: Anaphylaxis and Angioedema (5.1), Progressive multifocal leukoencephalopathy (5.2), Lymphopenia (5.3), Liver Injury (5.4), Flushing (5.5) [see Warnings and Precautions].
6.1 Clinical Trials Experience Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in clinical practice. The most common adverse reactions (incidence ≥10% and ≥2% more than placebo) for TECFIDERA were flushing, abdominal pain, diarrhea, and nausea. Adverse Reactions in Placebo-Controlled Trials In the two well-controlled studies demonstrating effectiveness, 1529 patients received TECFIDERA with an overall exposure of 2244 person-years [see Clinical Studies (14)]. The adverse reactions presented in the table below are based on safety information from 769 patients treated with TECFIDERA 240 mg twice a day and 771 placebo-treated patients. Table 1: Adverse Reactions in Study 1 and 2 reported for TECFIDERA 240 mg BID at ≥2% higher incidence than placebo
Flushing Abdominal pain Diarrhea Nausea Vomiting Pruritus Rash Albumin urine present Erythema Dyspepsia Aspartate aminotransferase increased Lymphopenia
TECFIDERA N=769 %
Placebo N=771 %
40 18 14 12 9 8 8 6 5 5 4 2
6 10 11 9 5 4 3 4 1 3 2 <1
Gastrointestinal TECFIDERA caused GI events (e.g., nausea, vomiting, diarrhea, abdominal pain, and dyspepsia). The incidence of GI events was higher early in the course of treatment (primarily in month 1) and usually decreased over time in patients treated with TECFIDERA compared with placebo. Four percent (4%) of patients treated with TECFIDERA and less than 1% of placebo patients discontinued due to gastrointestinal events. The incidence of serious GI events was 1% in patients treated with TECFIDERA. Hepatic Transaminases An increased incidence of elevations of hepatic transaminases in patients treated with TECFIDERA was seen primarily during the first six months of treatment, and most patients with elevations had levels <3 times the upper limit of normal (ULN) during controlled trials. Elevations of alanine aminotransferase and aspartate aminotransferase to ≥3 times the ULN occurred in a small number of patients treated with both TECFIDERA and placebo and were balanced between groups. There were no elevations in transaminases ≥3 times the ULN with concomitant elevations in total bilirubin >2 times the ULN. Discontinuations due to elevated hepatic transaminases were <1% and were similar in patients treated with TECFIDERA or placebo. Eosinophilia A transient increase in mean eosinophil counts was seen during the first 2 months of therapy. Adverse Reactions in Placebo-Controlled and Uncontrolled Studies In placebo-controlled and uncontrolled clinical studies, a total of 2513 patients have received TECFIDERA and been followed for periods up to 4 years with an overall exposure of 4603 person-years. Approximately 1162 patients have received more than 2 years of treatment with TECFIDERA. The adverse reaction profile of TECFIDERA in the uncontrolled clinical studies was consistent with the experience in the placebo-controlled clinical trials. 6.2 Post Marketing Experience The following adverse reaction has been identified during post approval use of TECFIDERA. 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. Liver function abnormalities (elevations in transaminases ≥3 times ULN with concomitant elevations in total bilirubin >2 times ULN) have been reported following TECFIDERA administration in post marketing experience [See Warnings and Precautions (5.4)].
