AAN Presidential Lecture: Challenges and Opportunities in Neurology

Illustration of a nerverticale cell
Ralph L. Sacco, MD, discusses challenges in the field of neurology and opportunities to overcome these challenges.

The following article is part of conference coverage from the 2019 American Academy of Neurology Annual Meeting (AAN 2019) in Philadelphia, PA. Neurology Advisor’s staff will be reporting breaking news associated with research conducted by leading experts in neurology. Check back for the latest news from AAN 2019.

PHILADELPHIA – Ralph L. Sacco, MD, MS, urged professionals to continue to provide hope for the growing numbers of patients with neurological diseases, which is both a challenge and an opportunity, in his presidential address at the 2019 American Academy of Neurology Annual Meeting, held May 4-10, 2019, in Philadelphia.

With the aging population comes an increase in disease burden. Dr Sacco highlighted that neurologic disorders are the leading cause of disability-adjusted life years and second leading cause of death globally. Leading causes of disability adjusted life years are stroke (accounting for 42%), migraine (accounting for 16%), and dementia (accounting for 10%).

To meet the growing demand, there needs to be an expansion of the neurological workforce. As the academy works to improve negative factors such as salary and work-life balance, neurologists need to inspire students to pursue a career in neurology and neuroscience.

In addition, the academy is advocating to increase the use of teleneurology and better payment for the use of telemedicine. This includes improving business practices and models along with expanding education for the use of telemedicine.

There is also a need to improve gender, workforce, and health disparities. The academy is developing mentors, networking opportunities, and increasing salary transparency. AAN has also published a recommendation paper in the 2017 to reduce neurodisparity.

Other challenges that Dr Sacco discussed were barriers to quality care, reimbursements cuts, raising drug prices, and raising engagement between patients and caregivers. He highlighted 2 key challenges:

  • Strengthening neurology departments: An academic initiative has been launched to create better resources for struggling academic departments. He stressed that academic departments need to focus on neuroimmunology, neurogenetics and gene therapy, neuromodulation, international care, and teleneurology.
  • Increasing access to high quality neurological care: Only 55% of countries have guidelines for neurologic care and 23% in low-income countries. Effective treatments are often underutilized due to inadequate access to evidence-based care.

Some of the key opportunities highlighted are as follows:

  • Translational research: Translational research is important for developing new medications and approaches for treating patients and neuroscience research is the most funded across all other disorders.  Dr Sacco refers to the National Institute of Health’s Blueprint for neuroscience research and the BRAIN Initiative®, which will guide new translational discoveries.
  • Genetics: Genetics can provide the opportunity to predict risk early on.  This includes pharmacogenomics, which can improve the selection of medications, and enhance efficacy and safety.  In addition, gene therapy, which can manipulate genes to cure rare neurological diseases, can have a beneficial impact in medical treatment.
  • Interventional specialty: There is a need for neurology to evolve into a more interventional specialty, such as those that exist in treating patients with acute stroke and epilepsy.
  • Disease-modifying therapies in multiple sclerosis: Currently there are 17 medications approved by the FDA, but there are opportunities for more.
  • Preventive neurology: Behavioral interventions and modifications can have a positive impact on neurology and neurologic diseases. In addition, preclinical detection can result in better outcomes.
  • Regenerative neurology: While not quite ready, stem cells, gene editing, and engineering biomaterials can provide opportunities and more hope for the increasing number of patients with neurological diseases.

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Overall, Dr Sacco emphasized the important of accelerating research to improve the way patients are treated and make a difference in patient well-being, and called out to neurologists to advocate for faster and better cures.

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Sacco R. Presidential plenary session. Presented at: 2019 American Academy of Neurology Annual Meeting, May 4-10, Philadelphia, Pennsylvania.