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VOLUME 32  ·  ISSUE 3  ·  March 2018

Victory for AAN! FAST Act Signed into Law. Read more on page 27.

SCIENTIFIC PROGRAM ANNOUNCED More than 3,000 Abstracts Once again, the AAN Annual Meeting will bring together a diverse group of scientists from around the globe and from a wide range of subspecialties to present and discuss the very latest science in the world of neurology. The 2018 Scientific Program reflects this vast neurology spectrum, and in Los Angeles this April 21 through 27 you’ll find everything from the latest updates on diagnostic and treatment techniques to prevention strategies reflected in the meeting’s more than 3,000 platform and poster presentations. Continued on page 14

March 29: Last Chance to Save on Annual Meeting Registration!

This Coding Webinar Can Help Ensure Proper Reimbursement

March 29 is your last chance to save big with early registration discounts to the upcoming Annual Meeting. The meeting’s allinclusive registration rate is your ticket to most everything the meeting has to offer—all week long and at no additional cost to you. The average Neurologist member will save $260 or more by taking advantage of this early registration opportunity. Don’t miss out—visit AAN.com/view/AM18 today!

Are you getting the most reimbursement you can for all aspects of patient care? This webinar will review E/M and CPT coding techniques to give you the confidence that you are getting paid for all of the time you spend on your patients— even when you’re not in a traditional office visit.

How Much Can You Save Before March 29? ƒƒ Neurologist Member: Save $260 with $720 early registration rate

Getting Paid for Your Time, All of the Time March 20, 2018  /  12:00 p.m.–1:00 p.m. ET Deadline to Register: March 19 Faculty: Bruce H. Cohen, MD, FAAN; Bryan Soronson, CRA, FACMPE, MPA; and Jeffrey Waugh, MD Continued on page 1

ƒƒ Non-neurologist Member: Save $150 with $420 early registration rate ƒƒ Junior Member: Save $90 with $245 early registration rate Cohen

12 AAN Personalizes Member Experience at Experiential Learning Area

16 Registration Opens This Month for July Sports Concussion Conference

Soronson

Waugh

25 March Deadline Coming Up for 2017 MIPS Submission


ROOTED IN INNOVATIVE SCIENCE. DRIVEN BY THE MANY FACES OF RELAPSING MULTIPLE SCLEROSIS.

© 2018 Celgene Corporation All rights reserved. 2/18 USII-CELG180007


AANnews · March 2018

CONTENTS Cover Scientific Program Announced March 29: Last Chance to Save on Annual Meeting Registration! This Coding Webinar Can Help Ensure Proper Reimbursement Looking Back, Moving Forward to a New Era for the Neurologist · · · · · · · · · · 4

Through Their Eyes  Lewis P. (Bud) Rowland, MD, FAAN · · · · · · · · · · · · · · ·

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Conferences & Community  Get Answers for Axon Registry Questions at Annual Meeting · · · ·

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Plenary Session Lineup Boasts Premier Findings, 40+ Top Researchers · · · · · · · · · · · · · · 8 Get Essential Tips for Professional Development— for Every Career Stage · · · · · · · 10

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AAN Personalizes Member Experience at Experiential Learning Area · · · · · · · · · · · · 12 How to Get the Most out of Your Exhibit Hall Experience · · ·

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AAN Shares Concussion Message with Super Bowl Crowds · · · · · · · · · · · · · · · ·

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Tools & Resources 

President’s Column 

Going to the Annual Meeting? Participate in AAN Business Meeting · · · · · · · · · · · · · · · · · ·

Enhance Your Care Team with Valuable AAN Memberships · · ·

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Expand Your Mind, Think Differently at New Innovation Hub · · · · · · · · ·12

March Deadline Coming Up for 2017 MIPS Submission · · · 25 Podcast Central · · · · · · · · · · · 25 AAN Issues New Position Statement on Lawful Physicianhastened Death · · · · · · · · · · · · 26

Policy & Guidelines  AAN Publishes Comprehensive Systematic Review on Treatment of Cerebellar Motor Dysfunction and Ataxia · · · · · · · 27 Capitol Hill Report · · · · · · · · · · 27 Review of Guidelines Ensures Most Current Available Evidence · · · · · · · · · · 28

Education & Research  Rydell Selected for ABMS Commission on Future of MOC · ·

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UCNS Issues Neurocritical Care Certifications and Recertifications · · · · · · · · · · ·

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American Brain Foundation  ‘Cure One, Cure Many’ Is Theme of Foundation Booth at 2018 Annual Meeting · · · · · · · 31

News Briefs The National Institute of Neurological Disorders and Stroke (NINDS), part of the National Institutes of Health, has named pediatric neurologist Nina Schor, MD, PhD, as deputy director. Schor joined the NINDS in January. She has been an AAN member since 1984. “Dr. Schor’s experience running a large university department and children’s hospital, along with her extensive basic research background and clinical work, make her an ideal candidate for this position,” said Walter J. Koroshetz, MD, FAAN, director of NINDS. “We are delighted to welcome Dr. Schor and look forward to working with her to advance the NINDS’ mission as it relates to neuroscience and neurological disease research.” A new AAN report, “An Interdisciplinary Response to Contemporary Concerns about Brain Death Determination,” was published in the January 31, 2018, online issue of Neurology ®. The report summarizes what was discussed at a multi-society brain death summit held at the AAN in October 2016, and reaffirms the validity of determination of death by neurologic criteria and the use of the AAN practice guideline to determine brain death in adults. 

Dates & Deadlines  · · · · · · · · 35

Registration Opens This Month for July AAN Sports Concussion Conference · · · · · · · · · · · · · · 16

The Vision of the AAN is to be indispensable to our members. The Mission of the AAN is to promote the highest quality patient-centered neurologic care and enhance member career satisfaction. Contact Information

For advertising rates, contact:

American Academy of Neurology 201 Chicago Avenue Minneapolis, MN 55415

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

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

memberservices@aan.com

Website: AAN.com

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

AAN Executive Director: Catherine M. Rydell, CAE Editor-in-Chief:  John D. Hixson, MD Managing Editor: Angela Babb, CAE Editor:  Tim Streeter Writers:  Ryan Knoke and Sarah Parsons Designers:  Siu Lee and Jim Hopwood Email:  aannews@aan.com

AANnews is published monthly by the American Academy of Neurology for its 34,000 members worldwide. Access this magazine and other AAN publications online at AAN.com/go/elibrary. The American Academy of Neurology ’ s registered trademarks and service marks are registered in the United States and various other countries around the world. “American Brain Foundation” is a registered service mark of the American Brain Foundation and is registered in the United States.


President’s Column 

Looking Back, Moving Forward to a New Era for the Neurologist As we celebrate our 70th anniversary this month, the AAN and its members have seen striking changes in the field of neurology. When the Academy was founded in 1948, there were few effective treatments for patients with neurologic disorders. As Dr. Labe Sheinberg said, patient evaluations were often a matter of “diagnose and adios.” Our abilities to diagnose improved with the advent of EEG and CT technology, but—with some remarkable exceptions such as Dilantin and L-dopa— treatments lagged. Nonetheless, our specialty continued to attract medical students, and in the 1970s there were questions as to whether we were turning out too many new neurologists from our academic programs! The Decade of the Brain during the 1990s—championed by the AAN—brought an influx of federal funding that significantly accelerated research on brain and neurological disorders and the discovery of new treatments. The more recent increases in funding for the BRAIN Initiative and Alzheimer's disease and related dementia research are also providing opportunities for translational discoveries to make dramatic improvements in our ability to treat neurological patients. But as we moved into the 2000s, we began to see declines in the number of medical students entering neurology even as announcements of exciting new treatments picked up pace. For the last decade, only approximately 2.6 percent of US medical students annually chose a career in neurology. Studies conducted by the AAN show a current shortfall of 11 percent in our workforce needed to provide care, and this is projected to grow to 20 percent in a matter of a few years. With the aging of our population, this gap in our neurological workforce could become even greater. In 2018, we now find ourselves in an exciting era with new interventions and opportunities for prevention that did not exist 70 years ago. In fact, in January, the American Heart Association/American Stroke Association published a guideline, affirmed by the AAN, that expands the time window for interventional treatments of stroke to nearly 24 hours, significantly longer than we had presumed from previous research. We also have many other new interventions available for our patients such as deep brain stimulation for Parkinson’s disease and other movement disorders, epilepsy surgery that can be curative, neuro stimulation devices for seizures, and new therapies for multiple sclerosis and spinal muscular atrophy. In the future, we hopefully will have opportunities to regenerate and rehabilitate the brain using stem cells and other approaches such as neuro-modulation. Not only that, but we are in a remarkable era of preventive neurology. We can prevent stroke with interventions like angioplasty and stenting for carotid stenosis and the use of antiplatelets and statins. We can administer new oral anticoagulants for atrial

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fibrillation. We can prevent migraine, try to alter cognitive decline via cognitive therapies and vascular risk factor control, and use a variety of approaches to limit falls and head injury. Our ability to image subclinical changes, use biomarkers and risk scores, and identify genetic predictors Sacco has refined the opportunities to detect people at risk for neurologic conditions. Neurologists are caring for patients across their lifespan and need to be even more involved with middle age, where we can identify preclinical stages of disease with earlier opportunities to prevent and intervene. We need to delay the transitions from wellness to illness, modify the course of neurological conditions, and compress the timeline of morbidity. Through our earlier engagement and focus on brain health, we can help our patients age successfully and extend their quality of life. At the same time, the AAN has taken major steps to turn around the supply shortage of neurologists and increase our pipeline by getting more students excited about neurology and neuroscience. To help ensure neurologists are providing the best possible quality care to patients, we are advocating for the increasing use of interdisciplinary teams and involvement of advanced practice providers to help ensure an efficient approach to care. The Academy has also strongly advocated for greater access and convenience via teleneurology. This has led me to believe we are at a crossroads for our profession with an opportunity to reinvent ourselves, to move from neurologists to “newrologists.” I asked the participants in our 2017 Transforming Leaders Program to tackle this as their group project and flesh out this concept from their particular vantage points. The questions put before them: How can the Academy expand the scope of neurologic practice to include a greater emphasis on preventive, interventional, and regenerative care? And how can this help address the workforce shortage, stimulate interest in neurology careers, as well as minimize and mitigate physician burnout? The Transforming Leaders Program participants envisioned the newrologist as the health care team leader, working with patients on preventive efforts as well as innovating care and


embracing new therapies. The newrologist is data-driven, quality- and patient-centered, and business savvy. The newrologist communicates, inspires, and motivates both coworkers and patients. And the newrologist works with and is supported by the greatest professional organization that advocates for patients and its members—the AAN. The Transforming Leaders Program participants developed an exciting, comprehensive action plan for the AAN to consider: ƒƒ Facilitate neurologist-led teams by reframing neurology as a team-based specialty, expanding the use of advanced practice providers (APPs). We’ve welcomed more than 1,000 APPs as members of the AAN, established a consortium, and are helping to define their role and providing clinical education and training to enhance their skills and value within this team. We will harness teleneurology to enhance teams and care coordination. We will develop and promote neurologists as data-driven team leaders and provide education and training in team leadership. Furthermore, we will seek to create team care pathways for brain health across the lifespan. This can be accomplished by expanding the influence of guidelines and care pathways created by neurologists, and integrating them into primary care and preventive screening. They will specify when to refer a patient to the next level of care and specify diagnostic and preventive measures to improve patient-centered quality care. ƒƒ Build tools to implement innovative therapies. While many effective neurology treatments exist in all subspecialty areas of neurology and span prevention and intervention, effective treatments are often poorly utilized. This may be because the neurologist is unaware or has limited understanding of treatments. There may be challenges due to lack of skills and resources, or difficulty navigating reimbursement. The AAN has made it a strategic priority to centralize and personalize resources for our members, providing onestop shopping for the newrologist to be able to conduct advanced searches by disorder, resource type, population group, setting, date, etc. The Academy should deliver personalized content through mobile and online tools highlighting new treatments, and create new educational modules to enhance members’ skills.