8 USE IN SPECIFIC POPULATIONS 8.1 Pregnancy Pregnancy Exposure Registry There is a pregnancy exposure registry that monitors pregnancy outcomes in women exposed to TECFIDERA during pregnancy. Encourage patients to enroll by calling 1-866-810-1462 or visiting www.tecfiderapregnancyregistry.com. Risk Summary There are no adequate data on the developmental risk associated with the use of TECFIDERA in pregnant women. In animals, adverse effects on offspring survival, growth, sexual maturation, and neurobehavioral function were observed when dimethyl fumarate (DMF) was administered during pregnancy and lactation at clinically relevant doses. [see data]. 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 In rats administered DMF orally (25, 100, 250 mg/kg/day) throughout organogenesis, embryofetal toxicity (reduced fetal body weight and delayed ossification) were observed at the highest dose tested. This dose also produced evidence of maternal toxicity (reduced body weight). Plasma exposure (AUC) for monomethyl fumarate (MMF), the major circulating metabolite, at the no-effect dose is approximately three times that in humans at the recommended human dose (RHD) of 480 mg/day. In rabbits administered DMF orally (25, 75, and 150 mg/kg/day) throughout organogenesis, embryolethality and decreased maternal body weight were observed at the highest dose tested. The plasma AUC for MMF at the no-effect dose is approximately 5 times that in humans at the RHD. Oral administration of DMF (25, 100, and 250 mg/kg/day) to rats throughout organogenesis and lactation resulted in increased lethality, persistent reductions in body weight, delayed sexual maturation (male and female pups), and reduced testicular weight at the highest dose tested. Neurobehavioral impairment was observed at all doses. A no-effect dose for developmental toxicity was not identified. The lowest dose tested was associated with plasma AUC for MMF lower than that in humans at the RHD. 8.2 Lactation Risk Summary There are no data on the presence of DMF or MMF in human milk. The effects on the breastfed infant and on milk production are unknown. The developmental and health benefits of breastfeeding should be considered along with the mother’s clinical need for TECFIDERA and any potential adverse effects on the breastfed infant from the drug or from the underlying maternal condition. 8.4 Pediatric Use Safety and effectiveness in pediatric patients have not been established. 8.5 Geriatric Use Clinical studies of TECFIDERA did not include sufficient numbers of patients aged 65 and over to determine whether they respond differently from younger patients. 10 OVERDOSE Cases of overdose with TECFIDERA have been reported. The symptoms described in these cases were consistent with the known adverse event profile of TECFIDERA. There are no known therapeutic interventions to enhance elimination of TECFIDERA nor is there a known antidote. In the event of overdose, initiate symptomatic supportive treatment as clinically indicated. 17 PATIENT COUNSELING INFORMATION Advise the patient to read the FDA-approved patient labeling (Patient Information) Dosage Inform patients that they will be provided two strengths of TECFIDERA when starting treatment: 120 mg capsules for the 7 day starter dose and 240 mg capsules for the maintenance dose, both to be taken twice daily. Inform patients to swallow TECFIDERA capsules whole and intact. Inform patients to not crush, chew, or sprinkle capsule contents on food. Inform patients that TECFIDERA can be taken with or without food [see Dosage and Administration (2.1)].
Anaphylaxis and Angioedema Advise patients to discontinue TECFIDERA and seek medical care if they develop signs and symptoms of anaphylaxis or angioedema [see Warnings and Precautions (5.1)]. Progressive Multifocal Leukoencephalopathy Inform patients that progressive multifocal leukoencephalopathy (PML) has occurred in patients who received TECFIDERA. Inform the patient that PML is characterized by a progression of deficits and usually leads to death or severe disability over weeks or months. Instruct the patient of the importance of contacting their doctor if they develop any symptoms suggestive of PML. Inform the patient that typical symptoms associated with PML are diverse, progress over days to weeks, and include progressive weakness on one side of the body or clumsiness of limbs, disturbance of vision, and changes in thinking, memory, and orientation leading to confusion and personality changes [see Warnings and Precautions (5.2)]. Lymphocyte Counts Inform patients that TECFIDERA may decrease lymphocyte counts. A blood test should be obtained before they start therapy. Blood tests are also recommended after 6 months of treatment, every 6 to 12 months thereafter, and as clinically indicated [see Warnings and Precautions (5.3), Adverse Reactions (6.1)]. Liver Injury Inform patients that TECFIDERA may cause liver injury. Instruct patients treated with TECFIDERA to report promptly any symptoms that may indicate liver injury, including fatigue, anorexia, right upper abdominal discomfort, dark urine, or jaundice. A blood test should be obtained before patients start therapy and during treatment, as clinically indicated [see Warnings and Precautions (5.4)]. Flushing and Gastrointestinal (GI) Reactions Flushing and GI reactions (abdominal pain, diarrhea, and nausea) are the most common reactions, especially at the initiation of therapy, and may decrease over time. Advise patients to contact their healthcare provider if they experience persistent and/or severe flushing or GI reactions. Advise patients experiencing flushing that taking TECFIDERA with food or taking a non-enteric coated aspirin prior to taking TECFIDERA may help [see Adverse Reactions (6.1)]. Pregnancy and Pregnancy Registry Instruct patients that if they are pregnant or plan to become pregnant while taking TECFIDERA they should inform their physician. Encourage patients to enroll in the TECFIDERA Pregnancy Registry if they become pregnant while taking TECFIDERA. [see Use in Specific Populations (8.1)]. 41347-09 Manufactured by: Biogen Cambridge, MA 02142 TECFIDERA is a trademark of Biogen. ÂŠ 2013-2017 Biogen 2/18
Education & Research
New AAN Publication Seeks ‘Negative, Inconclusive,’ and Confirmatory Studies
New Online Learning Center Provides Convenient, Centralized Hub for Resources
The AAN is announcing a call for papers to be published in Neurology ® Null Hypothesis, a new joint initiative between the journal Neurology ® and the Center for Biomedical Research Transparency (CBMRT). The organizations are working collaboratively on promoting the write-up and submission of research papers for well-designed yet “negative” or inconclusive studies, and replication work, as such results in biomedical research have substantial value to inform future research efforts and funding decisions, and to save study participants from avoidable risks.
