VOLUME 31 · ISSUE 6 · JUNE 2017
Y O U R M O N T H LY A A N M E M B E R S H I P M A G A Z I N E
Registration to Open This Month for 2017 Fall Conference Registration opens this month for the AAN Fall Conference, set for October 20 through 22 at The Cosmopolitan of Las Vegas. The Fall Conference is your year-end destination for acquiring the latest clinical advances in neurology from experts in the field while earning up to 15.75 CME credits. New this year are expanded Neurology Update topics and a new Neuro-ophthalmology/Neuro-otology Skills Workshop. The preliminary program includes: Autoimmune Neurology Autonomic Neurology Dementia Epilepsy Headache Movement Disorders Multiple Sclerosis Myelopathies Neurocritical Care Neuroinfectious Disease Neuromuscular Disease Neuro-ophthalmology Neuro-oncology Sleep Spine Disorders nn Stroke nn nn nn nn nn nn nn nn nn nn nn nn nn nn nn
THIS ISSUE 13 14 24 27
Improve Your Practice for Less Than $19 per Subscribed Webinar What to Know About Axon Registry Data Security AAN Publishes Guideline on Reducing Brain Injury After CPR AAN Receives Accreditation with Commendation from ACCME
Practice Management nn CPT Coding—A Case Based
Approach
nn Business Strategies for the Small
Group and Solo Practitioner
nn MACRA Quality Payment Program:
MIPS and APMs Overview
With its all-inclusive registration rate, the Fall Conference offers significant value, allowing you access to all programming and the ability to come and go from sessions at your convenience. Learn more and watch for registration to go live this month at AAN.com/view/fall. •
nn Improving Patient Care: Why
Measures and MIPS Matter
nn MIPS: Deep Dive on ACI Component nn How Coding Can Improve Your Value
October 20–22, 2017 The Cosmopolitan of Las Vegas
June 15 Early Registration and Hotel Deadline Approaching for Sports Concussion Conference 2O17
Neurology Update
July 14 –16 • Jacksonville, FL
June 15 is your last chance to save with deep discounts on registration and housing for the 2017 AAN Sports Concussion Conference, set for July 14 through 16 in beautiful Jacksonville, FL, at the Hyatt Regency Jacksonville-Riverfront. Continued on page 9
Shriver Speaks at Brain Health Fair Maria Shriver, journalist, activist, author, former First Lady of California, and the founder of The Women’s Alzheimer’s Movement, spoke at the Brain Health Fair during the Annual Meeting in Boston. She discussed Alzheimer’s disease and Move For Minds, an annual live event she started to raise awareness of the brain-body connection. See more Annual Meeting photos on page 10–12.
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Table of Contents COVER Registration to Open This Month for 2017 Fall Conference June 15 Early Registration and Hotel Deadline Approaching for Sports Concussion Conference Shriver Speaks at Brain Health Fair
PRESIDENT’S COLUMN
5 We Must All Hang Together
MEET YOUR LEADERS
6 Meet the Executive Staff of the AAN
CONFERENCES
9 Congratulations to 2017 Neuro Film Festival Winners!
Official Publication of the American Academy of Neurology
23 Explore the Latest Issues of Neurology Now, Neurology: Clinical Practice
30 Podcast Central
GUIDELINES
24 AAN Publishes Guideline on
Reducing Brain Injury After CPR
POLICY
24 Capitol Hill Report 25 AAN Member Uses Advocacy Training to Get Concussion Messages to Public
CME & MOC
26 New Continuum Examines
Neurology of Systemic Disease
10 Nearly 14,000 Gather in Boston
27 Watch Your Favorite Sessions from
11 Annual Meeting in the News 12 Brain Health Fair Educates
27 AAN Receives Accreditation with
to Advance Neurology, the Profession, and Patient Care
Boston Area Residents
PRACTICE
13 Improve Your Practice for Less
Than $19 per Subscribed Webinar
13 Share Zika Resources Program with Patients
14 What to Know About Axon Registry Data Security
14 Academy Publications Win Top Honors
22 AAN, APA Publish Updated
Dementia Management Quality Measurement Set
Boston Anytime, Anywhere with Annual Meeting On Demand Commendation from ACCME
27 Apply Now for UCNS Neurocritical
MEMBERSHIP
28 Last Chance to Apply for These Leadership Programs!
28 Upgrade Your Professional
Credentials with the FAAN Designation
28 Congratulations New FAANs!
CAREERS | 30 DATES AND DEADLINES | 31
The AAN signed on to a letter requesting a bipartisan approach to ensure continued full funding of cost-sharing reduction payments (CSRs) to maintain stability to the insurance markets so individuals in the exchanges can maintain access coverage. CSRs help nearly seven million enrollees access care by defraying their cost-sharing obligations, including co-payments, co-insurance, and deductibles. The Furthering Access to Stroke Telemedicine Act, HR 1148, now has 78 cosponsors. AAN member Lee Schwamm, MD, FAHA, of Harvard Medical School, will testify in support of the FAST Act as part of the CHRONIC Care Act, S. 870, authored by Finance Committee Chair Sen. Orrin Hatch (R-UT) and Ranking Member Ron Wyden (D-OR). • AANnews • June 2017
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 American Academy of Neurology 201 Chicago Avenue Minneapolis, MN 55415 Phone: (800) 879-1960 (toll free) (612) 928-6000 (international) Email:
memberservices@AAN.com
Website: AAN.com For advertising rates, contact: Eileen R. Henry Wolters Kluwer Health | Medical Research Lippincott, Williams & Wilkins Phone:
(732) 778-2261
Eileen.Henry@wolterskluwer.com
Care Certification or Recertification
NEWS BRIEFS
4
PUBLICATION
AAN Executive Director Catherine M. Rydell, CAE Editor-in-Chief: John D. Hixson, MD Managing Editor: Angela Babb, CAE Editor: Tim Streeter Writers: Ryan Knoke and Sarah Parsons Designers: Siu Lee and Jim Hopwood Email: aannews@AAN.com AANnews is published monthly by the American Academy of Neurology for its 32,000 members worldwide. Access this magazine and other AAN publications online at AAN.com/go/elibrary. The American Academy of Neurology’s registered trademarks and service marks are registered in the United States and various other countries around the world. “American Brain Foundation” is a registered service mark of the American Brain Foundation and is registered in the United States.
President’s Column
We Must All Hang Together Over the last few years, the AAN has Future breakthroughs for curing, preventing, and strengthened our advocacy efforts, expanded our treating neurological disorders require us to speak Government Relations Committee, and leveraged loudly for increased funding of NIH research. As our BrainPAC. Now more than ever, we need to you can see in this month’s Capitol Hill Report, we work together for the betterment of our patients were successful in our fight to preserve the gains and our profession. We are proud of our efforts we have made for federal funding of neurologic to remain evidence-based, consensus-driven, research in Congress’s final budget for the and guided by our mission and core values as we remainder of the 2017 fiscal year. Our members articulate well-developed advocacy positions. The and staff worked very hard last year to increase Academy recently published Health Care Delivery the budgets for the NIH and BRAIN Initiative. The Principles, a list of criteria by which we will gauge 21st Century Cures Act was a monumental step any proposed changes to the Affordable Care Ralph L. Sacco, MD, MS, forward, had strong bipartisan support, and needs Act. These principles were published in the FAHA, FAAN the proper appropriations to be successful. And May AANnews and you can find them online at we will continue to make the case that the health AAN.com/public-policy/position-statements. Considerable of our citizens and the economic future of our country are in effort by leadership and staff went into preparing this peril as long as 50+ million Americans are living with chronic document, which focuses specifically on the needs of and costly neurologic disease. neurologists and our patients. Cuts in research funding are not just suffered by our As Dr. Cascino mentioned in his final column in this space, the neuroscientists—they damage our ability to discover treatments political views of our members run across the spectrum. We all and cures our practicing neurologists can prescribe to their have our personal political philosophies and our heterogeneity patients. As Benjamin Franklin said, “We must, indeed, all hang as an organization makes us stronger. But it is not for the together or, most assuredly, we shall all hang separately.” Academy to assign praise or blame to any particular political Regulatory hassle that provides no value remains an party. While our members and staff who are deeply involved in issue that we need to convince Congress to address. advocating for neurology on Capitol Hill may be knowledgeable Burdensome regulations and job burnout do not impact of the tug-of-war that is involved in moving legislation through just practicing neurologists—they can dissuade medical Congress, the Academy itself must keep focused on furthering students from entering our specialty, which affects our the art and science of neurology, no matter who is in power and academic programs across the country at the very time we whatever our personal affiliations. When we advocate as an need to increase our work force. organization, we need to do our best to speak in one voice for what is best for our patients and profession. We must turn up the heat on Congress, each and every one of At the time of this writing, the House of Representatives has passed a revised version of the American Health Care Act (AHCA)—which still fails to meet several of our principles for health care. The bill has moved to the Senate, where Republicans have indicated they will work on their own version. Consequently, we will remain focused in applying our principles to any proposals, today and tomorrow.
us. Because what happens to one area of neurology can affect us all. So, when you get an Action Alert email in your inbox, this is when you must hang together with your colleagues. If the topic is health care reform, we need the support of our neuroscience and academic community. Likewise, when it Continued on page 8
AANnews • June 2017
5
Meet Your Leaders
Meet the Executive Staff of the AAN Catherine M. Rydell, CAE, Executive Director/CEO Catherine M. Rydell, CAE, has been the American Academy of Neurology’s executive director and chief executive officer since 1999. Along with her executive team, she oversees 185 staff. Under Rydell’s leadership, AAN membership has grown from 16,000 to 32,000 members. Since joining the AAN, Rydell has focused on strengthening advocacy and coalition-building efforts, increasing staff development, improving communication with members, and implementing its strategic plan. Under her leadership, the Academy increased educational offerings and established a companion organization to help support new member services and advocacy. Rydell also has been instrumental in expanding the influence and reach of the AAN by creating entities and initiatives to promote and advance the specialty of neurology. Rydell is a Certified Association Executive (CAE), the highest professional credential in the association industry. Less than five percent of all association professionals have earned a CAE designation. Rydell serves on the Board of Directors of the American Brain Foundation and as a member of the American Medical Association CEO Advisory Committee and the Specialty Society CEO Coalition. She serves as an ex officio member of the Neurology Residency Review Committee and the United Council of Neurologic Subspecialties (UCNS). She also serves on the Board of the University of North Dakota Foundation and Alumni Association. Prior to joining the AAN, Rydell served as executive director of the North Dakota Medical Association. From 1984 through 1996, Rydell served as a state representative in the North Dakota State Legislature, where she chaired the House Human Services Committee and the House Education Committee.
Bruce Levi, JD, General Counsel Bruce Levi, JD, is the general counsel for the AAN, the AAN Institute, and United Council for Neurologic Subspecialties. As general counsel, Levi is responsible for ensuring the legal integrity of the Academy and overseeing the delivery of legal services and resources to accomplish Academy priorities. Levi’s role includes legal counsel to the boards of directors, president, chief executive officer, and staff. The office of general
6
AANnews • June 2017
counsel acts as a strategic business partner by providing advice in numerous areas—including ethics, governance and organization policy, intellectual property and contracts, employment, and regulatory and governmental compliance. Levi performs other supervisory roles including board strategic planning in oversight of the Academy’s Member Insights department staff and human resources oversight. Prior to joining the Academy in 2011, Levi served over 25 years as a nonprofit and government lawyer. Serving as executive director and general counsel for the North Dakota Medical Association, he was engaged in association executive management and state and federal health policy development and advocacy. Levi provided legislative support as staff counsel to the North Dakota Legislative Assembly and facilitated statewide public policy mediation as policy counsel to the North Dakota Consensus Council, a public-private partnership of state government, business, and labor leaders. Levi is a 1992–1993 fellow of the Mondale Policy Forum of the Hubert H. Humphrey School of Public Affairs and completed the Minnesota Executive Program at the Carlson School of Management in 2013–2014, both programs at the University of Minnesota.
Timothy J. Engel, CPA, Chief Financial and Technology Officer Timothy J. Engel, CPA, is the AAN’s chief financial officer and has held the position since joining the Academy in 2006. Since joining the AAN, operating revenues have increased to $48 million in 2016 from $31 million in 2006 and total assets are now $94 million compared to $46 million in 2006. He provides strategic leadership and direction for the fiscal management of the AAN including annual budget preparation, cash management, tax compliance, and reporting. Engel also has oversight for information systems, data management, office facilities, and equipment. He was instrumental in managing the construction of the AAN’s headquarters building in Minneapolis. Engel provides chief financial and reporting services to the American Brain Foundation, United Council of Neurological Subspecialties and Child Neurology Foundation. He is a certified public accountant and holds a license from the Minnesota Board of Accountancy. Prior to joining the AAN, Engel was CFO for Public Radio International (PRI) from 1986 to 2006. During his time at PRI, he assisted in bringing many programs to public radio stations, including Marketplace, PRI’s The World, and Studio 360.
Engel is a Certified Public Accountant (CPA), earned a bachelor’s of art degree from University of St. Thomas, and completed the Minnesota Executive Program at the University of Minnesota Carlson School of Management.