ƒƒ Communicate the vision and purpose of the newrologist. Targeted efforts to integrate new initiatives into the AAN’s messages to our members that the AAN is an indispensable source of treatment tools and data. To the public our message will be that the neurologist is the key physician to optimize brain health. And we will affirm to payers and policymakers that neurologists are quality- and value-driven and leaders of the neurology interdisciplinary patient care team. Our profession has evolved enormously over the past 70 years, not always easily and certainly not always to our liking. The separation of neurology from psychiatry in the mid-20th century was difficult, at times contentious, but necessary for our specialty to stand on its own two feet. New treatments have successfully altered life for our patients, but required neurologists to be up-to-date on the availability and efficacy of these new agents. The support of the federal government for the elderly and poor through Medicare and Medicaid assured access to care while fostering increasing regulatory hassles for the medical community. Health care reform efforts of the past two decades have sought to bring down ever-growing, unsustainable costs while sowing confusion, frustration, and burnout in our ranks. Despite these hurdles, I hope you share my optimism for this forward-thinking view of the “newrologist.” We need to take full advantage of the exciting opportunities to intervene and prevent neurological conditions, expand the future scope of the practice of neurology, and remodel the image of the neurologist. This is a future that we neurologists must—and will—shape. 

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


Through Their Eyes 

Lewis P. (Bud) Rowland, MD, FAAN During 2018, AANnews celebrates the history of the Academy during its 70th anniversary with a series of interviews of past presidents. The following excerpt is from a 2012 Oral History Project interview between Lewis P. (Bud) Rowland, MD, FAAN, and Steven Frucht, MD. Rowland served the AAN in numerous capacities, including AAN president (1989–1991), president of the AAN Education and Research Foundation (now American Brain Foundation; 1995–1997), and as editor-in-chief of the flagship journal Neurology ® (1977–1986) and Neurology Today ® (2001–2009). He passed away in March 2017. SF: Maybe I can ask you about your activities with the Academy—with the journal and with the institution. LR: I was at one time president of the Academy. I was president of the foundation—the Academy foundation. I was made the president of the Academy by Steve (Steven P.] Ringel, who was a kingmaker. It was his idea. I enjoyed that and I thought it was important. Some people don’t like that kind of bureaucratic assignment but I relished it. The people who get into that are such, themselves, remarkable people. A guy like Fran (Francis I.] Kittredge—a big wheel in the organization. He had a private practice in Portland, Maine; we ended up having a pattern of having a clinician for one term (as AAN president] and then an academic for another term. I thought it worked great. We all learned a different field and I don’t think there was ever any friction between the two that “you’re taking my territory” or something like that. I just admired the whole bunch of them. SF: The Academy is certainly—it went through an explosive period of growth in the ’70s and in the ’80s in terms of the meeting and the size of the meeting, the presentations. LR: And the courses. Don’t forget the courses. I’ve been involved in the courses from way back. I developed a course called “The Scientific Basis of Neurology.” I really relished doing it because it was just fun and it was effective as determined by questionnaires and by requests to do it again for another year. I’ve forgotten how many years I did it—at least 10. That kind of thing still goes on. The courses are the main attraction of the Annual Meeting. And Continuum. I didn’t have much to do with that but that’s another important contribution to lifelong education. LR: I’ll tell you how the training grants started. It affected me and Fishman (Robert A. Fishman, AAN president 1975–1977]. The director of NINDB was Pearce Bailey (AAN president 1951–1953]. He was a friend of Merritt’s (Merritt Houston]. The story went something like this – this is an approximation of what happened 60 years ago. Houston and Pearce Bailey, they knew each other from being on committees together. Merritt probably had something to do with Bailey being picked as the director. Merritt was on the NINDB or DS council three times, the only one in history who was appointed three times. Bailey said to him, “Houston, we’re trying to set up some training programs to train clinical investigators. We think you ought to have one. Don’t you think so?” Houston said, “Of course I ought to have one. We ought to have one.” Then he said, “Do you

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have any candidates for it?” He said, “Well, I’ve got these two guys here that I call the Gold Dust Twins. Fishman and Rowland.” So, Bailey said, “Send down the information about them.” Well, he did and the next thing we knew, Houston said, “What are we going to do now that we have a clinical research grant?” Or maybe he had to put a program up that they could approve it down there. So that is how it started. Both Fishman and I got good training…. It was Darryl De Vivo. He and I were on a committee, might have been an Academy committee that was advising NIH. It was Darryl’s idea was that what we needed was a fellowship that would be sponsored by the Academy, funded half by the Academy and half by an academic center. We would call it Training in Research Clinical Investigation or Clinical. That is still going. I think at one time there were 30 of them. That was what we were asking. It still exists. It has been so successful compared to the number of outstanding people who were trained. I think it was all Darryl’s fault, not mine. He is very imaginative when it comes to organization. Former President Steven P. Ringel, MD, FAAN, spoke about Rowland’s contributions to the AAN’s publications in a 2017 interview with AAN staff writer Tim Streeter. TS: You mentioned Neurology Today. You and Dr. Rowland worked to launch that. SR: Yes. When I was chairing AAN Enterprises, or involved in AAN Enterprises, I really felt that the newspapers which were gaining prominence in the neurology newspapers weren’t doing a great job in the sense that they would

Rowland and Ringel.


Conferences & Community 

Foundation’s ‘Rowland Circle’ Honors Neurology Leader The American Brain Foundation invites AAN members to contribute to the Rowland Circle, honoring the legacy of Lewis P. (Bud) Rowland, who was president of the Academy when the Foundation was created. Anyone who donates $2,500 in 2017 or 2018 will be recognized as a charter member of the Rowland Circle. This generosity is recognized with a Rowland Circle lapel pin and two tickets to Commitment to Cures at the AAN Annual Meeting in Los Angeles in April. Already, the giving circle has 41 members who have each contributed $2,500—a number inspired by the 25th anniversary of the foundation’s launch. For more information, contact Shelly Rucks, American Brain Foundation, at srucks@AmericanBrainFoundation. org or (612) 928-6318.

have a reporter go out and report something, but they weren’t interviewing people to say, “Is this good stuff or not good stuff?” I felt we could really do a better job. Bud Rowland was a star. He was admired by everyone. He had been editor of Neurology, had been president of the American Academy of Neurology, had been president of the American Neurological Association, and on and on and on. Twenty-five years as chair at Columbia. He trained most of the many, many famous academic neurologists, so it was an easy choice picking him to edit this. I was his associate editor. The happy triad with Fay Ellis, who as it turned out was a wonderful journalist who came at that time from I think it was Lippincott before it was Wolters Kluwer. It turned out to be a very happy marriage for the three of us and the newspaper has just grown over the years. Really, Bud brought it credibility. He was a tireless editor. He loved making sure that things were accurate. He really made sure the quality was outstanding.

Get Answers for Axon Registry Questions at Annual Meeting The AAN’s Axon Registry® is your solution to fulfilling multiple regulatory requirements, and you can get a preview of the registry at the 2018 Annual Meeting in Los Angeles. The Axon Registry, a quality-improvement and Qualified Clinical Data Registry (QCDR), can be used by your practice to meet Merit-based Incentive Payment System (MIPS) reporting requirements and certain MOC requirements for the American Board of Psychiatry and Neurology (ABPN). When you’re at the Annual Meeting, come talk with registry staff, learn more about the Axon Registry, and see a registry User Dashboard demonstration. The Axon Registry booth, located in the Maximize Your Value: Improve Your Neurology Practice Experiential Learning Area on the main floor of the convention center, will have experts available for the entire meeting. Additionally, from April 21 through 24, a representative from registry vendor FIGMD will be available to answer technical questions and share information about the process. Stop by to see demonstrations of the dashboard and learn how having registry data at your fingertips can be a valuable resource for your practice. “Now is the time to decide how you will fulfill Quality Payment Program requirements,” said Lyell K. Jones, MD, FAAN, chair of the Registry Committee. “The Axon Registry will help neurologists satisfy three out of four MIPS components. Also, the Axon Registry participation is approved by the ABPN as an MOC Part IV PIP Clinical Module activity and can be used to waive eight credits of Part II Self-assessment.” If you’re looking for how Axon Registry participation will help your practice save time and be more efficient in handling reporting requirements and implementing quality improvement initiatives, stop by the booth and get all your questions answered. Don’t miss this opportunity to learn how to successfully maximize the value of your practice. 

TS: He had a red pen, didn’t he? SR: Yeah, he had a big red pen. That was what he was known for. When I started, my first paper submitted to Neurology, I got it back from Bud. We didn’t have track changes and computers, and Bud had redlined everything, but that was because he really was a journalist and understood, say it clearly, don’t use all these words, get rid of all this excess language. He was wonderful. Visit AAN.com/view/AANhistory to read the complete transcript of Rowland’s interview and learn about his pioneering work in movement disorders and run-in with 1950s McCarthyism. Ringel’s interview will be posted later this summer. 

AANnews  •  March 2018 7


Conferences & Community 

Plenary Session Lineup Boasts Premier Findings, 40+ Top Researchers More than 40 top researchers will present the very latest advances in neuroscience during the 2018 Annual Meeting’s premier lectures. Look for seven cutting-edge plenary sessions, one each day of the meeting beginning on Saturday evening. Hot Topics Plenary Session Saturday, April 21 / 4:15 p.m.–5:30 p.m.

