Patients with epilepsy are more likely to develop seizure clusters if they have symptomatic generalized epilepsy, an earlier age of onset of their seizures, or if they have status epilepticus, according to a recent review of medical records that looked at over 4000 adult outpatients with epilepsy. The investigators also found that clustering was more common in patients with symptomatic generalized epilepsy than in those with focal epilepsy or idiopathic generalized epilepsy. 

Chen B, Choi H, Hirsh LJ, et al.  Prevalence and risk factors of seizure clusters in adult patients with epilepsy. Epilepsy Res. 2017;133: 98-102.

Patients with epilepsy are more likely to develop seizure clusters if they have symptomatic generalized epilepsy, an earlier age of onset of their seizures, or if they have status epilepticus, according to a recent review of medical records that looked at over 4000 adult outpatients with epilepsy. The investigators also found that clustering was more common in patients with symptomatic generalized epilepsy than in those with focal epilepsy or idiopathic generalized epilepsy. 

Chen B, Choi H, Hirsh LJ, et al.  Prevalence and risk factors of seizure clusters in adult patients with epilepsy. Epilepsy Res. 2017;133: 98-102.

Patients with epilepsy are more likely to develop seizure clusters if they have symptomatic generalized epilepsy, an earlier age of onset of their seizures, or if they have status epilepticus, according to a recent review of medical records that looked at over 4000 adult outpatients with epilepsy. The investigators also found that clustering was more common in patients with symptomatic generalized epilepsy than in those with focal epilepsy or idiopathic generalized epilepsy. 

Chen B, Choi H, Hirsh LJ, et al.  Prevalence and risk factors of seizure clusters in adult patients with epilepsy. Epilepsy Res. 2017;133: 98-102.

A tiered grading system may help determine which patients with drug-resistant epilepsy are most likely to have resective surgery and become free of seizures. The Epilepsy Surgery Grading Scale used in the study consisted of 3 tiers and included MRI, electroencephalography, concordance between the MRI and EEG, semiology, and IQ. Using the grading system, investigators detected a significant difference between Grade 1 patients, who had a most favorable rating, and Grade 3, who had been classified as least favorable candidates for surgery.

Dugan P, Carlson C, Jette N, et al. Derivation and initial validation of a surgical grading scale for preliminary evaluation of adult patients with drug-resistant focal epilepsy [published online April 4, 2017]. Epilepsia. 2017;doi: 10.1111/epi.13730.

A tiered grading system may help determine which patients with drug-resistant epilepsy are most likely to have resective surgery and become free of seizures. The Epilepsy Surgery Grading Scale used in the study consisted of 3 tiers and included MRI, electroencephalography, concordance between the MRI and EEG, semiology, and IQ. Using the grading system, investigators detected a significant difference between Grade 1 patients, who had a most favorable rating, and Grade 3, who had been classified as least favorable candidates for surgery.

Dugan P, Carlson C, Jette N, et al. Derivation and initial validation of a surgical grading scale for preliminary evaluation of adult patients with drug-resistant focal epilepsy [published online April 4, 2017]. Epilepsia. 2017;doi: 10.1111/epi.13730.

A tiered grading system may help determine which patients with drug-resistant epilepsy are most likely to have resective surgery and become free of seizures. The Epilepsy Surgery Grading Scale used in the study consisted of 3 tiers and included MRI, electroencephalography, concordance between the MRI and EEG, semiology, and IQ. Using the grading system, investigators detected a significant difference between Grade 1 patients, who had a most favorable rating, and Grade 3, who had been classified as least favorable candidates for surgery.

Dugan P, Carlson C, Jette N, et al. Derivation and initial validation of a surgical grading scale for preliminary evaluation of adult patients with drug-resistant focal epilepsy [published online April 4, 2017]. Epilepsia. 2017;doi: 10.1111/epi.13730.

Patients with epilepsy are more likely to develop seizure clusters if they have symptomatic generalized epilepsy, an earlier age of onset of their seizures, or if they have status epilepticus, according to a recent review of medical records that looked at over 4000 adult outpatients with epilepsy. The investigators also found that clustering was more common in patients with symptomatic generalized epilepsy than in those with focal epilepsy or idiopathic generalized epilepsy. 

Chen B, Choi H, Hirsh LJ, et al.  Prevalence and risk factors of seizure clusters in adult patients with epilepsy. Epilepsy Res. 2017;133: 98-102.

Patients with epilepsy are more likely to develop seizure clusters if they have symptomatic generalized epilepsy, an earlier age of onset of their seizures, or if they have status epilepticus, according to a recent review of medical records that looked at over 4000 adult outpatients with epilepsy. The investigators also found that clustering was more common in patients with symptomatic generalized epilepsy than in those with focal epilepsy or idiopathic generalized epilepsy. 

Chen B, Choi H, Hirsh LJ, et al.  Prevalence and risk factors of seizure clusters in adult patients with epilepsy. Epilepsy Res. 2017;133: 98-102.

Patients with epilepsy are more likely to develop seizure clusters if they have symptomatic generalized epilepsy, an earlier age of onset of their seizures, or if they have status epilepticus, according to a recent review of medical records that looked at over 4000 adult outpatients with epilepsy. The investigators also found that clustering was more common in patients with symptomatic generalized epilepsy than in those with focal epilepsy or idiopathic generalized epilepsy. 

Chen B, Choi H, Hirsh LJ, et al.  Prevalence and risk factors of seizure clusters in adult patients with epilepsy. Epilepsy Res. 2017;133: 98-102.

