2022 February AANnews

VOLUME 34 · ISSUE 2 · FEBRUARY 2022

Visit AAN.com/Covid19 for the latest pandemic information and resources to support you and your crucial work.

SPEAKERS ANNOUNCED FOR PRESIDENTIAL AND FRONTIERS PLENARY SESSIONS IN SEATTLE Scientific Breakthroughs to Be Showcased Speakers have been announced for the Presidential and Frontiers Plenary Sessions, to be presented live and in person in Seattle during this year’s Annual Meeting. An impressive lineup of researchers will showcase their very latest breakthroughs in neuroscience during these always popular Annual Meeting sessions. Visit AAN.com/AM to learn more.

Presidential Plenary Session Seattle: April 2 –7 Virtual Experience: April 24–26

Sunday, April 3, 9:15 a.m.–12:00 p.m. PT Showcases the Annual Meeting’s premier lectures on some of the most significant new findings in neurology.

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Committee, Subcommittees to Advance Academic Neurology Initiatives

Virtual Annual Meeting Option Offers Convenient, Distinct Three-day Experience

Academic neurology departments face many challenges, including health care reform, research funding cuts, work force issues, graduate medical education funding cuts, reduced reimbursement for clinical services, increasing regulatory burden, and workforce burnout. In response, the AAN launched its Academic Initiative in 2017 under the leadership of Ralph L. Sacco, MD, MS, FAHA, FAAN, and immediately kicked off efforts by establishing a Neurology Department Chair Work Group and holding its first Neurology Department Summit

The convenience of a fully virtual Annual Meeting is returning April 24–26 following the in-person Annual Meeting in Seattle. While not intended as a replacement for the six-day, in-person meeting, the three-day virtual option will provide an accessible alternative—or supplement—to the Seattle program with its own unique lineup of top-tier education, valuable CME, cutting-edge science, and the opportunity to reconnect with friends and colleagues in a virtual environment.

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11 Neurology Today Ranks the Top Stories of 2022

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13 AAN Updates Guideline on Treatment of Painful Diabetic Polyneuropathy

Continued on page 15

22 Evans Selected as Recipient of 2022 President’s Award

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Not representative of a patient.

INDICATION KESIMPTA is indicated for the treatment of relapsing forms of multiple sclerosis (MS), to include clinically isolated syndrome, relapsing-remitting disease, and active secondary progressive disease, in adults.

IMPORTANT SAFETY INFORMATION Contraindication: KESIMPTA is contraindicated in patients with active hepatitis B virus infection.

WARNINGS AND PRECAUTIONS Infections: An increased risk of infections has been observed with other anti-CD20 B-cell depleting therapies. KESIMPTA has the potential for an increased risk of infections including serious bacterial, fungal, and new or reactivated viral infections; some have been fatal in patients treated with other anti-CD20 antibodies. The overall rate of infections and serious infections in KESIMPTA-treated patients was similar to teriflunomide-treated patients (51.6% vs 52.7%, and 2.5% vs 1.8%, respectively). The most common infections reported by KESIMPTA-treated patients in relapsing MS (RMS) trials included upper respiratory tract infection (39%) and urinary tract infection (10%). Delay KESIMPTA administration in patients with an active infection until resolved.

Consider the potential increased immunosuppressive effects when initiating KESIMPTA after an immunosuppressive therapy or initiating an immunosuppressive therapy after KESIMPTA. Please see additional Important Safety Information and Brief Summary of full Prescribing Information on the following pages.

Make KESIMPTA your 1 st choice for RMS POWER In two Phase 3 pivotal clinical trials vs teriflunomide, KESIMPTA demonstrated: • Significant reduction in ARR of up to nearly 60% vs teriflunomide ((P<0.001)1,2* • Profound reduction in mean number of Gd+ T1 lesions per scan of up to 98% ((P<0.001)1† • Superior reduction in mean number of new or enlarging T2 lesions per year of up to 85% ((P<0.001)1† • Significant risk reduction in 3-month CDP of 34% (P (P=0.002) and 6-month CDP of 32% (P=0.01)1,2†

PRECISION • A targeted and precisely delivered B-cell therapy1,3‡ Safety • Favorable safety profile similar to teriflunomide as demonstrated in 2 pivotal trials1

FLEXIBILITY • The first once-monthly (20 mg), SC, B-cell therapy administered at home or anywhere1§II

Learn more at KesimptaHCP.com Study Design: ASCLEPIOS I and II were 2 identical randomized, active-controlled, double-blind Phase 3 studies in patients with RMS, approximately 40% of whom were DMT treatment naïve. Patients were randomized to double-dummy subcutaneous KESIMPTA (20 mg every 4 weeks) or oral teriflunomide (14 mg daily) for up to 30 months. Primary endpoint was ARR. Key MRI endpoints were number of Gd+ T1 lesions, and annualized rate of new or enlarging T2 lesions. A key clinical endpoint was reduction in risk of 3-month CDP. Treatment duration was variable based on end of study criteria. Maximum duration 120 weeks, median duration 85 weeks.

ARR=annualized relapse rate; CDP=confirmed disability progression; DMT=disease-modifying therapy; Gd+=gadolinium-enhancing; MRI=magnetic resonance imaging; RMS=relapsing multiple sclerosis; SC=subcutaneous. *Primary endpoint: relative reduction in adjusted ARR vs teriflunomide of 51% (0.11 vs 0.22) in ASCLEPIOS I and 59% (0.10 vs 0.25) in ASCLEPIOS II. †Key clinical and MRI endpoints: reduction in mean number of Gd+ T1 lesions per scan vs teriflunomide of 98% (0.01 vs 0.45) in ASCLEPIOS I and 94% (0.03 vs 0.51) in ASCLEPIOS II; reductions in T2 lesions vs teriflunomide of 82% (0.72 vs 4.00) in ASCLEPIOS I and 85% (0.64 vs 4.15) in ASCLEPIOS II; reduced risk in 3-month CDP vs teriflunomide of 34% (15.0 vs 10.9) and 6-month CDP of 32% (8.1 vs 12.0) in pooled populations from both trials. ‡ The precise mechanism by which KESIMPTA exerts its therapeutic effects is unknown. § The initial dose period consists of 20 mg SC doses at Weeks 0, 1, and 2.

II KESIMPTA Sensoready® Pens must be refrigerated at 2°C to 8°C (36°F to 46°F). Keep product in the original carton to protect from light until the time of use. Do not freeze. To avoid foaming, do not shake.

References: 1. Kesimpta [prescribing information]. East Hanover, NJ: Novartis Pharmaceuticals Corp; 2020. 2. Hauser SL, Bar-Or A, Cohen JA, et al; for the ASCLEPIOS I and ASCLEPIOS II trial groups. Ofatumumab versus teriflunomide in multiple sclerosis. N Engl J Med. 2020;383(6):546-557.

3. Huck C, Leppert D, Wegert V, et al. Low-dose subcutaneous anti-CD20 treatment depletes disease relevant B cell subsets and attenuates neuroinflammation. J Neuroimmune Pharmacol. 2019;14(4):709-719.

IMPORTANT SAFETY INFORMATION (cont) WARNINGS AND PRECAUTIONS (cont) Hepatitis B Virus: Reactivation: No reports of hepatitis B virus (HBV) reactivation in patients with MS treated with KESIMPTA. However, HBV reactivation, in some cases resulting in fulminant hepatitis, hepatic failure, and death, has occurred in patients treated with ofatumumab at higher intravenous doses for chronic lymphocytic leukemia (CLL) than the recommended dose in MS and in patients treated with other anti-CD20 antibodies.

Infection: KESIMPTA is contraindicated in patients with active hepatitis B disease. Fatal infections caused by HBV in patients who have not been previously infected have occurred in patients treated with ofatumumab at higher intravenous doses for CLL than the recommended dose in MS. Perform HBV screening in all patients before initiation of KESIMPTA. Patients who are negative for HBsAg and positive for HB core antibody [HBcAb+] or are carriers of HBV [HBsAg+], should consult liver disease experts before starting and during KESIMPTA treatment.

Progressive Multifocal Leukoencephalopathy: No cases of progressive multifocal leukoencephalopathy (PML) have been reported for KESIMPTA in RMS clinical studies; however, PML resulting in death has occurred in patients being treated with ofatumumab at higher intravenous doses for CLL than the recommended dose in MS. In addition, JC virus infection resulting in PML has also been observed in patients treated with other anti-CD20 antibodies and other MS therapies. If PML is suspected, withhold KESIMPTA and perform an appropriate diagnostic evaluation. If PML is confirmed, KESIMPTA should be discontinued.

Vaccinations: Administer all immunizations according to immunization guidelines: for live or live-attenuated vaccines at least 4 weeks and, whenever possible at least 2 weeks prior to starting KESIMPTA for inactivated vaccines. The safety of immunization with live or live-attenuated vaccines following KESIMPTA therapy has not been studied. Vaccination with live or live-attenuated vaccines is not recommended during treatment and after discontinuation until B-cell repletion.

Vaccination of Infants Born to Mothers Treated with KESIMPTA During Pregnancy. For infants whose mother was treated with KESIMPTA during pregnancy, assess B-cell counts prior to administration of live or live-attenuated vaccines. If the B-cell count has not recovered in the infant, do not administer the vaccine as having depleted B-cells may pose an increased risk in these infants.

Injection-Related Reactions: Injection-related reactions with systemic symptoms occurred most commonly within 24 hours of the first injection, but were also observed with later injections. There were no life-threatening injection reactions in RMS clinical studies.

The first injection of KESIMPTA should be performed under the guidance of an appropriately trained health care professional.

If injection-related reactions occur, symptomatic treatment is recommended.

Reduction in Immunoglobulins: As expected with any B-cell depleting therapy, decreased immunoglobulin levels were observed.

Monitor the levels of quantitative serum immunoglobulins during treatment, especially in patients with opportunistic or recurrent infections and after discontinuation of therapy until B-cell repletion.

Consider discontinuing KESIMPTA therapy if a patient with low immunoglobulins develops a serious opportunistic infection or recurrent infections, or if prolonged hypogammaglobulinemia requires treatment with intravenous immunoglobulins.

Fetal Risk: Based on animal data, KESIMPTA can cause fetal harm due to B-cell lymphopenia and reduce antibody response in offspring exposed to KESIMPTA in utero. Transient peripheral B-cell depletion and lymphocytopenia have been reported in infants born to mothers exposed to other anti-CD20 B-cell depleting antibodies during pregnancy. Advise females of reproductive potential to use effective contraception while receiving KESIMPTA and for at least 6 months after the last dose.

Most common adverse reactions (>10%) are upper respiratory tract infection, headache, injection-related reactions, and local injectionsite reactions.

Please see additional Important Safety Information on the previous page and Brief Summary of full Prescribing Information on the following pages.

KESIMPTA, the KESIMPTA logo, and SENSOREADY are registered trademarks of Novartis AG.

Novartis Pharmaceuticals Corporation One Health Plaza East Hanover, New Jersey 07936-1080

©2020 Novartis

10/ 20

KSM-1395660

B:11.125"

S:9.75"

T:10.875"

KESIMPTA® (ofatumumab) injection, for subcutaneous use Initial U.S. Approval: 2009 BRIEF SUMMARY: Please see package insert for full prescribing information.

1 INDICATIONS AND USAGE KESIMPTA is indicated for the treatment of relapsing forms of multiple sclerosis (MS), to include clinically isolated syndrome, relapsing-remitting disease, and active secondary progressive disease, in adults.

4 CONTRAINDICATIONS KESIMPTA is contraindicated in patients with: • Active HBV infection [see Warnings and Precautions (5.1)].