Contemporary Clinical Issues Plenary Session Monday, April 23 / 9:15 a.m.–11:30 a.m.

Features translational research related to clinical issues of importance. Four outstanding physician-scientists provide summaries of their recent research findings and describe the clinical implications of the results.

Highlights issues most critical to practicing neurologists, including abstracts related to new therapeutic developments, clinical applications of basic and translational research, and innovative technical developments. Commentary and discussion follow each presentation.

ƒƒ Moderator: Eric Klawiter, MD, Member, Science Committee ƒƒ TBD / Neuroinflammation and Epilepsy ƒƒ Amynah Pradhan, PhD, University of Illinois at Chicago, Chicago, IL / Opioid Receptor Modulation of Headache

ƒƒ Moderator: Randolph S. Marshall, MD, FAAN, Member, Science Committee Retinal Microvasculature in Predicting Risk of Stroke Subtypes ƒƒ Presenter: Michelle P. Lin, MD, Johns Hopkins University School of Medicine, Baltimore, MD Discussant: Valerie Biousse, MD, Atlanta, GA

ƒƒ TBD / Brain Stimulation for Memory ƒƒ Jens Kuhle, MD, Universitätsspital Basel, Oberwil, Switzerland / Monitoring Multiple Sclerosis Using Blood Neurofilament Light Protein Presidential Plenary Session Sunday, April 22 / 9:15 a.m.–12:00 p.m. Features the AAN’s premier lecture awards for clinically relevant research and a presentation by a leading lecturer. Top researchers speak on some of the most significant findings in neurology in 2018. ƒƒ Moderator: Natalia S. Rost, MD, FAAN, Chair, AAN Science Committee ƒƒ Presidential Lecture: Francis S. Collins, MD, PhD, Director, National Institutes of Health, Bethesda, MD / California Dreaming: BRAIN and Precision Medicine in 2018 ƒƒ Sidney Carter Award in Child Neurology: Richard S. Finkel, MD, Nemours Children’s Hospital, Orlando, FL / Spinal Muscular Atrophy Is a Treatable Neurodegenerative Disease ƒƒ George C. Cotzias Lecture: Tallie Z. Baram, MD, PhD, University of California-Irvine, Irvine, CA / How Early-life Experiences Sculpt Your Brain: From Molecules to Circuits ƒƒ Robert Wartenberg Lecture: Lisa M. DeAngelis, MD, Memorial Sloan Kettering Cancer Center, New York, NY / Neuro-oncology: How Cancer and the Nervous System Interact

Predictors of Neurodegeneration in Idiopathic REM Sleep Behavior Disorder: A Multicenter Cohort Study ƒƒ Presenter: Ronald Postuma, MD, Montreal General Hospital, Montreal, Canada Discussant: Aleksandar Videnovic, MD, MSc, FAAN, MGH Neurological Clinical Research Institute, Boston, MA

Pediatric Brainstem Encephalitis Outbreak Investigation with Metagenomic Next-generation Sequencing ƒƒ Presenter: TBD Discussant: Michael R. Wilson, MD, UCSF, San Francisco, CA ƒƒ Maisha T. Robinson, MD, MS, Mayo Clinic, Jacksonville, FL / Neuropalliative Care ƒƒ Jeffrey Allan Cohen, MD, Cleveland Clinic, Cleveland, OH / Biosimiliars and Non-biologic Complex Drugs ƒƒ Deborah I. Friedman, MD, MPH, FAAN, University of Texas Southwestern Medical Center, Dallas, TX / Non-invasive Neurodulation

Clinical Trials Plenary Session Tuesday, April 24 / 9:15 a.m.–11:30 a.m. Covers important clinical topics identified from other society meetings that affect patient care. The latest updates within several clinical trials conducted over the course of the last year will be presented. ƒƒ Moderators: Deborah Hall, MD, PhD, FAAN, Member, Science Committee ƒƒ Petra Kaufmann, MD, FAAN, Member, Science Committee ƒƒ Holly E. Hinson, MD, MCR, Member, Science Committee ƒƒ Sarah J. Tabrizi, University of College London, London, United Kingdom / Effects of IONIS-HTTRx in Patients with Early Huntington’s Disease, Results of the First HTTLowering Drug Trial

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AANnews  •  March 2018


ƒƒ Michael J. Thorpy, MD, Montefiore Medical Center, Bronx, NY / A Randomized, Placebo-Controlled, Phase 3 Study of the Safety and Efficacy of Solriamfetol (JZP-110) for the Treatment of Excessive Sleepiness (ES) in Participants with Narcolepsy Types 1 and 2 (NT1/2) ƒƒ Gregory W. Albers, MD, Stanford, CA / Expanding the Time Window for Thombectomy: Results of the DEFUSE 3 Study ƒƒ Robert J. Fox, MD, FAAN, Cleveland Clinic, Cleveland, OH / A Phase II Trial of Ibudilast in Progressive Multiple Sclerosis ƒƒ David D. Adams, APHP, Le Kremlin-Bicetre, France / Patisiran, a RNAi Therapeutic, to Improve Outcomes in Hereditary Transthyretin-Mediated (hATTR) Amyloidosis with Polyneuropathy

Controversies in Neurology Plenary Session Thursday, April 26 / 9:15 a.m.–11:30 a.m. Features experts discussing the most current and controversial issues in neuroscience. The session follows a debate-style format in which two speakers argue opposite sides of a single topic, followed by a rebuttal. For the first time, AAN members will be weighing in on what they would like to see presented at this year’s session! ƒƒ Moderators: Aleksandar Videnovic, MD, MSc, FAAN Member, Science Committee ƒƒ Amy R. Brooks-Kayal, MD, FAAN, Member, Science Committee Do We Use Biomarkers Alone For Diagnosis of Alzheimer’s? ƒƒ Yes: TBD

ƒƒ Ramon R. Diaz-Arrastia, MD, PhD, FAAN, Penn Presbyterian Medical Center, Philadelphia, PA / Brain Oxygen Optimization in Severe Traumatic Brain Injury (BOOST) Phase 2 Trial: Towards Evidence-Based in the Neurological Intensive Care Unit

Would You Let Your Child Play Contact Sports?

ƒƒ Emily C. De Los Reyes, MD, Nationwide Childrens Hospital, Columbus, OH / Precision Medicine: Intracerebroventricular Enzyme Replacement Therapy with Cerliponase Alfa in Children with CLN2 Disease: Results from an Ongoing Multicenter Study

Should the Neurologist Be Primarily Responsible For Taking Care of Patients With Functional Disorders?

Frontiers in Neuroscience Plenary Session Wednesday, April 25 / 9:15 a.m.–11:30 a.m. Features basic and translational research related to clinical issues of importance. Six outstanding physician-scientists provide summaries of their recent research findings and describe the clinical implications of the results. ƒƒ Moderator: Paul M. George, MD, PhD, MSE, Member, Science Committee ƒƒ Emery N. Brown, MD, PhD, Harvard Medical School, Boston, MA / The Dynamics of the Unconscious Brain Under General Anesthesia

ƒƒ No: TBD ƒƒ Yes: Jack W. Tsao, MD, DPhil, FAAN, Memphis, TN ƒƒ No: Christopher Giza, MD; UCLA, Dept. of Neurosurgery, Los Angeles, CA

ƒƒ Yes: David L. Perez, MD, Massachusetts General Hospital, Boston, MA ƒƒ No: Andrea Leigh Haller, MD, Fort Wayne Neurological Center, Fort Wayne, IN Neurology Year in Review: Emerging Therapies Plenary Session Friday, April 27 / 9:15 a.m.–11:30 a.m. Features six speakers, each focusing on the latest research that has happened in the last year within a specific subspecialty topic. ƒƒ Moderator: Antonio M. P. Omuro, MD, Member, Science Committee

ƒƒ Jeff Lichtman, MD, PhD, Harvard University, Boston, MA / Does Connectomics Make Sense?

ƒƒ Ericka P. Simpson, MD, FAAN, Methodist Hospital, Houston, TX / Year in Review of Neuromuscular Diseases: Making Treatments Great Again

ƒƒ Amita Sehgal, PhD, University of Pennsylvania, Philadelphia, PA / Biology of Bedtime: Understanding Circadian Rhythms and Sleep

ƒƒ Kelly G. Knupp, MD, Children’s Hospital Colorado, Aurora, CO / Pediatric Epilepsy

ƒƒ Jack M. Parent, MD, University of Michigan, Ann Arbor, MI / Combining Patient-derived Cell and Animal Models to Uncover Epilepsy Mechanisms and Precision Therapies ƒƒ Alan Evans, PhD, McGill University, Montreal, Quebec, Canada / BigBrain: A High Resolution 3D Digital Human Brain Atlas ƒƒ Emmanuelle Waubant, MD, FAAN, University of San Francisco-California, San Francisco, CA / Pediatric MS: A Unique Window into Environmental and Genetic Risk Factors for MS

ƒƒ Antonio M. P. Omuro, MD, University of Miami Miller School of Medicine, Miami, FL / Neuro-Oncology Year in Review: Progress, Breakthroughs, and Future Directions ƒƒ Liana Apostolova, MD, FAAN, Indiana University School of Medicine, Indianapolis, IN / Dementia ƒƒ Matthew S. Robbins, MD, FAAN, Montefiore Headache Center, Bronx, NY / Headache Medicine 2018: Year In Review ƒƒ Steven R. Messé, MD, FAAN, FAHA, Hospital of the University of Pennsylvania, Philadelphia, PA / Finally, Some Closure on PFO Closure Don’t miss out on these outstanding sessions. Register today at AAN.com/view/AM18. 


Conferences & Community 

Get Essential Tips for Professional Development—for Every Career Stage Whether you’re a medical student, resident, fellow, junior faculty, senior faculty, practicing neurologist, or advanced practice provider, you’ll want to stop by the Navigating Your Career Experiential Learning Area the week of April 21 through 27 for comprehensive information and essential tips, tools, and resources for your professional development. Look for opportunities that include 30-minute one-on-one mentoring sessions, small group talks, and panel discussions. “The area focuses on career development at every stage,” said Maisha Robinson, MD, MS, who chairs the Navigating Your Career Workgroup. “Attendees will have an opportunity to obtain guidance on their future specialty, understand how to successfully incorporate research and education into their careers, appreciate the nuances of reviewing papers and applying for federal funding, learn the principles of improving their practice efficiency, enhance their interviewing skills...and much more.” Program highlights include: Academic Career Panel: Find out How to Get Your Career Started Speakers: Jennifer Molano, MD, FAAN; Joseph E. Safdieh, MD, FAAN Panelists will share their experiences about how they navigated the academic environment to start their careers. A focus will be placed on strategies to negotiate with your chair to make sure you have the resources you need for success. Choosing a Career Type—The Important Points! Speaker: Kelly Baldwin, MD You are fresh out of training and there are over 400 neurology positions. Where do you start, what is important, and what is an RVU and an FTE? Get the basics you need to know! Choosing Neurology as a Career? Choosing the Right Residency Program Speaker: Abbas Kharal, MD Medical students are exposed to many different specialties. Most students who are fascinatingly intrigued by the human brain have a hard time deciding between neurology, neurosurgery, and psychiatry. Choosing the right career path is often a cumbersome process given all the choices. Come chat with a successful neurology resident from the Harvard Partners Neurology Program to learn what things to consider as you make that career decision.