Jason Kopinski, CAE, Deputy Executive Director, AAN Jason Kopinski, CAE, is deputy executive director of the AAN and is responsible for membership, publications, and health policy. He joined the AAN in 2001 as a web developer. Accomplishments during his tenure include establishing the in-house development of web applications, assembling the creative services department, and revamping the strategic planning process. He has overseen the areas of digital development and strategy, technology, communications and marketing, business development, insights and research, project management, writing and graphic design, and strategic planning. He is currently leading the Academy’s first redesign of all of its publications at the same time. Kopinski is a Certified Association Executive (CAE), the highest professional credential in the association industry. A graduate of Concordia College in St. Paul, Kopinski has completed the Minnesota Executive Program at the University of Minnesota Carlson School of Management.
Christine E. Phelps, Deputy Executive Director, AAN Institute Christine Phelps has been with the AAN since 1986, with roles overseeing education, science, meeting services, membership, communications, and marketing, as well as leading the American Brain Foundation. In her current role as deputy executive director of the AAN Institute, Phelps has oversight of all research, education, corporate development, and conference activities of the AAN. In addition, Phelps leads the expansion and development of the AAN Leadership Programs. With her expertise in medical conference planning and over 30 years of experience overseeing the AAN Annual Meeting, Phelps has helped the conference grow from 4,000+ attendees in 1986 to nearly 14,000 people in Boston in 2017. A graduate of the University of Iowa, Phelps has served on the customer advisory boards for the cities of Dallas, Los Angeles, Philadelphia, St. Louis, Vancouver, and Washington, DC, and the state of Hawaii. An active member of the American Society of Association Executives and the Professional Convention Management Association (PCMA),
Phelps received PCMA’s 2016 Community Advocate of the Year Visionary Award for her work developing the AAN Brain Health Fair.
Angela M. Babb, CAE, APR, Chief Communications Officer Angela M. Babb, CAE, APR, is the chief communications officer of the AAN. She is responsible for all communications: building, sustaining, and managing the AAN’s reputation as seen and understood by members and the public. Babb is also responsible for all marketing, public relations, creative services, project management, digital content, and web development. Her team’s award-winning work continues to position the AAN as a leader in communications and digital strategies among medical associations around the world. Babb is a Certified Association Executive (CAE), the highest professional credential in the association industry. Babb is also accredited in public relations (APR) through the Public Relations Society of America (PRSA). The APR represents the highest standards of performance and professional practice and Babb’s mastery of strategic communications. Previously, Babb served as an award-winning broadcast journalist for more than 10 years, most recently at WCCO Radio in Minneapolis, where she co-anchored the WCCO News Hour at Five. She covered politics during Minnesota Governor Jesse Ventura’s administration, and her broadcast work was often featured by the national news. Babb currently serves as co-chair of the Communications Component group of the Council for Medical Specialty Societies, recently completed her second term on the board of directors for the PRSA Minnesota chapter, and is a member of ASAE and the Minnesota Interactive Marketing Association. She graduated summa cum laude from Metropolitan State University.
Christopher M. Becker, Chief Business Development Officer Christopher M. Becker has been with the AAN since 2011 and served as the chief business development officer since 2012. Becker works with member champions, division stakeholders, and potential partners to develop products and services that best fit the mission, vision, and values while optimizing/maximizing resources, membership value, and net income. Recent projects include working with stakeholders to
Continued on page 8
AANnews • June 2017
7
Meet Your Leaders
Meet the Executive Staff of the AAN increase access to Annual Meeting sessions by implementing an all-inclusive pricing structure. Attendees can now attend sessions all day, every day for one price. Becker is also currently working with internal and external stakeholders to allow all members to participate in, and receive the associated benefits of, the Axon Registry® at no charge. Prior to joining the AAN, Becker was an entrepreneur and the managing partner/CEO of a software as a service company for
Continued from page 7
13 years. His company specialized in collecting, standardizing, processing, and distributing research and educational content for 150+ health care associations around the world. Becker also spent 10 years in the pharmaceutical industry working in sales, sales training, sales management, product management, and new product development. Becker earned his bachelor’s degree in chemistry from Wabash College and his MBA from the Kellogg School of Management at Northwestern University. •
President’s Column
We Must All Hang Together
Continued from page 5
regards funding for research, we need to have every practicing neurologist involved. It takes just seconds to open these alerts, click a button or two, and send your representative or senator a message of support for neurology. As these emails build up in their inbox, they will begin to feel the heat. Believe me, this is not an insignificant action. These are the voices of their constituents, aka “voters.” Your voice, and your vote, count. It appears the midterm elections will be hotly contested, and you can make a difference. If you have a little more time to give, consider applying to attend Neurology on the Hill, which broke attendance records last winter with 216 of your colleagues advocating on Capitol Hill. I have been to DC numerous times and I know how important it is to educate lawmakers face-to-face about the issues affecting us, especially when we speak as constituents in their voting district. We really can enlighten and change minds in these discussions. It is empowering to be a citizen lobbyist. It is even more effective if we bring our patients with us. We are also working across organizations and bringing patient advocacy groups together to join forces as we did with the American Stroke Association/American Heart Association in 2016. We need to bring groups together to unify our positions and speak loudly in larger numbers. I hope you will consider applying for the 2018 event when applications open. We welcome new participants, experienced in advocacy or not, especially from underrepresented parts of the country. You might have a story to tell that can turn a skeptic into a believer. Yes, it can happen, even in Washington! When Congress is on recess in August, you can experience this power by attending town halls, visiting your lawmakers’ offices, or even inviting them to your clinic or laboratory. Again, this grassroots education can have a very strong impact when powered by your passion for neurology. Our advocacy efforts extend throughout the year and do not just involve our federal government, but also are aimed at state legislators.
8
AANnews • June 2017
Contact our terrific advocacy staff at advocacy@aan.com to learn more about these events. The AAN has worked hard to develop our advocacy expertise. I want to thank the 30 members who participated in the Palatucci Advocacy Leadership Forum last month. After 15 forums, we have graduated 440 members through this intensive training. The graduates will tell you the experience has changed their lives, and they have gone on to change the lives of patients and colleagues in their communities. We call upon these PALF graduates to use their talents and help the AAN move forward. Finally, we need to thank the many members who have generously supported our BrainPAC. We have gained an entry to some very influential Congressional members that would never have been possible in our pre-PAC days. I witnessed this myself at the 2017 Congressional Open House, when I saw so many of our elected officials recognizing and calling across the hall to our AAN staff on a first name basis. They know our name, who we are, and what we stand for. This kind of relationship building can go a long way to get our advocacy positions heard and acted upon. So, you can see, advocacy is at the heart of moving neurology forward, whether it is patient care, research, or improving our work lives. Even if you don’t aspire to lead the Academy, we need you to be a leader in advocating for neurology. We must all hang together.
Ralph L. Sacco, MD, MS, FAHA, FAAN President, AAN rsacco@aan.com
Conferences
June 15 Early Registration and Hotel Deadline Approaching for Sports Concussion Conference Continued from cover Each year, 1.6 to 3.8 million concussions result from sports/ recreation injuries in the United States, with the issue attracting significant media attention in recent years. New science is emerging quickly and breakthrough therapies are helping athletes recover from injuries previously thought untreatable. The Sports Concussion Conference will help you stay up-to-date on the latest information on the prevention, diagnosis, and treatment of sports concussion through interactive handson workshops, debates, and other engaging formats while earning up to 20 CME credits. Secure your spot today at AAN.com/ view/ConcussionConference. •
Keynote Speaker Announced William P. Meehan III, MD, will deliver the keynote lecture: Animal Modeling of Repetitive Concussion and CTE. Meehan is the director of the Micheli Center for Sports Injury Prevention, director of Research for the Brain Injury Center at Boston Children’s Hospital, and co-director of The Football Players Health Study at Harvard. He graduated from Harvard Medical School, where he is an associate professor of pediatrics and orthopaedics. He William P. Meehan III, MD conducts both clinical and scientific research in the area of sports injuries and concussive brain injury and his research has been funded by the National Institutes of Health, the Center for the Integration of Medicine and Innovative Technology, the National Football League Players Association, the National Football League, and the National Hockey League Alumni Association. He has multiple medical and scientific publications, is co-editor of the book, Head and Neck Injuries in Young Athletes, and is author of the books Kids, Sports, and Concussion: A Guide for Coaches and Parents and Concussions. •
Congratulations to 2017 Neuro Film Festival Winners! Congratulations to the following for sharing their powerful stories about the importance of neuroscience research.
GRAND PRIZE WINNER Neuroscience Is…™ Cool (category kids ages 13-17) Nancy Khuc for Neuroscience is Cool! When Nancy’s grandfather was diagnosed with Alzheimer’s disease, she wanted to know why he could not recognize his children, but could recite Vietnamese poems by heart. She was inspired, and now plans to learn as much as she can about the brain.
GRAND PRIZE WINNER Neuroscience Is…™ Rewarding (category for undergraduate and graduate students, medical students, and residents)
Gianluca Di Maria for The Brain Scientist: Neuroscience Is Rewarding. Following a neurologist in the clinic and a neuroscientist in the lab, this video highlights the challenging but rewarding nature of a career in neuroscience.
GRAND PRIZE WINNER Neuroscience Is…™ Essential (category for patients, families, and caregivers) William T. Doorley for Work in Progress: The Remarkable Journey of Dr. Warden. Dr. Deborah Warden, a neurologist, is living with primary lateral sclerosis (PLS). Her experience as a physician has helped
her accept her diagnosis, and coexist with it.
GRAND PRIZE WINNER Neuroscience Is…™ Critical (category for advocates, patient groups, and neurology professionals) Meghan Tucker for BethAnn Telford World Marathon Challenge. BethAnn Telford, a brain cancer survivor, ran seven marathons in seven days on seven continents to raise awareness and funding for brain cancer research. For BethAnn, advocacy is critical to finding a cure.
The Neuro Film Festival® aims to help build awareness and demonstrate the importance of neuroscience research by creating a culture that supports neurologic research and encourages more young people to pursue careers in neuroscience. View all 2017 Neuro Film Festival submissions on the Neuro Film Festival YouTube channel at Youtube.com/user/neurofilmfest/playlists. •
Conferences
Nearly 14,000 Gather in Boston to Advance Neurology, the Profession, and Patient Care The AAN’s 2017 Annual Meeting enjoyed extremely high attendance as Boston was the place to be for the latest information in science, education, and networking. For the second year, attendees praised the simplified registration format and wide range of interactive learning opportunities. •
e News h t in g in t e e Annual Mge of the Annual MeetihngMay 2, and
g era lips throu Press cov lative 1 media c 3 ,2 the cumu 7 r o d te ,” s n io s s genera th re ite, e ,237 “imp clips. On-s istered e s e th 6,672,225 r fo reg audience sted 122 potential s room ho e press. s th re f p o n rs to e s b o B m e ’s m N AA tional nd interna national a
Continued on page 12
AANnews • June 2017
11
Conferences
Brain Health Fair Educates Boston Area Residents The chance to hold a human brain, learn from expert neurologists, and hear Maria Shriver discuss her initiative to raise money for women-based research into Alzheimer’s disease drew more than 1,500 Boston area neurology patients, caregivers, families, and students to the Brain Health Fair at the Boston Convention and Exhibition Center on Friday, which was proclaimed Brain Health Awareness Day by Boston Mayor Marty Walsh.
