2019 April AANnews

VOLUME 33 · ISSUE 4 · April 2019

YOU CAN STILL SAVE ON ANNUAL MEETING Discounts End April 11 There’s still time to receive the Advance Registration discounted rate for the 2019 Annual Meeting this May 4 through 10 in historic Philadelphia.

Counting among its rich, historical firsts, Philadelphia is home to the nation’s first hospital, medical school, and even neurology program! Visit AAN.com/view/AM19 before April 11 to take advantage of the savings, and then start preparing for more than 250 expert-led, cutting-edge education opportunities; the most current breakthrough scientific research; and seemingly endless networking opportunities from among your worldwide community of more than 14,000 neurologists and neurology professionals.

Add the Free Philly Spectacular When You Register— Tickets are Limited!

While registering, be sure to reserve your free ticket for the Philly Spectacular—at Reading Terminal Market! A limited number of free tickets are available for this special kick-off celebration on Sunday, May 5, from 7:00 p.m. to 10:00 p.m. at one of the United States’ largest and oldest public markets. Tickets include an all-you-can-eat selection of beverages and delicious food, a live performance by the award-winning Jellyroll, transportation to and from the event, and private access to the neighboring Field House sports bar. There is a limit of one free ticket per registered Annual Meeting attendee; additional tickets may be purchased for $115 each through Annual Meeting registration. 

Applications Open This Month for Four Empowering Leadership Programs Building a diverse and inclusive network of leaders is imperative for the Academy to advance its mission, fully represent its members, and promote the highest quality patient-centered neurologic care in today’s ever-evolving and challenging health care environment. That’s why the AAN is invested in leadership development. And the four empowering opportunities coming available this month are designed specifically to equip participants with the skills, tools, and confidence to successfully tackle the challenges that lie ahead.

Continued on page 26

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2019 AAN Award Winners Announced

AAN Advocating on Multiple Fronts for E/M Services With the majority of neurologists’ payments coming from E/M services, the AAN continues to coalesce its efforts around ensuring reimbursement for E/M services is maintained. Our plan involves advocating directly with CMS and amplifying our voice through broad coalitions. Neurologists should be fairly compensated for their work.

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In 2018, the AAN was successful in delaying CMS’s implementation of collapsed E/M payment rates and postponement of changes to E/M reporting guidelines until 2021. Any changes to the value of E/M services impact all of

20 Top Researchers to

Present Latest Advances in Plenary Sessions

Continued on page 28

27 Get Data You Need to

Improve Your Compensation and Productivity

›

In Multiple Sclerosis–

THE ART OF BRAIN PRESERVATION Adding Grey to the Palette Completes the Picture

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AANnews · April 2019

News Briefs

CONTENTS Cover You Can Still Save on Annual Meeting Applications Open This Month for Four Empowering Leadership Programs AAN Advocating on Multiple Fronts for E/M Services President’s Column AAN Committed to Addressing Equity, Diversity, Inclusion, and Disparities · · · · 4 Conferences & Community 2019 AAN Award Winners Announced · · · · · · · · · · · · · 6 Vote on AAN and AAN Institute Board Nominees at Business Meeting · · · · · · · · · 17 Applications Double for 2019 Medical Student Scholarship to the Annual Meeting · · · · · · 17 Popular ‘Continuing the Conversation’ Opportunities Expanded for 2019 · · · · · · · · 18 Make the Innovation Hub Your Destination for Innovation · · · · 18 ‘Neighborhoods’ Make Poster Session Easy to Navigate · · · · 19 Top Researchers to Present Latest Advances During Plenary Sessions · · · · · · · · ·20 DeAngelis to Receive President’s Award · · · · · · · · ·23 Neuro Center’s Picnic Area to Offer Music, Food, Fun · · · · · ·23

Month for Sports Concussion Conference · · · · · · · · · · · · 23 Tools & Resources Get Data You Need to Improve Your Compensation and Productivity · · · · · · · · · · · · ·27 Read the New Issue of Neurology: Clinical Practice · · · · · · · · · · · · · · · 27 How Your AAN Is Addressing Members’ Top Concerns with Payers’ Administrative Hassles · · · · · ·28 Brain & Life Looks at Alzheimer’s, Grief, and More · · · · · · · · · · · · · · 29 Policy & Guidelines Capitol Hill Report · · · · · · · · ·30 Education & Research New NeuroBytes Videos Offer Quick, Convenient Learning · · ·32 New Continuum Examines Latest in Epilepsy · · · · · · · · ·32 Learn About UCNS Accreditation, Certification, and New Continuous Certification · · · · · · · · · · · ·32 American Brain Foundation Prestigious Lineup of Honorees Set for May 8 Commitment to Cures Fundraiser · · · · · · · · · · · · ·33

New Subcommittees Formed The AAN has created a new subcommittee to oversee all regional conferences. Jonathan GraffRadford, MD, serves as chair and Bert B. Vargas, MD, FAAN, serves as vice chair. The subcommittee serves under the Meeting Management Committee.

Also serving under the Meeting Management Committee is the new Industry Relations Subcommittee, with Jonathan P. Hosey, MD, FAAN, as chair and Ryan R. Walsh, MD, PhD, FAAN, as vice chair.

A new Pipeline Subcommittee has been created to develop and coordinate the AAN’s activities related to increasing the number of students entering neurology. Serving under the Education Committee, the subcommittee will coordinate its efforts with the Undergraduate Education Subcommittee and other key committees with initiatives related to workforce development.

Rana R. Said, MD, serves as chair and Justin T. Jordan, MD, MPH, serves as vice chair. 

Correction The March AANnews had an incorrect photo for Bruce H. Cohen, MD, FAAN.

Cohen

Careers · · · · · · · · · · · · · · · · 34

Registration Opens This

The Vision of the AAN is to be indispensable to our members.

The Mission of the AAN is to promote the highest quality patient-centered neurologic care and enhance member career satisfaction.

Contact Information

For advertising rates, contact:

American Academy of Neurology 201 Chicago Avenue Minneapolis, MN 55415

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

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

memberservices@aan.com

Website: AAN.com

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

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

AANnews is published monthly by the American Academy of Neurology for its 36,000 members worldwide. Access this magazine and other AAN publications online at AAN.com.

The American Academy of Neurology ’ s registered trademarks and service marks are registered in the United States and various other countries around the world.

“American Brain Foundation” is a registered service mark of the American Brain Foundation and is registered in the United States.

President’s Column

AAN Committed to Addressing Equity, Diversity, Inclusion, and Disparities NOTE: This message is printed in its original format that was sent to all members electronically.

February 21, 2019 Dear AAN Members, Earlier this week, you heard from Neurology ® Editor-in-Chief Robert A. Gross, MD, PhD, FAAN, regarding Neurology’s comprehensive action plan in response to the now retracted humanities article, “Lucky and the Root Doctor,” because the article contained racist characterizations.

I regret the error and offer my sincerest apology. The Academy is taking this situation seriously and working hard on your behalf to ensure all aspects of equity, diversity, inclusion, and disparities are a part of everything we do.

Sacco

I am committed to ensuring we emerge stronger from this experience.

While we have more work to do, this situation is particularly lamentable because it comes after AAN member volunteers devoted considerable effort over recent years to address aspects of equity, diversity, inclusion, and disparities—within our organizational structure and among our membership. At the highest level, our AAN core values include Diversity and Equity and “we commit to building and sustaining an inclusive organization that respects and values the diversity of our membership and the communities we serve and promotes equality in professional advancement and compensation.” I want to highlight some examples of what the Academy has been doing to address these critical issues.

Added more minority and women members to the AAN and AAN Institute Board of Directors and in leadership appointments to committees, subcommittees, workgroups, and task forces.

For the first time in history, four of the six officers of the proposed 2019-2021 AAN Board of Directors are women; President, President Elect, Secretary, Treasurer (AAN), Treasurer AAN Institute, and Vice President.

Created the AAN Diversity Leadership Program in 2014 to identify, orient, and cultivate underrepresented minority AAN members into future Academy leaders. Each year, up to 10 participants are given a unique opportunity to develop enhanced leadership skills through partnership with established AAN leaders and experience to prepare them to assume leadership roles with the AAN. Established a Joint Coordinating Council on Equity, Diversity, Inclusion, and Disparities (EDID) in September 2018 to ensure recommendations from the AAN’s Diversity Leadership Program, the AAN Gender Disparities Task Force, and the AAN Health Care Disparities Task Force are implemented across the entire organization. As envisioned

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AANnews • April 2019

by the 2018 Diversity Leadership Program participants, this council may gather and publish data pertinent to neurologic health equity and practitioner workforce diversity; develop and maintain effective guidelines and education programs for departmental leadership regarding EDID issues, initiatives, and standards; foster transparency and monitor progress; coordinate EDID efforts across AAN committees; coordinate with AAN advocacy to support legislation pertinent to neurologic health equity; support departmental EDID officers; and administer EDID-related service awards.

In January 2019, Neurology Today® published “Meet Neurology's Diversity Leaders,” (online at AAN.com/view/ DiversityLeaders) a paper by Orly Avitzur, MD, MBA, FAAN, that examined the roles—and rarity—of EDID officers and the ways that they are working to improve diversity in the academic workplace.

In March 2019, at the AAN’s second Chair Summit we will lead off with an important panel discussion on Diversity and Gender Disparities in Academic Departments and how best to address them, led by Roy Hamilton, MD, MS, FAAN.

The AAN’s Diversity Officer Work Group was created as part of the Academic Initiative in March 2018 with the charge of identifying goals, gaps, and tactics that will support the needs for diversity officers and plan for development of tools and resources. One of its tactics has been to identify 24 abstracts for posters displayed at the 2019 Annual Meeting to highlight diversity efforts across the field of neurology.

Along with the Diversity Officer Work Group, the AAN has established in recent years a Diversity Leadership Subcommittee, Medical Student Diversity Subcommittee, Leadership for Women Subcommittee, Spanish-language Work Group, Health Care Disparities Task Force, and Gender Disparities Task Force. We have sections for LGBTQI, as well as Women’s Issues in Neurology. I invite you to visit AAN.com to learn more about these efforts and access resources that shed light on the challenges we face and how you can promote greater diversity and inclusion in your workplace and community.

As in past years, our upcoming Annual Meeting in Philadelphia features numerous opportunities for attendees to learn more about diversity issues and their impact on our profession, patients, and everyday lives. These include talks on blind spots and the impact of conscious and unconscious bias, as well as Leadership programming in leadership CESC 19AM Ad—HalfUniversity Page Horizontal> ANNnews,on NJ,women NCP

and mitigating the impact of unconscious bias. Furthermore, we will have programming on how to create a diverse workforce in academic neurology, and much more.

We are also ensuring that our Academy staff receive regular training on all aspects of equity, diversity, inclusion, and disparities, to help foster our commitment to you.

We are committed to establishing metrics to ensure all of our efforts are measured and evaluated regularly over time, and keeping you informed on our progress.

I want you to know that, as regrettable as this event is, it also has been instructive. It underscores that we cannot let down our guard against racism, inequities, and disparities, whether casual or overt. We must see it and call it out. We must educate and empathize. We must work toward the day when everyone is treated with the dignity and respect they deserve. 

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

Placed in Neurology Journal, or Neurology Clinical Practice 8.25 x 5.4375 +0.125 bleed, 4C

Why Do You Want To Be At The World’s Best Neurology Conference?

Customizable, experiential, and inspirational education and CME opportunities Unparalleled networking opportunities with your community of 14,000+ neurology professionals from around the globe Unique and creative experiences in exciting and inspirational formats to fuel your mind, body, and spirit Registration still available!

Advance Registration: March 8 - April 11, 2019 On-site Registration: April 12-On-site.

AAN.com/view/AM19 ADVANCING NEUROLOGY. ADVANCING YOU.

Conferences & Community

2019 AAN Award Winners Announced Congratulations to the winners of the 2019 AAN awards. Most of these recipients will be celebrated with presentations of their awards during the Annual Meeting in Philadelphia, and some will present papers at the following noted times. The AAN thanks the American Brain Foundation for its support through philanthropy of the American Academy of Neurology's awards program.

A.B. BAKER AWARD FOR LIFETIME ACHIEVEMENT IN NEUROLOGIC EDUCATION

Funded by an endowment created by matching funds from the A.B. Baker Family Trust and Novartis Pharmaceuticals.