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AANnews  •  March 2018

Robinson

Choosing Teleneurology as a Career Speaker: Eric Anderson, MD, PhD As technology continues to change the way we practice medicine, new career paths in remote medicine have emerged. In this talk, you will learn about the pros and cons of choosing pure telemedicine or remote neurology as a career. Effective Neurology Residency Program Speaker: Ralph F. Józefowicz, MD, FAAN This talk will describe the key components of an effective neurology residency program, including establishing program goals, program leadership, faculty and residents, program structure, medical student teaching, resident research, resident recruitment, teaching conferences, resident and program evaluation, and ACGME issues.


How to Start a Career in Neurology Education Speaker: Joseph E. Safdieh, MD, FAAN

Teaching Communication Skills: From Good to Great Speaker: Tara Cook, MD

In this interactive small group session, the first steps that you should consider when embarking on a career as a medical educator in neurology will be covered. The session will answer common questions about what you should look for in a residency, a fellowship, and a first faculty appointment.

The ACGME requires neurology residents to show competence in certain palliative care skills, such as communication. A key communication skill is discussing goals of care. Yet, many neurologists who teach residents have never received formal training in this skill. In this session, a structured framework, REMAP, will be presented that can be used for teaching neurology trainees. REMAP bases the discussion on patient values and responding to emotion, thereby improving the quality of the physician-patient interaction. Following brief didactics, we will demonstrate how these frameworks may be applied in clinical practice.

K Is for Career Development—Tips from Successful Applications for NIH Career Development Awards Speaker: Logan Schneider, MD This talk will touch upon the many facets of the primary clinician-focused career development awards: K08 and K23. It will include not only elements that can help with the drafting of the 13 core pages of the application (Specific Aims, Candidate Information and Goals for Career Development, and Research Strategy), but will also discuss the logistics of compiling the additional 80+ pages that are critical to the success of the application. This topic is targeted to early career researchers who are interested in applying for transitional NIH funding awards, but will include general information relevant to any grant writing strategy. Mentorship Is Only as Good as the Mentee Speaker: Pearce Korb, MD, FAAN Join this discussion on what makes a good mentor-mentee relationship. Research in Residency: How to Choose the Right Project Speaker: Roy E. Strowd III, MD Research can be an important part of personal and career development during training as a resident. Residency can be a unique and sometimes tough time for research given the many competing demands for your time. Choosing the right project is essential. This short talk will cover the key components of the “right project” in residency. Attendees will be provided with a short handout and a list of key components of an “ideal” research project in residency.

The Peer Review—Why You Should Review Papers, and How to Do It Speaker: Logan Schneider, MD Like most aspects of training, the peer-review process often lacks guidance, resulting in a full spectrum of quality coming out of reviews…we’ve all experienced that rambling tangential review that we don’t know how to respond to. In order to ensure a less daunting prospect for those considering reviewing, a more satisfying experience for those future reviewers, and a more robust peer-review experience for reviewees, some general information on how to review a paper/grant will be provided. Participants should walk away from this experience feeling empowered to perform their first peer review, or possibly improve their reviews, for the benefit of the scientific community at large. Tools to Transition from Trainee to Attending Speaker: Safiullah Shareef, MD Deciding on a career track is a daunting task. Academic vs. clinical? Solo practice vs. small practice vs. large group? University vs. private? In this talk, we discuss tips, tools, decision models, and frameworks to make this career transition easier. For full presentation schedule and descriptions, visit AAN.com/view/ELA. 

Going to the Annual Meeting? Participate in AAN Business Meeting The AAN Business Meeting is scheduled for Saturday, April 21, 2018, from 3:00 p.m. to 4:00 p.m. PT, and will be held in the Los Angeles Convention Center. Academy leadership will review accomplishments on behalf of members and fiscal performance during 2017. 

AAN President Ralph L. Sacco, MD, MS, FAHA, FAAN, spoke to attendees at the 2017 business meeting in Boston. AANnews  •  March 2018 11


Conferences & Community 

AAN Personalizes Member Experience at Experiential Learning Area The Member Experience Experiential Learning Area at the 2018 Annual Meeting is your home during the week to connect, engage, and be recognized as a valued AAN member. Stop by daily to discover how your Academy is working hard to personalize your member experience through opportunities such as the new AAN.com, Synapse™ Online Communities, and other unique in-person and virtual experiences. Come have fun and: ƒƒ Update your AAN profile—and get your profile picture taken

ƒƒ Sign up for Synapse online communities

ƒƒ Learn about all the opportunities to increase your engagement with the Academy

ƒƒ Check out the recognition walls and congratulate your colleagues

ƒƒ See if you qualify to elevate your membership status

ƒƒ Win cool giveaways

Visit AAN.com/view/ELA for the most up-to-date topics and speakers. 

How to Get the Most out of Your Exhibit Hall Experience The 2018 Exhibit Hall is shaping up to be one of the biggest, most dynamic Annual Meeting Exhibit Halls yet. With this exciting growth comes increased opportunities and resources for attendees to meet organizations and learn about exciting new products and services that can help you do your job better and provide the best possible care for patients. Following are some quick tips for helping you navigate the hall and plan your time so you can take advantage of as many valuable resources as possible: ƒƒ View the Interactive Map Prior to the Annual Meeting, visit AAN.com/view/18AMExhibitMap to view a handy interactive floor plan and exhibitor map. ƒƒ Note Open Days and Hours Don’t wait to visit your key contacts—the Exhibit Hall is only open the following days and times: ŽŽ ŽŽ ŽŽ ŽŽ

Sunday, April 22, 11:30 a.m.–4:00 p.m. Monday, April 23, 11:30 a.m.–6:00 p.m. Tuesday, April 24, 11:30 a.m.–4:00 p.m. Wednesday, April 25, 11:30 a.m.–3:00 p.m.

ƒƒ Use the Conferences App Once on-site, download the Conferences App to quickly and easily help you navigate the hall. Keep an eye out for the Exhibit Guide and on-site signage—they’re there to help, too. ƒƒ Enjoy Complimentary Lunches Lunch will be provided in the Exhibit Hall on open days. Check out the daily schedule for fun events and networking opportunities. Visit AAN.com/view/18AM for more information and register to attend the 2018 AAN Annual Meeting. 

Expand Your Mind, Think Differently at New Innovation Hub Visit the new AAN Innovation Hub, conveniently situated in the center of the Annual Meeting Exhibit Hall, to discover new ways to expand your mind and think differently about your practice, your patients, and the future of neurology.

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AANnews  •  March 2018

Open Sunday through Wednesday during regular Exhibit Hall hours, this creative and interactive area will feature physician-led presentations on topics such as patient phone apps, new ways of using your EHR, virtual reality in the hospital setting, and more. Daily Wine & Paint Sessions will give attendees a creative outlet for learning, relaxing, and interacting with colleagues; teleneurology displays will offer a chance to see how telemedicine works and

whether it’s a good fit for your practice; and Monday evening’s Brainstorm: A Competition for the Innovator in All of Us will offer an exciting opportunity to watch your trailblazing colleagues present their most innovative solutions to patient, practice, and other neurology-related challenges in a dynamic game showstyle format. Learn more at AAN.com/view/am18/ exhibits. 


A study conducted in Italy of 617 people with Parkinson’s found that approximately 50% experienced symptoms of OFF within 5 years of diagnosis.1 OFF periods can occur throughout the day, can be unexpected and may appear more often over time.1-3 In a 2014 survey of > 3,000 people with Parkinson's, two-thirds of respondents reported having more than two hours of OFF time per day.4

OFFmatters.com PD5817 7/17

1. 2. 3. 4.

Stocchi F et al. Parkinsonism Relat Disord. 2014;20(2):204-211. Stacy M et al. Mov Disord. 2005;20(6):726-733. Stacy M et al. www.medscape.org/viewarticle/701955. 2009. Accessed April 2017. The Michael J. Fox Foundation Survey of Parkinson’s Patients’ Off Time Experience, July 2014.

ACORDA THERAPEUTICS® and the stylized ACORDA THERAPEUTICS® logo are registered trademarks of Acorda Therapeutics, Inc. ©2017 Acorda Therapeutics, Inc. All rights reserved.


Conferences & Community 

Scientific Program Announced 

Continued from cover

Look for: ƒƒ Seven cutting-edge plenary sessions, one each day beginning Saturday evening ƒƒ Six daily poster and e-poster sessions beginning Sunday ƒƒ Neuroscience in the Clinic sessions ƒƒ Invited Science Sessions ƒƒ More For more information and to browse the full listing of abstracts, visit AAN.com/view/AM18.

