Susan Jeffrey

April 25, 2014

The home of Independence Hall and the Liberty Bell will play host to the American Academy of Neurology (AAN) 66th Annual Meeting beginning this weekend.

Natalia Rost, MD, MPH, FAAN, director of the Acute Stroke Service at Massachusetts General Hospital, associate professor of neurology at Harvard Medical School, Boston, and vice-chair of the AAN Science Committee, discussed the upcoming meeting in Philadelphia with Medscape Medical News.

"First of all, we're back to our April schedule as opposed to last year being earlier in the year, and we're very excited to be going to Philadelphia, because it's an outstanding destination," Dr. Rost said. "It's a city that's very well prepared for large groups of attendees and has a lot to offer both from an historical aspect and the community sense — the neurology community in Philadelphia is very active, so we get a lot of support for the activities at the annual meeting, including the social program, so we're very excited."

In fact, registration is on track for among the largest attendance of any previous meeting, in terms of both US and international attendees, she noted.

Again this year, the AAN will be sponsoring their Brain Health Fair for the local community that hosts the meeting. The fair will be held on the first Saturday of the meeting, April 26, and will educate the community about various aspects of brain health. "We always work with the local neurology programs, and this year we're working very closely both with the adult and pediatric neurologists," Dr. Rost said. "As you know, the Children's Hospital of Philadelphia has a great pediatric neurology program, and Dr. Brenda Banwell, who is chair there, is very active in supporting this initiative."

One of the major overall thrusts of the meeting is a new focus on encouraging networking, particularly for international and younger attendees. "Feedback we've received in the past is that the program is so intense that people have limited opportunity to really talk to each other," Dr. Rost said. "So this year we are taking an hour between noon and 1 pm and making that an hour free from official programming. So you can take the time and meet with your colleagues and make it a networking opportunity."

Another networking feature they have programmed in is called "Meet to Eat," a free service provided by AAN to arrange dinner reservations for groups, a sort of concierge service. The "International Experience" is a space designated for international attendees to meet and network.

Dr. Natalia Rost

Program Adjustments

The logistics of program this year are somewhat different, Dr. Rost notes. "Everyone who is going to pick up either an electronic or a paper copy of the program will see that finally, in response to many requests throughout the years, we've changed the layout of the program and we have a new designation for the sessions," she said.

It's a long meeting, and there has been confusion about which sessions are included with registration and which require an additional fee, as well as following the various tracks.

"When you look at the program, I think you're going to like the way it's organized," she said. "We now have clear designations. For example, if it's an Integrated Neuroscience program, you're going to have a capital 'I' near that in the program and you'll know that it's a free program, because all science is free at the AAN.

"If it's a 'C', that would be a course, and that will be a paid education program. So people can know where they are in the day, and what are the provisions of attending."

Emerging Science

As always, interest will be high in the Emerging Science session, where some of the most recently available and cutting-edge data are selected to be presented for the first time. The platform sessions are down to 10 oral presentations from 12 last year, with additional poster presentations.

"We really pulled away from the 'late-breaking' science context, where sometimes it wasn't late-breaking science, it was really just late," Dr. Rost said wryly. "So we actually screened a large number of submissions — I think this year we had almost 70 submissions for the Emerging Science — but we really are looking for the work that comes out on the cusp of discovery," and was not yet complete and available for submission to the regular AAN program.

Some papers are brand new, while others are consolidating work that was previously presented and is in a new phase, she explained. "For example, I wanted to highlight abstract number 004, on florbetaben PET [positron emission tomography] scan excluding amyloid angiopathy in a phase 3 trial," she said. Work in this area is important in defining populations for clinical trials, for example. "So this is providing us with a neuroimaging surrogate biomarker which allows you to actually differentiate a specific subtype of dementia."

Another paper looks at potential mechanisms by which botulinum toxin may be effective in treating migraine headache, while another highlights the link between silent cerebrovascular disease and decline in cognitive function.

Preliminary results of some but not all of the abstracts have already been released by the AAN in advance of the meeting, and Medscape Medical News coverage of these can be found here.

Pub. Title Presenter
001 Drisapersen Treatment for Duchenne Muscular Dystrophy: Results of a 96-Week Follow-up of an open-Label Extension Study Following Two Placebo-Controlled Trials Nathalie Goemans, MD
002 Selective Inhibition of Meningeal Nociceptors by Botulinum Neurotoxin Type A (BoNT-A): Therapeutic Implications to Migraine and Other Pains Rami Burstein, MD
003 Asymptomatic Carotid Stenosis Is Associated With Cognitive Dysfunction Moira Dux, MD
004 A Negative Florbetaben PET Scan Reliably Excludes Amyloid Pathology as Confirmed by Histopathology in a Large Phase 3 Trial Marwan Sabbagh, MD
005 Coincident Alzheimer's Disease Modifies Alpha-Synuclein Pathology in Lewy Body Disease Jon Toledo, MD
006 Results of a phase 2 study of ISIS-SMNRx in Children With Spinal Muscular Atrophy Claudia Chiriboga, MD
007 Oral Sialic Acid Extended Release (SA-ER) Stabilizes Upper Extremity Muscle Strength in Human GNE Myopathy: A Phase 2 Study Zohar Argov, MD
008 Alemtuzumab Improves Brain MRI Outcomes in Patients With Active Relapsing-Remitting Multiple Sclerosis: 3-Year Follow-up of the CARE-MS Studies Douglas Arnold, MD
009 The Relationship Between Peripheral B-Cell Levels and MRI Disease Activity in Relapsing Remitting Multiple Sclerosis (RRMS) Daren Austin, MD
010 Prolonged-Release Fampridine Treatment and Walking Ability and Balance in Patients With Multiple Sclerosis: Results of the Randomized, Double-Blind MOBILE study Jan Lycke, MD

 

The Emerging Science Session will be held Wednesday, April 30, from 6:15 pm to 7:30 pm.

