Neurosurgery & Trauma

LOS ANGELES—A strict gluten-free diet may help protect against the nerve pain that some patients with gluten sensitivity experience, according to a preliminary study presented at the American Academy of Neurology’s 70th Annual Meeting. “These findings are exciting because it might mean that a relatively simple change in diet could help alleviate painful symptoms tied to gluten neuropathy,” said lead author Panagiotis Zis, MD, PhD, Honorary Senior Lecturer at the University of Sheffield, United Kingdom. “While our study shows an association between a self-reported gluten-free diet and less pain, it does not show that one causes the other.”

Gluten neuropathy is the second most common neurologic manifestation of gluten sensitivity, after cerebellar ataxia. It is defined as an idiopathic neuropathy, in the absence of an alternative etiology despite extensive investigations, and in the presence of serologic evidence of gluten sensitivity (IgA and/or IgG antigliadin antibodies).

To establish the prevalence of pain in patients with gluten neuropathy and to describe any contributory factors, Dr. Zis and colleagues invited all consecutive patients with gluten neuropathy attending a specialist gluten/neurology clinic to participate in their study. Pain was assessed via the DN4 questionnaire and the visual analog scale. The Overall Neuropathy Limitations Scale (ONLS) was used to assess the severity of neuropathy. The Mental Health Index (MHI-5) was used to measure participants’ general mental health status.

In all, 60 patients (76.7% males, mean age 70) with gluten neuropathy were recruited. Pain was present in 33 patients (55.0%). Comparison between groups of painful and non-painful gluten neuropathy did not show significant differences regarding age, gender, neuropathy severity, or neuropathy type. Patients with painless gluten neuropathy were more likely to be on a strict gluten-free diet (55.6% vs 21.2%). Patients with painful gluten neuropathy presented with significantly worse MHI-5 score (75.9 vs 87.4). Multivariate analysis showed that, after adjusting for age, gender, and MHI-5 score, adherence to a strict gluten-free diet was associated with lowering the odds of peripheral neuropathic pain by 88.7%.

 “This study is promising because it shows that a gluten-free diet may help lower the risk of pain for people with gluten neuropathy,” Dr. Zis said. “More research is needed to confirm these results and to determine whether the gluten-free diet led to the reduction in pain.”

LOS ANGELES—A strict gluten-free diet may help protect against the nerve pain that some patients with gluten sensitivity experience, according to a preliminary study presented at the American Academy of Neurology’s 70th Annual Meeting. “These findings are exciting because it might mean that a relatively simple change in diet could help alleviate painful symptoms tied to gluten neuropathy,” said lead author Panagiotis Zis, MD, PhD, Honorary Senior Lecturer at the University of Sheffield, United Kingdom. “While our study shows an association between a self-reported gluten-free diet and less pain, it does not show that one causes the other.”

Gluten neuropathy is the second most common neurologic manifestation of gluten sensitivity, after cerebellar ataxia. It is defined as an idiopathic neuropathy, in the absence of an alternative etiology despite extensive investigations, and in the presence of serologic evidence of gluten sensitivity (IgA and/or IgG antigliadin antibodies).

To establish the prevalence of pain in patients with gluten neuropathy and to describe any contributory factors, Dr. Zis and colleagues invited all consecutive patients with gluten neuropathy attending a specialist gluten/neurology clinic to participate in their study. Pain was assessed via the DN4 questionnaire and the visual analog scale. The Overall Neuropathy Limitations Scale (ONLS) was used to assess the severity of neuropathy. The Mental Health Index (MHI-5) was used to measure participants’ general mental health status.

In all, 60 patients (76.7% males, mean age 70) with gluten neuropathy were recruited. Pain was present in 33 patients (55.0%). Comparison between groups of painful and non-painful gluten neuropathy did not show significant differences regarding age, gender, neuropathy severity, or neuropathy type. Patients with painless gluten neuropathy were more likely to be on a strict gluten-free diet (55.6% vs 21.2%). Patients with painful gluten neuropathy presented with significantly worse MHI-5 score (75.9 vs 87.4). Multivariate analysis showed that, after adjusting for age, gender, and MHI-5 score, adherence to a strict gluten-free diet was associated with lowering the odds of peripheral neuropathic pain by 88.7%.

 “This study is promising because it shows that a gluten-free diet may help lower the risk of pain for people with gluten neuropathy,” Dr. Zis said. “More research is needed to confirm these results and to determine whether the gluten-free diet led to the reduction in pain.”

LOS ANGELES—A strict gluten-free diet may help protect against the nerve pain that some patients with gluten sensitivity experience, according to a preliminary study presented at the American Academy of Neurology’s 70th Annual Meeting. “These findings are exciting because it might mean that a relatively simple change in diet could help alleviate painful symptoms tied to gluten neuropathy,” said lead author Panagiotis Zis, MD, PhD, Honorary Senior Lecturer at the University of Sheffield, United Kingdom. “While our study shows an association between a self-reported gluten-free diet and less pain, it does not show that one causes the other.”

Gluten neuropathy is the second most common neurologic manifestation of gluten sensitivity, after cerebellar ataxia. It is defined as an idiopathic neuropathy, in the absence of an alternative etiology despite extensive investigations, and in the presence of serologic evidence of gluten sensitivity (IgA and/or IgG antigliadin antibodies).

To establish the prevalence of pain in patients with gluten neuropathy and to describe any contributory factors, Dr. Zis and colleagues invited all consecutive patients with gluten neuropathy attending a specialist gluten/neurology clinic to participate in their study. Pain was assessed via the DN4 questionnaire and the visual analog scale. The Overall Neuropathy Limitations Scale (ONLS) was used to assess the severity of neuropathy. The Mental Health Index (MHI-5) was used to measure participants’ general mental health status.

In all, 60 patients (76.7% males, mean age 70) with gluten neuropathy were recruited. Pain was present in 33 patients (55.0%). Comparison between groups of painful and non-painful gluten neuropathy did not show significant differences regarding age, gender, neuropathy severity, or neuropathy type. Patients with painless gluten neuropathy were more likely to be on a strict gluten-free diet (55.6% vs 21.2%). Patients with painful gluten neuropathy presented with significantly worse MHI-5 score (75.9 vs 87.4). Multivariate analysis showed that, after adjusting for age, gender, and MHI-5 score, adherence to a strict gluten-free diet was associated with lowering the odds of peripheral neuropathic pain by 88.7%.