BOSTON—Siponimod reduces the risk of three-month and six-month confirmed disability progression in patients with secondary progressive multiple sclerosis (MS), according to research described at the 69th Annual Meeting of the American Academy of Neurology. The treatment also appears to reduce relapse rate and the number of new lesions. The study is “the largest controlled double-blind study in secondary progressive MS,” according to Ludwig Kappos, MD, Chair of Neurology at University Hospital Basel in Switzerland.

Siponimod is a selective sphingosine 1-phosphate receptor-1 and -5 modulator with effects on the CNS and the peripheral nervous system. The treatment may have effects related to remyelination and neuroprotection, according to Dr. Kappos. He and his colleagues conducted a randomized, double-blind, placebo-controlled, phase III study to compare the effects of siponimod and placebo in patients with secondary progressive MS. The investigators randomized patients 2:1 to once-daily siponimod (2 mg) or placebo. Patients were treated for as long as three years in the double-blind phase of the study. In a subsequent extension study, participants were treated for as long as seven years.

The event- and exposure-driven study's primary end point was time to three-month confirmed disability progression, as assessed by the Expanded Disability Status Scale (EDSS). Key secondary end points included time to confirmed worsening of 20% or more from baseline in the Timed 25-Foot Walk test (T25FW) and T2 lesion volume change from baseline. Other secondary end points included six-month confirmed disability progression, annualized relapse rate, 12-item MS Walking Scale (MSWS-12), number of T1 gadolinium-enhancing and T2 lesions, and percent brain volume change.

The investigators randomized 1,651 patients. The population's mean age was 50, and mean EDSS score was 5.5. The sample was typical of the population of patients with secondary progressive MS.

Siponimod reduced the risk of three-month confirmed disability progression by 21% versus placebo. Dr. Kappos and colleagues consistently observed point estimates in favor of siponimod across predefined subgroups, including patients with no relapses in the two years before study initiation and patients without gadolinium-enhancing lesions at baseline.

The risk reduction observed for the T25FW was 6.2%, but was not statistically significant. Siponimod reduced the risk of six-month confirmed disability progression by 26%. In addition, siponimod reduced the annualized relapse rate by 55.5%, the number of T1 gadolinium-enhancing lesions by 86.6%, and the number of new T2 lesions by 81%. The relative differences in change from baseline in T2 lesion volume, MSWS-12, and percent brain volume change were 79.1%, 39.7%, and 23.4%, respectively, versus placebo. Siponimod's effects were more pronounced in patients with relapses at baseline, compared with those without, said Dr. Kappos.

—Erik Greb

BOSTON—Siponimod reduces the risk of three-month and six-month confirmed disability progression in patients with secondary progressive multiple sclerosis (MS), according to research described at the 69th Annual Meeting of the American Academy of Neurology. The treatment also appears to reduce relapse rate and the number of new lesions. The study is “the largest controlled double-blind study in secondary progressive MS,” according to Ludwig Kappos, MD, Chair of Neurology at University Hospital Basel in Switzerland.

Siponimod is a selective sphingosine 1-phosphate receptor-1 and -5 modulator with effects on the CNS and the peripheral nervous system. The treatment may have effects related to remyelination and neuroprotection, according to Dr. Kappos. He and his colleagues conducted a randomized, double-blind, placebo-controlled, phase III study to compare the effects of siponimod and placebo in patients with secondary progressive MS. The investigators randomized patients 2:1 to once-daily siponimod (2 mg) or placebo. Patients were treated for as long as three years in the double-blind phase of the study. In a subsequent extension study, participants were treated for as long as seven years.

The event- and exposure-driven study's primary end point was time to three-month confirmed disability progression, as assessed by the Expanded Disability Status Scale (EDSS). Key secondary end points included time to confirmed worsening of 20% or more from baseline in the Timed 25-Foot Walk test (T25FW) and T2 lesion volume change from baseline. Other secondary end points included six-month confirmed disability progression, annualized relapse rate, 12-item MS Walking Scale (MSWS-12), number of T1 gadolinium-enhancing and T2 lesions, and percent brain volume change.

The investigators randomized 1,651 patients. The population's mean age was 50, and mean EDSS score was 5.5. The sample was typical of the population of patients with secondary progressive MS.

Siponimod reduced the risk of three-month confirmed disability progression by 21% versus placebo. Dr. Kappos and colleagues consistently observed point estimates in favor of siponimod across predefined subgroups, including patients with no relapses in the two years before study initiation and patients without gadolinium-enhancing lesions at baseline.

The risk reduction observed for the T25FW was 6.2%, but was not statistically significant. Siponimod reduced the risk of six-month confirmed disability progression by 26%. In addition, siponimod reduced the annualized relapse rate by 55.5%, the number of T1 gadolinium-enhancing lesions by 86.6%, and the number of new T2 lesions by 81%. The relative differences in change from baseline in T2 lesion volume, MSWS-12, and percent brain volume change were 79.1%, 39.7%, and 23.4%, respectively, versus placebo. Siponimod's effects were more pronounced in patients with relapses at baseline, compared with those without, said Dr. Kappos.

—Erik Greb

BOSTON—Siponimod reduces the risk of three-month and six-month confirmed disability progression in patients with secondary progressive multiple sclerosis (MS), according to research described at the 69th Annual Meeting of the American Academy of Neurology. The treatment also appears to reduce relapse rate and the number of new lesions. The study is “the largest controlled double-blind study in secondary progressive MS,” according to Ludwig Kappos, MD, Chair of Neurology at University Hospital Basel in Switzerland.

Siponimod is a selective sphingosine 1-phosphate receptor-1 and -5 modulator with effects on the CNS and the peripheral nervous system. The treatment may have effects related to remyelination and neuroprotection, according to Dr. Kappos. He and his colleagues conducted a randomized, double-blind, placebo-controlled, phase III study to compare the effects of siponimod and placebo in patients with secondary progressive MS. The investigators randomized patients 2:1 to once-daily siponimod (2 mg) or placebo. Patients were treated for as long as three years in the double-blind phase of the study. In a subsequent extension study, participants were treated for as long as seven years.