2018 Scientific Program at a Glance Saturday, April 21 4:15 p.m.–5:30 p.m. Hot Topics Plenary Session Sunday, April 22 8:00 a.m.–9:00 a.m. S1: "Best of" Session: Cerebrovascular Disease and Interventional Neurology 9:15 a.m.–12:00 p.m. Presidential Plenary Session 11:30 a.m.–5:30 p.m. Poster Session I 1:00 p.m.–3:00 p.m. S2: Clinical Trials and Therapeutic Approaches in Neurodegenerative Diseases S3: Movement Disorders: Parkinson's Disease: Genetics, Biomarkers, and Diagnosis S4: Neuroepidemiology: Neurodegeneration, Epilepsy, Cerebrovascular Disease Risks S5: General Neurology: Advances in Neurotherapeutics

S10: Intracerebral and Subarachnoid Hemorrhage

N2: Neuroscience in the Clinic: Antisense Oligonucleotide (ASO) Therapy

N1: Neuroscience in the Clinic: Autism Myth Busters

Tuesday, April 24

Monday, April 23 8:00 a.m.–9:00 a.m. S11: “Best of” Session: Epilepsy/Clinical Neurophysiology (EEG) 9:15 a.m.–11:30 a.m. Contemporary Clinical Issues Plenary Session 11:30 a.m.–7:00 p.m. Poster Session II 1:00 p.m.–2:00 p.m. S12: Autonomic Disorders 1:00 p.m.–3:00 p.m. S13: Neuromyelitis Optica Spectrum Disorder and other Autoimmune Disorders S14: Education and Patient Outcomes Research

S6: MS Neuroimaging

S15: Cerebrovascular Disease Epidemiology and Outcomes

3:30 p.m.–4:30 p.m. S7: Pain and Palliative Care

S16: Neuro-ophthalmology/ Neuro-otology

3:30 p.m.–5:30 p.m. S8: Progressive MS Therapies and Age-Dependent Factors in MS Therapy

3:30 p.m.–5:30 p.m. S17: Sleep

S9: Epilepsy/Clinical Neurophysiology (EEG)

S18: Movement Disorders: Ataxia and Tremor S19: Epilepsy/Clinical Neurophysiology (EEG) II

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AANnews  •  March 2018

8:00 a.m.–9:00 a.m. S20: “Best of” Session: Headache 9:15 a.m.–11:30 a.m. Clinical Trials Plenary Session 11:30 a.m.–7:00 p.m. Poster Session III 1:00 p.m.–3:00 p.m. S21: Revascularization in Acute Ischemic Stroke S22: Advances in Muscular Dystrophy and Congenital Myopathy S23: Biologic and Clinical Discoveries in Neuro-oncology N3: Neuroscience in the Clinic: Challenges in Genetic Diagnosis in Neurology Invited Science: Movement Disorders 3:30 p.m.–5:30 p.m. S24: MS Outcome Measures and Biomarkers


S25: Advances in Amyotrophic Lateral Sclerosis

Neurobiology of Pain and Addiction, and the Path Toward Better Treatments

S45: Movement Disorders: Parkinsonian Disorders, Basic Science, and Imaging

S26: Movement Disorders: Parkinson's Disease Clinical Trials

Invited Science: Sleep

S46: Advances in Spinal Muscular Atrophy

4:30 p.m.–5:30 p.m. S37: Neuro-rehabilitation

N6: Neuroscience in the Clinic: Neurologic Complications of Cancer Immunotherapy: A New Frontier in Neuro-inflammation Invited Science: Neuro Trauma

5:45 p.m.–7:00 p.m. Emerging Science Session Wednesday, April 25 8:00 a.m.–9:00 a.m. S27: “Best of” Session: Movement Disorders 9:15 a.m.–11:30 a.m. Frontiers in Neuroscience Plenary Session 11:30 a.m.–7:00 p.m. Poster Session IV 1:00 p.m.–2:00 p.m. S28: Practice, Policy, and Ethics 1:00 p.m.–3:00 p.m. S29: Child Neurology and Developmental Neurology I

Thursday, April 26 8:00 a.m.–9:00 a.m. S38: "Best of" Session: Clinical Trial Updates in Neuromuscular Disorders 9:15 a.m.–11:30 a.m. Controversies in Neurology Plenary Session 11:30 a.m.–7:00 p.m. Poster Session V 1:00 p.m.–2:15 p.m. S39: History of Neurology

S30: Movement Disorders: Dystonia, Chorea, and other Disorders

1:00 p.m.–2:30 p.m. Invited Science: The Brain Research through Advancing Innovative Neurotechnologies (BRAIN) Initiative

S31: Therapeutics, Phenotypes, and Biomarkers in Neuromuscular Disorders

1:00 p.m.–3:00 p.m. S40: Acute Stroke Care

S32: Headache: Therapeutics

S41: Neurologic Infections

3:30 p.m. – 4:15 p.m. S33: Global Health

S42: Neurocritical Care

3:30 p.m.–5:30 p.m. S34: Behavioral and Cognitive Neurology S35: Child Neurology and Developmental Neurology II S36: MS Therapeutics and Clinical Research

N5: Neuroscience in the Clinic: Treatment of Progressive Multiple Sclerosis 3:30 p.m.–5:30 p.m. S43: Migraine S44: MS Risk Factors, Susceptibility, Diagnosis, and Cognitive Impairment

Friday, April 27 8:00 a.m.–9:00 a.m. S47: “Best of” Session: MS and CNS Inflammatory Disease 9:15 a.m.–11:30 a.m. Neurology Year in Review: Emerging Therapies Plenary Session 11:30 a.m.–5:30 p.m. Poster Session VI 1:00 p.m.–3:00 p.m. S48: Novel Biomarkers in Aging and Dementia S49: Neuro Trauma and Sports Neurology S50: Updates in General Neurology S51: Pediatric MS N7: Neuroscience in the Clinic: REM Sleep Behavior Disorder—Past, Present, Future 3:30 p.m.–5:30 p.m. S52: MS and CNS Inflammatory Disease: Basic Science S53: Epilepsy/Clinical Neurophysiology (EEG) III S54: Ischemic Stroke Prevention 

N4: Neuroscience in the Clinic: Opioid Use and Abuse: The Overlapping

AANnews  •  March 2018 15


Conferences & Community 

Registration Opens This Month for July AAN Sports Concussion Conference Each year, 1.6 to 3.8 million recreational and competitive American athletes develop a concussion. Sport-related concussion conversations are often shaped by the media, which increasingly has been reporting on this issue. The AAN believes the conversations surrounding sport-related concussion should be evidence- or consensus-based, and should be shaped by emerging scientific information. To this end, the 2018 AAN Sports Concussion Conference is poised to be a leading voice in shaping the sport-related concussion conversation for all clinicians, scientists, and care teams involved in the prevention, diagnosis, and management of sport-related concussion at the youth, high school, collegiate, and professional levels. Set for July 20 through 22 at the JW Marriott in Indianapolis, IN, the conference will bring together top experts to present the most up-to-date best practices and emerging scientific information through a variety of formats, including hands-on workshops and debates. Attendees can expect to: ƒƒ Describe the current state and emerging science regarding concussion pathophysiology, diagnosis, and management

SPORTS CONCUSSION JULY 20–22, 2018 INDIANAPOLIS, IN

CONFERENCE

ƒƒ Discuss the potential long-term sequelae from sportrelated brain trauma The conference has received accreditation by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians, who may earn up to 19.5 CME. The program is also approved by the Board of Certification, Inc (BOC) and Athletic Trainers may earn up to 19.5 CE. Early registration savings end June 14. Visit AAN.com/view/ ConcussionConference for the full schedule and to take advantage of early-bird discounts. 

ƒƒ Learn about the latest clinical tools and technologies for diagnosis and management ƒƒ Discover emerging issues in post-concussion syndrome diagnosis and management

Enhance Your Care Team with Valuable AAN Memberships Does your neurology team include advanced practice providers and/or business administrators? We know how valuable care team members are to the overall success of your practice, so we want to make sure you are aware of the many AAN resources available to these important colleagues. Specially priced AAN memberships for advanced practice providers and business administrators are a wise investment—providing a single source of incomparable career support and essential resources your care team members need to thrive throughout their professional lifetimes and enhance your practice and patient care.

Advanced Practice Provider Membership Benefits Include: ƒƒ Online education courses through the AAN at no additional cost (for PLUS membership only) ƒƒ Deep discounts on AAN conference registration, Continuum®, and other AAN products and services ƒƒ Subscriptions to Neurology ® journal (for PLUS membership only), Neurology® Clinical Practice*, Neurology Today ® (digital access only for lower tiered members), and AANnews®

Business Administrator Membership Benefits Include: ƒƒ Exclusive access to the 2018 Practice Management Webinar series ƒƒ Online education courses through the AAN at no additional cost (for PLUS membership only) ƒƒ Subscriptions to Neurology: Clinical Practice*, Neurology Today (digital access only for lower tiered members), and AANnews* ƒƒ Access to member-only resources including quality improvement resources, payment and reform tools, clinical practice guidelines, and online education programs

Your care team members can visit AAN.com/view/join to view a full listing of corresponding member benefits and to join or renew an existing membership.  *International members receive digital access only.

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AANnews  •  March 2018


AAN Shares Concussion Message with Super Bowl Crowds Amid the Super Bowl LII hoopla in Minneapolis last month, the first-floor windows of the AAN headquarters and a unique brain ice sculpture shared the AAN’s concussion mantra “When in Doubt, Check It Out” with many of the 1 million visitors for the football extravaganza. For several years, the Academy has run a year-round national public service awareness campaign on concussion to promote the AAN Sports Concussion guideline and provide free resources at AAN.com/concussion. Since the Super Bowl is one of the premier sports events, this was a singular opportunity. “With US Bank Stadium only a block away from our offices, we knew there would be tens of thousands of sports fans walking by the AAN headquarters that week,” said AAN Executive Director/CEO Catherine M. Rydell, CAE. “After months of planning and working with city officials, we wrapped our windows with bold images that underscores that concussion can affect participants of any age in a variety of sports, not just football. Landing on your head after a skateboard fall can be

just as dangerous as a collision on a football field. So, when in doubt, check it out with a qualified physician or neurologist.” The brain ice sculpture was installed in front of the AAN building in the Sensory Garden and proved to be an attraction where Super Bowl visitors stopped by to take pictures and post the images on social media using #ProtectYourBrain. The Academy shared its messaging via a large social media campaign that included Facebook, Twitter, and Instagram, where members and the public could keep up with the installation, join the conversation, and share posts. 

AANnews  •  March 2018 17


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

ANTISEIZURE THERAPY FINE-TUNED FOR YOUR PATIENTS


ED AND INDI P X

NEW E

TION CA

FOR PATIENTS 4 YEARS AND OLDER

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

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

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

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

For more information, visit www.AptiomHCP.com.