 “This study is promising because it shows that a gluten-free diet may help lower the risk of pain for people with gluten neuropathy,” Dr. Zis said. “More research is needed to confirm these results and to determine whether the gluten-free diet led to the reduction in pain.”

New Genetic Risk Factors for Stroke Determined

New genetic risk factors for stroke have been identified, thereby tripling the number of gene regions known to affect stroke risk, according to a study published online ahead of print March 12 in Nature Genetics. Researchers conducted a multiancestry genome-wide-association meta-analysis in 521,612 individuals (67,162 with stroke) and discovered 22 new stroke risk loci, bringing the total to 32. In addition, the investigators found shared genetic variation with related vascular traits (eg, blood pressure, cardiac traits, and venous thromboembolism) at individual loci and using genetic risk scores and linkage-disequilibrium-score regression. Several loci had distinct association and pleiotropy patterns for etiological stroke subtypes. Eleven new susceptibility loci indicate mechanisms not previously implicated in stroke pathophysiology. The researchers prioritized risk variants and genes through bioinformatics analyses using functional datasets.

Malik R, Chauhan G, Traylor M, et al. Multiancestry genome-wide association study of 520,000 subjects identifies 32 loci associated with stroke and stroke subtypes. Nat Genet. 2018 Mar 12 [Epub ahead of print].

MS Medication Withdrawn Because of Safety Concerns

Citing concerns about safety, Biogen and AbbVie announced March 2 that they will be withdrawing daclizumab (Zinbryta) from worldwide markets. Daclizumab has known risks, so it was usually prescribed only for people with relapsing multiple sclerosis who had tried two or more other medications that had not worked well enough. Reports of inflammatory encephalitis and meningoencephalitis led the European Medicines Agency to initiate an Article 20 referral procedure. In such referrals, a medicine or class of medicines are scientifically assessed because of concerns over safety or quality. However, Biogen and AbbVie concluded that, because of the complex nature of these reports and how few patients were taking daclizumab, it would be difficult to characterize the nature of the medication’s harms and benefits, so the companies instead have decided to withdraw the medication from the market.

Many Elderly Patients With Epilepsy Receive Interacting Treatments

Many elderly patients with epilepsy receive combinations of nonepilepsy drugs (NEDs) and antiepileptic drugs (AEDs) that could interact, according to a study published February 7 in Epilepsia. Researchers retrospectively analyzed 2008–2010 Medicare claims for a random sample of beneficiaries age 67 and older. Prevalent cases had a diagnosis of epilepsy and took one or more AEDs. Incident cases had no seizure or epilepsy claim codes or AEDs in the preceding 365 days. Interacting pairs of AEDs and NEDs were identified by literature review. Logistic regression models were used to examine factors affecting the likelihood of interaction risk. Interacting drug pairs affected NED efficacy in 24.5% of incident cases and 39% of prevalent cases. Combinations affected AED efficacy in 20.4% of incident cases and 29.3% of prevalent cases.

Faught E, Szaflarski JP, Richman J, et al. Risk of pharmacokinetic interactions between antiepileptic and other drugs in older persons and factors associated with risk. Epilepsia. 2018;59(3):715-723.

Are Physically Fit Women at Reduced Risk for Dementia?

High cardiovascular fitness in midlife is associated with decreased risk of subsequent dementia, according to a study published online ahead of print March 14 in Neurology. Physicians examined a population-based sample of 1,462 women ages 38 to 60 in 1968. A subsample of 191 women with an average age of 50 took a maximal ergometer cycling test to measure their peak cardiovascular capacity. Over the following 44 years, participants were tested for dementia six times. By 2012, 44 of the women developed dementia. Approximately 5% of the highly fit women developed dementia, compared with 25% of moderately fit women, and 32% of the women with low fitness. The highly fit women were 88% less likely to develop dementia than the moderately fit women.

Hörder H, Johansson L, Guo X, et al. Midlife cardiovascular fitness and dementia: A 44-year longitudinal population study in women. Neurology. 2018 Mar 14 [Epub ahead of print].

Data on Geriatric TBI May Be Inadequate

Many older adults with traumatic brain injury (TBI) respond well to aggressive management and rehabilitation, which suggests that age and TBI severity alone are inadequate prognostic markers, according to a study published online ahead of print February 15 in the Journal of Neurotrauma. Researchers reviewed the literature on incident TBI sustained in older adulthood. They found few geriatric-specific TBI guidelines to assist with complex management decisions and concluded that TBI prognostic models do not perform optimally in this population. Major barriers in management of geriatric TBI include underrepresentation of older adults in TBI research, lack of systematic measurement of preinjury health that may predict outcome and response to treatment, and lack of geriatric-specific TBI common data elements. Investigators need to develop more age-inclusive TBI research protocols, said the authors.

Gardner RC, Dams-O’Connor K, Morrissey MR, Manley GT. Geriatric traumatic brain injury: epidemiology, outcomes, knowledge gaps, and future directions. J Neurotrauma. 2018 Feb 15 [Epub ahead of print].

TDCS Improves Gait in Parkinson’s Disease

Transcranial direct-current stimulation (TDCS) reduces freezing of gait and improves executive function and mobility, according to a study published online ahead of print February 13 in Movement Disorders. Researchers examined 20 patients with Parkinson’s disease and freezing of gait. The patients received 20 minutes of TDCS or sham treatment during three separate visits. TDCS targeted the primary motor cortex and left dorsolateral prefrontal cortex simultaneously or primary motor cortex only. Participants completed the Timed Up and Go and Stroop tests before and after each stimulation session. Performance on the Timed Up and Go and Stroop tests improved after simultaneous stimulation of the primary motor cortex and left dorsolateral prefrontal cortex, but not after stimulation of the primary motor cortex alone or sham stimulation.

Dagan M, Herman T, Harrison R, et al. Multitarget transcranial direct current stimulation for freezing of gait in Parkinson’s disease. Mov Disord. 2018 Feb 13 [Epub ahead of print].

