2011 advances in neurological therapeu!cs€¦ · advances in neurological therapeutics faculty...

2011

Advances in Neurological Therapeu!csCon nuing Medical Educa on

September 17, 2011

Cleveland Clinic

Lou Ruvo Center for Brain Health

Las Vegas, Nevada

www.ccfcme.org/ANT11

3

Advances in Neurological Therapeutics

Table of Contents

Introduction Letter .................................................................................................................... 4

About the Course ...................................................................................................................... 5

Accreditation Statement ........................................................................................................... 6

Faculty Information ................................................................................................................... 7

Faculty Disclosure ..................................................................................................................... 8

Acknowledgements .................................................................................................................... 10

Agenda ........................................................................................................................................ 11

Biographies and Presentation Slides

Brian Appleby, MD

Rapidly Progressive Dementias: Current Treatments ................................................ 12

Charles Bernick, MD

Alzheimer’s Disease: Updates in Diagnosis and Therapies ...................................... 19

Jeffrey L. Cummings, MD, ScD

Recent Advances in Neurological Pharmacological Therapeutics ........................... 26

Stephen E. Jones, MD, PhD

Neuroimaging: New Radiological Diagnosis with the 3T fMRI ................................. 32

Susan Linder, PT, DPT, NCS

The Role of OT/PT in the Management of Neurological Disease .............................. 46

Erik Pioro, MD, PhD

ALS: New Approaches for Treatment .......................................................................... 53

Ryan Walsh, MD, PhD

Movement Disorders: Advances in Neurological Therapeutics .............................. 62

Timothy West, MD

Multiple Sclerosis: Advances in Clinical Management ............................................. 66

Dylan Wint, MD

Managing Depression & Psychosis in Neurological Disease .................................... 74

4

5


Saturday, September 17, 2011 | 8:00 AM — 6:00 PM

Keep Memory Alive Event Center

888 W. Bonneville Avenue | Las Vegas, NV 89106

Program Description

This course aims to advance the understanding of neurological therapeutics and to update practitioners regarding diagnosis and treatment of neurodegenerative disorders including Alzheimer’s disease, Parkinson’s disease, Multiple Sclerosis, Amyotrophic Lateral Sclerosis, and Rapidly Progressive Dementias. By providing the latest advances in diagnosis and treatment, we will help practitioners effectively manage patients in the earliest stages of these diseases and thereby raise the standards of patient prognosis and care.

Target Audience

This activity is intended for clinicians who treat patients with neurological disorders. We especially want to encourage neurologists, psychiatrists, family practice and primary care physicians, physician assistants, nurse practitioners, physical therapists and other allied health care professionals to attend.

Goals and Objectives

Upon completion of this program, the clinician/practitioner will be able to:

1. Identify early signs and symptoms of neurological diseases.

2. Utilize advances in neurological imaging to better diagnose neurological diseases.

3. Recognize and better manage the variety of behavioral complications of neurological illnesses.

4. Distinguish major advances in the pharmacological therapies of neurological disorders.

5. Anticipate the major drug-drug interactions.

6. Manage combination therapies in order to optimize patient function.

Disclaimer

The information in this educational activity is provided for general medical education purposes only and is not meant to substitute for the independent medical judgement of a physician relative to diagnostic and treatment options of a specific patient’s medical condition. The viewpoints expressed in this CME activity are those of the authors/faculty. They do not represent an endorsement by the Cleveland Clinic Foundation. In no event will the Cleveland Clinic Foundation be liable for any decision made or action taken in reliance upon the information provide through this CME activity.

6


Accreditation Statement

The Cleveland Clinic Foundation Center for Continuing Medical Education is accredited by the Accreditation Council for Continuing Medical Education for physicians.

The Cleveland Clinic Foundation Center for Continuing Medical Education designates this live activity for a maximum of 6.0 AMA PRA Category 1 Credits.™ Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Participants claiming CME credit from this activity may submit the credit hours to the American Osteopathic Association Council on Continuing Medical Education for Category 2 credit.

This course has also been submitted to the State of Nevada’s Physical Therapy Examiner’s Board for approval of 0.6 CEUs.

Evaluation Form and Certificate — MYCME

An online evaluation process has been instituted in order for you to receive CME credit for this conference.