The event- and exposure-driven study's primary end point was time to three-month confirmed disability progression, as assessed by the Expanded Disability Status Scale (EDSS). Key secondary end points included time to confirmed worsening of 20% or more from baseline in the Timed 25-Foot Walk test (T25FW) and T2 lesion volume change from baseline. Other secondary end points included six-month confirmed disability progression, annualized relapse rate, 12-item MS Walking Scale (MSWS-12), number of T1 gadolinium-enhancing and T2 lesions, and percent brain volume change.

The investigators randomized 1,651 patients. The population's mean age was 50, and mean EDSS score was 5.5. The sample was typical of the population of patients with secondary progressive MS.

Siponimod reduced the risk of three-month confirmed disability progression by 21% versus placebo. Dr. Kappos and colleagues consistently observed point estimates in favor of siponimod across predefined subgroups, including patients with no relapses in the two years before study initiation and patients without gadolinium-enhancing lesions at baseline.

The risk reduction observed for the T25FW was 6.2%, but was not statistically significant. Siponimod reduced the risk of six-month confirmed disability progression by 26%. In addition, siponimod reduced the annualized relapse rate by 55.5%, the number of T1 gadolinium-enhancing lesions by 86.6%, and the number of new T2 lesions by 81%. The relative differences in change from baseline in T2 lesion volume, MSWS-12, and percent brain volume change were 79.1%, 39.7%, and 23.4%, respectively, versus placebo. Siponimod's effects were more pronounced in patients with relapses at baseline, compared with those without, said Dr. Kappos.

—Erik Greb

BOSTON—In older people with multiple sclerosis (MS), fatigue and limited lower leg function are more common in people with MS progression than in those without, according to a preliminary study presented at the 69th Annual Meeting of the American Academy of Neurology.

“Study participants with those symptoms were more likely to progress from relapsing-remitting MS to secondary progressive MS within five years,” said study author Bianca Weinstock-Guttman, MD, a Professor in the Department of Neurology at the Jacobs School of Medicine and Biomedical Sciences at the University of Buffalo in New York. “Better understanding of who is at high risk of getting worse may eventually allow us to tailor more specific treatments to these people.”

Older age at disease onset, high frequency of relapses, and male sex have been found to be predictive of higher risk of conversion to secondary progressive MS. To further define predictors of disease progression, Dr. Weinstock-Guttman and colleagues investigated patient-reported outcomes in an aging cohort of patients with MS.

For the study, 155 people age 50 or older who had had relapsing-remitting MS for at least 15 years were evaluated for symptoms and level of disability at the beginning of the study and five years later, at which point they had been living with MS for an average of 22 years. The study subjects were part of the New York State MS Consortium.

In all, 30.3% of people in the study had progressed to secondary progressive MS by the five-year mark. Those who progressed to secondary progressive MS were older at study enrollment (54.8 vs 52.1) and had a higher Expanded Disability Status Scale score at baseline (3.5 vs 2.6) and at year 5 (5.6 vs 3.0). Those who progressed at year 5 were more likely to report lower limb problems at baseline (53.2% vs 21.5%; odds ratio, 3.0) and were more likely to report fatigue (91.5% vs 68.2%; odds ratio, 4.2), compared with those whose disease did not progress. The results were the same after researchers adjusted for other factors that could affect disease progression, such as age, disease duration, and disability severity.

“While more research needs to be done, this study brings us closer to understanding which older adults with MS may be at higher risk of getting worse,” said Dr. Weinstock-Guttman. “With the aging population, this information will be vital as people with MS, their families, and policy makers make decisions about their care.” The investigation was supported by the National MS Society.

—Glenn S. Williams

BOSTON—In older people with multiple sclerosis (MS), fatigue and limited lower leg function are more common in people with MS progression than in those without, according to a preliminary study presented at the 69th Annual Meeting of the American Academy of Neurology.

“Study participants with those symptoms were more likely to progress from relapsing-remitting MS to secondary progressive MS within five years,” said study author Bianca Weinstock-Guttman, MD, a Professor in the Department of Neurology at the Jacobs School of Medicine and Biomedical Sciences at the University of Buffalo in New York. “Better understanding of who is at high risk of getting worse may eventually allow us to tailor more specific treatments to these people.”

Older age at disease onset, high frequency of relapses, and male sex have been found to be predictive of higher risk of conversion to secondary progressive MS. To further define predictors of disease progression, Dr. Weinstock-Guttman and colleagues investigated patient-reported outcomes in an aging cohort of patients with MS.

For the study, 155 people age 50 or older who had had relapsing-remitting MS for at least 15 years were evaluated for symptoms and level of disability at the beginning of the study and five years later, at which point they had been living with MS for an average of 22 years. The study subjects were part of the New York State MS Consortium.

In all, 30.3% of people in the study had progressed to secondary progressive MS by the five-year mark. Those who progressed to secondary progressive MS were older at study enrollment (54.8 vs 52.1) and had a higher Expanded Disability Status Scale score at baseline (3.5 vs 2.6) and at year 5 (5.6 vs 3.0). Those who progressed at year 5 were more likely to report lower limb problems at baseline (53.2% vs 21.5%; odds ratio, 3.0) and were more likely to report fatigue (91.5% vs 68.2%; odds ratio, 4.2), compared with those whose disease did not progress. The results were the same after researchers adjusted for other factors that could affect disease progression, such as age, disease duration, and disability severity.