Patients With Major Stroke Need Realistic Planning

Doctors who care for patients with severe stroke should plan with patients and caregivers and discuss the possibility of death or survival with disability, according to a study published March 5 in the Canadian Medical Association Journal. Researchers recruited a purposive sample of people with total anterior circulation stroke at three stroke services and conducted serial, qualitative interviews with participants and their caregivers at six weeks, six months, and one year. Investigators also conducted a data-linkage study of all patients with anterior circulation stroke admitted to the three services over six months. About 57% of patients died within six months. Patients experienced immediate and persistent emotional distress and poor quality of life. Physicians should practice palliative care for these patients, but avoid using that term, said the authors.

Kendall M, Cowey E, Mead G, et al. Outcomes, experiences and palliative care in major stroke: a multicentre, mixed-method, longitudinal study. CMAJ. 2018;190(9):E238-E246.

Dengue Fever Is Associated With Increased Risk of Stroke

Dengue fever is associated with an increased risk of stroke in the first few months after diagnosis, according to a study published March 12 in Canadian Medical Association Journal. Using data from the Taiwan National Health Insurance Research Database, researchers examined 13,787 patients diagnosed with dengue fever between 2000 and 2012. The control cohort consisted of patients matched by demographic characteristics and stroke-related comorbidities who did not have dengue fever. The overall incidence rate of stroke was 5.33 per 1,000 person-years in the dengue fever cohort and 3.72 per 1,000 person-years in the control cohort. The adjusted hazard ratio of stroke was 1.16 in patients with dengue fever. The risk of stroke was 2.49 times higher in patients with dengue fever during the first two months after diagnosis, compared with controls.

Li HM, Huang YK, Su YC, Kao CH. Risk of stroke in patients with dengue fever: a population-based cohort study. CMAJ. 2018;190(10):E285-E290.

Do Survivors of Stroke Need Additional Help Taking Medication?

More than half of patients with stroke need help taking medication, according to a study published March 11 in BMJ Open. Approximately 600 community-dwelling patients with stroke responded to a five-item questionnaire about practical support that they need and receive. Approximately 56% of respondents got help with taking medication, and 11% needed additional help, including help with prescriptions and collection of medicines, getting medicines out of the packaging, and being reminded to take medicines. Being dependent on others was associated with experiencing more unmet needs with daily medicine taking. About 35% of respondents said that they had missed taking medicine in the previous 30 days. Younger patients with stroke were more likely to miss their medicines, possibly because they were less likely to receive help from a caregiver.

Jamison J, Ayerbe L, Di Tanna GL, et al. Evaluating practical support stroke survivors get with medicines and unmet needs in primary care: a survey. BMJ Open. 2018;8(3):e019874.

Sun Exposure Associated With Reduced Risk of MS

Living in areas with high ambient levels of ultraviolet-B light during childhood and the years before multiple sclerosis (MS) onset is associated with a lower MS risk, according to a study published online ahead of print March 7 in Neurology. Researchers identified 151 women with MS and 235 age-matched controls. The average age at MS onset was 40. All participants completed questionnaires about summer, winter, and lifetime sun exposure. Researchers separated the women into three groups representing low, moderate, and high ultraviolet-B ray exposure, based on their residence. Women who lived in sunnier climates with the highest exposure to ultraviolet-B rays had a 45% reduced risk of developing MS across all pre-MS onset age groups, when compared with participants living in areas with the lowest ultraviolet-B ray exposure.

Tremlett H, Zhu F, Ascherio A, Munger KL. Sun exposure over the life course and associations with multiple sclerosis. Neurology. 2018 Mar 7 [Epub ahead of print].

New Blood Pressure Guidelines May Not Benefit Everyone

The new blood pressure guidelines could harm certain patients, according to a study published online ahead of print March 2 in the Journal of the American College of Cardiology. Investigators examined the effect of 10-year cardiovascular disease (CVD) risk on primary outcome events and serious adverse events in the Systolic Pressure Intervention Trial, which was a basis for the new guidelines. They stratified patients by quartiles of risk and used Cox proportional hazards models to examine associations. From the first to fourth quartiles, the number needed to treat to prevent primary outcomes decreased from 91 to 38. The number needed to harm for all-cause serious adverse events increased from 62 to 250. Classifying patients by future risk could identify patients who would benefit from intensive treatment, said the authors.

Phillips RA, Xu J, Peterson LE, et al. Impact of cardiovascular risk on the relative benefit and harm of intensive treatment of hypertension. J Am Coll Cardiol. 2018 Mar 2 [Epub ahead of print].

—Kimberly Williams

New Genetic Risk Factors for Stroke Determined

New genetic risk factors for stroke have been identified, thereby tripling the number of gene regions known to affect stroke risk, according to a study published online ahead of print March 12 in Nature Genetics. Researchers conducted a multiancestry genome-wide-association meta-analysis in 521,612 individuals (67,162 with stroke) and discovered 22 new stroke risk loci, bringing the total to 32. In addition, the investigators found shared genetic variation with related vascular traits (eg, blood pressure, cardiac traits, and venous thromboembolism) at individual loci and using genetic risk scores and linkage-disequilibrium-score regression. Several loci had distinct association and pleiotropy patterns for etiological stroke subtypes. Eleven new susceptibility loci indicate mechanisms not previously implicated in stroke pathophysiology. The researchers prioritized risk variants and genes through bioinformatics analyses using functional datasets.

Malik R, Chauhan G, Traylor M, et al. Multiancestry genome-wide association study of 520,000 subjects identifies 32 loci associated with stroke and stroke subtypes. Nat Genet. 2018 Mar 12 [Epub ahead of print].

MS Medication Withdrawn Because of Safety Concerns

Citing concerns about safety, Biogen and AbbVie announced March 2 that they will be withdrawing daclizumab (Zinbryta) from worldwide markets. Daclizumab has known risks, so it was usually prescribed only for people with relapsing multiple sclerosis who had tried two or more other medications that had not worked well enough. Reports of inflammatory encephalitis and meningoencephalitis led the European Medicines Agency to initiate an Article 20 referral procedure. In such referrals, a medicine or class of medicines are scientifically assessed because of concerns over safety or quality. However, Biogen and AbbVie concluded that, because of the complex nature of these reports and how few patients were taking daclizumab, it would be difficult to characterize the nature of the medication’s harms and benefits, so the companies instead have decided to withdraw the medication from the market.

