VOLUME 32 · ISSUE 7 · JULY 2018
REGISTRATION OPENS THIS MONTH Expanded Curriculum The popular AAN Fall Conference is coming back to The Cosmopolitan of Las Vegas this October 26 through 28. While you can once again expect to discover the latest advances in neurology and practice improvement, plus earn valuable year-end CME, this year's conference will offer more choice than ever before. Look for a more diverse and robust array of topics and a curriculum that allows for complete flexibility to create your ideal schedule and come and go from sessions at your leisure.
Check back mid-month at AAN.com/view/Fall for the full program lineup and to secure your early registration savings of up to $200 off before August 22.
The Cosmopolitan of Las Vegas
2019 AAN Research Program Applications Open This Month
Nominations Sought for Board Positions
The AAN is committed to making a profound difference in the lives of researchers—in turn making a difference in the lives of patients with brain disease. The 2019 AAN Research Program exemplifies this dedication by supporting all types of research and training across all career levels and discovery stages. Look for applications to open this month at AAN.com/view/ResearchProgram.
The Nominations Committee will begin accepting nominations in mid-July for the Academy’s leadership election, including for a new president-elect, vice president, secretary, treasurer, and director positions. Members are encouraged to self-nominate or nominate a respected colleague by August 31, 2018.
July 12 Application Deadline Lawrence M. Brass Stroke Research Award Funded by the American Heart Association and American Stroke Association and the American Brain Foundation Continued on page 20
12 AAN Publishes Two-part Guideline Review Update on New AEDs
“Our Board needs dedicated leaders to maintain the outstanding performance of our academy,” said AAN President Ralph L. Sacco, MD, MS, FAHA, FAAN. “Overall, our goal is to maintain a strategic Board culture that is characterized by highly interested and engaged Board members, high attendance and enthusiasm, constructive dialogue, and informed decision-making. Potential nominees
13 Registration Still Available for Sports Concussion Conference
Continued on page 13
22 New NeuroLearn
Courses Added to Online Learning Center
In Multiple Sclerosis–
THE ART OF BRAIN PRESERVATION Adding Grey to the Palette Completes the Picture
GREY MATTERS, TOO
Learn more about Multiple Sclerosis at MSBrainPreservation.com/art © 2018 Celgene Corporation All rights reserved. 03/18 USII-CELG180067
AANnews · July 2018
CONTENTS Cover Registration Opens This Month 2019 AAN Research Program Applications Open This Month Nominations Sought for Board Positions President’s Column Amazement and Awe at the Annual Meeting · · · · · · · · · · 4 Through Their Eyes Recollections of Past AAN Presidents · · · · · · · · · · 6 Tools & Resources What to Keep in Mind When Choosing an EHR System · · · · 8 AAN Publishes New Patient Book on Migraine · · · · · · · · · 8 Improvement Activities Can Help You Boost MIPS Score · · · 9 Podcast Central · · · · · · · · · ·9 New Relationship Gives AAN Expertise Wider Distribution · · · · · · · · · · · · 10 AAN Participates in NINDS Stroke Tweet Chat · · · · · · · · 10 Policy & Guidelines Endorsing vs. Affirming a Non-AAN Guideline: What’s the Difference? · · · · · · · · · 11
Capitol Hill Report · · · · · · · 12 AAN Publishes Two-part Guideline Review Update on New AEDs · · · · · · · · · · · · 12
Conferences & Community Registration Still Available for This Month’s Sports Concussion Conference · · · · 13 Transforming Leaders Graduate Credits Experience for Helping Advance Epilepsy Program · · · · · · · 19 History, Art Provide Perfect Backdrop to Spring Meeting in Philadelphia · · · · · · · · · 19 Applications Open for 2018 Fall Conference Exhibitor Opportunities · · · · 19 Education & Research New NeuroLearn Courses Available in New Online Learning Center · · · · · · · · · 22 Take Note of These Continuum and Continuum Audio Improvements · · · · · · 23 Annual Meeting Draws Substantial Media Coverage · · · · · · · · · · · · · 24 American Brain Foundation Foundation Continues to Broaden Public Awareness · · · · · · · · · · · · 25 Careers · · · · · · · · · · · · · · · · · ·26 Dates & Deadlines · · · · · · · · · · 27 Membership · · · · · · · · · · · · · · 27 AAN Staff Singled Out for 2017 Great Performers Award · · · · 27
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:
Phone: (732) 778-2261 Email: Eileen.Henry@wolterskluwer.com
NEWS BRIEFS AAN President Ralph L. Sacco, MD, FAAN, and American College of Rheumatology President David I. Daikh, MD, PhD, wrote an oped, “Limiting Patient Choice Is the Wrong Way to Address High Drug Prices,” on our drug pricing advocacy efforts. It was published in April in The Hill and mentioned in Kaiser Health News. The oped evaluated some of the Trump administration’s proposed actions to address rising drug prices, and expressed concern that several of the most prominent proposals would not only fail to lower drug prices, but also severely limit our Medicare patients’ access to critical therapies. To strengthen offerings for medical students and residents to encourage and support their careers in neurology, the AAN offered two new programs at the 2018 Annual Meeting that drew more than 200 attendees. The Medical Student Symposium, developed with funding from the Conrad N. Hilton Foundation, helped connect medical students with neurologists and their peers who are interested in neurology. The new Young Investigator Symposium included training, mentoring, and networking designed to address the needs of pre- and early-career researchers. The AAN provided scholarships to medical students and residents to allow them to take part in these programs.
AAN Executive Director: Catherine M. Rydell, CAE Editor-in-Chief: John D. Hixson, MD Managing Editor: Angela Babb, CAE Editor: Tim Streeter Writers: Ryan Knoke and Sarah Parsons Designers: Siu Lee and Jim Hopwood Email: email@example.com
AANnews is published monthly by the American Academy of Neurology for its 34,000 members worldwide. Access this magazine and other AAN publications online at AAN.com/go/elibrary. The American Academy of Neurology ’ s registered trademarks and service marks are registered in the United States and various other countries around the world. “American Brain Foundation” is a registered service mark of the American Brain Foundation and is registered in the United States.
Amazement and Awe at the Annual Meeting Our Annual Meeting has always been an eye-opening experience for students and residents getting their first glimpse of the world of neurology. At our recent Annual Meeting in Los Angeles, I enjoyed the opportunity to meet many of the young women and men who are students in medical school and even high school who were special guests of the AAN. After the meeting, I reached out to some of them to get a better sense of what made the experience meaningful to them. I heard from three of the students who were recipients of our Neuroscience Research Prize. Their comments took me back to my early days, when an unquenchable passion for knowing more about the brain instigated the career I’ve been so fortunate to have. Like many of us, some of these young people had very personal motivations for their interest in the brain. “In my early high school career, my life became heavily influenced by chronic migraines,” said Jacquelyn Stochel, who at the time of the meeting was a high school senior from Yorktown Heights, NY. “Three years ago, I began to carry out my project. Even without prior lab experience, I was determined to conduct research on the disease that challenged me every day. Being able to share my experience
“Once again, thank you so much for this honor! This was my first AAN Annual Meeting, but hopefully not my last! I cannot wait to continue my studies in the brain sciences, and stay connected with the AAN!” —Jacquelyn Stochel
during the Presidential Plenary Session, and Sunday's poster session, was so meaningful! I learned so much, and I was glad I could empower women, young scientists, and patients of the migraine community.” Sarah Hoffman, a student from Ossining, NY, Sacco stressed the support of her teachers—a vital but perhaps underappreciated component in attracting young minds into our profession. “My inspiration for my research came from a long-time interest in medicine, but my inspiration to submit it to the AAN Neuroscience Research Prize came from my science research teachers, Mr. Angelo Piccirillo
“Thank you again. I am so beyond grateful for the opportunity I was given to be at the meeting.” —Alex Remnitz and Ms. Valerie Holmes, who had had past students submit to the competition and achieve finalist status, even students over 10 years ago who won it. They knew my data was strong and they pushed me to improve my paper further still and submit it to the contest.” Do you remember attending your first AAN Annual Meeting? Perhaps you had a similar wide-eyed reaction to the size and scope of our event that these people experienced and it helped kindle your interest in a neurology career. “Quite honestly, I was stunned when I saw the size of the plenary session hall,” said high school student Alex Remnitz of Armonk, NY. “I was surprised as to how many people were interested in my work and how different my own work was than everyone else's. I was surprised as to how clinical many of the studies in the poster hall were. Walking into the huge convention center and seeing all of these bright minds, both young and old, made me feel so proud of myself and all of my accomplishments throughout these past few years. Speaking to all of these brilliant people really made me think about the future and inspired me to potentially go into medicine.”
AAN Science Committee Chair Natalia S. Rost, MD, FAAN, congratulated Neuroscience Research Prize recipients, from left, Alex Remnitz, Jacquelyn Stochel, and Sarah Hoffman.
AANnews • July 2018
Sarah confessed, “My jaw pretty much dropped to the floor when I walked into the convention center, the size of the meeting was beyond anything I had ever imagined. I was secondly surprised by how gloriously nerdy everything was. The first thing I went to was the Neurobowl, and seeing things blown to that proportion just blew my mind. Lastly, I was amazed by how many listened to me speak at the plenary session and at the poster session, and how kind everyone was. I felt like a mini-celebrity!” I asked Sarah and Alex, “How can the AAN help you at this time in your education and development?” Sarah responded, “Attending the Annual Meeting was just another source of inspiration as I attempt to dive headfirst into a medical career. Their continued publication of novel research is, of course, key to my understanding of where neurological research stands and continued Annual Meetings will hopefully push me to attend one someday myself! To any other high schoolers considering performing research: if it's what you love, go for it, give it your all. If you do that, whether you win competitions or not, you will take so much more from the experience than from anything else in your high school life.” Alex suggested, “I think that the AAN can aid me in my future studies by continuing to promote and integrate neurology into other fields. Getting to see the breadth of research and attending the breakout rooms was an experience I would love to continue to do over the next few years.” Nidhi Patel is first-year medical student at my own institution, the University of Miami Miller School of Medicine, and she was one of more than 40 who received an AAN Medical Student Experience at the Annual Meeting Scholarship. Like Alex, Sarah, and Jacquelyn, her curiosity about Patel the brain began when she was young. “I have been interested in neuroscience since I was in high school, and this conference only deepened my desire to learn and become more involved in neurology. I wanted to thank you personally for this incredible opportunity because this scholarship allowed me to have one of the best experiences that I have had as a student at Miller. Besides learning about the newest neuroscience research, I got to learn about the day-to-day experience in neurology and meet some amazing physicians in subspecialties that I didn’t even know existed. To say I learned a lot and was inspired would be an understatement.” It’s long been known―from our own personal experiences, research, and anecdotes such as these―that we need to recognize and nurture this passion for understanding the brain and neurologic diseases when it is first evident. Our many awards and scholarships directed to young people are one aspect of our work in this area. Our grant from the Conrad N. Hilton Foundation to help increase the numbers of medical students who enter the neurology pipeline has both reinforced
the value of our ongoing efforts and presented new opportunities for reaching out to them. We need to better understand and meet their needs, determine the best window of opportunity, and provide them with invigorating support so they can remain excited about what we all know is the best career in medicine.
