Late 2012 is going to be great for MS

Wow wow wow

It's an exciting time for MS drug development and an even more exciting time for our patients and future MS patients. In the past year, oral BG00012 was catapulted from a niche place in the MS treatment landscape to a highly prominent international position. DEFINE data presented at ECTRIMS 2011 highlighted BG00012 as a safe, effective and mostly tolerable oral medication for the reduction of MS relapses and disability. The enthusiasm generated at ECTRIMS was still spreading at the point when top line results from the second Phase III trial (CONFIRM) were released. In CONFIRM, BG00012 was not only compared to placebo, but there was also an additional arm of subjects treated with Glatiramer Acetate. BG00012's superiority over placebo in DEFINE was confirmed by CONFIRM, and while CONFIRM was not designed to compare BG00012 head-to-head to Glatiramer Acetate, it is difficult not to make the natural conclusion that BG00012 probably performed better than Glatiramer Acetate as well. While performing better than Glatiramer Acetate is a significant accomplishment, especially in light of the disappointing performance of the high-dose high-frequency interferons compared to Glatiramer Acetate in the BEYOND and REGARD studies. In CONFIRM, however, BG00012 did not have a significant effect on sustained disability as compared to placebo; this raises the question, not of whether BG00012 will be FDA approved for the treatment of MS, but rather whether it will be approved for delaying MS disability in addition to reduction of relapses. Further exploration of prespecified subgroups and post hoc analyses will be quite useful.


Race of the orals

While large amounts of new data on Terflunomide were not released, it remains in the running as an oral, mostly safe MS medication. The safety will be further characterized by release of more data from the expansive list of Sanofi sponsored trials for this medication.


Head-to-head

Alemtuzumab is the most exciting medication in the MS pipeline for the foreseeable future.The combination of a quantum leap in efficacy (50% better than Rebif) and the infrequent dosing schedule (only 5 days in a row in the first year and not again until the second year when it is given for 3 days, and then some perhaps it will not need to be re-dosed in most people), makes Lemtrada an attractive option for many physicians and patients. In the CARE--MS-1 study Alemtuzumab was found to be significantly better (55%) than Rebif in reducing relapses, but the results for disability were not significant -- probably because the Rebif treated subjects did better than in prior studies of Rebif. The results of CARE-MS-2 confirm this assumption as Alemtuzumab was superior in terms of reducing relapses (49%) as well as sustained disability (42%) as compared to Rebif (not to be mistaken for trials comparing medications to placebo). We look forward to Genzyme, a Sanofi company, releasing more information on the annualized relapse rates in the two groups and we suspect that further investigation of patient subgroups will help clinicians understand in which patients there will be ~50% reduction as compared to Rebif as opposed to ~70% reduction compared to Rebif (as suggested in prior Phase II trials).



The decision tree for newly diagnosed patients may evolve to a question of how risk averse the individual patient is. For those wanting a medication with a very long safety record (at least in psoriasis), BG00012 may be first line, while in others who want the medication with the strongest efficacy, but with some potential for the development of humoral autoimmune diseases, Alemtuzumab may be the right choice.


Beyond T cells

Ocrelizumab is a humanized version of Rituximab, a monoclonal antibody directed against B cells -- a fairly new treatment paradigm for MS. Ocrelizumab will be dosed 4 times a year with the goal of reducing relapses as well as disability. Roche is studying Ocrelizumab for relapsing MS in the mirror OPERA 1 and 2 studies, while also studying Ocrelizumab in primary progressive MS.





Daniel Kantor, MD
Medical Director
Neurologique

President
Florida Society of Neurology
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Be a leader, help the network ... join neurologique@gmail.com

Multiple Sclerosis Team Approach Rule *** MS Patient Network


www.neurologique.org

Twitter, facebook, blogs and more.

Botox ... truth in advertising

A local news story in Jacksonville had good intentions, but it missed the point with its editing -- it made it sound like Botox was experimental for chronic migraine!

For those of you following our tweets, we first reported on the FDA approval of Botox for chronic migraine (15 or more headache days a month) a year ago.

So, let's set the record straight -- Botox is FDA approved for many things -- my comments on experimental treatments were after the reporter asked about future uses -- and I mentioned that it was being tested for baldness (alopecia areata). I didn't want everyone running to their doctors demanding Botox for something still in experimental phases -- but I made it clear that Botox is FDA approved for chronic migraines ... and more.

In fact, at the recent ECTRIMS (European Committee for the Treatment and Research in MS), I reported in real-time with Ashley from MS World about the various (FDA approved) uses for Botox relevant to MS: cervical dystonia, blepharospasm, chronic migraine, urinary bladder and more):

Among treatments for spasticity (Tai Chi, Yoga, Baclofen, Arbaclofen Intrathecal Baclfen pump, Botox):

So what can we learn from all this?