“While more research needs to be done, this study brings us closer to understanding which older adults with MS may be at higher risk of getting worse,” said Dr. Weinstock-Guttman. “With the aging population, this information will be vital as people with MS, their families, and policy makers make decisions about their care.” The investigation was supported by the National MS Society.

—Glenn S. Williams

BOSTON—In older people with multiple sclerosis (MS), fatigue and limited lower leg function are more common in people with MS progression than in those without, according to a preliminary study presented at the 69th Annual Meeting of the American Academy of Neurology.

“Study participants with those symptoms were more likely to progress from relapsing-remitting MS to secondary progressive MS within five years,” said study author Bianca Weinstock-Guttman, MD, a Professor in the Department of Neurology at the Jacobs School of Medicine and Biomedical Sciences at the University of Buffalo in New York. “Better understanding of who is at high risk of getting worse may eventually allow us to tailor more specific treatments to these people.”

Older age at disease onset, high frequency of relapses, and male sex have been found to be predictive of higher risk of conversion to secondary progressive MS. To further define predictors of disease progression, Dr. Weinstock-Guttman and colleagues investigated patient-reported outcomes in an aging cohort of patients with MS.

For the study, 155 people age 50 or older who had had relapsing-remitting MS for at least 15 years were evaluated for symptoms and level of disability at the beginning of the study and five years later, at which point they had been living with MS for an average of 22 years. The study subjects were part of the New York State MS Consortium.

In all, 30.3% of people in the study had progressed to secondary progressive MS by the five-year mark. Those who progressed to secondary progressive MS were older at study enrollment (54.8 vs 52.1) and had a higher Expanded Disability Status Scale score at baseline (3.5 vs 2.6) and at year 5 (5.6 vs 3.0). Those who progressed at year 5 were more likely to report lower limb problems at baseline (53.2% vs 21.5%; odds ratio, 3.0) and were more likely to report fatigue (91.5% vs 68.2%; odds ratio, 4.2), compared with those whose disease did not progress. The results were the same after researchers adjusted for other factors that could affect disease progression, such as age, disease duration, and disability severity.

“While more research needs to be done, this study brings us closer to understanding which older adults with MS may be at higher risk of getting worse,” said Dr. Weinstock-Guttman. “With the aging population, this information will be vital as people with MS, their families, and policy makers make decisions about their care.” The investigation was supported by the National MS Society.

—Glenn S. Williams

Post-ictal generalized EEG suppression (PGES) may signal impending sudden unexpected death in epilepsy (SUDEP), according to a recent analysis of 305 seizures that occurred in 17 patients who had definite or probable SUDEP. Researchers found that PGES duration was shorter in patients who died unexpectedly from epilepsy, when compared to living patients. They also found that earlier nursing intervention was linked to shorter seizures after generalized convulsive seizures and may help reduce the risk of SUDEP.

Kang JY, Rabiei AH, Myint L, Nei M. Equivocal significance of post-ictal generalized EEG suppression as a marker of SUDEP risk. Seizure. 2017;48:28-32.

Post-ictal generalized EEG suppression (PGES) may signal impending sudden unexpected death in epilepsy (SUDEP), according to a recent analysis of 305 seizures that occurred in 17 patients who had definite or probable SUDEP. Researchers found that PGES duration was shorter in patients who died unexpectedly from epilepsy, when compared to living patients. They also found that earlier nursing intervention was linked to shorter seizures after generalized convulsive seizures and may help reduce the risk of SUDEP.

Kang JY, Rabiei AH, Myint L, Nei M. Equivocal significance of post-ictal generalized EEG suppression as a marker of SUDEP risk. Seizure. 2017;48:28-32.

Post-ictal generalized EEG suppression (PGES) may signal impending sudden unexpected death in epilepsy (SUDEP), according to a recent analysis of 305 seizures that occurred in 17 patients who had definite or probable SUDEP. Researchers found that PGES duration was shorter in patients who died unexpectedly from epilepsy, when compared to living patients. They also found that earlier nursing intervention was linked to shorter seizures after generalized convulsive seizures and may help reduce the risk of SUDEP.

Kang JY, Rabiei AH, Myint L, Nei M. Equivocal significance of post-ictal generalized EEG suppression as a marker of SUDEP risk. Seizure. 2017;48:28-32.

BOSTON—Interim results from a small, preliminary study support a new type of treatment for progressive multiple sclerosis (MS). Results from the first six people enrolled in the phase I study, which was designed to enroll 10 people, were presented at the 69th Annual Meeting of the American Academy of Neurology. “While these results are very preliminary, and much more research is needed, we are excited there were no serious side effects,” said study author Michael P. Pender, MD, PhD, a Professor and Director of the Multiple Sclerosis Research Group at the University of Queensland in Brisbane, Australia.

The study investigated the relationship between MS and the Epstein-Barr virus (EBV). Previous research has suggested a role for EBV in MS pathogenesis. The study involved six people with progressive MS who had moderate to severe disability (ie, Expanded Disability Status Scale scores between 5.0 and 8.0).

In some people with MS, EBV-infected autoreactive B cells might accumulate in the CNS because of defective cytotoxic CD8+ T-cell immunity. Elimination of EBV-infected B cells may reduce the destruction of myelin in MS.

For the study, researchers removed the participants' own T cells and stimulated them to boost their ability to recognize and destroy cells infected with EBV. They then injected participants with infusions of escalating doses of T cells every two weeks for six weeks. They followed the patients for 26 weeks to look for evidence of side effects and possible improvement of symptoms.

Three participants showed symptomatic and objective clinical improvement, starting two to eight weeks after the first infusion.