The free, family-friendly day featured: nn “Ask a Neurologist” booth nn Latest treatments and research
advances nn Prevention and healthy lifestyle tips
nn 20-foot inflatable, interactive
walk-through brain nn Free bike helmet pickup nn Cranial nerve stations
nn Opportunity to hold an actual
human brain and view animal brains, including mouse and dolphin nn Brain-inspired crafts
The 2017 Brain Health Fair Platinum Sponsor was Allergan; Gold Sponsor was Supernus Pharmaceuticals, Inc.; and Silver Sponsors were Sanofi Genyzme, Sunovion Pharmaceuticals Inc., PSAV Presentation Services, Freeman. For more information on the event, visit BrainHealthFair.com. •
Practice
Improve Your Practice for Less Than $19 per Subscribed Webinar The AAN is dedicated to helping neurologists improve their practices and delivery of quality care to their patients. Our popular Practice Management Webinars offer the latest expert information and insights to help you navigate through the changes that lie ahead in the new health care landscape. And you can enjoy the flexibility to attend live webinars or access their recordings on demand at a more convenient time. Purchase any of these live or recorded webinars for $99 each, or subscribe to the complete series of 2017 webinars for only $189—that’s less than $19 per webinar. Upon completion of each webinar, you can earn 1 AMA PRA Category 1 Credit™ for physicians, or a certificate of completion for non-physicians. Recorded
How to Approach Advance Care Planning
Recorded
Successfully Participate in MACRA
Recorded
Getting What You Deserve—A Primer on Contracting
Recorded
Thriving in Small and Solo Neurology Practices
Recorded
Coding for Risk: How It Impacts Payment
June 6
Break the Code, or It Will Break Your Practice: Coding for Neurodiagnostic Procedures
August 1
A Guide to Teleneurology: Use It in Your Practice
October 10
Using the EHR or Axon Registry to Drive Quality Improvement
November 7
iNeurology: Best IT Practices
Learn more and subscribe today at AAN.com/view/pmw17. •
September 12 Open Your Heart, Open Your Notes: A Guide to Patient Engagement
Register by June 5 for Coding Webinar Offered June 6 The next webinar, “Break the Code, or It Will Break Your Practice: Coding for Neurodiagnostic Procedures,” will be offered on June 6, from 12:00 to 1:00 p.m. ET. The deadline to register at AAN.com/view/pmw17 is June 5. •
Share Zika Resources Program with Patients The Centers for Disease Control and Prevention (CDC) has asked the AAN to share the following information to help pregnant women and families find the medical help they need related to the Zika virus. Zika Care Connect, collaboration with the March of Dimes, is a new program designed to connect women, parents and caregivers of infants, and families affected by Zika to recommended health care services. Zika Care Connect establishes a network of specialty health care providers in 10 high-risk jurisdictions throughout the United States and its territories. The provider network is accessible via the Zika Care Connect website at Zikacareconnect.org and HelpLine. Zika Care Connect is continuing to seek health care specialists in maternal-fetal medicine, mental health, audiology, radiology, pediatric ophthalmology,
pediatric neurology, developmental pediatrics, infectious disease, and endocrinology to voluntarily join the network. The 10 jurisdictions at high risk for Zika include California, Florida, Georgia, Maryland, New Jersey, New York, Texas, Virginia, Puerto Rico, and the US Virgin Islands. Zika Care Connect plans to expand to 5-10 additional jurisdictions in the near future.
nn Maintain up-to-date profile
information on the Zika Care Connect website
If you are interested in joining the Zika Care Connect provider network, please visit the website or call the HelpLine toll-free at (844) 677-0447 for more information on enrolling. •
Participating providers will receive periodic emails with key Zika updates, including new CDC clinical guidance recommendations and patient resource tools. Joining the network is voluntary; Zika Care Connect seeks to include providers who can: nn Offer clinical services
recommended by the CDC
nn Receive new patient referrals nn Receive regular email updates
AANnews • June 2017
13
Practice
What to Know About Axon Registry Data Security The Axon Registry® database is a secure and efficient way for your practice to track quality care. The benefits of registry participation include improving patient care, showing value of neurology to payers, and reducing the burden of reporting requirements. Often practices looking to benefit from registry participation have questions about the privacy and security of their data. Below are answers to frequently asked questions and where to get more information. Are Axon Registry participants required to provide protected health information (PHI)? Yes, PHI is collected to assist with health care operations by facilitating implementation of quality improvement at the practice and provider level, including MIPS reporting. Collection of relevant patient data (including PHI) and statistical analysis of that data is used to improve the quality of neurologic care and patient outcomes. How is PHI used? The patient/encounter-related clinical data uploaded to FIGMD’s system is separated into de-identified clinical data and PHI data. The PHI data is secured separately until re-identification is needed for PQRS/MIPS reporting submitted to CMS. Some elements of the participant’s patients’ PHI also are used on the participant’s user dashboard. For each measure, the participant can view a list of patients who met, or did not meet, the measure. The patient’s name, date of birth, and medical record number are presented for the participant to investigate the patient documentation. A subset of the PHI, called a limited data set, will be provided, but not sold, to a partner analytics center, which will conduct data analysis on behalf of the AAN and other data requesters. The limited data set will not be provided to or sold to data requesters, including industry. Does the AAN have access to all my data in the Axon Registry? The AAN will only have access to aggregated data, either in the form of de-identified patient data or a limited data set. The AAN will not have access to fully-identifiable PHI. How will the AAN use the limited data set information? The information will be used for research to help improve AAN quality improvement and education products. In addition, this
will be a valuable neurology-focused database and we will be able to provide real-world evidence to researchers seeking to conduct secondary data analysis. Is the data collection and storage HIPAA compliant? The AAN and FIGMD comply with the laws and regulations applicable to the Axon Registry and have adopted HIPAA Privacy Policies and Procedures. Is the Axon Registry data secure? FIGMD has received full accreditation with the Electronic Healthcare Network Accreditation Commission (EHNAC). EHNAC performed a comprehensive third-party review to demonstrate the privacy and security of the registry data, as well as to demonstrate privacy and security for data exchange in cloud-enabled networks. An in-depth explanation of data security and compliance can be found in the Axon Registry Participation Agreement, which includes the Data Use Agreement and Business Associate Agreement, and is located at AAN.com/view/axon. John Hutchins, JD, deputy general counsel for the AAN, explained, “Reviewing the legal documents and assessing practice questions before joining the Axon Registry can be an extensive process, particularly for large institutions. As you’re working with your practice’s legal, clinical, and IT departments to coordinate enrollment, AAN registry staff, legal team, and vendor representatives are available to answer questions and provide information about the security measures in place for the Axon Registry.” If you have questions about the Axon Registry, contact registry@aan.com. •
Academy Publications Win Top Honors
14
The AAN publications Neurology Now® and Neurology Today® recently won top awards from the editorial awards competition sponsored by the American Society of Healthcare Publication Editors (ASHPE).
in the October/November 2016 issue, online at http://bit.ly/2eK7iYt. The patient magazine also won the Bronze for Best Single News/ Analysis Article, “Stem Cell Reality,” in the December 2016/January 2017 issue (http://bit.ly/2pFvpMG).
Neurology Now won the Gold Award for Best Profile, “Shining a Light,”
The Gold Award for Best Single News/Analysis Article was captured
AANnews • June 2017
by Neurology Today for its August 18, 2016, article, “Salary Disparities” (http://bit.ly/2pUN7MY ). The ASHPE awards competition is well-respected within the publishing industry, draws nearly 3,000 entries each year, and is judged by a panel of editors and graphics professionals in the publishing field. •
IN THE MANAGEMENT OF RMS
THINK
BEYOND Ad Page
RELAPSES RMS=relapsing forms of multiple sclerosis.
FOR PATIENTS WITH RELAPSING MS
IMPACT
DISABILITY
PROGRESSION NOW DMT=disease-modifying therapy; EDSS=Expanded Disability Status Scale; MS=multiple sclerosis.
INDICATION AUBAGIO® (teriflunomide) is indicated for the treatment of patients with relapsing forms of multiple sclerosis. IMPORTANT SAFETY INFORMATION WARNING: HEPATOTOXICITY AND RISK OF TERATOGENICITY • Severe liver injury including fatal liver failure has been reported in patients treated with leflunomide, which is indicated for rheumatoid arthritis. A similar risk would be expected for teriflunomide because recommended doses of teriflunomide and leflunomide result in a similar range of plasma concentrations of teriflunomide. Concomitant use of AUBAGIO with other potentially hepatotoxic drugs may increase the risk of severe liver injury. • Obtain transaminase and bilirubin levels within 6 months before initiation of AUBAGIO therapy. Monitor ALT levels at least monthly for 6 months after starting AUBAGIO. If drug-induced liver injury is suspected, discontinue AUBAGIO and start an accelerated elimination procedure with cholestyramine or activated charcoal. AUBAGIO is contraindicated in patients with severe hepatic impairment. Patients with pre-existing liver disease may be at increased risk of developing elevated serum transaminases when taking AUBAGIO. • AUBAGIO is contraindicated for use in pregnant women and in women of reproductive potential who are not using effective contraception because of the potential for fetal harm. Teratogenicity and embryolethality occurred in animals at plasma teriflunomide exposure lower than that in humans. Exclude pregnancy before the start of treatment with AUBAGIO in females of reproductive potential. Advise females of reproductive potential to use effective contraception during AUBAGIO treatment and during an accelerated drug elimination procedure after AUBAGIO treatment. Stop AUBAGIO and use an accelerated drug elimination procedure if the patient becomes pregnant. CONTRAINDICATIONS • Patients with severe hepatic impairment. • Pregnant women and females of reproductive potential not using effective contraception. • Patients with a history of hypersensitivity reaction to teriflunomide, leflunomide, or to any of the inactive ingredients in AUBAGIO. • Co-administration with leflunomide.
QUIETING MS Quietly for your patients with relapsing MS
‡
Start or switch to AUBAGIO (teriflunomide) 14 mg—the only oral DMT with a proven impact on disability progression in 2 Phase III trials ®
1-3
The majority of patients remained free from disability progression* with AUBAGIO 14 mg1
80 84 AN ESTIMATED
AN ESTIMATED
%
%
IN TEMSO
IN TOWER
OVER 108 WEEKS (P =0.03)1†
OVER 108 WEEKS (P <0.05)1†
*Disability progression was a secondary endpoint in TEMSO and TOWER.4,5 † Based on Kaplan-Meier estimates.1 TEMSO: A double-blind, placebo-controlled trial in patients with relapsing forms of MS (N=1088). Patients were randomized to receive AUBAGIO 14 mg (n=359), AUBAGIO 7 mg (n=366), or placebo (n=363) once daily for 108 weeks.4 TOWER: A double-blind, placebo-controlled trial in patients with relapsing forms of MS (N=1169). Patients were randomized to receive AUBAGIO 14 mg (n=372), AUBAGIO 7 mg (n=408), or placebo (n=389) once daily with results for up to 40 months of treatment.5
• The estimated proportion of patients with sustained disability progression: —TEMSO: 20.2%, 21.7%, and 27.3% with AUBAGIO 14 mg, AUBAGIO 7 mg, and placebo, respectively1 —TOWER: 15.8%, 21.1%, and 19.7% with AUBAGIO 14 mg, AUBAGIO 7 mg, and placebo, respectively1 • AUBAGIO 7 mg did not achieve a statistically significant reduction in risk of sustained disability progression versus placebo in either trial1 • Sustained disability progression was defined as at least a 1-point increase from baseline EDSS score ≤5.5 (or at least a 0.5-point increase for those with a baseline EDSS score >5.5) sustained for at least 12 weeks1 • AUBAGIO 14 mg and 7 mg achieved a significant relative reduction in risk of relapse in TEMSO (31% for both doses; P<0.05) and TOWER (36% and 22%, respectively; P<0.05)1
WARNINGS AND PRECAUTIONS • Hepatotoxicity: Patients with pre-existing acute or chronic liver disease, or those with serum ALT >2 times the upper limit of normal (ULN) before initiating treatment, should not normally be treated with AUBAGIO. In clinical trials, if ALT elevation was >3 times the ULN on 2 consecutive tests, patients discontinued AUBAGIO and underwent accelerated elimination. Consider additional monitoring if co-administering AUBAGIO with other potentially hepatotoxic drugs; monitor patients who develop symptoms suggestive of hepatic dysfunction (eg, unexplained nausea, vomiting, abdominal pain, fatigue, anorexia, or jaundice and/or dark urine). • Teratogenicity: AUBAGIO may cause fetal harm when administered in pregnant women. Teratogenicity and embryo-fetal lethality occurred in animal reproduction studies in multiple animal species at plasma teriflunomide exposures similar to or lower than that in humans at the maximum human recommended dose of 14 mg/day. AUBAGIO is contraindicated for use in pregnant women and females of reproductive potential not using effective contraception. Women who become pregnant while taking AUBAGIO may enroll in the AUBAGIO pregnancy registry by calling 1-800-745-4447, option 2. • Procedure for Accelerated Elimination of Teriflunomide: Teriflunomide is eliminated slowly from the plasma—it takes an average of 8 months, or up to 2 years, to reach plasma concentrations <0.02 mcg/mL. Elimination may be accelerated by administration of cholestyramine or activated charcoal, but this may cause disease activity to return in patients who were responding to AUBAGIO. • Bone Marrow Effects/Immunosuppression Potential/Infections: Decreases in white blood cell counts, mainly of neutrophils and lymphocytes, and platelets have been reported with AUBAGIO. Thrombocytopenia, including rare cases with platelet counts less than 50,000/mm3, has been reported in the postmarketing setting. Obtain a complete blood cell count within 6 months before starting treatment, with further monitoring based on signs and symptoms of bone marrow suppression. AUBAGIO is not recommended for patients with severe immunodeficiency, bone marrow disease, or severe uncontrolled infections. Tuberculosis (TB) has been observed in clinical studies of AUBAGIO. Before starting treatment, screen patients for latent TB infection with a tuberculin test. Treatment in patients with acute or chronic infections should not be started until the infection(s) is resolved. Administration of live vaccines is not recommended. The risk of malignancy, particularly lymphoproliferative disorders, or infection may be increased with the use of some medications with immunosuppressive potential, including teriflunomide.
