Susan Jeffrey

April 17, 2015

The nation's capital at the tail end of cherry blossom time is the backdrop this year to the American Academy of Neurology (AAN) 67th Annual Meeting, beginning this weekend.

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

"We're actually delighted to be at the hub of things happening in the spring in Washington, DC. It's going to be beautiful," Dr Rost said. They again expect the largest attendance to an AAN meeting, with the ease of travel to Washington and the fact that the meeting coincides in some states with spring school vacation.

"We're hoping some members will bring their families as well so they can enjoy the meeting but also have some time out with their kids and also enjoy the rest of the Cherry Blossom Festival." It's already underway, she noted, "but I think there's plenty of colors and sun to welcome the AAN in DC next week."

The program is largely similar in format to last year's, since it was "really favorably received," she said, but there are, as always, some novel aspects.

Attendees should watch, for example, for signs of the new "Neuroscience Is Essential" campaign. "It's a slogan but it's also a nationwide campaign that AAN is rolling out to help the professionals as well as the public understand the value of neuroscience in delivering care options for neurological patients, and also delivering a cure," Dr Rost said. "Even though we're a professional organization for neurologists, a lot of neurologists are also essential to neuroscience per se, and we work very closely with purely scientific organizations and I think we have the outreach and base and foundation from which we work in explaining to the public why neuroscience is important."

The AAN plans a booth where members are invited to come in and record a video testimonial on why they think neuroscience is essential in the process of delivering neurologic care. "So I think it will be very interesting, and hopefully these testimonials will live and reach out to the larger public, and that will be an exciting beginning to this campaign," she said.

Further in the interests of reaching out to other specialty organizations, the AAN will feature two sessions bringing important science from other subspecialty meetings, called Invited Science. This year, they have collaborated with the American Heart Association/American Stroke Association and the American Epilepsy Society to bring some of the top science from their major meetings to present to attendees here.

The hope is to bring this subspecialty science in particular to the general neurologist, Dr Rost said. "Nobody can go to all meetings, and general neurologists just don't often get the benefit of having the highly specialized subspecialty science available to them, so we're building these bridges, and hopefully if these two particularly receive good feedback, we'll move on and each year there will be a showcasing from different subspecialties."

As in the past couple of years, the program again notes specialized learning tracks, with specific programs and courses as well as the scientific sessions designated as part of these tracks. "Especially young investigators, I think, would appreciate having some guidance as to which courses may be educational for them with regard to maybe learning the methodologies of clinical research, some of the aspects of academic promotions, et cetera, so that's also clearly marked in the program."

Finally, with regard to the format, "all over the program you will see these advanced and modern ways of communicating with the attendees," she said. "You will see the ePosters, iTalks, the controversies that continue to be popular, you will see highlights, you will see platform blitzes."

The iTalks series, for example, are a series of informal, interactive speakers or panels that will be located in a designated room called the Innovations Room. "The audience is very free, it could be 30 people, it could be 300, and the room is set up to accommodate whatever volume of people is there," she said. "We're anxious — in a good way — to see how it goes."

MOC Session

A session on Monday likely to draw widespread interest will examine changes to maintenance of certification, hosted by the American Board of Psychiatry and Neurology (ABPN), according to the program, "to inform neurologists about the ABPN Maintenance of Certification requirements and recent changes."

"There have been a lot of changes, even over the past year, in discussing what is necessary and what is desirable," to maintain certification, Dr Rost said, changes that have affected specialties across medicine. "We're not a single field that is going through these changes. I think the community is trying to figure out, working with the certifying body ABPN, what is the standard for maintaining certification, and I think the conversation is very productive."

AAN President Timothy Pedley, MD, has been working closely with the ABPN in response to concern from the body of neurologists, and has twice communicated by open letter to the AAN membership about what is an ongoing process, Dr Rost said. "I think there was a sense perhaps in the initial wave of certification that some of the elements were excessive or may not be necessarily reflective of the activities that practising clinicians do," she said, "and the ABPN was very responsive."

She plans to attend this session herself in light of her own upcoming certification "because there are probably going to be changes to the process," Dr Rost said.

ABPN Maintenance of Certification Information Session: Monday, April 20, 1:30 pm to 3:00 pm, Marriott Independence Ballroom Salons ABCD (Level M4).

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 process was again focused on merit selection and peer review, Dr Rost noted. "A recurrent theme for us is to make sure that's it's not just late-submitted science, but it's really at the cutting edge of what's happening."