Be wary of the news that you here -- go straight to the source ... Neurologique, your source for neurological news that matters.

- Dr. Daniel Kantor, MD
Medical Director
Neurologique

info@neurologique.org
www.neurologique.org

Wow ... when enthusiasm is appropriate

Wow!


Enthusiasm is important, even (or especially) at international scientific meetings.

If you are following our (MSWorld and Neurologique) real-time videos from ECTRIMS (European Committee for the Treatment and Research in Multiple Sclerosis) -- the biggest MS meeting of the year. On 10/21/2011, Prof. Ralf Gold presented data from the phase 3 DEFINE study (Determination of the Efficacy and safety of oral Fumarate IN rElapsing-remitting MS) and it was exciting.

While we still need to wait for the CONFIRM study (it compares placebo, two doses of oral BG-12 and subcutaneous Glatiramer Acetate/Copaxone) to ensure that oral BG-12 (dimethyl fumarate) is as exciting as it looks in DEFINE: safe, effective for MS relapses and disability, effective for MRI and mostly well tolerated.

At the end of the presentation by Prof. Ralf Gold, I said "I think that I speak for most people when I say wow." I then asked about pregnancies (no malformations) and 3 vs 6 month disability progression.


This has gotten me known as the "Wow Doctor" -- it has even been covered in the media by Medpage.

One day, I hope that I can say "wow" about many other new therapies.


- Dr. Daniel Kantor, MD
Medical Director
Neurologique

info@neurologique.org
www.neurologique.org

Lack of focus and MS - Facebook Question and Answer

Here is another great question (and, hopefully, answer) from Neurologique's open Facebook page.


Question:

Why do some MS people feel so unfocused in the head and what can be done to help this feeling?

Answer:

There are many potential reasons for this:

1. Related to medication side effects.
2. From the MS itself -- fatigue.
3. From the MS itself -- cognitive problems.
4. Something also called "MS brain fog"
5. Depression.
6. Not from MS, but something else.


In terms of how to approach treatment, it is going to depend on the cause. Non-pharmacologically we use meditation (especially mindful meditation), breathing exercises, visual imagery, acupuncture, yoga, tai chi, cooling, etc.

Pharmacologically, we maximize the MS disease modifying drugs and we choose appropriate symptomatic treatments, like medicines for fatigue (Amantidine, Provigil, Nuvigil, B12, Caffeine, Stimulants etc.). At Neurologique we are also looking at an Ayurvedic herb called Ashwagandha for MS -elated fatigue.

Interestingly, there are two medications that I call "NeuroFunctional Enhancers" because they enhance function in people with neurological diagnoses. Thus far the class is made up of:

1) Ampyra (dalfampridine) -- FDA approved for gait dysfunction in MS, but because it helps the nerves work better, it can help in lots of ways.

2) Nuedexta (dextromethorphan + quinidine) -- FDA approved for pseudobulbar affect (regardless of cause), which is, basically, problems with coordinating your emotions and how you display them to others (affect). It has an effect on blocking the effects of glutamate in the brain, and is an NMDA antagonist and Sigma-1 Agonist (scientific mumble jumble)

I hope that this was useful.
.

MS with a negative LP (lumbar puncture or spinal tap)

As many of you know, I answer questions for the MS Foundation (MSF) and here is one that we thought would be interesting and useful to you.

Question:

I have 3 spots on my brain the doctor has tested me for MS even had a spinal tap it came up negative. I would like to know if I do have MS but just has not showed up yet sometimes I lose my balance and don't have much strength in my hands.

Answer:

Thank you for the question.

It is true that people with MS may have negative lumbar puncture's (LPs or spinal taps) and someone needs to explain your white spots on the brain, and more importantly, your symptoms. I strongly recommend that you see an MS specialist and that you consider (if not done already):

- Close Cervical spinal cord MRI with and without Gadolinium
- Close Thoracic spinal cord MRI with and without Gadolinium
- Visual Evoked potential (VEP)
- Somatosensory Evoked Potential (SSEP) of the upper and lower extremities
- Brainstem Auditory Evoked Potential/Response (BAEP/R)
- Optical Coherence Tomography (OCT)
- Lab work-up
- Repeat LP in a few years -- ut we don't want to wait that long!

MSF can help you find a neurologist near you ... they always help!!

I know that this means that you will need to be patient.

Thank you,

Daniel Kantor, MD
Medical Director
Neurologique

President
Florida Society of Neurology

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Be a leader, help the network ... join neurologique@gmail.com

Multiple Sclerosis Team Approach Rule *** MS Patient Network

info@neurologique.org

www.neurologique.org

Q&A with Dr. Kantor: Numbness

As many of you may know, I answer questions on multiple sites, including Avvo. I thought that this question and answer would be useful to many of you out there.

Question:

I have been experiencing numbness in my fingertips and toes. What could be causing this?

