What's Hot at AAN 2019?

Deborah Brauser

May 01, 2019

This year's American Academy of Neurology (AAN) Annual Meeting, scheduled for Saturday, May 4, to Friday, May 10, will take place in Philadelphia, Pennsylvania. The meeting can be summed up with the words, "Philly spectacular," says chair of the meeting's Science Committee, Natalia Rost, MD, MPH.

"That is what the opening party at the meeting is called, and I think it also describes the mood we have with regards to the upcoming meeting. I would refer to the entire meeting as a 'Philly spectacular' because of a program that will cover the spectrum of excitement," Rost, who is chief of the Stroke Division at Massachusetts General Hospital and professor of neurology at Harvard Medical School, Boston, told Medscape Medical News.

This year's event is expected to draw 15,000 or more participants — in part because of its central location in the "city of brotherly love."

"I think Philadelphia is always a welcome destination for travel, and it's kind of in the heartland," Rost said. She added that it's also convenient for attendees flying in from Europe and from South America.

For 2019, there will be more than 3000 abstracts, more than 250 courses, more than 50 scientific sessions, seven experiential learning areas, seven plenary sessions, three invited science sessions, and daily poster sessions.

Several meeting innovations that were introduced in recent years will return, such as Neuroscience in the Clinic sessions, Best Of scientific sessions, and shorter oral presentations to allow more time for interactivity; but there will also be plenty of new features.

These include the BrainDome, a larger-than-life brain through which attendees can take a guided, audiovisual tour, and the Grand Experience within the convention center's Grand Hall that will bring together science, career and mentoring information, presentations, and awards.

"There's an area that's perfectly set up in an open space with beautiful staircases and columns. It allows us to bring several presentation stages in one space, and we're hoping to create an experience where people can come together in almost a beehive dynamic," said Rost.

"I hope that when attendees arrive and they enter the area, they will actually experience the grandeur of the meeting, as that's where a lot of the energy will be concentrated," she added. "It's going to be a happening place."

Neuroscience in the Clinic Sessions

The six 2-hour Neuroscience in the Clinic sessions this year will focus on topics such as genetics, stem cells, and wearables. The first session on Sunday afternoon will focus on understanding epilepsy across the life span.

Rost noted that the topic of understanding all neurologic orders from childhood to adulthood comes up several times at the meeting.

"Many children with neurological conditions grow up to be adults with these conditions, and they need to transition from pediatric neurologists to adult neurology clinics," she said. "We need to look beyond the timeline of just, 'I'm going to take care of this patient between this age and this age.' We need to think about the years they have ahead of them."

  • N1 Neuroscience in the Clinic: Child Neurology: Emerging Understanding of the Epilepsy-Movement Disorder Spectrum Across the Lifespan, Sunday, May 5, 3:30 pm to 5:30 pm

  • N2 Neuroscience in the Clinic: Interpretation of Genetic Results, Monday, May 6, 1:00 pm to 3:00 pm

  • N3 Neuroscience in the Clinic: Stem Cells, Tuesday, May 7, 1:00 pm to 3:00 pm

  • N4 Neuroscience in the Clinic: Immunotherapies in Neurological Disease, Wednesday, May 8, 1:00 pm to 3:00 pm

  • N5 Neuroscience in the Clinic: Wearable Technology, Wednesday, May 8, 3:30 pm to 5:30 pm

  • N6 Neuroscience in the Clinic: The Brain Across the Menstrual Cycle, Thursday, May 9, 3:30 pm to 5:30 pm

Posters and Emerging Science

The ever popular Poster Neighborhoods will be back again this year, but Rost noted that there will be better markings for navigating the area and that the various topics will be integrated better.

In addition, during the afternoon on Friday, May 10, a new feature will be the "breaking of the neighborhood concept," Rost said. "We're going to create a community session where we break the silos between specialties to bring us all together to talk about neuroimaging."

Abstracts on neuroimaging, regardless of which subspecialty they fall under, will be brought together for this stand-alone session. "This will allow, for example, someone who does neuroimaging in multiple sclerosis to meet their colleagues in stroke science, with the link between them being white matter disease. Maybe we can learn from each other, we can cross-pollinate and exchange experiences," said Rost.

The Emerging Science Session, which in past meetings was often held in the evenings, will run much earlier this year. From 11:45 am to 12:20 pm on Tuesday, May 7, "late breaker" study results will be presented in a data blitz format, followed immediately by a 25-minute poster presentation session in the same room.

Rost noted that the theme of last year's Emerging Science Session leaned toward "exciting new treatments on the horizon" and that this year is almost a repeat of that theme.

"The theme of new scientific breakthroughs that are leading to practical applications continues," she said.