The AAN has launched an exclusive Online Learning Center to give members convenient, centralized access to AAN continuing medical education resources. The new AAN member benefit is available at AAN.com/view/LearningCenter and features: Gross
Petty Neurology: Null Hypothesis will be free and open to all, and will be available both in print and online, and anyone who receives Neurology will receive the print version. The plan is to publish a single issue before end of 2018; if it is popular, consideration will be given to publishing future issues.
“In order to advance science in a timely manner, data transparency is crucial,” said Robert A. Gross, MD, PhD, FAAN, editor-in-chief of Neurology. Yet, we have a dearth of papers that are confirmatory or that show that a new treatment is no better than the comparator. These data are critical, allowing investigators to have greater confidence in confirmed findings, and greater caution about treatments (or classes of treatments) that fail to show benefits. Our goal is to gather articles of these types, highlighting their results, so as to advance research in our field. We are thrilled to collaborate with CBMRT, whose mission is to bring confirmatory and ‘null’ data to light.” The Center for Biomedical Research Transparency was co-founded in 2016 by Sandra Petty, MBBS, FRACP, PhD, a neurologist/epileptologist with both clinical and lab research interests, as a non-profit organization focused on improving communication of negative and inconclusive results in biomedical research. A central project of the CBMRT involves establishing an environment―in collaboration with major societies and journals—where not only can such results be published, but where researchers can look forward to publishing these findings.
New and improved user interface with easy access to a host of resources
A centralized online learning dashboard where you can view all in-progress and completed courses Expanded course catalog with improved search capability by product, format, topic, and learning type The following programs are currently available at the Online Learning Center: NeuroSAE®—Online self-assessment exams NeuroLearnSM—Multimedia suite of online education courses Neurology MOC Prep Course—A comprehensive review and update program Evidence-based Medicine (EBM) Online—New format for popular in-person training; offers 10 modules that teach EBM concepts with common, real-life neurologic examples Practice Management Webinars—One-hour sessions available live and on demand Continuum®—Post-reading self-assessment and CME tests—COMING SOON “Going forward, the Online Learning Center will continue to grow and allow us to more effectively evaluate the effectiveness of AAN-sponsored learning initiatives and offer members a personalized approach toward meeting educational needs,” said Richard S. Isaacson, MD, chair of the eLearning Subcommittee. "We invite you to browse the courses and let us know what you think!” For feedback and questions, contact OnlineLearningCenter@aan.com.
Papers should be submitted to the Neurology submission website, NPub.org/submit under the category ‘Null Hypothesis.’ For more information, visit cbmrt.org/neurology.
AANnews • June 2018 19
Education & Research
Get Up-to-date on Assessment, Management of Behavioral Neurology and Psychiatry with New Continuum With neurobehavioral and psychiatric disorders affecting a growing proportion of the population, it is becoming increasingly important for neurologists to become more expert in the assessment and management of patients with cognitive and behavioral impairment due to brain disorders, as well as neurological patients with psychiatric disease, according to Morris Freedman, MD, FRCPC, FAAN, guest editor of the June issue of Continuum: Lifelong Learning in Neurology ® on these conditions. Topics in this Continuum® include: Bedside Approach to the Mental Status Assessment / David F. Tang-Wai, MDCM, FRCPC; Morris Freedman, MD, FRCPC, FAAN Clinical Assessment of Prefrontal Lobe Functions / Alexandre Henri-Bhargava, MDCM, MScCH, FRCPC; Donald T. Stuss, OC, O Ont, PhD, FRSC, FCAHS, CPsych, ABPP-CN; Morris Freedman, MD, FRCPC, FAAN Memory Dysfunction / G. Peter Gliebus, MD Primary Progressive Aphasia and Stroke Aphasia / Murray Grossman, MDCM, FAAN; David J. Irwin, MD Apraxia, Neglect, and Agnosia / H. Branch Coslett, D, FAAN Aggression and Agitation in Dementia / MD. Uri Wolf, MD, FRCPC; Yael Goldberg, PhD, CPsych; Morris Freedman, MD, FRCPC, FAAN
Coding for Behavioral Neurology and Psychiatry / Raissa Villanueva, MD, MPH; Bruce H. Cohen, MD, FAAN
All of the articles have corresponding interviews on Continuum® Audio, which is now included in a subscription to Continuum. AAN members receive a deep discount to Continuum and Continuum Audio for a subscription price of only $349. Subscribe now 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.