Steven L. Lewis, MD, FAAN / Allentown, PA

A.B. BAKER TEACHER RECOGNITION AWARD

Jorge J. Asconape, MD / Maywood, IL / Loyola University Chicago James Nicholas Brenton, MD / Charlottesville, VA / University of Virginia Kevin R. Cannard, MD, FAAN / Bethesda, MD / Walter Reed NMMC Miguel Chuquilin Arista, MD / Gainesville, FL / University of Florida Glen A. Cook, Jr., MD / Bethesda, MD / Walter Reed National Military Medical Center Monica B. Dhakar, MBBS / Atlanta, GA / Emory University School of Medicine Vanja C. Douglas, MD / San Francisco, CA / University of California, San Francisco Steven Richard Dunham, Jr., MD / Houston, TX / Baylor College of Medicine Jeffrey E. Dunn, MD, FAAN / Palo Alto, CA / Stanford University Medical Center Benjamin H. Eidelman, MB, FAAN / Jacksonville, FL / Mayo Clinic, Florida Gary Gallagher, MD / Ann Arbor, MI / University of Michigan Tarannum Khan, MD, MBBS / Weston, FL / Cleveland Clinic, Florida Arielle Marisa Kurzweil, MD / New York, NY / New York University Shaheen E. Lakhan, MD, PhD, Med, FAAN / Somerville, MA / Virginia Tech Kaustubh S. Limaye, MD / Iowa City, IA / University of Iowa Georgios Manousakis, MD / Minneapolis, MN / University of Minnesota Matthew A. McCoyd, MD / Maywood, IL / Loyola University, Stritch School of Medicine Prachi Mehndiratta, MD / Henrico, VA / Virginia Commonwealth University Nicte I. Mejia, MD, MPH, FAAN / Boston, MA / Massachusetts General Hospital Jeremy Moeller, MD / New Haven, CT / Yale University Jonathan Perk, MD, PhD / Brooklyn, NY / SUNY Downstate University

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AANnews • April 2019

Alejandro A. Rabinstein, MD, FAAN / Rochester, MN / Mayo Clinic Mehmood Rashid, MD / Toledo, OH / University of Toledo, College of Medicine & Life Sciences Yolanda Reyes-Iglesias, MD / Miami, FL / University of Miami, Miller School of Medicine Debra Roberts, MD, PhD / Rochester, NY / University of Rochester Medical Center Julie Roth, MD, FAAN / Providence, RI / Brown University Divya Singhal, MD / Oklahoma City, OK / University of Oklahoma/VAMC Oklahoma City Madhu Soni, MD, FAAN / Chicago, IL / Rush University Medical Center Roy E. Strowd III, MD / Winston Salem, NC / Wake Forest School of Medicine Lisa Sun, MD / Baltimore, MD / Johns Hopkins School of Medicine David F. Tang-Wai, MD, FRCPC / Toronto, ON / Toronto Western Hospital/University Health Network Joanne M. Wojcieszek, MD / Indianapolis, IN / IU Health Neuroscience Center

ADVANCED PRACTICE PROVIDER SCHOLARSHIP

Sponsored by the AAN Practice Committee.

Mary Epperson, RN, BSN, MSN, CPNP / St. Louis, MO Christa S. Cooper, PA-C, MMS, MPH / Chicago, IL

ALLIANCE AWARDS

Sponsored by the American Academy of Neurology and endowed by the former American Academy of Neurology Alliance.

FOUNDERS AWARD

Lily Zhou, BHSc, MD / Ottawa, ON, Canada S40: Stroke Risk Factors and Epidemiology Wednesday, May 8, 3:30 p.m.

S. WEIR MITCHELL AWARD

Andrew Findlay, MD / St. Louis, MO S23: Genetic Muscle Disorders Monday, May 6, 3:30 p.m.

AMERICAN ACADEMY OF NEUROLOGY PRESIDENT’S AWARD

This award is given by the American Academy of Neurology president for outstanding service to the American Academy of Neurology and the profession of neurology.

Lisa M. DeAngelis, MD, FAAN / New York, NY

AMERICAN BRAIN FOUNDATION BOARD CHAIR’S AWARD

Sponsored by the American Brain Foundation.

Edgar J. Kenton III, MD, FAAN, FAHA (given posthumously) / Philadelphia, PA Commitment to Cures Wednesday, May 8, 6:00 p.m.

ASSOCIATION OF INDIAN NEUROLOGISTS IN AMERICA LIFETIME ACHIEVEMENT AWARD

Sponsored by the American Brain Foundation.

Ram Ayyar, MBBS, MD, MRCP, FAAN / Miami, FL AINA Annual Meeting Monday, May 6, 6:00 p.m.

AWARD FOR CREATIVE EXPRESSION OF HUMAN VALUES IN NEUROLOGY

This award is sponsored by the Ethics, Law, and Humanities Committee, a joint committee of the American Academy of Neurology, the American Neurological Association, and the Child Neurology Society.

Ludwig Gutmann, MD, FAAN / Iowa City, IA The Intolerable Burden

BRUCE S. SCHOENBERG INTERNATIONAL AWARD IN NEUROEPIDEMIOLOGY

Sponsored by the American Academy of Neurology and endowed by GlaxoSmithKline, Inc. This award was not given for 2019.

CHILD NEUROLOGY NEUROSCIENCE RESEARCH PRIZE

Sponsored by the American Academy of Neurology and the Child Neurology Society.

Shan Lateef / Alexandria, VA Child Neurology Society Meeting October 23–26, 2019 Charlotte, NC

CLERKSHIP COORDINATOR RECOGNITION AWARD

Sponsored by the American Academy of Neurology.

Christina Cronin / Coram, New York / NYU Langone Health

CLERKSHIP COORDINATOR RECOGNITION AWARD

Sponsored by the American Academy of Neurology.

Celia Linton / Casselberry, Florida / University of Central Florida

CLERKSHIP DIRECTOR INNOVATION AWARD

Sponsored by the American Academy of Neurology.

Doris Kung, DO / Houston, Texas / Baylor College of Medicine

CLERKSHIP DIRECTOR TEACHING AWARD

Sponsored by the American Academy of Neurology Diana Barratt, MD, MPH, FAAN / Miami, Florida / Florida International University

COMMITMENT TO CURES AWARD

Sponsored by the American Brain Foundation.

Jeffrey Lurie / Philadelphia, PA Commitment to Cures Wednesday, May 8, 6:00 p.m.

DREIFUSS-PENRY EPILEPSY AWARD

Sponsored by the American Academy of Neurology and endowed by members of the American Academy of Neurology Epilepsy Section; Abbott Laboratories, Inc.; Cephalon, Inc.; Cyberonics, Inc.; Elan Pharmaceuticals, Inc.; GlaxoSmithKline; Novartis Neuroscience; Ortho-McNeil Neurologics; Pfizer Inc; Shire US, Inc; and UCB Pharma.

Daniel Friedman, MD, MS / New York, NY S36: Epilepsy/Clinical Neurophysiology (EEG) II Wednesday, May 8, 1:00 p.m.

ENHANCED RESIDENT LEADERSHIP PROGRAM

Supported in part by The Allergan Foundation and Lundbeck, LLC. Rachel Forman, MD / Chicago, IL / Rush University Medical Center Liana Theroux, MD / Charlottesville, VA / University of Virginia School of Medicine Maureen Handoko, MD, PhD / Houston, TX / Baylor College of Medicine Ezequiel Gleichgerrcht, MD / Charleston, SC / Medical University of South Carolina Neda Zarghami Esfahani, MD / Iowa City, IA / University of Iowa Hospitals and Clinics Vijay Ramanan, MD, PhD / Rochester, MN / Mayo Clinic

Long Davalos, MD / Cincinnati, OH / University of Cincinnati College of Medicine Margaret Blattner, MD, PhD / Saint Louis, MO / Washington University in St. Louis Elizabeth Duke, MD / Boston, MA / Boston Children's Hospital Sarah Woodson, MD / Bethesda, MD / NCC Walter Reed National Military Medical Center Saima Chaudhry, MD / Maywood, IL / Loyola University Medical Center Darrah Haffner, MD, MHS / Dallas, TX / University of Texas Southwestern Medical School Ashby Turner, MD / Cincinnati, OH / University of Cincinnati College of Medicine Allison Crowell, MD / Charlottesville, VA / University of Virginia Alicia Henriquez, MD / Aurora, CO / University of Colorado School of Medicine

FRANK A. RUBINO AWARD FOR EXCELLENCE IN CLINICAL NEUROLOGY TRAINING

Funded by Mayo Clinic Frank A. Rubino, MD, Development Fund.

Allen J. Aksamit, Jr. MD, FAAN / Rochester, MN / Mayo Clinic

H. RICHARD TYLER AWARD

Sponsored by the American Academy of Neurology and the American Academy of Neurology History Section.

This award was not given in 2019.

HAROLD WOLFF-JOHN GRAHAM AWARD

Sponsored by the American Academy of Neurology and endowed by Endo Pharmaceuticals.

Jelena Pavlovic, MD, PhD / New York, NY S20: Headache Imaging and Physiology and Episodic Syndromes Associated with Migraine Monday, May 6, 3:30 p.m.

INTERNATIONAL SCHOLARSHIP AWARD

Sponsored by the American Academy of Neurology.

Dona-Hui Ao, MD / Beijing, China Babawale Arabambi, MBBS, FWACP / Lagos, Nigeria Marjorie Anne Bagnas, MD / Manila, Philippines

Abiodun Bello, MBBS, FWACP / Ilorin, Nigeria Catalina Bensi, MD / Buenos Aires, Argentina Fabricio Castro de Borba, MD / São Paulo, Brazil Filipe Brogueira Rodrigues, MD, MSc / London, United Kingdom Avinash Chandra, MD / Kathmandu, India Marienke de Bruijn, MD / Tilburg, Netherlands Guillermo Delgado-Garcia, MD / Mexico City, Mexico Lingling Ding, MD / Beijing, China Victoria Carla Fernandez, MD / Buenos Aires, Argentina Divyani Garg, MBBS, MD / New Delhi, India Alicia Gonzalez-Martinez, MD / Madrid, Spain Wijoyo Halim, MD / Palu, Indonesia Calandri Ismael, MD / Buenos Aires, Argentina Joyce Jimenez-Zambrano, MD / Guayaquil, Ecuador Marilise Katsurayama, MD / São Paulo, Brazil Ravish Keni, MBBS, MD / Thiruvananthapuramm, India Priyanka Madaan, MD, DM / Chandigarh, India Mark Willy Mondia, MD / Manila, Philippines Tshering Pem, MBBS / Thimphu, Bhutan Chintan Prajapati, MBBS, MD / New Delhi, India Ahmed Effat Saied, MD, MSc / Mansoura, Egypt Lucas Scárdua Silva, MD / Campinas, Brazil Salma Suhana, MBBS, MD / Davanagere, India Satish Wagh, MD / Puducherry, India Sonam Yangzom, MBBS / Thimphu, Bhutan Florencia Yorio, MD / Buenos Aires, Argentina Stanley Zimba, MBChB, MMed / Lusaka, Zambia

IRWIN SCHATZ AWARD FOR AUTONOMIC DISORDERS

Sponsored by the American Academy of Neurology and endowed by Lundbeck, Inc. Roy Freeman, MD / Boston, MA S18: Autonomic Disorders Monday, May 6, 3:30 p.m.

Continued on page 9

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How Do You Compare?

NEUROLOGY COMPENSATION AND PRODUCTIVITY PHARMA AD Complete the AAN’s Neurology Compensation and Productivity Survey

by May 25 to find out!

AAN.com/view/BenchmarkReport

Conferences & Community

2019 AAN Award Winners Announced continued from page 7 JOHN DYSTEL PRIZE FOR MULTIPLE SCLEROSIS RESEARCH

Sponsored by the American Academy of Neurology and National Multiple Sclerosis Society and made possible through a special contribution from the John Dystel Multiple Sclerosis Research Fund at the National Multiple Sclerosis Society.

Anne Cross, MD / St. Louis, MO The Grand Experience Wednesday, May 8, 3:30 p.m.

JON STOLK AWARD IN MOVEMENT DISORDERS FOR YOUNG INVESTIGATORS

Sponsored by the American Academy of Neurology and endowed by Kyowa Pharmaceutical, Inc., Lineberry Research, Quintiles, Dr. Dennis Gillings, and VelaPharma.

Sheng-Han Kuo, MD / New York, NY S41: Imaging in Movement Disorders Wednesday, May 8, 3:30 p.m.