“Thank you once again to the AAN for giving medical students the opportunity to attend the Annual Meeting. It really helps shape our careers and changes our perspectives on neurology.” —Nidhi H. Patel
Consequently, I am delighted to announce a new program supported by the AAN that focuses on getting US-based college undergraduate students interested in a career in neurology and the neurosciences. The Neuroscience Is…TM Rewarding Internship program offers 10 students the opportunity to experience working in a clinic, practice, or academic environment with mentorship from an AAN member. The goal of the internship is to provide college students with an experience working in neuroscience and exposure to patient care in neurology. The internship program will take place during the fall 2018 semester and will include a student stipend and support of $1,500 for associated costs for each internship. If you, your institution, or practice are interested in being a mentor for this program, you can submit an application by Friday, August 3, 2018. For more information, visit AAN.com/view/2018Internship. I hope that you will seize whatever opportunities you may have in your community to promote our profession to young people. Whether mentoring a college or medical student, making yourself available as a guest speaker for science classes at your local schools, or nurturing the aspirations of a young student or even patient who wants to be part of the solution, you represent the key motivator to change our future and expand the neurology pipeline. Spread the word, share the passion that made you choose a career in neurology!
Ralph L. Sacco, MD, MS, FAHA, FAAN President, AAN firstname.lastname@example.org @DrSaccoNeuro on Twitter
AANnews • July 2018 5
Through Their Eyes
Recollections of Past AAN Presidents Stanley Fahn, MD, FAAN AAN President 2001−2003 AANnews® celebrates the history of the Academy during its 70th anniversary with a series of interviews of past presidents. The following excerpt is from a 2017 interview with Stanley Fahn, MD, FAAN (SF), conducted by AANnews editor Tim Streeter (TS). Fahn enjoyed a long association with AAN President Lewis P. “Bud” Rowland and is a preeminent authority on movement disorders. TS: How did you get involved in committee and leadership positions within the Academy? SF: Rowland had a mind to have a clinical research center in neurology [at the University of Pennsylvania] and he asked me—since I was working in the lab and I had done some work in Rowland’s lab at one time when I was still a resident at Columbia—if I would be his associate director, and I did. While I was there, he asked me to start a Parkinson’s clinic… I was working on pharmacology of L-DOPA. When I was at University of Pennsylvania, I got invited to give some talks at the American Academy of Neurology meeting, and one of the courses [was] the pharmacology course neuropharmacology. So, I got invited to start giving talks. I gave research papers at the Academy. People started to get to know you when you give talks, and eventually I was asked to join one of the committees, the Science Committee, and then even the Neuropharmacology Fellowship Committee evaluating other young people to get fellowships. And so, I sort of got involved that way. Ultimately, from the Science Committee, I also joined— I was asked to join—the Education Committee, and subsequently when Ted Munsat became president of the Academy, he came to me and asked would I like to move up to the chairmanship of that committee, and I hesitated. He said, “You ought to do it because we need you. It’ll be good for you,” and everything. So, I did that, and then I made a lot of innovations in the Education Committee and sort of moved up the ladder that way. TS: What would be the challenges that the Education Committee was facing in those years? SF: Well, I considered several different problems. The number one problem I thought, which I didn’t like at all, was that when I first joined the committee as a junior member, they were picking the heads and the speakers, the chairmen of the different courses, and the speakers for the courses like over a year ahead of time. They’re not even waiting for the previous—it was like it was a year and a half ahead of time and not waiting to see how these guys would do the year before. I mean, I thought that wasn’t so good.
AANnews • July 2018
So, when I became chairman, one of the first things I did, I said, “Look. Once we finish this cycle, we’re going to start a month after the Annual Meeting is over and we have 11 months. We’re going to pick our chairman, we’re going to get the speakers settled, and we can do it. All we have to do is work at it.” We made that innovation right away. Then, as chairman, I did a number of things. I opened up the committee. We tried to get new people on the committee every year…. and another thing I did—this happened when I was on the Science Committee—I proposed that they should have poster sessions, and no one wanted to have poster sessions. No one would go to poster sessions. They were— TS: Had they ever done those in the US before? SF: They never did poster sessions at any place in clinical neurology that I know of, but since I had been a lab scientist also, I had gone to basic science meetings, and there were
poster sessions. What I was impressed about was people would come after the full day, and then at the end of the day, they would have wine and cheese and everybody would go to the poster session. So, I proposed this. I said, “You know, if we give them something to eat, they will come, and if we have poster sessions at the end of the day with wine and cheese, they probably will show up. If we do something in the morning at breakfast like a donut and some coffee or orange juice, they will show up.” And sure enough, it took off, and that was the start of the poster sessions.
New! Neurology® Null Hypothesis CALL FOR PAPERS
TS: You were also responsible for starting the evening sessions too, correct? SF: Well, that—yes, I was. I decided that we needed to have, like, case studies. Because I was by that time a subspecialist in movement disorders, and I knew movement disorders are a very good educational tool with videotapes. We can show our cases, we can ask for discussion by the audience, and we can have a one-on-one with the audience and with the two professors teaching it. So, that worked out. Then, pretty soon we were doing case studies in neuromuscular disease, epilepsies, and all the other subspecialties, so that started the evening thing…. TS: I read that some of those sessions went quite late, that they enjoyed that exchange of knowledge. SF: Well, that’s probably mostly true for my own section. I started what’s called the Unusual Movement Disorder Seminar with my colleague from London, England, David Marsden, and I felt he was the leader of the European movement disorder people and I sort of had that reputation in the United States and that we would do unusual movement disorders, and we would show our own cases on movies. In those days, we didn’t have videos even, just movies. We would splice them together, but we opened up to the audience that they can bring their movies too, and eventually, of course, everything went videotape. They would bring their videotapes in those days after that, and we would show them. So, we would show some of ours, some of them, and then these would be opened up for discussion. What did we think we have? What’s the phenomenology? What do you think the diagnosis is? It evolved, and pretty soon it was packed audiences…. They waited outside. When the monitors weren’t there, they all snuck in anyway, and we were still having one-on-one talks, and we didn’t stop discussion. Discussion was going on, and then finally around two in the morning, we would finish, and we’d go out and have a beer and go to bed and try to get up for the next morning. I mean, eventually, we even had two sessions, one at the beginning of the Annual Meeting and one at the end of the Annual Meeting so everybody can come. We had packed houses. I did that for 20 years before I retired from it.
Neurology® is seeking papers for a special supplement, Neurology: Null Hypothesis, which will contain negative, inconclusive, and confirmatory studies. This special issue is a collaboration with the Center for Biomedical Research Transparency (CBMRT) to bring confirmatory and ‘null’ data to light. For more information, visit cbmrt.org/neurology.
Submit your paper now! NPub.org/Submit.
Visit AAN.com/view/AANhistory to read the complete transcript of Fahn’s interview and learn how the term “movement disorders” originated and how the Annual Meeting continued to evolve over the years.
Tools & Resources
What to Keep in Mind When Choosing an EHR System Choosing an electronic health record (EHR) system for your practice can be a daunting and overwhelming task. There are many aspects to consider and getting information to help you navigate many vendors and their offerings can be difficult. The AAN has come up with questions and topics you should be asking of an EHR vendor before signing on the dotted line. Here are some items to consider regarding your practice setting, provider documentation preferences, data hosting, and questions to ask regarding transmitting and receiving data from third parties, and meeting government reporting requirements. There are a variety of systems from which to choose and not all are perfect for your practice. Deciding on things that matter most to your practice is an important first step. Would you like a comprehensive EHR that is used by many different practices in your area, or would you like a smaller niche EHR that caters exclusively to smaller practices? If you choose to go with a smaller EHR, be sure to decide if you’d like billing software and clinical information handled by the same system. The chair of the AAN’s Practice Management & Technology Subcommittee, David A. Evans, MBA, recommended, “When considering vendor size, take into consideration the service and resources a larger vendor may have in product development and balance with the advantages a smaller vendor may provide by being niche and nimble. Having colleagues in the same specialty and in your region may provide some advantages in optimizing functionality of the system.” Subcommittee member Melissa Yu, MD, agreed. “A larger vendor will have more resources for research and development, may have more options for integration with other service, and even have more online self-help. A larger vendor may also service your local hospitals, allowing you to view inpatient records without leaving your office EHR system. A larger vendor may be costlier, however, and more difficult to customize for your specific needs.”
Asking the EHR representative before selection helps to avoid issues later. Some of the most important things to consider when selecting an EHR are understanding who owns the data, what Yu it can be used for, and if there are fees associated with sending data to third parties. Do you have enough resources in your practice to maintain a server for your data on-site or would you prefer that the EHR handle your data and keep it stored in the cloud? Cloud-based systems are generally cheaper and require fewer resources to operate, but before selecting this option you should discuss data access. Once data is moved from a local server into the cloud, you may have to pay a fee to export data for local use or to send it to a third party, such as a registry. Some AAN members have reported difficulty integrating with the Axon Registry ®, an AAN-sponsored clinical data registry for quality improvement, because of issues with data ownership and transfer. Find out more about EHR integration with Axon at AAN.com/view/Axon. Also, consider bandwidth needs for cloud-based systems, depending on practice size, and back-up methods in case your internet connection goes down. Consider how you will submit data to CMS programs such as the Merit-based Incentive Payment System (MIPS). Many EHRs will submit MIPS data on behalf of practices, but only on specific measures, or with additional costs. While selecting an EHR can be an intimidating task, there are many resources available to help. The Office of the National Coordinator for Health Information Technology has created resources regarding selecting and implementing an EHR system. You can check them out at Healthit.gov/playbook. If you have questions about topics to cover before selecting an EHR, please email email@example.com.
Thinking about the way you enter clinical data is also important. Do you prefer to write a narrative about the visit or use templates? Some EHRs provide ready-made templates for progress notes or easy ways to create them; others don’t.
AAN Publishes New Patient Book on Migraine The AAN has published a new patient education book on migraine and other headaches. Authored by William B. Young, MD, FAHS, FAAN, and Stephen D. Silberstein, MD, FACP, FAHS, FAAN, Navigating Life with Migraine and Other Headaches dispels common misperceptions about migraine and offers practical advice for patients. The 216-page book is available through all major booksellers and at BrainLifeMag.org/Books.