I have not injured my fingers or toes recently. I have had some numbness in some of my fingertips for awhile, but it seems to be getting more prevalent.

Answer:


I can understand why this is a concerning symptom. There are several possibilities, but remember that online discussions do not replace real life interactions with doctors -- especially neurologists.

The possibilities include that:

1. This is simply a variant of the weird things that we all feel.
2. This is not neurologic.
3. This is caused by a peripheral nerve problem -- like diabetes (diabetic neuropathy).
4. This is caused by a vitamin (like Vitamin B12) deficiency
5. This is caused by a spinal cord problem.
6. This is caused by something going on in the brain.

As you can see, there are a lot of possibilities and your best bet would be to see your primary care physician and then a neurologist.

Please try not to be worried until this is looked into (it may not be worth worrying about).


- Dr. Daniel Kantor, MD
  Medical Director 
  Neurologique 

  info@neurologique.org 
  www.neurologique.org

Exciting Advocacy News for FL: National Stage - Dr. Kantor appointed again to FMA Council on Lgislation

From FMA:

TO: Daniel Kantor, M.D.

FROM: Miguel Machado, M.D., President

RE: Reappointment to the FMA Council on LegislationTO:


I would appreciate your willingness to accept reappointment to serve on the FMA Council on
Legislation as the Medical District B representative during my term as President of the FMA,
effective July 31, 2011. Attached is a list of those who have been asked to serve with you.

There are two FMA Board of Governors & Council Days scheduled during the appointed year.
This meeting format is intended to facilitate interaction between the various councils/committees while minimizing travel expenses. While I cannot confirm the specific date and time each group is meeting, every effort is being made to accommodate a Friday or Saturday meeting time concluding with the Board of Governors meeting on Sunday. I respectfully ask that you keep the dates open for scheduling. FMA staff assigned to each council/committee will distribute meeting details approximately 6-8 weeks in advance. Please keep in mind that there may be instances when a particular group may find it necessary to meet by conference call, rather than in person. Those details will be provided by appropriate staff as well.

Exciting Advocacy News for FL: National Stage - Dr. Kantor placed on AMA Reference Committee on Legislation

From the AMA:

Dear Dr. Kantor

On behalf of the Speakers, it is my pleasure to invite you to serve the AMA House of Delegates at its Interim Meeting in New Orleans, Louisiana, November 12-15, 2011, as a member of Reference Committee B (Legislation).

As a member of a Reference Committee your responsibilities will include:

· Participation in the hearing on Sunday, November 13. (This open hearing will last as long as is necessary to receive comments on the business before you.)

· Participation in preparation of the report of the Reference Committee. (This includes an executive session of the full committee that immediately follows the conclusion of the open hearing as well as additional meetings, as needed, until the final report is complete. This often means being available throughout the night and the following morning.)

· Presence before the House during its consideration of the report of your Reference Committee.

In addition, virtual reference committees are planned for November as was done for Reference Committee E in June. Virtual (online) testimony will be accepted from approximately October 14 to October 30. Each reference committee will then have to meet by phone sometime the next week (October 31–November 4) so that a draft report can be prepared and posted on November 7 or 8, in time to allow the report to be reviewed by members of the House prior to the meeting. This process, although still in its trial phase, worked well in June, and in the end, resulted in a less harried experience for the reference committee members; we are hopeful for a similar experience at this meeting.

Your work on a Reference Committee is a service to American medicine and a very important contribution to the democratic process followed by the House of Delegates.

Outpouring of support for deceased neurologist, Jim Nealis, MD

In response to our earlier obituary for the passing of Jim Nealis, MD - Past President, Florida Society of Neurology (see original obituary), we received the following message:

Thank you. When I first arrived at Harvard in 1976, Jim was a fellow at the Seizure Unit (where I was assigned) with Dr. Cesare Lombroso. I did not know a soul there and Jim became a good friend, even inviting me out for St Patrick’s Day. He was a caring doctor and a fun guy to work with. I will never forget him. My condolences to his family.

Herminio Cuervo

Your FSN ... Helping Neurologists help their patients.

Daniel Kantor, MD
Medical Director
Neurologique

President
Florida Society of Neurology

www.neurologique.org

FSN Distinguished Panel: Drs. Alternburger and Wilson and Senator Fasano

`

Medicine 2011: Issues Facing Neurologists and Their Patients:

Local, State and Federal perspectives

Distinguished Guests:

Senator Mike Fasano -- Florida District 11

Karl Altenburger, MD – Past President, Florida Medical Association (FMA)

Cecil Wilson, MD --Immediate Past President, American Medical Association (AMA)

Schedule: September 17^th, 2011

12:00 – 12:15: Lunch preparation – FSN Business Meeting

12:15 – 12:20: Call to Order (Introduction of Board)

Daniel Kantor, MD

12:20 – 12:25: Introduction of distinguished panel

Daniel Kantor, MD

12:25 – 12:40: Pills Mills: How the Senate saved

FL Senator Mike Fasano

12:40 – 12:50: How the FMA works with specialists

Karl Altenburger, MD

12:50 – 1:10: Neurologists in the House of Medicine

Cecil Wilson, MD

1:10 – 1:20: Panel Discussion

Distinguished Guests

1:20 – 1:30 New Business and Concluding Remarks

Daniel Kantor, MD

FSN in Your Corner: Protecting you and your patients

Dear Fl Neurologist,

Your FSN has been working hard for you – on the local, State and Federal levels and we are excited by the results.