“One person with secondary progressive MS showed striking improvement,” Professor Pender said. This participant had normalization of lower extremity tone and plantar responses for the first time in 16 years. “This participant had a significant increase in ambulation from 100 yards with a walker at the start of the study, and over the previous five years, to three quarters of a mile, and was now also able to walk shorter distances with only one-sided assistance. Lower leg spasms that had persisted for years resolved.”

Professor Pender said another participant with primary progressive MS had reduced fatigue, increased productivity, and improved balance. Another responder had improved color vision, visual acuity, and manual dexterity; reduced fatigue; fewer lower extremity spasms; and less urinary urgency. All three responding participants had improvements in fatigue and ability to perform daily activities.  

“The best responses were seen in the two people who received T cells with the highest amount of reactivity to the EBV,” Professor Pender said. None of the six participants had serious side effects.

“Much more research needs to be done with larger numbers of participants to confirm and further evaluate these findings,” Professor Pender said. “But the results add to the mounting evidence for a role of the Epstein-Barr virus infection in MS and set the stage for further clinical trials.”

The study was a collaboration between the QIMR Berghofer Medical Research Institute, Royal Brisbane and Women's Hospital, and the University of Queensland. The study was supported by MS Queensland, MS Research Australia, QIMR Berghofer Medical Research Institute, and Perpetual Trustee Company Limited.    

—Glenn S. Williams

Suggested Reading

Pender MP, Csurhes PA, Smith C, et al. Epstein-Barr virus-specific adoptive immunotherapy for progressive multiple sclerosis. Mult Scler. 2014;20(11):1541-1544.

BOSTON—Interim results from a small, preliminary study support a new type of treatment for progressive multiple sclerosis (MS). Results from the first six people enrolled in the phase I study, which was designed to enroll 10 people, were presented at the 69th Annual Meeting of the American Academy of Neurology. “While these results are very preliminary, and much more research is needed, we are excited there were no serious side effects,” said study author Michael P. Pender, MD, PhD, a Professor and Director of the Multiple Sclerosis Research Group at the University of Queensland in Brisbane, Australia.

The study investigated the relationship between MS and the Epstein-Barr virus (EBV). Previous research has suggested a role for EBV in MS pathogenesis. The study involved six people with progressive MS who had moderate to severe disability (ie, Expanded Disability Status Scale scores between 5.0 and 8.0).

In some people with MS, EBV-infected autoreactive B cells might accumulate in the CNS because of defective cytotoxic CD8+ T-cell immunity. Elimination of EBV-infected B cells may reduce the destruction of myelin in MS.

For the study, researchers removed the participants' own T cells and stimulated them to boost their ability to recognize and destroy cells infected with EBV. They then injected participants with infusions of escalating doses of T cells every two weeks for six weeks. They followed the patients for 26 weeks to look for evidence of side effects and possible improvement of symptoms.

Three participants showed symptomatic and objective clinical improvement, starting two to eight weeks after the first infusion.

“One person with secondary progressive MS showed striking improvement,” Professor Pender said. This participant had normalization of lower extremity tone and plantar responses for the first time in 16 years. “This participant had a significant increase in ambulation from 100 yards with a walker at the start of the study, and over the previous five years, to three quarters of a mile, and was now also able to walk shorter distances with only one-sided assistance. Lower leg spasms that had persisted for years resolved.”

Professor Pender said another participant with primary progressive MS had reduced fatigue, increased productivity, and improved balance. Another responder had improved color vision, visual acuity, and manual dexterity; reduced fatigue; fewer lower extremity spasms; and less urinary urgency. All three responding participants had improvements in fatigue and ability to perform daily activities.  

“The best responses were seen in the two people who received T cells with the highest amount of reactivity to the EBV,” Professor Pender said. None of the six participants had serious side effects.

“Much more research needs to be done with larger numbers of participants to confirm and further evaluate these findings,” Professor Pender said. “But the results add to the mounting evidence for a role of the Epstein-Barr virus infection in MS and set the stage for further clinical trials.”

The study was a collaboration between the QIMR Berghofer Medical Research Institute, Royal Brisbane and Women's Hospital, and the University of Queensland. The study was supported by MS Queensland, MS Research Australia, QIMR Berghofer Medical Research Institute, and Perpetual Trustee Company Limited.    

—Glenn S. Williams

Suggested Reading

Pender MP, Csurhes PA, Smith C, et al. Epstein-Barr virus-specific adoptive immunotherapy for progressive multiple sclerosis. Mult Scler. 2014;20(11):1541-1544.

BOSTON—Interim results from a small, preliminary study support a new type of treatment for progressive multiple sclerosis (MS). Results from the first six people enrolled in the phase I study, which was designed to enroll 10 people, were presented at the 69th Annual Meeting of the American Academy of Neurology. “While these results are very preliminary, and much more research is needed, we are excited there were no serious side effects,” said study author Michael P. Pender, MD, PhD, a Professor and Director of the Multiple Sclerosis Research Group at the University of Queensland in Brisbane, Australia.

The study investigated the relationship between MS and the Epstein-Barr virus (EBV). Previous research has suggested a role for EBV in MS pathogenesis. The study involved six people with progressive MS who had moderate to severe disability (ie, Expanded Disability Status Scale scores between 5.0 and 8.0).

In some people with MS, EBV-infected autoreactive B cells might accumulate in the CNS because of defective cytotoxic CD8+ T-cell immunity. Elimination of EBV-infected B cells may reduce the destruction of myelin in MS.

For the study, researchers removed the participants' own T cells and stimulated them to boost their ability to recognize and destroy cells infected with EBV. They then injected participants with infusions of escalating doses of T cells every two weeks for six weeks. They followed the patients for 26 weeks to look for evidence of side effects and possible improvement of symptoms.

Three participants showed symptomatic and objective clinical improvement, starting two to eight weeks after the first infusion.