(continued on back)
Please see additional Important Safety Information and Brief Summary of Full Prescribing Information, including boxed WARNING, on the following pages. ‡
AUBAGIO is effective across key measures of disease activity: sustained disability progression (14 mg only), annualized relapse rate, and MRI activity. Overall discontinuation rates due to adverse events were 12.5% with AUBAGIO 14 mg, 11.2% with AUBAGIO 7 mg, and 7.5% with placebo, and treatment discontinuation rates due to common adverse events were ≤3.3% in the pooled clinical trials.1,6
Proven impact in newly diagnosed RMS patients1 In patients who had a first clinical event characteristic of RMS, AUBAGIO® (teriflunomide) provided freedom from relapses1
72
% REMAINED
IN TOPIC
RELAPSE FREE
VS 62% WITH PLACEBO (P <0.05)1
• 71% of patients remained relapse free with AUBAGIO 7 mg in the TOPIC trial1 • TOPIC is the only trial of an oral RMS therapy that studied patients who had a first clinical event consistent with acute demyelination occurring within 90 days of randomization1-3 TOPIC: A double-blind, placebo-controlled trial in patients with relapsing forms of MS (N=618). Patients were randomized to receive AUBAGIO 14 mg (n=216), AUBAGIO 7 mg (n=205), or placebo (n=197) once daily for 108 weeks. Patients had a first clinical event consistent with acute demyelination occurring within 90 days of randomization with 2 or more T2 lesions at least 3 mm in diameter characteristic of RMS.7
MAKE AUBAGIO YOUR FIRST CHOICE FOR NEWLY DIAGNOSED RMS PATIENTS IMPORTANT SAFETY INFORMATION (continued) • Hypersensitivity and Serious Skin Reactions: AUBAGIO can cause anaphylaxis and severe allergic reactions. Signs and symptoms have included dyspnea, urticaria, and angioedema including lips, eyes, throat, and tongue. Cases of serious skin reactions, including Stevens-Johnson syndrome and a fatal case of toxic epidermal necrolysis, have been reported with AUBAGIO. Very rare cases of Drug Reaction with Eosinophilia and Systemic Symptoms have also been reported with leflunomide. If a severe skin reaction develops with AUBAGIO, stop treatment and begin accelerated elimination. In such cases, patients should not be re-exposed to teriflunomide. • Peripheral Neuropathy: Peripheral neuropathy, including polyneuropathy and mononeuropathy, has been reported with AUBAGIO. Age >60 years, concomitant neurotoxic medications, and diabetes may increase the risk. If peripheral neuropathy is suspected, consider discontinuing treatment and performing accelerated elimination. • Increased Blood Pressure: Blood pressure increases and hypertension have occurred with AUBAGIO. Measure blood pressure at treatment initiation and manage any elevations during treatment. • Respiratory Effects: Interstitial lung disease (ILD), including acute interstitial pneumonitis, has been reported with AUBAGIO. ILD may be fatal and may occur acutely at any time during therapy with a variable clinical presentation. If discontinuation of the drug is necessary, consider initiation of an accelerated elimination procedure. Adverse Reactions: The most frequent adverse reactions (≥10% and ≥2% greater than placebo) with AUBAGIO 7 mg and 14 mg and placebo, respectively, were headache (18% and 16% vs 15%), ALT increased (13% and 15% vs 9%), diarrhea (13% and 14% vs 8%), alopecia (10% and 13% vs 5%), and nausea (8% and 11% vs 7%). Drug Interactions: Monitor patients when teriflunomide is coadministered with warfarin, or with drugs metabolized by CYP1A2, CYP2C8, substrates of OAT3 transporters, substrates of BCRP, or OATP1B1/1B3 transporters. Use in Specific Populations: Women who wish to become pregnant should discontinue AUBAGIO and undergo an accelerated elimination procedure. Use of effective contraception should be continued until plasma concentrations of teriflunomide are <0.02 mcg/mL. Nursing mothers should not use AUBAGIO. AUBAGIO is detected in human semen. To minimize any possible fetal risk, men not wishing to father a child and their female partners should use effective contraception. Men wishing to father a child should discontinue therapy and either undergo accelerated elimination or verify plasma teriflunomide concentration is <0.02 mcg/mL. Please see additional Important Safety Information on the previous pages and Brief Summary of Full Prescribing Information, including boxed WARNING regarding hepatotoxicity and use in pregnancy, on the following pages. References: 1. AUBAGIO (teriflunomide) [package insert]. Cambridge, MA: Genzyme Corporation; November 2016. 2. Tecfidera (dimethyl fumarate) [package insert]. Cambridge, MA: Biogen Inc.; February 2016. 3. Gilenya (fingolimod) [package insert]. East Hanover, NJ: Novartis Pharmaceuticals Corporation; February 2016. 4. O’Connor P, Wolinsky JS, Confavreux C, et al; TEMSO Trial Group. Randomized trial of oral teriflunomide for relapsing multiple sclerosis. N Engl J Med. 2011;365(14):1293-1303. 5. Confavreux C, O’Connor P, Comi G, et al; for the TOWER Trial Group. Oral teriflunomide for patients with relapsing multiple sclerosis (TOWER): a randomised, double-blind, placebo-controlled, phase 3 trial. Lancet Neurol. 2014;13(3):247-256. 6. Data on file, Sanofi/Genzyme. Summary of safety HMR1726-teriflunomide. December 5, 2013. 7. Miller AE, Wolinsky JS, Kappos L, et al; for the TOPIC Study Group. Oral teriflunomide for patients with a first clinical episode suggestive of multiple sclerosis (TOPIC): a randomised, double-blind, placebo-controlled, phase 3 trial. Lancet Neurol. 2014;13(10):977-986.
©2016 Genzyme Corporation. All rights reserved. AUBAGIO, Sanofi, and Genzyme registered in U.S. Patent and Trademark Office. GZUS.AUBA.15.01.0245(3) December 2016
AUBAGIO® (teriflunomide) tablets, for oral use
Rx Only
Brief Summary of Prescribing Information WARNING: HEPATOTOXICITY and RISK OF TERATOGENICITY • Hepatotoxicity Severe liver injury including fatal liver failure has been reported in patients treated with leflunomide, which is indicated for rheumatoid arthritis. A similar risk would be expected for teriflunomide because recommended doses of teriflunomide and leflunomide result in a similar range of plasma concentrations of teriflunomide. Concomitant use of AUBAGIO with other potentially hepatotoxic drugs may increase the risk of severe liver injury. Obtain transaminase and bilirubin levels within 6 months before initiation of AUBAGIO therapy. Monitor ALT levels at least monthly for six months after starting AUBAGIO [see Warnings and Precautions (5.1)]. If drug induced liver injury is suspected, discontinue AUBAGIO and start an accelerated elimination procedure with cholestyramine or charcoal [see Warnings and Precautions (5.3)]. AUBAGIO is contraindicated in patients with severe hepatic impairment [see Contraindications (4)]. Patients with pre-existing liver disease may be at increased risk of developing elevated serum transaminases when taking AUBAGIO. • Risk of Teratogenicity AUBAGIO is contraindicated for use in pregnant women and in women of reproductive potential who are not using effective contraception because of the potential for fetal harm. Teratogenicity and embryolethality occurred in animals at plasma teriflunomide exposures lower than that in humans. Exclude pregnancy before the start of treatment with AUBAGIO in females of reproductive potential. Advise females of reproductive potential to use effective contraception during AUBAGIO treatment and during an accelerated drug elimination procedure after AUBAGIO treatment. Stop AUBAGIO and use an accelerated drug elimination procedure if the patient becomes pregnant [see Contraindications (4), Warnings and Precautions (5.2, 5.3), Use in Specific Populations (8.1), and Clinical Pharmacology (12.3) in the full prescribing information].
1 INDICATIONS AND USAGE AUBAGIO® is indicated for the treatment of patients with relapsing forms of multiple sclerosis. 2 DOSAGE AND ADMINISTRATION The recommended dose of AUBAGIO is 7 mg or 14 mg orally once daily. AUBAGIO can be taken with or without food. Monitoring to assess safety • Obtain transaminase and bilirubin levels within 6 months before initiation of AUBAGIO therapy. Monitor ALT levels at least monthly for six months after starting AUBAGIO [see Warnings and Precautions (5.1)]. • Obtain a complete blood cell count (CBC) within 6 months before the initiation of treatment with AUBAGIO. Further monitoring should be based on signs and symptoms of infection [see Warnings and Precautions (5.4)]. • Prior to initiating AUBAGIO, screen patients for latent tuberculosis infection with a tuberculin skin test or blood test for mycobacterium tuberculosis infection [see Warnings and Precautions (5.4)]. • Exclude pregnancy prior to initiation of treatment with AUBAGIO in females of reproductive potential [see Warnings and Precautions (5.2)]. • Check blood pressure before start of AUBAGIO treatment and periodically thereafter [see Warnings and Precautions (5.7)]. 4 CONTRAINDICATIONS AUBAGIO is contraindicated in/with: • Patients with severe hepatic impairment [see Warnings and Precautions (5.1)]. • Pregnant women and females of reproductive potential not using effective contraception. AUBAGIO may cause fetal harm [see Warnings and Precautions (5.2 and 5.3) and Use in Specific Populations (8.1)]. • Patients with a history of a hypersensitivity reaction to teriflunomide, leflunomide, or to any of the inactive ingredients in AUBAGIO. Reactions have included anaphylaxis, angioedema, and serious skin reactions [see Warnings and Precautions (5.5)]. • Coadministration with leflunomide [see Clinical Pharmacology (12.3) in the full prescribing information]. 5 WARNINGS AND PRECAUTIONS 5.1 Hepatotoxicity Severe liver injury including fatal liver failure and dysfunction has been reported in some patients treated with leflunomide, which is indicated for rheumatoid arthritis. A similar risk would be expected for teriflunomide because recommended doses of teriflunomide and leflunomide result in a similar range of plasma concentrations of teriflunomide. Patients with pre-existing liver disease may be at increased risk of developing elevated serum transaminases when taking AUBAGIO. Patients with pre-existing acute or chronic liver disease, or those with serum alanine aminotransferase (ALT) greater than two times the upper limit of normal (ULN) before initiating treatment, should not normally be treated with AUBAGIO. AUBAGIO is contraindicated in patients with severe hepatic impairment [see Contraindications (4)]. In placebo-controlled trials, ALT greater than three times the ULN occurred in 61/1045 (5.8%) and 62/1002 (6.2%) of patients receiving AUBAGIO 7 mg and 14 mg, respectively, and 38/997 (3.8%) of patients receiving placebo, during the treatment period. These elevations occurred mostly within the first year of treatment. Half of the cases returned to normal without drug discontinuation. In clinical trials, if ALT elevation was greater than three times the ULN on two consecutive tests, AUBAGIO was discontinued and patients underwent an accelerated elimi-
nation procedure [see Warnings and Precautions (5.3)]. Of the patients who underwent discontinuation and accelerated elimination in controlled trials, half returned to normal or near normal values within 2 months. One patient in the controlled trials developed ALT 32 times the ULN and jaundice 5 months after initiation of AUBAGIO 14 mg treatment. The patient was hospitalized for 5 weeks and recovered after plasmapheresis and cholestyramine accelerated elimination procedure. AUBAGIO-induced liver injury in this patient could not be ruled out. Obtain serum transaminase and bilirubin levels within 6 months before initiation of AUBAGIO therapy. Monitor ALT levels at least monthly for six months after starting AUBAGIO. Consider additional monitoring when AUBAGIO is given with other potentially hepatotoxic drugs. Consider discontinuing AUBAGIO if serum transaminase increase (greater than three times the ULN) is confirmed. Monitor serum transaminase and bilirubin on AUBAGIO therapy, particularly in patients who develop symptoms suggestive of hepatic dysfunction, such as unexplained nausea, vomiting, abdominal pain, fatigue, anorexia, or jaundice and/or dark urine. If liver injury is suspected to be AUBAGIO-induced, discontinue AUBAGIO and start an accelerated elimination procedure [see Warnings and Precautions (5.3)] and monitor liver tests weekly until normalized. If AUBAGIO-induced liver injury is unlikely because some other probable cause has been found, resumption of AUBAGIO therapy may be considered. 5.2 Teratogenicity AUBAGIO may cause fetal harm when administered to a pregnant woman. Teratogenicity and embryo-fetal lethality occurred in animal reproduction studies in multiple animal species at plasma teriflunomide exposures similar to or lower than that in humans at the maximum human recommended dose (MHRD) of 14 mg/day [see Use in Specific Populations (8.1)]. AUBAGIO is contraindicated for use in pregnant women and females of reproductive potential not using effective contraception [see Contraindications (4) and Warnings and Precautions (5.3)]. 5.3 Procedure for Accelerated Elimination of Teriflunomide Teriflunomide is eliminated slowly from the plasma [see Clinical Pharmacology (12.3) in the full prescribing information]. Without an accelerated elimination procedure, it takes on average 8 months to reach plasma concentrations less than 0.02 mg/L, although because of individual variations in drug clearance it may take as long as 2 years. An accelerated elimination procedure could be used at any time after discontinuation of AUBAGIO. Elimination can be accelerated by either of the following procedures: • Administration of cholestyramine 8 g every 8 hours for 11 days. If cholestyramine 8 g three times a day is not well tolerated, cholestyramine 4 g three times a day can be used. • Administration of 50 g oral activated charcoal powder every 12 hours for 11 days. If either elimination procedure is poorly tolerated, treatment days do not need to be consecutive unless there is a need to lower teriflunomide plasma concentration rapidly. At the end of 11 days, both regimens successfully accelerated teriflunomide elimination, leading to more than 98% decrease in teriflunomide plasma concentrations. Use of the accelerated elimination procedure may potentially result in return of disease activity if the patient had been responding to AUBAGIO treatment. 5.4 Bone Marrow Effects/Immunosuppression Potential/Infections Bone Marrow Effects A mean decrease compared to baseline in white blood cell (WBC) count of approximately 15% (mainly neutrophils and lymphocytes) and in platelet count of approximately 10% was observed in placebo-controlled trials with 7 mg and 14 mg of AUBAGIO. The decrease in mean WBC count occurred during the first 6 weeks and WBC count remained low during treatment. In placebo-controlled studies, neutrophil count <1.5×109/L was observed in 12% and 16% of patients receiving AUBAGIO 7 mg and 14 mg, respectively, compared with 7% of patients receiving placebo; lymphocyte count <0.8× 109/L was observed in 10% and 12% of patients receiving AUBAGIO 7 mg and 14 mg, respectively, compared with 6% of patients receiving placebo. No cases of serious pancytopenia were reported in premarketing clinical trials of AUBAGIO but rare cases of pancytopenia and agranulocytosis have been reported in the postmarketing setting with leflunomide. A similar risk would be expected for AUBAGIO [see Clinical Pharmacology (12.3) in the full prescribing information]. Cases of thrombocytopenia with AUBAGIO, including rare cases with platelet counts less than 50,000/mm3, have been reported in the postmarketing setting. Obtain a complete blood cell count (CBC) within 6 months before the initiation of treatment with AUBAGIO. Further monitoring should be based on signs and symptoms suggestive of bone marrow suppression. Risk of Infection / Tuberculosis Screening Patients with active acute or chronic infections should not start treatment until the infection(s) is resolved. If a patient develops a serious infection consider suspending treatment with AUBAGIO and using an accelerated elimination procedure. Reassess the benefits and risks prior to resumption of therapy. Instruct patients receiving AUBAGIO to report symptoms of infections to a physician. AUBAGIO is not recommended for patients with severe immunodeficiency, bone marrow disease, or severe, uncontrolled infections. Medications like AUBAGIO that have immunosuppression potential may cause patients to be more susceptible to infections, including opportunistic infections. In placebo-controlled studies of AUBAGIO, no overall increase in the risk of serious infections was observed with AUBAGIO 7 mg (2.2%) or 14 mg (2.7%) compared to placebo (2.2%). However, one fatal case of klebsiella pneumonia sepsis occurred in a patient taking AUBAGIO 14 mg for 1.7 years. Fatal infections have been reported in the postmarketing setting in patients receiving leflunomide, especially Pneumocystis jiroveci pneumonia and aspergillosis. Most of the reports were confounded by concomitant immunosuppressant therapy and/or comorbid illness which, in addition to rheumatoid disease, may predispose patients to infection. In clinical studies with AUBAGIO, cytomegalovirus hepatitis reactivation has been observed. In clinical studies with AUBAGIO, cases of tuberculosis have been observed. Prior to initiating AUBAGIO, screen patients for latent tuberculosis infection with a tuberculin skin test or with a blood test for mycobacterium tuberculosis infection. AUBAGIO has not been studied in patients with a positive tuberculosis screen, and the safety of AUBAGIO in individuals with latent tuberculosis infection is unknown. For patients testing positive in tuberculosis screening, treat by standard medical practice prior to therapy with AUBAGIO.