Innovative Annual Meeting:

As you know, the FSNAnnual Meeting is fast approaching on Sept. 16 – 18, 2011. We are excited by the addition of a cognition & TBI (traumatic brain injury) program in the 37th Annual Course in Neuropsychology and Behavioral Neurology. Our Advances in Neurology Workshop promise to be innovative with Controversies in Neurology and Challenging Cases posed to and by our Neurology Chairmen. Your staff and primary care referring colleagues are sure to be enlightened by the Neurology for the Non-Neurologist: Localizing Neurologic Symptoms. Your family will be dazzled by the Disney Yacht Club pool and the proximity to the Disney parks … in short, everyone is sure to have an enlightening, productive and fun time at the FSN Annual Meeting at the Disney Yacht Club on September 16 – 18, 2011. If you haven’t yet, then please be sure to register and reserve your block of rooms online.

Unprecedented Distinguished Panel:

I am most proud of the distinguished panel that I will be introducing on Saturday September 17^th, 2011 at 12:00 – 1:20 PM. Cecil Wilson, MD – Immediate Past President of the AMA, Karl Altenburger, MD – Past President of the FMA (FL Medical Association) and Senator Mike Fasano will be addressing the topic of “Medicine 2011: Issues Facing Neurologists and Their Patients - Local, State and Federal perspectives.” The caliber of our panelists speaks volumes to the notoriety of your FSN and its place within the House of Medicine … with all the changes facing us, don’t be left in the dark!

Senator Mike Fasano	FL District 11
Karl Altenburger, MD	Past President, FL Medical Association (FMA)
Cecil Wilson, MD	Immediate Past President, AMA

Alert: West Nile Virus Outbreak:

There have been cases of Dengue Fever and neuroinvasive West Nile virus in different parts of the State. I have kept neurologists in Duval county abreast of the information disseminated by the FL Department of Health regarding the West Nile Virus cases. It is a privilege to represent you in discussions with the varied Public Health departments protecting the citizens of our great State. The FSN was the only State Specialty Society represented in these teleconferences and we are leading the way in both physician and Public education regarding this potentially dangerous outbreak … wherever there is an issue touching upon the nervous system, your FSN will be there representing YOU and your patients.

Value-added Membership benefits:

Your FSN recognizes that the economic downturn has affected each and everyone one of us, and we have developed a member benefits package to suit your needs:

1. Universal Waste Management (biomedical waste) -- 10% discount and lower price than competitors for FSN members Tel. (352)234-4BIO (4246)

2. TNP (The Neurologists’ Program) -- malpractice insurance and risk management

3. Long-term Care Insurance Program (Affinity)-- see below.

4. I.C. Systems Collection Agency

5. Medscape CMEs

6. The Southern Headache Society --we may do joint CME programs with discounts to FSN members (join the google group)

7. Discounts on medical books through Cambridge Publishing and Oxford Publishing (email fsneuro@gmail.com for your Promotional Code)

8. FSN lapel pins … get yours today!

9. Future pan-FL dinners

10. Regional pan-FL dinners -- stay updated and give your input.

Advocacy Victories … Finally Some Good News!

Your FSN advocated diligently for you and your patients. We have made strategic partnerships with the FMA (we have two neurologists on the FMA Board of Governor’s and I sit on the FMA Council on Legislation and the FMA PAC [Political Action Committee]), the AMA (I was recently elected to the FMA delegation to the AMA), the AAN (through various leadership, including Advocacy) and other organizations, such as the FL Academy of Physician Assistants (I sat alongside the FMA and FOMA [FL Osteopathic Medical Association] Presidents). Additionally, we have ties to the FL Agency for Persons with Disabilities (APD) and I recently ha a productive meeting with the Medical Director of First Coast Service Options (the FL Medicare contractor) – I will present this information at the FSN Annual Meeting.

1, Pill Mills – Board-certified neurologist are not limited by this legislation and you are free to practice without registering with the State.

2. Gun bill – It is not a felony to talk to your patients about safety (even gun safety) … just document the reason.

3. Sports concussions – the FL High School Athletics Association recognizes (without the need for government intervention or legislation) that only MDs/Dos are qualified to return an athlete to play … Your FSN is leading the way in education and protecting our youth.