AANnews • July 2018
To choose the best IA for your practice, first consider your patient population and take an inventory of what you’re already doing. In many cases, you may be implementing improvement activities in your practice without realizing it! For example, if you regularly provide timely communication of test results to patients, then you may have already accomplished one medium-weighted Improvement Activity. Also, consider what has buy-in from your staff and what is doable with your resources. For example, if you do not have an EHR, you will not be able to complete certain activities such as the use of certified EHR to capture patient-reported outcomes. You can also use IAs to improve your score in other MIPS performance categories. For example, perhaps you notice that your practice has not performed well on the quality measure “Amyotrophic Lateral Sclerosis (ALS) Patient Care Preferences” (Quality ID 386). If you implement practices/processes to develop regularly updated care plans for at-risk patients and share these with the beneficiary or caregiver(s) for at least 90 days, you may be able to improve performance on the above measure and you can attest to completing an Improvement Activity―even if you did not improve on the measure during the 90-day window. If you’re unsure where to start, the AAN is here to help. The Academy has created a table of Improvement Activities for Neurologists to Consider Implementing that you can access at https://bit.ly/2KfxzdY. If you have questions, send them to firstname.lastname@example.org.
Of the four performance categories in MIPS—including Quality, Cost, and Advancing Care Information—Improvement Activities (IAs) comprise 15 percent of your overall MIPS score in 2018. They reward clinicians for care focused on care coordination, beneficiary engagement, and patient safety. IAs are either “high” (worth 20 points) or “medium” weighted (worth 10 points), and are worth double for those in practices with 15 or fewer clinicians. To achieve full marks in this category, you must score 40 points.
downloads... a n o nd illi
ing ow gr
Do you want to maximize your success in the Merit-based Incentive Payment System (MIPS) in 2018? Consider using Improvement Activities to improve your score in other MIPS performance categories.
Improvement Activities Can Help You Boost MIPS Score
PODCAST CENTRAL Your Guide to New and Recent AAN Podcasts
Neurology Podcasts Visit Neurology.org/podcast to listen to Neurology ® podcasts and earn 0.5 AMA PRA Category 1 CME Credits™ by answering the multiple-choice questions in the online podcast quiz. Interviews based on articles from Neurology ® Clinical Practice, Neurology ® Genetics, and Neurology ® Neuroimmunology & Neuroinflammation are excluded from the CME program.
Available by July 1 Neurology: Conscious Sedation or Local Anesthesia During Endovascular Treatment for Acute Ischemic Stroke Bryan J. Eckerle, MD, and Rob A. van de Graaf, MD Neurology: Practice Guideline Update Summary: Efficacy and Tolerability of New AEDs: Treatment of New-onset Epilepsy Derek D. Bauer, MD, and Jacqueline A. French, MD Neurology: Longitudinal Analysis of Impulse Control Disorders in Parkinson's Disease Jason L. Crowell, MD, and Alexis Elbaz, MD, PhD Neurology: Non-invasive Vagus Nerve Stimulation as Acute Therapy for Migraine: The Randomized PRESTO Study Teshamae S. Monteith, MD, and Cristina Tassorelli, MD, PhD Neurology: Organic Solvents and MS Susceptibility: Interaction with MS Risk HLA Genes Stacey Lynn Clardy, MD, PhD, and Anna Karin Hedström, MD, PhD
AANnews • July 2018 9
Tools & Resources
New Relationship Gives AAN Expertise Wider Distribution The AAN has joined Evidence Street, the Blue Cross Blue Shield Association’s platform for disseminating medical evidence reviews. These reviews can be accessed by Blue Cross Blue Shield plans across the country as they develop and review coverage policies. Elaine C. Jones, MD, FAAN, chair of the AAN’s Payment Policy Subcommittee and member of the Board of Directors, said, “When the subcommittee was first approached with the idea, we agreed that this was an opportunity to share the Academy’s positions more widely. The Payment Policy Subcommittee strives to work with the health insurance industry towards highquality, patient-centered health care solutions for our members. The subcommittee already receives requests from several of the largest insurers for review and input on policies prior to implementation. By becoming a member of Evidence Street, the Academy can contribute to reviews shared with Blue Cross plans
across the country, expanding our reach and influence.” This new relationship also is an opportunity to enable AAN members to share their individual viewpoints through Evidence Street. When the Academy has a position Jones on the use of a therapy or device, we submit official AAN documents. However, sometimes the therapies being reviewed are new to market and we have not yet developed clinical guidelines addressing them. In this case, the AAN has the opportunity to request input from members who specialize in these areas. The members can submit a review that represents their own viewpoint on the issue, as opposed to the official position of the Academy. To learn more about Evidence Street, visit https://bit.ly/2IKrdVM.
AAN Participates in NINDS Stroke Tweet Chat In observance of May’s National Stroke Awareness Month, the AAN—represented by Ralph L. Sacco, MD, MS, FAHA, FAAN—along with NINDS, Million Hearts, and the American Stroke Association/American Heart Association co-hosted a NINDS Stroke Tweet Chat to discuss stroke signs, the importance of keeping one’s brain healthy, and the latest stroke research. AAN member Walter D. Koroshetz, MD, FAAN, director of NINDS, was the moderator. Also participating were Janet Wright, MD, executive director of Million Hearts, and Mary Ann Bauman, MD, participating on behalf of the ASA/AHA. AAN staff represented the Brain & Life™ patient and caregiver magazine and website. The one-hour event attracted 387 participants, generated 2,107 tweets using the #BrainforLife hashtag, and created more than 40 million impressions.
AANnews • July 2018
Policy & Guidelines
Endorsing vs. Affirming a Non-AAN Guideline: What’s the Difference? In addition to developing and publishing our own clinical practice guidelines, the AAN may be asked to review externally developed guidelines and to offer a statement of support. This results in either an AAN endorsement, an affirmation of value, or neither.
Process When we receive a request for review, we send the document to topic experts and at least one AAN guideline methodologist. The AAN recruits topic experts through open requests on Synapse or through requests to standing committees and subcommittees. Once the volunteers review the guideline, their feedback is passed along to the Practice Committee. After evaluating the expert reviewer comments and the guideline, the Practice Committee votes to make a recommendation to the Board of Directors. The Board ultimately decides whether the AAN should make a statement of support.
Endorsement vs. Affirmation Endorsement expresses full support of a document. In order to qualify for endorsement, a document must meet two criteria. First, it must be developed in a process that is “substantively equivalent” to the AAN guideline development process. This includes considerations such as: The author panel performed a systematic review of the literature The classification of evidence is based on the quality of the study design Recommendations are based on peer-reviewed evidence Recommendations are weighted based on the strength of the supporting evidence
The AAN methodologist considers whether the development process is similar enough to the AAN methodology. 1. Endorsement: The development process is substantively equivalent to the AAN process 2. Affirmation: The methodology is not substantively equivalent, but it is still of value to AAN members 3. Neither endorsement or affirmation The second consideration is whether the topic experts agree with the specific statements made in the guideline. The expert reviewers provide an opinion on the content: 1. Endorsement: They agree with all statements 2. Affirmation: They do not agree with all statements, but believe the document is of benefit to membership 3. Neither endorsement or affirmation If the methodologist and experts agree that the paper is eligible for endorsement or affirmation, a recommendation is made to the Practice Committee for a vote. If approved by Practice Committee, the document is sent to the AAN Institute Board of Directors for approval. Visit AAN.com/view/GuidelinePolicy to read the Systematic Review and Guideline Endorsement Policy.
The process is substantively equivalent
The process is not substantively equivalent, but it is still of value to AAN members
There are concerns with the methodology used
Agree with all statements made in the guideline
Do not agree with all statements, but believe the document is of benefit to membership
There are concerns with statements made in the document
AANnews • July 2018 11
Policy & Guidelines
Capitol Hill Report Capitol Hill Report presents regular updates on legislative and regulatory actions and how the Academy ensures that the voice of neurology is heard on Capitol Hill. It is emailed to US members twice monthly and is posted at AAN.com/view/HillReport. Below are some recent highlights. Matt Kerschner has joined the AAN’s Washington, DC, staff as a health policy associate working on issues related to the AAN's registry, health IT, and cognitive reimbursement. He will increase AAN communications with regulatory agencies, build relationships with regulators, and collaborate with our legislative team. Matt joins the AAN after graduating with his MPA from Columbia University. He previously worked at AARP, the American College of Surgeons, and America's Health Insurance Plans. Palatucci Advocacy Leadership Forum alum and AAN advocate Glynnis Zieman, MD, of Phoenix knows the importance of a soundbite for a good interview. She was recently featured in a piece by NPR for her work on domestic violence and traumatic brain injury. Zieman’s soundbites are everywhere in this interview including, “The domestic violence patients are the next chapter of brain injury.” The Senate Health, Education, Labor, and Pensions (HELP) Committee scheduled a June hearing on the Trump administration’s “American Patients First” drug pricing blueprint. The AAN is encouraged by the rising profile of increasing drug prices, a major issue raised by the AAN’s last two Neurology on the Hill events. Prior to the hearing, our DC staff met with health
policy staff of most members of the HELP Committee on both sides of the aisle so they are well aware of both the increasing costs of existing drugs for conditions like MS, as well as ultrahigh prices for new drugs used on rare conditions such as spinal muscular atrophy. AAN DC staff and other members of the Leaders Engaged on Alzheimer’s Disease Coalition met with top staff for the Labor, Health and Human Services (L-HHS) Appropriation Subcommittee to advocate for continued increases in funding for Alzheimer’s disease and the BRAIN Initiative. For the past three years, NIH, Alzheimer’s disease, and the BRAIN Initiative have each received significant increases in funding thanks to AAN advocacy and the sustained strong support of L-HHS Committee leadership. A new Right-to-Try law signed by President Trump allows terminally ill patients the right to request experimental treatments before full FDA approval. Forty states already have similar laws. In March, the AAN sent a letter to House leaders to raise concerns with the proposal, including patient safety risks, resource diversion in pursuit of unproven therapies, and the loss of participation in clinical trials, especially in rare disease studies.
AAN Publishes Two-part Guideline Review Update on New AEDs The AAN published a new guideline, Practice Guideline Update Summary: Efficacy and Tolerability of the New Antiepileptic Drugs Parts I and II, in the June 13, 2018, online issue of Neurology ®. Part I focuses on treatment of new-onset epilepsy and Part II focuses on treatment-resistant epilepsy. The guideline finds that there are many more effective and appropriate treatment choices for the management of epilepsy than the public may be aware, and patient care may be better served by a greater understanding
AANnews • July 2018
of newer antiepileptic drugs (AEDs). Second- and third-generation AEDs provide additional options to meet the many variables that need to be considered in the choice of an AED. These variables include the type of epileptic seizure; comorbid medical, cognitive, and psychiatric disorders; and patient age and gender. They also include patient preferences and economic factors. Clinicians need to ask patients to provide detailed information about the history and characteristics of their seizures and carefully assess
the medical, psychiatric, and cognitive profile of patients to determine whether any of the new AEDs may help or worsen each patient’s condition.