5 WARNINGS AND PRECAUTIONS 5.1 Infections An increased risk of infections has been observed with other anti-CD20 B-cell depleting therapies.

KESIMPTA has the potential for an increased risk of infections, including serious bacterial, fungal, and new or reactivated viral infections; some of these infections have been fatal in patients treated with other anti-CD20 antibodies. In Study 1 and Study 2 [see Clinical Studies (14) in the full prescribing information], the overall rate of infections and serious infections in patients treated with KESIMPTA was similar to patients who were treated with teriflunomide (51.6% vs 52.7%, and 2.5% vs 1.8%, respectively). The most common infections reported by KESIMPTA-treated patients in the randomized clinical relapsing MS (RMS) trials included upper respiratory tract infection (39%) and urinary tract infection (10%). Delay KESIMPTA administration in patients with an active infection until the infection is resolved.

Possible Increased Risk of Immunosuppressant Effects with Other Immunosuppressants When initiating KESIMPTA after an immunosuppressive therapy or initiating an immunosuppressive therapy after KESIMPTA, consider the potential for increased immunosuppressive effects [see Drug Interactions (7.1) and Clinical Pharmacology (12.2) in the full prescribing information]. KESIMPTA has not been studied in combination with other MS therapies.

Hepatitis B Virus Reactivation There were no reports of HBV reactivation in patients with MS treated with KESIMPTA. However, HBV reactivation, in some cases resulting in fulminant hepatitis, hepatic failure, and death, has occurred in patients being treated with ofatumumab for chronic lymphocytic leukemia (CLL) (at higher intravenous doses than the recommended dose in MS but for a shorter duration of treatment) and in patients treated with other anti-CD20 antibodies.

Infection KESIMPTA is contraindicated in patients with active hepatitis B disease.

Fatal infections caused by HBV in patients who have not been previously infected have occurred in patients being treated with ofatumumab for CLL (at higher intravenous doses than the recommended dose in MS but for a shorter duration of treatment). HBV screening should be performed in all patients before initiation of treatment with KESIMPTA. At a minimum, screening should include Hepatitis B surface antigen (HBsAg) and Hepatitis B Core Antibody (HBcAb) testing. These can be complemented with other appropriate markers as per local guidelines. For patients who are negative for HBsAg and positive for HB core antibody [HBcAb+] or are carriers of HBV [HBsAg+], consult liver disease experts before starting and during treatment with KESIMPTA. These patients should be monitored and managed following local medical standards to prevent HBV infection or reactivation.

Progressive Multifocal Leukoencephalopathy Progressive multifocal leukoencephalopathy (PML) is an opportunistic viral infection of the brain caused by the JC virus (JCV) that typically occurs in patients who are immunocompromised, and that usually leads to death or severe disability.

Although no cases of PML have been reported for KESIMPTA in the RMS clinical studies, PML resulting in death has occurred in patients being treated with ofatumumab for CLL (at substantially higher intravenous doses than the recommended dose in MS but for a shorter duration of treatment). In addition, JCV infection resulting in PML has also been observed in patients treated with other anti-CD20 antibodies and other MS therapies. At the first sign or symptom suggestive of PML, withhold KESIMPTA and perform an appropriate diagnostic evaluation. Magnetic resonance imaging (MRI) findings may be apparent before clinical signs or symptoms. Typical symptoms associated with PML are diverse, progress over days to weeks, and include progressive weakness on one side of the body or clumsiness of limbs, disturbance of vision, and changes in thinking, memory, and orientation leading to confusion and personality changes.

If PML is confirmed, treatment with KESIMPTA should be discontinued.

Vaccinations Administer all immunizations according to immunization guidelines at least 4 weeks prior to initiation of KESIMPTA for live or live-attenuated vaccines,

and whenever possible, at least 2 weeks prior to initiation of KESIMPTA for inactivated vaccines.

KESIMPTA may interfere with the effectiveness of inactivated vaccines.

The safety of immunization with live or live-attenuated vaccines following KESIMPTA therapy has not been studied. Vaccination with live or liveattenuated vaccines is not recommended during treatment and after discontinuation until B-cell repletion [see Clinical Pharmacology (12.2) in the full prescribing information].

Vaccination of Infants Born to Mothers Treated with KESIMPTA During Pregnancy In infants of mothers treated with KESIMPTA during pregnancy, do not administer live or live-attenuated vaccines before confirming the recovery of B-cell counts. Depletion of B-cells in these infants may increase the risks from live or live-attenuated vaccines.

Inactivated vaccines may be administered, as indicated, prior to recovery from B-cell depletion, but an assessment of vaccine immune responses, including consultation with a qualified specialist, should be considered to determine whether a protective immune response was mounted.

5.2 Injection-Related Reactions In Study 1 and Study 2, systemic and local injection reactions were reported in 21% and 11% of patients treated with KESIMPTA compared to 15% and 6% of patients treated with teriflunomide who received matching placebo injections, respectively [see Adverse Reactions (6.1) and Clinical Studies (14) in the full prescribing information].

Injection-related reactions with systemic symptoms observed in clinical studies occurred most commonly within 24 hours of the first injection, but were also observed with later injections. Symptoms observed included fever, headache, myalgia, chills, and fatigue, and were predominantly (99.8%) mild to moderate in severity. There were no life-threatening injection reactions in RMS clinical studies.

Local injection-site reaction symptoms observed in clinical studies included erythema, swelling, itching, and pain.

Only limited benefit of premedication with corticosteroids, antihistamines, or acetaminophen was observed in RMS clinical studies. The first injection of KESIMPTA should be performed under the guidance of an appropriately trained healthcare professional. If injection-related reactions occur, symptomatic treatment is recommended.

5.3 Reduction in Immunoglobulins As expected with any B-cell depleting therapy, decreased immunoglobulin levels were observed. Decrease in immunoglobulin M (IgM) was reported in 7.7% of patients treated with KESIMPTA compared to 3.1% of patients treated with teriflunomide in RMS clinical trials [see Adverse Reactions (6.1)].

Treatment was discontinued because of decreased immunoglobulins in 3.4% of patients treated with KESIMPTA and in 0.8% of patients treated with teriflunomide. No decline in immunoglobulin G (IgG) was observed at the end of the study. Monitor the levels of quantitative serum immunoglobulins during treatment, especially in patients with opportunistic or recurrent infections, and after discontinuation of therapy until B-cell repletion. Consider discontinuing KESIMPTA therapy if a patient with low immunoglobulins develops a serious opportunistic infection or recurrent infections, or if prolonged hypogammaglobulinemia requires treatment with intravenous immunoglobulins.

5.4 Fetal Risk Based on animal data, KESIMPTA can cause fetal harm due to B-cell lymphopenia and reduce antibody response in offspring exposed to KESIMPTA in utero. Transient peripheral B-cell depletion and lymphocytopenia have been reported in infants born to mothers exposed to other anti-CD20 B-cell depleting antibodies during pregnancy. Advise females of reproductive potential to use effective contraception while receiving KESIMPTA and for at least 6 months after the last dose [see Use in Specific Populations (8.1)].

6 ADVERSE REACTIONS The following clinically significant adverse reactions are discussed in greater detail elsewhere in the labeling: • Infections [see Warnings and Precautions (5.1)] • Injection-Related Reactions [see Warnings and Precautions (5.2)] • Reduction in Immunoglobulins [see Warnings and Precautions (5.3)] 6.1 Clinical Trials Experience Because clinical trials are conducted under widely varying conditions, adverse reactions 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.

Approximately 1500 patients with RMS received KESIMPTA in clinical studies. In Study 1 and Study 2, 1882 patients with RMS were randomized, 946 of whom were treated with KESIMPTA for a median duration of 85 weeks; 33% of patients receiving KESIMPTA were treated for up to 120 weeks [see Clinical Studies (14.1) in the full prescribing information]. The most common adverse reactions occurring in greater than 10% of patients treated

with KESIMPTA and more frequently than in patients treated with teriflunomide were upper respiratory tract infections, injection-related reactions (systemic), headache, and injection-site reactions (local). The most common cause of discontinuation in patients treated with KESIMPTA was low immunoglobulin M (3.3%), defined in trial protocols as IgM at 10% below the lower limit of normal (LLN).

Table 1 summarizes the adverse drug reactions that occurred in Study 1 and Study 2.

Table 1: Adverse Reactions in Patients with RMS with an Incidence of at Least 5% with KESIMPTA and a Greater Incidence Than Teriflunomide (Pooled Study 1 and Study 2) KESIMPTA 20 mg N = 946 % 39

Teriflunomide 14 mg N = 936 % 38

Injection-related reactions (systemic)

21

15

Headache

13

12

Injection-site reactions (local)

11

6

Urinary tract infection

10

8

Back pain

8

6

Blood immunoglobulin M decreased

6

2

Adverse Reactions Upper respiratory tract infectionsa

aIncludes

the following: nasopharyngitis, upper respiratory tract infection, influenza, sinusitis, pharyngitis, rhinitis, viral upper respiratory infection, tonsillitis, acute sinusitis, pharyngotonsillitis, laryngitis, pharyngitis streptococcal, viral rhinitis, sinusitis bacterial, tonsillitis bacterial, viral pharyngitis, viral tonsillitis, chronic sinusitis, nasal herpes, tracheitis.

Injection-Related Reactions and Injection-Site Reactions The incidence of injection-related reactions (systemic) was highest with the first injection (14.4%), decreasing with subsequent injections (4.4% with second, less than 3% with third injection). Injection-related reactions were mostly (99.8%) mild to moderate in severity. Two (0.2%) patients treated with KESIMPTA reported serious injection-related reactions. There were no life-threatening injection-related reactions. Most frequently reported symptoms (2% or greater) included fever, headache, myalgia, chills, and fatigue.

In addition to systemic injection-related reactions, local reactions at the administration site were very common. Local injection-site reactions were all mild to moderate in severity. The most frequently reported symptoms (2% or greater) included erythema, pain, itching, and swelling [see Warnings and Precautions (5.2)].

Laboratory Abnormalities Immunoglobulins In Study 1 and Study 2, a decrease in the mean level of IgM was observed in KESIMPTA-treated patients but was not associated with an increased risk of infections [see Warnings and Precautions (5.3)]. In 14.3% of patients in Study 1 and Study 2, treatment with KESIMPTA resulted in a decrease in a serum IgM that reached a value below 0.34 g/dL. KESIMPTA was associated with a decrease of 4.3% in mean IgG levels after 48 weeks of treatment and an increase of 2.2% after 96 weeks.

6.2 Immunogenicity As with all therapeutic proteins, there is potential for immunogenicity. The detection of antibody formation is highly dependent on the sensitivity and specificity of the assay. Additionally, the observed incidence of antibody (including neutralizing antibody) positivity in an assay may be influenced by several factors, including assay methodology, sample handling, timing of sample collection, concomitant medication, and the underlying disease. For these reasons, comparison of the incidence of antibodies in the studies described below with the incidence of antibodies in other studies or to other ofatumumab products may be misleading.

Treatment induced anti-drug antibodies (ADAs) were detected in 2 of 914 (0.2%) KESIMPTA-treated patients; no patients with treatment enhancing or neutralizing ADAs were identified. There was no impact of positive ADA titers on PK, safety profile or B-cell kinetics in any patient; however, these data are not adequate to assess the impact of ADAs on the safety and efficacy of KESIMPTA. 7 DRUG INTERACTIONS 7.1 Immunosuppressive or Immune-Modulating Therapies Concomitant usage of KESIMPTA with immunosuppressant drugs, including systemic corticosteroids, may increase the risk of infection. Consider the risk of additive immune system effects when coadministering immunosuppressive therapies with KESIMPTA.