4. EMG/NCS – We are setting up a joint panel of 3 neurologists and 3 physiatrists with the FL PM&R Society to explore issues related to EMG/NCS and how they affect your practice (and your patients’ safety) – please let us know your local concerns.

5. Booster seats – FL has seatbelt laws but does not sufficiently protect our children, and the FSN is committed to supporting FL Pediatricians in their noble advocacy efforts.

6. Bicycle helmets – FL Academy of PAs (FAPA) Foundation is working to raise Public awareness regarding bicycle helmet safety and the FSN supports protecting our youth’s brains … get your family involved today.

7. IPAB (Independent Payment Advisory Board)- The FSN was the only State Neurology Society to sign the opposition letter (signed also by the AAN) – your Board is proactive and will not let you down. http://bit.ly/ppFWfA

Outreach: Nigeria Florida Neuroscience Partnership (NFNP):

Giving beyond our borders: FL has 6 Neurology residency programs, as does Nigeria, yet the population of Nigeria is ~10 times greater than FL. With the spirit of giving to others, the FSN has been instrumental in forming the NFNP and is proud to announce the 2^nd Annual NFNP Meeting in Abuja, Nigeria on October 10 - 14, 2011. Be a part of this unique program and see another side of Neurology. There are only 50 neurologists in Nigeria! For some stories on the NFNP, please see: Article 1, Article 2, Article 3.

You can make a tax-free donation to the FSN (a 501(c)3 not-for-profit) in the name of the NFNP. You are going to make tax-deductible charitable donations anyway, why not make it to a project that helps millions of people without proper neurological care? A $100 donation (less than a dinner for two at a nice restaurant) will cover the expenses of 1 Nigerian to this important conference … better yet, volunteer to join the Faculty and fly to Abuja (potential group discounts available through Delta).

Your FSN enters the 21^st Century:

Have you jumped on the Social Media wave? Want to follow issues important to

Have you jumped on the Social Media wave? Want to follow issues important to you and your patients? Follow your FSN on twitter at twitter.com/FLneurology or on facebook (search: florida-society-of-neurology). Want to pay your dues online? Visit fsn.aan.com

Developing Leaders:

Your FSN is there for you on the local, State and National levels.

We are currently accepting nominations for the FSN Board of Directors and for Officers. The positions open are: President-Elect (2011 – 2013), Secretary-Elect (2011 – 2013) and Treasurer-Elect. As of the upcoming FSN Annual Meeting, your current Secretary, Glen Finney, will have completed his term (2009 – 2011) and your incoming Secretary will be Rossitza Chichkova (2011 – 2013); your current Treasurer, Nestor Galvez-Jimenez, will have completed his term (2009 – 2011) and your incoming Treasurer will be David Decker (2011 – 2013).

Thank you Glen and Nestor for your service!

Please email us your nominations (including self nominations) to fsneuro@gmail.com.

Congratulations to Achraf Makki, MD – I have recommended him to sit on AHCA’s advisory group for a new utilization management program for Florida Medicaid’s Advanced Outpatient Diagnostic Imaging services. I would like to remind everyone who isn’t a PALFer, to go ahead and apply by Sept 18, 2011 for the January 12 – 15, 2012 Palatucci Advocacy Leadership Forum. Developed your leadership skills … make FL proud.

Welcome New Members:

Your FSN would like to welcome the following new members:

• · Tetsuo Ashizawa, MD
• · David Burks, MD
• · Alfred Erontera, MD
• · Gregory Hanes, MD
• · Donna Hill, MD
• · Roman Kesler, DO
• · Ramon Lugo, DO
• · Benjamin Moore, MD
• · Donald Negroski, MD
• · Steven G. Sable, DO
  
• · Denise Taylor, DO

For your convenience, to pay your dues, you can use PayPal.

CME Corner:

The SouthernHeadache Society is hosting its 1st Annual Meeting in Asheville, NC

Do you have CME programs that you would like other FSN members to know about? Email us.

Your FSN is here for YOU.

Thank you,

Daniel Kantor, MD
Medical Director
Neurologique

President
Florida Society of Neurology

** Come to the FSN Annual Meeting: Sept 16 - 18, 2011. Register Today! **
----------------------------------------------------------------

Be a leader, help the network ... join neurologique@gmail.com

Multiple Sclerosis Team Approach Rule *** MS Patient Network


www.neurologique.org

Twitter, Facebook, Blogs, YouTube and more.


----------------------

The Florida Society of Neurology (FSN) has endorsed a discounted Long Term Care Insurance Program. This discounted program is now being made available to all FSN members and their families.

Considering the high cost for Long Term Care, this program is designed to help protect you, your family and your retirement security. Protection is available should you need care at home, in an assisted living or nursing home facilities.

To request information on this program click HERE.