To receive AMA PRA Category 1 Credit(s)™, please go to www.ccfcme.org/MYCME to complete the evaluation, and to print your CME certificate. Once you enter this site, please enter 020756. The code is active 30 days following the course.

User Instructions:

If you are a first-time user of “MYCME”, you will need to create a six-digit password comprised of any combination letters and/or numbers. This will become your permanent log-in for future Cleveland Clinic “MYCME” programs.

Log in to 1. www.ccfcme.org/MyCME.

Click on 2. New User? located under the log-in box.

Complete all the fields in the form and click on 3. Create Account.

Click on 4. Click Here to Login.

Log in using the information you just provided in the registration form.5.

In the “Regularly Scheduled Series” box enter the code 6. 020756.

Complete all the fields and hit 7. Submit.

Your official CME certificate will appear. Please print and keep with your permanent files.8.

Please note: Be sure to print your CME certificate and keep for your files. This is your permanent record; no other certificate will be generated. If you have problems claiming credit online, please contact the CME office at 216.444.9990

Physical Therapy Evaluation and Credit Certificate

In order to obtain credit for this conference, you must:

Complete the evaluation form and return it to the registration desk before you depart.1.

Complete the 2-ply certificate. Return the colored copy to the registration desk before you depart. 2. Please keep the WHITE copy for your records as it serves as your official certificate. Certificates are not mailed.

7


Conference Chair

Jeffrey L. Cummings, MD, ScD

Neurologist and Director

Cleveland Clinic Lou Ruvo Center for Brain Health

Cleveland Clinic Faculty

Brian Appleby, MD

Geriatric Psychiatrist


Charles Bernick, MD

Neurologist and Associate Director



Neuroradiologist, Diagnostic Radiologist

Center for Neuroimaging


Research Physical Therapist

Biomedical Engineering

Erik Pioro, MD, PhD

Neurologist

Lerner Research Institute Department of Neurosciences

Ryan Walsh, MD, PhD

Neurologist and Movement Disorders Specialist


Timothy West, MD

Neurologist


Dylan Wint, MD

Neurologist/Psychiatrist


8


Faculty Disclosures

In accordance with the Standards for Commercial Support issued by the Accreditation Council for Continuing

Medical Education (ACCME), the Cleveland Clinic Foundation Center for Continuing Education requires

resolution of all faculty conflicts of interest to ensure CME activities are free of commercial bias.

The following faculty have indicated that they may have a relationship which, in the context of their

presentation(s), could be perceived as a potential conflict of interest:

Charles Bernick, MD Teaching & Speaking Novartis Pharmaceuticals

Jeffrey L. Cummings, MD Consulting Abbott

Consulting Acadia

Consulting Accera

Consulting / Ownership Interest ADAMAS

Consulting Astellas Pharma US

Consulting Avanir

Consulting Avid

Consulting Bayer Healthcare

Consulting Bristol-Meyers-Squibb Co.

Consulting CoMentis

Consulting / Teaching & Speaking Eisai

Consulting Elan Pharmaceuticals, Inc.

Consulting EnVivo

Consulting ExonHit

Consulting / Teaching & Speaking Forest Pharmaceuticals

Consulting GE Healthcare

Consulting Genentech

Consulting GlaxoSmithKline

Consulting / Teaching & Speaking Lundbeck

Consulting / Ownership Interest MedAvante

Consulting Medivation

Consulting Medtronic

Consulting Merck & Company, Inc.

Consulting / Teaching & Speaking Merz

Consulting / Ownership Interest Neurokos

Owns copyright Neuropsychiatric Inventory

Consulting / Ownership Interest Neurotrax

Consulting / Teaching & Speaking Novartis Pharmaceuticals

Consulting / Teaching & Speaking Ortho McNeil Janssen Scientific Affairs LLC

Consulting / Teaching & Speaking Pfizer

Consulting / Ownership Interest Prana

Consulting reMYND

Consulting Sanofi Aventis

Consulting Schering Plough Corporation

Consulting SIGNUM BIOSCIENCE

Consulting / Ownership Interest Sonexa

Consulting Takeda

Consulting Toyama

Consulting UBC

Consulting Wyeth

9

Faculty Disclosures continued

The following faculty have indicated that they may have a relationship which, in the context of their

presentation(s), could be perceived as a potential conflict of interest:

Erik Pioro, MD, PhD Teaching & Speaking; Avanir

Membership on advisory committee

or review panel

The following faculty have indicated they have no relationship which, in the context of their presentation(s),

could be perceived as a potential conflict of interest:

Brian Appleby, MD



Ryan Walsh, MD, PhD

Timothy West, MD

Dylan Wint, MD

10


The Cleveland Clinic Educational Foundation acknowledges

educational grants for partial support of this activity from:

Baxter

Biogen IDEC

Elan

Martek Biosciences

TEVA Neuroscience

Please visit our vendors in the Exhibit Hall next to the Event Center.

Accera

GAITRite - CIR Systems, Inc.

life’sDHA

Medtronic

TechnoGym

TEVA Neuroscience

Creekside Home Health|Creekside Hospice|Nevada Premier Care

ALS Nevada

Alzheimer’s Associa!on

American Parkinson’s Disease Associa!on


Na!onal Mul!ple Sclerosis Society

11


Conference Agenda

8:00 - 8:45 AM Registration | Breakfast | Exhibits

8:45 - 9:00 AM Introduction Jeffrey L. Cummings, MD, ScD

9:00 - 9:30 AM Movement Disorders: Advances in Neurological Therapeutics Ryan Walsh, MD, PhD

9:30 - 10:00 AM Rapidly Progressive Dementias: Current Treatments Brian Appleby, MD

10:00 - 10:30 AM Managing Depression & Psychosis in Neurological Disease Dylan Wint, MD

10:30 - 10:45 AM Break | Exhibits

10:45 - 11:15 AM ALS: New Approaches for Treatment Erik Pioro, MD, PhD

11:15 - 11:45 AM Neuroimaging: New Radiological Diagnosis with the 3T fMRI Stephen E. Jones, MD, PhD

11:45 - 12:15 PM The Role of Occupational/Physical Therapy in the Management of Neurological Disease


12:15 - 1:15 PM Lunch | Exhibits

1:15 - 1:45 PM Alzheimer’s Disease: Updates in Diagnosis & Therapies Charles Bernick, MD

1:45 - 2:15 PM Multiple Sclerosis: Advances in Clinical Management Timothy West, MD

2:15 - 2:45 PM Recent Advances in Neurological Pharmacological Therapeutics Jeffrey L. Cummings, MD, PhD

2:45 - 3:30 PM Panel

3:30 - 4:00 PM Qualitative & Program Evaluations | Exhibits

4:00 PM Adjourn CME

4:00 - 6:00 PM

Guests are cordially invited to stay for a Q & A/Meet & Greet/Reception/Exhibit Visits at the conclusion of the CME conference.

12

BRIAN APPLEBY, M.D.

Geriatric Psychiatrist

Lou Ruvo Center for Brain Health, Main Campus, Ohio

Dr. Appleby is a neuropsychiatrist who treats and researches dementia and

cognitive disorders. His clinical and research interests include prion diseases (e.g.,

Creutzfeldt-Jakob disease) and young-onset dementias.

Dr. Appleby received a B.A. in biology and philosophy from Goucher College

and a M.D. from Georgetown University School of Medicine. He completed an

internship at Georgetown University Hospital and a psychiatric residency at The

Johns Hopkins Hospital, where he also completed a geriatric psychiatry fellowship.

Following his training, Dr. Appleby became Assistant Professor within the Division

of Geriatric Psychiatry and Neuropsychiatry at Johns Hopkins University School

of Medicine. He founded and directed the Johns Hopkins Creutzfeldt-Jakob Disease (CJD) Program and was

co-director of the Frontotemporal Dementia and Young-Onset Dementia Clinic. He joined the Cleveland Clinic

Center for Brain Health in July 2011 to focus on dementia care, education, and research.

Dr. Appleby is a member of the FDA Transmissible Spongiform Encephalopathy Advisory Committee and is a

member of the CJD Foundation Board of Directors. He is also a member of the Friends/Advisors Group of the CJD

International Support Alliance. He was nominated to the Rare Disease Day Research Hall of Fame in 2010.