Many Elderly Patients With Epilepsy Receive Interacting Treatments

Many elderly patients with epilepsy receive combinations of nonepilepsy drugs (NEDs) and antiepileptic drugs (AEDs) that could interact, according to a study published February 7 in Epilepsia. Researchers retrospectively analyzed 2008–2010 Medicare claims for a random sample of beneficiaries age 67 and older. Prevalent cases had a diagnosis of epilepsy and took one or more AEDs. Incident cases had no seizure or epilepsy claim codes or AEDs in the preceding 365 days. Interacting pairs of AEDs and NEDs were identified by literature review. Logistic regression models were used to examine factors affecting the likelihood of interaction risk. Interacting drug pairs affected NED efficacy in 24.5% of incident cases and 39% of prevalent cases. Combinations affected AED efficacy in 20.4% of incident cases and 29.3% of prevalent cases.

Faught E, Szaflarski JP, Richman J, et al. Risk of pharmacokinetic interactions between antiepileptic and other drugs in older persons and factors associated with risk. Epilepsia. 2018;59(3):715-723.

Are Physically Fit Women at Reduced Risk for Dementia?

High cardiovascular fitness in midlife is associated with decreased risk of subsequent dementia, according to a study published online ahead of print March 14 in Neurology. Physicians examined a population-based sample of 1,462 women ages 38 to 60 in 1968. A subsample of 191 women with an average age of 50 took a maximal ergometer cycling test to measure their peak cardiovascular capacity. Over the following 44 years, participants were tested for dementia six times. By 2012, 44 of the women developed dementia. Approximately 5% of the highly fit women developed dementia, compared with 25% of moderately fit women, and 32% of the women with low fitness. The highly fit women were 88% less likely to develop dementia than the moderately fit women.

Hörder H, Johansson L, Guo X, et al. Midlife cardiovascular fitness and dementia: A 44-year longitudinal population study in women. Neurology. 2018 Mar 14 [Epub ahead of print].

Data on Geriatric TBI May Be Inadequate

Many older adults with traumatic brain injury (TBI) respond well to aggressive management and rehabilitation, which suggests that age and TBI severity alone are inadequate prognostic markers, according to a study published online ahead of print February 15 in the Journal of Neurotrauma. Researchers reviewed the literature on incident TBI sustained in older adulthood. They found few geriatric-specific TBI guidelines to assist with complex management decisions and concluded that TBI prognostic models do not perform optimally in this population. Major barriers in management of geriatric TBI include underrepresentation of older adults in TBI research, lack of systematic measurement of preinjury health that may predict outcome and response to treatment, and lack of geriatric-specific TBI common data elements. Investigators need to develop more age-inclusive TBI research protocols, said the authors.

Gardner RC, Dams-O’Connor K, Morrissey MR, Manley GT. Geriatric traumatic brain injury: epidemiology, outcomes, knowledge gaps, and future directions. J Neurotrauma. 2018 Feb 15 [Epub ahead of print].

TDCS Improves Gait in Parkinson’s Disease

Transcranial direct-current stimulation (TDCS) reduces freezing of gait and improves executive function and mobility, according to a study published online ahead of print February 13 in Movement Disorders. Researchers examined 20 patients with Parkinson’s disease and freezing of gait. The patients received 20 minutes of TDCS or sham treatment during three separate visits. TDCS targeted the primary motor cortex and left dorsolateral prefrontal cortex simultaneously or primary motor cortex only. Participants completed the Timed Up and Go and Stroop tests before and after each stimulation session. Performance on the Timed Up and Go and Stroop tests improved after simultaneous stimulation of the primary motor cortex and left dorsolateral prefrontal cortex, but not after stimulation of the primary motor cortex alone or sham stimulation.

Dagan M, Herman T, Harrison R, et al. Multitarget transcranial direct current stimulation for freezing of gait in Parkinson’s disease. Mov Disord. 2018 Feb 13 [Epub ahead of print].

Patients With Major Stroke Need Realistic Planning

Doctors who care for patients with severe stroke should plan with patients and caregivers and discuss the possibility of death or survival with disability, according to a study published March 5 in the Canadian Medical Association Journal. Researchers recruited a purposive sample of people with total anterior circulation stroke at three stroke services and conducted serial, qualitative interviews with participants and their caregivers at six weeks, six months, and one year. Investigators also conducted a data-linkage study of all patients with anterior circulation stroke admitted to the three services over six months. About 57% of patients died within six months. Patients experienced immediate and persistent emotional distress and poor quality of life. Physicians should practice palliative care for these patients, but avoid using that term, said the authors.

Kendall M, Cowey E, Mead G, et al. Outcomes, experiences and palliative care in major stroke: a multicentre, mixed-method, longitudinal study. CMAJ. 2018;190(9):E238-E246.

Dengue Fever Is Associated With Increased Risk of Stroke

Dengue fever is associated with an increased risk of stroke in the first few months after diagnosis, according to a study published March 12 in Canadian Medical Association Journal. Using data from the Taiwan National Health Insurance Research Database, researchers examined 13,787 patients diagnosed with dengue fever between 2000 and 2012. The control cohort consisted of patients matched by demographic characteristics and stroke-related comorbidities who did not have dengue fever. The overall incidence rate of stroke was 5.33 per 1,000 person-years in the dengue fever cohort and 3.72 per 1,000 person-years in the control cohort. The adjusted hazard ratio of stroke was 1.16 in patients with dengue fever. The risk of stroke was 2.49 times higher in patients with dengue fever during the first two months after diagnosis, compared with controls.

Li HM, Huang YK, Su YC, Kao CH. Risk of stroke in patients with dengue fever: a population-based cohort study. CMAJ. 2018;190(10):E285-E290.

Do Survivors of Stroke Need Additional Help Taking Medication?