KENNETH M. VISTE, JR., MD, PATIENT ADVOCATE OF THE YEAR AWARD

Sponsored by the American Academy of Neurology and endowed by gifts from Dr. Viste’s colleagues, friends, and patients.

Aaron L. Berkowitz, MD, PhD / Boston, MA

LAWRENCE C. MCHENRY AWARD: AN AWARD FOR THE HISTORY OF NEUROLOGY

Sponsored by the American Academy of Neurology.

Stefano Sandrone, PhD / Milan, Italy S44: History of Neurology Thursday, May 9, 1:00 p.m.

MEDICAL STUDENT DIVERSITY SCHOLARSHIPS

Supported in part by grants from the Allergan Foundation

Laura Hernandez-Miyares / Philadelphia, PA / University of Pennsylvania, Perelman School of Medicine Kelly Boylan / Philadelphia, PA / University of Pennsylvania, Perelman School of Medicine Ganaelle Joseph-Senatus / Valhalla, New York / New York Medical College William Barbosa / New York, New York / New York University School of Medicine Felicia Cooper / Hershey, PA / Pennsylvania State University College of Medicine Joseph Aderemi / Auburn Hills, MI / Oakland University William Beaumont (OUWB) School of Medicine

Danielle Kellier / Philadelphia, PA / University of Pennsylvania, Perelman School of Medicine Jonathan Rodriguez / Caguas, Puerto Rico / San Juan Bautista School of Medicine Dayne Martinez / Philadelphia, PA / University of Pennsylvania, Perelman School of Medicine Mahdieh Hosseini / Philadelphia, PA / Lewis Katz School of Medicine at Temple University

MEDICAL STUDENT ESSAY AWARDS

Sponsored by the American Academy of Neurology.

Extended Neuroscience Award Laura McGarry / New York, NY Poster Session 2 Monday, May 6, 11:30 a.m.

MOVEMENT DISORDERS RESEARCH AWARD

Sponsored by the American Academy of Neurology, the Parkinson’s Foundation, and the American Academy of Neurology Movement Disorders Section and endowed by the Parkinson’s Foundation.

G. Milton Shy Award in Clinical Neurology Audrey Leasure / New Haven, CT Poster Session 2 Monday, May 6, 11:30 a.m.

Guenther Deuschl, MD, PhD / Kiel, Germany S16: Huntington’s Disease: From Bench to Clinical Trials Monday, May 6, 1:00 p.m.

Roland P. Mackay Award in Historical Aspects Stephanie Roses / Durham, NC Poster Session 2 Monday, May 6, 11:30 a.m.

MRIDHA SPIRIT OF NEUROLOGY HUMANITARIAN AWARD

Saul R. Korey Award in Experimental Neurology

Sponsored by the American Brain Foundation and funded through the philanthropy of Dr. and Mrs. Mridha.

Sona Mistry, MSc / Sheffield, United Kingdom Poster Session 2 Monday, May 6, 11:30 a.m.

James H. Bower, MD / Rochester, MN Global Health Section Meeting Monday, May 6, 8:15 a.m.

MICHAEL S. PESSIN STROKE LEADERSHIP PRIZE

NEUROENDOCRINE RESEARCH AWARD

Sponsored by the American Academy of Neurology and supported by friends of Dr. Andrew Herzog.

Sponsored by the American Academy of Neurology and endowed by Dr. Pessin’s family, friends, and colleagues.

Dena Dubal, MD / San Francisco, CA Neuroendocrinology Section Meeting

Alessandro Biffi, MD / Boston, MA S22: Stroke Genetics, Cellular Responses, and Animal Models Monday, May 6, 3:30 p.m.

NEUROLOGY® RESIDENT & FELLOW SECTION WRITING AWARD

Nathaniel M. Schuster / University of California, San Diego, MD Jacob R. Hascalovici, MD, PhD / Albert Einstein College of Medicine

MITCHELL B. MAX AWARD FOR NEUROPATHIC PAIN

Sponsored by the American Academy of Neurology and endowed by the United States Cancer Pain Relief Committee, the Mayday Fund, and friends of Dr. Mitchell Max.

NEURO-ONCOLOGY INVESTIGATOR AWARD

Sponsored by the American Academy of Neurology and supported by friends of Dr. Jerome Posner.

Troels Staehelin Jensen, MD, DMSc / Aarhus, Denmark S24: Lost Connections: From Functional Connectivity to Needs in Pain and Palliative Care Tuesday, May 7, 1:00 p.m.

Jorg Dietrich, MD, PhD / Boston, MA S14: Translational and Clinical Advances in Neuro-oncology Monday, May 6, 1:00 p.m.

Continued on page 15

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AANnews • April 2019 9

FOR THE TREATMENT OF RELAPSING FORMS OF MS

START STRONG. STAY STRONG.

In the 2-year DEFINE and CONFIRM pivotal trials, Tecfidera® (dimethyl fumarate) demonstrated a 53% and 44% relative reduction in annualized relapse rate (ARR) vs placebo, respectively (0.172 vs 0.364; P<0.0001), (0.224 vs 0.401; P<0.0001)2

INDICATION Tecfidera (dimethyl fumarate) is indicated for the treatment of patients 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

© 2019 Biogen. All rights reserved. 01/19 TEC-US-3189

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

THE #1 PRESCRIBED oral RMS therapy in the US since September 2013 Based on number of prescriptions from IMS NPA™ Weekly Data (September 27, 2013–December 14, 2018).

>340,000

people have been treated with TECFIDERA worldwide1

This includes clinical trial use and patients prescribed TECFIDERA

>625,000

global patient-years of treatment1

This includes clinical trial use and patients prescribed TECFIDERA

Over 10 Years 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 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.

of combined clinical trial and real-world experience1,2

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.

Please see following pages for Brief Summary of Full Prescribing Information.

Study Designs2 DEFINE: A 2-year, randomized, double-blind, placebocontrolled study in 1234 patients with RRMS. Secondary endpoint: ARR. CONFIRM: A 2-year, multicenter, randomized, double-blind, placebo-controlled study in 1417 patients with RRMS. Primary endpoint: ARR. RMS=relapsing multiple sclerosis; DEFINE=Determination of Efficacy and Safety of Oral Fumarate in Relapsing-Remitting Multiple Sclerosis; CONFIRM=Comparator and an Oral Fumarate in Relapsing-Remitting Multiple Sclerosis; RRMS=relapsing-remitting multiple sclerosis.

References: 1. Data on file, Biogen. 2. TECFIDERA Prescribing Information, Biogen, Cambridge, MA.

To get started, simply fill out a Start Form at

www.tecfiderahcp.com

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. Š 2013-2017 Biogen 2/18

Conferences & Community

2019 AAN Award Winners Announced continued from page 9 NEURO-ONCOLOGY SCIENTIFIC AWARD

Sponsored by the American Academy of Neurology and supported by friends of Dr. W.K. Alfred Yung.

Andreas von Deimling, MD / Heidelberg, Germany S14: Translational and Clinical Advances in Neuro-oncology Monday, May 6, 1:11 p.m.

NEUROSCIENCE RESEARCH PRIZE

Funded by the American Academy of Neurology.

Rachel Chernoff / Armonk, NY Poster Session 1 Sunday, May 5, 11:30 a.m.

Kevin Zhong / Basking Ridge, NJ Poster Session 1 Sunday, May 5, 11:30 a.m.

Caleb Shi / Hackensack, NJ Poster Session 1 Sunday, May 5, 11:30 a.m.

NORMAN GESCHWIND PRIZE IN BEHAVIORAL NEUROLOGY

Sponsored by the American Academy of Neurology and endowed through Dr. Geschwind’s family, friends, and colleagues; Pfizer Inc; and the Society for Behavioral and Cognitive Neurology.

Sonja Scholz, MD / Bethesda, MD S13: Behavioral and Cognitive Neurology: Behavioral Neurology, Aging, and Dementia Monday, May 6, 1:00 p.m.

POTAMKIN PRIZE FOR RESEARCH IN PICK’S, ALZHEIMER’S, AND RELATED DISEASES

Sponsored by the American Academy of Neurology and the American Brain Foundation and funded through the philanthropy of the Potamkin family.

Randall Bateman, MD / St. Louis, MO The Grand Experience Monday, May 6, 3:30 p.m.

PROGRAM COORDINATOR RECOGNITION AWARD

Ann Chowdhury Johnson, BA, C-TAGME / Phoenix, AZ / Barrow Neurological Institute Michelle R. Armstrong, MAEd, C-TAGME / Maywood, IL / Loyola University Medical Center

PROGRAM DIRECTOR RECOGNITION AWARD

Audrey Foster-Barber, MD, PhD / San Francisco, CA / UCSF Child Neurology Donald Gilbert, MD, FAAN / Cincinnati, OH / Cincinnati Children's Hospital Medical Center

PUBLIC LEADERSHIP IN NEUROLOGY AWARD

Sponsored by the American Brain Foundation.

Ann Romney / Salt Lake City, UT Commitment to Cures Wednesday, May 8, 6:00 p.m.

SAFETY AND QUALITY AWARD

Sponsored by the American Academy of Neurology.

Monisha A. Kumar, MD, and David G. Coughlin, MD / Philadelphia, PA Green Sheet Tool to Limit Unplanned ICU Readmission Danielle Larson, MD / Chicago, IL Development of a Parkinson’s Disease-specific Admission Order Set and Its Impact on Inpatient Medication Administration Elanagan Nagarajan, MD / Columbia, MO Hematoma Risk After Needle EMG in Patients with Newer Anticoagulation Minh-Thuy Nguyen / Boston, MA Improving Stroke Education in Spanishspeaking Patients

2019 RESEARCH PROGRAM RECIPIENTS CAREER DEVELOPMENT AWARD

Funded by the American Academy of Neurology.

Shouri Lahiri, MD / Cedars-Sinai Medical Center Susanna Mierau, PhD, MD / University of Cambridge

CLINICAL RESEARCH TRAINING SCHOLARSHIP

SHEILA ESSEY AWARD: AN AWARD FOR ALS RESEARCH

Funded by the American Academy of Neurology.

Aaron Gitler, PhD / Stanford, CA The Grand Experience Tuesday, May 7, 3:30 p.m.

Prashanth Ramachandran, MBBS / University of California, San Francisco Karisa Schreck, MD, PhD / Johns Hopkins University Jennifer Kim, MD, PhD / Massachusetts General Hospital, Brigham and Women’s, Harvard

Sponsored by the American Academy of Neurology, the American Brain Foundation and the ALS Association and supported through the philanthropy of the Essey Family and the ALS Association.

CLINICAL RESEARCH TRAINING SCHOLARSHIP IN ALS

SLEEP SCIENCE AWARD

Sponsored by the American Academy of Neurology and the American Academy of Neurology Sleep Section and endowed by Cephalon, Inc.

Funded by The ALS Association and American Brain Foundation in collaboration with the American Academy of Neurology.

Clifford Saper, MD, PhD / Boston, MA S46: Sleep Science and Therapy Updates Thursday, May 9, 1:00 p.m.

Jennifer Marsella, MD / University of Rochester

CLINICAL RESEARCH TRAINING SCHOLARSHIP IN HEADACHE

WAYNE A. HENING SLEEP MEDICINE INVESTIGATOR AWARD

Funded by the International Headache Society and American Brain Foundation in collaboration with the American Academy of Neurology.

Sponsored by the American Academy of Neurology and endowed by UCB, Inc., Lilly USA, Elite Home Medical & Respiratory, Inc., Raleigh Neurology Associates, and friends of Dr. Wayne A. Hening.

Faisal Amin, MD, PhD / Rigshospitalet

CLINICAL RESEARCH TRAINING SCHOLARSHIP IN MULTIPLE SCLEROSIS

Diego Carvalho, MD / Rochester, MN S46: Sleep Science and Therapy Updates Thursday, May 9, 1:22 p.m.

Funded by the Consortium of Multiple Sclerosis Centers, Biogen, and American Brain Foundation in collaboration with the American Brain Foundation.

Ulrike Kaunzner, MD / New York Presbyterian Hospital, Weill Cornell Medical Center Continued on page 16

›

AANnews • April 2019 15

Conferences & Community

2019 AAN Award Winners Announced continued from page 15 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.

This award was not given for 2019.

CLINICAL RESEARCH TRAINING SCHOLARSHIP IN NEUROMUSCULAR DISEASE

Funded by the Muscle Study Group and American Brain Foundation in collaboration with the American Academy of Neurology.

