2018 Annual Meeting AAN Extra — Sunday, Apr 22 by American Academy of Neurology

THE ANNUAL MEETING NEWS DAILY

Sunday, April 22, 2018

PRESIDENTIAL PLENARY SESSION TO SHOWCASE PREMIER LECTURERS AND TOP SCIENCE From updates on the BRAIN Initiative and precision medicine to overviews of new treatments for spinal muscular atrophy, today’s Presidential Plenary Session will showcase some of the most inspiring and innovative ideas in neurology. The session’s speakers will also delve into the effect of early-life experiences on the brain and interactions between cancer and the nervous system. Natalia S. Rost, MD, MPH, FAAN, FAHA, chair of the AAN Rost Science Committee, Continued on page 30 u

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Exhibit Hall Opens Today with Special 11:30 Lunch Reception Don’t Forget to Pick up Your Ticket(s) for Tonight’s 70th Anniversary Celebration!

Morning’s “Best of” 23 This Session to Feature Top Cerebrovascular Disease Abstracts out New ePoster 35 Check Areas as Poster Sessions Open This Morning

Boffo Brainiacs Bravely Brawl at Neurobowl! FLASH! HOLLYWOOD, USA: It was a movie casting director’s dream on stage at Neurobowl® Saturday night. The electricity in the air crackled as three teams of titans of the temporal lobe took the stage to audition for their greatest role: Neurobowl Champion! After many years of arduous preparation and student loan payments, this was their chance prove to the folks back home there really is a large neurology trophy. These three teams, absolutely crushing it in their genre costumes, made the audience forget the likes of Meryl Streep, Leonardo DiCaprio, and ZaSu Pitts. They were ready to perform—and perform they did! The casting directors for last night’s mental melee were the usual suspects: grand inquisitor Thomas A. Swift, MD, FAAN; the judicious judge Kapil D. Sethi MD, FRCP (UK), FAAN; and Bert B. Vargas, MD, FAAN, channeling Indiana Jones. Continued on page 21 u

Experience a Demo of Powerful Axon Registry The AAN’s Axon Registry ® is a valuable tool for hundreds of participating AAN members. It provides them the ability to submit data for quality reporting programs, such as the Merit Based Incentive Payment System (MIPS) and do quality improvement within their practice with the potential to meet MOC part IV PIP clinical module and part II self-assessment requirements. Continued on page 4 u

In Multiple Sclerosis, when it comes to Brain Preservation

Grey Matters, Too JOIN US AT

Booth 932

Sunday, April 22 Cover Presidential Plenary Session to

Showcase Premier Lecturers and Top Science

Boffo Brainiacs Bravely Brawl at Neurobowl!

Experience a Demo of Powerful Axon Registry

3 4 4 5 5 6 6 8

Sunday’s AAN Section Meetings Big Names to Join Wednesday’s Commitment to Cures to Help Raise Money for Research Daily Reminders Monday’s Hot Topics Program to Examine How Dramatic Changes in Stroke Care Will Impact Workforce, Staffing Exhibit Hall Opens Today with Special 11:30 Lunch Reception Don’t Forget to Pick up Your Ticket(s) for Tonight’s 70th Anniversary Celebration! Check out Newly Expanded Spanish Language Curriculum Today’s Experiential Learning Area Highlights

12 Through Their Eyes: Founding of the American Academy of Neurology

16 Shulman Selected for AAN

17 Collaboration Gives Continuum Bold

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

22 AAN.com Gets Personal at Member

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

New Look

Experience Experiential Learning Area

23 This Morning’s “Best of” Session to

Feature Top Cerebrovascular Disease Abstracts

28 Leaders Share Insights at Hall of

Presidents: Using Past Experience to Solve the Future’s Problems

28 AAN Creates New Medical Student Symposium

29 AAN Shares Overview of Highly

Successful 2017 at Business Meeting

33 Quotable Quotes 33 Visit UCNS Booth 33 Look for Post-program Opportunities

Contact Information: American Academy of Neurology 201 Chicago Avenue Minneapolis, MN 55415 USA Phone: (800) 879-1960 (Toll Free) or (612) 928-6100 (International) Fax: (612) 454-2744 Email: memberservices@aan.com Website: AAN.com AAN Executive Director/CEO: Catherine M. Rydell, CAE

35 Check out New ePoster Areas as

Managing Editor: Angela Babb, CAE Editor: Tim Streeter Writers: Ryan Knoke, Sarah Parsons Designer: Jim Hopwood Photography: Will Evans Printing: Lithographix, Inc. Email: aannews@aan.com

35 New Leadership Course Tackles

AANextra is published by the American Academy of Neurology.

to ‘Continue the Conversation’ with Faculty, Directors

Poster Sessions Open This Morning Unconscious Bias

36 Discover New Ways of Thinking

About Your Practice, Patients, and the Future at Innovation Hub

38 Tweets of the Day 38 Today’s Boxed Lunch Menu

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 Award

Sunday’s AAN Section Meetings 5:00 p.m.–6:00 p.m.

Autonomic Nervous System Section / LACC 305 Neuro-ophthalmology/Neuro-otology Section / LACC Petree Hall C Women’s Issues in Neurology Section / LACC Petree Hall D 

The American Academy of Neurology sincerely thanks Lithographix, Inc. for its outstanding service, steadfast professionalism, and high quality standards, as well as its generous donation of the 2018 Brain Health Fair program guide.

Big Names to Join Wednesday’s Commitment to Cures to Help Raise Money for Research Comedian Michael Pritchard, friend of the late Robin Williams, will serve as the program emcee at the American Brain Foundation’s 2018 Commitment to Cures this Wednesday evening beginning at 6:00 p.m. at the JW Marriott Los Angeles. The popular annual dinner highlights the work of the American Brain Foundation. Pritchard will entertain attendees with his unique comedic style while underscoring the importance of finding cures and treatments for brain disease. He will help recognize 2018 Public Leadership in Neurology Award recipient Temple Grandin, PhD, via video. Grandin is a professor of animal science at Colorado State University, consultant to

the livestock industry on animal behavior, and well-known autism spokesperson. DeMaurice Smith, executive director of the NFL Players’ Association, will receive the 2018 Commitment to Cures Award, and acoustic guitarist, singer, composer, and American Brain Foundation Honorary Board Member Billy McLaughlin will provide a memorable live performance. McLaughlin was diagnosed with focal dystonia in 2001, but his passion and drive sent him on an unlikely journey of teaching himself to play in what has now become his own signature left-handed style. Individual tickets are still available for this event for $125. Stop by the American Brain Foundation booth in the West

Lobby of the Los Angeles Convention Center between 7:00 a.m. and 4:00 p.m. today through Wednesday to purchase yours.

Join the Rowland Circle! Continue the significant impact Lewis P. “Bud” Rowland, MD, had on advancing the American Brain Foundation’s important work. Give $2,500 or more to help fund vital research into cures for Rowland Circle, the Foundation’s newest leadership giving recognition program.

Pritchard

Grandin

McLaughlin

Daily Reminders Education Program Syllabi and Slides Available Online Only Education Program syllabi and slides are available online only at AAN.com/view/syllabi or through the AAN Conferences Mobile App at AAN.com/view/MobileApp.

Log into the New AAN.com for Chance to Win! Log in on the Academy’s freshly redesigned AAN.com and you could win an Apple HomePod or Alexa Echo Plus. The drawing is open to any AAN member who logs in to AAN.com from Sunday to Thursday or stops by the AAN.com booth. The drawing will be held at noon on Thursday, and you must be present at the AAN.com booth to win.

May 7 Is Deadline to Submit Online Evaluations for Annual Meeting CME Complete your evaluations to get your CME hours by using the AAN Conferences Mobile App at AAN.com/view/MobileApp or by visiting AAN.com/view/CME. CME requests may be made until Monday, May 7, 2018. 

Sunday, April 22, 2018 • AANextra

Experience a Demo of Powerful Axon Registry Continued from cover

Visit the Maximize Your Value Experiential Learning Area in the south lobby to learn how to make the registry work for you. Tim Parr, vice president of technology for FIGmd, Inc., the registry technical partner with the AAN, will be on hand from Sunday through Tuesday to talk with members. On Sunday morning at 8:00 a.m., Parr and Lyell K. Jones, MD, FAAN, chair of the registry committee, will give a presentation, “How Can the Axon Registry Improve My Practice.” Stop by the booth all week to get a demonstration of the dashboard and get your questions answered by AAN registry staff. 

Monday’s Hot Topics Program to Examine How Dramatic Changes in Stroke Care Will Impact Workforce, Staffing Tomorrow’s Hot Topics in Stroke Education and Practice course, set to take place from 3:30 p.m. to 5:30 p.m. in Concourse Hall 151, will highlight how dramatic changes in the management of acute ischemic stroke (AIS) will impact the workforce, residency, staffing, and other aspects of the neurology profession and practice. The management of AIS has witnessed a dramatic transformation over the past few years. These changes are based on the 2017 DAWN study, 2018 DEFUSE-3 study, and American Heart Association and the American Stroke Association’s new guideline for early management of AIS, which the AAN recently affirmed, with recommendations to treat eligible patients for up to 24 hours with thrombectomy.

“Evaluating and treating stroke will be an essential skill of any future neurologic practice, and this

Fayad

course will examine how these seismic changes will impact the organization and delivery of acute stroke care services in terms of human, organizational, and financial costs,” said Pierre Fayad, MD, FAHA, FAAN, director of the course.

For more information about the DEFUSE-3 trial, attend the Clinical Trials Plenary Session on Tuesday from 9:15 a.m. to 11:30 a.m. in South Exhibit Hall K. 

Exhibit Hall Opens Today with Special 11:30 Lunch Reception Join your colleagues at 11:30 this morning for a special lunch reception to kick off this year’s Exhibit Hall. The luncheon, sponsored by Celgene Corporation, is an excellent opportunity to socialize with fellow attendees and meet more than 250 exhibiting organizations offering the latest products, services, and therapies in the neurology industry to help you excel in your career and provide the best possible care for your patients. Exhibitors include pharmaceutical companies, medical device vendors, equipment, and technology companies; and scores of voluntary health associations dedicated to helping people live with neurologic disease.

Highlights:

AAN’s Innovation Hub Stretch your brain in new directions at this creative and interactive area featuring unique physicianlead presentations, teleneurology demonstrations, daily paint and wine sessions, and more! Career Fair Neighborhood Learn about career opportunities available nationwide. Buzz Café This new area is a great spot to reconnect with colleagues while enjoying a complimentary caffeinated beverage. Technology Pavilion Experience cutting-edge technology that can change the way you care for patients.

Association Neighborhood Visit with our association partners who are fighting to further disease awareness and help raise funds to find cures. Charging Hubs Charge your devices while you check in with your office, catch up on emails, or just relax in these comfortable areas. Daily Complimentary Lunches Lunch will be provided in the Exhibit Hall on open days. Visit AAN.com/conferences-community/ annual-meeting/exhibits-advertisingindustry for a daily schedule of events. 

Exhibit Hall Hours:

Sunday, April 22 Open: 11:30 a.m.–4:00 p.m. Opening lunch reception: 11:30 a.m.–1:00 p.m. Monday, April 23 Open: 11:30 a.m.–6:00 p.m. Networking reception: 4:30 p.m.–6:00 p.m. Tuesday, April 24 Open: 11:30 a.m.–4:00 p.m. Wednesday, April 25 Open: 11:30 a.m.–3:00 p.m.

Don’t Forget to Pick up Your Ticket(s) for Tonight’s 70th Anniversary Celebration! Unclaimed Tickets Released to Rush Line at 4:00 p.m. If you secured your free, limited quantity ticket—or purchased additional tickets—to attend this year’s family friendly kickoff to the Annual Meeting, then don’t forget to stop by the Universal Studios booth in the West Lobby of the Los Angeles Convention Center by no later than 4:00 p.m. today to pick them up. Pre-reserved gratis tickets that are not picked up by 4:00 p.m. will be released for rush line. Rush line tickets are given away on a first-come, first-served basis. Limit one free ticket per registered Annual Meeting attendee.

JW Marriott. Guests staying at the Courtyard by Marriott LA Live, Hotel Figueroa, Hotel Indigo, Residence Inn by Marriott Los Angeles LA Live, and the Ritz-Carlton should walk to the JW Marriott to catch the bus to Universal Studios. View the shuttle schedule and learn more about the event at AAN.com/ view/70Anniversary. The event is sponsored by platinum event sponsor AveXis, Inc. 

The special 70th Anniversary Celebration will be held at Universal Studios and all tickets include transportation to/from the event, delicious food and beverages all evening, rides, and studio tour. Additional tickets may be purchased at Universal Studios on Sunday night beginning at 7:00 pm for $115; bring your AAN badge as your identifier.

Transportation Information Complimentary bussing to/from Universal Studios will be available from all hotels along the Annual Meeting shuttle route, plus from the Luxe City Center and the

Check out Newly Expanded Spanish Language Curriculum Look for six education courses and four Experiential Learning Area talks on a variety of topics, including MS, epilepsy, stroke, CNS infection and tropical medicine, and more—going on all week long and taught entirely in Spanish.

Education Courses

Research Corner: Moving Neurology Forward

C59: Actualización Sobre el Tratamiento de la Esclerosis Múltiple Sunday, 3:30 p.m.–5:30 p.m.

Opportunities for Translational Research Saturday, 3:40 p.m.–4:10 p.m.

C95: Actualización Sobre las Infecciones del Sistema Nerviosa Central y la Medicina Tropical Monday, 3:30 p.m.–5:30 p.m.

Navigating Your Career

C132: Actualization Científica Durante el Congreso Anual I Tuesday, 3:30 p.m.–5:30 p.m.

Clinical Training in the US for FMGs (Oportunidades de Entrenamiento Clínico en los Estados Unidos para Médicos Graduados en el Extranjero) Monday, 4:00 p.m.–4:30 p.m.

C171: Actualización Sobre Opciones Terapéuticas para la Epilepsia Farmacorresistente Wednesday, 3:30 p.m.–5:30 p.m.

Up Your Game as a Medical Educator in Neurology (Mejora Tu Desempeño Como Educador Médico) Monday, 12:15 p.m.–12:45 p.m.

C194: Actualización Sobre el Manejo del Ictus Cerebrovascular Thursday, 1:00 p.m.–3:00 p.m.

HeadTalks

C233: Actualización Científica Durante el Congreso Anual II Experiential Learning Area Presentations Friday, 1:00 p.m.–3:00 p.m.

Sunday, April 22, 2018 • AANextra

Neurological Exam Tips & Tricks: En Español Thursday, 3:00 p.m.–4:00 p.m. Visit AAN.com/conferences-community/annual-meeting/programand-events/spanish-language-curriculum to learn more. 

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Test your knowledge with The Migraine Prevention Challenge at Booth 1261.

TODAY’S EXPERIENTIAL LEARNING AREA HIGHLIGHTS HeadTalks Neurology Pictionary 12:00 p.m.–1:00 p.m. Join Bert B. Vargas, MD, FAAN, as he leads a high-energy charades-inspired guessing game centered around all things neurology. Hall of Presidents: Using Past Experience to Solve the Future’s Problems 1:30 p.m.–2:30 p.m. Don’t miss your chance to ask your AAN-related questions to a panel of Academy presidents including Ralph L. Sacco, MD, MS, FAHA, FAAN; Terrence L. Cascino, MD, FAAN; Robert C. Griggs, MD, FAAN; Francis I. Kittredge, MD, FAAN, Roger N. Rosenberg, MD, FAAN; Stanley Fahn, MD, FAAN; Stephen M. Sergay, MB BCh, FAAN; Thomas R. Swift, MD, FAAN; Sandra F. Olson, MD, FAAN; and Timothy A. Pedley, MD, FAAN.

Live Well: Taking Care of Your Patients Starts with Taking Care of You How Your Social Life Might Be Helping (or Harming) Your Brain 3:00 p.m.–3:45 p.m. Evidence implicating social and behavioral influences, such as social isolation, with higher risk of stroke, cognitive dysfunction, and accumulation of Alzheimer’s disease pathology suggests that healthy cognitive aging may be heavily influenced by social relationships, a largely unexplained modifiable risk factor that represents the combined effect of distinct functional (social support), and structural (social network) elements. Join Joel Salinas, MD, as he examines the existing evidence supporting this association and discusses challenges and opportunities in its study.