Vaccination No clinical data are available on the efficacy and safety of live vaccinations in patients taking AUBAGIO. Vaccination with live vaccines is not recommended. The long half-life of AUBAGIO should be considered when contemplating administration of a live vaccine after stopping AUBAGIO. Malignancy The risk of malignancy, particularly lymphoproliferative disorders, is increased with the use of some immunosuppressive medications. There is a potential for immunosuppression with AUBAGIO. No apparent increase in the incidence of malignancies and lymphoproliferative disorders was reported in the AUBAGIO clinical trials, but larger and longer-term studies would be needed to determine whether there is an increased risk of malignancy or lymphoproliferative disorders with AUBAGIO. 5.5 Hypersensitivity and Serious Skin Reactions AUBAGIO can cause anaphylaxis and severe allergic reactions [see Contraindications (4)]. Signs and symptoms have included dyspnea, urticaria, and angioedema including lips, eyes, throat, and tongue. Cases of serious skin reactions, including cases of Stevens-Johnson syndrome (SJS) and a fatal case of toxic epidermal necrolysis (TEN), have been reported with AUBAGIO. In patients treated with leflunomide, the parent compound, very rare cases of Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) have also been reported. Inform patients of the signs and symptoms of anaphylaxis and angioedema and signs and symptoms that may signal a serious skin reaction. Inform patients that a fever associated with signs of other organ system involvement (e.g., rash, lymphadenopathy, or hepatic dysfunction) may be drug-related. Instruct patients to discontinue AUBAGIO and seek immediate medical care should these signs and symptoms occur. Discontinue AUBAGIO, unless the reactions are clearly not drug-related, and begin an accelerated elimination procedure immediately [see Warnings and Precautions (5.3)]. In such cases, patients should not be re-exposed to teriflunomide [see Contraindications (4)]. 5.6 Peripheral Neuropathy In placebo-controlled studies, peripheral neuropathy, including both polyneuropathy and mononeuropathy (e.g., carpal tunnel syndrome), occurred more frequently in patients taking AUBAGIO than in patients taking placebo. The incidence of peripheral neuropathy confirmed by nerve conduction studies was 1.4% (13 patients) and 1.9% (17 patients) of patients receiving 7 mg and 14 mg of AUBAGIO, respectively, compared with 0.4% receiving placebo (4 patients). Treatment was discontinued in 0.7% (8 patients) with confirmed peripheral neuropathy (3 patients receiving AUBAGIO 7 mg and 5 patients receiving AUBAGIO 14 mg). Five of them recovered following treatment discontinuation. Not all cases of peripheral neuropathy resolved with continued treatment. Peripheral neuropathy also occurred in patients receiving leflunomide. Age older than 60 years, concomitant neurotoxic medications, and diabetes may increase the risk for peripheral neuropathy. If a patient taking AUBAGIO develops symptoms consistent with peripheral neuropathy, such as bilateral numbness or tingling of hands or feet, consider discontinuing AUBAGIO therapy and performing an accelerated elimination procedure [see Warnings and Precautions (5.3)]. 5.7 Increased Blood Pressure In placebo-controlled studies, the mean change from baseline to the end of study in systolic blood pressure was +2.3 mmHg and +2.7 mmHg for AUBAGIO 7 mg and 14 mg, respectively, and -0.6 mmHg for placebo. The change from baseline in diastolic blood pressure was +1.4 mmHg and +1.9 mmHg for AUBAGIO 7 mg and 14 mg, respectively, and -0.3 mmHg for placebo. Hypertension was an adverse reaction in 3.1% and 4.3% of patients treated with 7 mg or 14 mg of AUBAGIO compared with 1.8% for placebo. Check blood pressure before start of AUBAGIO treatment and periodically thereafter. Elevated blood pressure should be appropriately managed during treatment with AUBAGIO. 5.8 Respiratory Effects Interstitial lung disease, including acute interstitial pneumonitis, has been reported with AUBAGIO in the postmarketing setting. Interstitial lung disease and worsening of pre-existing interstitial lung disease have been reported during treatment with leflunomide. Interstitial lung disease may be fatal and may occur acutely at any time during therapy with a variable clinical presentation. New onset or worsening pulmonary symptoms, such as cough and dyspnea, with or without associated fever, may be a reason for discontinuation of therapy and for further investigation as appropriate. If discontinuation of the drug is necessary, consider initiation of an accelerated elimination procedure [see Warnings and Precautions (5.3)]. 5.9 Concomitant Use with Immunosuppressive or Immunomodulating Therapies Coadministration with antineoplastic, or immunosuppressive therapies used for treatment of multiple sclerosis has not been evaluated. Safety studies in which AUBAGIO was concomitantly administered with other immune modulating therapies for up to one year (interferon beta, glatiramer acetate) did not reveal any specific safety concerns. The long term safety of these combinations in the treatment of multiple sclerosis has not been established. In any situation in which the decision is made to switch from AUBAGIO to another agent with a known potential for hematologic suppression, it would be prudent to monitor for hematologic toxicity, because there will be overlap of systemic exposure to both compounds. Use of an accelerated elimination procedure may decrease this risk, but may also potentially result in return of disease activity if the patient had been responding to AUBAGIO treatment [see Warnings and Precautions (5.3)]. 6 ADVERSE REACTIONS The following serious adverse reactions are described elsewhere in the prescribing information: • Hepatotoxicity [see Contraindications (4) and Warnings and Precautions (5.1)] • Bone Marrow Effects/Immunosuppression Potential/Infections [see Warnings and Precautions (5.4)] • Hypersensitivity and Serious Skin Reactions [see Contraindications (4) and Warnings and Precautions (5.5)] • Peripheral Neuropathy [see Warnings and Precautions (5.6)] • Increased Blood Pressure [see Warnings and Precautions (5.7)]
AUBAGIO® (teriflunomide) tablets, for oral use • Respiratory Effects [see Warnings and Precautions (5.8)] 6.1 Clinical Trials Experience Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in clinical practice. A total of 2047 patients receiving AUBAGIO (7 mg or 14 mg once daily) constituted the safety population in the pooled analysis of placebo controlled studies in patients with relapsing forms of multiple sclerosis; of these, 71% were female. The average age was 37 years. Table 1 lists adverse reactions in placebo-controlled trials with rates that were at least 2% for AUBAGIO patients and also at least 2% above the rate in placebo patients. The most common were headache, an increase in ALT, diarrhea, alopecia, and nausea. The adverse reaction most commonly associated with discontinuation was an increase in ALT (3.3%, 2.6%, and 2.3% of all patients in the AUBAGIO 7 mg, AUBAGIO 14 mg, and placebo treatment arms, respectively). Table 1. Adverse Reactions in Pooled Placebo-Controlled Studies in Patients with Relapsing Forms of Multiple Sclerosis AUBAGIO AUBAGIO 7 mg 14 mg Placebo Adverse Reaction (N=1045) (N=1002) (N=997) Headache 18% 16% 15% Increase in Alanine aminotransferase 13% 15% 9% Diarrhea 13% 14% 8% Alopecia 10% 13% 5% Nausea 8% 11% 7% Paresthesia 8% 9% 7% Arthralgia 8% 6% 5% Neutropenia 4% 6% 2% Hypertension 3% 4% 2% Cardiovascular Deaths Four cardiovascular deaths, including three sudden deaths, and one myocardial infarction in a patient with a history of hyperlipidemia and hypertension were reported among approximately 2600 patients exposed to AUBAGIO in the premarketing database. These cardiovascular deaths occurred during uncontrolled extension studies, one to nine years after initiation of treatment. A relationship between AUBAGIO and cardiovascular death has not been established. Acute Renal Failure In placebo-controlled studies, creatinine values increased more than 100% over baseline in 8/1045 (0.8%) patients in the 7 mg AUBAGIO group and 6/1002 (0.6%) patients in the 14 mg AUBAGIO group versus 4/997 (0.4%) patients in the placebo group. These elevations were transient. Some elevations were accompanied by hyperkalemia. AUBAGIO may cause acute uric acid nephropathy with transient acute renal failure because AUBAGIO increases renal uric acid clearance. Hypophosphatemia In clinical trials, 18% of AUBAGIO-treated patients had hypophosphatemia with serum phosphorus levels of at least 0.6 mmol/L, compared to 7% of placebo-treated patients; 4% of AUBAGIO-treated patients had hypophosphatemia with serum phosphorus levels at least 0.3 mmol/L but less than 0.6 mmol/L, compared to 0.8% of placebo-treated patients. No patient in any treatment group had a serum phosphorus below 0.3 mmol/L. 6.2 Postmarketing Experience The following adverse reactions have been identified during postapproval use of AUBAGIO. 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. • Hypersensitivity reactions, some of which were severe, such as anaphylaxis and angioedema [see Warnings and Precautions (5.5)] • Severe skin reactions, including toxic epidermal necrolysis and Stevens-Johnson syndrome [see Warnings and Precautions (5.5)] • Thrombocytopenia [see Warnings and Precautions (5.4)] • Interstitial lung disease [see Warnings and Precautions (5.8)] • Pancreatitis 7 DRUG INTERACTIONS Effect of AUBAGIO on CYP2C8 substrates Teriflunomide is an inhibitor of CYP2C8 in vivo. In patients taking AUBAGIO, exposure of drugs metabolized by CYP2C8 (e.g., paclitaxel, pioglitazone, repaglinide, rosiglitazone) may be increased. Monitor these patients and adjust the dose of the concomitant drug(s) metabolized by CYP2C8 as required [see Clinical Pharmacology (12.3) in the full prescribing information]. Effect of AUBAGIO on warfarin Coadministration of AUBAGIO with warfarin requires close monitoring of the international normalized ratio (INR) because AUBAGIO may decrease peak INR by approximately 25%. Effect of AUBAGIO on oral contraceptives AUBAGIO may increase the systemic exposures of ethinylestradiol and levonorgestrel. Consideration should be given to the type or dose of contraceptives used in combination with AUBAGIO [see Clinical Pharmacology (12.3) in the full prescribing information]. Effect of AUBAGIO on CYP1A2 substrates Teriflunomide may be a weak inducer of CYP1A2 in vivo. In patients taking AUBAGIO, exposure of drugs metabolized by CYP1A2 (e.g., alosetron, duloxetine, theophylline, tizanidine) may be reduced. Monitor these patients and adjust the dose of the concomitant drug(s) metabolized by CYP1A2 as required [see Clinical Pharmacology (12.3) in the full prescribing information].
