Susan Jeffrey

March 15, 2013

Neurologists will travel this weekend to San Diego, California, for the American Academy of Neurology (AAN)'s 65th Annual Meeting to network and hear the latest news about developments in their field. With the bonus of beaches, sailing, and golf, there is much to anticipate and little to complain about.

Medscape Medical News talked with 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 meeting's Science Committee, about changes and hotly anticipated content expected to be presented.

One change for a start is the timing. "This year is a little bit unusual," she said. "Our conference is earlier. We usually meet in April, but who can complain about March in San Diego? AAN has been fortunate to work with a number of fantastic cities to which we keep returning, and San Diego is certainly one of them."

Emerging Science — Dialing Back on the "Rapid Fire"

Dr. Natalia Rost

One of the big changes last year to the program was the introduction of the Emerging Science session, formerly known as Late Breaking Science, where some of the most recently available, cutting-edge data were presented for the first time. As part of the new approach, presenters of the 15 studies in that session were limited to 5 minutes in a kind of "rapid fire," meant to pointedly provide the audience with the information they need. These presentations were then followed by a poster session that allowed for a question-answer period for the presenters.

Although attendance at that evening session was "phenomenal," Dr. Rost said, it proved a little stressful for some presenters more than others. "I actually was co-chairing the session and it was very exciting. For me, it was very dynamic, I loved the rapid pace and the distilled format in which the data were delivered," she said, "but I think for some speakers, it was slightly anxiety provoking because they really had 3 minutes to present the results of a big study. The audience loved it because I think one feels at times so oversaturated with information, but in this "rapid fire" format, the audience might have appreciated these crystallized 'bits' of knowledge, very concise, delivered as a bullet for each particular finding."

This year, they've limited presentations to 12, with an extra 2 minutes per presentation, she notes, "to allow for slightly more generous time for each one to be addressed, and they will still have time for a question and answer period."

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.

Start Time Pub. Title Presenter
5:45 pm 001 Novel CSF biomarkers for frontotemporal lobar degeneration with lesions immunoreactive to TDP-43 (FTLD-TDP) William Hu, MD, PhD
5:48 pm 002 Safety and efficacy of ORM-12741 on cognitive and behavioral symptoms in patients with Alzheimer's disease: a randomized, double-blind, placebo-controlled, parallel group, multicenter, proof-of-concept 12 week study Juha Rouru
5:51 pm 003 CSF (1,3) b-D-glucan as an adjunctive test for invasive CNS fungal infection due to presumed Exserohilum rostratum Jennifer Lyons, MD
5:54 pm 004 Antipsychotic efficacy and motor tolerability in a phase III placebo-controlled study of pimavanserin in patients with Parkinson's disease psychosis (ACP-103-020) Jeffrey Cummings, MD, FAAN
5:57 pm 005 A phase 2, placebo-controlled, randomized, double-blind trial of tozadenant (SYN-115) in patients with Parkinson's disease with wearing-off fluctuations on levodopa C. Olanow, MD, FAAN
6:00 pm 006 A placebo controlled, randomized, double-blind study to assess the safety and clinical benefit of rasagiline as an add-on therapy to dopamine agonist monotherapy in early Parkinson's disease (PD): The ANDANTE study Robert Hauser, MD, MBA, FAAN
6:03 pm 007 Davunetide for progressive supranuclear palsy: results of the AL-108-231, phase 2/3, 52 week, multi-center, randomized, double-blind, placebo-controlled clinical trial Adam Boxer, MD, PhD
6:06 pm 008 Interim analysis of 12 patients with amyotrophic lateral sclerosis (ALS) treated with autologous differentiated mesenchymal stem cells: preliminary data of a phase I/II clinical trial Dimitrios Karussis, MD, PhD
6:09 pm 009 A study to evaluate efficacy, safety and tolerability of single doses of tirasemtiv in patients with myasthenia gravis Donald Sanders, MD, FAAN
6:12 pm 010 Droxidopa treatment impact on orthostatic symptoms and standing systolic blood pressure in patients with Parkinson's disease (PD) and symptomatic neurogenic orthostatic hypotension (NOH) Stuart Isaacson, MD
6:15 pm 011 IMS-III like subgroup analysis in the North American SOLITAIRE Stent-Retriever Acute Stroke Registry Osama Zaidat, MD, FAAN
6:18 pm 012 Mutations in DEPDC5 cause familial focal epilepsy with variable foci and are a common cause of familial non-lesional focal epilepsy Massimo Pandolfo, MD


The Emerging Science Session will be held Wednesday, March 20, 2013 from 5:45 pm to 7:00 pm.

Controversies in Neuroscience

Another first last year, the Controversies in Neuroscience plenary forum proved to be "tremendously successful" and has become a regular part of the program, Dr. Rost said.

"The session will again be chaired by Dr. [Joseph] Jankovic and Dr. [Walter] Rocca and again we're trying to address multiple segments of the practice — not only the practitioners, not only the academic neurologists; we're trying to aim at every possible subspecialty and also different layers of the neurology practice," she said.