Read the guideline and access PDF summaries for clinicians and patients and a presentation slide set at AAN.com. For more information, contact Scott Wessels at email@example.com or (612) 928-6056.
Conferences & Community
Registration Still Available for This Month’s Sports Concussion Conference Online and on-site registration are still available for 2018 AAN Sports Concussion Conference this July 20 through 22 in Indianapolis, IN. The conference is designed for all disciplines involved in the prevention, diagnosis, and treatment of sports concussion, and attendees can expect to: Gain a better understanding of the current state and emerging science of concussion pathophysiology, diagnosis, and management Learn about the latest clinical tools and technologies for diagnosis and management Discover emerging issues in post-concussion syndrome diagnosis and management Discuss the potential long-term sequelae from sport-related brain trauma Earn up to 20 CME/CE credits With Indianapolis being home to the National Collegiate Athletic Association (NCAA) and NCAA Sport Science Institute, the conference also offers a special opportunity for the AAN to collaborate with the NCAA on some unique programming, including a networking reception at the NCAA Hall of Champions and a session on the NCAA-DoD CARE Consortium. Visit AAN.com/view/scc to browse the full program and to register.
Nominations Sought For Board Positions continued from cover for Board officers and directors should have certain fundamental characteristics such as vision and leadership; character, stewardship and integrity; knowledge and engagement in the mission of the AAN; personal commitment and diligence; and collegiality. If you feel you possess these characteristics, I invite you to submit a nomination. The AAN strives to be an inclusive organization with a Board that is representative of our membership. Likewise, if you know a colleague whose character and experience would benefit the AAN, please encourage your colleague to consider being nominated.” The Nominations Committee strives for balance and diversity, including geography, gender, subspecialty, professional setting, time in profession, and ethnic origin. The role of president-elect is a six-year commitment (two years each as president-elect, president, and past president). The vice president, secretary, treasurer, and directors’ terms are eligible for two additional two-year terms, for a total of
six years. Candidates for the Board of Directors must be Fellow members of the AAN. Membership will vote on the Nomination Committee’s proposed slate of officers at the 2019 Annual Meeting in Philadelphia, PA. Descriptions of the roles and responsibilities of these officers are available at AAN.com/view/nominations.
Board of Director meeting dates and locations for the two-year term are: June 21–22, 2019 (Minneapolis) September 13–14, 2019 (Minneapolis) January 22–26, 2020 (location to be announced) June 19–20, 2020 (Minneapolis) September 25–26, 2020 (Minneapolis) January 20–24, 2021 (location to be announced) Learn more at AAN.com/view/nominations.
AANnews • July 2018 13
BECAUSE RELAPSING MS AFFECTS MORE THAN HER. . .
NEWLY DIAGNOSED PATIENTS DESERVE THE #1 PRESCRIBED ORAL RMS THERAPY 1,2*†
Tecfidera® (dimethyl fumarate) is indicated for adults with relapsing forms of multiple sclerosis.
Important Safety Information
TECFIDERA is contraindicated in patients with known hypersensitivity to dimethyl fumarate or any of the excipients of TECFIDERA. TECFIDERA can cause anaphylaxis and angioedema after the first dose or at any time during treatment. Patients experiencing signs and symptoms of anaphylaxis and angioedema (which have included difficulty breathing, urticaria, and swelling of the throat and tongue) should discontinue TECFIDERA and seek immediate medical care. Progressive multifocal leukoencephalopathy (PML) has occurred in patients with MS treated with TECFIDERA. PML is an opportunistic viral infection of the brain caused by the JC virus (JCV) that typically only occurs in patients who are immunocompromised, and that usually leads to death or severe disability. A fatal case of PML occurred in a patient who received TECFIDERA in a clinical trial. PML has also occurred in the postmarketing setting in the presence of lymphopenia (<0.8x109/L) persisting for more than 6 months. While the role of lymphopenia in these cases is uncertain, the majority of cases occurred in patients with lymphocyte counts <0.5x109/L. The symptoms associated with PML are diverse, progress over days to weeks, and include progressive weakness on one side of the body or clumsiness of limbs, disturbance of vision, and changes in thinking, memory, and orientation leading to confusion and personality changes. At the first sign or symptom suggestive of PML, withhold
TECFIDERA and perform an appropriate diagnostic evaluation. MRI findings may be apparent before clinical signs or symptoms. TECFIDERA may decrease lymphocyte counts; in clinical trials there was a mean decrease of ~30% in lymphocyte counts during the first year which then remained stable. Four weeks after stopping TECFIDERA, mean lymphocyte counts increased but not to baseline. Six percent of TECFIDERA patients and <1% of placebo patients had lymphocyte counts <0.5x109/L. TECFIDERA has not been studied in patients with pre-existing low lymphocyte counts. There was no increased incidence of serious infections observed in patients with lymphocyte counts <0.8x109/L or ≤0.5x109/L in controlled trials, although one patient in an extension study developed PML in the setting of prolonged lymphopenia (lymphocyte counts predominantly <0.5x109/L for 3.5 years). In controlled and uncontrolled clinical trials, 2% of patients experienced lymphocyte counts <0.5x109/L for at least six months. In these patients, the majority of lymphocyte counts remained <0.5x109/L with continued therapy. A complete blood count including lymphocyte count should be obtained before initiating treatment, 6 months after starting, every 6 to 12 months thereafter and as clinically indicated. Consider treatment interruption if lymphocyte counts <0.5x109/L persist for more than six months and follow lymphocyte counts until lymphopenia is resolved. Consider withholding treatment in patients with serious infections until resolved. Decisions about whether or not to restart TECFIDERA should be based on clinical circumstances. Clinically significant cases of liver injury have been reported in
IN THE DEFINE‡ CLINICAL TRIAL, PATIENTS WERE:
LESS LIKELY TO EXPERIENCE
A RELAPSE3§ TECFIDERA: 27% (n=410) Placebo: 46% (n=408) [P<0.0001] Based on proportion of patients relapsed (PPR)||
LESS LIKELY TO EXPERIENCE
TECFIDERA: 16% (n=410) Placebo: 27% (n=408) [P=0.0050]
84% OF PATIENTS IN THE DEFINE TRIAL WERE FREE OF DISABILITY PROGRESSION VS 73% OF PLACEBO PATIENTS3
IN A SEPARATE ANALYSIS, THE NEWLY DIAGNOSED PATIENTS FROM THE PIVOTAL TRIALS WERE:
LESS LIKELY TO EXPERIENCE
TECFIDERA: 0.073 (n=221) Placebo: 0.233 (n=223) [P<0.0001]
STUDY DESIGN: This post hoc analysis of integrated data from DEFINE and CONFIRM# was conducted to examine the efficacy and safety of TECFIDERA in 678 newly diagnosed patients (59% of patients in DEFINE and 71% in CONFIRM were treatment-naive4,5). The newly diagnosed population included patients who had been diagnosed with RRMS within 1 year prior to study entry and were naive to MS disease-modifying therapy. The analysis included clinical and neuroradiological efficacy endpoints as well as basic safety data, or adverse events. This study was not designed in advance to analyze the endpoints presented in the subgroup of newly diagnosed patients.1 Most common adverse events reported in patients receiving TECFIDERA compared with placebo included flushing, nasopharyngitis, headache, diarrhea, nausea, upper abdominal pain, and abdominal pain.3
Important Safety Information (cont’d)
patients treated with TECFIDERA in the postmarketing setting. The onset has ranged from a few days to several months after initiation of treatment. Signs and symptoms of liver injury, including elevation of serum aminotransferases to greater than 5-fold the upper limit of normal and elevation of total bilirubin to greater than 2-fold the upper limit of normal have been observed. These abnormalities resolved upon treatment discontinuation. Some cases required hospitalization. None of the reported cases resulted in liver failure, liver transplant, or death. However, the combination of new serum aminotransferase elevations with increased levels of bilirubin caused by drug-induced hepatocellular injury is an important predictor of serious liver injury that may lead to acute liver failure, liver transplant, or death in some patients. Elevations of hepatic transaminases (most no greater than 3 times the upper limit of normal) were observed during controlled trials. Obtain serum aminotransferase, alkaline phosphatase, and total bilirubin levels before initiating TECFIDERA and during treatment, as clinically indicated. Discontinue TECFIDERA if clinically significant liver injury induced by TECFIDERA is suspected. TECFIDERA may cause flushing (e.g. warmth, redness, itching, and/or burning sensation). 40% of patients taking TECFIDERA reported flushing, which was mostly mild to moderate in severity. Three percent of patients discontinued TECFIDERA for flushing and <1% had serious flushing events that led to hospitalization. Taking TECFIDERA with food may reduce flushing. Alternatively, administration of non-enteric coated aspirin prior to dosing may reduce the incidence or severity of flushing. TECFIDERA may cause gastrointestinal (GI) events (e.g., nausea, vomiting, diarrhea, abdominal pain, and dyspepsia). Four percent of TECFIDERA patients and <1% of placebo patients discontinued due to GI events. The incidence of serious GI events was 1%. The most common adverse reactions associated with TECFIDERA
versus placebo are flushing (40% vs 6%) and GI events: abdominal pain (18% vs 10%), diarrhea (14% vs 11%), nausea (12% vs 9%). A transient increase in mean eosinophil counts was seen during the first two months. TECFIDERA should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. Encourage patients who become pregnant while taking TECFIDERA to enroll in the TECFIDERA pregnancy registry by calling 1-866-810-1462 or visiting www.TECFIDERApregnancyregistry.com. For additional Important Safety Information, please see adjacent Brief Summary of full Prescribing Information. *TECFIDERA is approved for adult patients only. † Based on prescriptions. ‡ Determination of Efficacy and Safety of Oral Fumarate in RelapsingRemitting MS.4 § Relapses were defined as new or recurrent neurologic symptoms not associated with fever or infection that lasted for at least 24 hours and were accompanied by new objective neurologic findings.4 || PPR is the percentage of patients who had one or more relapses over the course of the trial.4 ¶ Disability progression is defined as at least a 1-point increase from baseline EDSS of ≥1.0, OR at least a 1.5-point increase for patients with baseline EDSS of 0 sustained for 12 weeks.3 # Comparator and an Oral Fumarate in Relapsing-Remitting Multiple Sclerosis.5 References: 1. Gold R, Giovannoni G, Phillips JT, et al. Mult Scler. 2015;21(1):57-66. 2. IMS data September 27, 2013-December 8, 2017. 3. TECFIDERA Prescribing Information, Biogen, Cambridge, MA. 4. Gold R, Kappos L, Arnold DL, et al. N Engl J Med. 2012;367:10981107. Erratum in: N Engl J Med. 2012;367:2362. 5. Fox RJ, Miller DH, Phillips JT, et al. N Engl J Med. 2012;367:1087-1097. Erratum in: N Engl J Med. 2012;367:1673. © 2018 Biogen. All rights reserved. 02/18 TEC-US-2505
