Susan Jeffrey

April 19, 2017

Neurologists will gather in Boston, Massachusetts, this year for the American Academy of Neurology 2017 Annual Meeting (AAN). The meeting starts Saturday April 22 and runs to Friday April 28.

"I'm particularly excited to welcome everybody to my hometown," said Natalia Rost, MD, MPH, 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. "We'll be on our best behavior with the weather, and I promise there will be no more snow, even though we had snow on April 1," she said. "The flowers are blooming, the sky is blue, and I hope everyone enjoys their week in Boston."

Dr Rost reviewed the program with Medscape Medical News and pointed to a number of major changes in how attendees will experience the meeting.

"One of the features that is so intrinsic to the [AAN] is the desire to innovate with regard not to just the content but also the delivery of knowledge," she said. People learn in many different ways, she noted, and in setting the program, they have tried to create a variety of learning settings.

Top of the list is the introduction of Neuroscience in the Clinic sessions. "Gone are the Integrated Neuroscience Sessions that for years have been our focus of delivering hard core research with the experts' perspective on it," Dr Rost said. "The reason they are gone is because we thought in the current environment, the amount of information we're processing is so high that we needed to shorten the program," from 4.5 to 2 hours, she said. Further, the most important element of integration between clinical and bench science, "has not always worked in the past."

In their place, nine Neuroscience in the Clinic sessions will attempt more of a "dialogue," starting with a case presentation by a clinician to put the concept into a clinical context, then a researcher or scientist discussing scientific underpinnings, followed by discussion of current management and treatments, further examination of the historical context of these management options, and finally a discussion panel.

"So this is going to be something I think very interesting, because for the first time we're actually having this real back and forth between the clinical side of the story and its scientific underpinning, and on the other hand, we'll have a much more interactive approach to the session, considering the audience will be able to ask questions right away and potentially also bring their perspective into the discussion as they're dealing with certain issues," Dr Rost said.

Neuroscience in the Clinic Sessions

  • N1 Neuroscience in the Clinic: Neurobiology and Treatment of Disorders of Language and Action, Sunday, April 23, 1:00 pm to 3:00 pm

  • N2 Neuroscience in the Clinic: Child Neurology: Neurologic Disorder Through a Lifespan — A Focus on MS, Sunday, April 23, 3:30 pm to 5:30 pm

  • N3 Neuroscience in the Clinic: Cutting Edge Concussion Data from the NCAA-DoD Grand Alliance, Monday, April 24, 1:00 pm to 3:00 pm

  • N4 Neuroscience in the Clinic: Zika Virus: The Global Outbreak of a Neurotropic Virus, Tuesday, April 25, 1:00 pm to 3:00 pm

  • N5 Neuroscience in the Clinic: Stress and Neurologic Diseases: What Is It, and What Is the Provider to Do? Wednesday, April 26, 1:00 pm to 3:00 pm

  • N6 Neuroscience in the Clinic: Functional Recovery in Neurology and Neuroscience, Wednesday, April 26, 3:30 pm to 5:30 pm

  • N7 Neuroscience in the Clinic: Dopamine Transporter (DaT) Imaging, Thursday, April 27, 1:00 pm to 3:00 pm

  • N8 Neuroscience in the Clinic: Novel Therapeutic Targets in Critical Care Neurology: Intracerebral and Intraventricular Hemorrhage, Thursday, April 27, 3:30 pm to 5:30 pm

  • N9 Neuroscience in the Clinic: Afferent and Efferent Visual Pathway Manifestations of Neurodegenerative Diseases: Implications for Diagnosis and Treatment, Friday, April 28, 1:00 pm to 3:00 pm

"Best of" Scientific Platform Sessions

For the first time, they have gathered the top papers in a variety of disease states into single sessions that will feature the most highly ranked abstracts.

"In each disease category, we’ve identified the top 4 abstracts submitted for presentation," Dr Rost said. "These are the ones that normally would have gone into a regular oral platform presentation, but we really picked the best, highest-scored abstracts and arranged them in subspecialty specific sessions." There are six of these sessions that will occur every day of the week, starting Sunday.

"This will allow presentation time that's more lenient with regard to the timing for questions and answers, so I think this is also going to be of high interest — something that's worth waking up early for," Dr Rost said. "They start at 8 am, prior to plenary sessions and we will expect fairly high attendance."