Effect of AUBAGIO on organic anion transporter 3 (OAT3) substrates Teriflunomide inhibits the activity of OAT3 in vivo. In patients taking AUBAGIO, exposure of drugs which are OAT3 substrates (e.g., cefaclor, cimetidine, ciprofloxacin, penicillin G, ketoprofen, furosemide, methotrexate, zidovudine) may be increased. Monitor these patients and adjust the dose of the concomitant drug(s) which are OAT3 substrates as required [see Clinical Pharmacology (12.3) in the full prescribing information]. Effect of AUBAGIO on BCRP and organic anion transporting polypeptide B1 and B3 (OATP1B1/ 1B3) substrates Teriflunomide inhibits the activity of BCRP and OATP1B1/1B3 in vivo. For a patient taking AUBAGIO, the dose of rosuvastatin should not exceed 10 mg once daily. For other substrates of BCRP (e.g., mitoxantrone) and drugs in the OATP family (e.g., methotrexate, rifampin), especially HMG-Co reductase inhibitors (e.g., atorvastatin, nateglinide, pravastatin, repaglinide, and simvastatin), consider reducing the dose of these drugs and monitor patients closely for signs and symptoms of increased exposures to the drugs while patients are taking AUBAGIO [see Clinical Pharmacology (12.3) in the full prescribing information]. 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 AUBAGIO during pregnancy. Healthcare providers and patients are encouraged to report pregnancies by calling 1-800-745-4447, option 2 Risk Summary AUBAGIO is contraindicated for use in pregnant women and females of reproductive potential not using effective contraception because of the potential for fetal harm based on animal data. Human data are not available at this time to inform the presence or absence of drug-associated risk with the use of AUBAGIO during pregnancy. In animal reproduction studies in rat and rabbits, oral administration of teriflunomide during organogenesis caused teratogenicity and embryolethality at plasma exposures (AUC) lower than that at the maximum human recommended dose (MHRD) of 14 mg/day [see Data]. In the US 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 in the indicated population is unknown. Clinical Considerations Women who wish to become pregnant should discontinue use of AUBAGIO and undergo an accelerated elimination procedure to decrease the plasma concentration of teriflunomide to less than 0.02 mg/L (0.02 mcg/mL). Effective contraception should be used until is it verified that plasma concentrations of teriflunomide are less than 0.02 mg/L (0.02 mcg/mL) [see Warnings and Precautions (5.3)]. Human plasma concentrations of teriflunomide less than 0.02 mg/L (0.02 mcg/mL) are expected to have minimal embryofetal risk [see Contraindications (4) and Warnings and Precautions (5.3)]. If the patient becomes pregnant while taking this drug, stop treatment with AUBAGIO, inform the patient of the potential risk to the fetus, and perform the accelerated drug elimination procedure to achieve plasma concentrations of less than 0.02 mg/L (0.02 mcg/mL) [see Warnings and Precautions (5.3) and Clinical Pharmacology (12.3) in the full prescribing information]. Refer the patient to an obstetrician/gynecologist, preferably experienced in reproductive toxicity, for further evaluation and counseling [see Warnings and Precautions (5.2, 5.3)]. Data Animal Data When teriflunomide (oral doses of 1, 3, or 10 mg/kg/day) was administered to pregnant rats throughout the period of organogenesis, high incidences of fetal malformation (primarily craniofacial, and axial and appendicular skeletal defects) and embryofetal death were observed at doses not associated with maternal toxicity. Adverse effects on embryofetal development were observed following dosing at various stages throughout organogenesis. Maternal plasma exposure at the no-effect level (1.0 mg/kg/day) for embryofetal developmental toxicity in rats was less than that in humans at the maximum recommended human dose (MRHD, 14 mg /day). Administration of teriflunomide (oral doses of 1, 3.5, or 12 mg/kg/day) to pregnant rabbits throughout organogenesis resulted in high incidences of fetal malformation (primarily craniofacial, and axial and appendicular skeletal defects) and embryofetal death at doses associated with minimal maternal toxicity. Maternal plasma exposure at the no-effect dose (1.0 mg/kg/day) for embryofetal developmental toxicity in rabbits was less than that in humans at the MRHD. In studies in which teriflunomide (oral doses of 0.05, 0.1, 0.3, 0.6, or 1.0 mg/kg/day) was administered to rats during gestation and lactation, decreased growth, eye and skin abnormalities, and high incidences of malformation (limb defects) and postnatal death were observed in the offspring at doses not associated with maternal toxicity. Maternal plasma exposure at the no-effect dose for pre- and postnatal developmental toxicity in rats (0.10 mg/kg/day) was less than that in humans at the MRHD. In animal reproduction studies of leflunomide, embryolethality and teratogenic effects were observed in pregnant rat and rabbit at or below clinically relevant plasma teriflunomide exposures (AUC). In published reproduction studies in pregnant mice, leflunomide was embryolethal and increased the incidence of malformations (craniofacial, axial skeletal, heart and great vessel). Supplementation with exogenous uridine reduced the teratogenic effects in pregnant mice, suggesting that the mode of action (inhibition of mitochondrial enzyme dihydroorotate dehydrogenase) is the same for therapeutic efficacy and developmental toxicity. At recommended doses in humans, teriflunomide and leflunomide result in a similar range of plasma concentrations of teriflunomide. 8.2 Lactation Risk Summary It is not known whether this drug is excreted in human milk. Teriflunomide was detected in rat milk following a single oral dose. The developmental and health benefits of breastfeeding should be considered along with the mother’s clinical need for AUBAGIO and any potential adverse effects on the breastfed infant from AUBAGIO or from the underlying maternal condition.
AUBAGIO® (teriflunomide) tablets, for oral use 8.3 Females and Males of Reproductive Potential Pregnancy Testing Exclude pregnancy prior to initiation of treatment with AUBAGIO in females of reproductive potential. Advise females to notify their healthcare provider immediately if pregnancy occurs or is suspected during treatment [see Warnings and Precautions (5.2, 5.3) and Use in Specific Populations (8.1)]. Contraception Females Females of reproductive potential should use effective contraception while taking AUBAGIO. If AUBAGIO is discontinued, use of contraception should be continued until is it verified that plasma concentrations of teriflunomide are less than 0.02 mg/L (0.02 mcg/mL). Females of reproductive potential who wish to become pregnant should undergo an accelerated elimination procedure. Effective contraception should be used until it is verified that plasma concentrations of teriflunomide are less than 0.02 mg/L (0.02 mcg/mL) [see Warnings and Precautions (5.3)]. Males AUBAGIO is detected in human semen. Animal studies to specifically evaluate the risk of male-mediated fetal toxicity have not been conducted. To minimize any possible risk, men not wishing to father a child and their female partners should use effective contraception. Men wishing to father a child should discontinue use of AUBAGIO and either undergo an accelerated elimination procedure or wait until verification that the plasma teriflunomide concentration is less than 0.02 mg/L (0.02 mcg/mL) [see Warnings and Precautions (5.3)]. Infertility Administration of teriflunomide to male rats resulted in no adverse effects on fertility. However, reduced epididymal sperm count was observed [see Nonclinical Toxicology (13.1) in the full prescribing information]. Effects of AUBAGIO on fertility in humans have not been evaluated. 8.4 Pediatric Use Safety and effectiveness in pediatric patients have not been established. 8.5 Geriatric Use Clinical studies of AUBAGIO did not include patients over 65 years old. 8.6 Hepatic Impairment No dosage adjustment is necessary for patients with mild and moderate hepatic impairment. The pharmacokinetics of teriflunomide in severe hepatic impairment have not been evaluated. AUBAGIO is contraindicated in patients with severe hepatic impairment [see Contraindications (4), Warnings and Precautions (5.1), and Clinical Pharmacology (12.3) in the full prescribing information]. 8.7 Renal Impairment No dosage adjustment is necessary for patients with mild, moderate, and severe renal impairment [see Clinical Pharmacology (12.3) in the full prescribing information]. 10 OVERDOSAGE There is no experience regarding teriflunomide overdose or intoxication in humans. Teriflunomide 70 mg daily up to 14 days was well tolerated by healthy subjects. In the event of clinically significant overdose or toxicity, cholestyramine or activated charcoal is recommended to accelerate elimination [see Warnings and Precautions (5.3)]. Genzyme Corporation 500 Kendall Street Cambridge, MA 02142 A SANOFI COMPANY November 2016 TER-BPLR-SA-NOV16
Practice
AAN, APA Publish Updated Dementia Management Quality Measurement Set On May 1, 2017, the AAN and American Psychiatric Association (APA) updated dementia management quality measurement set was published simultaneously in Neurology ® and the American Journal of Psychiatry. The AAN and APA collaborated to update the measurement set originally created in 2009 in partnership with the PCPI Foundation. A multi-disciplinary work group was convened, and work group review resulted in decisions to retire or reconfigure three measures, to reaffirm six measures with modifications, and to develop and approve three new measures. A brief summary of measures is included below. For full measure specifications, visit AAN.com/practice/ quality-measures.
Six measures were updated to provide clarity on how to meet measure numerators. In the driving safety measure, the exception for patients with dementia who had already stopped driving was removed in response to reports that the exception had caused confusion in pay-for-reporting programs. In the caregiver education measure, new exceptions were created for patients without caregivers, caregivers with prior training and/or certification, and patient/caregiver dyads already connected with existing supports. For the functional status measure, additional clarity was provided on definitions of activities of daily living. The safety measure was modified to specify dual risk domains related to self/others or the environment.
Three new measures were created to address treatment gaps for disclosure of dementia diagnosis, pain assessment and follow-up for patients with dementia, and pharmacological treatment of dementia. The AAN and APA work group did not review the previously developed Cognitive Screening measure as the PCPI Foundation retained ownership of the measure. The PCPI Foundation launched a separate project to update that measure in 2016.
The Screening and Management Behavioral and Psychiatric Symptoms Associated with Dementia was updated to address both screening and management of psychiatric symptoms in one unified measure. As a result, separate measures on management of neuropsychiatric symptoms and depression screening were retired to reduce provider burden to report on three separate measures. The work group also retired the staging of dementia measure as a result of patient and caregiver feedback.
2015 Dementia Management Measurement Set Update
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Measure Title
Measure Description
Disclosure of Dementia Diagnosis*
Percentage of patients with a diagnosis of a qualifying dementing disorder or disease whose diagnosis has been disclosed to them and, if available, their primary caregiver.
Education and Support of Caregivers for Patients with Dementia
Percentage of patients with dementia whose caregiver(s) were provided with education on dementia disease management and health behavior changes AND were referred to additional resources for support in the last 12 months.
Functional Status Assessment for Patients with Dementia
Percentage of patients with dementia for whom an assessment of functional status was performed at least once in the last 12 months.
Screening and Management of Behavioral and Psychiatric Symptoms Associated with Dementia
Percentage of patients with dementia for whom there was a documented screening for behavioral and psychiatric symptoms, including depression, and for whom, if screening positive, there was also documentation of recommendations for management in the last 12 months.
Safety Concern Screening and Follow-up for Patients with Dementia
Percentage of patients with dementia or their caregiver(s) for whom there was a documented safety screening in two domains of risk: dangerousness to self or others and environmental risks, and for whom, if screening positive, there was documentation they were provided with recommendations for their mitigation, which may include referral to other resources, in the last 12 months.
Driving Screening and Follow-up for Patients with Dementia
Percentage of patients with dementia for whom there was a documented screening for driving risks and for whom, if screening positive, there was also documentation they were informed of alternatives to driving in the last 12 months.
AANnews • June 2017
Measure Title
Measure Description
Advance Care Planning and Palliative Care Counseling for Patients with Dementia
Percentage of patients with dementia who 1. have an advance care plan or surrogate decisions maker documented in the medical record or documentation in the medical record that an advance care plan was discussed but the patient did not wish or was not able to name a surrogate decision maker or provide an advance care plan AND Percentage of patients with dementia or their surrogate decision maker who 2. received comprehensive counseling regarding ongoing palliation and symptom management, and end of life decisions within two years of initial diagnosis or assumption of care
Pain Assessment and Followup for Patients with Dementia*
Percentage of patients with dementia who underwent documented screening for pain symptoms at every visit and if screening positive also had a documentation of a follow-up plan.
Pharmacological Treatment of Dementia*
Percentage of patients with dementia or their caregivers with whom available guidelineappropriate pharmacological treatment options and nonpharmacological behavior and lifestyle modifications were discussed at least once in the last 12-month period.