"One of the interesting takes among the emerging science selections this year is treatments for rare neurological disorders. We're going to have a presentation about a phase 3 trial on Charcot-Marie-Tooth neuropathy, which is fantastic because it's kind of a 'quiet' disease. People suffer without much of a splash. It isn't necessarily fatal, but it's extremely debilitating. And for the first time, we have some breakthroughs in treatment for Charcot-Marie-Tooth type 1A," Rost said.

"Also, there's something I haven't seen in my lifetime yet: Angelman syndrome," she added. "We'll be presenting a trial on pediatric patients with Angelman. This is exciting because it's a rarity and a disease we kind of memorize in medical school and then probably never see in the clinic, if you're an adult neurologist. But pediatric neurologists deal with this, and there's almost nothing they can do to help these children."

Rost also noted the presentation on a new antisense oligonucleotide agent for a genetic subtype of amyotrophic lateral sclerosis (ALS). "This is one of the most severe types of ALS, occurs at an early age, and is rapidly progressive. And there's a potential breakthrough we're seeing in the making," she said.

The following is a full list of the Emerging Science presentations:

  • 001 Efficacy and safety of PXT3003 in Patients With Charcot-Marie-Tooth Type 1A (CMT1A): Results of PLEO-CMT, an International Oivotal Phase 3 Trial, presented by Florian P. Thomas, MD, PhD

  • 002 Serum Linc LNMAT1 Correlated With Phosphorylateda-Synucleinas Serum Biomarkers of Parkinson's Disease: A Cross-Sectional Study, presented by Jing Zou, MD, PhD

  • 003 Development of an AAV-Based Micro-RNA Gene Therapy for Treating Spinocerebellar Ataxia Type 3, presented by Melvin Evers, PhD

  • 004 STARS: Results From a Safety and Efficacy Study of OV101 (Gaboxadol) in Adults and Adolescents With Angelman Syndrome, presented by Lynne Bird, MD

  • 005 Efficacy, Safety, and Tolerability of Rimegepant 75 mg Orally Dissolving Tablet for the Acute Treatment of Migraine: Results From a Phase 3, Double-Blind, Randomized, Placebo Controlled Trial, presented by Richard B. Lipton, MD

  • 006 Cannabidiol (CBD; 10 and 20 mg/kg/day) Significantly Reduces Convulsive Seizure Frequency in Children and Adolescents With Dravet Syndrome: Results of a Dose-Ranging, Multi-Center, Randomized, Double-Blind, Placebo-Controlled Trial, presented by Ian Miller, MD

  • 007 Safety, PK, PD, and Exploratory Efficacy in Single and Multiple Dose Study of a SOD1 Antisense Oligonucleotide (BIIB067) Administered to Participants With ALS, presented by Timothy Miller, MD, PhD

  • 008 Zilucoplan, a Subcutaneously Self-Administered Peptide Inhibitor of Complement Component 5 (C5) for the Treatment of Generalized Myasthenia Gravis: Results of a Phase 2 Randomized, Double-Blind, Placebo-Controlled Trial and Open-Label Long-term Extension, presented by James F. Howard Jr, MD

  • 009 Efficacy and Safety of Eculizumab in Aquaporin-4 Antibody Positive (AQP4-lgG+) Neuromyelitis Optica Spectrum Disorder (NMOSD): a Phase 3, Randomized, Double-Blind, Placebo-Controlled, Multicenter Trial (PREVENT), presented by Sean J. Pittock, MD

  • 010 Kelch-like Protein 11 Autoantibodies Are a Novel Biomarker of Testicular Cancer–Associated Paraneplastic Encephalitis, presented by Divyanshu Dubey, MD

  • 011 Modulation of CSF CASPASE-3 in MSC-NTF Cells (Nurown) in a Phase 2 ALS Study: Correlations With CSF Biomarkers and Clinical Response, presented by Ralph Z. Kern, MD

Rost noted that three phase 3 trials regarding NMOSD will be presented at the meeting. "This is kind of record breaking, as it's the first time to have this many pivotal trials on this condition being presented at the same meeting," she said.

Clinical Trials Plenary

Presentations at this year's Clinical Trials Plenary will include updated results from the SPRINT MIND trial, which assessed intensive blood pressure control on mild cognitive impairment; results from the phase 3 REVERSE trial on an investigational gene therapy for treating Leber's hereditary optic neuropathy; and 8-week treatment results for patients with episodic cluster headache.

Rost noted that presentations on headache and migraine treatment will be well represented in this plenary session in the Emerging Science Session and in two scientific sessions that are fully dedicated to the topic.

"The Science Committee was looking at the whole landscape of advances in this area. After several years of almost annual breakthroughs, in terms of treatments, we felt that it was time to make a synthesis of all the data that we have," she said.