Reza Seyedsadjadi, MD / Massachusetts General Hospital, Brigham and Women’s, Harvard

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.

David Coughlin, MD / University of Pennsylvania

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.

Anna Goodheart, MD / Massachusetts General Hospital, Brigham and Women’s, Harvard

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.

Jennifer Vermilion, MD / University of Rochester

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.

Kevin Keenan, MD / University of California, San Francisco

CLINICIAN SCIENTIST DEVELOPMENT AWARD IN MULTIPLE SCLEROSIS

Funded by the National Multiple Sclerosis Society and American Brain Foundation.

Omar Al-Louzi, MD / National Institutes of Health

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.

AANnews • April 2019

SUSAN S. SPENCER CLINICAL RESEARCH TRAINING SCHOLARSHIP IN EPILEPSY

Shruti Raja, MD / Duke University Medical Center

Funded by the American Epilepsy Society, Epilepsy Foundation, and American Brain Foundation in collaboration with the American Academy of Neurology.

LAWRENCE M. BRASS STROKE RESEARCH AWARD

Lisseth Burbano, MD / Florey Institute of Neuroscience and Mental Health 

Funded by the American Heart Association and American Stroke Association and the American Brain Foundation.

Jiang Xiaoyan, MD, PhD / University of Pittsburgh

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.

Sanaz Sedaghat, PhD / Feinberg School of Medicine, Northwestern University Christian Camargo, MD / University of Miami School of Medicine

NEUROSCIENCE RESEARCH TRAINING SCHOLARSHIP

Funded by the American Academy of Neurology.

Gary Ho, MD, PhD / Massachusetts General Hospital, Brigham and Women’s, Harvard Victoria Ho, MD, PhD / UCLA Kellen Winden, MD, PhD / Children’s Hospital Boston

PRACTICE RESEARCH TRAINING SCHOLARSHIP

Funded by the American Academy of Neurology.

Elan Guterman, MD / University of California, San Francisco

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.

Suma Babu, MD / Massachusetts General Hospital, Brigham and Women’s, Harvard

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.

16

Hyun-Sik Yang, MD / Massachusetts General Hospital, Brigham and Women’s, Harvard

Join Us in Celebrating Awards in a New Way! Join us at The Grand Experience stage for three special award presentations, each followed by a panel Q&A discussion with new award recipients.

Potamkin Prize for Research in Pick’s, Alzheimer’s, and Related Diseases Monday, May 6 at 3:30 p.m.

Recipient: Randall Bateman, MD Sheila Essey Award: An Award for ALS Research Tuesday, May 7 at 3:30 p.m.

Recipient: Aaron Gitler, PhD John Dystel Prize for Multiple Sclerosis Research Wednesday, May 8 at 3:30 p.m.

Recipient: Anne Cross, MD

Conferences & Community

Vote on AAN and AAN Institute Board Nominees at Business Meeting Members are encouraged to attend the AAN’s 2019 Business Meeting on Saturday, May 4, 2019, at 3:00 p.m. during the Annual Meeting in Philadelphia, PA, to participate in this election of the slate of nominees for AAN officer and director positions for the 2019–2021 term. The meeting will include reports from officers on the accomplishments of the AAN during 2018 and a review of the organizations’ fiscal health.

The current President Elect, James C. Stevens, MD, FAAN, will begin his term as President on May 11, 2019. The current President, Ralph L. Sacco, MD, MS, FAHA, FAAN, will then serve on the Board of Directors as Immediate Past President.

Officers: President Elect—Orly Avitzur, MD, MBA, FAAN Vice President—Ann H. Tilton, MD, FAAN Secretary—Carlayne E. Jackson, MD, FAAN Treasurer—Janis M. Miyasaki, MD, MEd, FRCPC, FAAN

Directors: Brenda Banwell, MD, FAAN Sarah M. Benish, MD, FAAN Charlene Gamaldo, MD, FAAN James N. Goldenberg, MD, FAAN Jonathan P. Hosey, MD, FAAN Elaine C. Jones, MD, FAAN Shannon M. Kilgore, MD, FAAN Brett M. Kissela, MD, MS, FAAN Thomas R. Vidic, MD, FAAN

Robert A. Gross, MD, PhD, FAAN, Editor-in-Chief of Neurology ® Catherine M. Rydell, CAE, Executive Director/CEO (non-voting)

Natalia S. Rost, MD, MPH, FAAN, FAHA, Chair, Science Committee (ex officio) Lyell K. Jones, Jr., MD, FAAN, Chair, Quality Committee (ex officio) A. Gordon Smith, MD, FAAN, Chair, Education Committee (ex officio) Robert A. Gross, MD, PhD, FAAN, Editor-in-Chief of Neurology (ex officio) Catherine M. Rydell, CAE, Executive Director/CEO (ex officio, non-voting)

The Academy is comprised of two legal entities, the AAN and the AAN Institute.

Most of the elected members of the AAN Board of Directors also serve ex officio on the Board of Directors of the AAN Institute, which includes an independent secretarytreasurer and additional members who serve in ex officio capacities. The AAN Institute Board of Directors will include the following members: Charles C. Flippen II, MD, FAAN, AAN Institute Secretary-Treasurer

Visit AAN.com/view/BOD to see the full slate of candidates and their bios. For more information, contact Karen Kasmirski, Executive Assistant, at kkasmirski@aan.com or (612) 928-6118. 

The following additional directors will serve as ex officio directors beginning on May 11: Nicholas E. Johnson, MD, FAAN, Chair, Advocacy Committee Brad C. Klein, MD, MBA, FAAN, Chair, Medical Economics and Practice Committee Gregory D. Cascino, MD, FAAN, Chair, Member Engagement Committee

Applications Double for 2019 Medical Student Scholarship to the Annual Meeting In only its second year, applications nearly doubled for the 2019 Medical Student Experience at the Annual Meeting Scholarship, a program that is made possible in part by a grant from the Conrad N. Hilton Foundation. In 2018, the program, which is designed to provide first-, second-, and third-year medical students with a personalized introduction to the field of neurology and exposure to diverse neurologic subspecialties and career options, attracted 66 applications, resulting in 45 awarded scholarships. This year, 55 students interested in exploring the field of neurology were selected for the Annual Meeting out of 126 applications.

In addition to the unique chance to take part in dedicated Annual Meeting educational activities, scientific presentations from leaders in the field of neurology, mentoring, and other opportunities to enrich their medical careers and broaden their professional networks, recipients also receive airfare, lodging, registration, a per diem, a certificate of recognition, a special meet-and-greet session, and attend the Sunday Medical Student Symposium: Careers in Neurology. 

AANnews • April 2019 17

Conferences & Community

Popular ‘Continuing the Conversation’ Opportunities Expanded for 2019 In response to last year’s successful pilot “Continuing the Conversation” programs, 2019 Annual Meeting attendees can expect to find even more opportunities to connect one-on-one with faculty, directors, and other attendees via 30-minute, small-group conversations at the conclusion of select courses. New this year is the addition of two programs that will offer similar post-course opportunities to talk one-on-one with a coding expert.

Continuing the Conversation

C34: E valuating Tremor in the Office Saturday, May 4 / 3:30 p.m.–4:00 p.m.

C76: Assessment of Rapidly Progressive Dementias II: Infections and Autoimmune Mediated Conditions Sunday, May 5 / 5:30 p.m.–6:00 p.m.

C120: Clinical EMG II: Case-based Clinical Applications of Nerve Conduction Studies and Needle Electromyography Monday, May 6 / 5:30 p.m.–6:00 p.m.

C164: Update on Medical Management of Stroke Tuesday, May 7 / 5:30 p.m.–6:00 p.m.

C204: N euro-ophthalmology III: Diplopia, Ocular Motility Disorders, and Nystagmus Wednesday, May 8 / 5:30 p.m.–6:00 p.m.

C203: Comprehensive Migraine Update II: Pharmacologic and Non-pharmacologic Therapies Wednesday, May 8 / 5:30 p.m.–6:00 p.m.

C236: N euro-rheumatology: Neurological Manifestations of Systemic Inflammatory and Autoimmune Disease II Thursday, May 9 / 5:30 p.m.–6:00 p.m.

NEW Continuing the Conversation: Coding C68: C erebrovascular Disease IV: Telestroke Sunday, May 5 / 3:30 p.m.–5:30 p.m.

C155: D eep Brain Stimulation II: Advanced Management in Movement Disorders and Applications Beyond Movement Disorders Tuesday, May 7 / 5:30 p.m.–6:00 p.m. 

Make the Innovation Hub Your Destination for Innovation Look for the space-themed Innovation Hub Experiential Learning Area in Exhibit Hall B and make it your destination for fun, dynamic, and innovative opportunities to recharge and tap into your creative side during your week in Philadelphia. From lively wine and paint sessions and medical improv to the popular Brainstorm competition, this unique area will help you get thinking differently about ways to approach your practice, patient care, and the future of neurology.

And don’t forget to look for these compelling new talks by leading topic experts going on throughout the week: A Novel Clinical Practice Model in Neurology Clinics: Practice Transformation Telemedicine FAILs: What Not to Do in a Telemedicine Encounter AI in Health Care: A Bridge to Physician Wellness Using Strategic Partnerships to Grow Your Practice Leveraging Technology to Reduce Implicit Bias and Improve Population Health Metrics

Advancements in Real-time Clinical Practice Innovations Remote Monitoring of Neurological Patients via Mobile Health Platform How to Build Clinical Research Studies in Private Practice What Can the AAN’s Compensation and Productivity Survey Do for You? Immersive Environments to Assess and Treat Traumatic Brain Injury: Reversing a Maladaptive Cortical Response to Injury

Fitness to Drive Testing…Warp Speed Ahead Potential Pitfalls in Telemedicine Visit AAN.com/view/ELA for more details, then be sure to stop by to explore this final frontier. 

MEM Plac 8.25

Conferences & Community

‘Neighborhoods’ Make Poster Session Easy to Navigate With 10 unique topic-related “neighborhoods” in each of this year’s five poster sessions, navigating your way to the breakthrough research of most interest to you is as easy as 1-2-3. Sessions will run daily in Exhibit Hall E from Sunday, May 5, through Thursday, May 9, from 11:30 a.m. to 6:30 p.m. with author standby between 5:30 p.m. and 6:30 p.m.

Publication Code Example: P1.2–003 P1 = Poster Session Number 2 = Neighborhood 003 = Poster Board Number 

001 006 007 012 013 018 019 024 025 030 031 036

002 005 008 011 014 017 020 023 026 029 032 035

003 004 009 010 015 016 021 022 027 028 033 034

001 016 017 032 033 048 049 064 065 080 081 096 097 112

002 015 018 031 034 047 050 063 066 079 082 095 098 111

003 014 019 030 035 046 051 062 067 078 083 094 099 110

004 013 020 029 036 045 052 061 068 077 084 093 100 109

005 012 021 028 037 044 053 060 069 076 085 092 101 108

006 011 022 027 038 043 054 059 070 075 086 091 102 107

007 010 023 026 039 042 055 058 071 074 087 090 103 106

008 009 024 025 040 041 056 057 072 073 088 089 104 105

001 002 003 004 005 006 012 011 010 009 008 007

1 2 3 001 006 007 012 013 018 019 024 025 030 031 036

002 005 008 011 014 017 020 023 026 029 032 035

003 004 009 010 015 016 021 022 027 028 033 034

013 014 015 016 017 018 024 023 022 021 020 019 025 026 027 028 029 030 036 035 034 033 032 031 037 038 039 040 041 042 048 047 046 045 044 043 049 050 051 052 053 054 060 059 058 057 056 055 061 062 063 064 065 066 072 071 070 069 068 067

4 5 6

001 002 003 004 005 006 012 011 010 009 008 007 013 014 015 016 017 018 024 023 022 021 020 019 025 026 027 028 029 030 036 035 034 033 032 031 037 038 039 040 041 046 045 044 043 042

001

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001 002 003 004 005 006 007 008 016 015 014 013 012 011 010 009 017 018 019 020 021 022 023 024 032 031 030 029 028 027 026 025 033 034 035 036 037 038 039 040 048 047 046 045 044 043 042 041 049 050 051 052 053 054 055 056 064 063 062 061 060 059 058 057 065 066 067 068 069 070 071 072 080 079 078 077 076 075 074 073

005 006

ePosters

Special Neuroimaging Posters and Talks on Friday!