  • "Best of Scientific Platform Sessions. Sunday to Thursday, 8:00 am to 9 am (program pages 48-49)

Shorter Oral Presentations

Another innovation is shorter oral platform presentations, now reduced to 12 minutes each. "By cutting just a few minutes from each presentation, which basically asks the presenters to be slightly more efficient, we were able to allocate some time for discussion at the end of oral platforms," Dr Rost said. "Traditionally, oral platforms are simply the presentation, maybe a couple of questions, and then moving on."

Instead, this year, an invited expert in the field will review the abstracts and give what amounts to an executive summary, synthesizing major points and attempting to underline how to put the new data into clinical context. "I think there will be more people staying in for the whole session because they'll be interested in how to put it all together into context from the bird's eye view," she said.

Poster Neighborhoods

Another innovation are what they are calling "Poster Neighborhoods," Dr Rost noted. "We get a tremendous amount of scientific submissions — over 2,700 abstracts were received — and these are challenging to navigate, especially in a poster hall," she said. "So what we've done this year, and luckily the new convention center in Boston allows us to do this with regard to space utilization, is to create thematic poster neighborhoods, again centered around a particular disease category."

The posters will be arranged in a semienclosed space, "creating almost like a community gathering place," she said, with seating and a more relaxed atmosphere. "The specialties will be able to gather there and hopefully have a conversation."

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.

One of the trials will be presented during the Clinical Trials Plenary Session on Tuesday, April 25, and the rest during an oral presentation with simultaneous poster presentation at an evening session later that day.

"I think you will see this year there's going to be a lot of advances in neuromuscular disease in general, and also in migraine management," Dr Rost said.

Interest is high, for example, in the use of immunomodulatory monoclonal antibodies for the prevention of migraine. Two phase 3 trials of an agent called erenumab (formerly AMG 334), STRIVE and ARISE, will be presented. "These monoclonal antibodies act almost like a blocking agent to prevent hyperexcitability and stop migraine in its tracks," she said. The issue is that these agents are expected to be very expensive.

"Not only in neurology, but in rheumatoid arthritis and Crohn's disease and a lot of other diseases using monoclonal antibodies, they are extremely expensive — very effective, but extremely expensive," she said. "It seems to me that the success of this treatment will speak inarguably for using it as a treatment option, but I wonder, how will our healthcare system evolve to allow for that type of a costly treatment?"

Other developments of interest will be results in the treatment of spinal muscular atrophy, as well as other muscular dystrophies, Dr Rost noted. One agent, nusinersen (Spinraza, Biogen and Ionis Pharmaceuticals), approved by the US Food and Drug Administration just in December 2016, is the first drug to treat spinal muscular atrophy, and is the subject of the phase 3 CHERISH study being presented at the meeting.

Although longer-term data with the new agent are still limited, she said, "I think it's already a promising sign that we some improvements in the disorders that are otherwise considered to be hopeless, slowly progressive, and in many cases, fatal."

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 online.

Clinical Trials Plenary Session, Tuesday, April 25, 9:15 am to 11:30 am

Pub. Title Presenter
001 Phase 3, Randomized, Double-blind, Placebo-controlled Study to Evaluate the Efficacy and Safety of Erenumab (AMG 334) in Migraine Prevention: Primary Results of the STRIVE Trial Peter Goadsby, MD, PhD

