Susan Jeffrey

April 14, 2016

Vancouver, British Columbia, Canada, is the destination for neurologists this year at the American Academy of Neurology (AAN)'s 2016 Annual Meeting starting this week.

"We're going back to Canada and we're excited about it," Natalia Rost, MD, MPH, associate director of the Acute Stroke Service at Massachusetts General Hospital, associate professor of neurology at Harvard Medical School, Boston, Massachusetts, and vice-chair of the Science Committee, told Medscape Medical News. "It's a very exciting city, with the mystique of the Pacific Northwest — the interface with nature, a different culture with a strong aboriginal influence, and I think it also has the glamor of an Olympic city."

The Vancouver Convention Center is among the most beautiful in North America and is actually listed among the top attractions in the city in itself because of its breathtaking views, she noted. "So that will be a big bonus for all of us."

The meeting itself is "new and improved," she said. For a start, it's 1 day shorter and "completely revamped," she said. "We basically now have science every day of the week. Starting Friday there is a plenary session every day, which is a big change because in previous years we did not have any plenary sessions on the Saturday and Sunday of the meeting, so that's new."

"We also have platform and poster sessions available every day starting Saturday, and those sessions are actually grouped in a way that they are in three discrete times per day: 6:30 am for the early birds, 1:00 to 3:00 pm, and then 3:30 pm to 5:30 pm," with poster presenters standing by between 5:30 and 7:00 pm.

"This is just an attempt to reorganize and streamline the science at the AAN. There are a lot of different ways that we present science, and the variety of types of events are very broad, and so we needed to kind of shake things up and makes things a little bit more streamlined," she said.

Every year, they include a new experimental format, and this year it is a half-day program called "Frontiers in Child Neurology," Dr Rost noted.

Child neurology is an important part of neurology and very much multidisciplinary, interfacing with multiple non-neurology specialties, including pediatrics, genetics, metabolism, and related disciplines, she said. "So we've been trying for years within the AAN scientific community to cultivate the subspecialty of pediatric neurology, and provide as much support and attention to this important subset of experts," she said. "So we created this half-day program specifically to highlight child neurology, and there is an element of cultivating careers; how do we develop a community of pediatric neurologists?"

There are also issues of transitioning of care, she said. "Obviously patients with pediatric neurological conditions grow up, and very frequently it's very difficult for these patients to find homes in adult neurology clinics, so we're discussing this and then basically scientific developments in the subspecialty as well. So this is going to be an interesting half-day program."

Frontiers in Child Neurology: Cultivating Careers, Transitioning Care, and Highlighting Scientific Developments: Saturday, April 16, 2016, 11:30 am to 4:30 pm.

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.

Among these new investigations is a phase 2 trial of clemastine fumarate for remyelination of chronic optic neuropathy in multiple sclerosis (MS). "Optic neuropathy in multiple sclerosis is one of the leading sources of disability, and the problem is that by the time the damage is done, there's really not much you can do to restore it," Dr Rost said. Using visual evoked potentials, these researchers were able to show evidence of remyelination for these patients with clemastine vs placebo.

Another abstract looks at using diffusion tensor imaging to look for evidence of traumatic brain injury among retired but living National Football League players. "This is a continuation of a topic that took us by storm," she said. "I think this is very important and goes beyond just defining this syndrome in football players; I think it's setting the field to understand how closed-brain injury affects brain cells and connections in the larger population."