Be sure to Horizontal> stop back to M: 19 FAAN Ad—Half Page ANExhibit Hall E during Friday’s Grand Finale lunch ced in AANnewsbetween 11:30 a.m. and 1:00 p.m. as the area is transformed to highlight 5 x 5.25 +0.125 bleed, 4C abstracts and talks related specifically to neuroimaging. 

8 9 10

001 002 003 004 005 006 007 014 013 012 011 010 009 008

001 016 017 032

008 009 024 025

001 002 003 004 008 007 006 005

015 016 017 018 019 020 021 028 027 026 025 024 023 022

033 034 035 036 037 038 039 040 048 047 046 045 044 043 042 041

009 010 011 012 016 015 014 013

029 030 031 032 033 034 035 042 041 040 039 038 037 036

049 050 051 052 053 054 055 056 064 063 062 061 060 059 058 057

017 018 019 022 021 020

043 044 045 046 047 048 049 056 055 054 053 052 051 050

065 080 081 086

002 015 018 031

066 079 082 085

003 014 019 030

004 013 020 029

005 012 021 028

006 011 022 027

007 010 023 026

067 068 069 070 071 072 078 077 076 075 074 073 083 084

023 024 025 028 027 026

Shine a light on your achievements Apply for a prestigious Fellow of the American Academy of Neurology (FAAN) designation.

AAN.com/view/FAAN

Conferences & Community

Top Researchers to Present Latest Advances During Plenary Sessions From the hottest translational research and other important clinical topics to controversial issues and a year-end review of top findings, this year’s plenary sessions will feature an impressive lineup of researchers showcasing their very latest breakthroughs in neuroscience. For the full roster of all seven plenary sessions, including the Frontiers and Presidential Plenary Sessions, visit AAN.com/view/plenary.

Hot Topics Plenary Session

Contemporary Clinical Issues Plenary Session

Features the latest, cutting-edge translational research related to clinical issues of importance. Four outstanding speakers will provide summaries of their recent research findings and describe the clinical implications of the results.

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

Saturday, May 4, 4:15 p.m.–5:30 p.m.

Moderator

Eric Klawiter, MD, FAAN Massachusetts General Hospital, Boston, MA Member, AAN Science Committee

Immunotherapies in Movement Disorders Virginia Lee, PhD University of Pennsylvania, Philadelphia, PA Evolution of AAVs for Widespread Gene Delivery to the Central Nervous System Sripriya Ravindra Kumar Gradinaru Lab, California Institute of Technology, Pasadena, CA Solving Neurological Mysteries with Lesion Network Mapping Michael D. Fox, MD, PhD Beth Israel Deaconess Medical School, Boston, MA Patient-Customized Oligonucleotide Therapy for an Ultra-Rare Neurogenetic Disease Timothy W. Yu, MD, PhD Boston Children’s Hospital, Boston, MA

Monday, May 6, 9:15 a.m.–11:30 a.m.

Moderator

Randolph S. Marshall MD, FAAN Columbia University, New York, NY Vice Chair, AAN Science Committee

Implementation and Patient Experience with Outpatient Subspecialty Teleneurology Visits at a Single Academic Institution over Four Years Presenter Lindsay Ross, MD Cleveland Clinic Foundation, Cleveland, OH Discussant Lawrence R. Wechsler, MD, FAAN University of Pittsburgh School of Medicine, Pittsburgh, PA Amyloid PET Leads to Frequent Changes in Management of Cognitively Impaired Patients: The Imaging DementiaEvidence for Amyloid Scanning (IDEAS) Study Presenter Gil Dan Rabinovici, MD University of California San Francisco Memory & Aging Center, San Francisco, CA Discussant Eric M. Reiman, MD Banner Alzheimer’s Institute, Phoenix, AZ

Pilot Study of Adoptive Cellular Immunotherapy for Progressive Multifocal Leukoencephalopathy with Ex Vivo Generated Polyomavirus-specific T-cells Presenter Irene C.M. Cortese, MD National Institutes of Health, Bethesda, MD Discussant Carolyn B. Britton, MD Columbia University Irving Medical Center, New York, NY Continuous Theta Burst Stimulation over Right Pars Triangularis Facilitates Naming Abilities in Chronic Post-stroke Aphasia by Enhancing Phonological Access Presenter Denise Y. Harvey, PhD University of Pennsylvania, Philadelphia, PA Discussant Eric M. Wassermann, MD National Institutes of Health, Bethesda, MD AFM: Beyond Acute and Flaccid Teri Schreiner, MD, MPH Children’s Hospital Colorado Department of Neurology, Aurora, CO Advances in the Acute Treatment of Migraine Jessica Ailani, MD Medstar Georgetown Neurology, McLean, VA

Clinical Trials Plenary Session Tuesday, May 7, 9:15 a.m.–11:30 a.m.

Covers important clinical topics identified from other society meetings that affect patient care. The latest updates within several clinical trials conducted over the course of the last year will be presented.

Moderators

Holly E. Hinson, MD, MCR, FAAN Oregon Health & Science University, Portland, OR Member, AAN Science Committee Deborah Hall, MD, PhD, FAAN Rush University, Chicago, IL Member, AAN Science Committee

SPRINT MIND: Results Update and Future Directions Jeff Williamson, MD Wake Forest Baptist Health, Wake Forest, NC Intravenous Immunoglobulin to Prevent Myasthenic Crisis After Thymectomy and Other Surgical Procedures Can Be Omitted: A Randomized, Controlled, Double-blind Trial Josep Gamez, MD, PhD Hospital Universitari Vall D’Hebron, Barcelona, Spain A Placebo-Controlled Study of Galcanezumab in Patients with Episodic Cluster Headache: Results from the 8-week Double-blind Treatment Phase David W. Dodick, MD, FAAN Mayo Clinic Arizona, Scottsdale, AZ

From Bench to Bedside to Beam: Hippocampal-sparing During Brain Irradiation Vinai Gondi, MD Radiation Oncology Consultants, Chicago, IL Randomized Controlled Trial of Inebilizumab in Neuromyelitis Optica Spectrum Disorder Bruce A.C. Cree, MD, PhD, MCR, FAAN University of California San Francisco, Multiple Sclerosis Center, San Francisco, CA rAAV2/2-ND4 for the Treatment of LHON: 72-week Data from the REVERSE Phase III Clinical Trial Mark L. Moster, MD, FAAN Wills Eye Hospital, Philadelphia, PA

Use of Tranexamic Acid in Patients with Traumatic Brain Injury: Results from the North American Multi-Center Prehospital TXA for TBI Trial Susan Rowell, MD, MCR Oregon Health & Science University, Portland, OR Continued on page 22

›

Conferences & Community

Top Researchers to Present Latest Advances During Plenary Sessions continued from page 21 Controversies in Neurology Plenary Session

Neurology Year in Review Plenary Session

Features experts discussing the most current and controversial issues in neuroscience. The session follows a debate-style format in which two speakers argue one side of a topic, followed by a rebuttal.

Features six speakers, each focusing on the latest research that has happened in the last year within a specific subspecialty topic.

Thursday, May 9, 9:15 a.m.–11:30 a.m.

Moderators

Amy R. Brooks-Kayal, MD, FAAN Children’s Hospital Colorado, Aurora, CO Member, AAN Science Committee Aleksandar Videnovic, MD, MSc, FAAN MGH Neurological Clinical Research Institute, Boston, MA Member, AAN Science Committee

Should Ambulances Bypass Primary Stroke Centers for Comprehensive Stroke Centers?

Yes: Lee H. Schwamm, MD Massachusetts General Hospital Department of Neurology, Boston, MA No: Johanna Therese Fifi, MD Mount Sinai Hospital, New York, NY

Saving the Clinical Art of Neurology: Humans Versus Machines?

Yes: Joseph R. Berger, MD, FAAN University of Pennsylvania, Philadelphia, PA No: David E. Newman-Toker, MD, PhD, FAAN Johns Hopkins University, Baltimore, MD

Continuous EEG in the ICU: Does it Really Matter?

Yes: Emily Jean Gilmore, MD Yale University School of Medicine, New Haven, CT No: Brandon P. Foreman, MD University of Cincinnati, Cincinnati, OH

22

AANnews • April 2019

Friday, May 10, 9:15 a.m.–11:30 a.m.

Moderator

Martinson K. Arnan, MD Bronson Neuroscience Center/Western Michigan University, Kalamazoo, MI Member, AAN Science Committee

Amyotrophic Lateral Sclerosis Jinsy Andrews, MD, FAAN Columbia University Medical Center, New York, NY Sleep

Alberto Ramos, MD Miller School of Medicine, Miami, FL

Emerging Neuromodulation Strategies for Traumatic Myelopathies Leif A. Havton, MD, PhD UCLA School of Medicine, Los Angeles, CA Neurology of Pregnancy Annette M. Langer-Gould, MD, PhD Kaiser Permanente Southern California, Pasadena, CA Non-Alzheimer’s Dementia and Cognitive Neurology Lauren R. Moo, MD Massachusetts General Hospital, Boston, MA Neuromyelitis Optica Spectrum Disorders: What a Difference a Few Years Makes Stacey Clardy, MD, PhD University of Utah, Salt Lake City, UT

Conferences & Community

DeAngelis to Receive President’s Award Lisa M. DeAngelis, MD, FAAN, has been selected by President Ralph L. Sacco, MD, MA, FAHA, FAAN, to receive the President’s Award for 2019.

Citing but a few of her many her accomplishments, Sacco said, “Dr. DeAngelis is chair of the department of neurology at Memorial Sloan Kettering Cancer Center, where she holds the Lillian Rojtman Berkman Chair in honor of Dr. Jerome Posner and is currently acting physician in chief. She has published extensively on a wide variety of topics in neuro-oncology and is particularly known for developing the current standard regimen to treat primary CNS lymphoma, the first brain tumor to be treated with chemotherapy exclusively. Lisa’s efforts have forever changed the strategic direction of our organization. She

has served on numerous subcommittees and committees and twice on the AAN Board of Directors. She has strengthened the AAN’s efforts for science by advancing our engagement with the NIH and other organizations. She also led the AAN’s Diversity Leadership Task Force. Given DeAngelis these multiple major contributions to advancing the AAN mission, Lisa is an exemplary leader and role model, and fully deserving of the 2019 President’s Award for her outstanding service to the AAN.” DeAngelis will receive the award during the Presidential Plenary Session on May 5 at the Annual Meeting. 

Neuro Center’s Picnic Area to Offer Music, Food, Fun Annual Meeting attendees will want to make sure and build time in their schedules to stop by the Neuro Center in Exhibit Halls B-E of the Pennsylvania Convention Center to take in the sights, sounds, and smells of the new Picnic Area. Open Sunday, Tuesday, and Wednesday from 11:30 a.m. to 4:00 p.m. and Monday from 11:30 a.m. to 6:00 p.m., the Picnic Area will provide a unique gathering space—complete with picnic tables and “turf”—for attendees to convene, eat lunch, socialize, and unwind with: Live music during select events, including the Bavarian-themed Exhibit Hall Opening Luncheon and Networking Reception Bingo from 1:00 p.m.–2:00 p.m. daily with chances to win prizes

Chef plating competition from 12:15 p.m.–12:45 p.m. Monday through Wednesday featuring four teams of three to four attendees competing for the most aesthetically pleasing arrangements of

pre-determined courses—including tasting samples for spectators An array of fun and challenging board games 

Registration Opens This Month for Sports Concussion Conference Registration opens early April for the 2019 AAN Sports Concussion Conference, set for July 26 through 28 in Indianapolis, IN. The conference will bring together top experts to present the latest scientific advances and best practices for the prevention, diagnosis, and management of sport-related concussion from youth on up to professional levels. This year’s highlights will include: An updated bootcamp offering more A keynote address on The Science of Seeking Concussion-related Abstracts hands-on training than ever before Concussion: Perspectives from the The 2019 Sports Concussion Conference Department of Defense A session specifically for athletic is currently accepting scientific abstract trainers that will focus on sideline A reception at the NCAA Hall of submissions on topics related to sports evaluation and management of Champions concussion. The submission deadline concussion is May 16, and submission of previously Look for more information and A report from the CDC, including an presented work is encouraged if it is of registration to open at AAN.com/view/SCC. overview of the CDC’s role in sports interest to the field. Visit AAN.com/view/ concussion prevention SCC for more on submission guidelines and to submit. 