This program offers special discounts not available to the general public for:

• you
• your family members including

Ø spouses

Ø parents

Ø grandparents

If you would like to forward this to a family member please feel free to do so.

Jacksonville Sharks: ArenaBowl XXIV World Champions

They've done it again!

Yet another Jacksonville team has made us proud by winning a National Championship.


Last year the Jacksonville Axemen Rugby Team won the National Championship (although this year they were defeated in round one of the playoffs). This year, the Jacksonville Sharks Arena Football Team made all of Jacksonville proud by winning ArenaBowl XXIV.

The team returned to Jacksonville on Saturday August 13th, at around the same time that I was returning from lecturing at the FAPA (FL Academy of Physician Assistants) Summer conference on MS and how to perform a neurologic exam. At the airport, a reporter commented to me (I am the Jacksonville Sharks and the Jacksonville Axemen Team Neurologist) that no players had a concussion this past year -- this is inaccurate but understandable. The general Public mistakenly associates concussions with only glaring brain injury, however concussion are often more subtle. Tim Tebow's concussion in October 2009, helped raise some awareness regarding concussions (see the video), although it is very hard to believe that it was his first. To further raise awareness, Dr. Kantor joined the medical advisory board of the Seeing Stars Foundation.

We call concussions mTBI (or mild traumatic brain injury), but they are not always so mild.




- Dr. Daniel Kantor, MD
Medical Director
Neurologique


Board Certified, Headache Medicine

info@neurologique.org
www.neurologique.org

In Memoriam: James G. T. Nealis, MD

IN MEMORIAM:

James G. T. Nealis, MD

March 7, 1945 - May 5, 2011

Jacksonville, FL

The Florida Society of Neurology is saddened by the news of the passing of Dr. Jim Nealis, past Secretary and President of the FSN (1982).

Dr. Nealis obtained his B.A. from Fordham University and his M.D. from the University of Miami. After residency training in Boston in Pediatrics and Neurology, Dr. Nealis served as an Instructor in Neurology at Harvard University School of Medicine and then returned to Florida, where he served as an Assistant Professor in both Clinical Neurology and Clinical Pediatrics at the Jacksonville campus of the University of Florida. He served patients in hospitals throughout the Jacksonville area and he contributed to the medical literature on pediatric seizures and EEG. His interests in Neurology were broad and he founded and directed the Jacksonville Alzheimer's Center (1987-1989).

Dr. Nealis is survived by his beloved wife Grace Arlene Kramer Nealis and the proud father of five sensational children Douglas and his wife Dawn, Gregory and his wife Melanie, James IV, Patrick, and Peyton. As well as four precious grandchildren, Cailyn, Austin, Sophia, and Madison. He is also survived by his sister Mary Farrell. A celebration of his life will be held at Southpoint Community Church at 7556 Salisbury Road at 10am Monday, May 9th. Burial will immediately follow at Oaklawn Cemetery. In Memory of Dr. Nealis, Contributions may be made to the American Center of Law and Justice PO BOX 90555, Washington DC 20090-0555. Dr. Nealis was a true humanitarian in the real sense. He was a man whose life was devoted to those unable to help themselves. HARDAGE-GIDDENS OAKLAWN CHAPEL, 4801 San Jose Blvd. is serving the family.

The loss of Dr. Nealis is a loss to the profession of Neurology and a loss to his patients. Our thoughts and prayers are with his family.

To sign the virtual Guest Book, please visit Legacy.com

Open Letter to FL neurologists

Dear FL Neurologist,

Although Hawaii away, many FL neurologists have made the long flight to the AAN Annual Meeting as presenters, lecturers, leaders and attendees.

We hope that you will join your FSN at these events:

1. Joint breakfast – FSN and NFNP (Please welcome our Nigerian colleagues)

- Tuesday, April 12 from 7:30 AM - 9:30 AM at the Hawaii Convention Center – Room 308B. A light breakfast will be served at this event.

2. Current Practice Issues in Neurology – Daniel Kantor will be presenting on Accountable care organizations (ACOs) and neurologists

- Wednesday, April 13, 2011 from 5:30pm-7:00pm at the Hawaii Convention Center, Room 315

3. Awards Plenary Session

- Thursday April 14 4:30 p.m.-6:30 p.m. Hawaii Convention Center Kamehameha III

4. General Neurology Highlights in the Field (6SH.006) – Daniel Kantor will be presenting how healthcare reform affects neurologists

- Thursday April 14 Location: Hawaii Convention Center Kalakaua Ballroom C

Stay tuned – visit our Twitter account for updates on when you can support our own Michael Finkel as he wins the prestigious Kenneth M. Viste Patient Advocate of the Year Award (the 2007 inaugural Award was also won by a FL neurologist, Kamel Elzawahry).