Maximize Your Value and Advocacy to Action How Can the Axon Registry Improve My Practice? 8:00 a.m.–9:00 a.m.

2017 Hall of Presidents Participants

Blind Spots: The Impact of Conscious and Unconscious Biases 3:00 p.m.–4:00 p.m. In a neurological exam, you don’t expect your patient to find their own blind spot, so why do we assume we can diagnosis our own? Jeffrey C. McClean II, MD, FAAN; Laraine Kaminsky; and Charles C. Flippen II, MD, FAAN, will lead this highly interactive presentation about the conscious and unconscious bias we all have, discussing the impact of those biases and making some recommendations on how to mitigate them.

Sunday, April 22, 2018 • AANextra

Have you been curious about how the Axon Registry can help you improve your practice and enhance your quality improvement activities? Lyell K. Jones, MD, FAAN, will be joined by Katie Hentges, AAN program manager for the Axon Registry ® , and Tim Parr, vice president of technology at FIGmd, the technical support behind the Axon Registry, to demonstrate how integrating the registry will improve your practice and increase the level of quality care that you offer your patients.

Research Corner: Moving Neurology Forward

Navigating Your Career

8:00 a.m.–5:30 p.m. Stop by throughout the day for all things Research Program related. Highlights include:

Research in Residency: How to Choose the Right Project 7:45 a.m.–8:15 a.m.

1:20 p.m.–1:50 p.m.: So, You Have a Research Idea—How Do You Turn It into a Project? with Edward H. Bertram, MD, FAAN 4:30 p.m.–5:00 p.m.: How to Start a Career in Clinical Trials with Aleksander Videnovic, MD, MSc, FAAN 5:00 p.m.–5:30 p.m.: Statistics and Study Design: Pearls and Pitfalls with Senan Ebrahim

Research can be an important part of personal and career development during training as a resident. Residency can be a unique and sometimes tough time for research given the many competing demands for your time. Choosing the right project is essential. All medical students, residents, and fellows are encouraged to join Roy E. Strowd III, MD, for a discussion on the key components of the “right project” in residency.

The Member Experience: Personalize Your Journey New AAN.com Stop by for live demonstrations of the new AAN.com to see how it’s been completely revamped to offer a highly personalized user experience! While there, don’t forget to take part in a fun and friendly competition with your colleagues to see who can best find their way around the new site—for a chance to win prizes! The AAN.com competition runs through Thursday. 

Sunday, April 22, 2018 • AANextra

I’M AFRAID TO FAINT AGAIN Look carefully. This may be the face of neurogenic orthostatic hypotension (nOH). If your patients with a pre-existing neurodegenerative disorder are suffering from dizziness or other symptoms that improve upon sitting, they could have nOH.1-3 Patients with nOH may experience symptoms that can make daily tasks a challenge.3,4 Understanding the symptoms commonly associated with nOH may help in diagnosis and may provide a path for appropriate symptom management.4 Access information about identifying and managing nOH in your patients and register for updates at NOHmore.com—your online resource for understanding why nOH matters. References: 1. Freeman R. Neurogenic orthostatic hypotension. N Engl J Med. 2008;358(6):615-624. 2. Kaufmann H, Malamut R, Norcliffe-Kaufmann L, et al. The Orthostatic Hypotension Questionnaire (OHQ): validation of a novel symptom assessment scale. Clin Auton Res. 2012;22(2):79-90. 3. Freeman R, Wieling W, Axelrod FB, et al. Consensus statement on the definition of orthostatic hypotension, neurally mediated syncope and the postural tachycardia syndrome. Clin Auton Res. 2011;21(2):69-72. 4. Low PA. Neurogenic orthostatic hypotension: pathophysiology and diagnosis. Am J Manag Care. 2015;21(suppl 13):s248-s257.

Through Their Eyes: Founding of the American Academy of Neurology Neurology was a very different field in the years leading up to the founding of the AAN. The American Board of Psychiatry and Neurology certified in both fields simultaneously. Most medical schools did not have separate departments of neurology. Neurology was typically a division of medicine, although in a few schools there was a single department of neurology and psychiatry. The American Neurological Association represented academic neurologists and limited its membership to 250, thus effectively excluding the majority of practicing neurologists. Fueled in part by the growing number of VA hospitals that were required to treat injured veterans following World War II, there was an increasing demand for more neurologists. Neurology residencies, which had been curtailed during the war, began to expand, and many new ones were created. There was no professional organization to meet the need of the majority of new neurologists. Lt. Col. Joseph A. Resch, MD, who came home from the war in 1946, was typical of many. The young doctor from Wisconsin had served seven years in the US Army Air Force and managed the hospital services for a fighter wing in New Guinea. Now, at age 32, he was working on his residency in Resch, 1947 neurology at the University of Minnesota under division chair Dr. A.B. Baker and eager to establish his career—as a neurologist. But Resch was told that he would probably have to practice psychiatry if he was to make a living and succeed in practice. He wanted to see patients who mainly had neurologic disorders. How would he stay current as neurologic research advanced? Would he need to find an academic position? That would be his only way he might eventually be elected to the ANA. Resch, like a growing number of newly

trained neurologists, sought a professional society that was inclusive and provided for his professional needs (especially continuing education and assistance with practice). “I got in with Dr. Baker and [Joe] Brown, who were the best teachers in the world,” Resch later shared in a 2008 interview. “They wanted to know how we were doing, and what do we think about things. That’s when I popped off, I guess, to the chief and said, “Well, neurology, in this situation, what do you do when you finish? There’s nothing that you can really belong to for a young neurologist.” The American Neurological

The Four Horsemen: DeJong, Baker, Sahs, and Forster

Association, a very old professional society, was really an organization for department heads or faculty people. They required that to be a member you had to have your boards, you had to have a list of publications and write a thesis. That’s pretty well not available for the fellows or brand-new neurologists…. So, Dr. Baker said, ‘Relax, we’re doing it.’ And they did, and it was really something.” Baker was sympathetic to Resch’s concerns. The times were changing. The recent world war had left tens of thousands of American soldiers wounded in body and psyche. Many had brain injuries that required ongoing treatment and rehabilitation. There was clearly a need for more neurologists. If neurology was to move from the shadow of psychiatry and stand as a distinct specialty of medicine, it must organize and grow. Baker began developing the idea of a new organization, collaborating with Russell N. DeJong (University of Michigan), Francis M. Forster (then at Jefferson Medical College in Philadelphia), Adolph L. Sahs (University of Iowa), and Joe R. Brown (then at the University of Minnesota and Minneapolis Veterans Administration hospital).

Baker, 1940s

Sunday, April 22, 2018 • AANextra

As Forster later recounted, “Abe gathered around him a number of disciples. Russ DeJong, Ady Sahs, and I were proud to be associated with him in these ventures. It was thus we became known as the Four Horsemen,” a nickname likely derived from “the Four Horsemen of the Notre Dame”—the legendary backfield for the 1920s college football team (itself a play off a Rudolph Valentino film and book of the Bible, “The Four Horsemen of the Apocalypse”). Baker invited 52 key neurologists to become charter members and Fellows of the new American Academy of Neurology (two later declined after initially accepting the honor). In the meantime, organizational papers were drawn up. Brown, the AAN’s first secretary-treasurer, shared his story of the Academy’s launch in his 1973 Annual Meeting presidential address “The Early Years of the American Academy of Neurology,” later published in the January 1974 issue of Neurology ® . “Abe Baker found a copy of a dental association constitution. We sat in his office over a few days’ time, copied large parts of this constitution with modifications to fit the principles of the Academy, and distributed the resulting document to the 52 original fellows for ratification.” The American Academy of Neurology was incorporated in the state of Minnesota on March 13, 1948. “In planning the Academy, you must keep in mind that one was breaking with tradition,” said Baker later recalled. “The American neurological tradition at that time was the American Neurological Association, and to consider a new neurologic group on a broad democratic scale was not to be tolerated. Therefore, for two years, I spoke to many important leaders in the neurologic field trying to stimulate some support for this new idea. Therefore, it was fairly well known that such a society was being considered and I believe most people felt that no one would have the courage to start such a group. In the ‘Old Guard’ or older members of neurology, the chief support and encouragement came from Drs. [Frederic] Lewey, [Robert] Wartenberg, [Walter] Schaller, and [Johannes] Nielsen.” Brown, 1959

Indeed, there were calls within the ANA to discipline the upstart Baker. Along with those neurologists cited by Baker, other defenders included Alphonse Vonderahe and Paul Yakovlev. Vonderahe, in particular, came up with a convincing argument for the fledgling Academy, according to Forster. “My mentor at the University of Cincinnati, Dr. Vonderahe, who would belong to the older group, had an uncanny ability to understand things. And he looked over the situation and said, ‘Frank, you know, this is like the United States government. The American Neurological is the Senate, and the American Academy of Neurology is the House of Representatives.’ And with that theme, we were able to convince pretty much everybody that there was nothing with the Academy. But I

think that was very wise. Dr. Vonderahe, he was an active member of the Academy, a Fellow man, for many years.” Baker escaped disciplinary action, but friction between the two organizations existed well through the 1950s, as related by Elan D. Louis, MD, FAAN, in Bailey, 1950 his article “The Early Struggles of the Fledgling American Academy of Neurology: Resistance from the Old Guard of American Neurology,” published by the journal Brain on January 3, 2013. An excerpt from a 1951 letter by then-AAN President Pearce Bailey [himself the son of a famed New York City neurologist] published in the first issue of Neurology ® , framed the situation in blunt terms: “The scope of the Academy is nationwide and hence antagonistic to the geographic sectionalism which always has hemmed in the neurology of the past. It should be recalled that the early American neurologists were all aristocrats, originating for the most part from the northeastern section of the United States and guided by the principles of rugged individualism. There were no middle or lower classes in the neurology of the early days.... Neurology needs a progressive middle class and the Academy, by virtue of its organizational plan, is equipped to help develop such a group.” Baker invited leading neurologists to Chicago for an organizational summit in June 1948 in the old Stevens Hotel that coincided with the annual meeting of the American Medical Association. Some 70 or so neurologists attended. According to Brown, it started out with a linguistic quagmire. “The first item of business was the presentation of the constitution and bylaws. This stirred extensive responses in the group, not to the principles involved but to the wordings used. Almost every neurologist present seemed to have an opinion as to how each phrase should be worded and where each punctuation mark should be placed. The discussion went on almost unendingly until it became necessary to stop it. This was accomplished by pointing out that the constitution had already been accepted and that any recommendations for change would have to be referred to a committee on constitution and bylaws.” And then it got worse, according to Brown. “The final item of business for the day was the election of officers. It was planned to have one organizational year with a president [Baker], vice president [Bailey], and secretarytreasurer [Brown], followed by a regular two-year term for the officers. For this reason, the nominating committee did not propose a candidate for president-elect, a failure that soon demonstrated our naivete. After the slate of three officers was presented, one member of the audience noted that no one had been named for the office of president-elect. He jumped up and nominated Walter Freeman for the office. Then someone else jumped up and moved that the nominations be closed.” Continued on page 14 u

Sunday, April 22, 2018 • AANextra

Dr. Walter J. Freeman, a prominent neurologist from Washington, DC, had played no role in forming the association. He was a controversial figure who would become even more so in the future for his promotion of lobotomies. His apparent coup provoked talk of disbanding the new Academy and starting over.

AAN for the rest of his career, particularly in guiding special courses for the Annual Meetings through the 1950s. Forster and Sahs later had terms as AAN president. DeJong became the founding editor-in-chief of the journal Neurology, which began publication in 1951; it was a position he held for 26 years.

Dr. Joe Resch completed his residency at the U of M and was As Brown related, “Dr. Freeman was known as a very accepted as a Junior member of the AAN in 1949. He was influential and strong-willed person. His becoming presidentone of the first neurologists in the Twin Cities to make a living elect was looked on by the organizers of the Academy as without seeing psychiatric patients (to show skeptics it could a real threat to the future of the be done, he carried a card with his appointments noted on organization. After the meeting it). He helped found the Minneapolis Clinic of Neurology Resch at AAN headquarters, March 2008. and the election were over, there in 1955 with Harold Noran. Resch was persuaded by was a discussion about what Baker to return to the university in 1962, where he was a could be done. One suggestion neurology professor, instructing residents and conducting made was that everyone resign research in neuroimmunology and cerebral vascular and start a new organization. disease for which he became known internationally. On returning home, however, I He also made use of his astute administrative skills. reviewed the records and found Resch became chair of the neurology department upon out that Dr. Freeman not only Baker’s retirement in 1976 and was not a fellow but also had served until 1982. He was an not joined the Academy and had active AAN board member not paid his dues. Consequently, he was (or “councilor,” as they were not eligible to be an officer. It became my known then) in the 1970s, and task to write him of this fact. He returned a returned to the AAN office letter graciously withdrawing his name. He in 2008 to help celebrate the attended future meetings of the Academy and 60th anniversary. He died the always was friendly during that time.” following year at age 94. Baker gained his full term as president through a mail vote of the new membership and served in this role until 1951. Afterward, he continued to be actively involved with the

Resch with AAN Executive Director and CEO Catherine M. Rydell, CAE.

To learn more about the AAN’s remarkable history, visit AAN. com/view/AANhistory. 

COME CELEBRATE THE

1-YEAR ANNIVERSARY JOIN US AT BOOTH

1802

VISIT US AT BOOTH #1202

TO LEARN MORE ABOUT GRT

GENE REPLACEMENT THERAPY:

A GENETIC EVOLUTION from Mendel’s work based in nature to notable advancements in medicine

We’ve come a long way since Mendel first laid the foundation of genetics— today, gene replacement therapy (GRT) is being investigated as a therapeutic approach that may have the potential to treat monogenic diseases at their source.1,2

References:1. Gayon J. From Mendel to epigenetics: history of genetics. C R Biol. 2016;339(7-8):225-230. 2. Naldini L. Gene therapy returns to centre stage. Nature. 2015;526(7573):351-360. © 2018 AveXis, Inc. All Rights Reserved. US-UNB-18-0039 04/18

Shulman Selected for AAN President’s Award Lisa M. Shulman, MD, FAAN, will receive the 2018 AAN President’s Award from Ralph L. Sacco, MD, MS, FAHA, FAAN, during today’s Presidential Plenary Session.

VISIT OUR BOOTH #509 The Mount Sinai Hospital is ranked No. 16 in Neurology & Neurosurgery by U.S. News & World Report, 2017-18. Our world-class specialists are commi ed to the discovery of new treatments for neurological conditions and hold faculty appointments at the Icahn School of Medicine at Mount Sinai, ranked among the nation’s top medical schools by U.S. News & World Report. • Comprehensive Stroke Center • Bendheim Parkinson and Movement Disorders Center • Corinne Goldsmith Dickinson Center for Multiple Sclerosis • Center for Headache and Facial Pain • Center for Cognitive Health and Alzheimer’s Disease Research • Parkinson’s Foundation Center of Excellence • Neuromuscular Disease Division • Neuro-Otology and Neurogenetics Division • Neuro-Infectious Diseases and NeuroAIDS Program • Epilepsy Program • Pediatric Neurology Division • Neuro-Oncology Program • Neuro-Ophthalmology Program • Health Outcomes and Knowledge Translation Research Division

1-800-MD-SINAI • mountsinai.org/neurology

“Dr. Shulman has worked tirelessly to further the mission of the AAN in so many ways,” said Sacco. “She has served on the AAN Board of Directors from 2007 to 2017 as a Shulman member, secretary, and treasurer, and been an exemplary Board member and steward of the AAN finances. Her able input has helped guide us in so many committees including Legislative Affairs, Joint Finance, Long Range Planning, Health Reform Task Force, Practice Improvement, and Publications. She has accomplished all of these tasks with enthusiasm and energy.” Shulman, who is the Eugenia Brin Professor of Parkinson’s Disease and Movement Disorders and the Rosalyn Newman Distinguished Scholar in Parkinson Disease at the University of Maryland, has also worked to champion enhanced patient education and including patient-reported measurements in outcome assessments. Since 2007, she has been the editorin-chief of Neurology Now ® Books and co-author of the reference book Parkinson’s Disease: A Complete Guide for Patients and Families, now in its third edition and translated in three languages. She is also a member of the Brain & Life™ (formerly Neurology Now ® ) editorial board and been active in helping plan the annual Brain Health Fair. From 1999 to 2000, she served as the AAN Neurology Public Policy Fellow in Washington, DC. Her major research interest is the impact of chronic neurologic diseases such as Parkinson’s disease on daily function and quality of life. She is author or editor of 200 books, chapters, and peer-reviewed publications. “Dr. Shulman has also joined our fight to raise funds to support research to cure brain disease,” Sacco said. “She has been a vocal member of the American Brain Foundation’s Board of Trustees since 2013, helping to define their strategic plan. Please join me in congratulating Lisa for her amazing service to the AAN and the American Brain Foundation.” 