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

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

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


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

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

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

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

Indication

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

Risk Differences: Additional Drug Patients with Events Per 1000 Patients

Epilepsy

1.0

3.4

3.5

2.4

Psychiatric

5.7

8.5

1.5

2.9

Other

1.0

1.8

1.9

0.9

Total

2.4

4.3

1.8

1.9

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

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


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

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

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

ADVERSE REACTIONS

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

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

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

Placebo

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

<1

2

6

Eye disorders Diplopia Blurred vision Visual impairment

2 1 1

9 6 2

11 5 1

Gastrointestinal disorders Nausea Vomiting Diarrhea Constipation Abdominal pain Gastritis

5 3 3 1 1 <1

10 6 4 2 2 2

16 10 2 2 2 <1

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

4 2 <1 1

4 2 2 2

7 3 2 1

Infections and Infestations Urinary tract infections

1

2

2

Injury, poisoning and procedural complications Fall

1

3

1

Metabolism and nutrition disorders Hyponatremia

<1

2

2

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

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

20 11 13 4 3 2 1 1 1

28 18 15 6 3 4 2 2 2

Psychiatric disorders Depression Insomnia

2 1

1 2

3 2

Respiratory, thoracic and mediastinal disorders Cough

1

2

1

Skin and subcutaneous tissue disorders Rash

1

1

3

Vascular disorders Hypertension

1

1

2

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


with partial-onset seizures, 393 patients ages 4 to 17 years received APTIOM, of whom 265 received APTIOM for at least 1 year. Adverse reactions reported in clinical studies of pediatric patients 4 to 17 years of age were similar to those seen in adult patients. Other Adverse Reactions with APTIOM Use Compared to placebo, APTIOM use was associated with slightly higher frequencies of decreases in hemoglobin and hematocrit, increases in total cholesterol, triglycerides, and LDL, and increases in creatine phosphokinase. Adverse Reactions Based on Gender and Race No significant gender differences were noted in the incidence of adverse reactions. Although there were few non-Caucasian patients, no differences in the incidences of adverse reactions compared to Caucasian patients were observed. Postmarketing Experience The following adverse reactions have been identified during postapproval use of APTIOM. Because these reactions are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure: Hematologic and Lymphatic Systems: leukopenia, agranulocytosis, thrombocytopenia, megaloblastic anemia, and pancytopenia Metabolism and Nutrition Disorders: syndrome of inappropriate antidiuretic hormone secretion (SIADH)

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

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

(mice), embryolethality (rats), and fetal growth retardation (all species), at clinically relevant doses. Advise a pregnant woman of the potential risk to a fetus. In the U.S. general population, the estimated background risk of major birth defects and miscarriage in clinically recognized pregnancies is 2–4% and 15–20%, respectively. The background risk of major birth defects and miscarriage for the indicated population is unknown. Data Animal Data When eslicarbazepine acetate was orally administered (150, 350, 650 mg/kg/day) to pregnant mice throughout organogenesis, increased incidences of fetal malformations was observed at all doses and fetal growth retardation was observed at the mid and high doses. A no-effect dose for adverse developmental effects was not identified. At the lowest dose tested, plasma eslicarbazepine exposure (Cmax, AUC) is less than that in humans at the maximum recommended human dose (MRHD, 1600 mg/day). Oral administration of eslicarbazepine acetate (40, 160, 320 mg/kg/day) to pregnant rabbits throughout organogenesis resulted in fetal growth retardation and increased incidences of skeletal variations at the mid and high doses. The no-effect dose (40 mg/kg/day) is less than the MRHD on a mg/m2 basis. Oral administration to pregnant rats (65, 125, 250 mg/ kg/day) throughout organogenesis resulted in embryolethality at all doses, increased incidences of skeletal variations at the mid and high doses, and fetal growth retardation at the high dose. The lowest dose tested (65 mg/kg/day) is less than the MRHD on a mg/m2 basis. When eslicarbazepine acetate was orally administered to female mice during pregnancy and lactation (150, 350, 650 mg/kg/day), the gestation period was prolonged at the highest dose tested. In offspring, a persistent reduction in offspring body weight and delayed physical development and sexual maturation were observed at the mid and high doses. The lowest dose tested (150 mg/kg/day) is less than the MRHD on a mg/m2 basis. When eslicarbazepine acetate was orally administered (65, 125, 250 mg/kg/day) to rats during pregnancy and lactation, reduced offspring body weight was seen at the mid and high doses. Delayed sexual maturation and a neurological deficit (decreased motor coordination) were observed at the highest dose tested. The no-effect dose for adverse developmental effects (65 mg/kg/day) is less than the MRHD on a mg/m2 basis. The rat data are of uncertain relevance to humans because of differences in metabolic profile between species. Lactation Eslicarbazepine is present in human milk. The effects of APTIOM on the breastfed infant or on milk production are unknown. The developmental and health benefits of breastfeeding should be considered along with the mother’s clinical need for APTIOM and any potential adverse effects on the breastfed infant from APTIOM or from the underlying maternal condition. Females and Males of Reproductive Potential Contraception Use of APTIOM with hormonal contraceptives containing ethinylestradiol or levonorgestrel is associated with lower plasma levels of these hormones. Advise women of reproductive potential taking APTIOM who are using a contraceptive containing ethinylestradiol or levonorgestrel to use additional or alternative non-hormonal birth control.

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

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


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

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

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

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

, used under license.

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


Tools & Resources 

March 31, 2018, is the deadline to submit your measures for the 2017 performance year, with the exception of CMS Web Interface users who will have to report quality data for the January 22, 2018, to March 16, 2018, timeframe. Visit QPP.cms.gov to access the data submission system for clinicians in the Quality Payment Program and submit your data to CMS. You’ll receive real-time feedback on your performance and even an estimation of your final 2019 payment adjustment. Note that you’ll need an Enterprise Identity Management (EIDM) account to submit online. If you have questions about MIPS, contact macra@aan.com. 

downloads... a n o nd illi g m

ng wi ro

If you are participating in the MIPS payment program, you still have time to submit 2017 performance data to avoid a negative payment adjustment in 2019.

Ove r1 7

March Deadline Coming Up for 2017 MIPS Submission

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 March 1 ƒƒ Neurology: Relapse Occurrence in Women with Multiple Sclerosis During Pregnancy in the New Treatment Era Stacey Lynn Clardy, MD, PhD, and Raed A. Alroughani, MD, FAAN ƒƒ Neurology: Atrial Fibrillation Detected After Stroke Is Related to a Low Risk of Ischemic Stroke Recurrence Mark Lawrence McAllister, MD, and Luciano A. Sposato, MD, MBA, FAHA ƒƒ Neurology: Clinical Practice: Molecular Genetic Testing for Hereditary Ataxia: What Every Neurologist Should Know Jeffrey B. Ratliff, MD, and Stephanie E. Wallace, MD ƒƒ Neurology: Neuroimmunology & Neuroinflammation: IgLON5 antibody: Neurological Accompaniments and Outcomes in 20 Patients Stacey Lynn Clardy, MD, PhD, and Andrew McKeon, MD, MB, BCh

AANnews  •  March 2018 25


Tools & Resources 

AAN Issues New Position Statement on Lawful Physician-hastened Death The AAN has issued new guidance for neurologists treating terminally ill adult patients who are suffering and request to hasten their death. The new AAN position statement, published in the February 27, 2018, print issue of the Neurology ® journal leaves the decision of whether to practice lawful physicianhastened death (LPHD) to the conscientious judgment of neurologists acting on behalf of their adult patients who live in US states and territories where it is allowed. It is endorsed by the Child Neurology Society. The AAN has adopted the term “lawful physician-hastened death” because, while similar to the term physician-assisted death, it removes ambiguity regarding the motivation of a patient, which is not to commit suicide, but to hasten death to relieve suffering. In lawful physician-hastened death, the physician issues a prescription, but the patient administers it. It is not the same as euthanasia, in which the physician both issues and administers the prescription. The AAN remains opposed to euthanasia, which is illegal in all US states and territories. “As lawful physician-hastened death has become legal in more states, neurologists look to the AAN for guidance,” said lead author James Russell, MD, FAAN, chair of the AAN’s Ethics,

Law, and Humanities Committee. “The AAN carefully deliberated this important issue, taking into account all aspects of the ethical debate, as well as the expectations of adult patients dying with neurological illness, and feels this guidance allows for neurologists and their patients to make the decision best for them where it is legally allowed.”

Russell

Lawful physician-hastened death first became legal in Oregon in 1997. Since then, it has become legal in five more states—California, Colorado, Montana, Vermont, and Washington—as well as in the District of Columbia. In most LPHD states, professional organizations and associations including the AAN are prohibited by law from censuring or disciplining their members for participating or refusing to participate in LPHD. This is the context in which the AAN considered its current position on LPHD and the potential application of its member disciplinary process. In 2014, the AAN surveyed neurologists and found a notable percentage of them might feel bound by conscience to comply with the wishes of their dying patients. More than 70 percent of respondents in states where lawful physician-hastened death is allowed endorsed it as an ethically permissible behavior. Of those, half reported they would be willing to assist their patients who requested lawful physician-hastened death. “The American Academy of Neurology believes the primary role of physicians is to prevent and treat disease whenever possible,” said Russell. “When treatments no longer work, palliative care to alleviate suffering for patients is crucial. The AAN advocates for palliative care research to identify new ways to more effectively alleviate suffering of dying patients, but it also acknowledges that not all suffering can be relieved with current care and some patients may request lawful physician-hastened death.” This new position statement replaces the AAN’s 1998 position statement titled “Assisted Suicide, Euthanasia, and the Neurologist.” 

This Coding Webinar Can Help Ensure Proper Reimbursement  Continued from cover

Remember, many of the 2018 practice management webinars will include a panel to provide more perspectives on the information presented. Also, members who subscribe to the complete series of webinars can access a Synapse online community page to ask further questions, whether they participate live or watch the recorded webinar.

26

AANnews  •  March 2018

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


Policy & Guidelines 

AAN Publishes Comprehensive Systematic Review on Treatment of Cerebellar Motor Dysfunction and Ataxia The AAN published “Comprehensive Systematic Review: Treatment of Cerebellar Motor Dysfunction and Ataxia” in Neurology® online on February 9, 2018, and in print in the upcoming March 6 issue. The purpose of a systematic review is to summarize existing evidence and the strength of that evidence. This is distinct from evidence-based guidelines, which provide recommendations for care. This comprehensive systematic review was endorsed by the A-TCP Children’s Project.

Capitol Hill Report Zesiewicz

Many diseases can cause ataxia. There is weak evidence for the use of drug and nondrug treatments for motor manifestations of cerebellar disease, and the strength of the evidence varies by therapy. For all therapies, the evidence about duration of treatment effect is limited by the duration of supporting studies. Clinicians should know that: ƒƒ There is not enough evidence to support or refute the use of many of the drugs currently used to treat ataxia. ƒƒ 4-AP is likely effective in reducing ataxia attack frequency for patients with episodic ataxia 2. ƒƒ Riluzole is probably effective in improving clinical rating scale scores for some patients with neurodegenerative ataxias. ƒƒ Daily inpatient rehabilitation with physical and occupational therapy for patients with degenerative ataxia probably improves clinical rating scales scores. ƒƒ For patients with ataxia associated with multiple sclerosis, there is possibly no benefit of the addition of pressure splints to supplement neuromuscular rehabilitation. ƒƒ There is not enough evidence to support or refute the use of stochastic whole-body vibration therapy. “More preclinical and clinical work is needed to identify therapies for these debilitating ataxia disorders,” said Theresa A. Zesiewicz, MD, FAAN, lead author. Read the comprehensive review and access PDF summaries for clinicians and patients at AAN.com. For more information, contact Scott Wessels at swessels@aan.com or (612) 928-6056. 

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.