Rapidly Progressive Dementia: Current Treatments

13 14

15 16

17 18

19

CHARLES BERNICK, M.D.

Neurologist and Associate Director

Lou Ruvo Center for Brain Health, Las Vegas, NV

Dr. Bernick graduated summa cum laude from Rice University with a BA degree

in history. He received his MD from University of Texas Southwestern, being

elected to the medical honor society, alpha omega alpha. Dr. Bernick completed

a neurology residency at the University of Miami, followed by a fellowship in

neurology at the University of Arizona.

Dr. Bernick has been involved in the field of Alzheimer’s disease research and

treatment for close to 20 years, beginning as the attending neurologist for the

University of California, Davis Alzheimer’s Disease Diagnostic and Treatment

Center. Dr. Bernick moved to Las Vegas in 1994 to join the University of Nevada School of Medicine. Since that

time, he has directed the development of a statewide network of Alzheimer’s disease care, with clinics in Las

Vegas, Reno and Elko.

In addition to co-authoring numerous scientific articles, Dr. Bernick has participated in studies of virtually every

medication now available for Alzheimer’s disease. He has served as a grant reviewer and committee member for

the national Alzheimer’s Association and is currently part of their regional Medical and Scientific Committee.

Alzheimer’s Disease: Updates in Diagnosis and Therapies

20

21 22

23 24

25 26

JEFFREY L. CUMMINGS, M.D., ScD

Ranked by the Journal of Alzheimer’s Disease as the 6th most prolific researcher

of the disease over a 23-year period, Dr. Cummings’ research and leadership

contributions in the field of Alzheimer’s disease have been recognized through the

Henderson Award of the American Geriatrics Society (2006), the Research Award

of the John Douglas French Alzheimer’s Research Foundation (2008), and the

Ronald and Nancy Reagan Research Award of the national Alzheimer’s Association

(2008). In 2010, he received the Legacy Award from the Ticki Wilkerson-Kassel

Movement Therapy Foundation and was honored by the American Association of

Geriatric Psychiatry with their Distinguished Scientist Award.

Dr. Cummings is the author of the Neuropsychiatric Inventory (NPI) which has

become the most commonly used tool for characterizing behavioral disturbances in dementia syndromes and for

measuring the effect of antidementia therapies on neuropsychiatric symptoms in Alzheimer’s disease and other

dementias. Dr. Cummings is an experienced clinical trialist with expertise in clinical trial design and analysis,

global trial implementation, and trial outcome measures. He is a member of the Alzheimer’s Disease Cooperative

Study and of the oversight committee of the NINDS Neuroprotection in Parkinson’s Disease program.

Dr. Cummings completed Neurology residency and a Fellowship in Behavioral Neurology at Boston University,

Boston, Massachusetts. U.S. training was followed by a Research Fellowship in Neuropathology and

Neuropsychiatry at the National Hospital for Nervous Diseases, Queen Square, London, England. Dr. Cummings

was formerly Professor of Neurology and Psychiatry at UCLA, director of the Mary S. Easton Center for Alzheimer’s

Disease Research at UCLA, and director of the Deane F. Johnson Center for Neurotherapeutics at UCLA. He

is past president of the Behavioral Neurology Society and of the American Neuropsychiatric Association. Dr.

Cummings has authored or edited 30 books and published nearly 600 peer-reviewed papers.

Neurologist and Director

Lou Ruvo Center for Brain Health, Nevada, Florida, Ohio

Recent Advances in Neurological Pharmacological Therapeutics

27 28

29 30

31 32

Dr. Jones is a member of the neuroradiology division at the Cleveland Clinic.

Prior to medical school, he was a research physicist at MIT, after receiving

his PhD in physics at Cornell University (Ithaca, NY), and an undergraduate

education at Caltech. After his research interests shifted from astrophysics

to neuroscience, his wife (a psychiatrist at the time at Massachusetts General

Hospital) convinced him to enter medical school at Tufts (Boston) and apply

his physics and mathematical skills towards medicine. He completed intern-

ship, radiology residency, and a neuroradiology fellowship at the Massachu-

setts General Hospital. His current interests are in applying MRI, fMRI, DTI,

and functional connectivity towards neurological illness. He lives in Cleveland Heights with his wife, three

children, two dogs, one cat, and a decreasing number of goldfish.