Mood Disorders / Jeffrey Rakofsky, MD; Mark Rapaport, MD Obsessive-Compulsive Disorder / Peggy M.A. Richter, MD, FRCPC; Renato T. Ramos, MD Psychosis / Lindsey A. Schrimpf, MD; Arpit Aggarwal, MD; John Lauriello, MD Conversion Disorder / Anthony Feinstein, MD, PhD Assessment and Management of Posttraumatic Stress Disorder / Janet Ellis, MBBChir, MD, FRCPC; Ari Zaretsky, MD, FRCPC Diagnosis and Management of Anxiety Disorders / Peter Giacobbe, MD, MSc, FRCPC; Alastair Flint, MD, FRCPC, FRANZCP Assessment of Medical Decision-making Capacity in Patients with Alzheimer Disease / Joshua J. Rodgers, MD; Joseph S. Kass, MD, JD, FAAN
Apply Now to Recertify in Neurocritical Care Through UCNS If your Neurocritical Care certification through the United Council for Neurologic Subspecialties (UCNS) is expiring in 2018, now is the time to apply for recertification. Those who apply by the early deadline of July 2 will save $500 on the application fee. The late application deadline is July 16. The exam is scheduled for the week of December 3–7, 2018. To apply, visit UCNS.org.
AANnews • June 2018
Conferences & Community
Leadership Programs Graduate Reflects on Being a Leader… and the Leader She’s Becoming There is always something new to learn, and never underestimate the importance of reflection. These are the two grains of wisdom that the Diversity Leadership Program (DLP) and Transforming Leaders Program (TLP) most impressed upon graduate Rachel Salas, MD, FAAN. “In the last couple of years, I have done more work than ever in developing my leadership skills to continue my journey as a leader,” she said. “With that, I have had some time to reflect on myself as the leader I am—and am becoming—and tried to identify my strengths and weaknesses. Each leadership or development opportunity I experience allows me to appreciate new perspectives. These AAN programs have been invaluable and gone beyond just developing me as a leader. They have allowed me to feel valued as a member, a neurologist, an educator, and as a person. I am now even more committed to the AAN for all their effort.” Since being involved in the DLP in 2015–2016 and the TLP in 2017–2018, Salas, a neurologist at Johns Hopkins University in Baltimore, has dramatically increased her leadership role within the Academy—a step she directly credits to the Leadership Programs. She currently serves on the Medical Student Diversity and Undergraduate Education Subcommittees, where she is involved in the Medical Student Research and Young Investigator Medical Student Scholarships. “My involvement with the AAN has helped me find wellness and inspiration in many of the things I have done—and will do—professionally,” she said. The programs have also helped Salas see entirely new things about herself—and how others see her. “I had the opportunity to complete a Discovery Insights Profile through the DLP and was determined to be a ‘inspirer,’ which describes my leadership nature,” she explained. “What I found most powerful about this assessment was learning what others in the DLP group thought of me (before them knowing my results). It made me realize that while we may see ourselves one way, others may see us in a different light.” A separate StrengthsFinders assessment opened Salas’s eyes to various strengths in many facets of her non-professional life. “Not only did I learn about my strengths as a leader, but as a team player, peer, and even as a mother, partner, sibling, daughter, and friend. And I was also able to identify areas to improve that have been instrumental in me becoming a better leader,
clinician, peer, supervisor, mother, friend... person.” Speaking from the perspective of an underrepresented individual in medicine, Salas admits that there has always been doubt in the back of her mind that made her question her leadership ability or capacity Salas to share her perspective(s) within a field she did not see as being representative of her. “Because of this, I am thankful that I have had such support from the AAN and that the AAN is invested in diversity and inclusion, as well as in neurologists in their mid-careers. I believe programs like the DLP and TLP are what make the AAN unique. And the field of neurology and the patients we care for are what ultimately benefit from these programs.” When asked if she would recommend the DLP and TLP programs, Salas responded with “A tremendous yes! There are no reasons not to recommend these! If you want to be a better leader as a neurologist, these are the programs for you. If you strive to learn to engage more within the AAN, these are the program for you. If you want to be a better person…these are the programs for you.” The Transforming Leaders Program is an elite, 10-month, intensive training program designed to identify and develop talent among experienced AAN member neurologists who are 10 or more years out of residency and interested in future leadership roles in the AAN and the field of neurology. For more information and to apply for the 2018–2019 program by the June 4 application deadline, visit AAN.com/Lead. The Diversity Leadership Program is a crucial aspect of the AAN’s leadership diversification strategy intended to identify, mentor, and engage AAN members from underrepresented minority groups. Applications for the 2019 program will open this fall. The Transforming Leaders Program is supported in part by grants from Allergan, Inc., Lundbeck LLC., Sanofi Genzyme, and Supernus Pharmaceuticals, Inc. The Diversity Leadership Program is supported in part by grants from Allergan, Inc., Lilly, and Supernus Pharmaceuticals, Inc.