Collaboration Gives Continuum Bold New Look The latest issue of Continuum: Lifelong Learning in Neurology ® tackles Child Neurology, a topic that hasn’t been addressed in a dedicated issue for 18 years. It also features an eye-catching new design—inside and out—to mark this publication’s 25th anniversary and improve its functionality.

include a hint of gold within the illustration. “For those who prefer a table of contents (rather than an illustration) on their issue cover, readers can simply flip the issue over to see the full list of review articles and page numbers; this ability to have essentially two functional covers is unique to Continuum given our freedom from advertising content,” said Lewis.

Editor-in-Chief Steven L. Lewis, MD, FAAN, is both pleased with the results and the process that brought about this design change. “Our editorial board, the AAN staff, and our publishing staff at Wolters Kluwer collaborated with the design professionals at Pentagram, who did Lewis remarkable work in re-envisioning the ‘packaging’ of the material in Continuum to make the important information we cover in print and online as readable and visually interesting as possible, all for the sake of optimizing educational effectiveness.”

“To increase readability,” Lewis continued, “other enhancements to the print issue include the single-column design for the review articles (rather than the previous twocolumn design) and the lack of right-sided justification; the ‘jagged’ edge on the right side of the text, it turns out, is helpful to improve ease of readability as we read from one line to the next. Another feature that may be helpful to some readers is the semicircular tabs along the side of the issue, assisting readers in knowing where one article ends and the next one begins.” Visit Continuum in the West Lobby to learn more about the new design and the inclusion of Continuum® Audio in every money-saving subscription! 

Extensive thought and work went into creating a striking new look for the cover. “Through Pentagram, we secured the graphic wizardry of Peter Grundy, the British artist selected to produce a series of Continuum covers beginning with the February 2018 issue. Peter is one of the world’s leading information illustrators. Since 1980, he has evolved a simple, elegant combination of ideas and iconography to form inventive infographics for clients and institutions around the world including the Imperial War Museum, Shell International, the World Bank, and the United Nations. In 2013, he illustrated The Human Body, a book for children and adults which gave medical illustration a refreshing new look.” Grundy worked to both accurately and whimsically convey the topic of each of the 18 issues. “I set out to create a look and feel for Continuum that was firstly distinctive, secondly medically informative but at the same time fresh and friendly,” he said. “I wanted to break away from traditional medical illustration and do something elegant and beautiful. Something worthy of cover art that could become a new look for Continuum.” Lewis said that there are artifacts of the signature gold color that reinforced Continuum’s most recent identity (the publication was originally teal in its early years). The spine retains a modern gold hue, and most issue covers will

Sunday, April 22, 2018 • AANextra

INDUSTRY THERAPEUTIC UPDATE FROM ADAMAS PHARMACEUTICALS, INC. HOW CAN WE

FIGHT DYSKINESIA IN

PARKINSON’S DISEASE? Join us for personal and professional perspectives on Parkinson’s disease, with a focus on dyskinesia. This dynamic program features a roundtable discussion among leading experts in the treatment of dyskinesia in Parkinson’s disease, as well as a heartfelt keynote presentation by the daughter of the late, great Muhammad Ali, who lived with Parkinson’s disease for years before he was diagnosed. Don’t miss this opportunity to hear engaging personal and professional perspectives on the impact and management of Parkinson’s disease, with a focus on dyskinesia.

TUESDAY, APRIL 24TH 2018

7:00 PM–10:00 PM REGISTRATION BEGINS AT 6:30 PM

San Diego Ballroom • Westin Bonaventure Hotel • Los Angeles, CA COMPLIMENTARY DINNER WILL BE SERVED

GOCOVRI (amantadine) extended release capsules is the first and only medicine approved by the FDA for the treatment of dyskinesia in patients with Parkinson’s disease receiving levodopa-based therapy, with or without concomitant dopaminergic medications.

IMPORTANT SAFETY INFORMATION CONTRAINDICATIONS

GOCOVRI is contraindicated in patients with creatinine clearance below 15 mL/min/1.73 m2. WARNINGS AND PRECAUTIONS Falling Asleep During Activities of Daily Living and Somnolence: Patients treated with Parkinson’s disease medications have reported falling asleep during activities of daily living. If a patient develops daytime sleepiness during activities that require full attention (eg, driving a motor vehicle, conversations, eating), GOCOVRI should ordinarily be discontinued or the patient should be advised to avoid potentially dangerous activities. Suicidality and Depression: Monitor patients for depression, including suicidal ideation or behavior. Prescribers should consider whether the benefits outweigh the risks of treatment with GOCOVRI in patients with a history of suicidality or depression.

PRESENTERS

KEYNOTE SPEAKER

Rajesh Pahwa, MD

Laverne & Joyce Rider Professor of Neurology Kansas Medical Center Chief, Parkinson Disease & Movement Disorder Division Director, Parkinson Foundation Center of Excellence Kansas City, KS

Daniel E. Kremens, MD, JD Associate Professor of Neurology Department of Neurology Sidney Kimmel Medical College at Thomas Jefferson University Philadelphia, PA

Stuart Isaacson, MD

Associate Professor of Neurology Herbert Wertheim College of Medicine Florida International University Miami, FL Director, Institute for Neurodegenerative Diseases of Florida Parkinson’s Disease and Movement Disorders Center of Boca Raton Alzheimer’s and Memory Disorders Center of South Florida Boca Raton, FL

MARYUM ALI Daughter of Muhammad Ali “My Father’s Journey, and What It Means to Me”

IMPORTANT SAFETY INFORMATION (cont.) WARNINGS AND PRECAUTIONS (cont.) Hallucinations/Psychotic Behavior: Patients with a major psychotic disorder should ordinarily not be treated with GOCOVRI because of the risk of exacerbating psychosis. Observe patients for the occurrence of hallucinations throughout treatment, especially at initiation and after dose increases. Dizziness and Orthostatic Hypotension: Monitor patients for dizziness and orthostatic hypotension, especially after starting GOCOVRI or increasing the dose. Withdrawal-Emergent Hyperpyrexia and Confusion: Rapid dose reduction or abrupt discontinuation of GOCOVRI, may cause an increase in the symptoms of Parkinson’s disease or cause delirium, agitation, delusions, hallucinations, paranoid reaction, stupor, anxiety, depression, or slurred speech. Avoid sudden discontinuation of GOCOVRI. Impulse Control/Compulsive Behaviors: Patients may experience urges (eg, gambling, sexual, money spending, binge eating) and the inability to control them. It is important for prescribers to ask patients or their caregivers about the development of new or increased urges. Consider dose reduction or stopping medications. ADVERSE REACTIONS The most common adverse reactions (>10%) were hallucination, dizziness, dry mouth, peripheral edema, constipation, fall, and orthostatic hypotension. DRUG INTERACTIONS Other Anticholinergic Drugs: The dose of GOCOVRI should be reduced if atropine-like effects are observed. Drugs Affecting Urinary pH: The pH of the urine has been reported to influence the excretion rate of amantadine. Monitor for efficacy or adverse reactions under conditions that alter the urine pH. Alcohol: Concomitant use with alcohol is not recommended, as it may increase the potential for CNS effects such as dizziness, confusion, lightheadedness, and orthostatic hypotension. Please see Brief Summary of full Prescribing Information on the next page.

Please visit us at Booth 703 For more information and to preregister for this program, please visit

www.fightdyskinesia.com Seating is limited, so preregistration is recommended. This promotional, non-CME program is intended only for healthcare professionals involved in the treatment of people with Parkinson’s disease. This is not an AAN-endorsed event.

GOCOVRI™ (amantadine) extended release capsules Brief Summary of full Prescribing Information. See full Prescribing Information. Rx Only. INDICATIONS AND USAGE: GOCOVRI is indicated for the treatment of dyskinesia in patients with Parkinson’s disease receiving levodopa-based therapy, with or without concomitant dopaminergic medications. CONTRAINDICATIONS: Contraindicated in patients with creatinine clearance below 15 mL/min/1.73 m2 WARNINGS AND PRECAUTIONS: Falling Asleep During Activities of Daily Living and Somnolence: Patients treated with Parkinson’s disease medications have reported falling asleep while engaged in activities of daily living, including the operation of motor vehicles, which sometimes has resulted in accidents. Patients may not perceive warning signs, such as excessive drowsiness, or they may report feeling alert immediately prior to the event. In controlled clinical trials, somnolence and fatigue were reported in 4% vs. 1% of patients treated with GOCOVRI or placebo, respectively. Before initiating treatment with GOCOVRI, advise patients of the potential to develop drowsiness and specifically ask about factors that may increase the risk for somnolence with GOCOVRI, such as concomitant sedating medications or the presence of a sleep disorder. If a patient develops daytime sleepiness or episodes of falling asleep during activities that require full attention (e.g., driving a motor vehicle, conversations, eating), GOCOVRI should ordinarily be discontinued. If a decision is made to continue GOCOVRI, patients should be advised not to drive and to avoid other potentially dangerous activities. There is insufficient information to establish that dose reduction will eliminate episodes of falling asleep while engaged in activities of daily living or daytime somnolence. Suicidality and Depression: In controlled clinical trials, suicidal ideation or suicide attempt was reported in 2% vs. 0%; depression or depressed mood 6% vs. 1%; confusional state 3% vs. 2%; apathy 2% vs. 0%, in patients treated with GOCOVRI or placebo, respectively. Monitor patients for depression, including suicidal ideation or behavior. Prescribers should consider whether the benefits outweigh the risks of treatment with GOCOVRI in patients with a history of suicidality or depression. Hallucinations/Psychotic Behavior: Patients with a major psychotic disorder should ordinarily not be treated with GOCOVRI because of the risk of exacerbating psychosis. In controlled trials, the incidence of patients who experienced visual hallucination, auditory hallucination, delusions, illusions, or paranoia was 25% vs 3%; hallucinations caused discontinuation of treatment in 8% vs.0%; in patients treated with GOCOVRI or placebo, respectively. Observe patients for the occurrence of hallucinations throughout treatment, especially at initiation and after dose increases. Dizziness and Orthostatic Hypotension: In controlled clinical trials, 29% vs. 2% experienced dizziness, syncope, orthostatic hypotension, presyncope, postural dizziness or hypotension; and 3% vs. 0% discontinued study treatment because of dizziness, postural dizziness, or syncope; in patients receiving GOCOVRI or placebo, respectively. Monitor patients for dizziness and orthostatic hypotension, especially after starting GOCOVRI or increasing the dose. Concomitant use of alcohol with GOCOVRI is not recommended. Withdrawal-Emergent Hyperpyrexia and Confusion: A symptom complex resembling neuroleptic malignant syndrome (characterized by elevated temperature, muscular rigidity, altered consciousness, and autonomic instability), with no other obvious etiology, has been reported in association with rapid dose reduction, withdrawal of, or changes in drugs that increase central dopaminergic tone. Abrupt discontinuation of GOCOVRI may cause an increase in the symptoms of Parkinson’s disease or cause delirium, agitation, delusions, hallucinations, paranoid reaction, stupor, anxiety, depression, or slurred speech. If possible, avoid sudden discontinuation of GOCOVRI. Impulse Control/Compulsive Behaviors: Patients can experience intense urges to gamble, increased sexual urges, intense urges to spend money, binge eating, and/or other intense urges, and the inability to control these urges while taking one or more of the medications, including GOCOVRI, that increase central dopaminergic tone. In some cases, these urges were reported to have stopped when the dose was reduced or the medication was discontinued. Because patients may not recognize these behaviors as abnormal, it is important for prescribers to specifically ask patients or their caregivers about the development of such urges, and to consider dose reduction or stopping GOCOVRI treatment. ADVERSE REACTIONS: Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in practice. GOCOVRI was evaluated in two double-blind, placebo-controlled efficacy trials of similar design and population: Study 1 (123 patients) and Study 2 (75 patients). The study population was approximately 56% male and 94% white, with a mean age of 65 years (age range from 34 years to 82 years). The mean duration of levodopa-induced dyskinesia was 4 years (range 0.1 to 14 years). Active treatment started at 137 mg once daily for one week, followed by a dose increase to 274 mg once daily. The treatment duration was 25 weeks for Study 1 and 13 weeks for Study 2. Study 1 was stopped prematurely unrelated to safety, with 39/100 patients (safety population) treated with GOCOVRI for 24 weeks. The most common adverse reactions reported in >10% of GOCOVRI-treated patients and more frequently than on placebo were: hallucination, dizziness, dry mouth, peripheral edema, constipation, falls, and orthostatic hypotension. The overall rate of discontinuation because of adverse reactions was 20% vs. 8% for patients treated with GOCOVRI or placebo, respectively. Adverse reactions that led to treatment discontinuation in at least 2% of patients were hallucination (8% GOCOVRI vs. 0% placebo), dry mouth (3% GOCOVRI vs. 0% placebo), peripheral edema (3% GOCOVRI vs. 0% placebo), blurred vision (GOCOVRI 3% vs.0% placebo), postural dizziness and syncope (GOCOVRI 2% vs. 0% placebo), abnormal dreams (GOCOVRI 2% vs. 1% placebo), dysphagia (GOCOVRI 2% vs. 0% placebo), and gait disturbance (GOCOVRI 2% vs. 0% placebo). Pooled Analysis of Adverse Reactions Reported for ≥ 3% of Patients Treated with GOCOVRI 274 mg (N=100) or placebo (N=98), respectively: Psychiatric disorders: visual and/or auditory hallucination (21%, 3%); anxiety and/or generalized anxiety (7%, 3%); insomnia (7%, 2%); depression/depressed mood (6%, 1%); abnormal dreams (4%, 2%); confusional state (3%, 2%). Nervous system disorders: dizziness (16%, 1%); headache (6%, 4%); dystonia (3%, 1%). Gastrointestinal disorders: dry mouth (16%, 1%); constipation (13%, 3%); nausea (8%, 3%); vomiting (3%, 0%). General disorders and administration site conditions: peripheral edema (16%, 1%); gait disturbance (3%, 0%). Injury, poisoning and procedural complications: fall (13%, 7%); contusion (6%, 1%) Infection and infestations: urinary tract infection (10%, 5%). Skin and