Congress Passes FAST Act and Additional AAN Priorities In February, Congress passed budget legislation that contained several significant priorities of the AAN, including the final passage of the Furthering Access to Stroke Telemedicine (FAST) Act. Working with the American Heart Association and American Stroke Association (AHA/ ASA), the AAN has been a lead advocate for the FAST Act over the last three years. The FAST Act changes federal policy to allow Medicare to pay for telestroke services in all geographic areas, not just rural as allowed by current law. This policy change should increase access to critical, timely care for those suffering from stroke. ƒƒ This was first introduced in 2015, and was a top priority for AAN’s Neurology on the Hill in 2016 and 2017. ƒƒ In July 2017, AAN Board member Brett Kissela, MD, FAAN, testified in favor of the FAST Act in front of the House Energy & Commerce Committee which later passed the bill from committee on a unanimous 51-0 vote. The budget resolution also addressed other major AAN priorities including: ƒƒ $2 billion increase for the National Institutes of Health for 2018-2019 ƒƒ $6 billion to combat the opioid crisis ƒƒ Elimination of the Independent Payment Advisory Board, a provision of the Affordable Care Act that greatly threatened physician Medicare payments and access to care for patients ƒƒ Extended the Children’s Health Insurance Plan for another four years, to a total of 10 years ƒƒ Permanently repealed the therapy caps that threatened rehabilitation services ƒƒ MACRA fixes, including the elimination of MIPS payment adjustments applying to Part B drugs. 

AANnews  •  March 2018 27


Policy & Guidelines 

Review of Guidelines Ensures Most Current Available Evidence The high number of guidelines retired in 2017 is an anomaly due to the policy change and the rate of guidelines retired is anticipated to return to two per year. The subcommittee hopes that a new document type in development—the focused update—will reduce the number of guidelines that are retired without a replacement and keep guidelines as Harden current as possible. Focused updates are being designed to efficiently update only outdated content rather than entire guidelines when possible. In the meantime, as this new document type is refined, automatic retirement of “The AAN’s leadership has taken the outlook that an outdated guidelines that have been out of date for five years will help guideline does not serve the mission of the AAN, which is ensure that all published AAN guidelines reflect the most to provide the highest level of service to the members,” said current available evidence. Cynthia L. Harden, MD. “The AAN guidelines must be up-to“The AAN is constantly working toward providing timely and date in order to be of service to the members. This strategy accurate guidelines,” said Harden. “The new focused update mitigates the chance that outdated guidelines will be used. process should go a long way toward meeting that goal.” Members can consult a retired guideline with the caveat that there may be more recent management approach that is not Guidelines Retired in 2017 addressed in the retired guideline.” ƒƒ Botulinum Neurotoxin for the Treatment of Spasticity In 2017, eight guidelines were retired as a result of this new Maintaining currency of all published AAN clinical practice guidelines and systematic reviews (guidelines) is a priority for the Guideline Development, Dissemination, and Implementation Subcommittee. Retiring, updating, and reaffirming guidelines that are out of date is key. To speed the process, the Board of Directors recently approved a policy that any AAN guidelines that have not been either updated or reaffirmed by five years after the previous publication or reaffirmation will be retired automatically.

policy. These guidelines had been identified as in need of an update but this was not started due to prioritization of new and updated guideline projects. In total, 56 of the AAN’s 137 guidelines have been retired. On average, the AAN annually retires two and publishes five guidelines.

AAN guidelines are reviewed by the subcommittee for currency every three years. Subcommittee members and participants on the original author panel review new studies published since the last literature search and then determine if the guideline should be reaffirmed, flagged for an update but kept as a current guideline on the AAN website, or retired immediately. Guidelines can be retired for the following reasons: interventions discussed in the guideline may be outdated; safety concerns with the conclusions and recommendations; and the guideline has been replaced by a more recent publication.

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AANnews  •  March 2018

ƒƒ Assessment: Transcranial Doppler Ultrasonography ƒƒ Practice Parameter: Evaluation and Treatment of Depression, Psychosis, and Dementia in Parkinson Disease (An Evidence-based Review)

ƒƒ Practice Parameter: Treatment of Postherpetic Neuralgia ƒƒ Practice Parameter: Treatment of Parkinson Disease with Motor Fluctuations and Dyskinesia (An Evidencebased Review) ƒƒ Practice Parameter: Neuroimaging of the Neonate ƒƒ Practice Parameter: Therapies for Benign Paroxysmal Positional Vertigo (An Evidence-based Review) ƒƒ Evaluating an Apparent Unprovoked First Seizure in Adults 


AAN ANNUAL MEETING:

SHINING THE SPOTLIGHT ON YOUR CAREER REGISTER TODAY I especially liked the experiential learning areas. They really captured the kinetic energy of the meeting.

This [meeting] provided so many fundamentals that I need in everyday practice. —Advanced Practice Provider Member

—Neurologist Member

I’m going to tell my fellow residents to go to the Annual Meeting. It’s a fantastic networking and educational opportunity. I plan to go for years to come. —Junior Member

Registration still available! AAN.com/view/AM18

APRIL 21–April 27, 2018 ADVANCING NEUROLOGY. ADVANCING YOU.


Education & Research 

Rydell Selected for ABMS Commission on Future of MOC Catherine M. Rydell, CAE, AAN executive director and CEO, has been selected to serve on the American Board of Medical Specialties (ABMS) Continuing Board Certification: Vision for the Future Initiative Commission. ABMS launched the commission to bring together multiple partners to envision a system of continuing board certification, also known as Maintenance of Certification (MOC), that is meaningful, relevant, and of value, while remaining responsive to the patients, hospitals, and others who expect that physician specialists are maintaining their knowledge and skills to provide quality specialty care. The commission, consisting of 27 members, will engage the profession, public, and other stakeholders by gathering information, holding hearings, and addressing initial questions. The aim is to have an open, transparent, collaborative and inclusive process. The commission will present a set of recommendations to the ABMS and its member boards for their consideration and implementation on February 1, 2019.

Rydell has played key roles in discussions between medical societies and the ABMS related to MOC. Most recently, her leadership led to a joint summit of the national medical specialty societies and the state medical societies. For the summit in December 2017, representatives Rydell were invited from the American Board of Medical Specialties and specialty boards, the Accreditation Council for Graduate Medical Education, Federation of State Medical Boards, Council of Medical Specialty Societies, and American Medical Association. At the summit, the certifying boards agreed that they must collaborate with the societies in the development of a meaningful MOC process or risk the loss of professional self-regulation. Learn more about the new ABMS Vision Initiative at VisionInitiative.org. 

UCNS Issues Neurocritical Care Certifications and Recertifications An additional recertification The United Council for examination for Neurocritical Neurologic Subspecialties Care will be offered this year. (UCNS) has issued Applications will be available new certifications and starting April 1 and will be due recertifications in Neurocritical July 2, with the examination Care. A total of 154 physicians scheduled for the week of received certification and Fink December 3 through 7, 2018. 109 physicians received recertification. UCNS “A total of 1,374 physician certification is a measure of expertise diplomates are now certified in demonstrating that these physicians Neurocritical Care, the highest are properly trained and experienced in distinction of expertise in this neurologic Neurocritical Care.

subspecialty,” said Matthew E. Fink, MD, FAAN, chair of the UCNS Certification Council. “A high percentage of physicians who were due for recertification chose to take the exam, which demonstrates their commitment to lifelong learning and shows that they continue to find value in their UCNS certifications.” A total of 2,823 physicians are UCNS diplomates. For a list of the newly certified and recertified diplomates, visit UCNS.org. 

DELIVERING YOU VALUE 87 Percent* of Your Member Dues Go Directly to Your Member Benefits

*2018 projection

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AANnews  •  March 2018


American Brain Foundation 

‘Cure One, Cure Many’ Is Theme of Foundation Booth at 2018 Annual Meeting Cure One, Cure Many’ is the guiding principle of the American Brain Foundation—one that sets it apart from other organizations raising money for a single brain disease, and one that more broadly unites the Foundation with all AAN members. It is an outlook grounded in science, based on an understanding that advances in, or a cure for, one brain disease can and will lead to advances in research, and possibly cures, for others. It is a philosophy that gives hope and understanding to families affected by multiple neurologic conditions and the many people who are impacted by brain disease. It is also the theme for this year’s Foundation booth during the AAN Annual Meeting April 21 through 27 in Los Angeles. All meeting attendees are encouraged to stop by the booth throughout the week to meet staff and learn more about the Foundation’s important work, including the creation of the world’s first single neuroscience crowdfunding website at AmericanBrainFoundation.org. Visitors to the site can learn about current research in many areas of brain disease and either support a very specific research project that most interests, moves, or motivates them, or make a general donation to support all efforts.

The Foundation booth will once again feature the Jenga GIANT challenge by which participants can try their hand at “outsmarting brain disease.” This fun, challenging, and interactive exercise figuratively illustrates the “Cure One, Cure Many” concept, with 54 different brain diseases inscribed on wooden blocks which are at first carefully interwoven to form a tower. As the blocks are slowly removed, the significance of their connectedness becomes increasingly evident until the game ends with them all tumbling to the ground. Meeting attendees are also encouraged to attend the Commitment to Cures fundraiser on Wednesday, April 25, at the JW Marriott Los Angeles. Comedian Michael Pritchard, friend of the late Robin Williams, will serve as the program emcee and be joined by 2018 Public Leadership in Neurology Award recipient Temple Grandin, PhD, via video. DeMaurice Smith, executive director of the NFL Players’ Association, will receive the 2018 Commitment to Cures Award, and acoustic guitarist, singer, composer, and American Brain Foundation Honorary Board Member Billy McLaughlin will provide a memorable live performance. Individual tickets are $125, and tables for 10 are available for $1,500. Visit events@AmericanBrainFoundation.org to secure your spot.