For example, there will be a debate by experts on whether intra-arterial therapy should be used as a standard treatment in acute stroke, a hot topic in the wake of presentation of the long-awaited IMS-III (Interventional Management of Stroke Phase III) trial, as well as MR-RESCUE (Mechanical Embolectomy versus Standard Care for Acute Ischemic Stroke) and a third large Italian trial at the recent International Stroke Conference, all of which showed no benefit of intravascular therapy over thrombolysis.

Another debate will look at the issue of whether levodopa should be initiated right at the time of diagnosis.

"We also bring some cutting-edge science, by discussing stem cells research in neurology, and then we also talk about potential augmentive treatment in multiple sclerosis, like use of vitamin D, for example, in this population of patients," Dr. Rost said. "So I think this is going to be again a standing-room-only plenary session."

The 2013 Controversies in Neuroscience Session will be held Thursday, March 21, 4 pm to 6 pm.

Integrated Neuroscience Sessions

While the new sessions always command attention, the "staple of neuroscience learning at the AAN Annual Meeting are the Integrated Neuroscience Sessions [INSs]," Dr. Rost said. The 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, than as moderated posted session.

"There is an element of knowledge exchange which is really informative, and there is always excellent feedback from the attendees on how by the end of the session, they get the entire field covered in 1 shot," she said. Of the 11 INSs this year, 6 are part of a novel collaboration between the Science Committee and the Committee on Education as part of the Specialist in Focus tracks. "The educational part of this INS will be specifically designed by members of the educational committee who are recommending the content and the speakers, so it's an excellent way to overlap between science and education."

There is a wide range of hot topics, from an INS on sports neurology to neuro-oncology, neuro-ophthalmology, and one on what's called "dimorphic neurology," that is, the effect of sex on brain development and function. For herself, the acute stroke INS will be of particular interest, again because of the recent findings on the role of endovascular therapies and anticipated advnaces in acute stroke neuroscience.

"Most of the people who come to AAN are general neurologists who actually practice this science every day, and what the INS brings with regard to the overview of the entire field and with regard to potentially outlining future directions, I think, is very important and very timely."







New Moderated Platforms

Another program innovation by the Science Committee this year is moderated platform sessions. "These are a few abstracts that have been selected as platform presentations within each of the 10 selected topics of high interest across different subspecialties," Dr. Rost said. The authors will present their science, and then discussion led by session co-chairs will occur; the co-chairs will encourage questions and discussion, and "contextualize" the data, the program notes. "It's going to be a very dynamic session," she said.

The 10 moderated platform sessions occur Wednesday, March 20, from 4:00 pm to 5:30 pm.

  • S31 Multiple Sclerosis: Novel Treatments

  • S32 Clinical Classification and Characterization of Stroke

  • S33 Movement Disorders: Imaging

  • S34 Aging and Dementia: Genetics and Biochemical Markers

  • S35 Translational Research Advances in Neuro-oncology

  • S36 Anterior Horn: Clinical Trials

  • S37 Autonomic Disorders

  • S38 Infections: HIV

  • S39 Central Clinical Neurophysiology

  • S40 Headache: Clinical

Plenary Sessions

Not least are the major plenary sessions. While many of these, such as the President's Plenary Session, recur every year, one new session rolling out this year is Neurology Year in Review.

"The larger concept is to present an overview of leading subspecialties within neurology, talking about notable pratice developments  and scientific advances within the particular field," Dr. Rost said. "So this year we will review neuro-ophthalmology, stroke, multiple sclerosis, ALS [amyotrophic lateral sclerosis], epilepsy and Alzheimer's, and we're bringing people who are the leading experts within each subspecialty to do a kind of an overview of what has happened at the forefront of each subspecialty. They're also going to try leverage the wealth of information to the general practitioner so that there's an emphasis on applicability of the knowledge to practice, and this translational component that goes between the high laboratory science to the application at the bedside."

Another anticipated session is the Clinical Trials Plenary, presenting some of the top trial results in the field, including those that were first presented at other meetings this year, such as the IMS-III trial in acute stroke.

  • Presidential Plenary Session: Tuesday, March 19, 9 am to noon

  • Hot Topics Plenary Session: Tuesday, March 19, 5:15 pm to 6:15 pm

  • Contemporary Clinical Issues Plenary Session: Wednesday, March 20, 9:00 am to noon

  • Frontiers in Clinical Neuroscience Plenary Session: Thursday, March 21, 9:00 am to 11:00 am

  • Clinical Trials Plenary Session: Friday, March 22, noon to 1:30 pm

  • Neurology Year in Review Plenary Session: Friday, March 22, 5:15 pm to 6:45 pm

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

Selected abstracts from the meeting have been prereleased, and news coverage of these is already available on Medscape's AAN 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) 65th Annual Meeting. March 16-23, 2013, San Diego, California.