subcutaneous tissue disorders: livedo reticularis (6%, 0%); pigmentation disorder (3%, 0%). Metabolism and nutrition disorders: decreased appetite (6%, 1%). Vascular disorders: orthostatic hypotension, including postural dizziness, syncope, presyncope, and hypotension (13%, 1%). Eye disorders: blurred vision (4%, 1%); cataract (3%, 1%); dry eye (3%, 0%). Musculoskeletal and connective tissue disorders: joint swelling (3%, 0%), muscle spasm (3%, 0%). Reproductive system and breast disorders: benign prostatic hyperplasia—all male (6%, 2%). Respiratory, thoracic and mediastinal disorders: cough (3%, 0%). Other clinically relevant adverse reactions observed at <3% included somnolence, fatigue, suicide ideation or attempt, apathy, delusions, illusions, and paranoia. Difference in the Frequency of Adverse Reactions by Gender in Patients Treated with GOCOVRI. Adverse reactions reported more frequently in women (n=46) vs. men (n=54), were: dry mouth (22% vs.11%), nausea (13% vs. 4%), livedo reticularis (13% vs. 0%), abnormal dreams (9% vs. 0%) and cataracts (7% vs. 0%), respectively. Men vs. women reported the following adverse reactions more frequently: dizziness (20% vs. 11%), peripheral edema (19% vs. 11%), anxiety (11% vs. 2%), orthostatic hypotension in (7% vs. 2%) and gait disturbance (6% vs. 0%), respectively. Difference in the Frequency of Adverse Reactions by Age in Patients Treated with GOCOVRI. Hallucinations (visual or auditory) were reported in 31% of patients age 65 years and over (n=52), vs.10 % in patients below the age of 65 years (n=48). Falls were reported in 17% of patients age 65 and over, vs. 8% of patients below age 65. Orthostatic hypotension was reported in 8% of patients age 65 and over, compared to 2% of patients below age 65. DRUG INTERACTIONS: Other Anticholinergic Drugs: Products with anticholinergic properties may potentiate the anticholinergic-like side effects of amantadine. The dose of anticholinergic drugs or of GOCOVRI should be reduced if atropine-like effects appear when these drugs are used concurrently. Drugs Affecting Urinary pH: The pH of the urine has been reported to influence the excretion rate of amantadine. Urine pH is altered by diet, drugs (e.g., carbonic anhydrase inhibitors, sodium bicarbonate), and clinical state of the patient (e.g., renal tubular acidosis or severe infections of the urinary tract). Since the excretion rate of amantadine increases rapidly when the urine is acidic, the administration of urine acidifying drugs may increase the elimination of the drug from the body. Alterations of urine pH towards the alkaline condition may lead to an accumulation of the drug with a possible increase in adverse reactions. Monitor for efficacy or adverse reactions under conditions that alter the urine pH to more acidic or alkaline, respectively. Live Attenuated Influenza Vaccines: Due to its antiviral properties, amantadine may interfere with the efficacy of live attenuated influenza vaccines. Therefore, live vaccines are not recommended during treatment with GOCOVRI. Inactivated influenza vaccines may be used, as appropriate. Alcohol: Concomitant use with alcohol is not recommended, as it may increase the potential for CNS effects such as dizziness, confusion, lightheadedness, and orthostatic hypotension, and may result in dose-dumping. USE IN SPECIFIC POPULATIONS: Pregnancy: There are no adequate data on the developmental risk associated with use of amantadine in pregnant women. Based on animal data, may cause fetal harm. Lactation: Amantadine is excreted into human milk, but amounts have not been quantified. There is no information on the risk to a breastfed infant. The developmental and health benefits of breastfeeding should be considered along with the mother’s clinical need for GOCOVRI and any potential adverse effects on the breastfed infant from GOCOVRI or from the underlying maternal condition. Pediatric Use: Safety and effectiveness of GOCOVRI in pediatric patients have not been established. Geriatric Use: In Phase 3 clinical trials, the mean age of patients at study entry was 65 years. Of the total number of patients in clinical studies of GOCOVRI, 46% were less than 65 years of age, 39% were 65-74 years of age, and 15% were 75 years of age or older. Hallucinations and falls occurred more frequently in patients 65 years of age or older, compared to those less than 65 years of age. No dose adjustment is recommended on the basis of age. GOCOVRI is known to be substantially excreted by the kidney, and the risk of adverse reactions may be greater in patients with impaired renal function. Because elderly patients are more likely to have decreased renal function, care should be taken in dose selection, and it may be useful to monitor renal function. Renal Impairment: GOCOVRI is contraindicated for use in patients with end-stage renal disease (creatinine clearance values lower than 15 mL/min/1.73 m2). A 50% dose reduction of GOCOVRI dosage to a starting daily dose of 68.5 mg daily for a week, followed by a daily maintenance dose of 137 mg is recommended in patients with moderate renal impairment (creatinine clearance between 30 and 59 mL/min/1.73 m2). For patients with severe renal impairment (creatinine clearance between 15 and 29 mL/min/m2), a daily dose of 68.5 mg is recommended. Overdosage: Deaths have been reported from overdose with amantadine immediaterelease. The lowest reported acute lethal dose was 1 gram of amantadine hydrochloride (equivalent to 0.8 g amantadine). Acute toxicity may be attributable to the anticholinergic effects of amantadine. Drug overdose has resulted in cardiac, respiratory, renal, or central nervous system toxicity. Pulmonary edema and respiratory distress (including adult respiratory distress syndrome, ARDS) have been reported with amantadine; renal dysfunction, including increased BUN and decreased creatinine clearance, can occur. Central nervous system effects that have been reported with overdose include agitation, aggressive behavior, hypertonia, hyperkinesia, ataxia, tremor, disorientation, depersonalization, fear, delirium, psychotic reactions, lethargy, and coma. Seizures may be exacerbated in patients with prior history of seizure disorders. Hyperthermia has occurred with amantadine overdose. For acute overdosing, general supportive measures should be employed along with immediate gastric decontamination if appropriate. Give intravenous fluids if necessary. The excretion rate of amantadine increases with acidification of urine, which may increase the elimination of the drug. Monitor patients for arrhythmias and hypotension. Electrocardiographic monitoring may be needed after ingestion because arrhythmias have been reported after overdose, including arrhythmias with fatal outcomes. Adrenergic agents, such as isoproterenol, in patients with an amantadine overdose has been reported to induce arrhythmias. Monitor blood electrolytes, urine pH, and urinary output. Although amantadine is not efficiently removed by hemodialysis, this procedure may be useful in the treatment of amantadine toxicity in patients with renal failure. Gocovri, the Gocovri logo, Adamas, and the Adamas logo are trademarks of Adamas Pharmaceuticals, Inc. or its related companies. © 2018 Adamas Pharmaceuticals, Inc. or its related companies. All rights reserved. GOC-0202 03/18

Boffo Brainiacs Bravely Brawl at Neurobowl! Continued from cover

The superheroes of Team Boston—last year’s winner—flexed their mighty medullas against the whip smart willises of the highly logical Team Midwest. But Boston clearly had more than a feeling this was their night and told the Spocksters “don’t look back” as they blew them off the stage. Now, it came to the gangsters of Team West Coast to bust up the joint. The wise guys and gals went to the mattresses, rattling off volley after volley of multi-syllabic responses to the confounding questions of the stentorian Swift. They edged ahead, appearing destined for glory! But they couldn’t outperform the mighty minds of the brainy Bostonians, who—once again— clinched the covet role of Neurobowl Champion!

Team Boston (Returning Champs) Aaron Berkowitz, MD Jeremy D. Schmahmann, MD, FAAN Janice Wiesman, MD, FAAN David Thaler, MD, PhD, FAHA Anthony Amato, MD, FAAN Marie E. Pasinski, MD — Alternate

Team Midwest

Team West Coast

Timothy R. Fullam, MD Jennifer Bickel, MD, FAAN Steven Vernino, MD, PhD, FAAN Julie E. Hammack, MD, FAAN Benjamin M. Greenberg, MD, FAAN Tyler R. Koehn, MD — Alternate

Veronica Santini, MD Holly E. Hinson, MD, MCR Jeffrey Gelfand, MD, MAS, FAAN Jeffrey Ralph, MD Rafael Zuzuarregui, MD 

AAN.com Gets Personal at Member Experience Experiential Learning Area Stop by the Member Experience: Personalize Your Journey Experiential Learning Area to learn all about the new and improved AAN.com. Academy staff will be on hand for demonstrations and to answer any questions you have. Take it for a test drive of your own to experience its: Personalized content based on your career needs Improved usability and clean and intuitive user interface with easy-to-understand navigation Powerful search platform that incorporates all AAN products and services and makes finding what you need easier than ever While there, take part in a friendly competition with your colleagues to see who best knows their way around the new site and enter to win high-tech prizes. 

Other Highlights of the Member Experience Experiential Learning Area Stop by all week long to get connected, engaged—and even recognized: Join SynapseSM Online Communities Update your AAN profile and get your profile picture

taken

Learn about all the opportunities to increase your

engagement with the Academy See if you qualify to elevate your membership status to the premier Fellow of the American Academy of Neurology (FAAN) Check out the recognition walls and congratulate your deserving colleagues Win cool giveaways

Sunday, April 22, 2018 • AANextra

This Morning’s “Best of” Session to Feature Top Cerebrovascular Disease Abstracts Don’t miss this morning’s “Best of” session featuring the top four abstracts on cerebrovascular disease. The session is a perfect lead-in to today’s Presidential Plenary Session that immediately follows.

Cerebrovascular Disease and Interventional Neurology

8:00 a.m.–9:00 a.m. 408B 8:00 a.m. Minocycline Protects Against Delayed Cerebral Ischemia After Subarachnoid Hemorrhage via Matrix Metalloproteinase-9 Inhibition —Glenn Harris, Ananth Vellimana, Meng-Liang Zhou, Itender Singh, Diane Aum, James Nelson, Umeshkumar Athiraman, ByoungJun Han, Gregory Zipfel 8:08 a.m. Genome-Wide Association Study of Hematoma Volume Identifies 17p12 as a Novel Susceptibility Locus for Severity and Outcome in Intracerebral Hemorrhage — Sandro Marini, William J. Devan, Farid Radmanesh, Laura Miyares, Timothy Poterba, Bjorn Hansen, Bo Norrving, Eva Giralt-Steinhauer, Jordi Jimenez-Conde, Roberto Elosua, Elisa Cuadrado-Godia, Carolina Soriano, Jaume Roquer Gonzalez, Christina Kourkoulis, Alison Ayres, Kristin Schwab, David Tirschwell, Magdy Selim, Devin Brown, Scott Silliman, Bradford Worrall, James Meschia, Chelsea Kidwell, Joan Montaner, Israel Fernandez-Cadenas, Pilar Delgado, Steven Greenberg, Arne Lindgren, Charles Matouk, Kevin Sheth, Daniel Woo, Christopher Anderson, Jonathan Rosand, Guido Falcone 8:16 a.m. Association of Prothrombin Complex Concentrates Administration and Hematoma Enlargement in NOAC-related Intracerebral Hemorrhage —Stefan Gerner, Stefan Schwab, Hagen Huttner 8:24 a.m. Left Atrial Endothelial Dysfunction, Inflammation and Fibrosis Induced by Selective Insular Cortex Ischemic Stroke in Rats —Brittany Balint, Victoria Thorburn, Victoria Jaremek, Maryse Paquet, Shawn Whitehead, Luciano Sposato 8:35 a.m. Panel Discussion/Meet the Investigator 

For patients with epilepsy 12 years of age and older for the treatment of partial-onset seizures (POS) with or without secondarily generalized seizures and adjunctive therapy in the treatment of primary generalized tonic-clonic (PGTC) seizures

RETHINK CO N V U L S I V E S E I Z U R E CO NTRO L AT B O OTH 17 15

HELP QUIET THE NOISE OF CONVULSIVE SEIZURES

Prescribed for

100,000 PATIENTS1*†

Approved in

Available in

COUNTRIES1†

FORMULATIONS2

TO LEARN MORE, VISIT FYCOMPA .COM/HCP Please see Important Safety Information, including a Boxed WARNING for Serious Psychiatric and Behavioral Reactions, on adjacent page. Please see Brief Summary of Prescribing Information on following pages.

* Worldwide figure for FYCOMPA® from 2012 through July 2017. Nearly 20,000 patients prescribed FYCOMPA in the United States. †Across different indications.

IMPORTANT SAFETY INFORMATION WARNING: SERIOUS PSYCHIATRIC AND BEHAVIORAL REACTIONS • Serious or life-threatening psychiatric and behavioral adverse reactions including aggression, hostility, irritability, anger, and homicidal ideation and threats have been reported in patients taking FYCOMPA® • These reactions occurred in patients with and without prior psychiatric history, prior aggressive behavior, or concomitant use of medications associated with hostility and aggression • Advise patients and caregivers to contact a healthcare provider immediately if any of these reactions or changes in mood, behavior, or personality that are not typical for the patient are observed while taking FYCOMPA or after discontinuing FYCOMPA • Closely monitor patients particularly during the titration period and at higher doses • FYCOMPA should be reduced if these symptoms occur and should be discontinued immediately if symptoms are severe or are worsening

SERIOUS PSYCHIATRIC AND BEHAVIORAL REACTIONS

SOMNOLENCE AND FATIGUE FYCOMPA caused dose-dependent increases in somnolence and fatigue-related events. Somnolence was reported in 16% and 18% of patients in the partial-onset seizure trials randomized to receive FYCOMPA at doses of 8 mg and 12 mg per day, respectively, compared to 7% of placebo-treated patients. Fatigue-related events were reported in 12% and 15% of patients in the partial-onset seizure trials randomized to receive FYCOMPA at doses of 8 mg and 12 mg per day, respectively, compared to 5% of placebo-treated patients. These adverse reactions occurred mostly during the titration phase. These adverse reactions were also observed in the PGTC seizure clinical trial. Patients should be advised against engaging in hazardous activities requiring mental alertness, such as operating motor vehicles or dangerous machinery, until the effect of FYCOMPA is known.

FALLS Falls were reported in 5% and 10% of patients in the partial-onset seizure clinical trials randomized to receive FYCOMPA at doses of 8 mg and 12 mg per day, respectively, compared to 3% of placebo-treated patients.

DRUG REACTION WITH EOSINOPHILIA AND SYSTEMIC SYMPTOMS (DRESS)

In the partial-onset seizures clinical trials, hostility- and aggression-related adverse reactions occurred in 12% and 20% of patients randomized to receive FYCOMPA at doses of 8 mg and 12 mg per day, respectively, compared to 6% of patients in the placebo group. These effects were dose-related and generally appeared within the first 6 weeks of treatment, although new events continued to be observed through more than 37 weeks. These effects in FYCOMPA-treated patients led to dose reduction, interruption, and discontinuation more frequently than placebo-treated patients. Homicidal ideation and/or threat have also been reported postmarketing in patients treated with FYCOMPA. The combination of alcohol and FYCOMPA significantly worsened mood and increased anger. Patients taking FYCOMPA should avoid the use of alcohol. Patients, their caregivers, and families should be informed that FYCOMPA may increase the risk of psychiatric events. Patients should be monitored during treatment and for at least one month after the last dose of FYCOMPA, and especially when taking higher doses and during the initial few weeks of drug therapy (titration period) or at other times of dose increases. Similar serious psychiatric and behavioral events were observed in the primary generalized tonic-clonic (PGTC) seizure clinical trial.

DRESS, also known as multiorgan hypersensitivity, has been reported in patients taking AEDs, including FYCOMPA. DRESS may be fatal or life-threatening. DRESS typically, although not exclusively, presents with fever, rash, lymphadenopathy, and/or facial swelling, in association with other organ system involvement. If signs or symptoms are present, immediately evaluate the patient and discontinue FYCOMPA if an alternative etiology for signs or symptoms cannot be established.

SUICIDAL BEHAVIOR AND IDEATION

FYCOMPA may decrease the efficacy of contraceptives containing levonorgestrel. Plasma levels of FYCOMPA were decreased when administered with moderate and strong CYP3A4 inducers, including, carbamazepine, phenytoin, or oxcarbazepine. Multiple dosing of FYCOMPA 12 mg per day enhanced the effects of alcohol on vigilance and alertness, and increased levels of anger, confusion, and depression. These effects may also be seen when FYCOMPA is used in combination with other CNS depressants.

Antiepileptic drugs (AEDs), including FYCOMPA, increase the risk of suicidal thoughts or behavior in patients. Anyone considering prescribing FYCOMPA or any other AED must balance the risk of suicidal thoughts or behavior with the risk of untreated illness. Epilepsy and many other illnesses for which AEDs are prescribed are themselves associated with morbidity and mortality and an increased risk of suicidal thoughts and behavior. Patients, their caregivers, and families should be informed of the risk and advised to monitor and immediately report the emergence or worsening of depression, suicidal thoughts or behavior, thoughts about self-harm and/or any unusual changes in mood or behavior. Should suicidal thoughts and behavior emerge during treatment, consider whether the emergence of these symptoms in any given patient may be related to the illness being treated.