More than half of patients with stroke need help taking medication, according to a study published March 11 in BMJ Open. Approximately 600 community-dwelling patients with stroke responded to a five-item questionnaire about practical support that they need and receive. Approximately 56% of respondents got help with taking medication, and 11% needed additional help, including help with prescriptions and collection of medicines, getting medicines out of the packaging, and being reminded to take medicines. Being dependent on others was associated with experiencing more unmet needs with daily medicine taking. About 35% of respondents said that they had missed taking medicine in the previous 30 days. Younger patients with stroke were more likely to miss their medicines, possibly because they were less likely to receive help from a caregiver.

Jamison J, Ayerbe L, Di Tanna GL, et al. Evaluating practical support stroke survivors get with medicines and unmet needs in primary care: a survey. BMJ Open. 2018;8(3):e019874.

Sun Exposure Associated With Reduced Risk of MS

Living in areas with high ambient levels of ultraviolet-B light during childhood and the years before multiple sclerosis (MS) onset is associated with a lower MS risk, according to a study published online ahead of print March 7 in Neurology. Researchers identified 151 women with MS and 235 age-matched controls. The average age at MS onset was 40. All participants completed questionnaires about summer, winter, and lifetime sun exposure. Researchers separated the women into three groups representing low, moderate, and high ultraviolet-B ray exposure, based on their residence. Women who lived in sunnier climates with the highest exposure to ultraviolet-B rays had a 45% reduced risk of developing MS across all pre-MS onset age groups, when compared with participants living in areas with the lowest ultraviolet-B ray exposure.

Tremlett H, Zhu F, Ascherio A, Munger KL. Sun exposure over the life course and associations with multiple sclerosis. Neurology. 2018 Mar 7 [Epub ahead of print].

New Blood Pressure Guidelines May Not Benefit Everyone

The new blood pressure guidelines could harm certain patients, according to a study published online ahead of print March 2 in the Journal of the American College of Cardiology. Investigators examined the effect of 10-year cardiovascular disease (CVD) risk on primary outcome events and serious adverse events in the Systolic Pressure Intervention Trial, which was a basis for the new guidelines. They stratified patients by quartiles of risk and used Cox proportional hazards models to examine associations. From the first to fourth quartiles, the number needed to treat to prevent primary outcomes decreased from 91 to 38. The number needed to harm for all-cause serious adverse events increased from 62 to 250. Classifying patients by future risk could identify patients who would benefit from intensive treatment, said the authors.

Phillips RA, Xu J, Peterson LE, et al. Impact of cardiovascular risk on the relative benefit and harm of intensive treatment of hypertension. J Am Coll Cardiol. 2018 Mar 2 [Epub ahead of print].

—Kimberly Williams

New Genetic Risk Factors for Stroke Determined

New genetic risk factors for stroke have been identified, thereby tripling the number of gene regions known to affect stroke risk, according to a study published online ahead of print March 12 in Nature Genetics. Researchers conducted a multiancestry genome-wide-association meta-analysis in 521,612 individuals (67,162 with stroke) and discovered 22 new stroke risk loci, bringing the total to 32. In addition, the investigators found shared genetic variation with related vascular traits (eg, blood pressure, cardiac traits, and venous thromboembolism) at individual loci and using genetic risk scores and linkage-disequilibrium-score regression. Several loci had distinct association and pleiotropy patterns for etiological stroke subtypes. Eleven new susceptibility loci indicate mechanisms not previously implicated in stroke pathophysiology. The researchers prioritized risk variants and genes through bioinformatics analyses using functional datasets.

Malik R, Chauhan G, Traylor M, et al. Multiancestry genome-wide association study of 520,000 subjects identifies 32 loci associated with stroke and stroke subtypes. Nat Genet. 2018 Mar 12 [Epub ahead of print].

MS Medication Withdrawn Because of Safety Concerns

Citing concerns about safety, Biogen and AbbVie announced March 2 that they will be withdrawing daclizumab (Zinbryta) from worldwide markets. Daclizumab has known risks, so it was usually prescribed only for people with relapsing multiple sclerosis who had tried two or more other medications that had not worked well enough. Reports of inflammatory encephalitis and meningoencephalitis led the European Medicines Agency to initiate an Article 20 referral procedure. In such referrals, a medicine or class of medicines are scientifically assessed because of concerns over safety or quality. However, Biogen and AbbVie concluded that, because of the complex nature of these reports and how few patients were taking daclizumab, it would be difficult to characterize the nature of the medication’s harms and benefits, so the companies instead have decided to withdraw the medication from the market.

Many Elderly Patients With Epilepsy Receive Interacting Treatments

Many elderly patients with epilepsy receive combinations of nonepilepsy drugs (NEDs) and antiepileptic drugs (AEDs) that could interact, according to a study published February 7 in Epilepsia. Researchers retrospectively analyzed 2008–2010 Medicare claims for a random sample of beneficiaries age 67 and older. Prevalent cases had a diagnosis of epilepsy and took one or more AEDs. Incident cases had no seizure or epilepsy claim codes or AEDs in the preceding 365 days. Interacting pairs of AEDs and NEDs were identified by literature review. Logistic regression models were used to examine factors affecting the likelihood of interaction risk. Interacting drug pairs affected NED efficacy in 24.5% of incident cases and 39% of prevalent cases. Combinations affected AED efficacy in 20.4% of incident cases and 29.3% of prevalent cases.

Faught E, Szaflarski JP, Richman J, et al. Risk of pharmacokinetic interactions between antiepileptic and other drugs in older persons and factors associated with risk. Epilepsia. 2018;59(3):715-723.

Are Physically Fit Women at Reduced Risk for Dementia?

High cardiovascular fitness in midlife is associated with decreased risk of subsequent dementia, according to a study published online ahead of print March 14 in Neurology. Physicians examined a population-based sample of 1,462 women ages 38 to 60 in 1968. A subsample of 191 women with an average age of 50 took a maximal ergometer cycling test to measure their peak cardiovascular capacity. Over the following 44 years, participants were tested for dementia six times. By 2012, 44 of the women developed dementia. Approximately 5% of the highly fit women developed dementia, compared with 25% of moderately fit women, and 32% of the women with low fitness. The highly fit women were 88% less likely to develop dementia than the moderately fit women.

Hörder H, Johansson L, Guo X, et al. Midlife cardiovascular fitness and dementia: A 44-year longitudinal population study in women. Neurology. 2018 Mar 14 [Epub ahead of print].