SPORTS CONCUSSION JULY 26–28, 2019 INDIANAPOLIS, IN

CONFERENCE

AANnews • April 2019 23

WE’RE LOOKING AT Ms INSIDE AND OUT We are digging deeper and exploring different options that may hold the next big advancement in the science of multiple sclerosis—right now.

Whether it’s hidden in the innate and adaptive immune systems, tertiary lymphoid tissue, B and T cell interaction, or beyond the blood-brain barrier—it’s time to take a closer look, and build a better future for patients.

Join us at GetCloserToMS.com

©2018 EMD Serono Inc. All rights reserved. US/CLA/0518/0034

Conferences & Community

Applications Open This Month for Four Empowering Leadership Programs continued from cover Past participants of these all-expenses-paid programs have found them to be incredibly valuable—specifically, the personalized coaching with industry-leading consultants, mentorship by neurology leaders, and expansion of professional network. And the AAN as an organization has also benefitted greatly from these graduates, many of who started out serving the Academy through one of these programs and went on to achieve work group, committee, and even board of director positions.

Visit AAN.com/view/lead beginning April 15 to submit your application. The deadline to apply is June 17.

Transforming Leaders Program

Designed to help you turn your aspirations to transform your community, institution, or field of neurology into reality through executive-level coaching and a fully customized intensive leadership development training program.

As a participant, you will: Learn how to contribute more meaningfully, in turn reducing burnout and shifting focusing on your highest priorities Become an agent of change with increased confidence to understand, analyze, and solve programs Break through barriers to achieve your goals with more clarity, efficiency, and less conflict Learn how to work better in teams, leverage the unique strengths of team members, and inspire and motivate team members to achieve common goals.

Take advantage of networking opportunities with AAN Board and committee members Join a supportive network of like-minded individuals with an interest in future roles of responsibility within the AAN and field of neurology This program is supported in part by Allergan, Inc., Neurocrine Biosciences, and Sanofi Genzyme.

Emerging Leaders Program

Designed to identify, engage, and mentor talent among early-career members interested in future leadership roles within the AAN and the field of neurology. As a participant, you will: Gain career-building experience through an assigned leadership project to help the Academy advance its mission and support members Learn tools to develop self-awareness and improve communication Develop organizational leadership skills and learn tactics for leading both yourself and others Obtain an in-depth knowledge of the Academy structure, organization, mission, and leverageable resources Take advantage of networking opportunities with AAN committee chairs and leaders Gain confidence in your abilities to tackle new opportunities and challenges Find inspiration and support through a network of like-minded individuals

26

AANnews • April 2019

This program is supported in part by ACADIA Pharmaceuticals, Inc., Sanofi Genzyme, and Supernus Pharmaceuticals, Inc.

Women Leading in Neurology

Designed to tackle gender disparities head-on and help women advance to the top levels of leadership in their fields and within the Academy. As a participant, you will: Address sensitive topics of gender bias and disparity in medicine and learn skills to address those biases Hone your executive presence to empower and influence others Learn to negotiate for what you want and manage and lead with confidence Find a strong community and mentorship with like-minded women from within the AAN’s expansive network as the largest association of neurologists Learn tools and tactics to set goals, seek balance, and identify your biggest priorities both personally and professionally This program is supported in part by ACADIA Pharmaceuticals, Inc., Allergan, Inc., and UCB, Inc.

Practice Leadership Program

Designed to identity and engage solo and small practitioners interested in helping to shape the future of neurology within the AAN and/or their communities. The program’s flexible schedule was designed to accommodate restricted schedules of busy practitioners. As a participant, you will: Learn strategies for business growth, how to effectively negotiate contracts, and improve your understanding of coding and reimbursement for future payment models Understand the changing regulatory burden and mitigate its demands on your practice Learn strategies to effectively lead staff and run efficient office hours Obtain an in-depth knowledge of the Academy structure, organization, mission, and resources that you can leverage to help you on your leadership journey Connect with a mentor and like-minded support network of individuals who understand and may have dealt with your same unique challenges 

Tools & Resources

Get Data You Need to Improve Your Compensation and Productivity Do you know what the average salary is for your subspecialty?

Do you know what the average wait time is for patients in your area? Do you know what the average rate is for on-call services? Without data, you’re flying blind. Take the Neurology Compensation and Productivity Survey to help you make data driven decisions.

Nearly 1,400 AAN members submitted data in 2017, making this the largest survey and report dedicated to the field of neurology and neurologic subspecialties. But the data doesn’t work without you. The more respondents the survey has—whether new or past participants—the stronger the data is for everyone in the field of neurology As the landscape of medicine continues to change, having access to neurology-specific benchmarks can help you make datainformed decisions. Participating in the AAN’s Compensation and Productivity Survey, now open until May 25, and sharing your de-identified, protected data, is the only way you can gain free access to this treasure trove of data.

Members who have participated in previous surveys have greatly valued the insights they have gained, not only being able to compare their compensation and productivity to their peers and advocating for themselves but finding insights on ways to improve their practices.

“The AAN’s Neurology Compensation and Productivity Report is an essential tool for our practice,” said David A. Evans, MBA, chief operating officer of Texas Neurology in Dallas and chair of the AAN’s Practice Management and Technology Subcommittee. “By having comparative data, we have been able to identify variances in several areas to include compensation, call pay, benefits, and RVUs. I also use it to analyze the ratios between metrics, such as compensation-to-RVUs and call pay-to-number of hospital beds. When I filter using varying criteria on the report’s online dashboard, I am always finding actionable data points.”

Evans

Klein

Markowski

“Reviewing [the] ancillary services provided by colleagues encouraged us to look into and implement additional services in our community,” said AAN Board Member Brad C. Klein, MD, MBA, FAAN, Abington Neurological Associates, vice chair of AAN’s Medical Economics and Management Committee.

You also can use the data to advocate on your behalf, as Michael E. Markowski, DO, FAAN, did. “We were able to reference this report’s compensation data to agree upon fair market salary for our region and practice setting as well as set reasonable RVU productivity parameters.”

By participating, you’re helping maintain the survey’s reputation as the largest neurology-specific survey resulting in actionable data that participants can use to compare their compensation, identify improvement opportunities in their practices, and help the Academy spot trends and areas of concern.

Participate by May 25 in order to receive free access to the survey data, a $600 value. We’ve increased the usability of compensation and productivity data: access data in a new, interactive dashboard; filter data by subspecialty, practice setting, years of practice, and more.

Visit AAN.com/view/BenchmarkReport to learn more about how to participate. Email questions to benchmark@aan.com. 

Read the New Issue of Neurology: Clinical Practice

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The April issue of Neurology Clinical Practice features a thought-provoking commentary

by Melissa J. Armstrong, MD, MSc, FAAN, on “Tackling the Imposter Phenomenon to Advance Women in Neurology.” Among an assortment of topics, dementia is the focus of two articles, and another takes on shared decision making in mild cognitive impairment. ®

Neurology: Clinical Practice, published six times a year, is a member benefit available in print (for US members only) and online. Visit Neurology.org/cp for more information.

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Tools & Resources

How Your AAN Is Addressing Members’ Top Concerns with Payers’ Administrative Hassles One of the ways the AAN supports its members is by advocating for neurologists with commercial payers. Over the years we’ve heard about the increasing burden payers’ utilization management techniques put on practices. To better understand what you consider to be the greatest challenge in dealing with insurance companies, the AAN conducted a survey asking you to identify and describe which coverage issues you consider to be the biggest hassle.

a meeting with the Payment Policy Subcommittee and AAN leadership, and the conversation will focus on the rising cost of prescription medications, the resulting utilization management techniques, and how we can work together to address the burden this places on our members and their patients.

If you have questions relating to payers or other aspects of your practice, contact the AAN at practice@aan.com.

Out of the insurance processes listed, members most frequently selected prior authorization as the process posing the greatest challenge. That was followed by peer-to-peer reviews and step therapy programs. Members expressed concerns with the processes themselves and their effects on neurology practices, including the time-consuming nature and increasing frequency of the programs and their impact on patient care.

The AAN’s Payment Policy Subcommittee has been reviewing the survey and is excited to have this information to share in conversations with payers in 2019. While the subcommittee represents our members with payers on an ongoing basis, this spring the subcommittee is hosting a Payer Summit at the 2019 Annual Meeting. The AAN will invite representatives from commercial payers across the United States to attend

AAN Advocating on Multiple Fronts for E/M Services continued from cover medicine but much more profoundly affects neurology because of its high use of the complex level codes. Neurologists are the top biller of 99205. As such, our key goal is to maintain level 5 E/M codes. We also want to maintain more levels of service, rather than collapsing levels 2-4 to one payment.

Our E/M action plan includes these efforts: Participation in the AMA CPT/RUC process: AAN members actively participate in the American Medical Association (AMA) process of establishing and reviewing new CPT codes. The CPT guidelines and descriptors to report office visit codes will undergo extensive revision for implementation in 2021. The AAN participated in an AMA/ Specialty Society RVS Update Committee (RUC) survey for physician office visits. This survey will help the AAN, in concert with the RUC, recommend accurate relative values for physician work and direct practice expense to CMS. Meeting with CMS: The AAN met with CMS in March to ensure neurology’s voice is heard as CMS considers how policy changes impact patients who receive complex care.

Legislative activity: The AAN also is working on Capitol Hill to educate Congress on the value of cognitive care and why it is important to appropriately value this care. At the 2019 Neurology on the Hill event, 214 AAN members shared their daily experiences of treating complex, chronic conditions and asked Congress to oppose any payment

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policy that would further devalue complex evaluation and management services. It’s important to get this on the radar of lawmakers as Congress can help communicate our urgency to CMS, typically by addressing these concerns in a letter to CMS signed onto by members of Congress Data analysis: The AAN also is working on data analysis to develop a data driven argument to CMS that demonstrates the value of cognitive care and impact of potential changes on neurologists and our patients.

In July, proposed payment changes for 2020 will be announced

by CMS. The AAN will review and respond to these proposed changes, paying close attention to any new updates for E/M. In November, CMS will publish its final rule for 2020. The cycle will begin again for 2021, which is the anticipated effective date for any E/M changes.

Watch for the latest updates on AAN.com and analysis of changes in future issues of AANnews®. The AAN will keep you informed of proposed changes and how they may impact your practice and patient care.

Tools & Resources

Brain & Life Looks at Alzheimer’s, Grief, and More In the new issue of Brain & Life®, the AAN’s popular patient magazine, actress, producer, and singer/songwriter Rita Wilson shares her experience with her mother’s Alzheimer’s disease. The article also looks at where Alzheimer’s research is headed.

A second feature examines grief and how it affects people psychologically, emotionally, and even neurologically. It also offers advice for how to process grief in as healthy a way as possible.

Caregivers looking to transition family members to an assisted living facility will appreciate our tips on how to find the right place.

Brain & Life magazine is free for AAN members in the United States to distribute to patients, who also can subscribe for free. If you would like to adjust the number of copies you receive for your patients or update your clinic address, email BeGreen@WasteFreeMail.com. All members have online access to the magazine articles and additional resources at BrainandLife.org. Share the website with your patients! 

A P R I L/M AY 2 0 19

Grief How We Heal After Loss Nutrition Smart Ways to Keep Weight On Assisted Living How to Find the Right Facility

Inspired Advocate Actress Rita Wilson raises awareness of Alzheimer’s diseas e in memory of her mother

Learning that fits your hectic lifestyle Now all you need is 3-6 minutes to get the latest video updates in neurology.

Introducing NeuroBytes.

Free with AAN membership

AAN.com/view/NeuroBytes

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..

Advocates Educate Congress on Key Issues During Neurology on the Hill Member Perspective by Michael E. Markowski, DO, FAAN I was thrilled to be back in Washington, DC, with 214 neurologists from 48 states advocating for our patients and colleagues. It has been incredible to see the growth of Neurology on the Hill (NOH) over the past 16 years as this event creates the foundation for so many crucial relationships with members of Congress. Advocacy efforts such as NOH have permitted critical access to legislators, the Centers for Medicare & Medicaid Services (CMS), and other government representatives who have the ability to change our medicine practice significantly, for better or worse.

Prior to NOH, the AAN and my colleagues on the Government Relations Committee choose three issues to address based on AAN member surveys, while factoring any current legislation which we could support. This year, our NOH “asks” were preserving access to neurologists, addressing the rising costs of medications and step therapy exceptions, along with increased funding for vital neurology research. With many recently elected first-term representatives, it was essential to again explain the vital role of neurologists and the myriad of chronic, complex, and often incurable diseases we treat. One out of six people has a neurological disease, costing our health care system over $600 billion per year.