Salas received the 2018 Clerkship Director Teaching Award from Jaffar Khan, MD, FAAN.
AANnews • June 2018 21
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Conferences & Community
Policy & Guidelines
The More You Participate, the More You Stand Out with New Synapse Badges SynapseSM is the AAN’s member-only online community platform where participants can partner with colleagues; engage in conversation; exchange ideas; and share scientific, practice, and professional insights. Now, it has introduced a new incentive to increase engagement and make this AAN member benefit even more robust. The new Contributor Badge program recognizes Synapse members who contribute to the Synapse conversation in a number of ways. The more members engage, the more they get recognized. Examples include: Posting a new discussion or replying to an existing post Uploading your profile picture or adding a biography to your profile Submitting, reading, or downloading a library item
Most Valuable Contributor Program Synapse members looking to take their engagement to an even higher level should consider the Most Valuable Contributor program. Email email@example.com to find out how. More than one half of AAN members belong to one or more of the 45+ AAN sections and consortia, and their associated Synapse communities. Join this vibrant network of neurologists and neuroscience professionals in a wide range of subspecialties and interest areas at AAN.com/Synapse.
Capitol Hill Report Capitol Hill Report presents regular updates on legislative and regulatory actions and how the Academy ensures that the voice of neurology is heard on Capitol Hill. It is emailed to US members twice monthly and is posted at AAN.com/ view/HillReport. Below are some recent highlights. There was recent committee action in both the House and Senate on bills related to the opioid epidemic. In total, the House Energy and Commerce (E&C) Health Subcommittee approved 56 bills focused on combating the opioid crisis, while the Senate package (S. 2680) contains 40 bipartisan proposals from 38 different senators. Both packages included an AAN priority, the Advancing Cutting Edge (ACE) Research Act, which provides significant flexibility to the National Institutes of Health (NIH) to study the effects of pain medication on the brain and develop nonopioid, non-addictive pain treatments. Additionally, the E&C package included another AAN priority, the Standardizing Electronic Prior Authorization for Safe Prescribing Act, H.R. 4841, which requires: Insurance companies to offer electronic prior authorization (ePA) for prescriptions in Medicare Part D or Medicare Advantage plans. It also instructs the Centers for Medicare and Medicaid Services (CMS) to continue efforts to standardize ePA to streamline the process to improve health outcomes and reduce costs. This bill was a top priority at the AAN’s annual Neurology on the Hill in February, which drew 211 AAN members from 49 states and DC into congressional offices to discuss the burdens of prior authorization on patients and physicians. In April, the AAN signed a letter of support for H.R. 4841 to the bill authors Reps. Dave Schweikert (R-AZ), Mike Thompson (D-CA), Bill Johnson (R-OH), and Ben Ray Lujan (D-NM), detailing the benefits of ePA, including the time saved by eliminating phone and fax PA. The bill was included in the opioids package because it will help ensure legitimate beneficiary access to prescribed medications, which partners well with the other efforts in the package to curb opioid misuse.
AANnews • June 2018
American Brain Foundation
Researchers and Foundation Philanthropist Honored Two of neurology’s most significant research awards were bestowed by the AAN at the Annual Meeting in Los Angeles, and the man responsible for one of those awards was himself honored by the American Brain Foundation. Since 1996, the $50,000 Sheila Essey Award—An Award for ALS Research, an internationally recognized AAN scientific award, has been made possible by the generosity of the Essey family to honor the memory of Sheila Essey, who battled ALS for 10 years and died from the disease in 2004. Their funding, given annually to the American Brain Foundation through the ALS Association, recognizes an individual who has made significant contributions in research in the search for the cause, treatment, prevention, and cure for amyotrophic lateral sclerosis. The recipient of the 2018 Sheila Essey Award, is Timothy M. Miller, MD, PhD, from the Washington University School of Medicine in St. Louis. Richard Essey, Sheila’s husband and initiator of this award, has been a tireless advocate for ALS research and serves as an honorary board member of the American Brain Foundation. He was recognized in Los Angeles with the Foundation’s Board Chair Award at the Foundation’s annual Commitment to Cures dinner. Their son, James Essey, joined the American Brain Foundation Board of Directors in January.