Data on Geriatric TBI May Be Inadequate

Many older adults with traumatic brain injury (TBI) respond well to aggressive management and rehabilitation, which suggests that age and TBI severity alone are inadequate prognostic markers, according to a study published online ahead of print February 15 in the Journal of Neurotrauma. Researchers reviewed the literature on incident TBI sustained in older adulthood. They found few geriatric-specific TBI guidelines to assist with complex management decisions and concluded that TBI prognostic models do not perform optimally in this population. Major barriers in management of geriatric TBI include underrepresentation of older adults in TBI research, lack of systematic measurement of preinjury health that may predict outcome and response to treatment, and lack of geriatric-specific TBI common data elements. Investigators need to develop more age-inclusive TBI research protocols, said the authors.

Gardner RC, Dams-O’Connor K, Morrissey MR, Manley GT. Geriatric traumatic brain injury: epidemiology, outcomes, knowledge gaps, and future directions. J Neurotrauma. 2018 Feb 15 [Epub ahead of print].

TDCS Improves Gait in Parkinson’s Disease

Transcranial direct-current stimulation (TDCS) reduces freezing of gait and improves executive function and mobility, according to a study published online ahead of print February 13 in Movement Disorders. Researchers examined 20 patients with Parkinson’s disease and freezing of gait. The patients received 20 minutes of TDCS or sham treatment during three separate visits. TDCS targeted the primary motor cortex and left dorsolateral prefrontal cortex simultaneously or primary motor cortex only. Participants completed the Timed Up and Go and Stroop tests before and after each stimulation session. Performance on the Timed Up and Go and Stroop tests improved after simultaneous stimulation of the primary motor cortex and left dorsolateral prefrontal cortex, but not after stimulation of the primary motor cortex alone or sham stimulation.

Dagan M, Herman T, Harrison R, et al. Multitarget transcranial direct current stimulation for freezing of gait in Parkinson’s disease. Mov Disord. 2018 Feb 13 [Epub ahead of print].

Patients With Major Stroke Need Realistic Planning

Doctors who care for patients with severe stroke should plan with patients and caregivers and discuss the possibility of death or survival with disability, according to a study published March 5 in the Canadian Medical Association Journal. Researchers recruited a purposive sample of people with total anterior circulation stroke at three stroke services and conducted serial, qualitative interviews with participants and their caregivers at six weeks, six months, and one year. Investigators also conducted a data-linkage study of all patients with anterior circulation stroke admitted to the three services over six months. About 57% of patients died within six months. Patients experienced immediate and persistent emotional distress and poor quality of life. Physicians should practice palliative care for these patients, but avoid using that term, said the authors.

Kendall M, Cowey E, Mead G, et al. Outcomes, experiences and palliative care in major stroke: a multicentre, mixed-method, longitudinal study. CMAJ. 2018;190(9):E238-E246.

Dengue Fever Is Associated With Increased Risk of Stroke

Dengue fever is associated with an increased risk of stroke in the first few months after diagnosis, according to a study published March 12 in Canadian Medical Association Journal. Using data from the Taiwan National Health Insurance Research Database, researchers examined 13,787 patients diagnosed with dengue fever between 2000 and 2012. The control cohort consisted of patients matched by demographic characteristics and stroke-related comorbidities who did not have dengue fever. The overall incidence rate of stroke was 5.33 per 1,000 person-years in the dengue fever cohort and 3.72 per 1,000 person-years in the control cohort. The adjusted hazard ratio of stroke was 1.16 in patients with dengue fever. The risk of stroke was 2.49 times higher in patients with dengue fever during the first two months after diagnosis, compared with controls.

Li HM, Huang YK, Su YC, Kao CH. Risk of stroke in patients with dengue fever: a population-based cohort study. CMAJ. 2018;190(10):E285-E290.

Do Survivors of Stroke Need Additional Help Taking Medication?

More than half of patients with stroke need help taking medication, according to a study published March 11 in BMJ Open. Approximately 600 community-dwelling patients with stroke responded to a five-item questionnaire about practical support that they need and receive. Approximately 56% of respondents got help with taking medication, and 11% needed additional help, including help with prescriptions and collection of medicines, getting medicines out of the packaging, and being reminded to take medicines. Being dependent on others was associated with experiencing more unmet needs with daily medicine taking. About 35% of respondents said that they had missed taking medicine in the previous 30 days. Younger patients with stroke were more likely to miss their medicines, possibly because they were less likely to receive help from a caregiver.

Jamison J, Ayerbe L, Di Tanna GL, et al. Evaluating practical support stroke survivors get with medicines and unmet needs in primary care: a survey. BMJ Open. 2018;8(3):e019874.

Sun Exposure Associated With Reduced Risk of MS

Living in areas with high ambient levels of ultraviolet-B light during childhood and the years before multiple sclerosis (MS) onset is associated with a lower MS risk, according to a study published online ahead of print March 7 in Neurology. Researchers identified 151 women with MS and 235 age-matched controls. The average age at MS onset was 40. All participants completed questionnaires about summer, winter, and lifetime sun exposure. Researchers separated the women into three groups representing low, moderate, and high ultraviolet-B ray exposure, based on their residence. Women who lived in sunnier climates with the highest exposure to ultraviolet-B rays had a 45% reduced risk of developing MS across all pre-MS onset age groups, when compared with participants living in areas with the lowest ultraviolet-B ray exposure.

Tremlett H, Zhu F, Ascherio A, Munger KL. Sun exposure over the life course and associations with multiple sclerosis. Neurology. 2018 Mar 7 [Epub ahead of print].

New Blood Pressure Guidelines May Not Benefit Everyone

The new blood pressure guidelines could harm certain patients, according to a study published online ahead of print March 2 in the Journal of the American College of Cardiology. Investigators examined the effect of 10-year cardiovascular disease (CVD) risk on primary outcome events and serious adverse events in the Systolic Pressure Intervention Trial, which was a basis for the new guidelines. They stratified patients by quartiles of risk and used Cox proportional hazards models to examine associations. From the first to fourth quartiles, the number needed to treat to prevent primary outcomes decreased from 91 to 38. The number needed to harm for all-cause serious adverse events increased from 62 to 250. Classifying patients by future risk could identify patients who would benefit from intensive treatment, said the authors.