When switching from therapies with immune effects, the duration and mechanism of action of these therapies should be taken into account because of potential additive immunosuppressive effects when initiating KESIMPTA. 8 USE IN SPECIFIC POPULATIONS 8.1 Pregnancy Risk Summary There are no adequate data on the developmental risk associated with the use of KESIMPTA in pregnant women. Ofatumumab may cross the placenta and cause fetal B-cell depletion based on findings from animal studies (see Data).

Transient peripheral B-cell depletion and lymphocytopenia have been reported in infants born to mothers exposed to other anti-CD20 antibodies during pregnancy. B-cell levels in infants following maternal exposure to KESIMPTA have not been studied in clinical trials. The potential duration of B-cell depletion in infants exposed to ofatumumab in utero, and the impact of B-cell depletion on the safety and effectiveness of vaccines, are unknown. Avoid administering live vaccines to neonates and infants exposed to KESIMPTA in utero until B-cell recovery occurs [see Warnings and Precautions (5.2) and Clinical Pharmacology (12.2) in the full prescribing information].

Following administration of ofatumumab to pregnant monkeys, increased mortality, depletion of B-cell populations, and impaired immune function were observed in the offspring, in the absence of maternal toxicity, at plasma levels substantially higher than that in humans (see Data).

In the U.S. general population, the estimated background risk of major birth defects and miscarriage in clinically recognized pregnancies is 2% to 4% and 15% to 20%, respectively. The background risk of major birth defects and miscarriage for the indicated population is unknown.

Data Animal Data Intravenous administration of ofatumumab (weekly doses of 0, 20, or 100 mg/kg) to pregnant monkeys during the period of organogenesis (gestations days 20 to 50) resulted in no adverse effects on embryofetal development; however, B-cell depletion was observed in fetuses at both doses when assessed on gestation day 100. Plasma exposure (Cave) at the no-effect dose (100 mg/kg) for adverse effects on embryofetal development was greater than 5000 times that in humans at the recommended human maintenance dose of 20 mg. A no-effect dose for effects on B-cells was not identified; plasma exposure (Cave) at the low-effect dose (20 mg/kg) was approximately 780 times that in humans at the recommended human maintenance dose (RHMD) of 20 mg/month.

Intravenous administration of ofatumumab (5 weekly doses of 0, 10, and 100 mg/kg, followed by biweekly doses of 0, 3, and 20 mg/kg) to pregnant monkeys throughout pregnancy resulted in no adverse effects on the development of the offspring. However, postnatal death, B-cell depletion, and impaired immune function were observed in the offspring at the high dose.

The deaths at the high dose were considered secondary to B-cell depletion.

Plasma exposure (Cave) in dams at the no-effect dose (100/20 mg/kg) for adverse developmental effects was approximately 500 times that in humans at RHMD. A no-effect level for mortality and immune effects in offspring was not established because of the limited number of evaluable offspring at the low dose.

8.2 Lactation Risk Summary There are no data on the presence of ofatumumab in human milk, the effects on the breastfed infant, or the effects of the drug on milk production.

Human IgG is excreted in human milk, and the potential for absorption of ofatumumab to lead to B-cell depletion in the infant is unknown. The developmental and health benefits of breastfeeding should be considered along with the mother’s clinical need for KESIMPTA and any potential adverse effects on the breastfed infant from KESIMPTA or from the underlying maternal condition.

8.3 Females and Males of Reproductive Potential Contraception Females of childbearing potential should use effective contraception while receiving KESIMPTA and for 6 months after the last treatment of KESIMPTA [see Warnings and Precautions (5.4) and Clinical Pharmacology (12.3) in the full prescribing information].

8.4 Pediatric Use Safety and effectiveness in pediatric patients have not been established.

8.5 Geriatric Use Clinical studies of KESIMPTA did not include sufficient numbers of geriatric patients to determine whether they respond differently from younger subjects.

Manufactured by: Novartis Pharmaceuticals Corporation East Hanover, NJ 07936 U.S. License No.: 1244 KESIMPTA and SENSOREADY is a [registered] trademark of Novartis AG. T2020-112

AANnews · February 2022

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

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

F E B R UA RY/M A R C H 2 0 2 2 B R A I N A N D LI F E .O R G

In the Genes Genetic Research May Finetune Treatment Smog Fog How Dirty Air Affects Brain Health

11

Tony Bennett Inspires Hope After a Diagnosis of Alzheimer’s

19

‘Unrelenting Persistence’ Pays Off for Women Leading in Neurology Graduate

22

New Patient-physician Video Now Online

In revealing his diagnosis of Alzheimer’s disease in 2021, singer Tony Bennett and his family aim to reduce the stigma around the illness and inspire other patients and their families.

Myasthenia Gravis New Drugs Offer More Options

It’s music that saves Tony.”

— S U S A N B E N N E T T,

Contact Information American Academy of Neurology 201 Chicago Avenue Minneapolis, MN 55415 Phone: (800) 879-1960 (toll free) (612) 928-6000 (international) Email:

memberservices@aan.com

Website: AAN.com

W I F E O F TO N Y B E N N E T T

Since graduating from the AAN’s Women Leading in Neurology program in 2020, Yasmin Khakoo, MD, has assumed several important leadership roles outside of her already demanding position as a pediatric neurologist and neuro-oncologist as well as child neurology director.

For advertising rates, contact: Michael J. O’Brien II Account/Relationship Manager Wolters Kluwer Phone: (978) 578-4514 Email:

Michael.Obrien @wolterskluwer.com

AAN Chief Executive Officer: Mary E. Post, MBA, CAE

The second patient-physician video with neurologists and their patients discussing neurologic care is now available, hosted by President Orly Avitzur, MD, MBA, FAAN.

Editor-in-Chief: Melissa W. Ko, MD, FAAN, CPE Managing Editor: Angela M. Babb, MS, CAE, APR Editor: Tim Streeter Writers: Ryan Knoke and Sarah Parsons

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Apply by March 4 at AAN.com/NOH for Neurology on the Hill, to be held May 23–24, 2022, in Washington, DC. The Palatucci Advocacy Leadership Forum will take place July 21–24, 2022, at the Hyatt Tamaya Resort in Albuquerque, NM. Apply by March 28 at AAN.com/PALF.

AAN in the News The new AAN guideline for treatment of early Parkinson’s disease was covered

by Yahoo!, Healio, and the Associated Press. The new AAN position statement for ethical guidance on aducanumab was covered by The New York Times, BBC World Service Radio, UPI, and other outlets. A Neurology ® study linking more years playing football to more brain lesions on MRI was covered by “CBS Mornings” and hundreds of affiliates, as well as HealthDay and The Guardian. 

PRESIDENT'S COLUMN

For the Love of Neurology When I started business school in 1997, there were four other physicians in my class. As they speculated about how they would change careers while we learned about new fields such as economics, finance, and management—and eventually, did just that—I could not help but think about how those choices paled compared to neurology. The thought of giving up clinical practice made me sad, and the prospect of a future without our profession unimaginable.

Twenty-five years later, as I write this February column, I am certain that I made the right decision.

Although the frustrations that led me to pursue an MBA—the beginning of regulatory changes in health care including the introduction of Avitzur the resource-based relative value scale (RBRVS) system in 1992, which changed the way Medicare paid for physician services, and the intrusion of insurance mandates that interfered with clinical care decisions—have only increased over the past quarter century, I still love the practice of neurology.

Indeed, it is the love of neurology which binds us all together: specialists and generalists, private practitioners and academicians, researchers and trainees, and other members of the health care team. I think a lot, these days, about commitment to our field as many of you are battling a fifth COVID-19 surge and are understandably bone tired.

Some of you have spoken to me about the feeling of futility as unvaccinated patients are filling your hospitals again, and the prolonged public mistrust of science has left you demoralized and questioning your purpose.

In this setting of battered morale, it is sometimes challenging to find the joy in neurology and remember why we chose this profession. I recently read an advance copy of A Molecule Away from Madness: Tales of the Hijacked Brain, which will be released this month, and I was reminded of the excitement that I felt during training, a feeling that I still have when a new neurologic discovery is made or when I arrive at a difficult diagnosis which helps a patient. I had planned to read a chapter or two each evening, but the author, neurologist Sara Manning Peskin, MD, MS, so compellingly captured the mysteries of the brain and the thrill of the underlying neuroscience that I stayed up late into the night to get to the end. Not since Oliver Sacks has a writer moved me to such extent or made me so proud of the history of our profession. If you have not yet read her work in the New York Times about human fallibility or about dying, I also recommend those compositions highly. I have invited her to speak with me about her book at a HeadTalks presentation in Seattle, and I am certain you will hear more from her in the years to come. It will be the debut of Orly’s Book Club, in which I hope to feature other authors in future meetings.

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AANnews • February 2022

I also found joy in a little book that came my way earlier this week. Neurology in a Nutshell, written by two adult children of neurologist Taimur Zaman, MD, explains neurology to children in a fun and engaging way. In this paperback, neurologists are depicted as mystery-solving detectives on the hunt for bandits lurking in the nervous system. The captioned illustrations are sure to make you smile, regardless of your age.

Of course, the ties that bind us are much more than books.

We are bound by a desire to get together in settings like the Great Neuro Reunion and exchange ideas, learn, and brainstorm side-by-side. During our last in-person Annual Meeting in 2019, I interviewed medical students who had received scholarships to attend the meeting in Philadelphia; speaking with them was one of the highlights of my trip. Several were deciding between a few specialties, but once there, they were quickly hooked. One commented, “Being surrounded by people from all over the world who have the same passion and who were so generous with their time was extraordinary!”

Another summed it up by saying, “When you go through each specialty rotation in med school, they tell you to ask yourself, ‘Are these my people?’ and the answer which resonated loud and clear to me at the Pennsylvania Convention Center, was ‘Yes, these are my people.’”

It was at another of those Annual Meetings during business school when I attended a full-day course in practice management and suddenly realized what I wanted to do with my newfound knowledge. I later reached out to the speakers and inquired whether there could be room for me on the AAN Medical Economics Subcommittee. I, too, had found my people. 

Orly Avitzur, MD, MBA, FAAN President, AAN oavitzur@aan.com @OrlyA on Twitter For this month of February—which celebrates love and the love of reading—I asked several colleagues who work with me on the AAN Board of Directors to share why they love neurology (and which is their favorite book that describes our field). I would love to hear from you, too. 

“I count myself as one of the ‘lucky ones’ who found a profession that has provided me with incredible challenges, opportunities, discovery, joy, sorrow, frustration as well as immense satisfaction since I began my journey in neurology four decades ago. As I sit down to write a few of my thoughts, I realized how easy it has been to get out of bed every day and care for those who present themselves to my clinic. They often have significant fears of what I might discover, but the humbling privilege of utilizing the knowledge I have accumulated through my training, reading, and experience in order to offer hope, solutions, and in some cases actual cures, cannot be undervalued.