“One person with secondary progressive MS showed striking improvement,” Professor Pender said. This participant had normalization of lower extremity tone and plantar responses for the first time in 16 years. “This participant had a significant increase in ambulation from 100 yards with a walker at the start of the study, and over the previous five years, to three quarters of a mile, and was now also able to walk shorter distances with only one-sided assistance. Lower leg spasms that had persisted for years resolved.”

Professor Pender said another participant with primary progressive MS had reduced fatigue, increased productivity, and improved balance. Another responder had improved color vision, visual acuity, and manual dexterity; reduced fatigue; fewer lower extremity spasms; and less urinary urgency. All three responding participants had improvements in fatigue and ability to perform daily activities.  

“The best responses were seen in the two people who received T cells with the highest amount of reactivity to the EBV,” Professor Pender said. None of the six participants had serious side effects.

“Much more research needs to be done with larger numbers of participants to confirm and further evaluate these findings,” Professor Pender said. “But the results add to the mounting evidence for a role of the Epstein-Barr virus infection in MS and set the stage for further clinical trials.”

The study was a collaboration between the QIMR Berghofer Medical Research Institute, Royal Brisbane and Women's Hospital, and the University of Queensland. The study was supported by MS Queensland, MS Research Australia, QIMR Berghofer Medical Research Institute, and Perpetual Trustee Company Limited.    

—Glenn S. Williams

Suggested Reading

Pender MP, Csurhes PA, Smith C, et al. Epstein-Barr virus-specific adoptive immunotherapy for progressive multiple sclerosis. Mult Scler. 2014;20(11):1541-1544.

Enhanced Recovery After Surgery (ERAS), a program implemented by Kaiser Permanente Northern California – a multihospital integrated health system – significantly reduced length of stay and complication rates, according to a report published in JAMA Surgery.

Beginning in 2014, when the ERAS program was implemented in 20 Kaiser hospitals, progress was made on the goal of improving inpatient safety, as well as improvements in-hospital mortality, rates of early ambulation, patient nutrition, and reduced opioid use, said Vincent X. Liu, MD, of the division of research, Kaiser Permanente Oakland, and his associates. Those outcomes were studied in the context of a similar group of patients in other, non-ERAS hospitals to determine the degree of change in each area.

shironosov/Thinkstock

Enhanced Recovery After Surgery (ERAS), a program implemented by Kaiser Permanente Northern California – a multihospital integrated health system – significantly reduced length of stay and complication rates, according to a report published in JAMA Surgery.

Beginning in 2014, when the ERAS program was implemented in 20 Kaiser hospitals, progress was made on the goal of improving inpatient safety, as well as improvements in-hospital mortality, rates of early ambulation, patient nutrition, and reduced opioid use, said Vincent X. Liu, MD, of the division of research, Kaiser Permanente Oakland, and his associates. Those outcomes were studied in the context of a similar group of patients in other, non-ERAS hospitals to determine the degree of change in each area.

shironosov/Thinkstock

Enhanced Recovery After Surgery (ERAS), a program implemented by Kaiser Permanente Northern California – a multihospital integrated health system – significantly reduced length of stay and complication rates, according to a report published in JAMA Surgery.

Beginning in 2014, when the ERAS program was implemented in 20 Kaiser hospitals, progress was made on the goal of improving inpatient safety, as well as improvements in-hospital mortality, rates of early ambulation, patient nutrition, and reduced opioid use, said Vincent X. Liu, MD, of the division of research, Kaiser Permanente Oakland, and his associates. Those outcomes were studied in the context of a similar group of patients in other, non-ERAS hospitals to determine the degree of change in each area.

shironosov/Thinkstock

Presenters

Tracy Cardin, ACNP, SFHM ; Emilie Thornhill, PA-C
 

Session summary

The Nurse Practitioner and Physician Assistant (NP/PA) special interest forum at HM17 drew more than 60 providers, including NPs, PAs, and physicians.

Emilie Thornhill, a certified PA and chair of the NP/PA Committee, and Tracy Cardin, SHM board member, updated the attendees regarding the work of the NP/PA committee over the last year. The committee has created a comprehensive “NP/PA Toolkit,” which was developed over the last 2 years in response to common inquiries about deployment and integration of NPs and PAs into Hospital Medicine practice groups.

• Benchmarking Surveys related to NP/PA burnout, including aspects of protected time, engagement, and workload; scheduling and deployment models; and NP/PA designation as faculty or staff.
• Increased utilization and engagement with HMX as a platform for sharing ideas and success stories to increase HM NP/PA visibility.
• Creation of a “Bizarre Bylaws Blog” to disseminate best practices and improve hospital bylaws through innovative storytelling of antiquated bylaws.
• Improved NP and PA participation and engagement with local chapters.

Key takeaways for HM

• An NP/PA Toolkit resource to be posted on the SHM website.
• The NP/PA committee will transition to a Special Interest Group over the next year.
• Hospital Medicine Exchange (HMX) engagement and participation are encouraged.
• An “Implementation and Optimization Project” to help improve workforce development is pending for the coming year.

Nicolas Houghton is an NP hospitalist in Cleveland and an editorial board member of The Hospitalist.

Presenters

Tracy Cardin, ACNP, SFHM ; Emilie Thornhill, PA-C
 

Session summary

The Nurse Practitioner and Physician Assistant (NP/PA) special interest forum at HM17 drew more than 60 providers, including NPs, PAs, and physicians.

Emilie Thornhill, a certified PA and chair of the NP/PA Committee, and Tracy Cardin, SHM board member, updated the attendees regarding the work of the NP/PA committee over the last year. The committee has created a comprehensive “NP/PA Toolkit,” which was developed over the last 2 years in response to common inquiries about deployment and integration of NPs and PAs into Hospital Medicine practice groups.