First, we discussed the need to preserve access to neurologists and value the cognitive care we provide, specifically by opposing the CMS proposal to consolidate the current evaluation and management (E/M) codes. The median neurologist receives 75 percent of their reimbursement through these E/M codes, which have been unchanged since 1997. We were collectively shocked in July 2018 when CMS proposed to consolidate the five E/M codes down to two, significantly reducing payments for complex patients, disproportionately affecting

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patients with neurological diseases. Due to a swift response from the AAN along with many physician and patient groups, this proposal was ultimately delayed for two years. The AAN advocacy efforts helped lead to a bipartisan letter signed by 90 members of the House of Representatives and 24 senators opposing the cuts. This proposal was “budget neutral” per CMS, however, it would have been very harmful to our patients. During NOH, we encouraged our legislators to oppose any payment policy which would further devalue complex E/M services and preserve patient access to neurologists.

The second issue we discussed was the outrageous cost of prescription medications and one of its downstream effects, insurance mandated “step therapy.” One in four Americans has problems affording prescription medications yet little been done to decrease costs. Medications to treat neurological diseases are among the most expensive on the market, including several older generic medications which have increased significantly over the past decade, some greater than 1,000 percent since 2005. The timing of NOH was fortuitous, coinciding with the Senate Finance Committee hearing with CEOs of seven major pharmaceutical companies about drug pricing.

Due to the absurd cost of medications, insurances are intruding upon our doctor-patient relationship through mandates such as “step therapy.” Also known as “fail first” therapy, insurers commonly mandate certain medications prior to authorizing the

Harness the Power of Your Quality Data with the Axon Registry

prescribed medication, which has caused much frustration in my community neurology practice on Cape Cod. At NOH, we encouraged our representatives to cosponsor the bipartisan Restoring the Patient’s Voice Act of 2019, which requires group insurance to make exceptions to step therapy in certain circumstances including if the medication is contraindicated, unsafe, or the patient is currently stable on an effective treatment.

Similar to recent years, our final request was increased funding for neurological research. We again requested an increase in NIH funding along with robust support for the BRAIN Initiative. In addition, we requested re-authorization of the Patient-Centered Outcomes Research Institute (PCORI), a unique federal program which funds head-to-head medication trials not supported through the NIH or industry. Neurology is one of the top three specialties funded by PCORI, which is set to expire on September 30, 2019.

It was wonderful to work with so many dedicated colleagues across the country as their efforts at NOH will pay dividends for our patients. NOH has allowed me to foster a relationship with my senators and my congressman, Rep. Keating, who I have met with personally for the past several years and has become a strong supporter of neurologists and our patients.

In addition to our advocacy efforts, NOH participants were fortunate to learn from Surgeon General Vice Admiral Jerome M. Adams, MD, MPH, along with hearing Susan Schneider Williams, the widow of Robin Williams, share her amazing story of their battle with Lewy Body dementia. Sharing our patient stories is our most effective method to convince legislators to act upon our behalf. 

Got Epic? We can work with them.

The Axon Registry® is a qualified clinical data registry focused on quality improvement in neurologic care. It crunches real-time data for FREE to help your institution: • Create quality improvement projects with your staff • Benchmark your outcomes against others in your institution or nationally • Reduce the burden of unnecessary documentation • Receive credit for multiple MOC requirements • Demonstrate the value of neurology to public and private payers

Put the Axon Registry to work for you. Discover how at

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Education & Research

New NeuroBytes Videos Offer Quick, Convenient Learning No matter how busy you are, the AAN’s latest online learning opportunities are designed to fit even the most hectic, fast-paced lifestyle. Now, with NeuroBytes, all you need is three to six minutes to get timely updates in neurology, along with additional resources for further optional self-guided exploration as time allows.

Available Videos

Fundamental Concepts of Alzheimer’s Risk Reduction Hyperacute Management of Ischemic Stroke Management of Patent Foramen Ovale in Cryptogenic Ischemic Stroke Amyloid Hypothesis and Surrounding Controversy CPT Coding Update for In-Office Cognitive Testing

Learn About UCNS Accreditation, Certification, and New Continuous Certification You can learn more about certification and accreditation through the United Council for Neurologic Subspecialties (UCNS) at the AAN Annual Meeting.

UCNS staff will be available to answer your questions at Booth #1316 during Exhibit Hall hours. Find out the details about the new continuous certification program that replaces the previous recertification process. Residents and fellows will also have a chance to learn more about UCNS-accredited neurologic subspecialty fellowship training programs and certification opportunities at the Early Career Reception Monday evening.

Information is also available at UCNS.org. 

Coming Soon

Clinical Approach to Localization and Diagnosis of Ptosis Differentiating Peripheral Vs. Central Causes of Acute Vestibular Syndrome Neurologic Complications of Immune Checkpoint Inhibitors CAR-T Therapy

All NeuroBytes videos are available free to AAN members at the AAN’s Online Learning Center at AAN.com/view/NeuroBytes.

Members can also visit AAN.com/view/SubscribeNB to sign up to receive email updates each month as new courses become available.

New Continuum Examines Latest in Epilepsy

Continuum

The April issue of Continuum: Lifelong Learning in Neurology ® updates readers on the latest information on epilepsy.

Cynthia L. Harden, MD, co-guest editor of this issue with Erik K. St. Louis, MD, FAAN, said, “The scope of topics covered in a cross-sectional manner is different from other Continuum issues on this topic. The issue includes an article on the management of patients with well-controlled epilepsy, which is an overlooked population that deserves more attention. Concise presentations of managing autoimmune epilepsy and epilepsy etiologies will be helpful, and an article on drug-resistant epilepsy presents options for patients for whom antiepileptic drugs have failed. These, along with an article on EEG, will be very applicable to the practicing neurologist.”

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LIF EL ON

G LE AR NI NG

IN NE UR OL OG

Y®

Epilepsy

EDIT OR-I N-CH IEF: STEV EN L. GUES T EDIT LEWI S, ORS: CYN THIA L. HARD MD, FA AN EN, MD; ERIK K. ST.

Harden

APRI L 2019

LOUI S, MD,

MS, FA AN

St. Louis

AAN members pay only $349 per year for a subscription to Continuum® and Continuum® Audio. Subscribe now by contacting Wolters Kluwer at (800) 361-0633, (301) 223-2300 (international); or Shop.LWW.com/continuum. AAN Junior members who are transitioning to neurologist memberships can receive a 50-percent discount on the already low member rate for the Continuum and Continuum Audio subscription.

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American Brain Foundation

Prestigious Lineup of Honorees Set for May 8 Commitment to Cures Fundraiser Former first lady of Massachusetts Ann Romney and Philadelphia Eagles owner Jeffrey Lurie will be honored during the American Brain Foundation’s 2019 Commitment to Cures, set for May 8 at the historic Union League of Philadelphia, just three blocks from the Philadelphia Convention Center. The popular annual dinner and fundraiser has a long tradition of supporting the Foundation’s research mission by offering an opportunity for leaders in neurology to honor prestigious members of the public for their contributions to finding cures for brain diseases through advocacy, public awareness, and fundraising.

Romney will receive the Public Leadership in Neurology Award for her tireless advocacy in raising awareness of and research for multiple sclerosis, as well as her collaboration in the Ann Romney Center for Neurologic Diseases at Brigham and Women’s Hospital. Located in Boston, MA, the center describes itself as a collaborative global pursuit to accelerate treatments, prevention, and cures for five of the world’s most complex neurologic diseases: multiple sclerosis, Alzheimer’s disease, ALS, Parkinson’s disease, and brain tumors.

Romney

Lurie

Rendell

Jeffrey Lurie will also be on hand to receive the Foundation’s Commitment to Cures Award. After receiving their awards, both Romney and Lurie will join former governor of Pennsylvania Ed Rendell for an intimate fireside chat. Rendell, who recently announced that he has Parkinson’s disease, will lead Romney and Lurie in an important talk about moving the ball forward to find cures for brain diseases.

Space and tickets are limited. Individual tickets are $125, and tables for 10 are available for $1,500. Visit AmericanBrainFoundation.org/C2C to secure your spot, or contact events@americanbrainfoundation.org or (866) 770-7570 for more information. 

Philadelphia Eagles owner, two-time Academy Award-winning motion picture producer, and autism research philanthropist

Designed for today’s neurologists Fresh, new look coming to your mailbox!

• Timely, curated, expert commentary on latest research • Editor’s Picks podcast for noteworthy news • Real-time reports from major neurology conferences

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AAN.com/careers

Visit the AAN’s Neurology Career Center to view hundreds of additional jobs and sign up for customized, confidential notifications when positions of interest are added.

Neurologist Opportunities: Central, South-Central and Northeastern PA at Geisinger, we’ve been focused on advancing the future of health for more than a century. Today we continue with MyCode Community Health Initiative, our groundbreaking genomics program, to diagnose medical conditions earlier, including patients predisposed to neurological disorders.

What you do at Geisinger shapes the future of health and improves lives—for our patients, communities, and you. Join our neurology team with the opportunity to practice general neurology or in several specialties, including Neuro-Oncology, Neuromuscular, Movement Disorder and many more.

Interested candidates, please reach out to Lori Surak at ljsurak@geisinger. edu EOE Medical Officer The Center for Devices and Radiological Health's Office of Device Evaluation is searching for outstanding neurologists interested in the regulatory review process of new medical devices and their safety and effectiveness evaluation prior to their introduction to the marketplace.

As members of a multidisciplinary team of scientists and clinicians in the Division of Neurological and Physical Medicine Devices, medical officers consult in the review of devices in one or more of these product areas: rehabilitation devices including orthoses, prostheses, pain management devices, brain-computer interfaces, diathermy devices, and functional electrical stimulators; neurostimulation devices including spinal cord stimulators, peripheral nerve stimulators, and deep brain stimulators; EEG and non-EEG based neuro-diagnostic devices, mobile medical apps; neurosurgical, neurovascular and neuro-interventional devices. Qualifications: Doctor of Medicine or Doctor of Osteopathy from a school in the United States or Canada approved by a recognized accredited body in the year of the applicant's graduation OR a Doctor of Medicine or equivalent degree from a foreign medical school that provided education and medical knowledge substantially equivalent to accredited schools in the United States. Clinical fellowship/practice in Neurology is required. Clinical fellowships or expertise in neurological disorders, including stroke, dementia and neuromuscular diseases is desirable. Location: Office is located in Silver Spring, Maryland on the White Oak Campus. Salary: For medical officers, Civil Service salary range starting at $137,508.00 per year. Salary and level of responsibility are commensurate with education and experience.

Benefits: Outstanding leave package, Health Insurance, Life Insurance, Retirement, Maxiflex Schedule, Telecommuting, Health Units, Fitness Centers and participation in Federal Credit Unions. There are opportunities for professional development, which may include further training, attendance at scientific meetings and conferences, and clinical activities. FDA is an equal opportunity employer and has a smoke free environment. To qualify for employment, all applicants must meet all civil service or commissioned corps requirements including U.S. citizenship. Interested candidates should send a CV and cover letter to CDR Avena Russell: Avena.Russell@fda.hhs. gov, FDA/Center for Devices and Radiological Health, Office of Device Evaluation, Division of Neurological and Physical Medicine Devices.

Neurologists Needed—Roanoke/Salem, VA LewisGale Physicians— Neurology, is looking to expand our Neurology team, with the addition of Inpatient/Outpatient Neurologists, Outpatient only Neurologists, and Inpatient only Neuro-Hospitalists. Employment with an established practice offers competitive compensation and benefits—including paid malpractice insurance, paid vacation, CME allowance, 401K and relocation assistance.

Possible sign-on bonus offered. Also, the hospital supports multiple GME programs which affords the opportunity to participate in graduate medical education. LewisGale Medical Center, located in Salem, Virginia, is a regional leader in utilizing the latest medical technology, such as intracranial stereotactic radiosurgery to treat brain tumors and other neurological disorders, digital biplane angiography, EEG, MRI, advanced MRI, CT and ultrasound. The Medical Center, which is a nationally-accredited Stroke Center, qualified for the Silver Achievement Award for 2010 from the American Heart Association’s “Get with the Guidelines” program. Our facility was also recognized by the American Heart Association at the International Stroke Conference and in the AHA US News and World Report Best Hospitals advertisement. To learn more about us and to share your professional interests, please contact Laura Hinkle at (804) 237-7772 or laura.hinkle@hcahealthcare.com. Job Requirements: Board Certified/ Board Eligible. To apply for this job, contact Laura Hinkle at laura.hinkle@ hcahealthcare.com, (804) 237-7772.