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„ AAN.com/careers

„ Visit the AAN’s Neurology Career Center to view hundreds of additional jobs and sign up for customized, confidential notifications when positions of interest are added. Neurologist Boarded in Sleep/Neurologist Focus in Headache/ General Neurologist/Neurohospitalist/Psychiatrist/ Neuro-psychiatrist We are a private practice multispecialty group in North San Diego County consisting of Twenty-One physicians, 2 Neuropsychologists, 1 Psychiatrist, and six Physician Assistants, practicing in a number of different disciplines. Our practice includes multiple fellowship trained and boarded subspecialists with expertise in neurophysiology, epilepsy monitoring, sleep medicine, headache medicine, stroke care, neuro-rehabilitation, neuropsychology, movement disorders, and psychiatry. We have a sleep lab and four offices in the region. We practice at Scripps Memorial Hospital Encinitas-Acute Inpatient Rehab, Scripps Memorial Hospital in La Jolla, California, Palomar Pomerado Hospital in Escondido and Poway California, as well as Tri City Medical Center in Oceanside, California. We have affiliations with all the major health systems in San Diego including Scripps, UCSD, Sharp and Kaiser. This practice has been in existence since 1977 and is well positioned in the community to provide neurological services. Most partners have academic appointments at UCSD as volunteer faculty. We have a busy clinical trials practice. Our practice has grown out of a desire to combine the benefits of private practice with elements of research and academics. Our desire is to attract several BC/BE, highly qualified, energetic and motivated physicians for our Multidisciplinary Neurology practice as we continue to grow. We are recruiting for the following positions: Neurologist Boarded in Sleep/ Neurohospitalist/General neurologist/Neurologist with focus on Headache/Migraine/as well as a Neuropsychiatrist/ Psychiatrist. There is partnership opportunity. Our practice has had Electronic Health Records for many years, we are Joint Commission accredited. You can visit our website at www.neurocenter.com. Please email CV directly to vtibbs@ neurocenter.com as well as rossies@neurocenter.com General Neurologist Opportunity Located in Central Texas Close to Austin/Houston Work Location: College Station, Texas. CHI St Joseph Health is a member of Catholic Health Initiatives (CHI) whose mission is to nurture the healing ministry of the church, supported by education and research. CHI is the second largest Catholic healthcare system in the country with over 90,000 employees in 19 states. CHI St Joseph Health, based in Bryan, Texas for over 80 years, joined CHI in November of 2014 and is a proud member of the CHI Texas Division. Job Summary: The candidate will join our well-established neurology service line consisting of 3 neurologists as well as neurosurgeons. The ideal candidate will have a strong focus on clinical excellence and patient satisfaction. Candidate will display exceptional interpersonal skills and desire to develop strong ties with the community and existing medical staff. This position will include inpatient and outpatient care with call expectation of 1:4. Education and Certifications required: Boarded in Neurology, Texas licensed, preferred. 1–3 Years’ experience preferred, but new grads will be considered. Salary and Benefits: Salary range is negotiable based upon experience. Competitive salary, excellent benefits, sign-on bonus, relocation CME reimbursement for new for continuing education, licensure and certification. Email glazarine@ st-joseph.org Neurohospitalist Presbyterian Healthcare Services (PHS) is a locally owned, not-for-profit healthcare system of eight hospitals, a statewide health plan and a growing multi-specialty medical group with more than 800 physicians and advanced practice clinicians. Founded in New Mexico in 1908, it is the state’s largest private employer with approximately 11,000 employees. We are seeking to fill the following positions: General Neurology – 36 hours of direct patient care with 4 hours of administrative time per week, call is shared with no more than 6 days per month, must be able to perform and interpret EEG and EMG. Neurology Hospitalist – 7 on 7 off schedule working Tuesday to Tuesday with Advanced Practitioner support. Vascular Neurohospitalist – willing to help grow the stroke program from primary to comprehensive certification, willing to do stroke clinic, including ED TIA discharges and

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AANnews  •  March 2018

community stroke outreach and education, provider will be joining Neurointerventionalist along with Neurosurgeon. Benefits – nationally competitive salary with relocation allowance sign-on/commitment bonus, generous Time Off Program, comprehensive benefits package, CME allowance, 403b retirement savings program with both matching program and employer contributions. About Us: Presbyterian’s story is really the story of the remarkable people who have chosen to work here. Starting with Reverend Cooper who began our journey in 1908, the hard work of thousands of physicians, employees, board members, and other volunteers brought Presbyterian from a tiny tuberculosis sanatorium to a statewide healthcare system, serving more one in three New Mexicans with healthcare or coverage. We are part of New Mexico’s history – and committed to its future. That is why we will continue to work just as hard and care just as deeply to serve New Mexico for years to come. About New Mexico: New Mexico’s unique blend of Spanish, Mexican and Native American influences contribute to a culturally rich lifestyle. Add in Albuquerque’s International Balloon Fiesta, Los Alamos’ nuclear scientists, Roswell’s visitors from outer space, and Santa Fe’s artists, and you get an eclectic mix of people, places and experiences that make this state great. Cities in New Mexico are continually ranked among the nation’s best places to work and live by Forbes magazine, Kiplinger’s Personal Finance, and other corporate and government relocation managers like Worldwide ERC. New Mexico offers endless recreational opportunities to explore, and enjoy an active lifestyle. Venture off the beaten path, challenge your body in the elements, or open yourself up to the expansive sky. From hiking, golfing and biking to skiing, snowboarding and boating, it’s all available among our beautiful wonders of the west. AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke free campuses. If you are interested please contact me at: Kelly Herrera, Physician Recruiter, Presbyterian Healthcare Services. (505) 923-5662; kherrera@phs.org Neurologist Singing River Health System is located on the beautiful Gulf Coast of Mississippi. We are seeking a full-time physician to join our Neurology practice of 3 physicians and 4 full time mid-levels. Providers will work on a one in four call rotation to cover two clinics and two hospitals in Jackson County. Ocean Springs Hospital and the primary clinic is located in Ocean Springs while Singing River Hospital and a second clinic is located 16 miles to the east in Pascagoula. Clinic hours are Monday – Friday. Both locations are in new, multi-specialty facilities. Patient population is well established with diverse demographics and payor mixes. Singing River Health System is recognized by the AHA as a Primary Stroke Center. Board Certified or Board Eligible required. Suitable candidates can expect the following: competitive incentive package with a guaranteed base plus performance and production bonuses, relocation assistance or sign on bonus and student loan assistance, annual CME allowance, annual pledge towards licensure and fees, Malpractice Coverage provided by Singing River Health System, paid Time Off per Human Resources policy and procedure, benefit package per Human Resources Employment Policy including medical, dental, vision, short-term and long-term disability, life insurance etc. The Community: Jackson County is a coastal community that is the perfect place to work, live and raise a family. With small town values, excellent schools, community events and recreational activities. This area is great for outdoorsman with beaches, boating, fishing and hunting. We offer a smalltown atmosphere but are nestled in between two larger cities, New Orleans, Louisiana and Mobile, Alabama. Both are just about an hour away and have big city amenities. Email krisann. dikes@mysrhs.com General Neurology Wheaton Franciscan Healthcare, a part of Ascension Wisconsin has an exciting opportunity for a General Neurologist in Racine, Wisconsin. Opportunity: Join a well-established practice in Racine, Wisconsin consisting of Four Neurologists and Three Advanced Practice Providers. Coverage will be for One Hospital with a 24/7 Hospitalist

Team. Call: Weekday call, evenings only- primarily pager call; weekends 1:4. Approximately 10-15 patients per day. Multispecialty group with strong referral patterns. Highly competitive compensation package. Excellent benefits, including a great retirement plan. Facility: EEG-Routine inpatient/outpatient, continuous inpatient video EEG monitoring, EMG/Nerve Conduction, EP Polysomnography, Sleep Disorder studies with New 6 bed Sleep Lab, CT: 3 scanners including a 64 slice all helical capability, MRI: 2 Scanners including GE 450W wide bore in 2011, PET/CT, US: 6 Siemens S2000 with 3D/4D and MSK capability. Email noell.buelow@ascension.org Neurologist Sentara Healthcare, an Award Winning, Innovative Healthcare System in Beautiful Coastal Virginia, is looking for 2 neurologists for our expanding neurology division. Sentara is one of the most integrated and progressive healthcare organizations in the nation. Recognized nationally for our quality of care, technology and innovation, we are comprised of 13 hospitals across Virginia and Northeastern North Carolina and Sentara Medical Group, an over 1,000-provider multispecialty group. Clinical research initiatives are encouraged and supported. All candidates will have an appointment in the Department of Neurology at Eastern Virginia Medical School (EVMS) and have an opportunity to participate in our educational mission. The Institute has neurology subspecialty representation in vascular neurology, epilepsy, neuromuscular disorders, cognitive disorders, headache, movement disorders, neuropsychology and autonomic disorders. Two Excellent opportunities: NeuroHospitalist based at Sentara Norfolk General-voted #1 Hospital in Virginia, a 543-bed quaternary care facility and Primary Stroke Center with a dedicated Neuro-ICU. The opportunity will be 7days on//7 days off with resident physicians and advanced practice clinicians supporting the busy service. General Neurologist based at Sentara Obici Hospital, a wellequipped, full-service, 176-bed facility with Primary Stroke Center Certification. This predominately outpatient opportunity has APC support and no stroke call responsibility. Call 2-3 times a month and every 5th–6th weekend. Live where others vacation. Lucrative compensation and benefits including pension plan. Loan Forgiveness. PA/NP support. Teaching opportunities. Excellent schools. Great coastal lifestyle. Practice in a beautiful coastal region that offers excellent shopping, dining, cultural and recreational opportunities. One ½ hours from Richmond, 3 hours south of Washington DC, and 4 hours from Virginia’s beautiful mountains. Email kmmille1@sentara.com

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 May 2018 print edition of AANnews must A be submitted by April 1, 2018. The same deadline applies to changes/cancellations.  he American Academy of Neurology reserves the T right to decline, withdraw, or edit advertisements at its discretion. Every care is taken to avoid mistakes, but the responsibility for clerical or printer errors does not exceed the cost of the ad.


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MARCH 2

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

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

Webinar: Building Better Care Teams: Integrating APPs into Your Practice (Register by April 30) AAN.com/view/pmw18

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

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

MARCH 29 Deadline: Annual Meeting Early Registration AAN.com/view/AM18

MAY 1

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

Deadline: UCNS Autonomic Disorders Certification Applications UCNS.org/go/subspecialty/autonomic/ certification

APRIL 21–27

MAY 1

AAN Annual Meeting Los Angeles, CA AAN.com/view/AM18

Deadline: UCNS Behavioral Neurology & Neuropsychiatry Certification and Recertification Applications UCNS.org/go/subspecialty/behavioral/ certification

APRIL 21 AAN Business Meeting Los Angeles Convention Center Los Angeles, CA AAN.com/view/AM18

May 7 Deadline: Sports Concussion Conference Abstract Submissions AAN.com/view/ConcussionConference

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MAY 22 Webinar: Managing Headache Without Giving Yourself One: Using Tools and Technologies for Better Practice Management (Register by May 21) AAN.com/view/pmw18

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AANnews  •  March 2018 35


A deeper look at the science behind migraine

Beyond the actual pain of migraine is the everyday impact on patientsâ&#x20AC;&#x2122; lives. Today, a growing understanding of the CGRP neuropeptide brings new insights to the science behind the migraine experience. CGRP = calcitonin gene-related peptide.

Le a rn m o re a t

scienceofm ig ra i ne.co m

Š 2017 Amgen Inc. All rights reserved. USA-334-053710

2018 March AANnews  

2018 March AANnews

2018 March AANnews  

2018 March AANnews