They were pleased to see a variety of clinical trials submitted "because in the end, we all want to see the results of our scientific labor being brought to a practical application," she noted. "Some of these abstracts have been exemplary in that sense."

Among the interesting findings are preliminary phase 1b results with a monoclonal antibody, aducanumab (BIIB037, Biogen), in patients with mild or prodromal Alzheimer's disease. Results of the PRIME trial were presented at the International Conference on Alzheimer's and Parkinson's Diseases (AD/PD 2015); results here will look at findings by disease stage, or APOE ε4 status.

A novel compound for super-refractory status epilepticus in the SAGE trial and one for Huntington's disease will also be of great interest, Dr Rost said. Studies also include two pediatric trials, including one using a cannabis product for seizures, "obviously a hot topic," she noted.

Preliminary results of some 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 Randomized, Double-Blind, Placebo-Controlled, Phase IB Study of Aducanumab (BIIB037), an Anti-AB Monoclonal Antibody, in Patients With Prodromal or Mild Alzheimer's Disease: Interim Results By Disease Stage and APOE4 Status Jeffrey J. Sevigny, MD
002 Imaging Microglial/Macrophage Activation in the Early Stage of Alzheimer's Disease: A PET Study Using [18F]DPA-714 Coupled With PiB Lorraine Hamelin
003 The Burden of Neurological Disorders (1990-2013); Preliminary Findings of the Global Burden of Disease 2013 Study Maziar Moradi-Lakeh, MD, MPH
004 Phase I/II Trial of SAGE-547 in Super-Refractory Status Epilepticus Stephen Kanes, MD, PhD
005 Epidiolex (Cannabidiol) in Treatment Resistant Epilepsy Orrin Devinsky, MD
006 Oral Fingolimod Versus Placebo in Patients With Primary Progressive Multiple Sclerosis (PPMS): Results of the INFORMS Phase III Trial Fred D. Lublin, MD
007 PML Risk Stratification Using Anti-JCV Antibody Index and L-selectin (CD62L) Nicholas Schwab, PhD
008 Evidence of Remyelination with the Anti-LINGO-1 Monoclonal Antibody BIIB033 After Acute Optic Neuritis Diego Cadavid, MD
009 Subcutaneous Natalizumab 300mg Every 4 Weeks Is Comparable to Standard Intravenous Dosing in REFINE: A Study Exploring the Safety, Tolerability, and Efficacy of Multiple Natalizumab Treatment Regimens in Patients With Relapsing Multiple Sclerosis Maria Trojano, MD
010 NNZ-2566: A Novel, Experimental Treatment for Adolescent and Adult Females With Rett Syndrome Daniel G. Glaze, MD
011 SMN2 Splicing Modifier RG7800 Shows Dose-Dependent Increase of Full Length SMN2mRNA in First-In-Human Study Heidemarie Kletzl, PharmD, PhD
012 First Time Use of SD-809 in Huntington Disease (First-HD) Samuel A. Frank, MD
013 Topically Applied Ketoprophen Gel (ELS-M11) in the Treatment of Severe Migraine Pain Wolfgang Liedtke, MD, PhD
014 OnabotulinumtoxinA Treatment in Adult Patients With Post-stroke Lower Limb Spasticity: Results From a Double-Blind, Placebo-Controlled, Phase 3 Clinical Trial Theodore Wein, MD

The Emerging Science Session will be held Wednesday, April 22, from 6:15 pm to 7:45 pm.

Integrated Neuroscience Sessions

Twelve Integrated Neuroscience Sessions are again planned, Dr Rost said. Topics are designed with a vertically integrated four-hour session on a specific topic. The sessions incorporate expert talks giving background and context to the area, followed by top abstracts in that research area. Some are presented as a short "data blitz" presentation followed by questions and answers, and some as moderated poster sessions.

Six of these are combined with educational programs as part of Subspecialty in Focus tracks, she noted. For example, I1, on neuroophthalmology, was developed in collaboration with the North American Neuro-Ophthalmology Society. "There's a lot of science in this group so they've been able to put together an outstanding sessions," she noted. "We haven't had a neuro-ophthalmology session like that in a while so I think there was a lot of excitement about that."

Other sessions cover management of asymptomatic vascular lesions, such as aneurysms and carotid stenosis, and dopamine-mediated neuroplasticity in movement disorders. An interesting session looks at paraneoplastic encephalopathies, cancers presenting first as neurologic deterioration mediated by an immune response, that have in the past been controversial.