When I reflect on my day today, I began with answering the Neurology Question of the Day, enthusiastically discussing the results with my colleagues, then working through my schedule which included patients with cognitive afflictions (FTD, vascular dementia, AD), neuromuscular diseases (myasthenia gravis, cervical radiculopathy, small fiber neuropathy), CNS vasculitis, movement disorders (Parkinson’s disease, RLS) and a patient with Burning Mouth syndrome (for real). Such is the wonderful ‘box of chocolates’ schedule of a comprehensive community neurologist! I know I am with my tribe when walking down a hallway or attending a meeting sparks a discussion concerning the latest challenging case, recent article in neuroscience, or troubleshooting our EMR, coding and billing, or pre-cert woes. Another joy I share with my neuro-tribe is discussing recent books/articles we have come across concerning our field which have been thoughtprovoking or life-affirming. Dr. Avitzur has called for suggested reading and I am currently finishing Whole Brain Living by Jill Bolte Taylor, PhD, a neuroanatomist who previously wrote My Stroke of Insight, a New York Times bestseller chronicling her personal journey after suffering an intracerebral hemorrhage. The book combines psychology and her understanding of the human brain to explain our perceptions, experiences, and behaviors. There are many other outstanding books which deal with the fascinating unknown of our nervous system and our calling as compassionate healers. When I started my career, I had a hunch that the neurologic discoveries and advances made in my lifetime would continue to hold my interest and add fuel to my love for our profession. I certainly have not been disappointed. Salute to our tribe!”

—James C. Stevens, MD, FAAN AAN Immediate Past President

“Finding where you fit in medicine is crucial and neurology is definitely my home. Each week of hospital duty brings satisfaction of solving mysteries for some of our patients and families to allow them to progress and often the humbling experience that there will always be more to discover. My home is further defined by movement disorders and now palliative care. In the latter, I found the best of medicine—to see and hear my patients and their families and to help them with the spiritual struggles that illness often brings. My humble addition to Dr. Avitzur's list is The Five Invitations: Discovering What Death Can Teach Us About Living Fully, by Frank Ostaseski.”

—Janis Miyasaki, MD, MEd, FRCPC, FAAN AAN Vice President

“I spend most of my time caring for patients with neuromuscular conditions that are progressive and debilitating and despite the emotional challenges of dealing with ‘terminal’ patients, I find that I am increasingly inspired by their innovation and resiliency. I am in love with neurology because I am in love with my patients and the lessons about life that they teach me. ‘Carpe diem’ has been my motto for many years as most of my ALS patients are now younger than I am. One of my favorite books is Tuesdays with Morrie which is the true story of Mitch Albom, a journalist, who provides an account of his former professor Morrie Schwartz’s anecdotes about life as he deals with an ALS diagnosis.

Morrie reminds us that: ‘The way you get meaning into your life is to devote yourself to loving others, devote yourself to your community around you, and devote yourself to creating something that gives you purpose and meaning.’ Neurology is a career that provides me that purpose and meaning and the opportunity to make lives better.

—Carlayne E. Jackson, MD, FAAN AAN President Elect

AANnews • February 2022

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PRACTICE AAN Provides Ethical Guidance on Issues of Consent for People with Stroke Who gives consent for treatment when a person with stroke cannot? The AAN issued a position statement for neurologists on how to navigate consent issues for people who have experienced acute ischemic stroke. The statement was published in the January 10, 2022, online issue of Neurology® at Neurology.org. It was developed by the Ethics, Law, and Humanities Committee, a joint committee of the AAN, American Neurological Association, and Child Neurology Society. This position statement replaces the AAN’s 1999 position paper as well as a 2011 policy statement on this topic.

“Stroke treatments that are effective in preserving brain function can only help if administered quickly, sometimes within just a few hours, yet consent for such treatments must often happen when the person who has had a stroke lacks the ability to make decisions and when those who could make decisions for them may be unavailable,” said position statement author Justin A. Sattin, MD, of the University of Wisconsin in Madison and a member of the AAN’s Ethics, Law, and Humanities Committee. “This position statement provides ethical guidance for neurologists on how to navigate the decision-making process for stroke patients when time is of the essence.”

The AAN position statement says when a person with stroke is unable to give consent for treatment, advance health care directives may provide guidance on their wishes. However, it says such directives, like living wills, are often overly specific or too vague, addressing terminal conditions, but not debilitating conditions like stroke. Another form of an advance directive that can be used is a power of attorney, a person who serves as a surrogate decision maker. Next of kin may also be authorized to serve as a surrogate decision maker.

The position statement explains that a surrogate decision maker may not be adequately prepared for representing a stroke patient’s wishes. Neurologists may need to guide them, giving priority to a patient’s preferences, if documented, and if not, then determining what the person would want based on their beliefs. When beliefs are unknown, it says decisions should be made based on the person’s best interests.

When a stroke patient needs emergency treatment and has no advance directive or surrogate decision maker, the position statement says treatments may be provided based on ethical presumptions of consent—what a person would consent to if they could be asked.

“A stroke is a medical emergency, so by providing this ethical guidance, the American Academy of Neurology aims to help neurologists navigate issues concerning treatment consent so they can provide the highest quality patient care as quickly as possible, saving lives and improving patient outcomes,” said President Orly Avitzur, MD, MBA, FAAN. The position statement says when there is a generally accepted treatment like clot-busting drugs, neurologists may proceed with treatment on the presumption of consent, if necessary.

When treatments require more consideration of risks versus benefits, such as for endovascular treatment, a procedure to remove a clot, the position statement says the decision on whether to proceed should be informed by how closely a person’s case matches what is recommended in current treatment guidelines.

When there are treatments for which evidence is lacking, the statement advises that neurologists should work with their medical institutions to develop treatment protocols.

Finally, the position statement says for stroke research, laws regarding consent by surrogates vary state to state, but the federal Common Rule, a rule of ethics in research, allows lawful surrogates to provide consent. 

Tony Bennett Inspires Hope After a Diagnosis of Alzheimer’s In revealing his diagnosis of Alzheimer’s disease in 2021, singer Tony Bennett and his family aim to reduce the stigma around the illness and inspire other patients and their families. In the February issue of Brain & Life®, his wife, Susan, explains how music keeps her husband busy and engaged—and more like his old self, the charming performer.

People with myasthenia gravis, a progressive neuromuscular disease, just got new treatment options after the US Food and Drug administration approved two medications. In this feature, Brain & Life describes how the new medications work and advises patients on how to choose the right treatment. Tips are offered for covering the cost of these new drugs.

As scientists identify more genes that cause neurologic disorders, they may develop tests that target these genes. The magazine looks at how these advances affect conditions like Parkinson’s,

F E B R UA RY/M A R C H 2 0 2 2 B R A I N A N D LI F E .O R G

In the Genes Genetic Research May Finetune Treatment

epilepsy, Alzheimer’s, and inherited disorders and whether people at risk for them should undergo genetic testing.

Smog Fog How Dirty Air Affects Brain Health

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

Myasthenia Gravis New Drugs Offer More Options

It’s music that saves Tony.”

— S U S A N B E N N E T T, W I F E O F TO N Y B E N N E T T

Neurology Today Ranks the Top Stories of 2021 As COVID-19 closes in on its second year, posing new challenges for neurology and other specialties, how does one measure progress? Neurology Today’s annual feature on the best advances of the year, “The News That Mattered in 2021: Neurology Today’s Editorial Board Top Picks,” provides a way forward.

Neurology Today editorial Board Top Picks

can memantine improve cognition in down syndrome?

article in brief: The Neurology Today editorial board highlights the advances that occurred in 2021 across multiple subspecialties and areas of practice. every subspecialty. The selections of the most important advances in 2021 by members of the Neurology Today editorial board highlighted below are not all game-changers, but whether incremental or transformational, they have all moved the field forward in practice and the care of patients.

ADvANCED PRACTICE PRACTIONERS

The Pick: Cook CL, Schwarz HB. Advanced practice clinicians-neurology’s underused resource. JAMA Neurol 2021; 78(8):903-904.

julie a. gurwell, phd, pa-c Associate Professor, Director of Advanced Practice Providers University of Kentucky Louisville, KY

Kreimer S. Professionalism: On training and retaining advanced practice clinicians in neurology. Neurol Today 2021;21(15):1,9.

The Findings: These two articles provide an important reminder that advanced practice clinicians can be valued team members of neurology care teams in collaboration with physicians when they are supported and mentored. The articles discuss the intrinsic challenges of

CEREBROvASCULAR DISEASE james c. grotta, md, faan Director of Stroke Research at the Clinical Institute for Research and Innovation Memorial Hermann-Texas Medical Center, Houston, TX

The Pick: Ebinger M, Siegerink B, Kunz A, et al. Association between dispatch of mobile stroke units and functional outcomes among patients with acute ischemic stroke in Berlin. JAMA 2021;325:454-466.

Grotta JC, Yamal J-M, Parker et al.

Prospective, multicenter, controlled trial of mobile stroke units. New Engl J Med 2021;385:971-81.

The Findings: Previous studies had shown that mobile stroke units, specialized ambulances with CT imaging, personnel, and drugs, integrated with

emergency medical services systems, can accurately diagnose strokes and speed delivery of tissue plasminogen activator (tPA) treatment into the pre-hospital setting. These two studies from Berlin and seven sites in the US were the first large, controlled trials showing that mobile stroke unit management translates to substantially better clinical outcomes as measured by the modified Rankin scale at 90 days. Better results were driven by more and faster tPA treatment, especially in the first “golden” hour after symptom onset.

Why It’s Important: The biggest current challenge in acute stroke treatment is getting appropriate treatment to the patient and getting the patient to the appropriate treatment, and doing this as fast as possible. Mobile stroke units are a way to achieve all this by taking the most widely used effective treatment, intravenous thrombolysis, to the patient immediately following the 911 call, and by triaging patients with large vessel occlusions directly to hospitals that can do thrombectomy.

The Pick: LeCouffe ND, Kappelhof M, Treurniet KM, et al. A randomized trial of intravenous alteplase before endovascular treatment for stroke. New Engl J Med 2021;385:1833-44

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the official news source of the a merican academy of neurology | neurology today.com January 20, 2022 | volume 22 | issue 2

direct oral anticoagulants are safe for very elderly Patients with stroke and atrial fibrillation

training and utilizing advanced practice clinicians, as well as offer insights on ways to onboard and engage advanced practice providers to prevent attrition.

Advanced practice clinicians can help increase access to neurologic care.

Although hiring advanced practice clinician requires a significant financial

investment, if integrated falls strategically, and bleeding, instead placing them fitzgerald Why It’s Important: Thesusan demand for that investment will lead to onbetter older provitamin K antagonists (VKA), neurologic care continues to outpace vider retention, and subsequent continuaspirin or perhaps nothing at all. the availability of neurology clinicians. ity for access to neurology. The new study, published online

A

new study of patients older November 8 in Annals of Neurology, than 85 who had a recent used real-world data from stroke cenSuzuki K, Matsumaru Y, Takeuchi M, et Japan.