The 30th Potamkin Prize for Research in Pick’s, Alzheimer’s and Related Diseases, sometimes referred to as the “Nobel Prize of Alzheimer’s research,” is an internationally recognized AAN scientific award recognizing major contributions to the understanding of the cause, prevention, treatment of these diseases. David A. Bennett, MD, of Rush University Medical Center in Chicago, was awarded the 2018 Potamkin Prize for his work in dementia research. The Potamkin Prize is made possible by philanthropic contributions to the American Brain Foundation from the Potamkin family. The goal of the award is to help attract the best medical minds and most dedicated scientists in the world to the field of dementia research. In honor of 30 years of awards, past recipients were invited to a lunch with the benefactor prior to this year’s presentation. The Potamkin family is the Foundation’s single largest personal donor, providing more than $2 million since 1988 to fund the Potamkin Prize. All of the American Academy of Neurology’s scientific awards are made possible through the generosity of current or past donors. To learn more about how you can make a difference and create your legacy, or recognize a mentor or loved one, contact the American Brain Foundation at info@AmericanBrainFoundation.org, or Shelly Rucks at (612) 928-6318. ALS philanthropist Richard “Dick” Essey and his Board Chair plaque from the American Brain Foundation.
Timothy M. Miller, MD, PhD, received the 2018 Sheila Essey Award.
David A. Bennett, MD, accepted the Potamkin Award.
AANnews • June 2018 25
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.
Nurse Practitioner—Neurology Cheyenne Regional Medical Center (CRMC), an independent, county-owned community hospital, is seeking a Nurse Practitioner for an employed position in our Neurology Clinic. We are located in the southeast corner of Wyoming. Individuals interested in working in a team management environment, who enjoy seeing a broad spectrum of medical issues, and like establishing longer term relationships with their patients will find this job especially satisfying. This position offers up to $30,000 in student loan repayment in addition to an attractive salary, incentives, relocation assistance, sign-on bonus and CMEs. CRMC provides a robust benefits package and paid malpractice. Wyoming is a very friendly tax state—having no state income tax, low property taxes and no sales tax on food. Cheyenne, the state capital of Wyoming, is a community of approximately 65,000 residents. The location is ideal, being about 90 minutes north of a major metropolitan area, Denver, but also within 20 minutes of mountains, reservoirs, rivers and wide-open spaces. The community offers panoramic views of the Rocky Mountains, 320+ days of sunshine per year and four seasons—including cool summer nights, spectacular fall days and many mild winter days. The region also offers world-class skiing, hiking, biking, fishing and camping opportunities. For those who love the arts, Cheyenne has a well-regarded symphony, chamber singers and community theater in addition to a variety of museums, western-themed attractions and several farmers markets. For the sports fan, pro football, baseball, hockey, soccer and basketball are all available about 90 minutes south. Job Requirements. Must be a licensed Nurse Practitioner in the State of Wyoming. Must have neurology experienceeither as part of clinical rotation or work history. To apply for this position, contact Phyllis Hime, firstname.lastname@example.org. Phone: (307) 633-7767. Neurologist—Outpatient Central Vermont Medical Center (CVMC), a partner in The University of Vermont Health Network is recruiting for a Neurologist to join our practice. Located in the heart of the Green Mountain state, CVMC has a reputation for clinical excellence with a staff deeply rooted in our community. We have attracted and retained a very talented staff due to our focus on lifestyle and professional growth. Our Neurology practice specializes in epilepsy/ seizure disorders, stroke, chronic headaches/migraines, multiple sclerosis, Parkinson’s and Alzheimer disease, as well as movement and neuromuscular disorders. Candidates interested in reading EEG’s and/or conducting/interpreting EMG’s welcomed. We are looking for a physician who wants to work in an area where you can have a long, sustainable career and enjoy the special lifestyle that comes with living in Vermont. The financial package includes a market based, competitive salary plus quality and productivity bonuses. Full benefit package includes moving expenses and assistance with student loans. Job Requirements. BC/BE Neurologist. To apply for this position, contact Sarah Child, sarah.child@ cvmc.org. Phone: (802) 225-1739. Apply URL: http://cvmc.org Neurology Opportunities The largest neurological private practice