Neuroradiologist, Diagnostic Radiologist

Cleveland Clinic Center for Neuroimaging, Cleveland, Ohio

STEPHEN E. JONES, M.D., Ph.D.

Neuroimaging: New Radiological Diagnosis with the 3T fMRI

33 34

35 36

37 38

39 40

41 42

43 44

45 46

SUSAN LINDER, PT, DPT, NCS

Research Physical Therapist

Cleveland Clinic, Main Campus, Ohio

The Role of Occupational/Physical Therapy in the Management of Neurological Disease

Susan Linder conducts clinical research to investigate interventions that facilitates

neuromotor recovery and decreases disability in patients with neurologic diseases.

As a physical therapist, Susan developed expertise in neurologic rehabilitation

specializing in the treatment of stoke, brain injury, and neurodegenerative dis-

eases. She obtained board certification as a neurologic clinical specialist and has

taught numerous courses in neurologic physical therapy as part of the Physical

Therapy curriculum at Cleveland State University. Susan developed the Stroke

Exercise Program at Lakewood Hospital with the mission to provide an environ-

ment where patients with chronic stroke can participate in aerobic and task-based

exercise to improve their cardiovascular fitness. She is currently the research physical therapist and study coor-

dinator in a NIH R01 multi-site trial investigating the utilization of robotics to improve upper extremity function

with acute stroke. She is also a co-investigator (PDF grant, CCF) in a project to develop a portable, computerized

concussion assessment system.

47 48

49 50

51 52

53

ERIK PIORO, M.D., Ph.D., FRCPC

Director of the Section of Amyotrophic Lateral Sclerosis and Related DisordersCleveland Clinic, Cleveland, Ohio

Dr. Pioro specializes in the care of patients with ALS and other complex

neurodegenerative motor neuron disorders and runs clinical trials to find effective

treatments for these diseases. His primary research focus is using magnetic

resonance imaging to identify and monitor the progression of motor neuron

degeneration in the brains of patients with ALS and related conditions, and the

correlation of imaging changes with human and mouse ALS brain tissue.

Dr. Pioro received his medical degree from the University of Calgary in Alberta,

Canada, which was followed by a doctorate in philosophy (PhD) at the University

of Oxford in England as a Rhodes Scholar. He completed his neurology residency at

the Montreal Neurologic Institute at McGill University in Montreal, Canada, where he also completed a fellowship

in magnetic resonance spectroscopy. He also trained as a clinical and research fellow in electromyography/

neuromuscular diseases at Cleveland Clinic, where he remained on staff.

Dr. Pioro is the recipient of several awards as well as grants from the National Institutes of Health, the ALS

Association and the Packard Center for ALS Research at Johns Hopkins University. He is a member of several

professional associations, including the American Academy of Neurology, Society for Neurosciences, American

Association of Neuromuscular and Electrodiagnostic Medicine and World Federation of Neurology. He serves on

the scientific committee for the international ALS CARE Database. He holds the Barry Winovich Chair for ALS

Research at the Lerner Research Institute of Cleveland Clinic.

Dr. Pioro has published numerous journal articles, book chapters and abstracts on clinical and basic-science topics

related to neuromuscular function and disease, particularly in relation to ALS and related disorders. He also serves

on the Editorial Board of the journal Neuroscience Imaging, and he serves as an ad hoc reviewer for several

journals, including ALS and Motor Neuron Disorders, Annals of Neurology, Brain, Muscle and Nerve, Journal of

Neurochemistry, Journal of Neuroimmunology, Journal of Neuroscience, Molecular Neurobiology, and Neurology.

ALS: New Approaches for Treatment

54

55 56

57 58

59 60

61 62

RYAN WALSH, M.D., Ph.D.