The FSN will also be represented by Drs. Kantor and Elzawahry at the State Society Leadership Roundtable and the Payment Policy/NeuroCAC Representatives/State Society Leaders

Throughout the week, we will be accepting your information about when you are presenting posters/lectures – please add it as a comment on our Facebook page and we will then spread the word on Twitter as well!

Our promoting your presentations is just another way how your FSN is here for you.


1. Membership

Membership benefits keep expanding.

a. Universal Waste Management (biomedical waste) -- 10% discount and lower price than competitors for FSN members,
b. TNP (The Neurologists’ Program) -- malpractice insurance.
c. Medscape CMEs
d. The Southern Headache Society --we may do joint CME programs with discounts to FSN members
e. Discounts on medical books through Cambridge Publishing and Oxford Publishing (email fsneuro@gmail.com for your Promotional Code)


If you have paid your 2011 FSN dues then you have already received a lapel pin to wear proudly on your blazer or white coat. If you pay your dues at the AAN, you will receive a pin at the FSN-NFNP breakfast on Tuesday.


Don't forget to pay your 2011 dues online or we can discuss this with your office manager -- please have them contact us. Also, your ARNPs, PAs and nurses can join the FSN as well.


Our Pan-FL Dinner Meeting on March 10th 2011 was a great success and the presentation can be found online on our website.


2. Education/Annual Meeting -- The schedule looks great so save the date: Orlando, FL: 09/16-18/11 -- FSN Annual Meeting (Disney Yacht Club)


3. Website/Communications -- The FSN has entered the 2010s and we have a social media presence that you can sign up for at Twitter and Facebook

Also, everytime we send out the 'FSN in Your Corner' emails, they get added to the website. We are considering having a members only section of the website for content (including CME and practice management seminars).


4. Outreach -- The Outreach Committee is doing an amazing job along with our Nigerian colleagues applying for an American Board of Internal Medicine Foundation grant.Come and meet your Nigeria colleagues all the way in Hawaii -- The Nigeria Florida Neuroscience Partnership will be joinging the FSN on Tuesday, April 12 from 7:30am-9:30am at the Hawaii Convention Center – Room 308B. A light breakfast will be served at this event.


5. Advocacy/Legislation -- Your FSN continues to get media coverage, for example in Neurology Reviews. To summarize:

a. Pill Mills -- This is becoming even more complicated, with the Senate and the House pitted against each other and the Governor weighing in against the PDMP (Prescription Drug Monitoring Program). Representative Scheck wants to get rid of all physician dispensing. To make this even more confusing, the Department of Health is finally launching the PDMP, (the vendor bidding battle has been settled) but the whole program may be shut down.


On much better notes, we have 2 victories for our patients and for your practice:

b. Sports concussion -- These bills HB 301 / SB 730 are gliding through their committees (currently in Education in the House and Rules in the Senate). It looks like MDs/DOs will be the final arbiters of return to play, but they may delegate parts of their responsibilities to ARNPs, PAs and athletic trainers. Neuropsychology reports and computerized testing may be used as supportive documentation. This is a major improvement over allowing other practitioners to clear our youth athletes -- this is a victtory for our patients.

c. Gun bill -- The NRA was pushing for doctrs to be punished by up to 5 million dollars in fines and 5 years in prison simply fr asking if their patients own guns. This is a patient safety issue but it is being disguised as an affront on the 2nd Amendment. Our 1st Amendment rights and the doctor-patient relationship. In another victory, HB 155 was amended to allow physicians to ask the gun question if it related to health and safety. Doctors also can record the information in their records (they were trying to bar this). In a nod to the NRA, doctors would not be allowed to discriminate against gun owners.

Can you see now why you should pay your dues online

This is going to be a very difficult session because almost nothing that adds to the budget or increases any fees/taxes to citizens will be passed.

On a frustrating note, Senator Mike Bennett on 04/04/11 lashed out at the Florida Medical Association (FMA), calling it a "greedy" group whose political agenda was about ensuring doctors salaries, not improving access to health care. "The FMA, the doctors, are greedy," said Bennett. "They want to continue to be able to double bill, they want to be able to continue to restrict access to health care for greed."

We have been educating and advocating for FL neurology needs, but since we are a 501(c)3, we have not lobbied and so I have been asked to not only continue to sit on the FMA Council on Legislation but also to join the Board of the FMA PAC (political action committee).

I accepted this position on the condition that FL neurologists would be recognized when donations are made so that FL neurologists can have their voices heard. Those of you that have already been contributing to the FMA PAC, can either do so through me or simply write “Neurology” on the check that they send it to the FMA PAC. Please do not direct any of the donations to the FSN, as we are a 501(c)3 tax exempt organization, instead make your checks out to the Senator Gaetz Campaign (maximum donation $500) and write “Neurology” on the memo line and email me.

Lastly, don’t forget that because the FSN is a tax-exempt 501(c)3 nonprofit, you can make tax free charitable donations (beyond your dues) to the FSN.