Phillips RA, Xu J, Peterson LE, et al. Impact of cardiovascular risk on the relative benefit and harm of intensive treatment of hypertension. J Am Coll Cardiol. 2018 Mar 2 [Epub ahead of print].

—Kimberly Williams

Despite the rise in pediatric concussions, two-thirds of these youth do not return for recommended follow-up care in Ontario, reported Liraz Fridman, PhD, of York University, Toronto, and associates.

In a 10-year, retrospective, population-based study, 126,654 children aged 5-18 years presented with concussions to emergency departments and physician offices in Ontario between April 1, 2003, and March 31, 2014. In 2003, 7,126 children were evaluated for a concussion, compared with 21,681 children by 2013.

James Boulette/iStockphoto

SOURCE: Fridman L et al. J Pediatr. 2018;192:184-8

Despite the rise in pediatric concussions, two-thirds of these youth do not return for recommended follow-up care in Ontario, reported Liraz Fridman, PhD, of York University, Toronto, and associates.

In a 10-year, retrospective, population-based study, 126,654 children aged 5-18 years presented with concussions to emergency departments and physician offices in Ontario between April 1, 2003, and March 31, 2014. In 2003, 7,126 children were evaluated for a concussion, compared with 21,681 children by 2013.

James Boulette/iStockphoto

SOURCE: Fridman L et al. J Pediatr. 2018;192:184-8

Despite the rise in pediatric concussions, two-thirds of these youth do not return for recommended follow-up care in Ontario, reported Liraz Fridman, PhD, of York University, Toronto, and associates.

In a 10-year, retrospective, population-based study, 126,654 children aged 5-18 years presented with concussions to emergency departments and physician offices in Ontario between April 1, 2003, and March 31, 2014. In 2003, 7,126 children were evaluated for a concussion, compared with 21,681 children by 2013.

James Boulette/iStockphoto

SOURCE: Fridman L et al. J Pediatr. 2018;192:184-8

Short Stature in Children Linked to Future Stroke

Short stature at ages 7 to 13 is associated with increased risk of stroke in adulthood, according to a study published online ahead of print February 15 in Stroke. Data were examined for 311,009 schoolchildren born between 1930 and 1989. Cox proportional hazards regressions were performed to estimate hazard ratios. Among the participants, 10,412 were diagnosed with ischemic stroke, and 2,546 were diagnosed with intracerebral hemorrhage. Height at age 7 was inversely and significantly associated with ischemic stroke in both sexes and with intracerebral hemorrhage in men, but not in women. Associations were similar at older childhood ages and were stable throughout the study period. No statistically significant associations for growth from ages 7 to 13 were observed for ischemic stroke or intracerebral hemorrhage.

Gjærde LK, Truelsen TC, Baker JL. Childhood stature and growth in relation to first ischemic stroke or intracerebral hemorrhage. Stroke. 2018 Feb 15 [Epub ahead of print].

FDA Expands Treatment Window for Trevo Device

The FDA has cleared the use of the Trevo clot-retrieval device to treat certain patients with stroke as long as 24 hours after symptom onset, thus expanding its indications. The device is cleared as an initial therapy for acute ischemic stroke to reduce paralysis, speech difficulties, and other disabilities. It is to be used in addition to t-PA. Trevo was previously cleared for use in patients six hours after symptom onset. The agency evaluated data from a clinical trial comparing 107 patients treated with Trevo and medical management with 99 patients receiving medical management alone. About 48% of patients treated with Trevo were functionally independent three months after stroke, compared with 13% of patients receiving medical management. Stryker, headquartered in Kalamazoo, Michigan, markets the device.

Positive Views on Aging May Reduce Dementia Risk

Older adults who gain positive beliefs about old age from their culture are less likely to develop dementia, according to a study published February 7 in PLoS One. The cohort included 4,765 Health and Retirement Study participants age 60 or older who were dementia-free at baseline. In the total sample, people with positive age beliefs at baseline were significantly less likely to develop dementia, after adjusting for relevant covariates. Among people with APOE ε4, participants with positive age beliefs were 49.8% less likely to develop dementia than people with negative age beliefs. The results of this study suggest that positive age beliefs, which are modifiable and reduce stress, can be protective, even for older individuals at high risk of dementia, said the investigators.

Levy BR, Slade MD, Pietrzak RH, Ferrucci L. Positive age beliefs protect against dementia even among elders with high-risk gene. PLoS One. 2018 Feb 7;13(2):e0191004.

Should Women Stop MS Treatment During Pregnancy?

Natalizumab exposure for as long as 12 weeks of gestation increases the risk of spontaneous abortion, compared with exposure to injectable treatments or no treatment, in women with multiple sclerosis (MS), according to a study published online ahead of print February 7 in Neurology. Data for all pregnancies occurring between 2009 and 2015 in patients with MS treated with natalizumab were collected and compared with data for pregnancies in untreated patients and patients treated with injectable immunomodulatory agents. A total of 92 pregnancies were tracked in 83 women. In the multivariable analysis, natalizumab exposure was associated with spontaneous abortion. The rate of spontaneous abortion was within the estimates for the general population, however, as was the rate of major congenital anomalies.

Portaccio E, Annovazzi P, Ghezzi A, et al. Pregnancy decision-making in women with multiple sclerosis treated with natalizumab: I: Fetal risks. Neurology. 2018 Feb 7 [Epub ahead of print].

Walking Ability After Stroke Improves With Arm Exercise

Arm exercise may improve walking ability after stroke, according to a study published online ahead of print December 6, 2017, in the Journal of Neurophysiology. Researchers worked with a group of older adults who had had a stroke between seven months and 17 years before the study. Participants underwent three 30-minute, moderate-intensity arm cycling training sessions each week for five weeks. Bilateral soleus stretch reflexes were elicited at rest and during 1-Hz arm cycling. Investigators measured physical abilities before and after arm training using several standardized scales and tests of physical function. Performance significantly improved on all walking tests and improved as much as 28% on the Timed Up and Go test. Several subjects had less tightness in their muscles after completing the arm cycling trial.