The full list of Clinical Trials Plenary Session presentations, scheduled for Tuesday, May 7, from 9:15 am to 11:30 am, is as follows:

  • SPRINT MIND: Results Update and Future Directions, presented by Jeff Williamson, MD

  • Intravenous Immunoglobulin to Prevent Myasthenic Crisis After Thymectomy and Other Surgical Procedures Can Be Omitted: A Randomized, Controlled, Double-Blind Trial, presented by Josep Gamez, MD, PhD

  • A Placebo-Controlled Study of Galcanezumab in Patients With Episodic Cluster Headache: Results From the 8-Week Double-Blind Treatment Phase, presented by David W. Dodick, MD

  • From Bench to Bedside to Beam: Hippocampal-Sparing During Brain Irradiation, presented by Vinai Gondi, MD

  • Randomized Controlled Trial of Inebilizumab in Neuromyelitis Optica Spectrum Disorder, presented by Bruce A. C. Cree, MD, PhD

  • rAAV2/2-ND4 for the Treatment of LHON: 72-Week Data From the REVERSE Phase 3 Clinical Trial, presented by Mark Moster, MD

  • Use of Tranexamic Acid in Patients With Traumatic Brain Injury: Results From the North American Multi-Center Prehospital TXA for TBI Trial, presented by Susan Rowell, MD

Presidential Talks, Hot Topics, Controversies

During this year's Presidential Plenary Session, scheduled for Sunday, May 5, from 9:15 am to noon, which will be moderated by Rost, the Presidential Lecture will be given by Ralph L. Sacco, MD, Miller School of Medicine, the University of Miami, Florida.

Sacco will be speaking on challenges, opportunities, and "the way forward" in the field of neurology.

The Hot Topics Plenary Session is scheduled for Saturday, May 4, from 4:15 pm to 5:30 pm and will include talks on immunotherapies in movement disorders and "solving neurological mysteries" in lesion network mapping.

The always entertaining Controversies in Neurology Plenary is scheduled for Thursday, May 9, from 9:15 am to 11:30 am. Topics to be debated this year include whether using continuous EEG in the intensive care unit "really matters" and whether ambulances should bypass primary stroke centers and instead to go to comprehensive stroke centers.

The latter is especially interesting for Rost, because stroke is her specialty.

"There's been a lot of talk about how best to provide care. In the US, there has been the creation of multiple tiers of hospitals, which I think is a great development for patients because of the quality of care; but it also created a lot of uncertainty in the way local EMS providers are expected to behave," she said.

"In states that don't have specific requirements with regards to what to do with a particular patient population, they are struggling with whether they should be bringing patients to the closest facility or to a comprehensive stroke center, where they'll received more specialized care," she added.

Noted talks by guest speakers during the Advancing Medicine: Inspiration and Innovation series will include Hugh Herr, PhD, the "leader of the bionic age," speaking on how neurology can interact with artificial intelligence and robotics; Patricia Churchland, an author and professor of philosophy, who will be talking about ethics in neuroscience; and pediatrician and public health advocate Mona Hanna-Attisha, MD, who will discuss her research exposing the water crisis in Flint, Michigan.

Other plenaries include the following:

  • Contemporary Clinical Issues Plenary Session, Monday, May 6, 9:15 am to 11:30 am

  • Frontiers in Neuroscience Plenary Session, Wednesday, May 8, 9:15 am to 11:30 am

  • Neurology Year in Review Plenary Session, Friday, May 10, 9:15 am to 11:30 am

The latter will include talks on neuromodulation, ALS, and neurology for pregnant patients.

"Robust, Spirited Environment"

Preliminary results of some studies have already been released by the AAN in advance of the meeting. Coverage of these studies by Medscape Medical News can be found on Medscape's AAN conference Web page.

Rost said that overall, AAN 2019 is all about new advances and scientific breakthroughs. "Almost nowhere else can you be among so many colleagues with so many subspecialties in such a robust, spirited environment," she said.

She added that it all kicks off with the opening party, which is scheduled for Sunday, May 5, from 7:00 pm to 10:00 pm at the historic Reading Terminal Market. Tickets to this event will provide access to all-you-can eat food and beverages, entertainment, and transportation to the site, which is a converted train terminal.

"We're looking forward to thousands of neurologists enjoying Philadelphia flavors and tastes. So we have exciting social parts and plenty of science to offer at this year's meeting," Rost said.

"We tend to sometimes get drawn into the everyday routine and forget about how exciting our field is, with such robust scientific underpinnings. That sense of reinvigoration that you get from this meeting is something that can get you going for the rest of the year," she concluded.

A full listing of meeting presentations can be found on the AAN website. Onsite coverage from Medscape Medical News journalists will begin Sunday, May 5. For more news, join us on Facebook and Twitter. Also, follow the annual meeting Twitter feed using #AANAM.

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