Preliminary results of some 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 Efficacy of Eslicarbazepine Acetate Versus Controlled-Release Carbamazepine as Monotherapy in Patients With Newly Diagnosed Partial-Onset Seizures Elinor Ben-Menachem, MD
  Safety and Tolerability of Eslicarbazepine Acetate as Monotherapy in patients With Newly Diagnosed Partial-Onset Seizures Pedro Kowacs, MD
003 Cerebrospinal Fluid Findings in Ebola Survivors with Neurological Sequelae Bridgette Billioux
004 Neurologic Manifestations of Arboviruses in the Epidemy of Pernambuco, Brazil Maria Lucia Brito Ferreira, MD
005 Incidence of Traumatic Brain Injury (TBI) in Retired NFL Players. Correlation with Diffusion Tensor (DTI) MRI and Neuropsychological Testing Francis Conidi, MD, DO
006 Sports Related Concussion Diagnosis Using Advanced Measures of Cerebrovascular Reactivity (PPMS): Results of the INFORMS Phase III Trial Robert Hamilton
007 Effect of Propranolol and Clonidine On Mechanically Ventilated Patients with Severe Traumatic Brain Injury: The DASH After TBI Randomized Control Trial Mayur Patel, MD, MPH
008 Positive Phase II Double-Blind Randomized Placebo-Controlled Crossover Trial of Clemastine Fumarate for Remyelination of Chronic Optic Neuropathy in MS Ari Green, MD
009 Natalizumab Versus Placebo in Patients With Secondary Progressive Multiple Sclerosis (SPMS): Results From ASCEND, a Multicenter, Double-Blind, Placebo-Controlled, Randomized Phase 3 Clinical Trial Deborah Steiner, Steiner
010 ADVANCE Phase 3 Extension Study (ATTAIN): Peginterferon Beta-1a 125 mcg Every 2 Weeks Demonstrated Sustained Efficacy in RMS Patients Treated up to 5 Years Damian Fiore
011 Evaluation of the NEDA (No Evidence of Disease Activity) Measure for Predicting Long-Term Outcomes From the Pivotal Trial of Interferon Beta-1b in Multiple Sclerosis Douglas Goodin, MD
012 GDF-15, Lactate as Well as Clinical Grading Scale Was Improved by Sodium Pyruvate Therapy in Mitochondrial Myopathy Michio Hirano, MD
013 Orally-Administered TRPV1 and TRPA1 Activators Reduce Night Leg Cramps in a Randomized, Blinded, Placebo-Controlled, Crossover Human Trial Jennifer Cermak
014 ADS-5102 (Amantadine HCl) Extended-Release Capsules Reduced Levodopa-Induced Dyskinesia in the Phase 3 EASE LID Study Rajesh Pahwa, MD

 

The Emerging Science Session will be held Tuesday, April 19, from 5:45 pm to 7:15 pm.

Integrated Neuroscience Sessions

Integrated Neuroscience Sessions, featuring some of the major developing areas in neurologic practice, have been increased this year to 13 over the 12 such sessions held in previous years.

"I probably say this every year, but I continue to think of this way of presenting science at the AAN as one of the premier scientific sessions because it has this vertical integration of cutting-edge, state-of-the-art expert presentations on the topics we are covering, the best platform presentations in a data blitz format that highlights some of the live research that's going on at the clinical and also benchside, and then we have a poster session, which is basically a professor-led rounds," Dr Rost said.

Saturday

  • I1 Redefining Parkinson's Disease: Novel Approaches to Understanding the Mechanisms and Developing Treatments: 1:00 pm to 5:30 pm

  • I2 Stroke in the Elderly and Young: Challenges for the Next Decade: 1:00 pm to 5:30 pm

Sunday

  • I3 New and Emerging Therapeutic Options in Migraine and Other Headache Disorders: 1:00 pm to 5:30 pm

  • I4 Advances in Acquired and Genetic Muscle Diseases: 1:00 pm to 5:30 pm

  • I5 Sex-Related Factors in Neurological Disease: 1:00 pm to 5:30 pm

Monday

  • I6 Future Directions and Challenges in Stroke Team Action Therapy (STAT): 1:00 pm to 5:30 pm

  • I7 The Human Connectome: Implications for Clinical Neurology: 1:00 pm to 5:30 pm

  • I8 Emerging Technologies for Neurological Research and Care: #Emerging-Tech #Neurologist @AAN

Tuesday

  • I9 Sleep, Clocks, and Alzheimer's Disease: 1:00 pm to 5:30 pm

  • I10 Remyelination and Repair in Multiple Sclerosis: 1:00 pm to 5:30 pm

Wednesday

  • I11 Neurocritical Care and Neuroscience Crossroads: From Bench to Bedside: 1:00 pm to 5:30 pm

  • I12 Amyloid and Beyond: From Bench to Bedside: 1:00 pm to 5:30 pm

Thursday

  • I13 Sports-Related Concussion: Vision and Vestibular Insights: 1:00 pm to 5:30 pm

Invited Science Sessions

Invited Science Sessions promote "cross-pollination" between neurologic societies, bringing the best science from subspecialty meetings to be presented at the AAN meeting, Dr Rost noted. Last year, it was science from the American Stroke Association International Stroke Conference and the American Epilepsy Society.

This year, research from the Movement Disorders Society's International Congress of Parkinson's Disease and Movement Disorders (MDS), held in June 2015, and the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS), held in September 2015.