in north east Indiana is currently searching for multiple BC/BE outpatient neurologists with subspecialty training in the following areas: Sleep, movement disorders, concussion; Pediatric Neurology; Neurological Intensivist. This private practice group, comprised of Neurologists, Neurosurgeons and Nurse Practitioners, has been serving the tri-state area (Indiana, Ohio, Michigan) for 49 years as the region’s top provider in patient services caring for spinal, brain and neurological disorders. The practice provides full diagnostic services on site as well as operates its own sleep and infusion centers. This group handles all the major stroke work at four (4) hospitals. There is also active participation in national clinical research studies on the latest neurological treatments. Work out of one main office and cover two
AANnews • June 2018
hospitals which are 10 minutes apart by car. Whether you are focused on providing outstanding patient-centered care, teaching the next generation of care providers or growing into a leadership role, it’s time to join Fort Wayne Neurological Center! Position Details: Shared Neurology call; Night and weekend call schedule rotated among providers; Group consists of 11 physicians, 7 Neurologists, 4 Neurosurgeons; Competitive compensation, plus bonus; Partnership track available for interested candidate; Full benefits package including 401(k) and Profit Sharing; Paid malpractice insurance. Why you’ll love Fort Wayne, Indiana: Since Fort Wayne’s establishment, our three rivers: the St. Mary’s, the St. Joseph, and the Maumee, have been an intrinsic part of the city. From adventuring the 90 miles of trails, to getting out onto the blue ways, there are plenty of opportunities for you to experience the great outdoors in Fort Wayne. Fort Wayne is a three-time All-America City Award winner and has been consistently cited for the high quality of life, low cost of living and warm Hoosier Hospitality. Fort Wayne is Indiana’s second-largest city and is home to over 250,000 residents. (Allen County, Indiana’s largest county by size, has a population of 355,000.) Nearly equidistant from Chicago, Cincinnati, and Detroit, it has historically served as a transportation and communications center for Northeast Indiana, and an incubator for many products and companies. To apply for this position, contact Don Shook, dshook@fwnc. com. Phone: (260) 399-4704. Fax: (260) 432-9296. Neurology Opportunities at Reading Hospital 2 Fellowship trained Vascular/Stroke Neurologists and 2 Fellowship trained Neuro-Interventional Vascular Neurologists. New graduates are encouraged to apply. Neuroscience Center. Reading Hospital is aggressively developing a Comprehensive Stroke Program in response to community need and expanding volume. The stroke program is driven by the busiest Emergency Department in PA with over 135,000 visits per year with call primarily being done by telestroke. Over the past 4 years, Reading Hospital has hired 13 Neurologists and 2 Neurosurgeons, including a Vascular Neurologist and an Endovascular Neurosurgeon. The Neuro ICU is currently with 3 Neurocritical Care Neurologists. We are also recruiting a second Endovascular Neurosurgeon in addition to the opportunities listed above. Very Competitive Salary, Physician Incentive Program, Relocation Assistance, Educational Loan Assistance, 403(b) and 457(b) Retirement and Savings Plans, CME Allowance and Stipend, Comprehensive Benefits Package, Occurrence-based Malpractice Insurance, Supportive health system to advance goals, including clinical research opportunities. Reading Hospital—Tower Health. 600+ bed, tertiary care facility; 36-acre campus; 44+ remote locations. 1000+ medical staff. Clinical campus of Jefferson Medical College of Thomas Jefferson University. Member of the Alliance of Independent Academic Medical Centers (AIAMC) and the Council of Teaching Hospitals(COTH) of the AAMC. Clinically affiliated with PCOM. Top 5% nationally for patient safety/clinical performance. Member Institution of the Jefferson Kimmel Cancer Center Network. Branch Medical School Campus of Drexel University College of Medicine in joint development with Tower Health; Expected opening: 2020/2021 school. Achievements and Awards: Certified by TJC as an Advanced Primary Stroke Center since 2006. TJC participant in on-line Solutions Exchange for physician “Best Practice” since 2011. AHA/ ASA Target Stroke Honor Roll 2015–2017. AHA/ASA Gold Plus achievement award 11 years (2007–2017). AHA/ASA Best Practice Toolkit since 2009. Only Acute Stroke Rehabilitation Program in Berks County accredited by the Commission on Accreditation of Rehabilitation Facilities since 2006. Nationally recognized 100 Best Hospital for Stroke Care 5 years (2013–2017). Distinguished for Clinical Excellence in Stroke Care 11 years (2007-2017). To apply,