Tecfidera® (dimethyl fumarate) delayed-release capsules, for oral use Brief Summary of Full Prescribing Information 1 INDICATIONS AND USAGE TECFIDERA is indicated for the treatment of patients with relapsing forms of multiple sclerosis. 2 DOSAGE AND ADMINISTRATION 2.1 Dosing Information The starting dose for TECFIDERA is 120 mg twice a day orally. After 7 days, the dose should be increased to the maintenance dose of 240 mg twice a day orally. Temporary dose reductions to 120 mg twice a day may be considered for individuals who do not tolerate the maintenance dose. Within 4 weeks, the recommended dose of 240 mg twice a day should be resumed. Discontinuation of TECFIDERA should be considered for patients unable to tolerate return to the maintenance dose. The incidence of flushing may be reduced by administration of TECFIDERA with food. Alternatively, administration of non-enteric coated aspirin (up to a dose of 325 mg) 30 minutes prior to TECFIDERA dosing may reduce the incidence or severity of flushing [see Clinical Pharmacology (12.3)]. TECFIDERA should be swallowed whole and intact. TECFIDERA should not be crushed or chewed and the capsule contents should not be sprinkled on food. TECFIDERA can be taken with or without food. 2.2 Blood Tests Prior to Initiation of Therapy Obtain a complete blood cell count (CBC) including lymphocyte count before initiation of therapy [see Warnings and Precautions (5.3)]. Obtain serum aminotransferase, alkaline phosphatase, and total bilirubin levels prior to treatment with TECFIDERA [see Warnings and Precautions (5.4)]. 3 DOSAGE FORMS AND STRENGTHS TECFIDERA is available as hard gelatin delayed-release capsules containing 120 mg or 240 mg of dimethyl fumarate. The 120 mg capsules have a green cap and white body, printed with “BG-12 120 mg” in black ink on the body. The 240 mg capsules have a green cap and a green body, printed with “BG-12 240 mg” in black ink on the body. 4 CONTRAINDICATIONS TECFIDERA is contraindicated in patients with known hypersensitivity to dimethyl fumarate or to any of the excipients of TECFIDERA. Reactions have included anaphylaxis and angioedema [see Warnings and Precautions (5.1)]. 5 WARNINGS AND PRECAUTIONS 5.1 Anaphylaxis and Angioedema TECFIDERA can cause anaphylaxis and angioedema after the first dose or at any time during treatment. Signs and symptoms have included difficulty breathing, urticaria, and swelling of the throat and tongue. Patients should be instructed to discontinue TECFIDERA and seek immediate medical care should they experience signs and symptoms of anaphylaxis or angioedema. 5.2 Progressive Multifocal Leukoencephalopathy Progressive multifocal leukoencephalopathy (PML) has occurred in patients with MS treated with TECFIDERA. PML is an opportunistic viral infection of the brain caused by the JC virus (JCV) that typically only occurs in patients who are immunocompromised, and that usually leads to death or severe disability. A fatal case of PML occurred in a patient who received TECFIDERA for 4 years while enrolled in a clinical trial. During the clinical trial, the patient experienced prolonged lymphopenia (lymphocyte counts predominantly <0.5x109/L for 3.5 years) while taking TECFIDERA [see Warnings and Precautions (5.3)]. The patient had no other identified systemic medical conditions resulting in compromised immune system function and had not previously been treated with natalizumab, which has a known association with PML. The patient was also not taking any immunosuppressive or immunomodulatory medications concomitantly. PML has also occurred in the postmarketing setting in the presence of lymphopenia (<0.8x109/L) persisting for more than 6 months. While the role of lymphopenia in these cases is uncertain, the majority of cases occurred in patients with lymphocyte counts <0.5x109/L. At the first sign or symptom suggestive of PML, withhold TECFIDERA and perform an appropriate diagnostic evaluation. Typical symptoms associated with PML are diverse, progress over days to weeks, and include progressive weakness on one side of the body or clumsiness of limbs, disturbance of vision, and changes in thinking, memory, and orientation leading to confusion and personality changes. MRI findings may be apparent before clinical signs or symptoms. Cases of PML, diagnosed based on MRI findings and the detection of JCV DNA in the cerebrospinal fluid in the absence of clinical signs or symptoms specific to PML, have been reported in patients treated with
other MS medications associated with PML. Many of these patients subsequently became symptomatic with PML. Therefore, monitoring with MRI for signs that may be consistent with PML may be useful, and any suspicious findings should lead to further investigation to allow for an early diagnosis of PML, if present. Lower PML-related mortality and morbidity have been reported following discontinuation of another MS medication associated with PML in patients with PML who were initially asymptomatic compared to patients with PML who had characteristic clinical signs and symptoms at diagnosis. It is not known whether these differences are due to early detection and discontinuation of MS treatment or due to differences in disease in these patients. 5.3 Lymphopenia TECFIDERA may decrease lymphocyte counts. In the MS placebo controlled trials, mean lymphocyte counts decreased by approximately 30% during the first year of treatment with TECFIDERA and then remained stable. Four weeks after stopping TECFIDERA, mean lymphocyte counts increased but did not return to baseline. Six percent (6%) of TECFIDERA patients and <1% of placebo patients experienced lymphocyte counts <0.5x109/L (lower limit of normal 0.91x109/L). The incidence of infections (60% vs 58%) and serious infections (2% vs 2%) was similar in patients treated with TECFIDERA or placebo, respectively. There was no increased incidence of serious infections observed in patients with lymphocyte counts <0.8x109/L or ≤0.5x109/L in controlled trials, although one patient in an extension study developed PML in the setting of prolonged lymphopenia (lymphocyte counts predominantly <0.5x109/L for 3.5 years) [see Warnings and Precautions (5.2)]. In controlled and uncontrolled clinical trials, 2% of patients experienced lymphocyte counts <0.5x109/L for at least six months, and in this group the majority of lymphocyte counts remained <0.5x109/L with continued therapy. TECFIDERA has not been studied in patients with pre-existing low lymphocyte counts. Obtain a CBC, including lymphocyte count, before initiating treatment with TECFIDERA, 6 months after starting treatment, and then every 6 to 12 months thereafter, and as clinically indicated. Consider interruption of TECFIDERA in patients with lymphocyte counts less than 0.5x109/L persisting for more than six months. Given the potential for delayed recovery of lymphocyte counts, continue to obtain lymphocyte counts until their recovery if TECFIDERA is discontinued or interrupted due to lymphopenia. Consider withholding treatment from patients with serious infections until resolution. Decisions about whether or not to restart TECFIDERA should be individualized based on clinical circumstances. 5.4 Liver Injury Clinically significant cases of liver injury have been reported in patients treated with TECFIDERA in the postmarketing setting. The onset has ranged from a few days to several months after initiation of treatment with TECFIDERA. Signs and symptoms of liver injury, including elevation of serum aminotransferases to greater than 5-fold the upper limit of normal and elevation of total bilirubin to greater than 2-fold the upper limit of normal have been observed. These abnormalities resolved upon treatment discontinuation. Some cases required hospitalization. None of the reported cases resulted in liver failure, liver transplant, or death. However, the combination of new serum aminotransferase elevations with increased levels of bilirubin caused by drug-induced hepatocellular injury is an important predictor of serious liver injury that may lead to acute liver failure, liver transplant, or death in some patients. Elevations of hepatic transaminases (most no greater than 3 times the upper limit of normal) were observed during controlled trials [see Adverse Reactions (6.1)]. Obtain serum aminotransferase, alkaline phosphatase (ALP), and total bilirubin levels prior to treatment with TECFIDERA and during treatment, as clinically indicated. Discontinue TECFIDERA if clinically significant liver injury induced by TECFIDERA is suspected. 5.5 Flushing TECFIDERA may cause flushing (e.g., warmth, redness, itching, and/or burning sensation). In clinical trials, 40% of TECFIDERA treated patients experienced flushing. Flushing symptoms generally began soon after initiating TECFIDERA and usually improved or resolved over time. In the majority of patients who experienced flushing, it was mild or moderate in severity. Three percent (3%) of patients discontinued TECFIDERA for flushing and <1% had serious flushing symptoms that were not lifethreatening but led to hospitalization. Administration of TECFIDERA with food may reduce the incidence of flushing. Alternatively, administration of non-enteric coated aspirin (up to a dose of 325 mg) 30 minutes prior to TECFIDERA dosing may reduce the incidence or severity of flushing [see Dosing and Administration (2.1) and Clinical Pharmacology (12.3)]. 6 ADVERSE REACTIONS The following important adverse reactions are described elsewhere in labeling: Anaphylaxis and Angioedema (5.1), Progressive multifocal leukoencephalopathy (5.2), Lymphopenia (5.3), Liver Injury (5.4), Flushing (5.5) [see Warnings and Precautions].
6.1 Clinical Trials Experience Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in clinical practice. The most common adverse reactions (incidence ≥10% and ≥2% more than placebo) for TECFIDERA were flushing, abdominal pain, diarrhea, and nausea. Adverse Reactions in Placebo-Controlled Trials In the two well-controlled studies demonstrating effectiveness, 1529 patients received TECFIDERA with an overall exposure of 2244 person-years [see Clinical Studies (14)]. The adverse reactions presented in the table below are based on safety information from 769 patients treated with TECFIDERA 240 mg twice a day and 771 placebo-treated patients. Table 1: Adverse Reactions in Study 1 and 2 reported for TECFIDERA 240 mg BID at ≥2% higher incidence than placebo
Flushing Abdominal pain Diarrhea Nausea Vomiting Pruritus Rash Albumin urine present Erythema Dyspepsia Aspartate aminotransferase increased Lymphopenia
TECFIDERA N=769 %
Placebo N=771 %
40 18 14 12 9 8 8 6 5 5 4 2
6 10 11 9 5 4 3 4 1 3 2 <1
Gastrointestinal TECFIDERA caused GI events (e.g., nausea, vomiting, diarrhea, abdominal pain, and dyspepsia). The incidence of GI events was higher early in the course of treatment (primarily in month 1) and usually decreased over time in patients treated with TECFIDERA compared with placebo. Four percent (4%) of patients treated with TECFIDERA and less than 1% of placebo patients discontinued due to gastrointestinal events. The incidence of serious GI events was 1% in patients treated with TECFIDERA. Hepatic Transaminases An increased incidence of elevations of hepatic transaminases in patients treated with TECFIDERA was seen primarily during the first six months of treatment, and most patients with elevations had levels <3 times the upper limit of normal (ULN) during controlled trials. Elevations of alanine aminotransferase and aspartate aminotransferase to ≥3 times the ULN occurred in a small number of patients treated with both TECFIDERA and placebo and were balanced between groups. There were no elevations in transaminases ≥3 times the ULN with concomitant elevations in total bilirubin >2 times the ULN. Discontinuations due to elevated hepatic transaminases were <1% and were similar in patients treated with TECFIDERA or placebo. Eosinophilia A transient increase in mean eosinophil counts was seen during the first 2 months of therapy. Adverse Reactions in Placebo-Controlled and Uncontrolled Studies In placebo-controlled and uncontrolled clinical studies, a total of 2513 patients have received TECFIDERA and been followed for periods up to 4 years with an overall exposure of 4603 person-years. Approximately 1162 patients have received more than 2 years of treatment with TECFIDERA. The adverse reaction profile of TECFIDERA in the uncontrolled clinical studies was consistent with the experience in the placebo-controlled clinical trials. 6.2 Post Marketing Experience The following adverse reaction has been identified during post approval use of TECFIDERA. Because these reactions are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure. Liver function abnormalities (elevations in transaminases ≥3 times ULN with concomitant elevations in total bilirubin >2 times ULN) have been reported following TECFIDERA administration in post marketing experience [See Warnings and Precautions (5.4)].