The Zi study, along with similar the safety and efficacy of stroke along with atrial ters toa compare al. The effect of mechanical thrombecstudy reported last year, conducted fibrillation (AF) found that both DOAC to VKA by measuring outcomes tomy without vs with intravenous in China, demonstrated the already known benefits non-inferiority such as recurrent stroke and intracranial thrombolysis on functional outcome for skipping. (DOACs) bleeding. of direct oral anticoagulants among patients with acute ischemic compared with vitamin K antagonists “Our data are reassuring in that direct It’s Important: The preponderance stroke. JAMA 2021;325(3):244-253. held true even forWhy this very old and often oral anticoagulants maintain their favorbeprofile given as frail population. of evidence is that tPA should able in the oldest old with recent Zi W, Qiu Z, Li F, et al. Effect ofSome endovassoonare as possible patients whoindicating qualphysicians hesitant in toall prestroke, that reluctance to use cular treatment alone vsscribe intravenous including those who are candidates the newerify, direct oral anticoaguthem in these patients is not justified,” alteplase plus endovascularlants treatment on prevention for endovascular thrombectomy. for stroke in their very said the study’s lead author, Alexandros functional independence inelderly patientsAF with patients because of fears of Polymeris, MD, a neurology resident and a c u t e i s c h e m i c s t r o k e . JA M A The Pick: Halliday A, Bulbulia R, Bonati L, et al. Second asymptomatic carotid 2021;325(3):234-243. surgery trial (ACST-2): A randomised The Findings: Among patients who comparison of carotid artery stenting qualify for systemic thrombolysis with versus carotid endarterectomy. Lancet tPA, about 25 percent harbor clots in the 2021; 398:1065–1073. large vessels or large vessel occlusions studies had does this model prepare (LVOs). Endovascular thrombectomy is The Findings: Previousbut how well olgafor rukovets was a powerfully effective treatment these suggested that carotid stenting trainees for the disorders they will see in than endartpatients, but tPA usually cannot dissolve associated with more risk routine neurologic practice? the these large clots. Consequently, there erectomy. In asymptomatic patients, In a Viewpoint published in JAMA benefit of either procedure over mediis uncertainty if tPA should be given or eurology residents currently Neurology on December 6, Daniel Shalev, cal therapy is still in question, so any skipped in LVO patients. The LeCouffe complete one month of full- MD, an instructor in medicine and psyrisk would the balance. study tested non-inferiority and could timeincreased clinical training in psy-tip chiatry at Weill Cornell Medicine in New In this large international randomized not exclude that skipping tPA was infechiatry, as required by the York, and Nuri Jacoby, MD, an associate study of 3,265 patients, serious comrior to giving it. In fact, patients receivAccreditation Council for professor of clinical neurology at SUNY plications similarlyDownstate uncommon ing tPA on average had better outcomes Graduate Medical Educationwere (ACGME), Health Sciences University than those in whom it was skipped. This after carotid artery stenting and carotid was confirmed in a Swiss study, pre- endarterectomy, and the long-term sented but not yet published (SWIFT- effects on fatal or disabling stroke were Continued on page 20 DIRECT), and in the Suzuki study from comparable.

PhD candidate in the neurology department and stroke center at University Hospital Basel in Switzerland.

“Based on these findings, more stroke patients could benefit from treatment with direct anticoagulants in the future,” Dr. Polymeris said.

Background information in the new report noted that current guidelines from the American Heart Association/ American Stroke Association recommend DOACs in patients with AF for recurrent stroke prevention in preference to VKAs, based on the results of randomized-controlled trials. But whether that recommendation should apply to the very old is often questioned by doctors

iSTOcKPHOTO

A

s 2021 came to a close, studies about COVID-19 continued to dominate across major journals and institutions. But even with another year of the coronavirus and a troubling variant, neurology witnessed the expansion of developments across

because persons 85 or older were barely represented in the clinical trials and neither were those with very recent ischemic stroke.

Settling that uncertainty is important, especially given Continued on page 30

is it time to update Psychiatry training for neurologists?

Proposals for How to Get It Done

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and Maimonides Medical Center in Brooklyn, pointed to gaps in both the format and content of psychiatry training for neurologists and called for both to be modernized.

“A large number of disorders, including dementia, fall at the intersection of neurology and psychiatry,” Dr. Jacoby told Neurology Today. “Many disorders that are traditionally the purview of one field or the

other such as Parkinson’s disease, epilepsy, psychotic disorders, and stroke have neuropsychiatric manifestations. And there are workforce challenges in both specialties that can make referral and consultation difficult. It’s critical that neurologists receive psychiatry training that empowers them to provide care to patients with psychiatric comorbidities,” he said. “Current Continued on page 16 training in

the Best neurology advances of 2021

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“2021 has proven to be a year when the engines of neurology research and innovation continued to move forward, despite great challenges,” said Neurology Today Editor-in-Chief Joseph E. Safdieh, MD, FAAN, the Gertrude Feil Associate Dean of Curricular Affairs, vice chair of education, and professor of neurology at Weill Cornell Medical College. “The advances highlighted by our editorial board, all leaders in the field, offer up hope for the future of our specialty and for our patients.” 

the news that mattered in 2021

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This past year’s selections, published in print and online on NeurologyToday.com on January 20, highlight the most noteworthy achievements across subspecialties— from dementia and genetics, sleep and epilepsy, neuromuscular disorders and stroke, movement disorders and neuro-oncology, neurocritical care and ethics, to legislative and wellness initiatives, and more.

Look for the studies, initiatives, and developments that moved the field forward and led to important changes in practice—and why they matter.

JANuAry 20, 2022 | NeurOlOGy TODAy | 19

Best advances

periodicals

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NeurologyToday (ISSN 1533-7006), an official publication of the American Academy of Neurology, is published Semi Monthly for the Academy by Wolters Kluwer Health, Inc, at 1800 Dual Highway, Suite 201, Hagerstown, MD 21740-6636. Periodicals Postage Paid at Hagerstown, MD and at additional mailing offices. POSTMASTER: Send address changes to Neurology Today, PO Box 1610, Hagerstown, MD 21740.

03/01/22 5:13 PM

AANnews • February 2022

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PRACTICE Neurology: Clinical Practice Offers Variety of Timely Topics The new issue of Neurology ® Clinical Practice leads with a Special Editorial

by Tissa Wijeratne, MBBS, MD, FRACP, FRCP, FAAN, on “Global Advocacy in Action: World Brain Day 2021 dedicated to Stopping Multiple Sclerosis.”

Research articles include “Primitive Reflexes and Dementia in Adults with Down Syndrome,” by Jordan Harp, PhD, et al; “Embedded Palliative Care for Amyotrophic Lateral Sclerosis: A Pilot Program and Lessons Learned,”

by Kara Bischoff, MD, et al; “Adverse Childhood Experiences in Patients with Neurologic Disease,” by Adys Mendizabal, MD, et al; “Perioperative

Neurocognitive Screening Tools for At-risk Surgical Patients,” by Stephen Choi, MSc, MD, et al; and “COVID-19 Outcomes in Hospitalized Patients with Neurodegenerative Disease: A Retrospective Cohort Study,” by Roshni Abee Patel, MD, et al.

Published continuously online and in print six times a year, Neurology: Clinical Practice is free to AAN members via the website (and available in print for US members only) who have a current subscription to Neurology. Visit Neurology.org/cp for more information. 

Volume 12, Number 1, February 2022

Neurology.org/CP

A peer-reviewed clinical neurology journal for the practicing neurologist

RESEARCH

Primitive Reflexes and Dementia in Adults With Down Syndrome RESEARCH

COVID-19 Outcomes in Hospitalized Patients With Neurodegenerative Disease: A Retrospective Cohort Study RESEARCH

Embedded Palliative Care for Amyotrophic Lateral Sclerosis: A Pilot Program and Lessons Learned REVIEW

Perioperative Neurocognitive Screening Tools for At-Risk Surgical Patients

Survey Results to Guide Axon Registry Improvements In an annual survey of Axon Registry ® participants in the fall of 2021, 60 percent of survey participants believe the Axon Registry is a “very valuable” or “valuable” resource for their practice and overall participant satisfaction in the Axon Registry remained at 70 percent. Merit Incentive Payment System (MIPS), quality improvement, and maintenance of certification were the three most popular benefits for joining the Axon Registry. Respondents included 87 percent clinicians and 13 percent administrative and non-clinical staff.

The survey results show that the COVID-19 pandemic is still impacting quality improvement. Approximately 53 percent of survey respondents stated that the pandemic made quality

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AANnews • February 2022

improvement more difficult. Telehealth and virtual visits were the primary impacts on how the pandemic has affected practice ability to collect data needed to calculate quality measures.

The purpose of the annual survey is to receive feedback from participants on improvements the AAN can make to ensure the best experience possible. After receiving participant feedback, the AAN will provide more detailed resources for participating sites, including a data dictionary to ensure accurate documentation. If you have any suggestions or need assistance with the Axon Registry, please contact registry@aan.com. 

GUIDELINES AAN Updates Guideline on Treatment of Painful Diabetic Polyneuropathy The AAN published “Oral and Topical Treatment of Painful Diabetic Polyneuropathy Practice Guideline Update Summary” in the December 27, 2021, online issue and the January 4, 2022, print issue of Neurology®. This practice guideline updates the 2011 AAN practice guideline on the treatment of painful diabetic neuropathy.

Of note, there were new studies on sodium channel blockers, which changed recommendations. There is also evolving literature outside the guideline on opioids that led to recommendations. An intention of the authors is for this guideline update to also highlight the recognition now among the medical community that the risks of the use of opioids for painful diabetic neuropathy therapy outweigh the benefits.

According to the guideline, clinicians should assess patients with diabetes for neuropathy and pain. For patients with painful diabetic neuropathy, clinicians should review all available options to reduce pain, including oral, topical, and nonpharmacologic interventions.

Clinicians should think about medication use for individual patients in terms of patient preference, cost, comorbidities, effect sizes, and side-effect profiles. It is important for clinicians to think about treatment of painful diabetic neuropathy in terms of medication class. Patients need to be re-evaluated regarding efficacy and tolerability after starting treatment. If a medication in one class is not working or is causing intolerable side effects, another medication class should be tried instead of another medication in the same class. Clinicians should not use opioids for the treatment of painful diabetic neuropathy.

A review of clinical trials suggested that drugs from the following four classes, in no order, reduce pain due to diabetic neuropathy: Serotonin-norepinephrine reuptake inhibitors (SNRIs) such as duloxetine, venlafaxine, and desvenlafaxine Tricyclic antidepressants (TCAs) such as amitriptyline, nortriptyline, and imipramine Gabapentinoids such as gabapentin and pregabalin Sodium channel blockers such as carbamazepine, oxcarbazepine, lamotrigine, valproic acid, and lacosamide

Joint Guideline and Measurement Set Dissemination The AAN has simultaneously published “Quality Improvement in Neurology: Polyneuropathy Quality Measurement Set,” a quality measurement set on polyneuropathy. This simultaneous dissemination is being piloted by the AAN to allow clinicians to operationalize guidelines more immediately and integrate the recommendations into practice.

Read the guideline and access a clinician summary, patient and family summary, slide presentation set, at AAN.com/Guidelines and measurement set at AAN.com/QualityMeasures.

For more information, email guidelines@aan.com. 

Seattle: April 2 –7 Virtual Experience: April 24–26

Get Ready for the Great Neuro Reunion!

Reunite with your neurology community from around the globe at the Annual Meeting to experience the most comprehensive educational offerings and largest scientific program in the field with options to participate in person, virtually, or both.

Learn more and register now at

AAN.com/AM.

EVENTS Speakers Announced for Presidential and Frontiers Plenary Sessions in Seattle continued from cover Presidential Plenary Session Moderator: Natalia S. Rost, MD, MPH, FAAN, FAHA Boston, MA Chair, AAN Science Committee

Seattle: April 2 –7 Virtual Experience: April 24–26

Presidential Lecture Post-COVID Challenges to Scientific Research -Brenda Banwell, MD, FAAN, Philadelphia, PA -Merit E. Cudkowicz, MD, MSc, Boston, MA -Nina F. Schor, MD, PhD, FAAN, Bethesda, MD Banwell

Cudkowicz

Schor

George C. Cotzias Lecture Autism and Genetics Daniel H. Geschwind, MD, PhD Los Angeles, CA Sidney Carter Award in Child Neurology Vascular Pediatrics Catherine M. Amlie-Lefond, MD, FAAN Seattle, WA

Robert Wartenberg Lecture Leaving No One Behind: Charting the Course to Cerebrovascular Health Equity Bruce I. Ovbiagele, MD, MSc, FAAN San Francisco, CA

Frontiers in Neuroscience Plenary Session Wednesday, April 6, 9:15 a.m.–11:30 a.m. PT Six presenters will provide summaries of their new or late-breaking basic and translational research and describe the clinical implications of the results.