send your CV or contact: Kenneth Nichols. Director, Medical Staff Recruitment. Phone: (484) 628-6581. Email: kenneth. email@example.com. To learn more, visit our websites: towerhealth.org. careers.towerhealth.org Seeking FT Neurologist for Outpatient Care in Suburban Baltimore County, Maryland This is an outstanding opportunity to join a busy, well-established, and growing neurology practice in Baltimore County, Maryland. We are seeking to add an energetic neurologist who is looking for a practice which offers the variety and excitement of general neurology with lifestyle-friendly work hours. The practice is strictly out-patient. There is no hospital call, nor evening or weekend work. Our referral base is among the best in the region, with the practice itself having grown over a twenty year period. We are right across from a major community hospital, and the city of Baltimore boasts two world-class tertiary centers available for referrals and special consultations. Our clinical and diagnostic arrangement offers substantial financial opportunities. We perform routine and ambulatory EEGs, EDX and ABI, VNG, and formal cognitive testing. We have a dynamic physical therapy suite for treating neurologic and musculoskeletal conditions. Subspecialty training will be considered but is not a prerequisite. Applicants with an interest in an optional buy-in /earn-in are preferred. Benefits are comprehensive and competitive, and include health, dental, 401k, disability, and vacation. For further information, contact Dr. Steven L. Strauss, MD, PhD, at firstname.lastname@example.org Seeking Exceptional Neurologist at our Racine, Milwaukee, and Stevens Points Locations Enjoy a superior quality of life and practice medicine in a primary care focused organization. Ascension Wisconsin is a combination of four healthcare systems—Affinity Health System, Columbia St. Mary’s, Ministry Health Care, and Wheaton Franciscan Healthcare. Together there is a total of 24 hospitals, 111 primary care clinics, approximately 23,500 associates, including nearly 1,000 medical group clinicians all delivering compassionate, personalized care every day. Ascension Healthcare is the largest nonprofit health system in the US and the world’s largest Catholic health system. Neurology opportunities with Ascension, WI: Comprehensive general neurology practice. Receive generous benefits, including a great retirement and competitive compensation package. Excellent on call schedules. Enjoy state of the art facilities with leading edge technology. Join an excellent work/life balance opportunity that is filled with friendly, thriving communities. For more information contact: Anneliese Pratt, Physician Recruiter: Anneliese.Pratt@ascension.org 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 August 2018 print edition of AANnews A must be submitted by July 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.
Dates & Deadlines
Deadline: UCNS Fellowship Training Program Application Deadline UCNS.org
Deadline: UCNS Neurocritical Care Recertification Examination Application (Early application deadline July 2; late application deadline July 16) UCNS.org/go/subspecialty/neurocritical/ certification
Deadline: UCNS Neuroimaging Certification and Recertification Examinations Application (Early application deadline August 1; late application deadline August 15) UCNS.org/go/subspecialty/neuroimaging/ certification
JUNE 4 Leadership Program Application Deadline: Transforming Leaders, Emerging Leaders, Women Leading in Neurology, and Practice Leadership AAN.com/view/Lead
JUNE 14 Early Registration and Hotel Deadline: Sports Concussion Conference Indianapolis, IN AAN.com/view/ConcussionConference
JULY 20–22, 20 Sports Concussion Conference Indianapolis, IN AAN.com/view/SCC
AUGUST 21 Webinar: Improving Patient Access, Engagement, and Care (Register by August 20) AAN.com/view/pmw18
JUNE 19 Webinar: 5 Benchmarks That Can Make or Break Your Practice (Register by June 18) AAN.com/view/pmw18
Neurology Disputes & Debates:
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Comment on Neurology® journal articles and read what others are saying at Neurology.org/N AANnews • June 2018 27
Non-motor symptoms of OFF periods affecting the lives of people with Parkinson’s may include anxiety, mood changes, fatigue, irritability and cognitive dysfunction.1,2 Unexpected symptoms can affect everyday life, for example, reduction in mobility and avoidance of activities. 3 Symptom variability among patients can make recognition of OFF periods challenging for clinicians.4
1. 2. 3. 4.
Stacy M et al. Mov Disord. 2005;20(6):726-733. Witjas T et al. Neurology. 2002;59(3):408-413. Hechtner MC et al. Parkinsonism Relat Disord. 2014;20(9):969-974. Pahwa R et al. Curr Res Med Opin. 2009;25(4):841-849.
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2018 June AANnews