8 USE IN SPECIFIC POPULATIONS 8.1 Pregnancy Pregnancy Exposure Registry There is a pregnancy exposure registry that monitors pregnancy outcomes in women exposed to TECFIDERA during pregnancy. Encourage patients to enroll by calling 1-866-810-1462 or visiting www.tecfiderapregnancyregistry.com. Risk Summary There are no adequate data on the developmental risk associated with the use of TECFIDERA in pregnant women. In animals, adverse effects on offspring survival, growth, sexual maturation, and neurobehavioral function were observed when dimethyl fumarate (DMF) was administered during pregnancy and lactation at clinically relevant doses. [see data]. In the U.S. general population, the estimated background risk of major birth defects and miscarriage in clinically recognized pregnancies is 2-4% and 15-20%, respectively. The background risk of major birth defects and miscarriage for the indicated population is unknown. Data Animal Data In rats administered DMF orally (25, 100, 250 mg/kg/day) throughout organogenesis, embryofetal toxicity (reduced fetal body weight and delayed ossification) were observed at the highest dose tested. This dose also produced evidence of maternal toxicity (reduced body weight). Plasma exposure (AUC) for monomethyl fumarate (MMF), the major circulating metabolite, at the no-effect dose is approximately three times that in humans at the recommended human dose (RHD) of 480 mg/day. In rabbits administered DMF orally (25, 75, and 150 mg/kg/day) throughout organogenesis, embryolethality and decreased maternal body weight were observed at the highest dose tested. The plasma AUC for MMF at the no-effect dose is approximately 5 times that in humans at the RHD. Oral administration of DMF (25, 100, and 250 mg/kg/day) to rats throughout organogenesis and lactation resulted in increased lethality, persistent reductions in body weight, delayed sexual maturation (male and female pups), and reduced testicular weight at the highest dose tested. Neurobehavioral impairment was observed at all doses. A no-effect dose for developmental toxicity was not identified. The lowest dose tested was associated with plasma AUC for MMF lower than that in humans at the RHD. 8.2 Lactation Risk Summary There are no data on the presence of DMF or MMF in human milk. The effects on the breastfed infant and on milk production are unknown. The developmental and health benefits of breastfeeding should be considered along with the mother’s clinical need for TECFIDERA and any potential adverse effects on the breastfed infant from the drug or from the underlying maternal condition. 8.4 Pediatric Use Safety and effectiveness in pediatric patients have not been established. 8.5 Geriatric Use Clinical studies of TECFIDERA did not include sufficient numbers of patients aged 65 and over to determine whether they respond differently from younger patients. 10 OVERDOSE Cases of overdose with TECFIDERA have been reported. The symptoms described in these cases were consistent with the known adverse event profile of TECFIDERA. There are no known therapeutic interventions to enhance elimination of TECFIDERA nor is there a known antidote. In the event of overdose, initiate symptomatic supportive treatment as clinically indicated. 17 PATIENT COUNSELING INFORMATION Advise the patient to read the FDA-approved patient labeling (Patient Information) Dosage Inform patients that they will be provided two strengths of TECFIDERA when starting treatment: 120 mg capsules for the 7 day starter dose and 240 mg capsules for the maintenance dose, both to be taken twice daily. Inform patients to swallow TECFIDERA capsules whole and intact. Inform patients to not crush, chew, or sprinkle capsule contents on food. Inform patients that TECFIDERA can be taken with or without food [see Dosage and Administration (2.1)].
Anaphylaxis and Angioedema Advise patients to discontinue TECFIDERA and seek medical care if they develop signs and symptoms of anaphylaxis or angioedema [see Warnings and Precautions (5.1)]. Progressive Multifocal Leukoencephalopathy Inform patients that progressive multifocal leukoencephalopathy (PML) has occurred in patients who received TECFIDERA. Inform the patient that PML is characterized by a progression of deficits and usually leads to death or severe disability over weeks or months. Instruct the patient of the importance of contacting their doctor if they develop any symptoms suggestive of PML. Inform the patient that typical symptoms associated with PML are diverse, progress over days to weeks, and include progressive weakness on one side of the body or clumsiness of limbs, disturbance of vision, and changes in thinking, memory, and orientation leading to confusion and personality changes [see Warnings and Precautions (5.2)]. Lymphocyte Counts Inform patients that TECFIDERA may decrease lymphocyte counts. A blood test should be obtained before they start therapy. Blood tests are also recommended after 6 months of treatment, every 6 to 12 months thereafter, and as clinically indicated [see Warnings and Precautions (5.3), Adverse Reactions (6.1)]. Liver Injury Inform patients that TECFIDERA may cause liver injury. Instruct patients treated with TECFIDERA to report promptly any symptoms that may indicate liver injury, including fatigue, anorexia, right upper abdominal discomfort, dark urine, or jaundice. A blood test should be obtained before patients start therapy and during treatment, as clinically indicated [see Warnings and Precautions (5.4)]. Flushing and Gastrointestinal (GI) Reactions Flushing and GI reactions (abdominal pain, diarrhea, and nausea) are the most common reactions, especially at the initiation of therapy, and may decrease over time. Advise patients to contact their healthcare provider if they experience persistent and/or severe flushing or GI reactions. Advise patients experiencing flushing that taking TECFIDERA with food or taking a non-enteric coated aspirin prior to taking TECFIDERA may help [see Adverse Reactions (6.1)]. Pregnancy and Pregnancy Registry Instruct patients that if they are pregnant or plan to become pregnant while taking TECFIDERA they should inform their physician. Encourage patients to enroll in the TECFIDERA Pregnancy Registry if they become pregnant while taking TECFIDERA. [see Use in Specific Populations (8.1)]. 41347-09 Manufactured by: Biogen Cambridge, MA 02142 TECFIDERA is a trademark of Biogen. ÂŠ 2013-2017 Biogen 2/18
Conferences & Community
Transforming Leaders Graduate Credits Experience for Helping Advance Epilepsy Program Barbara Jobst, MD, FAAN, was already an experienced AAN member when she was accepted to the 2016–2017 Transforming Leaders Program. But since completing the intensive experience, she feels she’s obtained even greater recognition and visibility within her institution and her epilepsy subspecialty community. In addition to teaching her more broadly how to, in her words, “approach a project in a systematic way, learn additional organizational skills, and not take failures as a setback, but as challenge,” Jobst also credits the skills she gained with helping her advance a big-scale project at her institution of DartmouthHitchcock Medical Center in Lebanon, NH, to larger national recognition. “We developed a program called Home Based Self-management and Cognitive Training Changes Lives (HOBSCOTCH), which is part of the Managing Epilepsy Well (MEW) Network, which focuses on improving quality of life in patients with epilepsy by providing strong research and public health outreach,” she explained. “While HOBSCOTCH has been shown to improve memory in patients with epilepsy in a randomized controlled trial, the far bigger challenge has been disseminating and distributing the program to a larger audience due to an inherited bias against behavioral treatments, and having it recognized as a viable treatment option. “Transforming Leaders helped me to formulate a strategic plan to move HOBSCOTCH and the MEW Network to a greater national visibility, as demonstrated by a greater presence at national
meetings, within community organizations such as the Epilepsy Foundation, and professional societies such as the AAN and the American Epilepsy Society. Since the conclusion of the Transforming Leaders Program, HOBSCOTCH is now offered in three additional states.”
Jobst sees the personalized coaching aspect of the program to be one of its key strengths. “The program focused on personal growth and I am sure every participant benefited from the professional coaching. The peer coaching by fellow Transforming Leaders participants was also invaluable.” Added Jobst, “I enthusiastically endorse the program, especially as it focuses on mid- and late-career skills, as many programs focus on young investigators or junior physicians. The skills taught here are invaluable and I definitely appreciated the diversity of the program. It initiated— hopefully—lifelong friendships.” The Transforming Leaders Program is designed to identify and develop talent among experienced members 10 or more years out of residency for future leadership roles in the AAN and the field of neurology through personal coaching sessions, networking opportunities with AAN leaders, and collaboration with colleagues on personal and collaborative leadership projects. Learn more at AAN.com/view/transforming-leaders.
History, Art Provide Perfect Backdrop to Spring Meeting in Philadelphia Beautiful, vibrant, historic, and art-filled Philadelphia will be in full bloom and bursting with spring color and energy as it welcomes the AAN to its 71st Annual Meeting May 4 through 10, 2019. There’s no better city from which to experience the excitement of an AAN Annual Meeting, and you can once again expect to find programmatic diversity and endless opportunities for customization, top-tier education and science that you can’t get anywhere else, and even a few surprises and innovations that you’ve come to expect from the AAN. Visit AAN.com/view/AM19Interest to sign up to be notified when registration goes live—and see you in Philly!
Applications Open for 2018 Fall Conference Exhibitor Opportunities The Exhibit Hall during the 2018 Fall Conference is a not-to-be-missed opportunity for organizations you might work with to showcase products, information, and services of particular interest to the neurology community. Set for October 26 through 28 at The Cosmopolitan of Los Vegas, the Fall
Conference will offer a smaller, more intimate setting for industry partners, hospital networks, and non-profits to connect and share with approximately 700 neurology professionals. If your organization—or an organization with which you partner—would like to take advantage of this exhibiting opportunity,
visit AAN.com/conferences-community/ regional-conferences/fall-conference/ exhibits-advertising-sponsorship/ by October 1 to apply. In addition, please help us get the word out to smaller organizations that may be less familiar with the Fall Conference but would benefit from attending.
AANnews • July 2018 19
Conferences & Community
2019 AAN Research Program Applications Open This Month continued from cover August 15 Application Deadline Clinician Scientist Development Award in Multiple Sclerosis Funded by the National Multiple Sclerosis Society and the American Brain Foundation
October 1 Application Deadline Career Development Award Funded by the American Academy of Neurology
Clinical Research Training Scholarship Funded by the American Academy of Neurology
Neuroscience Research Training Scholarship Funded by the American Academy of Neurology
Practice Research Training Scholarship Funded by the American Academy of Neurology
Clinical Research Training Scholarship in Parkinson's Disease Funded by the Parkinson's Foundation and American Brain Foundation In collaboration with the American Academy of Neurology
Clinical Research Training Scholarship in Parkinson’s Disease Funded by the Parkinson’s Foundation and American Brain Foundation In collaboration with the American Academy of Neurology Supported in part by a grant from AbbVie.