Moderator: Paul M. George, MD, PhD, MSE, FAAN Stanford, CA Vice Chair, AAN Science Committee

Neurobiology of COVID-19 Robyn S. Klein, MD, PhD St. Louis, MO

Roles of Astrocytes in CNS Inflammation Francisco J. Quintana, PhD Boston, MA

Mapping the Connectivity of Consciousness Brian Edlow, MD Boston, MA

Advances in Frontotemporal Degeneration Adam L. Boxer, MD, PhD San Francisco, CA

Mapping the ALS Exosome: A Step Towards Prevention Eva Feldman, MD, PhD, FAAN Ann Arbor, MI mRNA Vaccines for Therapeutic Applications in Neuroscience Michael Lim, MD Palo Alto, CA

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AANnews • February 2022

Look for These Additional Plenary Sessions!

Controversies in Neurology Plenary Session Saturday, April 2, 9:15 a.m.–11:15 a.m. PT Features experts discussing the most current and controversial issues in neuroscience. The session follows a debate-style format in which two speakers argue one side of a topic, followed by a rebuttal.

Hot Topics Plenary Session Saturday, April 2, 5:00 p.m.–6:00 p.m. PT Features the latest, cutting-edge translational research related to clinical issues of importance. Four outstanding speakers will provide summaries of their recent research findings and describe the clinical implications of the results.

Contemporary Clinical Issues Plenary Session Monday, April 4, 9:15 a.m.–11:30 a.m. PT Highlights issues most critical to practicing neurologists,

including abstracts related to new therapeutic developments, clinical applications of basic and translational research, and innovative technical developments. Commentary and discussion follow each presentation.

Clinical Trials Plenary Session Tuesday, April 5, 9:15 a.m.–11:30 a.m. PT Covers important clinical topics identified from other society meetings that affect patient care. The latest updates within several clinical trials conducted over the course of the last year will be presented.

Neurology Year in Review Plenary Session Thursday, April 7, 9:15 a.m.–11:30 a.m. PT Features six speakers, each focusing on the latest research that has happened in the last year within a specific subspecialty topic. 

Virtual Annual Meeting Option Offers Convenient, Distinct Three-day Experience continued from cover Highlights of the virtual option include: Quick Learning Sessions to help you start each day with a brief overview of that day’s top takeaways and highlights 40+ unique courses and sessions featuring live Q&A Seven program tracks Neurology Case Conferences New Advances in Neurology Wellness Trainees Spanish Language Career/Leadership Clinical Practice Four Plenary Sessions, each followed by a live “fireside chat” with that day’s speaker(s): Presidential Plenary showcasing the Robert Wartenberg Lecture, George C. Cotzias Lecture, and Sidney Carter Award in Child Neurology Clinical Plenary with select

trial presentations from the Annual Meeting in Seattle Frontiers in Neuroscience Plenary featuring a selection of speakers from the Annual Meeting in Seattle Controversies in Neurology Plenary tackling a new current and controversial issue in neuroscience as an encore presentation from the Annual Meeting in Seattle and featuring scholarly debate between two experts, each advocating for one side of a single topic, followed by a rebuttal Edutainment bringing you outsideof-the-box talks to refresh and energize your mind Poster Hall presenting the latest research Chat function to help you engage and connect with fellow attendees

Access to session recordings through May 14, 2022 Visit AAN.com/AM to learn more and to register and secure the best rates before February 17. 

Attend in Person and Virtually for Maximum Value with Platinum Package!

Get the maximum value—and a 25-percent discount—by purchasing the Platinum registration package, which includes Gold registration to both the virtual Annual Meeting option and the in-person meeting in Seattle April 2–7. Between the two options that’s nine full days of programming—PLUS extended access to recordings from both meetings through March 1, 2023! 

AANnews • February 2022

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EDUCATION Committee, Subcommittees to Advance Academic Neurology Initiatives­­ continued from cover

in 2018. Since then, efforts have included sharing best practices on topics such as revenue generation and funding the education mission; bringing together women chairs of neurology departments and academic business administrators; developing resources for division chiefs and diversity officers, developing webinars for departments to share information on COVID response, financial repercussions, and reactivating departments after the initial surge; and Equity, Diversity, and Inclusion (EDI) initiatives, including a webinar on Neurology Departments Addressing Systemic Racism.

In 2021, an Academic Neurology Committee and four subcommittees were created: Department Chair Subcommittee, Diversity Officer Subcommittee, Division Chief Subcommittee, and Advancing Women in Academics Subcommittee.

“Neurology academic departments deliver clinical care to neurology patients, lead transformative cutting-edge research, and train the leaders of tomorrow in both neurology and neuroscience,” said Sacco, chair of the Academic Neurology Committee. “Academic departments and neurologists are critical to the field of neurology and neuroscience and to patients and trainees, but they are also vital to the health of the Academy. As such, it was imperative to examine the needs of academic neurology department in a holistic manner and develop tangible resources and solutions in support of the future of academic neurology. This committee structure can support these aims, similar to the way the Medical Economics and Practice Committee focuses on the clinical and business aspects of the practice of neurology.”

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AANnews • February 2022

Looking forward, the committee and subcommittees are already deep in the planning and execution of the third Neurology Department Chair Summit in 2022. Additionally, a new Academic Learner Engagement Center, known as the Academic Exchange, will be offered at the in-person Annual Meeting in Seattle this April. The Academic Exchange will provide innovative and interactive education sessions, mentoring, and networking opportunities throughout the week.

Additionally, plans are in the works to continually add to the growing number of online programs and resources designed specifically for academic constituents.

“It is essential for the field of neurology and neuroscience— and the AAN as an organization—that the Academy meet the needs of academic neurologists. Towards this end, the AAN is investing in resources that ensure that academic neurologists may rely on the AAN to support them across their professional lifetime,” said AAN President Orly Avitzur, MD, MBA, FAAN. “The AAN has long been the home for both the academic neurologists and practicing neurologists, and it will continue to be. However, in the past the AAN has primarily focused on medical students, residents, program directors, clerkship directors, and fellowship directors within neurology academic departments, rather than taking a comprehensive approach to identify and address the needs of all constituents, including the leadership within academic neurology departments.

The AAN’s Academic Initiative, and the new committee and subcommittees, seek to do just that.”

Visit AAN.com for continued updates on the AAN’s Academic Initiative. 

The Academic Neurology Committee champions the viability of academic neurology by addressing business and organizational issues of academic neurology departments including leadership, mentorship, financial, EDI, and sharing of best practices. The committee will help address engagement of the academic neurology workforce; care delivery at academic health systems; promoting neurologic health equity in academic departments; ensuring the health of academic neurology departments; providing resources to support the financial well-being, viability, and innovation of the practice of neurology within academic departments; expanding and supporting neuroscience research; and creating novel ways to educate and assist key academic leaders to provide high-value, team-based, patient-centered, clinical care within academic departments.

Ralph L. Sacco, MD, MS, FAHA, FAAN, Chair

The Division Chief Subcommittee provides guidance and resources to division chiefs at all academic neurology institutions to support their leadership and strategic directions for the clinical, research, and academic activities.

Jennifer J. Majersik, MD, FAAN, Chair

The Advancing Women in Academics Subcommittee advances the Women in Academics Work Group to address issues facing women at all levels in academic neurology, including but not limited to promotion, compensation, and department environments.

Kathleen M. Shannon, MD, FAAN, Chair 

The Department Chair Subcommittee provides guidance and developing opportunities and resources for department chairs to support their leadership and strategic directions for the clinical, research, and academic activities.

S. Andrew Josephson, MD, FAAN, Chair The Diversity Officer Subcommittee develops opportunities and resources for diversity officers to focus on issues of equity, diversity, and inclusion that affect staff, trainees, and faculty.

Nimish A. Mohile, MD, FAAN, Chair

neurology PODCAST®

Neurology ® Podcast:

20 Minutes Pack a Punch!

Subscribe and download the latest podcast at Neurology.org/podcast AANnews • February 2022

17

EDUCATION Latest on Neurology of Pregnancy in February Continuum The current issue of Continuum: Lifelong Learning in Neurology ® shares new insights on the neurology of pregnancy.

Guest Editor Mary A. O’Neal, MD, FAAN, said, “There are a lot of new updates about management of pregnancy in women with demyelinating disease, headaches, and epilepsy. It’s important to know that women with migraine have not only an increased risk for preeclampsia, but also an increased risk of gestational hypertension.

Neurologists may be surprised to learn that, while pregnancy does not confer a higher risk for incidence of brain tumor, pregnancy is associated with worsening tumor aggressive behavior.”

Content for this issue includes: Pregnancy Management in Multiple Sclerosis and Other Demyelinating Diseases Maria K. Houtchens, MD; Riley M. Bove, MD Epilepsy and Pregnancy Yi Li, MD, PhD; Kimford J. Meador, MD, FAAN, FAES, FRCPE Neuromuscular Disorders and Pregnancy Janice M. Massey, MD, FAAN; Karissa L. Gable, MD Headache in Pregnancy and Lactation Melissa Rayhill, MD, FAHS Maternal Stroke Associated with Pregnancy Eliza C. Miller, MD, MS Managing Central Nervous System Tumors During Pregnancy Na Tosha N. Gatson, MD, PhD, FAAN Neuro-ophthalmology and Pregnancy Heather E. Moss, MD, PhD, FAAN Neurologic Complications of Obstetric Anesthesia Janet F.R. Waters, MD, MBA, FAAN Legal and Ethical Challenges in the Care of the Pregnant Patient After Brain Death Joseph S. Kass, MD, JD, FAAN; Rachel V. Rose, JD, MBA

O'Neal

The issue includes a postreading selfassessment and test with the opportunity to earn up to 20 AMA PRA Category 1 Credits™ toward Self-assessment CME. AAN members pay only $399 per year for a subscription to Continuum® and Continuum® Audio. Subscribe now by contacting Wolters Kluwer at (800) 361-0633 or (301) 223-2300 (international) or visit shop.lww.com/continuum. AAN Junior members who are transitioning to neurologist memberships are eligible to receive a 60-percent discount on the already low member rate for the Continuum and Continuum Audio subscription. 

Continuum LIFELONG LEARNING IN NEUROLOGY®

FEBRUARY 2022

VOL. 28

NO. 1

Neurology of Pregnancy EDITOR-IN-CHIEF: STEVEN L. LEWIS, MD, FA AN GUEST EDITOR: MARY ANGELA O’NEAL, MD, FA AN

CONTINUUMJOURNAL.COM

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AANnews • February 2022

‘Unrelenting Persistence’ Pays off for Women Leading in Neurology Graduate Since graduating from the AAN’s Women Leading in Neurology (WLN) program in 2020, Yasmin Khakoo, MD, has assumed several important leadership roles outside of her already demanding position as a pediatric neurologist and neuro-oncologist as well as child neurology director at MSK Kids at Memorial Sloan Kettering, and professor of clinical pediatrics at Weill Cornell Medical College in New York City. A self-proclaimed “late bloomer,” Khakoo credits her success to having outstanding role models “starting with my parents, immigrant physicians from India who always championed the underdog,” she said. But Khakoo also describes herself as “unrelentingly persistent.”

She applied for WLN in 2017—only to be declined—but reapplied and was accepted in 2018. “Through WLN, I learned that sometimes you have to advocate for your beliefs even if someone is going to disagree.”

Khakoo’s persistence has paid off. Her list of accomplishments in the short time since graduating from the WLN is impressive.