*New measure added in 2015
Select measures have already been approved for use in the Merit-based Incentive Payment System (MIPS) for 2017. This measurement set will be reviewed for updates every three years. The AAN plans to develop new measures for mild cognitive impairment in 2017. If interested in participating in this project, contact Amy Bennett at abennett@aan.com. •
Explore the Latest Issues of Neurology Now, Neurology: Clinical Practice Christine Ha, the first blind contestant and winner of MasterChef USA in 2012, has neuromyelitis optica. She explains how and when she was diagnosed, what treatment she is prescribed, and how the condition has changed her life in the cover story for the June/July Neurology Now ®. The patient magazine also explores how doctors are learning more about how women are affected by neurologic disease. “Women and Neuro Disease” looks at the ways women experience certain disorders like MS, migraine, Parkinson’s disease, and epilepsy and the unique medical challenges they face from hormonal influences to different reactions to medication and fertility concerns. AAN members may elect to receive multiple copies of
Neurology Now to distribute to their patients, who also can subscribe for free. Visit NeurologyNow.com to learn more or access your AAN member profile to adjust the number of copies you receive.
In the new issue of Neurology® Clinical Practice, a resident boot-camp for reducing door-to-needle times at academic medical centers is profiled. Other story topics include barriers and facilitators to ER physician use of the test and treatment for BPPV, and the COOK CLA ING use of ultrasound in Maste SS Finds rChef Chris neuromuscular disease. Zest fo tine H N
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Neurology: Clinical Practice, published six times a year, is available in print (for US members only), online, and for the iPad and Android. Visit Neurology.org/cp for more information. •
AANnews • June 2017
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Guidelines
AAN Publishes Guideline on Reducing Brain Injury After CPR The AAN’s “Practice Guideline: Reducing Brain Injury After Cardiopulmonary Resuscitation” was published online in Neurology® on May 10, 2017, and in print in Neurology on May 30, 2017. The guideline was endorsed by the Neurocritical Care Society. This guideline assesses the evidence for the acute therapeutic interventions that are provided to reduce brain injury in adult patients who are comatose after successful cardiopulmonary resuscitation (CPR) and to make evidence-based recommendations. The guideline’s key findings include: nn For patients who are comatose in whom the initial cardiac
rhythm is either pulseless ventricular tachycardia (VT) or ventricular fibrillation (VF) after out-of-hospital cardiac arrest (OHCA), therapeutic hypothermia (TH; 32°C–34°C for 24 hours) is highly likely to be effective in improving functional neurologic outcome and survival compared with normothermia and should be offered. nn For patients who are comatose in whom the initial
cardiac rhythm is either VT/VF or asystole/pulseless electrical activity (PEA) after OHCA, targeted temperature management (TTM; 36°C for 24 hours, followed by rewarming to 37°C over 8 hours and maintenance of normothermia 37.5°C for 72 hours) is likely as effective as TH and is an acceptable alternative to TH. nn Patients who are comatose after successful resuscitation
from cardiac arrest require complex neurologic and medical care in the critical care unit.
“TH (32°C–34°C)/TTM (36°C) requires active temperature management for 24 hours. For TTM to be effective, active intervention is necessary to maintain a core temperature of 36°C or less,” said lead guideline author Romergryko G. Geocadin, MD, FAAN, FNCS. “There is currently a low Romergryko G. Geocadin, utilization of TH/TTM in nonresponsive MD, FAAN, FNCS patients after cardiac arrest. TH/TTM is primarily a treatment for brain injury after CPR and it is provided to improve the chances of recovery of brain function; however, at present, neurologists are not sufficiently involved in the early care of these patients. The role of the neurologist needs to expand from one who provides prognostication days after CPR, to one who provides active interventions such as TH/TTM to minimize brain injury early after CPR. This intervention not only improves survival but also enhances quality of life in cardiac arrest survivors.” Read the guideline and access PDF summaries for clinicians and patients, and a slide presentation set on AAN.com. For more information, contact Jon Dittman at jdittman@aan.com or (612) 928-6056. •
Policy
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. Capitol Hill Report is testing a bullet-point format. Let us know what you think at mamery@aan.com. Here is the latest from Washington. nn Congress agreed on a final 2017 funding plan averting any potential government
shut downs. Of interest to the AAN, the agreement includes funding for: §§ National Institutes of Health: $34 billion. Increase of $2 billion (6.2%), includes $352
million from the 21st Century Cures Act §§ BRAIN Initiative: $260 million. Increase of $110 million, which was a request of the AAN’s Neurology on the Hill effort in February §§ Alzheimer’s disease: $1.39 billion. Increase of $4 million §§ NINDS: $1.783 billion. Increase of $87 million §§ Telehealth: $1.5 million. Directs the Health Resources and Services Administration (HRSA) to develop a plan to create a telehealth center of excellence §§ Opioid abuse: $800 million, a significant increase from $150 million. The money will be shared between the Centers for Disease Control and Prevention (CDC), the Substance Abuse and Mental Health Services Administration (SAMHSA), and HRSA nn The US House narrowly passed the amended American Health Care Act, a bill that repeals and
replaces several provisions of the Affordable Care Act. Due to concerns about reduced access to health insurance coverage, the AAN and most other medical groups oppose the bill. The legislation moved to the Senate. •
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AANnews • June 2017
Policy
AAN Member Uses Advocacy Training to Get Concussion Messages to Public Nicole Reams, MD, an AAN member and neurologist at the NorthShore Medical Group in Glenview, IL, attended the 2016 Palatucci Advocacy Leadership Forum (PALF) to learn how to better advocate for sports concussion initiatives for which she feels passionate. Reams, who will be presenting “Diagnostic Approach to Traumatic Encephalopathy Syndrome” at the AAN’s Sports Concussion Conference on July 16, from 8:30 a.m. to 10:00 a.m., has used the media training she received at PALF to good advantage to get the word out about concussion to her community. She has given four phone interviews with magazines produced by the health system with which she works, one phone interview for a University of Chicago newspaper article, as well as one on-camera, taped interview for her local Fox news station.
that I could direct the conversation. They did not ultimately choose many of the questions I submitted. But the morning of the interview, Fox did supply me with the questions they would ask me so that I could think through my answers prior to filming.”
“That media training was essential to my comfort giving interviews,” she said. “During the PALF conference last year, we practiced answering questions live in front of an audience, answering questions on-camera to an interviewer and then watching it back for constructive criticism, as well as preparing a message or tagline and then recording that on camera. Each of these experiences allowed me to gain confidence with the media and helped to hone my skills so that my messages were concise, understandable, and allowed me to get my point across.”
While the media is often portrayed as looking for “gotcha” moments, interviews such as the ones Reams participated in may be more collaborative as the newspaper or TV broadcaster seek to provide their audiences with valuable information from a credible professional. “I was happy to learn that many media sources allow you to review your interview prior to publication and you may be allowed to provide feedback or edit your quotes to ensure that the article is clear and accurate. I have learned to ask for this when I start a media interaction as this gives you more control over the final product.”
Neurologists in solo or small group practice who wish to get their messages to local media need to personally reach out to news editors at newspapers, magazines, and television stations. For Reams, being part of a university medical system meant she had professionals available who could make these contacts. “I am lucky to have a great marketing team at NorthShore University HealthSystem, and my team obtained three of these four interviews and opportunities. My name was given to the University of Chicago columnist by an athletic team I work with who was aware of my expertise with concussion management.”
Another key to a successful interview? “Practice!” said Reams. “I was lucky to be exposed to great media training at the Palatucci Forum so I could practice with my peers and get some of the cobwebs out before I was providing interviews to these various sources. I recall being very nervous the first time we did a taped interview during the PALF conference, but by the end of just those few days, I felt very comfortable.”
A successful interview requires preparation and understanding of what the media may require, as well as getting one’s points across with well-rehearsed answers. On one hand, said Reams, “I did not receive any prepping for the university article so this was off-the-cuff. But the magazine articles were patient stories, so I was sure to review my office visits with these patients to ensure I recalled the details of our interactions. For the Fox news television interview, I was allowed to submit questions I wished for them to ask me so
Even though the desire to share one’s professional insights as a neurologist with the community may be altruistic and take time away from the clinic or home life, it can provide additional benefits, as Reams found. “I saw an increase in my direct patient referrals and increased confidence of new patients when coming to see me. I would often get comments like ‘I saw you on TV!’ or ‘My doctor is famous!’ which, although is humorous, seemed to give my patients some reassurance that I was qualified.” Perhaps media-savvy physicians will begin to append “ASOTV” after their “MD”—As Seen on TV! •
AANnews • June 2017
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CME & MOC
New Continuum Examines Neurology of Systemic Disease The neurology of systemic disease is the focus of the latest issue of Continuum: Lifelong Learning in Neurology ®. Participants can earn up to 14 hours of AMA PRA Category 1 Credit™ (12 of which apply to MOC Self-Assessment credit). Canadian participants can earn up to 14 hours of Self-Assessment CME credits to help fulfill Section 3 MOC requirements of the Royal College of Physicians and Surgeons of Canada. “Neurology often interfaces with other subspecialties of internal medicine. Neurologists frequently encounter neurologic disease in patients with known systemic disorders; not infrequently neurologic disease is the presenting manifestation of medical illness,” said guest editor Neeraj Kumar, MD, consultant in the department of neurology, Mayo Clinic, and professor of neurology, Mayo Medical School, Rochester, MN. “The ‘Systemic Diseases’ issue will include discussion on the neurologic aspects of various subdivisions of internal medicine.” Articles include: nn Autoimmune Neurology of the Central Nervous System,
by W. Oliver Tobin, MBBCh, BAO, PhD, and Sean J. Pittock, MD
nn Neurologic Complications of Cardiac and Aortic Disease,
by James P. Klaas, MD
nn Neurologic Complications of Lymphoma, Leukemia, and
Paraproteinemias, by Michelle L. Mauermann, MD, FAAN
nn Rheumatology and Neurology, by Elliot L. Dimberg,
MD, FAAN
nn Renal Disease and Neurology, by Sara E. Hocker, MD nn Gastroenterology and Neurology, by Ronald F. Pfeiffer,
MD, FAAN
nn Liver Disease and Neurology, by Robert N.
nn Nutrients and Neurology, by Neeraj Kumar, MD nn Environmental Neurologic Injuries, by Rodolfo Savica,
MD, PhD
The issue also includes a section on ethical and medicolegal issues covering response to medical errors, a section on practice issues focused on safety considerations during transitions of care from inpatient to outpatient settings, and coding for medication-related poisoning and adverse effects. Continuum® is published six times per year. Subscribe to Continuum by contacting Wolters Kluwer at (800) 361-0633, (301) 223-2300 (international), or LWW.com/continuum. Junior members who are transitioning to Active or Associate memberships can receive a 50-percent discount on the already low member rate for Continuum subscriptions. •
Schwendimann, MD, FAAN, and Alireza Minagar, MD, FAAN
nn Endocrine Emergencies with Neurologic Manifestations,
by Makoto Ishii, MD, PhD
nn Neurologic Complications of Transplantation,
by Amy A. Pruitt, MD
Neeraj Kumar, MD
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AANnews • June 2017
Watch Your Favorite Sessions from Boston Anytime, Anywhere with Annual Meeting On Demand Now you can get all the excellent programing you may have missed at this year’s Annual Meeting in Boston—from the comfort of your home or office! AAN Annual Meeting On Demand gives you access more than 500 hours* of presentations, including syllabi for 200+ programs, plus: nn Watch like you’re there in person
By combining slides with synchronized audio, Annual Meeting On Demand technology re-creates the live session experience.
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Order Now to Receive a $500 Apple, Best Buy, or Amazon Gift Card! Visit orders.ondemand.org/aan/ad2 or call (800) 501-2303 (US only) or (818) 844-3299, Monday–Friday from 6:00 a.m. to 5:00 p.m. PT. • * Specific presentations within a session may not be available or may be audio-only if the presenter has confidential patient information or otherwise declines to be recorded.
AAN Receives Accreditation with Commendation from ACCME Accreditation is essential to the AAN’s education and scientific programs. The AAN has been reviewed by the Accreditation Council for Continuing Medical Education (ACCME) and awarded Accreditation with Commendation for six years as a provider of continuing medical education (CME) for physicians. Accreditation in the ACCME System seeks to assure the medical community and the public that the AAN delivers education that is relevant to clinicians’ needs, evidence-based, evaluated for its effectiveness, and independent of commercial influence.