McKnight Clinical Translational Research Scholarship in Cognitive Aging and Age-Related Memory Loss Funded by the McKnight Brain Research Foundation through the American Brain Foundation, and the American Academy of Neurology
Clinician Scientist Development Award in Myasthenia Gravis Funded by the Myasthenia Gravis Foundation of America and American Brain Foundation In collaboration with the American Academy of Neurology
Susan S. Spencer Clinical Research Training Scholarship in Epilepsy Funded by the American Epilepsy Society, Epilepsy Foundation, and American Brain Foundation In collaboration with the American Academy of Neurology
Robert W. Katzman, MD, Clinical Research Training Scholarship in Alzheimer's and Dementia Research Funded by the Alzheimer's Association and American Brain Foundation In collaboration with the American Academy of Neurology
Clinical Research Training Scholarship in Muscular Dystrophy Funded by the Muscular Dystrophy Association and American Brain Foundation In collaboration with the American Academy of Neurology
Clinical Research Training Scholarship in Headache Funded by the International Headache Society and American Brain Foundation In collaboration with the American Academy of Neurology
Clinical Research Training Scholarship in ALS Funded by The ALS Association and American Brain Foundation In collaboration with the American Academy of Neurology
Richard Olney Clinician Scientist Development Award in ALS Funded by The ALS Association and American Brain Foundation In collaboration with the American Academy of Neurology
Clinician Scientist Development Award in Interventional Neurology Funded by the Society of Vascular and Interventional Neurology and American Brain Foundation In collaboration with the American Academy of Neurology
Clinical Research Training Scholarship in Tourette Syndrome Funded by the Tourette Association of America and American Brain Foundation In collaboration with the American Academy of Neurology
AANnews • July 2018
Cure One, Cure Many We bring researchers and donors together to defeat brain disease. The American Brain Foundation invests in research for all brain diseases, because advances in a cure for one brain disease will lead to cures for others. This is how we will reach our vision of a world with cures for brain disease.
Make a gift in honor of a loved one or caregiver at
Education & Research
New NeuroLearn Courses Available in New Online Learning Center Free with Membership! Two new NeuroLearn courses are now available, and free* with your membership, through the AAN’s new, convenient, centralized hub for continuing medical education resources— the Online Learning Center at Learning.AAN.com. Each offers multimedia presentations with references and resources via a convenient online format that allows you to take on your own time and at your own pace from anywhere there’s an internet connection.
Introduction to Teleneurology
With a continuing shortage of neurologists, ever-expanding treatments and medications for neurologic disorders, and a projection of increasing numbers of patients with Alzheimer’s and other neurodegenerative diseases, the need for neurologic care is greater than ever. Teleneurology has far-reaching implications for the future practice of medicine and the delivery of care, and this course will help prepare you to implement this increasingly important method of care into your practice while offering 1 AMA PRA Category 1 Credit™ upon successful CHP: 17 Axon Registry Ad—Half Page Horizontal> AN completion.
Placed in AANnews .25 x 5.25 +0.125 bleed, 4C
Psychiatric Comorbidities Associated with Migraine When asking about the history of present illness in headache, neurologists obtain little to no information about psychiatric comorbidities and have limited knowledge of and use of screening tools for assessment. This course will teach you how to accurately identify and screen for migraine psychiatric comorbidities and create an appropriate treatment plan for your patients while offering 2 AMA PRA Category 1 Credits™ upon successful completion. * Free access is limited to one course per online learning program at a time. Medical Students, Business Administrators, and Advanced Practice Providers at the lower dues rate are not eligible.
The Axon Registry: Insightful. Practical. Secure. Welcome to the Axon Registry®—an exclusive benefit for AAN members. Participate in the registry so you can: • Measure and improve the quality of your care • Meet PQRS/Quality reporting requirements, reduce administrative burden • Qualify for MOC Part IV Improvement in Medical Practice Clinical Module • Use data to demonstrate value to payers
The Axon Registry is ready to serve you! AAN.com/view/axon
AANnews • July 2018
Take Note of These Continuum and Continuum Audio Improvements AAN members now can enjoy several recent updates to Continuum® and Continuum® Audio to enhance their education experience.
Canadian participants can claim credit for each interview by listening to the interview, completing the posttest and evaluation, and reporting the activity in MAINPORT. US and Canadian participants can listen to interviews and complete tests/evaluations online at Continuum.Audio-Digest.org or on the iOS or Android AAN Continuum Audio app.
The redesigned ContinuumJournal.com launched in June and now more closely resembles the new colorful print design. New features include: Increased functionality and enhanced readability Streamlined table of contents Easier navigation to review articles and PDFs Ability to sort back issues by topic or year More integration with Continuum Audio
Continuum Audio Platform and App Access All subscribers to Continuum and Continuum Audio have access to both products. Make good use of your subscription by accessing and using Continuum Audio. To access Continuum Audio for the first time, you must log in using the online platform before logging in to the app.
Online Learning Center Continuum is now a part of the AAN’s new Online Learning Center, and all of its CME activities have moved to this new platform at ContinPub.com/CME. The Online Learning Center serves as central hub for members to access online learning programs and complete CME and self-assessment activities.
To log in to Continuum Audio online:
Continuum LIF EL ON
G LE AR NI NG
IN NE UR OL OG
1. Go to Continuum.Audio-Digest.com 2. Click “Login” and sign in with your AAN Member ID and password
Behaviora lN and Psych eurology iatry
EDIT OR-I N-CH IEF: STEV EN L. GUE ST EDIT LEW IS, OR: MOR RIS FREE DMA MD, FA AN N, MD, FRCP C, FA AN
To download and access the Continuum Audio iOS or Android app:
Continuum Audio Accreditation by Royal College Beginning with June 2018 interviews, Continuum Audio is accredited by the Royal College of Physicians and Surgeons of Canada for its Self-Assessment Program (Section 3). This accreditation applies only to interviews from June 2018 going forward and does not apply retroactively.
3. Your accounts will sync and you will be required to register
1. Search for “AAN Continuum Audio” in the App Store or Google Play store 2. Select this app icon 3. Install the app 4. When installed, log in using your AAN Member ID and password If you experience any issues logging in to Continuum Audio, contact Audio Digest Foundation customer support at (800) 423-2308. CON TINU
UMJ OUR NAL.
Are You Getting Your AANe-news?
Don’t miss the latest news headlines from your Academy! As an exclusive member benefit, you should be receiving AANe-news™ the second and fourth Wednesday of each month if your email address is on file. If not, be sure to set your email filter to accept firstname.lastname@example.org as a friendly address. Or update your email address at AAN.com/MemberProfile.
It’s Not Spam... It’s AANe-news!
AANnews • July 2018 23
Education & Research
Annual Meeting Draws Substantial Media Coverage The AAN issued 10 AAN Annual Meeting press releases about science presented at the meeting as well as a new AAN guideline. The press release titled “Diet Shown to Reduce Stroke Risk May Also Reduce Risk of Depression” was covered by ABC’s Good Morning America as well as USA Today, CBS News, AARP, Medscape, and MedPage Today. The press release “When Others Fail, New Migraine Treatment May Work” was covered by NBC News, U.S. News & World Report, the BBC, and Reuters.
TIME, Travel and Leisure, The New York Times, and the Chicago Tribune. “Physically Fit Women Nearly 90 Percent Less Likely to Develop Dementia” was covered by The Washington Post, CBS Evening News, People, CNN, USA Today, and Newsweek.
The AAN guideline on disease-modifying therapies for multiple sclerosis was highlighted during an Annual Meeting press conference featuring authors Alexander Rae-Grant, MD, FAAN, and Ruth Ann Marrie, MD, PhD. Articles about the guideline were published in Medscape, MedPage Today, WebMD, and Neurology Advisor. Weekly press releases on Neurology ® journal studies that were highly visible in the press this spring included “More Than Relaxation? Saunas May Be Linked to Lower Stroke Risk,” which was covered in MEM: 17 FAAN Recruitment Campaign Ad—Half Page Horizontal> AN Placed in AANnews 8.25 x 5.25 +0.125 bleed, 4C
Set Yourself Apart Get the recognition you deserve. Add the Fellow of the AAN (FAAN) designation to your already impressive credentials. Learn how at AAN.com/view/FAAN.
Alexander Rae-Grant, MD, and Ruth Ann Marrie, MD, PhD, spoke at the press conference.
American Brain Foundation
Foundation Continues to Broaden Public Awareness What’s in a name? A recent survey revealed that just over 60 percent of AAN members know about the American Brain Foundation. By contrast, nearly 85 percent of members know about the AAN Foundation. In 2012, the American Academy of Neurology Foundation was renamed the American Brain Foundation in an effort to broaden public awareness and support from patients, caregivers, practitioners, and educators. We are continuing to work to expand our reach and recently placed full-page awareness advertisements in the May issues of Forbes, Inc., Fast Company, and a special edition of Men’s Health, thanks to donations of space from the magazines’ media companies.
which have been funded by generous Foundation donors— recognize career accomplishments. For more information and to show your support, visit AmericanBrainFoundation.org.
As our public awareness grows, the support of Academy members becomes more crucial. Just as many members’ institution and university development offices often cite participation percentages of staff, faculty, and classes, the American Brain Foundation is often asked about the percentage of supporting Academy members. Our goal is to increase this percentage throughout 2018. The American Brain Foundation invests in research on the continuum of brain diseases. The cornerstone of our research investment continues to be Clinical Research Training Scholarships; an effort that we believe uniquely “bookends” AAN members’ careers by supporting the next generation of young researchers before the Academy’s scientific awards—
What Is Your Legacy? The American Brain Foundation recently received notification of gifts from three individual estates. These gifts help fulfill the donors’ life goals and wishes to continue making a difference, even after they are gone. If you have already included the Foundation in your estate plans—thank you! If you are considering doing so or would like to know more about naming the Foundation as a beneficiary of a retirement asset and how it could save your heirs income tax, please visit AmericanBrainFoundation/ plannedgiving.org, or contact Shelly Rucks at (612) 928-6318 or SRucks@AmericanBrainFoundation.org to learn more about all of your available options for creating your legacy.
AANnews • July 2018 25
Visit the AAN’s Neurology Career Center to view hundreds of additional jobs and sign up for customized, confidential notifications when positions of interest are added.