The societies provide a list of their top 10 papers and AAN invites six of these researchers to present their data at the annual meeting.

  • Invited Science MDS: Tuesday, April 19, 3:30 pm to 5:30 pm

  • Invited Science ECTRIMS: Wednesday, April 20, 3:30 pm to 5:30 pm

Controversies in Neurology

This year, the Controversies in Neurology plenary session looks at some of the most pressing clinical questions in neurology. Chaired by Joseph Jankovic, MD, and Aleksandar Videnovic, MD, it features three major topics. Attendees will be polled before and after the debates to see how they may have been swayed by the discussion.

The first debate looks at whether cognitive-enhancing activities can really stave off dementia. "There is a lot of discussion with regard to whether cross-word puzzles or Sudoku, and not just what's freely available, but paid cognitive activities which have been marketed to our patients extensively, do they actually help prevent dementia," Dr Rost said.

A second debate will examine to what extent vascular risk factors may contribute to parkinsonism. "Stroke risk factors may also affect the progression of Alzheimer's disease," Dr Rost said. "Now we're seeing similar things in the field of Parkinson's, where patients with Parkinson's disease may have elements of subcortical white matter changes, and all sorts of features of silent brain infarcts affecting the disease progression. So there's going to be some discussion on whether vascular disease may also be contributing to the pathophysiology of parkinsonism."

Finally, a particularly hot topic — and potentially heated discussion — will be whether early aggressive treatment is better than an approach of slower escalation for most patients with multiple sclerosis. "There are pros and cons on both sides, and people feel very passionate; not just professionals but patients as well, who committed to getting this issue cleared up," she said.

  • Cognitive Enhancing Activities: Do they Prevent Dementia?

  • Is Vascular Etiology a Common Cause of Parkinsonism?

  • Is Early Aggressive Treatment a More Beneficial Approach Than Escalation of Treatment for Most Patients with MS?

The 2016 Controversies in Neurology Session will be held Monday, April 18, 9:00 am to 11:30 am.

Plenary Sessions

Finally, the major plenary sessions are also on the agenda. The Presidential Plenary Session, chaired by Lisa M. DeAngelis, MD, chair of the AAN Science Committee, features this year's award lecturers. The Presidential Lecture will be given by Brent C. James, MD, Institute for Health Care Delivery Research at Intermountain Health Care, Salt Lake City, Utah. The George C Cotzias Lecture will be given by Josep O. Dalmau, MD, PhD, from the University of Barcelona, Spain, and the University of Pennsylvania, Philadelphia; Elizabeth M. Berry-Kravis, MD, PhD, takes the Sidney Carter Award in Child Neurology; and Jerome Engel, Jr, MD, PhD, will give the Robert Wartenburg Lecture.

The Clinical Trials Plenary Session, comoderated by Dr Rost, has some very interesting new data, she noted. This session was developed 7 years ago with the aim of highlighting data that move neurologic care forward. "We always were perceived as a kind of a 'diagnose and adios' specialty, but we actually were having active investigations that attempted throughout the decades to bring new treatments," Dr Rost said. "So now we're kind of at the peak of harvesting these results of large-scale investigations."

Trial results include phase 3 results testing use of dichlorphenamide in periodic paralysis, "which is a rare condition, but quite debilitating," she noted, so having assembled enough patients to have a trial was already "impressive." Preliminary results will be presented from a trial of gene therapy in childhood cerebral adrenoleukodystrophy, "a deadly disease that now we may have therapeutic options for," she added. The KINECT-3 trial looks at a potential treatment for tardive dyskinesia, a debilitating effect associated with long-term levodopa therapy in Parkinson's disease.

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

  • Presidential Plenary Session: Sunday, April 17, 9 am to noon

  • Hot Topics Plenary Session: Friday, April 15, 5:30 pm to 7:00 pm

  • Contemporary Clinical Issues Plenary Session: Saturday, April 16, 9:00 am to 11 am

  • Frontiers in Neuroscience Plenary Session: Tuesday, April 19, 9:00 am to 11:30 pm

  • Clinical Trials Plenary Session: Wednesday, April 20, 9:00 am to 11:00 am

  • Neurology Year in Review Plenary Session: Thursday, April 21, 9:00 am to 11:30 am

Medscape Medical News coverage from onsite reporters will begin Saturday, April 16; follow us on Twitter (@MedscapeNeuro). To search the AAN scientific or educational programs, visit the AAN Web site. Follow the annual meeting Twitter feed using #AANAM.

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