She was appointed by Kathleen M. Shannon, MD, FAAN, to become the vice chair of the AAN’s Advancing Women in Academics Subcommittee and nominated by her WLN mentor, Ann H. Tilton, MD, FAAN, to the AAN’s Women in Academic Medicine Work Group, where they collaborated to develop its mission statement. In June 2021, Khakoo received the Pediatric Neurology Teaching Award at Weill Cornell Medical College. She is even bringing her expertise and passion to the 2022 AAN Annual Meeting by serving as the Child Neurology and Developmental Neurology Topic Chair for the meeting’s Scientific Program. In her first term as chair of the Scientific Selection & Program Planning Committee for the 2022 Annual Meeting of the Child Neurology Society, she also hopes to bridge ideas between the two societies.

“But what I am most excited about,” she adds, “is becoming the editor-in-chief of the Pediatric Neurology journal as of January 2022, thanks, in large part, to outgoing editor-in-chief Steve Roach, MD, who epitomizes #he4she!”

She is quick to credit her mentors/sponsors—specifically Tilton; Joanne L. Smikle, PhD; Cynthia Comella, MD, FAAN; Maisha T. Robinson, MD, FAAN; Lynne P. Taylor, MD, FAAN; Nina F. Schor, MD, PhD, FAAN; and Allison Brashear, MD, FAAN—for helping her articulate career goals and outline an action plan to achieve them. “The connections I made with colleagues and leaders in neurology through the WLN are what I value the most,” said Khakoo. “With the SARS-Cov-2 pandemic starting at the end of our training, many of us reached out to each other for support. In fact, the class of 2020 continues to meet periodically (virtually) and we hope to see each other IRL (in real life) at the AAN Annual Meeting in Seattle in April 2022. I believe in ‘holding the ladder’ for others to rise and have invited some in my WLN cohort to review abstract reviews and consider joining committees I chair.”

A Barnard College alumna, Khakoo has always been a strong advocate of women and other underrepresented groups in medicine and beyond. She encourages others to apply for AAN leadership positions and plans to use her WLN experience to

Khakoo

help other child neurologists identify mentors and sponsors.

“As the editor-in-chief of Pediatric Neurology, I also plan to bring pediatric neurology into the digital age, to further diversify the board/reviewers and engage trainees and junior faculty, and align child neurology with pediatric scientist development pathways.”

In addition to caring for children and young adults with brain tumors, Khakoo is an international expert in the field of rare pediatric neurologic diseases including congenital melanocytic nevi/neurocutaneous melanocytosis and neuroblastomaassociated opsoclonus myoclonus ataxia syndrome. She is also involved in research collaborations to preserve quality of life and cognition in pediatric patients receiving treatment for all cancers.

The AAN’s Women Leading in Neurology program is an empowering and inspirational leadership program designed to help mid-career participants tackle gender disparities head-on, create a peer network with other female AAN members, and advance to the top levels of leadership in their fields and within the Academy. Learn more at AAN.com/WLN. 

Thank you to the organizations supporting this program in part: Alexion, AstraZeneca Rare Disease Allergan, an AbbVie Company Amgen argenx Eisai, Inc. Merz Therapeutics UCB, Inc.

AANnews • February 2022

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EDUCATION Five Training Programs Achieve UCNS Accreditation Five fellowship training programs recently attained accreditation through the United Council for Neurologic Subspecialties. Programs attaining UCNS accreditation status offer the core curriculum established by the subspecialty and meet required quality standards established by the UCNS. Accreditation is a voluntary process of evaluation and peer review based on UCNS accreditation standards. Fellows who complete a UCNS-accredited program meet the training eligibility requirements to apply for certification in the subspecialty. There are now 223 UCNS-accredited training programs in UCNS-recognized subspecialties.

Congratulations to the following: PROGRAM

PROGRAM DIRECTOR

Behavioral Neurology & Neuropsychiatry Rhode Island Hospital/Brown University

Chuang-Kuo Wu, MD, PhD

University of Kansas Medical Center

Ryan Townley, MD

Cedars-Sinai Medical Center

Sarah Kremen, MD

Headache Medicine George Washington University School of Medicine

Amanda Tinsley, MD

Neurocritical Care Albany Medical Center

Tamer Abdelhak, MD

Training programs interested in applying for accreditation will find application and program requirement information for each subspecialty at UCNS.org/accreditation. Applications received by the June 1, 2022, deadline will be reviewed for accreditation in the fall of 2022. 

RITE Exam Scheduled for This Month The RITE® (Residency In-service Training Exam) is set to take place February 15 through 19, with more than 270 programs and approximately 3,500 residents ready to assess their current level of knowledge in neurology and neuroscience, identify areas for potential growth, and track their progression throughout their residency.

Enrollment is up four percent from 2021, and the modifications to test administration that were put in place in 2021 in response to the challenges related to the pandemic will remain in place for the 2022 testing to ensure programs can follow their individual institution’s COVID-19 protocols. While the testing window will return to five days as in previous years, programs will have maximum flexibility in scheduling. The 2021 test delivery platform will also return, allowing programs to offer remote administration.

In response to feedback from programs and residents, the 2022 RITE will also focus more on clinical-based content and feature upgraded imaging studies, with video currently being pilot tested for a limited number of questions.

Learn more about the RITE at AAN.com/RITE. 

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AANnews • February 2022

UCNS Certifies New Diplomates in Clinical Neuromuscular Pathology The United Council for Neurologic Subspecialties has certified 14 new diplomates in the neurologic subspecialty of Clinical Neuromuscular Pathology. Demonstrating their expert knowledge in their subspecialty, these physicians now hold the distinction of being UCNS diplomates after passing the 2021 UCNS Clinical Neuromuscular Pathology Certification Examination. There are now 83 UCNS diplomates who are certified in Clinical Neuromuscular Pathology. The next UCNS Clinical Neuromuscular Pathology Certification Examination will take place in 2023. To see the list of new diplomates, visit “News” at UCNS.org. 

Patient Reported Outcome Measures Ad—Half Page Horizontal> AN n AANnews 5 +0.125 bleed, 4C

Applications Now Open for Behavioral Neurology & Neuropsychiatry Certification Examination Applications are now open for the United Council for Neurologic Subspecialties Behavioral Neurology & Neuropsychiatry Certification Examination scheduled to take place October 31 to November 4, 2022.

Applicants must be a diplomate in good standing of the American Board of Psychiatry and Neurology (ABPN), American Osteopathic Association (AOA), or possess equivalent certification by the Royal College of Physicians and Surgeons of Canada (RCPSC), in addition to meeting other practice and medical licensure requirements. The four-hour, 200-multiplechoice question exam will be administered online with live virtual proctoring.

Visit UCNS.org/certification to see the complete certification eligibility criteria and the examination content outline.

Application deadline is May 1, 2022. 

Make Your Patient Your Partner Invest in the outcomes that matter most to your patients. Learn about common Patient Reported Outcome (PRO) scales and tools used in neurology at AAN.com/PRO.

MEMBERSHIP Evans Selected as Recipient of 2022 President’s Award AAN President Orly Avitzur, MD, MBA, FAAN, has named David A. Evans, MBA, as recipient of the annual President’s Award.

Evans is the chief executive officer of Texas Neurology and executive director of the Neurologix Foundation in Dallas, TX. He serves as chair of the AAN’s Health Policy Subcommittee and Committee on Public Engagement and is a member of the AAN’s Advocacy and Industry Relations committees.

He is immediate past chair of the Practice Management & Technology Subcommittee and past chair of the BRAINS Section. Evans also served as a member of the Medical Economics & Management Committee, the BrainPAC Executive Committee, and chair of the AAN’s Neurology Compensation and Productivity Survey.

“David Evans, MBA, is one of the hardest-working volunteers I have ever encountered,” said Avitzur. “His dedication to the AAN since his involvement in 2004 has been exemplary and earned him respect and admiration from the many members who have worked with him over the years. He is currently chairing the Health Policy Subcommittee and the Committee on Public Engagement and has been a standout member of multiple other committees, work groups, task forces, sections, and teams. He has led many educational programs

as director and served as a speaker on medical economics, practice, policy, health information technology, advocacy, and much more. He is multi-talented and Evans widely recognized for always going the extra mile and doing so with a bright smile.

All who know him call him a friend and I am honored to present him with the 2022 President’s Award.”

Evans stated, “It is an honor to be the recipient of this year’s AAN President’s Award and I am extremely thankful to the AAN for this recognition. I am grateful for the roles I have served at the AAN over the years, and they continue to be some of the most rewarding aspects of my career. I am thankful for working alongside all the other volunteers who are dedicated in their service to their colleagues and community, the bonds that we have developed will last a lifetime. I would also like to thank the doctors at Texas Neurology for their support in my roles over the years at the AAN. Their support and encouragement has meant everything to me in allowing me to serve the neurology community.” 

New Patient-physician Video Now Online The second patient-physician video with neurologists and their patients discussing neurologic care is now available, hosted by President Orly Avitzur, MD, MBA, FAAN. In this episode, Brain Health and Epilepsy, Avitzur discusses the value of the physician-patient partnership with patient Michael McKenna and his neurologist, Joseph I. Sirven, MD, FAAN, who is a professor of neurology and editor-in-chief of Brain & Life® en Español, our patient magazine for Spanish-speaking readers.

McKenna is living with epilepsy and is a responsive neurostimulation ambassador and patient educator.

Watch their conversation at YouTube.com/AANchannel. 

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AANnews • February 2022

Connect with Funding Resources for Underrepresented Researchers Inclusion is the reason the AAN was founded. To be an organization that is the home for all neurologists. It is what makes us stronger.

In 2020, the AAN Board of Directors adopted a new goal to be a fully inclusive, deliberately diverse, and anti-racist organization. We also expanded our core values of Inclusion, Diversity and Equity to now include, Anti-racism, and Social Justice, otherwise known as IDEAS. We are working hard to achieve this new goal and demonstrate these expanded values through an actionable roadmap approved by the Board. Members should look for updates in AANnews to follow our progress.

Following through on a suggestion in the report from the AAN’s Special Commission on Racism, Inequity, and Social Justice, the Science Committee and Research Program Subcommittee have compiled a list of three dozen resources outside of the Academy that help underrepresented researchers in neurology secure funding, including such organizations as the Alzheimer’s Association, National Ataxia Foundation, Child Neurology Society, and McKnight

Endowment Fund for Neuroscience, as well as numerous programs within the National Institutes of Health and the National Institute of Neurological Disorders and Stroke.

For links to these resources, visit AAN.com/UIN-research or contact Michelle Maxwell at mmaxwell@aan.com. 

AAN Sections Connect You to Colleagues Around the Globe in Your Subspecialty or Interest Area—for Free!

Engage in rich and timely discussion with other AAN members from more than 140 countries sharing your area of interest by joining one or more of the AAN’s 40+ sections representing a broad range of subspecialties. Section membership is free to AAN members and allows you to take part in rich and timely discussions with your neurology peers from around the globe to share ideas and concerns and help shape the future of neurology. Visit AAN.com/Sections to learn more and to join. 

Membership Includes Access to the New Synapse Mobile App!

Membership in one or more AAN Sections also includes access to our associated online SynapseSM Member Communities, where a growing number of participants are discussing the latest health care topics. A new Synapse mobile app is also available to make connecting with your neurology colleagues easier than ever— from the convenience of a mobile device! Visit Synapse.AAN.com to learn more and download. 

AANnews • February 2022

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ADVOCACY

Capitol Hill Report Capitol Hill Report presents regular updates on legislative and regulatory actions and how the Academy ensures that the voice of neurology is heard on Capitol Hill. It is emailed to US members twice monthly and is posted at AAN.com/view/HillReport.

Below are some recent highlights.