Multiple neurologist opportunities with Tower Health. At Brandywine Hospital: neurologist with ability to read EEGs & EMGs (outpatient and inpatient consults) located in Chester County. Brandywine Hospital is a 171-bed acute care facility that has served its community for over 100 years offering a full range of inpatient, outpatient, medical and surgical, diagnostic, and emergency care. Brandywine continues to expand its medical staff and programs, additional duties at Jennersville Hospital in West Grove, Pennsylvania. Next opportunity at Phoenixville Hospital: neurologist with ability to read EEGs & EMGs (outpatient and inpatient) located in Chester County. Phoenixville Hospital is a 151-bed facility that provides comprehensive medical services through 25,000 emergency room visits, 8,200 inpatient admissions and 500+ community outreach programs annually. Next opportunity at Pottstown Hospital: neurologist with ability to read EEGs & EMGs (outpatient) located in Montgomery County. Pottstown Hospital is a 232-bed acute care hospital offering a full range of services, including inpatient and outpatient, medical, surgical, obstetric, pediatric, diagnostic, and emergency care. About Tower Health. Across 1450+ beds and over 75 convenient locations, Tower Health's 2,000 providers and 11,000+ team members provide a full range of medical care—from prevention, screenings and education; to the latest clinical services and surgeries available; to rehabilitation. We also offer wellness programs and public health services that ensure our communities are the healthiest they can be. Reading Hospital is aggressively developing a comprehensive stroke program in response to community need and expanding volume. The stroke program is driven by the busiest Emergency Department in Pennsylvania with over 135,000 visits per year with call primarily being done by telestroke. We offer: competitive salary, comprehensive benefits, including health, dental, vision, life and disability insurance, generous time-off allowance, educational loan assistance, relocation assistance, CME stipend, occurrence-based malpractice insurance, 403(b) and 457(b) retirement plans, H1b and green card support, academic, quality improvement and research opportunities. For additional information contact: Kenneth Nichols, Medical Staff Recruiter. (484) 628-6581. Kenneth.Nichols@towerhealth.org www.towerhealth.org careers.towerhealth.org Neurohospitalist opening affiliated with teaching hospital with new neurology residency program. Medical school affiliated Academic Medical Center. Opportunity to join growing neurology department of 8 Neurologists. Faculty members including general, pediatric, neuromuscular, movement, epilepsy and vascular. 7 days on 7 days off schedule with opportunity for outpatient clinic. Accredited neurophysiology center on site. Multidisciplinary team includes radiologists, pharmacists, nursing, dietitians, physical, occupational and speech therapists. Comprehensive benefits package including malpractice, excellent starting salary and sign-on bonus, academic appointment, educational stipend available. Named one of 150 great places to work in healthcare—Becker´s hospital review. Excellent public and private Schools. NCAA division I intercollegiate sports teams. Driving distance for skiing, water sports, hiking, etc. Short distance to 4 major metro areas. Expanding downtown area, concert halls and a theater community. Mention code 180418 NHO. Pediatric Neurology opening affiliated with teaching hospital with new Neurology Residency Program. Medical school affiliated Academic Medical Center. Opportunity to join two practicing pediatric neurologists. Join medical school department of neuroscience including neurology, neurosurgery & neurophysiology. Faculty members including child & adult neurologists, as well as functional, pediatric & spine neurosurgeons.
Established, accredited long-term epilepsy monitoring unit. 36 bed NICU; 12 bed pediatric ICU level III center. New, $30 million pediatric hospital expansion. Clinical research interest encouraged. Excellent starting salary, full benefits and sign-on bonus. Educational stipend available. An outdoor enthusiast´s haven. Enjoy the scenic shores of a historic river. Take in the four-season views while mountain hiking. Enjoy a sunset cruise under the stars. The region´s best skiing at your doorstep. Year-round family fun. A down-to-earth place to live combined with amazing cultural sensations. NCAA division one intercollegiate sports teams. Mention code 180420 CHN. Neurology/neuroimaging/multiple sclerosis/clinic research with partnership. Full-time, board-certified neurology, established, physician-owned practice and facility, predominantly out-patient and limited call for hospital patients, complex regional neurology clinic with strong clinical research practice, neuroimaging, electrophysiology, neuro-ophthalmology, infusion services in dynamic, fast-growing, beautiful suburb of Nashville, Tennessee, a town with stellar local education options, and a state without income tax and excellent value for the cost of living. Live close to your workplace with easy commute. Desire long-term partner who will participate actively in the organization development. CME coverage provided. Partnership, partnership-track, or employment options available. Health insurance for employee, disability insurance is provided. Moving expenses provided. 401(k) available following 1 year of employment with match and profitsharing. Additional insurance available as group option. Partnership available including owning facility real estate and practice. Email: email@example.com Neurologist needed in Northern California. Dignity Health Medical Group—Sierra Nevada, a service of Dignity Health Medical Foundation, is a well-established multi-specialty group featuring cardiology, ENT, neurology, obgyn, oncology, internal medicine and family practice. We are aligned with Dignity Health, the fifth largest healthcare system in the country and the largest hospital provider in California, as well as Sierra Nevada Memorial Hospital. Our Grass Valley Group, located less than 60 miles from Sacramento, is currently recruiting a neurologist. This opportunity offers: join an existing neurologist in our outpatient clinic, adult and geriatric patients, 80% outpatient/20% inpatient, surgery referred out, 1:4 ER and inpatient call with tele-medicine robot available for neurology consults, hospital is a certified advanced primary stroke center, affiliated with the Dignity Health Neurological Institute, catchment area of 99,000 people with 24% 65 years of age or older, traditional employment model with: competitive salary guarantee period, productivity and quality incentives, attractive benefits package (comprehensive healthcare coverage, free medical insurance, 401K, paid malpractice, CME allowance, etc.), generous time off. The natural beauty of Nevada county, combined with the rich history and economic vitality of the area, provides an appealing quality of life that is highly valued by residents and visitors alike. Grass Valley, the largest city in western Nevada county, has a population of just over 12,000 people. Although Grass Valley and the other cities of Nevada county offer a small-town feel, the conveniences and offerings of major metropolitan areas (Sacramento, San Francisco & Reno) are only a short drive away. Our charming historic towns offer fine dining and wine tasting, museums and art galleries, antiques, shopping and a range of cultural attractions. A yearround climate of moderate weather with warm summers and short winters offer outstanding recreational opportunities, including fishing, whitewater rafting, hiking, biking, boating, hunting, skiing, golfing, gold panning and camping. For more
information, please contact: Physician Recruitment. Phone: (888) 599-7787. Email: firstname.lastname@example.org. http://www.dignityhealth.org/physician-careers Opportunity to Join a Well-Regarded Health System in Suburban Philadelphia Main Line Health System, located in the beautiful western suburbs of Philadelphia has opportunities for neurologists looking to join a well-regarded health system. Opportunities: • Outpatient opportunities or combination of outpatient/neurohospitalist position • Enjoy the benefits of working in a wellestablished, employed practice • Diverse neurologic patient mix • Enjoy the support of respected and top-level primary care, hospitalists and other specialists within Main Line Health community • Reasonable call schedules • Open to all sub specialties (except sleep medicine) o Cognitive, headache and movement disorder training a plus Benefits and Lifestyle: • High income potential with competitive base compensation and production incentives • Excellent benefits package • Financial security with working for a top ranked, financially secure hospital system • Area is well known for the top ranked (nationally) public and private schools • Less than an hour drive to historic Philadelphia • Wonderful cultural opportunities • Short drive to beaches, mountains, New York City and Washington, DC Main Line Health (MLH) is a not-for-profit health system serving portions of Philadelphia and its western suburbs. At its core are four of the region’s respected acute care hospitals—Lankenau Medical Center, Bryn Mawr Hospital, Paoli Hospital and Riddle Hospital—as well as one of the nation’s premier facilities for rehabilitative medicine, Bryn Mawr Rehabilitation Hospital; Mirmont Treatment Center for drug and alcohol recovery; and Main Line Health HomeCare & Hospice, a home health service. Main Line Health also consists of Main Line HealthCare, one of the region’s largest multi-specialty physician networks, and the Lankenau Institute for Medical Research, a non-profit biomedical research organization located on the campus of Lankenau Medical Center. Main Line Health is also comprised of five outpatient health centers located in Broomall, Collegeville, Exton, Concordville and Newtown Square. Main Line Health Hospitals, with more than 10,000 employees and 2,000 physicians, are the recipients of numerous awards for quality care and service, including System Magnet® designation, the nation’s highest distinction for nursing excellence, and being named among the nation’s best employers by Forbes magazine. Main Line Health is among the area’s leaders in medicine, providing advanced patient-centered care, education and research to help our community stay healthy. Forward CV to: Rose Caione Physician Recruiter email@example.com. Phone: (484) 580-4146.
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 September 2018 print edition of A AANnews must be submitted by August 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.
Neurology Podcasts: ®
20 Minutes Pack a Punch! Download the latest podcast at neurology.org/podcast
AANnews • July 2018
AAN Staff Singled Out for 2017 Great Performers Award The Great Performers Award debuted in 2016 to recognize AAN staff who went above and beyond in their delivery of products, programs, and services to meet the needs of our more than 34,000 members. The growth and success of the AAN could not happen without the continuing commitment and innovative ideas of our staff, especially the dedication of the 11 recipients of the 2017 Great Performers Award. AANnews would like to honor these staff members as a capstone to the recognition they have already received at a recent all-staff meeting in front of their peers. Front row: Denise Shouse, Senior Director, Marketing & Communications; Amy Nostdahl, Senior Manager, Leadership Development; Leah Johnson, Associate Director, Digital Strategy & Innovation; Michelle Uher, Director, Communications & Public Relations. Back row: Nick Weber, Senior Manager, Web Development; Luana Ciccarelli, Senior Manager, Reimbursement & Coding; Andrew Imholte, Director, Creative Services; John Hutchins, Deputy General Counsel; Nate Kosher, Science Program Manager, Annual Meeting & Conferences; Amanda Chamberlain, Senior Manager, Online Learning; Karen Kasmirski, Executive Assistant.
Dates & Deadlines JULY 2018
SEPTEMBER 2018 TUE
Deadline: UCNS Neurocritical Care Recertification Examination Application (Early application deadline July 2; late application deadline July 16) UCNS.org/go/subspecialty/neurocritical/ certification
Sports Concussion Conference Indianapolis, IN AAN.com/view/SCC
Deadline: UCNS Neuroimaging Certification and Recertification Examinations Application (Early application deadline August 1; late application deadline August 15) UCNS.org/go/subspecialty/neuroimaging/ certification
Deadline: Fall Conference Advance Registration and Hotel AAN.com/view/Fall
Webinar: Using Guidelines and Quality Measures to Become a Better Neurologist (Register by September 24) AAN.com/view/pmw18
Webinar: Improving Patient Access, Engagement, and Care (Register by August 20) AAN.com/view/pmw18
Deadline: Fall Conference Early Registration AAN.com/view/Fall
AANnews • July 2018 27
Find more information at
Â© 2018 Amgen Inc. All rights reserved. USA-334-055312
2018 July AANnews