"The leading expert in the world on this, Dr Joseph Dalmau [MD, PhD, who helped to coordinate the session] has worked for a long time to flesh out this concept and has shown over and over again in his studies the evidence for these paraneoplastic antibodies," she said. "It's now been well accepted in the field and I think it will be an exciting session to pioneer at the AAN."

Saturday

  • I1 New Windows into the Brain: Technological Advances in Frontline Neurologic Diagnosis via the Visual and Oculomotor Systems: 8 am to noon

  • I2 Management of Asymptomatic Cerebrovascular Lesions: 1 pm to 5 pm

Sunday

  • I3 Dopamine-mediated Neural Plasticity in Motor and Non-motor Circuits: 8 am to noon

  • I4 Infectious, Paraneoplastic, and Autoimmune Encephalopathies: Advances in Clinical Diagnosis and Emerging Insights about Pathogenesis: 1 pm to 5 pm

Monday

  • I5 Pediatric Neurotrauma: From Coma to Concussions: 8 am to noon

  • I6 Future Therapies: How We Will Be Treating, Preventing and Curing Epilepsy in the Year 2025: 1 pm to 5 pm

Tuesday

  • I7 The Global Burden of Neurological Infections: Epidemiology, Treatment and Prevention: 1 pm to 5 pm

  • I8 Advances in ALS and Other Motor Neuron Diseases: 1 pm to 5 pm

Wednesday

  • I9 Treating Dementia in an Age of Mixed Disease: 2 pm to 6 pm

  • I10 The Dynamic Brain in Health and Disease: Plasticity and Reprogramming: 1 pm to 5 pm

Thursday

  • I11 The Promise of Novel Biomarker Approaches in Advancing Treatment: 1 pm to 5 pm

  • I12 Obesity and Neurological Disorders: 1 pm to 5 pm

Controversies in Neurology

The Controversies in Neurology plenary forum has proven to be "tremendously successful" and has become a regular part of the program, Dr Rost said.

Again chaired by Joseph Jankovic, MD, and Walter Rocca, MD, there are three major topics. The first looks at whether whole exome sequencing is ready to be part of neurologic care today. Christine Klein, MD, from the University of Luebeck, Germany, takes the pro argument, and Claes Wahlestedt, MD, PhD, University of Miami Miller School of Medicine, Florida, takes the con.

A second talk looks at whether stem cells, which have held promise in addressing neurologic disease, are really ready for clinical trials. Clive Svendsen, PhD, Cedars-Sinai Medical Center, Los Angeles, California, will argue they are, and C. Warren Olanow, MD, from Mount Sinai Medical Center, New York, will discuss why they are not.

Finally, a particularly hot topic today looks at whether neurologists should prescribe opioids for neurologic pain, with Charles E. Argoff, MD, Albany Medical Center, and Gary M. Franklin, MD, MPH, University of Washington, Seattle, taking opposing sides of this question.

  • Should Whole Exome Sequencing Be Part of Neurologic Care Today?

  • Is the Science of Stem Cells Ready for Clinical Trials in Neurologic Disease?

  • Should Neurologists Prescribe Opioids for Neurologic Pain?

The 2015 Controversies in Neurology Session will be held Thursday, April 23, 5:30 pm to 7 pm.

Plenary Sessions

Finally, the major plenary sessions will generate a lot of interest.

Among these, the Presidential Plenary on Tuesday, again moderated by Lisa M. DeAngelis, MD, chair of the Science Committee, features lectures by leading researchers in their fields, including outgoing AAN president Dr Pedley taking the Presidential Lecture.

Dr Rost will co-moderate the Clinical Trials Plenary on Friday afternoon in which clinical trials, some new and some already presented elsewhere, will be discussed, including new data from trials in Lambert-Eaton myasthenia syndrome, progressive MS, and Duchenne muscular dystrophy.

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

  • Presidential Plenary Session: Tuesday, April 21, 9 am to noon

  • Hot Topics Plenary Session: Tuesday, April 21, 5:30 pm to 6:45 pm

  • Contemporary Clinical Issues Plenary Session: Wednesday, April 22, 9:00 am to noon

  • Frontiers in Clinical Neuroscience Plenary Session: Thursday, April 23, 9:00 am to noon

  • Clinical Trials Plenary Session: Friday, April 24, noon to 1:30 pm

  • Neurology Year in Review Plenary Session: Friday, April 24, 4:30 pm to 6:00 pm

Medscape Medical News coverage from onsite reporters will begin April 20. 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) 67th Annual Meeting. April 18-24, 2015, Washington, DC.

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