DIZZINESS AND GAIT DISTURBANCE FYCOMPA caused dose-related increases in events related to dizziness and disturbance in gait or coordination. Dizziness and vertigo were reported in 35% and 47% of patients in the partial-onset seizure trials randomized to receive FYCOMPA at doses of 8 mg and 12 mg per day, respectively, compared to 10% of placebo-treated patients. Gait disturbance related events were reported in 12% and 16% of patients in the partial-onset seizure clinical trials randomized to receive FYCOMPA at doses of 8 mg and 12 mg per day, respectively, compared to 2% of placebo-treated patients. These adverse reactions occurred mostly during the titration phase. These adverse reactions were also observed in the PGTC seizure clinical trial.

WITHDRAWAL OF AEDs A gradual withdrawal is generally recommended with AEDs to minimize the potential of increased seizure frequency, but if withdrawal is a response to adverse events, prompt withdrawal can be considered.

MOST COMMON ADVERSE REACTIONS The most common adverse reactions in patients receiving FYCOMPA (≥5% and ≥1% higher than placebo) include dizziness, somnolence, fatigue, irritability, falls, nausea, weight gain, vertigo, ataxia, headache, vomiting, contusion, abdominal pain, and anxiety.

DRUG INTERACTIONS

PREGNANCY AND LACTATION Physicians are advised to recommend that pregnant patients taking FYCOMPA enroll in the North American Antiepileptic Drug (NAAED) Pregnancy Registry. Caution should be exercised when FYCOMPA is administered to pregnant or nursing women as there are no adequate data on the developmental risk associated with use in pregnant women, and no data on the presence of perampanel in human milk, the effects on the breastfed child, or the effects of the drug on milk production.

HEPATIC AND RENAL IMPAIRMENT Use in patients with severe hepatic or severe renal impairment is not recommended. Dosage adjustments are recommended in patients with mild or moderate hepatic impairment. Use with caution in patients with moderate renal impairment.

DRUG ABUSE AND DEPENDENCE FYCOMPA is a Schedule III controlled substance and has the potential to be abused and lead to drug dependence.

REFERENCES: 1. Data on file. Eisai Inc. Woodcliff Lake, NJ. 2. FYCOMPA US Prescribing Information. Woodcliff Lake, NJ: Eisai Inc.

Please see Brief Summary of Prescribing Information on following pages. FYCOMPA® is a registered trademark of Eisai R&D Management Co., Ltd., licensed to Eisai Inc. ©2018 Eisai Inc. FYCO-US2026 March 2018

FYCOMPA® (perampanel) tablets, for oral use, CIII FYCOMPA® (perampanel) oral suspension, CIII Initial U.S. Approval: 2012 Brief Summary of Full Prescribing Information dated July 2017 WARNING: SERIOUS PSYCHIATRIC AND BEHAVIORAL REACTIONS • Serious or life-threatening psychiatric and behavioral adverse reactions including aggression, hostility, irritability, anger, and homicidal ideation and threats have been reported in patients taking FYCOMPA. • These reactions occurred in patients with and without prior psychiatric history, prior aggressive behavior, or concomitant use of medications associated with hostility and aggression. • Advise patients and caregivers to contact a healthcare provider immediately if any of these reactions or changes in mood, behavior, or personality that are not typical for the patient are observed while taking FYCOMPA or after discontinuing FYCOMPA. • Closely monitor patients particularly during the titration period and at higher doses • FYCOMPA should be reduced if these symptoms occur and should be discontinued immediately if symptoms are severe or are worsening. WARNINGS AND PRECAUTIONS Serious Psychiatric and Behavioral Reactions In the controlled partial-onset seizure clinical trials, hostilityand aggression-related adverse reactions occurred in 12% and 20% of patients randomized to receive FYCOMPA at doses of 8 mg and 12 mg per day, respectively, compared to 6% of patients in the placebo group. These effects were dose-related and generally appeared within the first 6 weeks of treatment, although new events continued to be observed through more than 37 weeks. FYCOMPA-treated patients experienced more hostility- and aggression-related adverse reactions that were serious, severe, and led to dose reduction, interruption, and discontinuation more frequently than placebo-treated patients. In general, in placebo-controlled partial-onset seizure clinical trials, neuropsychiatric events were reported more frequently in patients being treated with FYCOMPA than in patients taking placebo. These events included irritability, aggression, anger, and anxiety, which occurred in 2% or greater of FYCOMPA-treated patients and twice as frequently as in placebo-treated patients. Other symptoms that occurred with FYCOMPA and were more common than with placebo included belligerence, affect lability, agitation, and physical assault. Some of these events were reported as serious and life-threatening. Homicidal ideation and/or threat were exhibited in 0.1% of 4,368 FYCOMPA-treated patients in controlled and open label trials, including non-epilepsy trials. Homicidal ideation and/or threat have also been reported postmarketing in patients treated with FYCOMPA. In the partial-onset seizure clinical trials, these events occurred in patients with and without prior psychiatric history, prior aggressive behavior, or concomitant use of medications associated with hostility and aggression. Some patients experienced worsening of their pre-existing psychiatric conditions. Patients with active psychotic disorders and unstable recurrent affective disorders were excluded from the clinical trials. The combination of alcohol and FYCOMPA significantly worsened mood and increased anger. Patients taking FYCOMPA should avoid the use of alcohol. Similar serious psychiatric and behavioral events were observed in the primary generalized tonic-clonic seizure clinical trial. In healthy volunteers taking FYCOMPA, observed psychiatric events included paranoia, euphoric mood, agitation, anger, mental status changes, and disorientation/confusional state. In the non-epilepsy trials, psychiatric events that occurred in perampanel-treated patients more often than placebo-treated patients included disorientation, delusion, and paranoia. Patients, their caregivers, and families should be informed that FYCOMPA may increase the risk of psychiatric events. Patients should be monitored during treatment and for at least 1 month after the last dose of FYCOMPA, and especially when taking higher doses and during the initial few weeks of drug therapy (titration period) or at other times of dose increases. Dose of FYCOMPA should be reduced if these symptoms occur. Permanently discontinue FYCOMPA for persistent severe or worsening psychiatric symptoms or behaviors and refer for psychiatric evaluation. Suicidal Behavior and Ideation Antiepileptic drugs (AEDs), including FYCOMPA, increase the risk of suicidal thoughts or behavior in patients taking these drugs for any indication. Patients treated with any AED for any indication should be monitored for the emergence or worsening of depression, suicidal thoughts or behavior, and/or any unusual changes in mood or behavior. Pooled analyses of 199 placebo-controlled clinical trials (mono- and adjunctive therapy) of 11 different AEDs showed that patients randomized to one of the AEDs had approximately twice the risk (adjusted Relative Risk 1.8, 95% CI: 1.2, 2.7) of suicidal thinking or behavior compared to patients randomized to placebo. In these trials, which had a median treatment duration of 12 weeks, the estimated incidence of suicidal behavior or ideation among 27,863 AED-treated patients was 0.43%, compared to 0.24% among 16,029 placebo-treated patients, representing an increase of approximately one case of suicidal thinking or behavior for every 530 patients treated. There were four suicides in drug-treated patients in the trials and none in placebo-treated patients, but the number is too small to allow any conclusion about drug effect on suicide. The increased risk of suicidal thoughts or behavior with AEDs was observed as early as 1 week after starting drug treatment with AEDs and persisted for the duration of treatment assessed. Because most trials included in the analysis did not extend beyond 24 weeks, the risk of suicidal thoughts or behavior beyond 24 weeks could not be assessed. The risk of suicidal thoughts or behavior was generally consistent among drugs in the data analyzed. The finding of increased risk with AEDs of varying mechanisms of action and across a range of indications suggests that the risk applies to all AEDs used for any indication. The risk did not vary substantially by age (5-100 years) in the clinical trials analyzed. Table 1 shows absolute and relative risk by indication for all evaluated AEDs. Table 1. Risk by indication for antiepileptic drugs in the pooled analysis Indication

Placebo Patients with Events per 1000 Patients

Drug Patients with Events per 1000 Patients

Epilepsy Psychiatric Other Total

1.0 5.7 1.0 2.4

3.4 8.5 1.8 4.3

Relative Risk: Incidence of Events in Drug Patients/ Incidence in Placebo Patients 3.5 1.5 1.9 1.8

Risk Difference: Additional Drug Patients with Events per 1000 Patients 2.4 2.9 0.9 1.9

The relative risk for suicidal thoughts or behavior was higher in clinical trials for epilepsy than in clinical trials for psychiatric or other conditions, but the absolute risk differences were similar for the epilepsy and psychiatric indications. Anyone considering prescribing FYCOMPA or any other AED must balance the risk of suicidal thoughts or behavior with the risk of untreated illness. Epilepsy and many other illnesses for which AEDs are prescribed are themselves associated with morbidity and mortality and an increased risk of suicidal thoughts and behavior. Should suicidal thoughts and behavior emerge during treatment, the prescriber needs to consider whether the emergence of these symptoms in any given patient may be related to the illness being treated. Neurologic Effects Dizziness and Gait Disturbance FYCOMPA caused dose-related increases in events related to dizziness and disturbance in gait or coordination. In the controlled partial-onset seizure clinical trials, dizziness and vertigo were reported in 35% and 47% of patients randomized to receive FYCOMPA at doses of 8 mg and 12 mg per day, respectively, compared to 10% of placebo-treated patients. The gait disturbance related events (including ataxia, gait disturbance, balance disorder, and abnormal coordination) were reported in 12% and 16% of patients randomized to

receive FYCOMPA at doses of 8 mg and 12 mg per day, respectively, compared to 2% of placebo-treated patients. Elderly patients had an increased risk of these adverse reactions compared to younger adults and pediatric patients. These adverse reactions occurred mostly during the titration phase and led to discontinuation in 3% of FYCOMPA-treated patients compared to 1% of placebo-treated patients. These adverse reactions were also observed in the primary generalized tonic-clonic seizure clinical trial. Somnolence and Fatigue FYCOMPA caused dose-dependent increases in somnolence and fatigue-related events (including fatigue, asthenia, and lethargy). In the controlled partial-onset seizure clinical trials, 16% and 18% of patients randomized to receive FYCOMPA at doses of 8 mg and 12 mg per day, respectively, reported somnolence compared to 7% of placebo patients. In the controlled partial-onset seizure clinical trials, 12% and 15% of patients randomized to receive FYCOMPA at doses of 8 mg and 12 mg per day, respectively, reported fatigue-related events compared to 5% of placebo patients. Somnolence or fatigue-related events led to discontinuation in 2% of FYCOMPA-treated patients and 0.5% of placebo-treated patients. Elderly patients had an increased risk of these adverse reactions compared to younger adults and pediatric patients. In the controlled partial-onset seizure clinical trials, these adverse reactions occurred mostly during the titration phase. These adverse reactions were also observed in the primary generalized tonic-clonic seizure clinical trial. Risk Amelioration Prescribers should advise patients against engaging in hazardous activities requiring mental alertness, such as operating motor vehicles or dangerous machinery, until the effect of FYCOMPA is known. Falls An increased risk of falls, in some cases leading to serious injuries including head injuries and bone fracture, occurred in patients being treated with FYCOMPA (with and without concurrent seizures). In the controlled partial-onset seizure clinical trials, falls were reported in 5% and 10% of patients randomized to receive FYCOMPA at doses of 8 mg and 12 mg per day, respectively, compared to 3% of placebo-treated patients. Falls were reported as serious and led to discontinuation more frequently in FYCOMPA-treated patients than placebo-treated patients. Elderly patients had an increased risk of falls compared to younger adults and pediatric patients. Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS)/Multiorgan Hypersensitivity Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS), also known as Multiorgan hypersensitivity, has been reported in patients taking antiepileptic drugs, including FYCOMPA. DRESS may be fatal or life-threatening. DRESS typically, although not exclusively, presents with fever, rash, lymphadenopathy, and/or facial swelling, in association with other organ system involvement, such as hepatitis, nephritis, hematological abnormalities, myocarditis, or myositis sometimes resembling an acute viral infection. Eosinophilia is often present. Because this disorder is variable in its expression, other organ systems not noted here may be involved. It is important to note that early manifestations of hypersensitivity, such as fever or lymphadenopathy, may be present even though rash is not evident. If such signs or symptoms are present, the patient should be evaluated immediately. FYCOMPA should be discontinued if an alternative etiology for the signs or symptoms cannot be established. Withdrawal of Antiepileptic Drugs There is the potential of increased seizure frequency in patients with seizure disorders when antiepileptic drugs are withdrawn abruptly. FYCOMPA has a half-life of approximately 105 hours so that even after abrupt cessation, blood levels fall gradually. In epilepsy clinical trials FYCOMPA was withdrawn without down-titration. Although a small number of patients exhibited seizures following discontinuation, the data were not sufficient to allow any recommendations regarding appropriate withdrawal regimens. A gradual withdrawal is generally recommended with antiepileptic drugs, but if withdrawal is a response to adverse events, prompt withdrawal can be considered. ADVERSE REACTIONS 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. Partial-Onset Seizures A total of 1,038 patients receiving FYCOMPA (2, 4, 8, or 12 mg once daily) constituted the safety population in the pooled analysis of the placebo-controlled trials (Studies 1, 2, and 3) in patients with partial-onset seizures. Approximately 51% of patients were female, and the mean age was 35 years. Adverse Reactions Leading to Discontinuation In controlled clinical trials (Studies 1, 2, and 3), the rate of discontinuation as a result of an adverse reaction was 3%, 8%, and 19% in patients randomized to receive FYCOMPA at the recommended doses of 4 mg, 8 mg, and 12 mg per day, respectively, and 5% in patients randomized to receive placebo. The adverse reactions most commonly leading to discontinuation (≥1% in the 8 mg or 12 mg FYCOMPA group and greater than placebo) were dizziness, somnolence, vertigo, aggression, anger, ataxia, blurred vision, irritability, and dysarthria. Most Common Adverse Reactions Table 2 gives the incidence in the controlled clinical trials (Studies 1, 2, and 3) of the adverse reactions that occurred in ≥2% of patients with partial-onset seizures in the FYCOMPA 12 mg dose group and more frequent than placebo (in order of decreasing frequency for the 12 mg dose group). The most common dose-related adverse reactions in patients receiving FYCOMPA at doses of 8 mg or 12 mg (≥4% and occurring at least 1% higher than the placebo group) included dizziness (36%), somnolence (16%), fatigue (10%), irritability (9%), falls (7%), nausea (7%), ataxia (5%), balance disorder (4%), gait disturbance (4%), vertigo (4%), and weight gain (4%). For almost every adverse reaction, rates were higher on 12 mg and more often led to dose reduction or discontinuation. Table 2. Adverse Reactions in Pooled Placebo-Controlled Trials in Patients with Partial-Onset Seizures (Studies 1, 2, and 3) (Reactions ≥ 2% of Patients in Highest FYCOMPA Dose (12 mg) Group and More Frequent than Placebo) Placebo n=442 % Dizziness Somnolence Headache Irritability Fatigue Falls Ataxia Nausea Vertigo Back pain Dysarthria Anxiety Blurred vision Gait disturbance Weight gain Cough Upper respiratory tract infection Vomiting Hypersomnia Anger Aggression Balance disorder Diplopia Head injury Hypoaesthesia Pain in extremity Constipation

9 7 11 3 5 3 0 5 1 2 0 1 1 1 1 3 3 3 0 <1 1 1 1 1 1 1 2

4 mg n=172 % 16 9 11 4 8 2 1 3 4 2 1 2 1 1 4 1 3 2 1 0 1 0 1 1 0 0 2

FYCOMPA 8 mg n=431 % 32 16 11 7 8 5 3 6 3 2 3 3 3 4 4 1 3 3 2 1 2 5 1 1 0 2 2

12 mg n=255 % 43 18 13 12 12 10 8 8 5 5 4 4 4 4 4 4 4 4 3 3 3 3 3 3 3 3 3

Table 2. Adverse Reactions in Pooled Placebo-Controlled Trials in Patients with Partial-Onset Seizures (Studies 1, 2, and 3) (Reactions ≥ 2% of Patients in Highest FYCOMPA Dose (12 mg) Group and More Frequent than Placebo) (cont.) Myalgia Coordination abnormal Euphoric mood Confusional state Hyponatremia Limb injury Mood altered Arthralgia Asthenia Contusion Memory impairment Musculoskeletal pain Oropharyngeal pain Paraesthesia Peripheral edema Skin laceration