Emerging Science Platform Session, Tuesday, April 25, 5:45 to 7:15 pm

Pub. Title Presenter
001 A Phase 3, Randomized, Double-blind, Placebo-controlled Study to Evaluate the Efficacy and Safety of Erenumab in Migraine Prevention: Primary Results of the ARISE Trial David W Dodick, MD
002 Non-invasive Vagus Nerve Stimulation for the Acute Treatment of Episodic and Chronic Cluster Headache: Findings from the Randomized, Double-blind, Sham-controlled ACT2 Study Peter Goadsby, MD, PhD
003 Double-blind, Randomized, Placebo-controlled, Phase III Study (TOLEDO) to Evaluate the Efficacy of Apomorphine Subcutaneous Infusion in Reducing OFF Time in Parkinson's Disease Patients with Motor Fluctuations Not Well Controlled on Optimized Medical Treatment Regina Katzenschlager, MD
004 Intraputaminal AADC Gene Therapy for Advanced Parkinson's Disease: Interim Results of a Phase 1b Trial Chadwick W. Christine, MD
005 Motor Effects and Safety of IPX203, an Investigational Extended-release Formulation of Carbidopa-Levodopa, in Advanced Parkinson's Disease: A Single-dose Phase 2 Study Mark Stacy, MD
006 Results of a Phase 1 Study of ABBV-8E12 in Patients with Progressive Supranuclear Palsy and Phase 2 Study Design in Alzheimer's Disease and PSP Hana Florian
007 Sustained Seizure Reduction with Adjunctive Everolimus for Treatment-refractory Seizures Associated with Tuberous Sclerosis Complex (TSC): Long-term Results from the Phase 3 EXIST-3 Study David N. Franz, MD
008 Cannabidiol (CBD) Significantly Reduces Drop Seizure Frequency in Lennox-Gastaut Syndrome (LGS): Results of a Dose-ranging, Multi-center, Randomized, Double-blind, Placebo-controlled trial (GWPCARE3) Anup D. Patel, MD
009 Efficacy and Safety of Nusinersen in Children with Later-onset Spinal Muscular Atrophy (SMA): Interim Results of the Phase 3 CHERISH Study Richard S. Finkel, MD
010 Subcutaneous Immunoglobulin for Maintenance Treatment in Chronic Inflammatory Demyelinating Polyneuropathy (CIDP), a Multicenter Randomized Double-blind Placebo-controlled Trial: The PATH Study Ivo N. Van Schaik, MD
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
014
Orally-administered TRPV1 and TRPA1 activators reduce Night Leg Cramps in a randomized, blinded, placebo-controlled, crossover human trial
ADS-5102 (amantadine HCl) Extended-Release Capsules Reduced Levodopa-Induced Dyskinesia in the Phase 3 EASE LID Study
Jennifer Cermak
Rajesh Pahwa, MD

Plenary Sessions

Finally, the major plenary sessions are also on the agenda, Dr Rost said. "Plenary sessions this year are no exception in terms of the excellence of the participants and the breadth of the subspecialties in neurology that we're covering."

The Hot Topics Plenary Session will kick off the meeting on Saturday. Dr Rost is again comoderating the Clinical Trials Plenary Session, now in its seventh year.

"We were particularly rich on subject of clinical trials," she said. "We actually had a very hard time selecting the material because we had so many great trials to pick from, and so what we've done is basically tried to pick the best of the science that is most ready for clinical application and is potentially practice-changing."

The Presidential Plenary Session, chaired by Dr Rost, features this year's award lecturers.

Full listings of presenters and moderators at this year's plenary sessions can be found on the AAN website.

  •    Presidential Plenary Session: Sunday, April 23, 9:15 am to noon

  •    Hot Topics Plenary Session: Saturday, April 22, 5:00 pm to 6:30 pm

  •    Contemporary Clinical Issues Plenary Session: Monday, April 24, 9:15 am to 11:30 am

  •    Frontiers in Neuroscience Plenary Session: Wednesday, April 26, 9:15 am to 11:30 am

  •    Clinical Trials Plenary Session: Tuesday, April 25, 9:15 am to 11:30 am

  •    Neurology Year in Review Plenary Session: Friday, April 28, 9:15 am to 11:30 am

"This is an exciting time to be a neurologist, or to recruit medical students to be interested, because a lot of them perceive neurology throughout medical school as basically 'diagnose and adios,' " Dr Rost concluded. "This is like the 70s and 80s attitude, and now we can do so many things for stroke, epilepsy, multiple sclerosis, as well as neuromuscular and neurodegenerative disorders, and I think we're making a difference. Sometimes change is slow but for each individual patient, even a slow change is more welcome than the uncertainty of neurological deterioration, so we just have to keep on going."

Medscape Medical News coverage from onsite reporters will begin Saturday, April 22; follow us on Twitter @MedscapeNeuro. To search the AAN scientific or educational programs, visit the AAN website. Follow the annual meeting Twitter feed, using #AANAM or #AAN2017.

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