• Benchmarking Surveys related to NP/PA burnout, including aspects of protected time, engagement, and workload; scheduling and deployment models; and NP/PA designation as faculty or staff.
• Increased utilization and engagement with HMX as a platform for sharing ideas and success stories to increase HM NP/PA visibility.
• Creation of a “Bizarre Bylaws Blog” to disseminate best practices and improve hospital bylaws through innovative storytelling of antiquated bylaws.
• Improved NP and PA participation and engagement with local chapters.

Key takeaways for HM

• An NP/PA Toolkit resource to be posted on the SHM website.
• The NP/PA committee will transition to a Special Interest Group over the next year.
• Hospital Medicine Exchange (HMX) engagement and participation are encouraged.
• An “Implementation and Optimization Project” to help improve workforce development is pending for the coming year.

Nicolas Houghton is an NP hospitalist in Cleveland and an editorial board member of The Hospitalist.

Presenters

Tracy Cardin, ACNP, SFHM ; Emilie Thornhill, PA-C
 

Session summary

The Nurse Practitioner and Physician Assistant (NP/PA) special interest forum at HM17 drew more than 60 providers, including NPs, PAs, and physicians.

Emilie Thornhill, a certified PA and chair of the NP/PA Committee, and Tracy Cardin, SHM board member, updated the attendees regarding the work of the NP/PA committee over the last year. The committee has created a comprehensive “NP/PA Toolkit,” which was developed over the last 2 years in response to common inquiries about deployment and integration of NPs and PAs into Hospital Medicine practice groups.

• Benchmarking Surveys related to NP/PA burnout, including aspects of protected time, engagement, and workload; scheduling and deployment models; and NP/PA designation as faculty or staff.
• Increased utilization and engagement with HMX as a platform for sharing ideas and success stories to increase HM NP/PA visibility.
• Creation of a “Bizarre Bylaws Blog” to disseminate best practices and improve hospital bylaws through innovative storytelling of antiquated bylaws.
• Improved NP and PA participation and engagement with local chapters.

Key takeaways for HM

• An NP/PA Toolkit resource to be posted on the SHM website.
• The NP/PA committee will transition to a Special Interest Group over the next year.
• Hospital Medicine Exchange (HMX) engagement and participation are encouraged.
• An “Implementation and Optimization Project” to help improve workforce development is pending for the coming year.

Nicolas Houghton is an NP hospitalist in Cleveland and an editorial board member of The Hospitalist.

Photo by Graham Colm

The Indian government waited months to report its first cases of Zika virus to the World Health Organization (WHO), according to a statement from the agency.

The WHO said that, on May 15, Ministry of Health and Family Welfare-Government of India reported 3 laboratory-confirmed cases of Zika virus disease in the Bapunagar area of the Ahmedabad district in Gujarat, India.

The first of these cases was originally discovered in November 2016, and the other 2 were discovered in January 2017 and February 2017, respectively.

Chief Secretary of Gujarat State J. N. Singh told The Times of India that “the government consciously did not go public with the cases.”

However, B.J. Medical College (BJMC), where the cases were discovered, reported them to the National Institute of Virology, Pune, which informed the Indian Council of Medical Research and the Union government “as per protocol,” according to Singh.

Soumya Swaminathan, director-general of the Indian Council of Medical Research, told Scroll.in that the discovery of Zika at BJMC prompted increased surveillance for the virus in Ahmedabad. However, because no additional cases of Zika were found, the government felt no need to inform the public.

The same Scroll.in article reported that Bapunagar residents are angry but not surprised the government did not inform the public of the Zika cases. In fact, there is a theory that the government failed to disclose the Zika cases out of fear that the news would disrupt the Vibrant Gujarat Summit, a conference for investors taking place in Gandhinagar.

However, the mayor of Ahmedabad, Gautam Shah, denied this, as well as any knowledge of the Zika cases prior to the WHO’s disclosure. And Shankar Chaudhary, Gujarat’s health minister, said the government complied with WHO guidelines on reporting Zika cases.

Case details

Singh told The Times of India that all 3 Zika patients “are well and have shown no complications till now.”

According to the WHO, the first Zika case was a 34-year-old female who delivered a “clinically well baby” at BJMC in Ahmedabad on November 9, 2016. She developed a low-grade fever after delivery while still in the hospital. She had no history of fever during pregnancy and no history of travel for the past 3 months.

The Viral Research & Diagnostic Laboratory at BJMC found the patient was positive for Zika virus. Subsequent testing at the National Institute of Virology, Pune, confirmed this finding.

The second case of Zika virus was detected during antenatal clinic surveillance. Between January 6 and 12 of this year, 111 blood samples were collected in the antenatal clinic at BJMC.

One of these samples, from a 22-year-old pregnant female, tested positive for Zika. According to Singh, this patient also delivered a healthy baby.

The third case of Zika was detected via acute febrile illness surveillance. Between February 10 and 16 of this year, 93 blood samples were collected from patients treated for febrile illness treated at BJMC. And a 64-year-old male who had febrile illness for 8 days tested positive for Zika.

The WHO said these findings suggest low-level transmission of Zika virus, but new cases may occur in the future. The agency recommended strengthening surveillance in the area.

The WHO did not recommend any travel or trade restriction to India based on these Zika cases. And the agency noted that several steps have been taken to inform the public of the risk of Zika in India and prevent an outbreak in the country. 

Photo by Graham Colm

The Indian government waited months to report its first cases of Zika virus to the World Health Organization (WHO), according to a statement from the agency.