2 0 0 <1 <1 <1 <1 1 1 1 1 1 1 1 1 1

1 1 0 1 0 1 1 0 1 0 0 1 2 0 1 0

1 <1 <1 1 0 1 <1 3 2 2 1 1 2 1 1 2

3 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2

Primary Generalized Tonic-Clonic Seizures A total of 81 patients receiving FYCOMPA 8 mg once daily constituted the safety population in the placebo-controlled trial in patients with primary generalized tonic-clonic seizures (Study 4). Approximately 57% of patients were female, and the mean age was 27 years. In the controlled primary generalized tonic-clonic seizure clinical trial (Study 4), the adverse reaction profile was similar to that noted for the controlled partial-onset seizure clinical trials (Studies 1, 2, and 3). Table 3 gives the incidence of adverse reactions in patients receiving FYCOMPA 8 mg (≥4% and higher than in the placebo group) in Study 4. The most common adverse reactions in patients receiving FYCOMPA (≥10% and greater than placebo) were dizziness (32%), fatigue (15%), headache (12%), somnolence (11%), and irritability (11%). The adverse reactions most commonly leading to discontinuation in patients receiving FYCOMPA 8 mg (≥2% and greater than placebo) were vomiting (2%) and dizziness (2%). Table 3. Adverse Reactions in a Placebo-Controlled Trial in Patients with Primary Generalized Tonic-Clonic Seizures (Study 4) (Reactions ≥ 4% of Patients in FYCOMPA Group and More Frequent than Placebo)

Dizziness Fatigue Headache Somnolence Irritability Vertigo Vomiting Weight gain Contusion Nausea Abdominal pain Anxiety Urinary tract infection Ligament sprain Balance disorder Rash

Placebo n=82 % 6 6 10 4 2 2 2 4 4 5 1 4 1 0 1 1

FYCOMPA 8 mg n=81 % 32 15 12 11 11 9 9 7 6 6 5 5 4 4 4 4

Weight Gain Weight gain has occurred with FYCOMPA. In controlled partial-onset seizure clinical trials, FYCOMPA-treated adults gained an average of 1.1 kg (2.5 lbs) compared to an average of 0.3 kg (0.7 lbs) in placebo-treated adults with a median exposure of 19 weeks. The percentages of adults who gained at least 7% and 15% of their baseline body weight in FYCOMPA-treated patients were 9.1% and 0.9%, respectively, as compared to 4.5% and 0.2% of placebo-treated patients, respectively. Clinical monitoring of weight is recommended. Similar increases in weight were also observed in adult and pediatric patients treated with FYCOMPA in the primary generalized tonic-clonic seizure clinical trial. Elevated triglycerides Increases in triglycerides have occurred with FYCOMPA use. Comparison of Sex and Race No significant sex differences were noted in the incidence of adverse reactions. Although there were few non-Caucasian patients, no differences in the incidence of adverse reactions compared to Caucasian patients were observed. Postmarketing Experience The following adverse reactions have been identified during post approval use of FYCOMPA. 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. Dermatologic: Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS). Psychiatric: Acute psychosis, hallucinations, delusions, paranoia, delirium, confusional state, disorientation, memory impairment. DRUG INTERACTIONS Contraceptives With concomitant use, FYCOMPA at a dose of 12 mg per day reduced levonorgestrel exposure by approximately 40%. Use of FYCOMPA with contraceptives containing levonorgestrel may render them less effective. Additional non-hormonal forms of contraception are recommended. Moderate and Strong CYP3A4 Inducers The concomitant use of known moderate and strong CYP3A4 inducers including carbamazepine, phenytoin, or oxcarbazepine with FYCOMPA decreased the plasma levels of perampanel by approximately 50-67%. The starting doses for FYCOMPA should be increased in the presence of moderate or strong CYP3A4 inducers. When these moderate or strong CYP3A4 inducers are introduced or withdrawn from a patient’s treatment regimen, the patient should be closely monitored for clinical response and tolerability. Dose adjustment of FYCOMPA may be necessary. Alcohol and Other CNS Depressants The concomitant use of FYCOMPA and CNS depressants including alcohol may increase CNS depression. A pharmacodynamic interaction study in healthy subjects found that the effects of FYCOMPA on complex tasks such as driving ability were additive or supra-additive to the impairment effects of alcohol. Multiple dosing of FYCOMPA 12 mg per day also enhanced the effects of alcohol to interfere with vigilance and alertness, and increased levels of anger, confusion, and depression. These effects may also be seen when FYCOMPA is used in combination with other CNS depressants. Care should be taken when administering FYCOMPA with these agents. Patients should limit activity until they have experience with concomitant use of CNS depressants (e.g., benzodiazepines, narcotics, barbiturates, sedating antihistamines). Advise patients not to drive or operate machinery until they have gained sufficient experience on FYCOMPA to gauge whether it adversely affects these activities. USE IN SPECIFIC POPULATIONS Pregnancy Pregnancy Exposure Registry There is a pregnancy exposure registry that monitors pregnancy outcomes in women exposed to antiepileptic drugs (AEDs), such as FYCOMPA, during pregnancy. Encourage women who are taking FYCOMPA during pregnancy to enroll in the North American Antiepileptic Drug

(NAAED) Pregnancy Registry by calling 1-888-233-2334 or visiting http://www.aedpregnancyregistry.org. Risk summary There are no adequate data on the developmental risk associated with use in pregnant women. In animal studies, perampanel induced developmental toxicity in pregnant rat and rabbit at clinically relevant doses. In the U.S. general population the estimated background risk of major birth defects and miscarriage in clinically recognized pregnancies is 2-4% and 15-20%, respectively. The background risk of major birth defects and miscarriage for the indicated population is unknown. Oral administration of perampanel (1, 3, or 10 mg/kg/day) to pregnant rats throughout organogenesis resulted in an increase in visceral abnormalities (diverticulum of the intestine) at all doses tested; maternal toxicity was observed at the mid and high doses. In a dose-ranging study at higher oral doses (10, 30, or 60 mg/kg/day), embryo lethality and reduced fetal body weight were observed at the mid and high doses tested. The lowest dose tested (1 mg/kg/day) is similar to a human dose of 8 mg per day based on body surface area (mg/m2). Upon oral administration of perampanel (1, 3, or 10 mg/kg per day) to pregnant rabbits throughout organogenesis, embryo lethality was observed at the mid and high doses tested; the no-effect dose for embryo-fetal developmental toxicity in rabbit (1 mg/kg/day) is approximately 2 times a human dose of 8 mg per day based on body surface area (mg/m2). Oral administration of perampanel (1, 3, or 10 mg/kg per day) to rats throughout gestation and lactation resulted in fetal and pup deaths at the mid and high doses (associated with maternal toxicity) and delayed sexual maturation in males and females at the highest dose tested. No effects were observed on measures of neurobehavioral or reproductive function in the offspring. The no-effect dose for pre- and postnatal developmental toxicity in rat (1 mg/kg/day) is similar to a human dose of 8 mg per day based on body surface area (mg/m2). Lactation Risk summary There are no data on the presence of perampanel in human milk, the effects on the breastfed child, or the effects of the drug on milk production. Perampanel and/or its metabolites are excreted in rat milk, and are detected at concentrations higher than that in maternal plasma. The developmental and health benefits of breastfeeding should be considered along with the mother’s clinical need for FYCOMPA and any potential adverse effects on the breastfed child from FYCOMPA or from the underlying maternal condition. Females and Males of Reproductive Potential Contraception Use of FYCOMPA may reduce the efficacy of hormonal contraceptives containing levonorgestrel. Advise women taking FYCOMPA who are using a levonorgestrel-containing contraceptive to use an additional non-hormonal form of contraception while using FYCOMPA and for a month after discontinuation. Pediatric Use The safety and efficacy of FYCOMPA for the treatment of partial-onset seizures in pediatric patients 12 years of age and older was established by three randomized double-blind, placebo-controlled, multicenter studies, which included 72 pediatric patients between 12 and 16 years of age exposed to FYCOMPA. The safety and efficacy of FYCOMPA for the adjunctive therapy of primary generalized tonic-clonic seizures in pediatric patients 12 years of age and older was established in a single randomized double-blind, placebo-controlled, multicenter trial (n=164), which included 11 pediatric patients 12 to 16 years of age exposed to FYCOMPA; an additional 6 patients were treated with FYCOMPA in the open label extension of the study. The safety and effectiveness of FYCOMPA in pediatric patients less than 12 years of age have not been established. Juvenile Animal Data Oral administration of perampanel (1, 3, 3/10/30 mg/kg/day; high dose increased on postnatal days [PND] 28 and 56) to young rats for 12 weeks starting on PND 7 resulted in reduced body weight, reduced growth, neurobehavioral impairment (water maze performance and auditory startle habituation) at the mid and high doses, and delayed sexual maturation at the high doses. CNS signs (reduced activity, incoordination, excessive grooming/scratching), pup death, decreased hindlimb splay, and decreased hindlimb grip strength were observed at all doses. Effects on pup body weight, pup growth, hindlimb splay, impairment in the water maze performance, and auditory startle persisted after dosing was stopped. A no-effect dose for postnatal developmental toxicity was not identified in this study. Oral administration of perampanel (1, 5,5/10 mg/kg/day; high dose increased on PND 56) to juvenile dogs for 33 weeks, starting on PND 42, resulted in CNS signs (incoordination, excessive grooming/licking/scratching, spatial disorientation, and/or ataxic gait) at all doses tested. Geriatric Use Clinical studies of FYCOMPA did not include sufficient numbers of patients aged 65 and over to determine the safety and efficacy of FYCOMPA in the elderly population. Because of increased likelihood for adverse reactions in the elderly, dosing titration should proceed slowly in patients aged 65 years and older. Hepatic Impairment Use of FYCOMPA in patients with severe hepatic impairment is not recommended, and dosage adjustments are recommended in patients with mild or moderate hepatic impairment. Renal Impairment Dose adjustment is not required in patients with mild renal impairment. FYCOMPA should be used with caution in patients with moderate renal impairment, and slower titration may be considered. Use in patients with severe renal impairment or patients undergoing hemodialysis is not recommended. DRUG ABUSE AND DEPENDENCE Controlled Substance FYCOMPA contains perampanel and is listed as a Schedule III controlled substance. Abuse Prescription drug abuse is the intentional non-therapeutic use of a drug, even once, for its rewarding psychological or physiological effects. Drug addiction, which develops after repeated drug abuse, is characterized by a strong desire to take a drug despite harmful consequences, difficulty in controlling its use, giving a higher priority to drug use than to obligations, increased tolerance, and sometimes physical withdrawal. Drug abuse and drug addiction are separate and distinct from physical dependence (for example, abuse may not be accompanied by physical dependence). Studies of human abuse potential were performed to evaluate the abuse potential of FYCOMPA (8 mg, 24 mg, and 36 mg) as compared to alprazolam C-IV (1.5 mg and 3 mg), and oral ketamine C-III (100 mg) in recreational polydrug users. Supra-therapeutic doses of FYCOMPA 24 and 36 mg produced responses for “Euphoria” that were similar to ketamine 100 mg and alprazolam 3 mg. For “High,” FYCOMPA 24 mg and 36 mg produced responses comparable to ketamine 100 mg and significantly higher than both doses of alprazolam on a visual analog scale (VAS). “Drug Liking,” “Overall Drug Liking,” and “Take Drug Again” for FYCOMPA were each statistically lower than ketamine 100 mg. In addition, for “Bad Drug Effects,” FYCOMPA 24 mg and 36 mg produced responses significantly higher than ketamine 100 mg. For “Sedation,” FYCOMPA 24 and 36 mg produced responses similar to alprazolam 3 mg and higher than ketamine 100 mg. Additionally, on VAS measures related to dissociative phenomena such as “Floating,” “Spaced Out,” and “Detached,” FYCOMPA at supra-therapeutic doses produced responses similar to ketamine 100 mg and greater than both doses of alprazolam tested. Of note, due to somnolence a number of subjects had missing data around Tmax of FYCOMPA. The above described data might represent an underestimate of FYCOMPA’s effects. The duration of effects of higher doses of FYCOMPA on the majority of measures was much greater than alprazolam 3 mg and ketamine 100 mg. In this study, the incidence of euphoria following FYCOMPA administration 8 mg, 24 mg, and 36 mg was 37%, 46%, 46%, respectively, which was higher than alprazolam 3 mg (13%) but lower than ketamine 100 mg (89%). Dependence Physical dependence is characterized by withdrawal symptoms after abrupt discontinuation or a significant dose reduction of a drug. The potential for FYCOMPA to produce withdrawal symptoms has not been adequately evaluated. OVERDOSAGE There is limited clinical experience with FYCOMPA overdose. The highest reported overdose (approximately 264 mg) was intentional. This patient experienced serious adverse reactions of altered mental status, agitation, and aggressive behavior and recovered without sequelae. In general, the adverse reactions associated with overdoses were similar to the reactions at therapeutic doses with dizziness reported most frequently. There were no reported sequelae. There is no available specific antidote to the overdose reactions of FYCOMPA. In the event of overdose, standard medical practice for the management of any overdose should be used. An adequate airway, oxygenation, and ventilation should be ensured; monitoring of cardiac rhythm and vital sign measurement is recommended. A certified poison control center should be contacted for updated information on the management of overdose with FYCOMPA. Due to its long half-life, the reactions caused by FYCOMPA could be prolonged.

AAN Creates New Medical Student Symposium As part of its efforts to increase the number of medical students choosing neurology, the AAN is offering a new Medical Student Symposium at the Annual Meeting.

Cascino

Fahn

Griggs

Kittredge

Pedley

Olson

Rosenberg

Sergay

Swift

Leaders Share Insights at Hall of Presidents: Using Past Experience to Solve the Future’s Problems

Sacco

Disneyland has its animatronic Hall of Presidents. But at the Annual Meeting, we go one step further with live presidents who have served the Academy and the field of neurology over the years. You can see and hear them today at Hall of Presidents: Using Past Experience to Solve the Future’s Problems, from 1:30 p.m. to 2:30 p.m. on the HeadTalks Stage.

The event will be moderated by AAN President Ralph L. Sacco, MD, MS, FAHA, FAAN. Former presidents scheduled to appear include current Past President Terrence L. Cascino, MD, FAAN; Stanley Fahn MD, FAAN; Robert C. Griggs, MD, FAAN; Francis I. Kittredge, MD, FAAN; Timothy A. Pedley, MD, FAAN; Sandra F. Olson, MD, FAAN; Roger N. Rosenberg, MD, FAAN; Stephen M. Sergay, MB BCh, FAAN; and Thomas R. Swift, MD, FAAN.

Sunday, April 22, 2018 • AANextra

Through funding from the Conrad N. Hilton Foundation, the AAN has developed today’s symposium to help connect medical students with neurologists and their peers who are interested in neurology. Students will have the chance to meet with neurologists in various subspecialties in a round robin format, with opportunities to discuss their education and career path, work-life balance, and any questions they have. “Many of the students who are attending this symposium are able to do so through scholarships the AAN Smith provided thanks to the grant from the Conrad N. Hilton Foundation,” said A. Gordon Smith, MD, FAAN, chair of the Education Committee and principal investigator on the Hilton grant. “We are excited to create new ways to generate interest in neurology among medical students and help grow the neurology professional pipeline. We have a fun pop culture session planned where students can see how neurology is portrayed and then hear from neurologists about their experiences treating patients with similar conditions.” Smith noted that the symposium also includes ample time for medical students to interact on a more casual basis with the neurologists taking part. “Sometimes it’s hard to fit in all your questions in the few minutes of time after a program, so we built in plenty of time for students to get their questions answered and hopefully make some valuable connections.” 