The ACCME System employs a rigorous process for evaluating institutions’ CME programs according to standards that reflect the values of the educator community and aim to accelerate learning, inspire change, and champion improvement in health care. Through participation in accredited CME, clinicians and teams drive improvement in their practice and optimize the care, health, and wellness of their patients. A. Gordon Smith, MD, FAAN
“The Academy’s recent ACCME Accreditation with Commendation is a reflection of the dedication of the outstanding work of our hundreds of physician educators and the AAN education staff who are committed to supporting our members’ lifelong learning needs,” said Education Committee Chair A. Gordon Smith, MD, FAAN. •
Apply Now for UCNS Neurocritical Care Certification or Recertification Applications are now available for the 2017 certification and recertification examinations in Neurocritical Care through the United Council for Neurologic Subspecialties (UCNS). The deadline to apply is July 17, 2017. The examination is scheduled for the week of December 4–8 at Pearson VUE testing centers. Examinations are offered biennially. All Neurocritical Care diplomates certified in 2007 and 2008 should apply to take the 2017 recertification exam to avoid lapses in certification. There are currently 1,241 physicians certified in Neurocritical Care through the UCNS. For applications and more information, visit UCNS.org/go/subspecialty/ neurocritical/certification or contact Todd Bulson at (612) 928-6067 or tbulson@ucns.org. • AANnews • June 2017
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Membership
Last Chance to Apply for These Leadership Programs! June 5 Deadline
July 1 Deadline
Transforming Leaders Program
NEW! Women Leading in Neurology
NEW! Live Well, Lead Well Program
Emerging Leaders Program
An elite, 10-month leadership training program for US member neurologists who are 10 or more years out of residency. Learn more and apply at AAN.com/view/TLP.
A 10-month program for US female AAN member neurologists 10 or more years out of neurology training. Learn more and apply at AAN.com/view/WLN.
A unique nine-month program designed for US neurologists (residency through late career) that will empower them to cultivate well-being and resilience in their lives, increase engagement at work, and develop strong, lasting leadership skills. Learn more and apply at AAN.com/view/LWLW.
A six-month leadership training program for US early career members who are 10 or less years out of residency. Learn more and apply at AAN.com/view/ELP. •
Upgrade Your Professional Credentials with the FAAN Designation The AAN is seeking applications and nominations for its highly regarded Fellow of the American Academy of Neurology (FAAN) member category. The FAAN designation will: nn Set you apart both within the Academy and in many other circumstances throughout your professional career nn Provide the recognition you deserve for your exemplary contributions to the field of neurology nn Offer exclusive eligibility to serve on the AAN Board of Directors, a unique opportunity that could allow you to have a
significant impact on the future direction of the AAN and the field of neurology
To apply, nominate a colleague, or learn about qualifications, visit AAN.com/view/FAAN today. For more information, contact AAN Member Services at memberservices@aan.com or (800) 879-1960. •
Congratulations New FAANs! The AAN congratulates the following members who were named Fellows between January and March, 2017. Maged Mohamed AbdelNaseer, MD, FAAN Gyula Acsadi, MD, FAAN Joachim M. Baehring, MD, FAAN Nandini Bakshi, MD, FAAN Diana M. Barratt, MD, MPH, FAAN Edward H. Bertram, MD, FAAN Patrick M. Capone, MD, PhD, FAAN Josep O. Dalmau, MD, PhD, FAAN
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AANnews • June 2017
Rohit Das, MD, FAAN Georgius Dewanto, MD, FAAN Salim I. Dib, MD, FAAN Rose M. Dotson, MD, FAAN Ana C. Felix, MD, FAAN Katrina A. Gwinn, MD, FAAN Ioannis Karakis, MD, FAAN Ali Kadim Karim, MD, FAAN Kimbra L. Kenney, MD, FAAN Bhupendra O. Khatri, MD, FAAN Pravin Khemani, MD, FAAN Batool Kirmani, MD, FAAN
Pearce Korb, MD, FAAN Max R. Lowden, MD, FAAN For-Shing Lui, MD, FAAN Rama K. Maganti, MD, FAAN William M. Mallonee, MD, FAAN Samuel H. Markind, MD, FAAN Elena Moro, MD, FAAN Rajeev Motiwala, MD, FAAN Dean K. Naritoku, MD, FAAN Ricardo Nitrini, MD, FAAN Ronald C. Petersen, PhD, MD, FAAN
Ralf Reilmann, MD, FAAN John G. Schmidt, MD, FAAN Taofiki Ajao Sunmonu, MD, FAAN Ezgi Tiryaki, MD, FAAN Diego Torres-Russotto, MD, FAAN Renee D. Van Stavern, MD, FAAN Robyn G. Young, MD, FAAN Tjalf Ziemssen, MD, FAAN •
Letâ&#x20AC;&#x2122;s All Commit To Outsmarting Brain Disease. The American Brain Foundation is the central driving force behind bringing all neurologists, researchers, patients, and caregivers together to help generate funding for and awareness of brain disease. By examining the whole brain, we get the whole picture. Because we believe itâ&#x20AC;&#x2122;s all connected. So a cure for one disease could be a cure for others.
Mission: The American Brain Foundation brings researchers and donors together to defeat brain disease. For more information, visit www.AmericanBrainFoundation.org
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. Fellowship in Neuroimaging Winchester Neurological Consultants, Inc., in conjunction with V irginia Commonwealth University and Winchester Medical Center, is offering a clinical Neuroimaging Fellowship for BC/BE neurology graduates that can be completed in one or two years. Located approximately an hour from Washington, DC, our United Council of Neurologic Subspecialties fully accredited fellowship offers extensive training in the performance and interpretation of diagnostic inpatient and outpatient MRI, CT, Doppler, TCD, and myelography—utilizing four state of the art M R I sc anners and four multi - slice C T units. Responsibilities include supervision and interpretation of imaging, assisting with acute stroke protocols, and direct patient care. Availability: immediate. Research interests are encouraged. Salary is $60,000.00 per year plus benefits. CV’s should be emailed to gsteele@ winchesterneurological.com Neurologist St. Peters Health Partners Medical Associates, P.C., is seeking additional Neurologists to join its practice. These are exciting opportunities to join an established neurology department as it grows its services. Enjoy excellent colleagues, strong system practice support, inpatient and outpatient care settings, and a physician friendly environment. St. Peter’s Neurology, is seeking qualified candidates for two new full time Neurology positions for summer 2017 placement. Positions include general, office based, neurology with inpatient consultation, and hospital only neurology (neurohospitalist). These are excellent opportunities to join a respected and expanding team of seven physicians as the organization develops its neuroscience service line across the Capital District of NY. Applicants should be able to perform EMG/NCS and EEG. Some sleep study
reading is available in the outpatient setting. We recently opened a beautiful new office space. Sub-specialty development will occur over the next few years, with MS already in place. We offer a supportive practice environment with established patient bases with strong demand. These are exciting opportunities to join a dynamic and growing organization as it takes its neurology program to the next level of integration. Find out more and apply online at www.sphp.com and www. sphpma.com. These opportunities are not accepting J1 or H1B visa candidates. Applicants should have the following: Board Certified/Eligible in Neurology. Fellowship training in various sub-fields welcome but not required. Applicants should possess excellent clinical skills, communication skills, and a strong commitment to providing excellent care that is team oriented. Applicants should desire to provide general neurological care. Recruitment package: St. Peter’s Health Partners Medical Associates, P.C. offers a comprehensive salary and compensation package that includes: Competitive salary with incentives, excellent benefits; including health/vision/dental insurances, paid malpractice, including post-SPHP employment tail coverage, CME time & expense allowance, paid time away from the practice, 2-part retirement savings program with employer matching program, relocation assistance is available, starting bonus may be available.
York City. Berkshire Health Systems Opportunity: BC/BE General Neurologist; General neurology or sub-specialty interests welcome; 1 in 7 call arrangement gives you the ‘perfect’ position to balance both your professional interests and personal commitments. Flexible balance of inpatient/ outpatient coverage. Competitive compensation and benefits package, including productivity option and relocation. Berkshire Medical Center, BHS’s 302-bed community teaching hospital and Trauma Center, is a major teaching affiliate of the University of Massachusetts Medical School. With the latest technology and a systemwide electronic health record, BHS is the region’s leading provider of comprehensive healthcare services. Interested candidates are invited to contact: Shelly Sweet, Physician Recruitment Specialist; msweet@bhs1.org or apply online at: www.berkshirehealthsystems.org
Neurologist We understand the importance of balancing work with a healthy personal lifestyle. Berkshires, a 4-season resort community. Endless cultural opportunities. World renowned music, art, theater, and museums. Yearround recreational activities from skiing to kayaking. Excellent public and private schools make this an ideal family location. Just 2 ½ hours from both Boston and New
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.
AANnews® Classified Advertising T he AAN offers a complete package of print, online, and in-person recruitment advertising opportunities. Visit AAN.com/careers for all AAN options, rates, and deadlines.
d copy for the August 2017 print edition of AANnews A must be submitted by July 1, 2017. The same deadline applies to changes/cancellations.
Practice
Podcast Central
13 mi lli Ov an on d er d g ow row nlo ing ads ... !
Your Guide to New and Recent AAN Podcasts
Neurology ® Podcasts Visit Neurology.org to listen to Neurology podcasts and earn 0.5 AMA PRA Category 1 CME Credits™ by answering the multiple-choice questions in the online podcast quiz. Interviews based on articles from Neurology® Clinical Practice, Neurology ® Genetics, and Neurology ® Neuroimmunology & Neuroinflammation are excluded from the CME program.
Available by June 1 nn Neurology: Post-stroke Epilepsy in Long-term Survivors of Primary Intracerebral Hemorrhage Rahul Guha, MD, and Anna-Maija Lahti nn Neurology: Evaluating the Safety of Beta-Interferons in MS: A Series of Nested Case-control studies Michael Levy, MD, PhD, and Helen Tremlett, PhD nn Neurology: Neuroimmunology & Neuroinflammation: Microarray Screening of Guillain-Barré Syndrome Sera for
Antibodies to Glycolipid Complexes
Ted M. Burns, MD, and Hugh J. Willison, MBBS, PhD
nn Neurology: Neuroimmunology & Neuroinflammation: Next-generation Sequencing in Neuropathological Diagnosis
of Infections of the Nervous System
Heather D. Harle, MD, MD, and Carlos A. Pardo, MD
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JUNE 5 Application Deadline: Transforming Leaders AAN.com/view/TLP Application Deadline: Women Leading In Neurology AAN.com/view/WLN Application Deadline: Live Well, Lead Well AAN.com/view/LWLW
JUNE 6 Webinar: Break the Code, or It Will Break Your Practice: Coding for Neurodiagnostic Procedures (Register by June 5) AAN.com/view/pmw17
JUNE 15 Early Registration Deadline: Sports Concussion Conference AAN.com/view/ConcussionConference
JUNE 30 Application Deadline: NeuroSAE® Editor-in-Chief AAN.com/view/NeuroSAE
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Application Deadline: Emerging Leaders AAN.com/view/ELP
Webinar: A Guide to Teleneurology: Use It in Your Practice (Register by July 31) AAN.com/view/pmw17
JULY 14–16 Sports Concussion Conference Jacksonville, FL AAN.com/view/ConcussionConference
JULY 17 Application Deadline: UCNS Neurocritical Care Certification and Recertification UCNS.org/go/subspecialty/neurocritical/ certification
SAVE THE DATES! JULY 14–16, 2017 Sport Concussion Conference AAN.com/view/SportConcussion
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JUNE 1 Deadline: UCNS Accreditation UCNS.org
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July 14 –16 • Jacksonville, FL
OCTOBER 20–22, 2017 Fall Conference The Cosmopolitan of Las Vegas AAN.com/view/17FC
AANnews • June 2017
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Are you seeing the whole picture?
FPO
Migraine is a common and debilitating neurological disease.1-3 Uncover its true impact on the lives of patients, and see how the neuropeptide CGRP can play a key role in migraine’s complex pathophysiology. 2,4-9 References: 1. Barbanti P, Aurilia C, Egeo G, Fofi L. Future trends in drugs for migraine prophylaxis. Neurol Sci. 2012;33(suppl 1):S137-S140. 2. Edmeads J, Findlay H, Tugwell P, Pryse-Phillips W, Nelson RF, Murray TJ. Impact of migraine and tension-type headache on life-style, consulting behaviour, and medication use: a Canadian population survey. Can J Neurol Sci. 1993;20:131-137. 3. Munakata J, Hazard E, Serrano D, et al. Economic burden of transformed migraine: results from the American Migraine Prevalence and Prevention (AMPP) Study. Headache. 2009;49:498-508. 4. Lipton RB, Bigal ME, Diamond M, et al; for AMPP Advisory Group. Migraine prevalence, disease burden, and the need for preventative therapy. Neurology. 2007;68:343-349. 5. Hu XH, Markson LE, Lipton RB, Stewart WF, Berger ML. Burden of migraine in the United States. Arch Intern Med. 1999;159:813-818. 6. Buse DC, Rupnow MFT, Lipton RB. Assessing and managing all aspects of migraine: migraine attacks, migraine-related functional impairment, common comorbidities, and quality of life. Mayo Clin Proc. 2009;84:422-435. 7. Russo AF. Calcitonin gene-related peptide (CGRP): a new target for migraine. Annu Rev Pharmacol Toxicol. 2015;55:533-552. 8. Russell FA, King R, Smillie S-J, Kodji X, Brain SD. Calcitonin gene-related peptide: physiology and pathophysiology. Physiol Rev. 2014;94:1099-1142. 9. Goadsby PJ, Edvinsson L, Ekman R. Release of vasoactive peptides in the extracerebral circulation of humans and the cat during activation of the trigeminovascular system. Ann Neurol. 1988;23:193-196.
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Learn more about the impact of migraine and the science behind it at
www.scienceofmigraine.com/learnmore
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