Integrated Neuroscience Sessions

While the new sessions always command attention, the Integrated Neuroscience Sessions are "still the premier science" at the meeting, Dr. Rost said. Topics are designed with a vertically integrated 4-hour session on a specific topic, incorporating expert talks giving background and context to the area, followed by top abstracts in that research area, some presented as a "data blitz," followed by questions and answers, and some as moderated poster sessions.

"For example, one of the sessions is the burden of global burden of neurological disease," Dr. Rost noted. "Because we are seeing such a high attendance of international participants, we thought it would be great to highlight the concepts of global neurological disease burden."

The integrated sessions are being combined in some cases with education courses in 6 "Subspecialty in Focus" (SIF) tracks aimed at subspecialists. The SIF 6 tracks this year are cerebrovascular disease, epilepsy, child neurology, sleep disorders, sports neurology/government services, and geriatric neurology.

Sunday

Monday

Tuesday

Wednesday

Thursday

Friday

Controversies in Neurology

Now 2 years in, the Controversies in Neurology plenary forum has proven to be "tremendously successful" and has become a regular part of the program, Dr. Rost said. "We got an overwhelming squall of approval for this, literally standing room only at the plenary session last year," she said.

Again chaired by Dr. Joseph Jankovic and Dr. Walter Rocca, there are 3 major topics for this year. One is whether preventing relapses prevents the progressive phase of MS. "On one hand you would think that if you prevent the worsening along the way, you may be slowing the overall disability, but there is some controversy about it still," said Dr. Rost. Maria Trojano, MD, and Helen Tremlett, PhD, BPharm, will take on opposing sides of that issue.

A second talk looks at the question arising from highly anticipated results of the recently reported ARUBA (A Randomized trial of Unruptured Brain Arteriovenous malformations) that showed better outcomes with a conservative than with an interventional approach to unruptured arteriovenous malformations (AVMs). Discussants will be Robert M. Friedlander, MD, taking the position that intervention is useful, and J.P. Mohr, MD, the legendary stroke neurologist who served as principal investigator of ARUBA, taking the opposing position, Dr. Rost notes.

Finally, a particularly hot topic in light of developments in both medical and consumer spheres is the question of whether neurologists should prescribe marijuana for their patients with neurologic disorders. Barbara S Koppel, MD, and John C.M. Brust, MD, will be discussants. "This controversy came up as the Science Committee was discussing these topics, and I think it's going to be a fantastic discussion," Dr. Rost said.

The 2014 Controversies in Neurology Session will be held Thursday, May 2, 5:30 pm to 7 pm:

  • Does Preventing Relapses Prevent Against Progressive MS

  • Is Intervention for Asymptomatic AVM Useful?

  • Should Neurologists Prescribe Marijuana?

Plenary Sessions

Finally, the major plenary sessions will also draw a lot of attention. "I have to say we have, again, outstanding plenaries," Dr. Rost said. "The process that goes into selecting these speakers is highly competitive. We consider what is cutting edge in the context of the plenaries, and try to find presenters whose depth of understanding the subject and skillful delivery cover every angle of the scientific matter.

"Extensive discussions and a voting process often decides our selection of finalists out of a great pool of talent out there," she said.

The Presidential Plenary on Tuesday, moderated by Lisa M. DeAngelis, MD, chair of the Science Committee, features lectures by leading researchers in the field. Among these, the Presidential Lecture is given this year by James L. Bernat, MD, discussing challenges to the ethics and professionalism of today's neurologists, and the Robert Wartenburg Lecture will be given by David M. Holtzman, MD, who will examine the road forward in Alzheimer's disease.

Dr. Rost will moderate the Clinical Trials Plenary on Friday afternoon, presenting some of the top trial results in the field, including those that were first presented at the most recent subspecialty meetings, such as FAST-MAG (Field Administration of Stroke Therapy–Magnesium Phase 3 Clinical Trial), which studied prehospital magnesium in acute stroke. Other trials included are the TOPIC trial of teriflunomide in multiple sclerosis, the NORDIC (Neuro-Ophthalmology Research Disease Investigator Consortium) study on acetazolamide in idiopathic intracranial hypertension, newly published in JAMA; and a dual presentation of 2 phase 2 trials of monoclonal antibodies for the prevention of migraine, early results of which were just released in advance of presentation during the Emerging Science session at this meeting.

Full listings of presenters and moderators at this year's plenary sessions can be found here.

Presidential Plenary Session: Tuesday, April 29, 9 am to noon

  • Hot Topics Plenary Session: Tuesday, April 29, 5:30 pm to 6:30 pm

  • Contemporary Clinical Issues Plenary Session: Wednesday, April 30, 9:00 am to noon

  • Frontiers in Clinical Neuroscience Plenary Session: Thursday, May 1, 9:00 am to noon

  • Clinical Trials Plenary Session: Friday, May 2, noon to 1:30 pm

  • Neurology Year in Review Plenary Session: Friday, May 2, 5:30 pm to 7:00 pm

Selected abstracts from the meeting have been prereleased, and news coverage of these is already available on Medscape Medical News' AAN Annual Meeting collection page. Medscape Medical News coverage from onsite reporters will begin Monday.

To search the AAN scientific or educational programs, visit the AAN Web site. Follow the annual meeting Twitter feed using #AANAM.

American Academy of Neurology (AAN) 66th Annual Meeting. April 26-May 2, 2014, Philadelphia, Pennsylvania.

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