AAN Shares Overview of Highly Successful 2017 at Business Meeting For the AAN and its 34,000 members, 2017 was a very good year, according to leadership at the annual Business Meeting. President Ralph L. Sacco, MD, MS, FAHA, FAAN, remarked how the AAN has gone from “great to exceptional,” with member retention at an all-time high. “Financially, things are terrific, and that helps us take on new initiatives.” He went on to say, “We’re addressing tough issues,” particularly through a number of Presidential Task Forces that are tackling drug pricing, health care disparities, wellness, gender disparities, and business innovation. “We are making very fast progress and these task forces will soon be reporting to the Board on their work and recommendations.”

this March, where the AAN brought together more than 100 neurology department chairs who, by and large, have the same problem: “Revenue, revenue, revenue.” The summit gave AAN leaders the opportunity to promote the resources the Academy already has available to the chairs and their departments and hear where additional help is needed. The issues discussed are being prioritized for further action.

Among a number of initiatives to help members in solo and small practices in 2017, the AAN created a new Practice Leadership Program and Practice Ambassador Program. The latter consisted of eight site visits by AAN staff to practices around the country to learn more about their challenges and how the The president also AAN can help; the visits Sacco Miyasaki Rydell cited significant are continuing to new accomplishments in locations in 2018. advocacy efforts, including record attendance at Neurology on the Hill. And, in spite of gridlock in Washington, the AAN has Another topic of longtime concern has been growing the successfully lobbied for a nine-percent increase in funding for neurology work force to meet the rising demand for care. NINDS, and a whopping 54-percent increase in funding for Sacco noted that one out of seven members is a student, and the BRAIN Initiative. Congress also passed the FAST Act for the Academy is pushing to make neurology mandatory in the telestroke, legislation the Academy championed relentlessly. third year of study, rather than the fourth year, by which time Sacco gave credit to the AAN’s political action committee, many students have decided upon a specialty. BrainPAC, which provides access to the legislative leaders who Advanced practice providers now comprise more than 1,000 are sympathetic to the needs of neurologists and their patients. AAN members, and a work force study of this segment of Sacco called attention to the first Neurology Chair Summit held membership is underway to

Continued on page 37 u

A N INDU S T RY THERAPEU T I C UPDAT E FROM G E H E A LT H CA R E “ Why aim for earlier diagnosis of neurodegenerative disorders?” We’ve all heard it. Now we’re talking about it. Catch this lively discussion on the impact of early diagnosis.

The great diagnosis debate View video of the debate online at: gehealthcare.com/talkingtime

#TalkingTime Saturday, April 21, 2018, 8:00 PM PT. Platinum Ballroom, JW Marriott Hotel

This event is not part of the 2018 American Academy of Neurology Annual Meeting. CME credits will not be given by any accredited organizations for attending this event. March 2018 JB56403US

This Morning’s Presidential Plenary Session to Showcase Premier Lecture Award Winners and Top Science Continued from cover

will moderate the session, which runs from 9:15 a.m. to 12:00 p.m. in South Exhibit Hall K. The topics

and speakers are: Presidential Lecture: California Dreaming: BRAIN and Precision Medicine in 2018

Sidney Carter Award in Child Neurology: Spinal Muscular Atrophy Is a Treatable Neurodegenerative Disease

George C. Cotzias Lecture: How Early-life Experiences Sculpt Your Brain: From Molecules to Circuits

Francis S. Collins, MD, PhD, Director, National Institutes of Health, Bethesda, MD

Richard S. Finkel, MD, Nemours Children’s Hospital, Orlando, FL

Tallie Z. Baram, MD, PhD, University of CaliforniaIrvine, Irvine, CA

Collins

Sunday, April 22, 2018 • AANextra

Finkel

Baram

Robert Wartenberg Lecture: Neuro-oncology: How Cancer and the Nervous System Interact Lisa M. DeAngelis, MD, FAAN, Memorial Sloan Kettering Cancer Center, New York, NY 

DeAngelis

THE FIRST FDA-APPROVED TREATMENT INDICATED FOR ADULTS WITH TARDIVE DYSKINESIA (TD)1

ONE CAPSULE, ONCE DAILY1 Convenient, once-daily dosing without complex titration1

Not actual size

• INGREZZA 80 mg provided rapid and significant reductions in TD severity by 6 weeks1,2 —with continued reductions in TD severity through 48 weeks1,3 • Generally well tolerated in clinical trials across a broad range of TD patients1,2 • Selectively inhibits VMAT2, with no appreciable binding affinity for dopaminergic (including D2) or serotonergic receptors1

VMAT2, vesicular monoamine transporter 2.

Not an actual patient

I S I T T D O R A C U T E E P S ? | TA K E T H E T D C H A L L E N G E AT B O O T H # 1 0 2 2 EPS, extrapyramidal symptoms.

W W W. I N G R E Z Z A H C P. C O M

Important Information INDICATION & USAGE

INGREZZA® (valbenazine) capsules is indicated for the treatment of adults with tardive dyskinesia.

IMPORTANT SAFETY INFORMATION WARNINGS & PRECAUTIONS Somnolence INGREZZA can cause somnolence. Patients should not perform activities requiring mental alertness such as operating a motor vehicle or operating hazardous machinery until they know how they will be affected by INGREZZA.

QT Prolongation INGREZZA may prolong the QT interval, although the degree of QT prolongation is not clinically significant at concentrations expected with recommended dosing. INGREZZA should be avoided in patients with congenital long QT syndrome or with arrhythmias associated with a prolonged QT interval. For patients at increased risk of a prolonged QT interval, assess the QT interval before increasing the dosage.

ADVERSE REACTIONS

The most common adverse reaction (≥5% and twice the rate of placebo) is somnolence. Other adverse reactions (≥2% and >placebo) include: anticholinergic effects, balance disorders/falls, headache, akathisia, vomiting, nausea, and arthralgia. You are encouraged to report negative side effects of prescription drugs to the FDA. Visit MedWatch at www.fda.gov/medwatch or call 1-800-FDA-1088. Please see the adjacent page for brief summary of Prescribing Information and visit www.INGREZZAHCP.com for full Prescribing Information. REFERENCES: 1. INGREZZA [package insert]. San Diego, CA: Neurocrine Biosciences, Inc; 2017. 2. Hauser RA, Factor SA, Marder SR, et al. KINECT 3: a phase 3 randomized, double-blind, placebo-controlled trial of valbenazine for tardive dyskinesia. Am J Psychiatry. 2017;174(5):476-484. 3. Factor SA, Remington G, Comella CL, et al. The effects of valbenazine in participants with tardive dyskinesia: results of the 1-Year KINECT 3 extension study. J Clin Psychiatry. 2017;78(9):1344-1350.

for oral use

Brief Summary: for full Prescribing Information and Patient Information, refer to package insert. INDICATIONS AND USAGE

INGREZZA is a vesicular monoamine transporter 2 (VMAT2) inhibitor indicated for the treatment of adults with tardive dyskinesia.

WARNINGS AND PRECAUTIONS

Somnolence INGREZZA can cause somnolence. Patients should not perform activities requiring mental alertness such as operating a motor vehicle or operating hazardous machinery until they know how they will be affected by INGREZZA. QT Prolongation INGREZZA may prolong the QT interval, although the degree of QT prolongation is not clinically significant at concentrations expected with recommended dosing. In patients taking a strong CYP2D6 or CYP3A4 inhibitor, or who are CYP2D6 poor metabolizers, INGREZZA concentrations may be higher and QT prolongation clinically significant. For patients who are CYP2D6 poor metabolizers or are taking a strong CYP2D6 inhibitor, dose reduction may be necessary. For patients taking a strong CYP3A4 inhibitor, reduce the dose of INGREZZA to 40 mg once daily. INGREZZA should be avoided in patients with congenital long QT syndrome or with arrhythmias associated with a prolonged QT interval. For patients at increased risk of a prolonged QT interval, assess the QT interval before increasing the dosage.

Endocrine Disorders: blood glucose increased General Disorders: weight increased Infectious Disorders: respiratory infections Neurologic Disorders: drooling, dyskinesia, extrapyramidal symptoms (non-akathisia) Psychiatric Disorders: anxiety, insomnia During controlled trials, there was a dose-related increase in prolactin. Additionally, there was a dose-related increase in alkaline phosphatase and bilirubin, suggesting a potential risk for cholestasis.

DRUG INTERACTIONS

Drugs Having Clinically Important Interactions with INGREZZA Table 2: Clinically Significant Drug Interactions with INGREZZA Monoamine Oxidase Inhibitors (MAOIs) Clinical Implication:

Prevention or Management: Examples: isocarboxazid, phenelzine, selegiline Strong CYP3A4 Inhibitors Clinical Implication:

ADVERSE REACTIONS

The following adverse reactions are discussed in more detail in other sections of the labeling: • Somnolence • QT Prolongation Clinical Trials Experience Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in practice.

Prevention or Management: Examples: Strong CYP2D6 Inhibitors

The safety of INGREZZA was evaluated in 3 placebo-controlled studies, each 6 weeks in duration (fixed dose, dose escalation, dose reduction), including 445 patients. Patients were 26 to 84 years of age with moderate to severe tardive dyskinesia and had concurrent diagnoses of mood disorder (27%) or schizophrenia/schizoaffective disorder (72%). The mean age was 56 years. Patients were 57% Caucasian, 39% African-American, and 4% other. With respect to ethnicity, 28% were Hispanic or Latino. All subjects continued previous stable regimens of antipsychotics; 85% and 27% of subjects, respectively, were taking atypical and typical antipsychotic medications at study entry. Adverse Reactions Leading to Discontinuation of Treatment A total of 3% of INGREZZA treated patients and 2% of placebo-treated patients discontinued because of adverse reactions. Common Adverse Reactions Adverse reactions that occurred in the 3 placebo-controlled studies at an incidence of ≥2% and greater than placebo are presented in Table 1. Table 1: Adverse Reactions in 3 Placebo-Controlled Studies of 6-week Treatment Duration Reported at ≥2% and >Placebo INGREZZA (n=262) (%)

Placebo (n=183) (%)

Concomitant use of INGREZZA with strong CYP2D6 inhibitors may increase the exposure (Cmax and AUC) to valbenazine’s active metabolite compared with the use of INGREZZA alone. Increased exposure of active metabolite may increase the risk of exposure-related adverse reactions.

Prevention or Management:

Consider reducing INGREZZA dose based on tolerability when INGREZZA is coadministered with a strong CYP2D6 inhibitor.

Examples:

paroxetine, fluoxetine, quinidine

10.9%

4.2%

Anticholinergic effects (dry mouth, constipation, disturbance in attention, vision blurred, urinary retention)

5.4%

4.9%

Balance disorders/fall (fall, gait disturbance, dizziness, balance disorder)

4.1%

2.2%

Headache Akathisia (akathisia, restlessness)

3.4% 2.7%

2.7% 0.5%

Vomiting Nausea Musculoskeletal Disorders

2.6% 2.3%

0.6% 2.1%

Arthralgia

2.3%

0.5%

Strong CYP3A4 Inducers Clinical Implication:

Prevention or Management: Examples: Digoxin

General Disorders Somnolence (somnolence, fatigue, sedation) Nervous System Disorders 1

Gastrointestinal Disorders

Within each adverse reaction category, the observed adverse reactions are listed in order of decreasing frequency.

Other Adverse Reactions Observed During the Premarketing Evaluation of INGREZZA Other adverse reactions of ≥1% incidence and greater than placebo are shown below. The following list does not include adverse reactions: 1) already listed in previous tables or elsewhere in the labeling, 2) for which a drug cause was remote, 3) which were so general as to be uninformative, 4) which were not considered to have clinically significant implications, or 5) which occurred at a rate equal to or less than placebo.

Concomitant use of INGREZZA with strong CYP3A4 inhibitors increased the exposure (Cmax and AUC) to valbenazine and its active metabolite compared with the use of INGREZZA alone. Increased exposure of valbenazine and its active metabolite may increase the risk of exposure-related adverse reactions. Reduce INGREZZA dose when INGREZZA is coadministered with a strong CYP3A4 inhibitor. itraconazole, ketoconazole, clarithromycin

Clinical Implication:

Variable and Fixed Dose Placebo-Controlled Trial Experience

Adverse Reaction1

Concomitant use of INGREZZA with MAOIs may increase the concentration of monoamine neurotransmitters in synapses, potentially leading to increased risk of adverse reactions such as serotonin syndrome, or attenuated treatment effect of INGREZZA. Avoid concomitant use of INGREZZA with MAOIs.

Concomitant use of INGREZZA with a strong CYP3A4 inducer decreased the exposure of valbenazine and its active metabolite compared to the use of INGREZZA alone. Reduced exposure of valbenazine and its active metabolite may reduce efficacy. Concomitant use of strong CYP3A4 inducers with INGREZZA is not recommended. rifampin, carbamazepine, phenytoin, St. John’s wort1

Clinical Implication:

Concomitant use of INGREZZA with digoxin increased digoxin levels because of inhibition of intestinal P-glycoprotein (P-gp).

Prevention or Management:

Digoxin concentrations should be monitored when co-administering INGREZZA with digoxin. Increased digoxin exposure may increase the risk of exposure related adverse reactions. Dosage adjustment of digoxin may be necessary.

The induction potency of St. John’s wort may vary widely based on preparation.

Drugs Having No Clinically Important Interactions with INGREZZA Dosage adjustment for INGREZZA is not necessary when used in combination with substrates of CYP1A2, CYP2B6, CYP2C8, CYP2C9, CYP2C19, CYP2E1, or CYP3A4/5 based on in vitro study results.

OVERDOSAGE

Human Experience The pre-marketing clinical trials involving INGREZZA in approximately 850 subjects do not provide information regarding symptoms with overdose. Management of Overdosage No specific antidotes for INGREZZA are known. In managing overdose, provide supportive care, including close medical supervision and monitoring, and consider the possibility of multiple drug involvement. If an overdose occurs, consult a Certified Poison Control Center (1-800-222-1222 or www.poison.org). For further information on INGREZZA, call 84-INGREZZA (844-647-3992). Distributed by: Neurocrine Biosciences, Inc. San Diego, CA 92130 INGREZZA is a trademark of Neurocrine Biosciences, Inc. CP-VBZ-US-0203v2 09/17

QUOTABLE QUOTES Burcu Zeydan, MD Rochester, MN How would you advise young neurologists to attend the Annual Meeting for their first time?

It’s a very extensive meeting, especially for young clinicians, to get updates about the improvements. This is a tremendous chance because they also have a lot of courses, and you have the opportunity to share your research at the poster presentations.

J. Clay Goodman, MD, FAAN Houston, TX How has the meeting changed since you first attended in 1976?

Huge improvements. I think we had like six courses back then, and now we have so many and so diverse and very good. What are you looking forward to this year?

Just networking with old friends and attending some of the sessions. The Plenary Sessions are particularly good. I’m running a basic course for residents in neuropathology and participating in that. Do you have advice for first-time attendees?

Everybody is friendly. You can walk up to anybody and introduce yourself. I recommend to my students to do that. It’s such a friendly group and they can network very easily.

Visit UCNS Booth For answers to your questions about certification and accreditation through the United Council for Neurologic Subspecialties (UCNS), visit the UCNS booth #1114 during Exhibit Hall hours, starting at 11:30 a.m. today. Learn about UCNSaccredited fellowship training, subspecialty certification, and career opportunities in emerging neurologic subspecialties. 

Lenka Hvizdosova, medical student Olomouc, Czech Republic What are you hoping to get out of the Annual Meeting?

I haven't decided exactly what I will be attending but I’m probably most interested in Parkinson’s disorder. I am here with colleagues and will network with other researchers. I would like to get a picture of how here in America you take care of patients and what is your view on disorders I am interested in. Sara C. Schuler, MD Decatur, GA What are your perceptions over the years about how the meeting has changed?

It’s getting more accessible by apps, which is good. In other words, more computerized. On the other hand, that’s bad for some of the older doctors. It seems to be getting more away from general neurology a little bit, which bothers me because I’m a general neurologist. It’s become a little more specialized, which is the way neurology is going. I’m looking forward to some of the hospitalist sessions. I do that as part of my work, in a hospital. I’m looking forward to multiple sclerosis; I see a lot of those patients. And also, Los Angeles.