AAN Advocates for Veterans with Neurologic Conditions Nine million veterans are enrolled in Veterans Health Administration (VHA) care around the nation, including many who suffer from neurologic disease. Many of these veterans benefit from the unique care of neurology-related Centers of Excellence—which focus on epilepsy, headache, Parkinson’s disease, and multiple sclerosis—that are fully integrated into a VA medical center to better coordinate multidisciplinary care.

Unfortunately, funding for most of these centers has been stagnant, some for two decades, despite the growing need for neurologic care for veterans. To help address this need, recently the AAN and our coalition partners successfully persuaded Congress to include language for the Fiscal Year 2022 appropriations process that urges strong funding for all the VA Neurology Centers of Excellence.

The AAN will continue to advocate for strengthening care for all veterans with neurologic conditions—including robust funding for the VA Neurology Centers of Excellence. To accomplish this goal, we work with our coalition partners who have been instrumental in supporting the AAN’s advocacy and in leading efforts to promote the important work of each disease-specific center. You can dig deeper into each Center of Excellence and our coalition partners on AAN.com.

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AANnews • February 2022

More Advocacy News Progress on the Build Back Better Act (BBBA) has ground to a halt after a statement from Sen. Joe Manchin (D-WV) expressing his unwillingness to support the bill in its current form. The AAN will continue to advocate for proposals the Academy supported that were a part of the BBBA, such as those that will make prescription drug prices more sustainable, improve our health care workforce, provide affordable insurance coverage to more Americans, and help address critical health care inequities.

The AAN submitted official comments on December 21 in support of the Biden administration’s vaccine mandate for health care workers. The AAN recognizes the necessity for this mandate and is strongly supportive of all efforts being made to vaccinate health care workers to protect them, and their patients, from COVID-19. Elements of this mandate are being held up in court and the AAN will continue to monitor and advocate on this issue. 

April 6, 2022

AMERICAN BRAIN FOUNDATION Cure One, Cure Many Aims to Advance Research Across Full Spectrum of Diseases The American Brain Foundation’s Cure One, Cure Many program takes a whole-brain approach to funding advances in our understanding of the brain and nervous system by recognizing the interconnectedness of brain diseases. It is the Foundation’s position that by examining the whole brain, we get the whole picture, and that when we cure one brain disease, we will cure many.

In pursuing this vision for a future free of brain disease, the Foundation partners with the AAN’s Research Program to fund innovative research by the best and brightest investigators.

The Foundation’s Cure One, Cure Many program initiatives include: The 2022 Cure One, Cure Many Award, a $3 million, multi-year research award research award for the early diagnosis of Lewy body dementia The Goadsby Headache Research Fund, which supports research to advance our understanding of migraine and develop treatments The Health Disparities Research Fund, created to ensure everyone has access to diagnoses and treatments

A new initiative for 2022 will be establishing the Stephen Hauser Multiple Sclerosis Research Fund.

These programs are only made possible through donations, partnerships, and advocacy. With your help, we can continue to support the vital research today into the cures of tomorrow.

Visit AmericanBrainFoundation.org/donate to learn more about how you can support the Foundation’s efforts in creating more opportunities for researchers to help lead the way to cures. 

The COVID-19 & the Brain Fund, which supports research on the effects of COVID-19 on the brain and nervous system

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Community Education

Professional Growth

Practice Management

Advocacy

Wellness Research

WHAT YOU NEED

WHEN YOU NEED IT Only AAN membership offers access to the highest quality resources— when you need them—from the world’s largest and most trusted community of neurology professionals.

Join or renew today.

AAN.com/Membership

Careers.AAN.com

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

Adult Neurologist, Northern New Jersey—Neurology Group of Bergen County, P.A.—Ridgewood, New Jersey Neurology Group of Bergen County is offering an Adult Neurologist the opportunity to join our independent, physician owned partnership. Our 18 neurologist group offers an unsurpassed work-life balance. We provide adult and pediatric neurological care at a single office and single hospital, with multiple established sub-specialties.

General neurologists, sub-specialists, and neuro-hospitalist candidates are welcome to apply for full-time or part-time position. Highlights: Independent, physician owned practice —Partnership track—Affluent suburban community, 30 minutes from NYC, with an excellent school system— Favorable on call schedule with gradual reduction—Collegial noncompetitive environment. Benefits: Generous salary, increasing to full partnership compensation—5 weeks vacation for the first year of employment, increasing to full partner benefit—Medical, dental, and vision insurance —Malpractice insurance coverage—Life insurance—401K and profit sharing plan. Email CV to hlijtmaer@neurobergen. com and for more information visit: www.neurobergen.com Practice Outpatient Neurology in the Most Popular Tourist Destination in the US—Synapse Neurology— Clermont, Florida Enjoy practicing in one of the MOST POPULAR travel destinations in the United States. From science programs to music festivals, bowl games and of course home to Mickey and Minnie Mouse, this City Beautiful attracts people from all over world where you can work and play.

Synapse Neurology, located in Clermont, 26 miles west of Orlando is actively recruiting a Board-Certified General Neurologist or a fellowship trained neurologist to join the well-respected, established, and busy practice. This is a rapidly growing practice. Opportunities exist to develop subspecialty practices in a variety of areas, including, but not limited to, movement disorders, neuromuscular, headache, Cognitive neurology, MS and epilepsy. Practice Details and Features Include: General Neurologist, Nurse Practitioner, 5200 square foot modern office with electronic EMR, Clinical Neurophysiology Lab with EMG and EEG, In office Infusion Center, Botox Therapy, Outpatient Practice.

Compensation and Benefits: 300K + 30K sign on Bonus and Full benefits package. Email CV and Cover Letter to administrator@synapseneurology.com Director of Research—Cleveland Clinic—Las Vegas, Nevada Cleveland Clinic Neurological Institute announces its search for a Director of Research to lead and expand the robust

research programs at Cleveland Clinic Lou Ruvo Center in Las Vegas, Nevada. To be considered, candidates must have an MD or equivalent degree, be Board Certified and have a record of proven success and a passion for research in Alzheimer’s disease and related dementias. The successful applicant will develop a purpose-driven mission that builds on abundant expertise and resources at the Lou Ruvo Center for Brain Health. The successful candidate will lead and mentor the research team in Las Vegas while collaborating with investigators at the Cleveland and Florida locations.

This includes major roles in our two NIH-funded Centers (Exploratory Alzheimer’s Disease Research Center and COBRE Center for Neurodegeneration and Translational Neuroscience), as well as research programs in movement disorders and multiple sclerosis. You will be fully supported in your own investigational pursuit of clinically relevant knowledge and improved therapeutics for Alzheimer’s disease and related dementias. Direct observation and understanding of cognitive disorders through clinical service is a required component of the position. The successful candidate will have academic accomplishments suitable for appointment as an associate or full professor at Cleveland Clinic Lerner College of Medicine.

This position will be supported by a $2M endowed chair.

Responsibilities will include: Strategic planning and leadership for growth of the research program, Directing, supporting, mentoring and developing investigator-initiated research studies, Outpatient clinical service and patient care (no call or weekends). This important position commands a competitive salary enhanced by an attractive benefits package including but not limited to: Excellent medical, dental, vision coverage, Comprehensive disability and life insurance benefits, Medical malpractice and tail coverage provided, Generous allowances for vacation, sick time, holidays and professional meetings, Reimbursement for society memberships and journal subscriptions, Highly competitive retirement plans with generous employer contribution.

Interested candidates, please be sure to include your current CV and cover letter with application at https:// www.practicematch.com/physicians/job-details.cfm/680063 General Neurologist, Academic Clinician Track—Perelman School of Medicine at the University of Pennsylvania— Philadelphia, Pennsylvania The Department of Neurology at the Perelman School of Medicine at the University of Pennsylvania seeks candidates for an Assistant Professor position in the non-tenure academic clinician track. Expertise is required in the

specific area of General neurology with an interest in spine disease. This would include basic evaluation of common neurological conditions such as headache, neuropathy, seizures, dementia and stroke. A special interest in spine disease including back pain with radiculopathy, spinal stenosis and mechanical disorders is desirable.

Applicants must have an M.D. degree. Board eligible or Certified in Neurology. Teaching responsibilities may include teaching residents and medical students, as well as formal lecture opportunities within the department. Clinical responsibilities may include Outpatient, Inpatient care and Electromyography (EMG). Opportunities to participate in clinical trials may be available. The primary location for this position will be at Pennsylvania Hospital. To apply visit: apply.interfolio.com/89624. We seek candidates who embrace and reflect diversity in the broadest sense. The University of Pennsylvania is an EOE. Minorities/women/individuals with disabilities/protected veterans are encouraged to apply. The University of Pennsylvania values diversity and seeks talented students, faculty and staff from diverse backgrounds. The University of Pennsylvania is an equal opportunity and affirmative action employer. Candidates are considered for employment without regard to race, color, sex, sexual orientation, gender identity, religion, creed, national or ethnic origin, citizenship status, age, disability, veteran status or any other legally protected class. Questions or concerns about this should be directed to the Executive Director of the Office of Affirmative Action and Equal Opportunity Programs, University of Pennsylvania, 421 Franklin Building, 3451 Walnut Street, Philadelphia, PA 19104-6205; or (215) 898-6993 (Voice) or (215) 898-7803 (TDD).  AANnews® Classified Advertising

he AAN offers a complete package of print, online, T and in-person recruitment advertising opportunities.

Visit careers.AAN.com for all AAN options, rates, and deadlines. d copy for the April 2022 print edition of AANnews A must be submitted by March 1, 2022. The same deadline applies to changes/cancellations. he American Academy of Neurology reserves the T right to decline, withdraw, or edit advertisements at its discretion. Every care is taken to avoid mistakes, but the responsibility for clerical or printer errors does not exceed the cost of the ad. 

AANe-news. Because Your Time Is Valuable.

Sent to your email address the second and fourth Wednesday of each month, AANe-news™ delivers the latest top headlines and resources from the Academy so you can quickly scan and connect directly with the information you need to know.

Another members-only solution from your AAN.

AANnews • February 2022

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FEBRUARY 1

Application Available: UCNS Behavioral Neurology & Neuropsychiatry Certification UCNS.org/BNNPcertification Application Available: 2022 Palatucci Advocacy Leadership Forum AAN.com/PALF

MARCH 1

Application Available: UCNS Autonomic Disorders Certification UCNS.org/ADcertification Deadline: UCNS Interventional Neurology Certification UCNS.org/INcertification

MARCH 4

FEBRUARY 15–19

RITE® Exam AAN.com/RITE

Application Deadline: Neurology on the Hill AAN.com/NOH

FEBRUARY 17

MARCH 17

Deadline: Annual Meeting Early Registration AAN.com/AM MEM: 20 FAAN Recruitment Ad—Half Page Horizontal> AN FEBRUARY 18 Placed in AANnews 8.25 x 5.25 +0.125 bleed, Select 4C Deadline: Section Leadership

Elections AAN.com/Synapse

Deadline: Annual Meeting Advance Registration AAN.com/AM

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APRIL 1

Deadline: UCNS Headache Medicine Certification UCNS.org/HMcertification

APRIL 2–7

Annual Meeting in Seattle AAN.com/AM

APRIL 24–26

Annual Meeting Virtual Experience AAN.com/AM

APRIL 26–27

AAN Career Fair Careers.AAN.com

MARCH 28

Application Deadline: Palatucci Advocacy Leadership Program AAN.com/PALF

SHINE A LIGHT ON YOUR ACHIEVEMENTS Apply for a prestigious Fellow of the American Academy of Neurology (FAAN) designation.

AAN.com/FAAN