The WHO said that, on May 15, Ministry of Health and Family Welfare-Government of India reported 3 laboratory-confirmed cases of Zika virus disease in the Bapunagar area of the Ahmedabad district in Gujarat, India.

The first of these cases was originally discovered in November 2016, and the other 2 were discovered in January 2017 and February 2017, respectively.

Chief Secretary of Gujarat State J. N. Singh told The Times of India that “the government consciously did not go public with the cases.”

However, B.J. Medical College (BJMC), where the cases were discovered, reported them to the National Institute of Virology, Pune, which informed the Indian Council of Medical Research and the Union government “as per protocol,” according to Singh.

Soumya Swaminathan, director-general of the Indian Council of Medical Research, told Scroll.in that the discovery of Zika at BJMC prompted increased surveillance for the virus in Ahmedabad. However, because no additional cases of Zika were found, the government felt no need to inform the public.

The same Scroll.in article reported that Bapunagar residents are angry but not surprised the government did not inform the public of the Zika cases. In fact, there is a theory that the government failed to disclose the Zika cases out of fear that the news would disrupt the Vibrant Gujarat Summit, a conference for investors taking place in Gandhinagar.

However, the mayor of Ahmedabad, Gautam Shah, denied this, as well as any knowledge of the Zika cases prior to the WHO’s disclosure. And Shankar Chaudhary, Gujarat’s health minister, said the government complied with WHO guidelines on reporting Zika cases.

Case details

Singh told The Times of India that all 3 Zika patients “are well and have shown no complications till now.”

According to the WHO, the first Zika case was a 34-year-old female who delivered a “clinically well baby” at BJMC in Ahmedabad on November 9, 2016. She developed a low-grade fever after delivery while still in the hospital. She had no history of fever during pregnancy and no history of travel for the past 3 months.

The Viral Research & Diagnostic Laboratory at BJMC found the patient was positive for Zika virus. Subsequent testing at the National Institute of Virology, Pune, confirmed this finding.

The second case of Zika virus was detected during antenatal clinic surveillance. Between January 6 and 12 of this year, 111 blood samples were collected in the antenatal clinic at BJMC.

One of these samples, from a 22-year-old pregnant female, tested positive for Zika. According to Singh, this patient also delivered a healthy baby.

The third case of Zika was detected via acute febrile illness surveillance. Between February 10 and 16 of this year, 93 blood samples were collected from patients treated for febrile illness treated at BJMC. And a 64-year-old male who had febrile illness for 8 days tested positive for Zika.

The WHO said these findings suggest low-level transmission of Zika virus, but new cases may occur in the future. The agency recommended strengthening surveillance in the area.

The WHO did not recommend any travel or trade restriction to India based on these Zika cases. And the agency noted that several steps have been taken to inform the public of the risk of Zika in India and prevent an outbreak in the country. 

Photo by Graham Colm

The Indian government waited months to report its first cases of Zika virus to the World Health Organization (WHO), according to a statement from the agency.

The WHO said that, on May 15, Ministry of Health and Family Welfare-Government of India reported 3 laboratory-confirmed cases of Zika virus disease in the Bapunagar area of the Ahmedabad district in Gujarat, India.

The first of these cases was originally discovered in November 2016, and the other 2 were discovered in January 2017 and February 2017, respectively.

Chief Secretary of Gujarat State J. N. Singh told The Times of India that “the government consciously did not go public with the cases.”

However, B.J. Medical College (BJMC), where the cases were discovered, reported them to the National Institute of Virology, Pune, which informed the Indian Council of Medical Research and the Union government “as per protocol,” according to Singh.

Soumya Swaminathan, director-general of the Indian Council of Medical Research, told Scroll.in that the discovery of Zika at BJMC prompted increased surveillance for the virus in Ahmedabad. However, because no additional cases of Zika were found, the government felt no need to inform the public.

The same Scroll.in article reported that Bapunagar residents are angry but not surprised the government did not inform the public of the Zika cases. In fact, there is a theory that the government failed to disclose the Zika cases out of fear that the news would disrupt the Vibrant Gujarat Summit, a conference for investors taking place in Gandhinagar.

However, the mayor of Ahmedabad, Gautam Shah, denied this, as well as any knowledge of the Zika cases prior to the WHO’s disclosure. And Shankar Chaudhary, Gujarat’s health minister, said the government complied with WHO guidelines on reporting Zika cases.

Case details

Singh told The Times of India that all 3 Zika patients “are well and have shown no complications till now.”

According to the WHO, the first Zika case was a 34-year-old female who delivered a “clinically well baby” at BJMC in Ahmedabad on November 9, 2016. She developed a low-grade fever after delivery while still in the hospital. She had no history of fever during pregnancy and no history of travel for the past 3 months.

The Viral Research & Diagnostic Laboratory at BJMC found the patient was positive for Zika virus. Subsequent testing at the National Institute of Virology, Pune, confirmed this finding.

The second case of Zika virus was detected during antenatal clinic surveillance. Between January 6 and 12 of this year, 111 blood samples were collected in the antenatal clinic at BJMC.

One of these samples, from a 22-year-old pregnant female, tested positive for Zika. According to Singh, this patient also delivered a healthy baby.

The third case of Zika was detected via acute febrile illness surveillance. Between February 10 and 16 of this year, 93 blood samples were collected from patients treated for febrile illness treated at BJMC. And a 64-year-old male who had febrile illness for 8 days tested positive for Zika.

The WHO said these findings suggest low-level transmission of Zika virus, but new cases may occur in the future. The agency recommended strengthening surveillance in the area.

The WHO did not recommend any travel or trade restriction to India based on these Zika cases. And the agency noted that several steps have been taken to inform the public of the risk of Zika in India and prevent an outbreak in the country.