Your FSN is committed to serving your needs, so you will be receiving regular emails from me.

CME Programs in FL:

• Orlando, FL: 09/16-18/11 -- FSN Annual Meeting (Disney Yacht Club)

If you have CME announcements, please email me at fsneuro@gmail.com

Daniel Kantor, MD
Medical Director
Neurologique

President
Florida Society of Neurology

Your FSN is here for you.

Parkinson's Event: "10 Mountains 10 Years" screening at the Palm Beach Film Festival

Attention: Patient, carepartners, healthcare professionals and the Public, please take note of the great event this weekend:

"10 Mountains 10 Years" screening at the Palm Beach Film Festival

PRESS RELEASE

Contact:
Elizabeth K. Barber, PhD, Advocate
Parkinson’s Action Network and PALF, American Academy of Neurology
Tel: 331-452-3530; Fax: 630-665-3940
Email: ekbarber2@aol.com

Winfield Resident To Attend Parkinson’s Action Network
Event in Washington, DC to Put Education and Advocacy in Action

February 25, 2011 – Residents of Illinois will join members of the Parkinson’s disease community from across America in Washington, DC for the Parkinson’s Action Network (PAN) Research & Public Policy Forum, from February 28 through March 2, 2011.

At the PAN Forum, people living with Parkinson’s, their families and caregivers, and others working toward finding a cure for Parkinson’s come together in the Nation’s Capital to:

 Receive updates on the latest Parkinson’s disease research;
 Learn about where they can be most effective in helping educate elected officials about Parkinson’s;
 Attend grassroots advocacy workshops; and
 Meet with Members of Congress and their staff to talk about ways in which the government can support efforts to find better treatments and a cure, as well as improve the quality of life for people living with Parkinson’s

During the Forum, Dr. Elizabeth Barber, PhD, Parkinson’s Advocate from Winfield, Illinois and member of the American Academy of Neurology and the American Parkinson’s Disease Association will join/lead a team of advocates from Illinois to meet with Illinois Senators and Representatives and/or their staff to educate them about Parkinson’s disease, and why their vote on certain issues matter to people with Parkinson’s.

“The PAN Forum is an incredible opportunity to join forces with other advocates from across the country and let our voices be heard in Washington,” said Dr. Barber. I am excited to represent the people of Winfield, Illinois in our nation’s capital, particularly since the American Parkinson’s Disease Association, Midwest Chapter has just relocated to Winfield, and will work hard to make a difference for people with Parkinson’s and their families. “I am particularly excited to share the promising research results I have achieved in working with my mother, using supplements complementary to her prescribed Parkinson’s drugs which I am seeking support to have them studied in a larger clinical trial. I will also share the importance of an ordered environment in addition to a regular medication, dining, and exercise regime. I will also highlight the necessity of warning Parkinson’s patients of complications with accidental falls if they are prescribed anticoagulants.”

# # #

The Parkinson’s Action Network is the unified voice of the Parkinson’s community advocating for better treatments and a cure. In partnership with other Parkinson’s organizations and our powerful grassroots network, PAN educates the public and government leaders on better policies for research and an improved quality of life for people living with Parkinson’s. For more information, go to www.parkinsonsaction.org.




- Dr. Daniel Kantor, MD BSE
Medical Director
Neurologique

President
Florida Society of Neurology

info@neurologique.org
www.neurologique.org

Finger contractures and MS

I received the following question on the MSF African-American forum:

Question:

Dear Doctor,

Are finger contractures a MS symptom? If so, what is the remedy?

Thanks.

Answer:

Thank you for the excellent question -- we need to approach your question as three separate ones:

1. Is what you are describing called finger contractures?

2. Can MS be the cause of the symptom?

3. How can you treat the symptom?

Before we go onto "1," let's describe for everyone what you mean by finger contractures:

Finger contractures are when the fingers are more than simply tight (spasticity), but actually shortned muscles or tendons from being contracted for too long. This makes the fingers look like they are tight and abnormal.

1. One should not simply assuming that every tight finger muscles is a contracture. For example, dystonia ("dys" -- "abnormal" or "bad" muscle tone) may appear to you as a contracture, but it is completely different and has different treatments.

Your neurologist can help you with this.


2.Yes, MS can cause spasticity, that if left for a long time, could turn into contractures. However, there are any other reasons for contractures.

So, once again -- speak to your neurologist.


3. Your treatment plan, is just that -- YOUR treatment plan and should be individualized and personalized in a partnership between you and your neurologist.

For actual contractures (not simply spasticity, which may be treated with stretching, yoga, oral muscle relaxants, injectable botulinum toxin and intrathecal baclofen pumps etc.), surgical release is sometimes considered.


I hope that this was useful.

Thank you,

Daniel Kantor, MD
Medical Director
Neurologique

President
Florida Society of Neurology
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