Look for Post-program Opportunities to ‘Continue the Conversation’ with Faculty, Directors Look for new opportunities to connect with faculty, directors, and other attendees via 30-minute, small-group conversations over wine and cheese at the conclusion of select courses. The new pilot program, “Continuing the Conversation,” will offer audience members opportunities to connect one-on-one with directors in another room after the program, where they can ask questions of the directors—no more standing in line after the program! Sunday, 5:30 p.m.–6:00 p.m. following the day’s C26, C44, and C58 Neuro-ophthalmology courses Director: Nancy Newman, MD, FAAN Room 512 Monday, 3:00 p.m.–3:30 p.m. following C70 Evaluating Tremor in the Office Director: Vicki Shanker, MD Room 403B 

Sunday, April 22, 2018 • AANextra

Being a teaching hospital makes us stronger. Being a teaching hospital for two great medical schools makes us NewYork-Presbyterian Hosptial. What happens when two great medical schools bring their highly regarded faculties and groundbreaking research to one hospital? You get more innovation. A wider breadth of expertise. Greater diversity. And most importantly, better outcomes for patients. The physician faculties of Columbia and Weill Cornell have powered NewYork-Presbyterian to U.S. News & World Reportâ&#x20AC;&#x2122;s top ranking for New York hospitals for 17 straight years.

Learn more at nyp.org/amazingadvances

Check out New ePoster Areas as Poster Sessions Open This Morning New this year for the poster sessions, we’ve added semiprivate viewing areas for ePosters, allowing for a more interactive and dynamic engagement and discussion with presenters. Look for 12 ePosters each day, where you can delve into the data through touchscreen displays. Today’s Poster Session I will run from 11:30 a.m. to 5:30 p.m. in West Exhibit Hall A of the convention center, with presenter standby from 4:00 p.m. to 5:30 p.m. Again this year, we’ve clustered all topic-related posters together into “neighborhoods” to enhance your discussions and make the posters easier to navigate. See the map for the neighborhood locations.

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Remaining Poster Session Schedule Poster Session II Monday: 11:30 a.m.–7:00 p.m. author standby from 5:30 p.m.–7:00 p.m. Poster Session III Tuesday: 11:30 a.m.–7:00 p.m. author standby from 5:30 p.m.–7:00 p.m.

343

ePosters

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Poster Session IV Wednesday: 11:30 a.m.–7:00 p.m. author standby from 5:30 p.m.–7:00 p.m.

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Poster Discussion

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T:10.875”

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Today’s ePoster Sessions: MS and CNS Inflammatory Disease and Neuromuscular and Clinical Neurophysiology (EMG) Be sure and check out the center of the poster hall for today’s interactive, touchscreen ePosters. 

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Epilepsy/Clinical Neurophysiology (EEG) Lunchtime Poster Discussion Session Join today’s lunchtime Poster Discussion Session at the poster discussion stage between 12:00 p.m. and 12:50 p.m., where a group of 10 abstracts will be presented by their authors in a five-minute data blitz with a moderator leading stimulating discussion on the content.

434 439 433 454 440 432 457 453 441 431 458 452 442 430 443 429 469 459 451 470 468 460 450 444 471 467 461 449 462 438 477 472 466 445 437 478 476 473 465 479 475 474 456 446 436 463 455 447 435 480 448 464

Poster Session V Thursday: 11:30 a.m.–7:00 p.m. author standby from 5:30 p.m.–7:00 p.m. Poster Session VI Friday: 11:30 a.m.–5:30 p.m. author standby from 4:00 p.m.–5:30 p.m.

New Leadership Course Tackles Unconscious Bias Research indicates that unconscious bias plays a role in decision-making among medical professionals and results in a disparity of outcomes in the health care field. A new Leadership University course offered tomorrow will delve into mitigating the impact of this unconscious bias.

3:00 p.m. to 4:00 p.m. today at the HeadTalks Experiential Learning Area titled “Blind Spots: The Impact of Conscious and Unconscious Biases.” The HeadTalks area is in the South Lobby of the convention center. 

The three-hour, participatory workshop will offer practical and applicable strategies for identifying and mitigating unconscious bias and growing and leveraging inclusiveness at a personal, team, and organizational level. The workshop will be led by Laraine Kaminsky, a global diversity strategist and speaker who has worked with physicians, other health care providers, and organizations in the medical field. No registration is needed for the course, C81, “Mitigating the Impact of Unconscious Bias Workshop,” which meets in Room 409 AB from 1:00 p.m. to 4:00 p.m. on Tuesday. Kaminsky will also be joined by Charles C. Flippen II, MD, FAAN, and Jeffrey C. McClean II, MD, FAAN, for a talk from

McClean

Flippen

Kaminsky

Sunday, April 22, 2018 • AANextra

Discover New Ways of Thinking About Your Practice, Patients, and the Future at Innovation Hub Visit the Innovation Hub in the Exhibit Hall throughout the week to expand your mind into new ways of thinking about your practice, your patients, and the future of neurology. This dynamic and interactive new addition to the Annual Meeting experience will feature unique physician-led presentations, teleneurology demonstrations, daily paint and wine sessions, and more!

Innovation Hub Schedule: Sunday 12:00 p.m.–12:30 p.m. Welcome to the Exhibit Hall 12:30 p.m.–1:00 p.m. NP Burnout Revisited: Not Just the Doctors Joseph Fritz, PhD, and Ariel Clay 1:00 p.m.–2:00 p.m. The M3D Lab: 3D Printing, VR and AR in Medicine Korak Sarkar, MD 2:00 p.m.–2:30 p.m. Integrating Teleneurology into Your Practice—A Hands-on Training Raghav Govindarajan, MD, FAAN 2:30 p.m.–3:00 p.m. Innovations for Multiple Sclerosis Monitoring and Care Tanuja Chitnis, MD, FAAN 3:00 p.m.–4:00 p.m. Hand-in-Hand with Art and Advocacy Daniel Potts, MD, FAAN Monday 11:30 a.m.–12:00 p.m. Relaxation Tools: See One, Do One, Teach One Jennifer Bickel, MD, FAAN 12:30 p.m. –1:00 p.m. Effectively Incorporating Telehealth into Clinical Research Christopher Tarolli, MD 1:00 p.m.–1:30 p.m. Democratizing Technology in Health Care Allen L. Gee, MD, PhD, FAAN 1:30 p.m. – 2:00 p.m. American Brain Foundation Neuroscience Crowdfunding Site Eugene Scharf, MD 2:00 p.m.–2:30 p.m. Concussion: There’s an App for That Jose Posas, MD 2:30 p.m.–3:00 p.m. Health IT Innovations for the Neurology Office Eric Cheng, MD, MS, FAAN, and Allan Wu, MD

Sunday, April 22, 2018 • AANextra

3:00 p.m.–3:30 p.m. Telemovement: Using Telemedicine in an Outpatient Neurology Setting Jaime Hatcher-Martin, MD 3:30 p.m.–4:00 p.m. Scribes: Write or Wrong? Pearce Korb, MD, FAAN; Joseph Fritz, PhD; and Jennifer McVige, MD 4:00 p.m.–4:30 p.m. Leveraging Predictive Analytics to Improve No Shows in the Emory Clinic Department of Neurology Gregory Esper, MD, MBA 12:00 p.m.–12:30 p.m. The Future of Neurology Jack W. Tsao, MD, DPhil, FAAN, and David Benezra, MD 4:30 p.m.–6:00 p.m. Brainstorm: A Competition for the Innovator in All of Us Tuesday 11:30 a.m.–12:00 p.m. Clinical Decision Support for Ordering of Diagnostic Imaging David A. Evans, MBA, and Eric M. Cheng, MD, MS, FAAN 12:00 p.m.–12:30 p.m. Using Technology to Enhance Patient Engagement David A. Evans, MBA, and Allison L. Weathers, MD, FAAN 12:30 p.m.–1:00 p.m. Back to the Future, Innovations Revisiting Neurohealth Space Allen L. Gee, MD, PhD, FAAN

2:00 p.m.–2:30 p.m. Being a Neurologist in the Digital Age: Managing your Professional Personal Digital Profile Jeff Kraakevik, MD 2:30 p.m.–3:00 p.m. The Why and How of Getting a Billion Dollar EHR to Make Their System Work Better for Neurologists Allison Weathers, MD, FAAN 3:00 p.m.–3:30 p.m. Technological Evolution in Sports Concussion Ilan Danan, MD 3:30 p.m.–4:00 p.m. Quantitative Gait Analysis in Neurologic Conditions: Neurodevelopmental Disorders as a Case Example Rujuta Bhatt Wilson, MD Wednesday 11:30 a.m.–12:00 p.m. Balancing Business and Wellness: Non-traditional Work Settings Elaine C. Jones, MD, FAAN 12:00 p.m.–12:30 p.m. Utilizing Wearable Technology to Improve Neurological Care Anup Patel, MD, FAAN 1:00 p.m.–1:30 p.m. Using Axon Registry ® to Improve Your Practice Lyell K. Jones, MD, FAAN 1:30 p.m.–2:00 p.m. Acupuncture FAQ Jennifer Bickel, MD, FAAN

1:00 p.m.–1:30 p.m. Get Paid for Your Mental Status Exams...Use App Technology to Innovate What You Do Brad C. Klein, MD, MBA, FAAN

2:00 p.m.–2:30 p.m. The New AAN.com: Innovations to Streamline and Personalize Your Online Experience Bert B. Vargas MD, FAAN

1:30 p.m.–2:00 p.m. Liftware Suite of Assistive Devices: Putting the User First William Marks, MD, and Anupam Pathak

2:30 p.m.–3:00 p.m. The Importance of Social Media in a Non-Insurance Based Practice Peter McAllister 

AAN Shares Overview of Highly Successful 2017 at Business Meeting Continued from page 29

determine how to help answer their unique needs. During the brief Q&A near the end of the meeting, one nurse practitioner in the audience spoke of challenges she’s experienced in integrating the roles of neurologists and APPs, and that some neurologists are spending more time on their computers or reviewing charts instead of using that time with their patients. AAN Board Member Charles C. Flippen II, MD, FAAN, responded that the younger neurologists he’s working with are very attuned to a team approach to care and that, with time, this should become the norm.

registry. “I was cautiously optimistic several months ago, but now I am very optimistic” that the funding goal will be reached. She also touted the new AAN.com and its personalization for each member’s needs—“If you haven’t logged on yet, I strongly encourage you to do so and see the enormous changes we’ve made for you”—and the redesign of the AAN’s esteem publications, including the flagship journal Neurology®. “The ‘green journal’ is not green anymore!” she said. The AAN’s $60,000 in financial support of AAN neurologists in need after the devastating hurricanes of last year was also highlighted.

Sacco noted that perhaps the neurologists in the nurse practitioner’s anecdote were suffering from burnout. The president spoke earlier in his remarks about the AAN’s continuing efforts to understand burnout and promote wellness, a deep concern that Past President Terrence L. Cascino, MD, FAAN, brought to the fore during his recent tenure. “We’re leading the way on this issue,” Sacco said.

Rydell spent more time addressing the thorny issue of Maintenance of Certification (MOC). Calling this a “national crisis,” she spoke of her participation in a December 2017 stakeholder summit, where she told the assembly that “Physicians cannot give up self-regulation.” At the end of the summit, there was agreement that the certifying boards must collaborate with societies in developing meaningful MOC process or risk the loss of self-regulation. After the summit, Rydell was selected to serve on the American Board of Medical Specialties (ABMS) Continuing Board Certification: Vision for the Future Initiative Commission. ABMS launched the commission to bring together multiple partners to envision a system of continuing board certification that is meaningful, relevant, and of value, while remaining responsive to the patients, hospitals, and others who expect that physician specialists are maintaining their knowledge and skills to provide quality specialty care.

AAN Treasurer Janis Miyasaki, MD, FAAN, reviewed the AAN’s 2017 financial performance. “Your Academy is in a strong financial position,” she said. Miyasaki noted that $0.85 out of every $1.00 of dues supported products and services that directly benefited members in 2017. AAN Executive Director and CEO Catherine M. Rydell, CAE, spoke of her pride in the fact that the Academy has 91.5 percent of the market share of neurologists in the US. “I talk to many leaders at other organizations and they would kill to have that number.” Rydell briefly highlighted the success of the Axon Registry® in 2017. The Academy is seeking additional funding for the

To learn more about the AAN’s professional and financial accomplishments last year, read the 2017 Annual Report available online at AAN.com/view/AnnualReport. 

INDUSTRY THERAPEUTIC UPDATE FROM AKCEA THERAPEUTICS*: CHARTING THE COURSE

in Diagnosis of Rare Peripheral Neuropathies Monday, April 23, 2018 7:00 pm | Doors Open 6:30 pm

Westin Bonaventure | Beaudry B | Lobby Level 404 S Figueroa Street | Los Angeles, CA

Please visit register.chartingthecoursepn.com to register for this event. Join Sami Khella, MD, Chair, and our expert faculty panel at this industry therapeutic update where we will discuss rare peripheral neuropathies, including chronic inflammatory demyelinating polyneuropathy, hereditary ATTR amyloidosis, and Charcot-Marie-Tooth disease. This interactive session will illustrate diagnostic challenges and provide guidance toward making a differential diagnosis among these rare neuropathies. Stop by Akcea booth #707 for more information!

Moderator: Sami Khella, MD Professor of Clinical Neurology Chief Department of Neurology Penn Presbyterian Medical Center Philadelphia, PA

*Pursuant to a potential transaction involving a collaboration with Ionis Pharmaceuticals, Inc., which remains subject to stockholder approval and customary closing conditions. Please note that this is a promotional, non-CME program, and no CME credits will be given for attendance. This event is not sponsored or endorsed by AAN. ©2018 Akcea Therapeutics, Inc. All rights reserved. TTR-084 04/18

TWEETS OF THE DAY Kathryn Nichol @neuronerd|

@PedsEpilepsyDoc explains the cannabis space in neurology at #AANAM

Today’s Boxed Lunch Menu Hot Lunch Option: Location: Exhibit Hall G Do not miss today’s special Opening Exhibit Hall luncheon! Enjoy lunch while exploring the hundreds of neurology products and services throughout the Exhibit Hall G.

docmitasha @docmitasha

AAN feels so high tech and futuristic this year! Love all the improvements! #AANAM

Aarti Sarwal @aartisarwal

Be deliberate about reevaluating what kind of mentors and sponsors you need in your career path at that time ! Build your personal board of directors for each chapter of your life #WomenInMedicine #Leadership #AANAM @AANMember @ womeninmedchat @DrABrashear @ JFreischlag 

HHBBQ beef brisket served over mashed potatoes and steamed corn HHKale and quinoa salad HHHoney biscuits HHPeanut butter granola cookie HHWhole fresh fruit ~V, VG, DF, GF

Cold Lunch Options: Locations: South Lobby, West Hall A, and Exhibit Hall G Choose from three convenient locations, each featuring two cold box lunch options. Grab your lunch and check out the talks on the Experiential Learning Area stages near the South Lobby; pick up your lunch and head to the Poster Discussion Sessions in West Hall A; or explore the hundreds of neurology products and services throughout the Exhibit Hall. Option I: HHBlackened salmon filet ~DF, GF HHWhite bean, chick peas, roasted red pepper with honey Dijon mustard vinaigrette ~DF, GF, V, VG HHPeanut butter granola cookie HHWhole fresh fruit ~V, VG, DF, GF Option II: HHTuscan marinated and tofu ~V, VG, DF, GF HHFarro, blistered tomatoes, and roasted vegetable salad ~V, VG, DF, GF HHPeanut butter granola cookie HHWhole fresh fruit ~V, VG, DF, GF V = Vegetarian GF = Gluten free VG = Vegan DF =Dairy free 

Are your patients asking about cannabis? How does cannabis work? What are the differences between the products out there?

Find answers and explore the science at the

CannabinoidClinical.com Booth #435

CannabinoidClinical.com is sponsored by Greenwich Biosciences, Inc., a GW Pharmaceuticals plc company. This site is not intended to provide medical advice or to suggest that any product mentioned is safe or efficacious for any disease or condition. This website is intended for a US audience. ÂŠ2018 Greenwich Biosciences, Inc. All rights reserved.

VISIT US AT BOOTH #1315