Join one of the best health care providers and teaching hospital in the state Pediatric Neurology. Employed Position. Competitive salary with full benefit package. $50K sign-on bonus. More than 30 specialties are represented. Procedures performed: Advanced MS infusion therapies, Electromyography (EMG), Electroencephalogram (EEG), Evoked potentials studies, Lumbar puncture, Nerve conduction studies, Therapeutic injections for migraine and Epilepsy Monitoring Unit for long-term monitoring.

Neurology department specializes in the following conditions Autism, Cerebral palsy, Dementia, Epilepsy, Multiple sclerosis (MS), Neuropathy, Stroke, Seizures, Migraine, Nerve and muscle disorders and Tremors.

"Hip, Historic and Almost Heaven"—Tourism Board. The cultural, recreational, and business capital of the Appalachian Mountains. Excellent Public and Private Schools. NCAA Division I Intercollegiate Sports Teams. Driving distance for skiing, water sports, hiking, etc. Bike friendly community with a network of trails. Art walks, downtown street festivals and brown bag concert series. Come play—multiple family friendly venues and activities.

Mention Code 180802—CHN. Job Requirements are MD or DO Medical Degree, Eligible to be state licensed in the United States, United States Residency and/or Fellowship training. To apply for this job, contact Timothy Stanley. Direct: (404) 591-4224. (800) 492-7771, tstanleyweb@phg.com.

Fax: (404) (591-4237. Cell/Text: (770) 265-2001.

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AANnews • April 2019

Cognitive Neurologist The Department of Neurology at the NYU Langone Medical Center, a world-class patient-centered integrated academic medical center, has an exciting opportunity to join our team on the tenureeligible academic track. Strong skills in the clinical and research aspects of Cognitive Neurology, as well as a commitment to excellence in teaching and clinical trials, are required. The candidate should have a successful record of obtaining external Federal funding. Appropriate candidates will be considered for an endowed chair: The Lulu P. and David J. Levidow Professorship in Neurology. To qualify, you must have a MD or MD/PhD degree and be board certified in Neurology. NYU is an equal opportunity, affirmative action employer. Women and minority candidates are strongly encouraged to apply. Please submit a curriculum vitae, cover letter, and 3 reference letters to: Steven L. Galetta, MD, Philip K. Moskowitz, MD, Professor and Chair NYU Langone Medical Center Ambulatory Care Center 240 E. 38th Street, 20th Floor New York, New York 10016. Email contact: Jaclyn.Bonello@nyumc.org or to Thomas Wisniewski, MD, Gerald J. and Dorothy R. Friedman Professor of the New York University Alzheimer's Disease Center Professor of Neurology, Pathology and Psychiatry New York University School of Medicine. Alexandria East River Science Park, Rm 802 450 East 29th Street New York, NY 10016. Tel: (212) 263-7993, Fax: (212) 263-7528. Web: www.med.nyu.edu/people/wisnit01. Email: thomas.wisniewski@nyumc.org Neurohospitalist for Florida. Daily work is usually 8-5 with many days shorter. Usually 16-20 patients a day and some days less. Weekend calls 1–2 weekends a month. Usually does not require returning to the hospital after 5pm. Medical hospitalist admits all patients. Join a group of over 70 neurologists. First Choice Neurology is the largest Neurology group in Florida. www.FCNeurology.net. The ideal candidate is an energetic team worker with good communication skills. Earn top income with reasonable amount of work, great work/leisure balance. Generous production incentive plus salary. Live and work in paradise in a Ft. Lauderdale suburb where people come to vacation. Great weather, affordable real estate prices, excellent public and private schools. Short and easy commute to work with close proximity to two international airports. Work with collegial and flexible team who appreciate your work. Having Florida license is a plus. Paid malpractice or legal defense with health insurance allowance and paid vacation. Great opportunity. To apply for this job, contact Bashar Lutfi MD, bmlutfi@yahoo.com, Tel: (954) 756-0615.

Neurology Medical Director. Envision Physician Services and Kendall Regional Medical Center are seeking a Director of Neurology to lead our newly established inpatient neurology program located in beautiful Miami, Florida. This position is full time, Monday-Friday with an 8 a.m.–5 p.m. schedule. Physicians with previous leadership experience or physicians looking to advance their career into a leadership position are encouraged to apply. Candidate must be a vascular trained neurologist. Facility Information: Kendall Regional Medical Center has been honored by being nationally recognized with many prestigious awards and accolades, including: Thomson Reuters 100 Top Hospitals, a HealthGrades Distinguished Hospital (Top 5%) for Clinical Excellence, The Joint Commission Certification as a Primary Stroke Center, accredited Chest Pain Center with PCI, and most recently, by the Joint Commission as a “Top Performer” on key quality measures. Kendall Regional Medical Center, an award-winning 417-bed hospital, is recognized for providing a wide array of services to the residents of South Florida, as well as visitors from around the world. This prestigious facility offers 24-hour comprehensive medical, surgical and diagnostic services, including trauma and burn care, pediatrics and maternity services, an orthopedic and spine institute, along with patient and community services. For over 40 years, we have been committed to expanding and improving every facet of the organization, devoting significant time and resources to enhancing the facility, staff and medical care. Kendall Regional Medical Center has grown into a major tertiary-care teaching facility with an outstanding staff. Community Information: The City of Miami is known as the “Magic City” and is located in Southeast Florida, between the Florida Everglades and the Atlantic Ocean. It is known for its diverse culture, ethnicities, and is recognized worldwide as an international hub. Kendall offers warm weather, inviting water, soft sandy beaches, and a sizzling nightlife. Outdoor enthusiasts can golf, snorkel, and boat their way through Miami or enjoy the art deco style museums, shops and boutiques. The area is home to several highly rated public and charter schools and universities including Florida International University and University of Miami. Kendall offers the option of both city and suburban living and has several communities offering a variety of family entertainment including swimming pools, sporting events, shopping malls and many other activities.

The location is ideal with easy access to airports and the Port of Miami home to several cruise ships traveling to the Caribbean Islands and South America. Envision Physician Services is a dynamic, physician-led organization which has been offering exceptional career opportunities since 1972. With more than 14,000 affiliated providers coast-to-coast, Envision Physician Services is nationally-recognized for delivering clinical excellence supported through innovation, integration and exceptional leadership. Whether you are considering full-time, part-time or independent contractor opportunities with Envision Physician Services, you can rest assured you will be working for an industry-leader who delivers a vast array of benefits unmatched within the industry, including: Physician-led organization Strong leadership on a local, regional and national level Exceptional quality of practice backed by comprehensive support services Optimal staffing ratios and flexible scheduling options “A” rated professional liability insurance Extensive variety of practice settings coast-to-coast Competitive compensation including several benefit options Opportunities for professional development, mentoring and career advancement Comprehensive education and training

on leadership, management and clinical best practices, including a wide variety of CME programs Colleague referral bonus program *Benefits vary by division, clinical specialty and employment status Company Information Quality people. Quality care. Quality of LIFE.(TM) Envision Physician Services is a national physician-led practice management company. This privately held company provides outsourced clinical department recruitment, staffing, management and billing/collection services for hundreds of hospitals and health systems nationwide. Known for its unique structure, Envision Physician Services develops local practices, supports them with regionally-located clinical leadership and operational personnel and provides them access to unprecedented national resources.

Each Envision Physician Services practice has its own unique culture, but all sites recruit and hire clinicians who share the company's core values of being patient-focused, customer-centered and caregiver-inspired.

Envision Physician Services is a family of companies, each of which has clinical staffing needs. Full-time, part-time, and independent contractor opportunities are available through Envision Physician Services. Candidates considering a career within the Envision Physician Services family of companies will find a variety of community types (from small towns to major urban areas), practice settings (small hospitals to major academic health systems), job levels (entry level to senior management), and competitive pay with exceptional benefits. Specialties supported include Emergency Medicine, Hospital Medicine, Women’s and Children’s, Surgery, Anesthesia and Radiology/Teleradiology. Envision Physician Services is proud to be an EOE/AA employer. To apply for this job, contact Jaime Crosse at Jaime.Crosse@emcare.com West Virginia Neurophysiology Opening—Medical School Affiliated Academic Medical Center Neurophysiology. Opportunity to join growing Neurology department of 8 Neurologists. Faculty members including General, Pediatric, Neuromuscular, Movement and Vascular. New Neurology Residency Program. Accredited Neurophysiology Center on site.

Multidisciplinary team includes Radiologists, Pharmacists, Nursing, Dietitians and Physical, Occupational and Speech Therapists. Excellent Salary plus Full Benefits and Academic Appointment. An outdoor enthusiast´s haven. Enjoy the scenic shores of an historic river. Take in the four-season views while mountain hiking. 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. Excellent Public and Private Schools. Short Distance to 4 Major Metro Areas. Grand prize winner America´s Best Communities Competition.

Contact jpolver1@phg.com. Mention code 180316 – CN. Georgia Neurology and Neurohospitalist Job—Join a Nationally Recognized Health System Outpatient Neurology. Multiple Practice Locations available. Monday–Friday Schedule. 215-bed, not-for-profit hospital. Competitive salary—guarantee plus incentives, Up to $100K forgivable loan. Opportunity for sub-specialty interests, particularly Neurophysiology, Stroke and Electrophysiology. EMG reading experience preferred. System call 1:9. Visa candidates considered. Neurohospitalist.

7 on/7 off schedule. Consultative service. Both hospitals are designated Primary Stroke Centers by DNV GL Healthcare. Supported by Advanced Practice Providers. Providers would be part of ´Teleneurology´ and ´Telestroke´ coverage rotation. EEG reading experience preferred. Vascular fellowship training is a plus. Competitive salary—guarantee plus incentives, Up to $100K forgivable loan. Benefits. Comprehensive medical, dental and vision benefits. Health and dependent care flexible spending accounts.

Company-paid long-term and short-term disability. Personal, dependent and spousal life insurance. Optional life insurance. Voluntary benefits program (whole life, accident, critical illness, cancer and specified health insurance). Malpractice coverage. 401(k) with employer match with an elective deferred compensation retirement program which allows you to contribute an unlimited amount of income on a tax-deferred basis to our core mutual funds. Communities conveniently located 30 to 40 minutes outside of Downtown Atlanta. An Abundance of Natural Beauty and Southern Charm. Countless Amenities and Low Cost of Living. Excellent Education System Including Both Public and Private Options. Incredible Shopping and Dining. Multiple Residential Areas. Endless Entertainment Options including Both Professional and NCAA Athletics. Close Proximity to Everything Atlanta has to Offer. Minutes Away from Hartsfield International Airport. Timothy Stanley; Direct: (404) 591-4224 or (800) 492-7771; tstanleyweb@phg.com; Fax: (404) 591-4237. Cell / Text: 770) (265-2001. Mention Code 180747 - N

AANnews® Classified Advertising

he AAN offers a complete package of print, online, and T in-person recruitment advertising opportunities. Visit careers.AAN.com for all AAN options, rates, and deadlines. d copy for the June 2019 print edition of AANnews A must be submitted by May 1, 2019. 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.

PHARMA AD He’s showing signs of forgetfulness

RECOGNIZE THE SYMPTOMS OF MILD COGNITIVE IMPAIRMENT (MCI) DUE TO ALZHEIMER’S DISEASE Alzheimer’s disease is a continuum of 3 stages1: • Preclinical • MCI due to Alzheimer’s disease • Alzheimer’s disease dementia

By the time symptoms of MCI appear, amyloid beta may have been accumulating for 10-20 years during the preclinical stage.2,3

Learn why the MCI stage could be your earliest opportunity to identify Alzheimer’s disease.

Visit www.ADcontinuum.com References: 1. Alzheimer’s Association. 2018 Alzheimer’s Disease Facts and Figures. Alzheimers Dement. 2018;14:367-429. 2. Beason L, Goh J, Kraut M, O’Brien R, Ferrucci L, Resnick S. Changes in brain function occur years before the onset of cognitive impairment. J Neurosci. 2013;33(46):18008-18014. 3. Dubois B, Hampel H, Feldman HH, et al. Preclinical Alzheimer’s disease: definition, natural history, and diagnostic criteria. Alzheimers Dement. 2016;12(3):292-323. © 2019 Biogen. All rights reserved. 02/19 ALZ-US-0140