Director, Parkinson’s Disease & Movement Disorders Program


Dr. Walsh has long-standing clinical and research interests in the neurosciences that

began as an undergraduate at Georgetown University. During Dr. Walsh’s subsequent

training in the NIH-funded MD/PhD program at The University of Cincinnati, he

built upon his interest in brain networks which led to an interest in the clinical field

of Neurology. Dr. Walsh pursued residency training in Neurology at The University

of Chicago, and his growing research and clinical research interests resulted in a

first-author scientific publication in the journal NeuroImage, the publication of a

book chapter reviewing the etiology of Parkinson’s Disease, and the publication of

a clinical report in the journal Neurology during his residency. These experiences

as a physician-scientist led Dr. Walsh to pursue fellowship training in Movement

Disorders, Memory Disorders, and neuroimaging to investigate the fundamental mechanisms underlying brain

network physiology as well as treat the clinical phenotype of their dysfunction.

Dr. Walsh pursued fellowship training with two acknowledged world leaders in Movement Disorders, Dr. David

Standaert and Dr. Ray Watts, at The University of Alabama at Birmingham (UAB), where he developed an MRI-based

analysis of brain networks underlying cognitive dysfunction in Parkinson’s Disease. Though Dr. Walsh’s imaging

approaches were novel to UAB at the time, he actively sought and obtained external guidance from a world-leader in

this field, Dr. David Eidelberg. Utilizing this collaborative mentorship approach, Dr. Walsh was able to obtain highly

competitive funding from the Parkinson’s Disease Foundation (PDF; their only Clinical Postdoctoral Fellowship

awarded for 2009-2010) and from the Civitan International Research Center Emerging Scholars Program during

the second year of his fellowship. He also received a consecutive year of funding from the PDF.

Movement Disorders: Advances in Neurological Therapeutics

63 64

65 66

Director of the Multiple Sclerosis Program at Cleveland Clinic Lou Ruvo Center

for Brain Health, Dr. West received his undergraduate degree in Neuroscience at

Brigham Young University in Provo, Utah. He completed his medical degree and

Neurology residency at the University of California, San Francisco. After serving

as Chief Neurology Resident he stayed on to complete a fellowship in clinical

neuroimmunology that was funded by the National MS Society.

Dr. West is very involved in clinical research and has experience running clinical

trials within an MS Center. He has published original articles on Multiple Sclerosis

relating to the safety of therapeutics and the clinical predictors within the early

stages of the disease. His research interests are focused on improving patient outcomes and the development of

novel therapeutics in the treatment of Multiple Sclerosis.

Aside from research, Dr. West has a great passion for teaching and has taught within the medical school at UC San

Francisco for the past three years. He frequently participates in patient education programs and is very committed

to providing comprehensive care for patients with Multiple Sclerosis. As such, part of his clinical fellowship

included special training in neuro-urology, spasticity management and neurodiagnostics.

Director, Multiple Sclerosis Program


TIMOTHY WEST, M.D.

Multiple Sclerosis: Advances in Clinical Management

67 68

69 70

71 72

73 74

DYLAN WINT, M.D.

Neurologist | Psychiatrist


Dr. Wint joined the staff at the Lou Ruvo Center for Brain Health in May 2010.

He has extensive experience in researching, diagnosing, and treating disorders of

the brain. He has designed and/or participated in research studies of behavioral

sequelae of traumatic brain injury, the effects of dopaminergic medications on the

human reward system, cognition in schizophrenia, and irritability and aggression

in Huntington disease. At the Center for Brain Health, Dr. Wint supervises the

Education in Neurodegeneration program for high school, college, and professional

students. He also directs the Center’s Fellowship in Cognitive Disorders.

Dr. Wint received his undergraduate and medical degrees at Stanford University

and the University of Miami, respectively. After finishing simultaneous residencies in Neurology and Psychiatry

at the University of Florida, he completed a fellowship in deep brain stimulation and served on the faculty. During

a two-year fellowship at the Section on Integrated Neuroimaging at the National Institutes of Health, Dr. Wint

performed studies of the brain’s attentional and reward systems in healthy individuals and those with a variety of

brain disorders. He subsequently joined the Emory University Department of Psychiatry and Behavioral Sciences.

At Emory, he developed the Program in Neurologic Psychiatry, a clinical, research, and educational unit dedicated

to optimizing the understanding, diagnosis, and treatment of behavioral problems in patients with neurologic

illnesses.

Managing Depression & Psychosis in Neurological Disease

75 76

2011 advances in neurological therapeu!cs€¦ · advances in neurological therapeutics faculty...

Documents