Kaupp C, Pearcey GE, Klarner T, et al. Rhythmic arm cycling training improves walking and neurophysiological integrity in chronic stroke-the arms can give legs a helping hand in rehabilitation. J Neurophysiol. 2017 Dec 6 [Epub ahead of print].

CSF May Indicate Parkinson’s Disease Phenotype

Lower CSF alpha-synuclein level is associated with diagnosis and motor phenotype in moderate and advanced Parkinson’s disease, according to a study published in the February issue of Movement Disorders. Researchers analyzed data from BioFIND, a cross-sectional, observational study that examines clinical and biomarker characteristics in moderate and advanced Parkinson’s disease and matched healthy controls. Investigators compared alpha-synuclein concentrations across diagnosis, biofluids, and CSF biomarkers. Correlations of CSF biomarkers and Movement Disorders Society Unified Parkinson’s Disease Rating Scale, motor phenotype, Montreal Cognitive Assessment, and REM sleep behavior disorder questionnaire scores in Parkinson’s disease were examined. CSF alpha-synuclein level was lower in Parkinson’s disease versus controls. Plasma and saliva alpha-synuclein levels did not differ between Parkinson’s disease and controls, and alpha-synuclein did not significantly correlate among biofluids.

Goldman JG, Andrews H, Amara A, et al. Cerebrospinal fluid, plasma, and saliva in the BioFIND study: relationships among biomarkers and Parkinson’s disease features. Mov Disord. 2018;33(2):282-288.

Social Interaction May Improve Quality of Life in Dementia

Increasing the amount of social interaction for people with dementia living in care homes to one hour a week improves quality of life when combined with personalized care, according to a study published February 6 in PLoS Med. In all, 847 people with dementia in 69 care homes were included in this study, which compared a psychosocial intervention plus antipsychotic treatment review with standard treatment using an intention-to-treat analysis. The primary outcome was quality of life. Staff were trained in person-centered care, social interaction, and education in antipsychotic medications. A total of 553 participants completed the nine-month randomized controlled trial. The intervention significantly improved quality of life, agitation, and overall neuropsychiatric symptoms. Benefits were greatest in people with moderately severe dementia.

Ballard C, Corbett A, Orrell M, et al. Impact of person-centred care training and person-centred activities on quality of life, agitation, and antipsychotic use in people with dementia living in nursing homes: a cluster-randomised controlled trial. PLoS Med. 2018 Feb 6;15(2):e1002500.

Adjunctive Cetirizine Reduces Relapses in Neuromyelitis Optica

In patients with neuromyelitis optica, adding cetirizine to standard therapy is safe and well tolerated and may reduce relapses, according to a study published online ahead of print February 2 in Neurology Neuroimmunology & Neuroinflammation. This pilot, open-label, add-on trial of cetirizine followed 16 patients with neuromyelitis optica taking 10 mg/day of oral cetirizine for one year in addition to their usual treatment. The primary end point was the annualized relapse rate while on the same disease-modifying therapy before starting cetirizine, compared with that while taking cetirizine. Participants were monitored for new neurologic episodes and potential adverse events related to the study drug. Annualized relapse rate was 0.4 before cetirizine treatment and 0.1 afterward. Cetirizine did not affect participants’ Expanded Disability Status Scale scores.

Katz Sand I, Fabian MT, Telford R, et al. Open-label, add-on trial of cetirizine for neuromyelitis optica. Neurol Neuroimmunol Neuroinflamm. 2018 Feb 2 [Epub ahead of print].

Stroke Risk Factors Specific to Women Identified

Investigators have identified stroke risk factors specific to women, according to a study published online ahead of print February 8 in Stroke. A literature review found risk factors in the three main categories of endogenous hormones, exogenous hormones, and pregnancy-related exposures. These factors include early age of menarche, early age at menopause, low levels of dehydroepiandrosterone, and taking oral estrogen or combined oral contraceptives. The risk factors are common, and not all women who have one or more of them will have a stroke. Clinicians should consider history of pregnancy complications, including gestational diabetes, pre-eclampsia, or hypertension during or immediately following pregnancy, when evaluating a patient for stroke risk, said the investigators. These women should be monitored carefully and told that they are at higher risk, they added.

Demel SL, Kittner S, Ley SH, et al. Stroke risk factors unique to women. Stroke. 2018 Feb 8 [Epub ahead of print].

FDA Clears Embrace for Monitoring Seizure Activity

The FDA has cleared the Embrace smart watch for detecting generalized tonic-clonic seizures. The device uses advanced machine learning and measures multiple indicators, including electrodermal activity. It also sends alerts to summon caregivers when it detects seizures. In a multisite clinical study, 135 patients with epilepsy were admitted to epilepsy monitoring units for continuous monitoring with video-EEG while they wore the device. A total of 6,530 hours of data were recorded over 272 days, including data for 40 generalized tonic-clonic seizures. The device’s algorithm detected 100% of the seizures. The trial used the gold standard of defining seizures as those clinically labelled by at least two out of three independent epileptologists, who examined the video-EEG data without seeing any data used by Embrace. The Embrace watch was approved in Europe in April 2017 as a medical device for seizure monitoring and alert. Empatica, which markets the watch, is located in Cambridge, Massachusetts.

FDA Approves Glatopa for Relapsing Forms of MS

The FDA has approved Glatopa (glatiramer acetate injection) 40 mg/mL, as a thrice-weekly generic treatment option for relapsing forms of multiple sclerosis (MS). Doses should be administered at 48-hour intervals. The treatment is intended to be fully substitutable for Copaxone. A 20-mg/mL formulation of the drug has been available since June 2015. Glatopa is contraindicated in patients with known hypersensitivity to glatiramer acetate or mannitol. The most common adverse reactions with glatiramer acetate injection 40 mg/mL versus placebo are injection-site reactions such as erythema (22% vs 2%). The most common side effects of glatiramer acetate injection 20 mg/mL versus placebo are erythema, vasodilatation, rash, dyspnea, and chest pain. Sandoz, which markets Glatopa, is headquartered in Holzkirchen, Germany.

—Kimberly Williams

Short Stature in Children Linked to Future Stroke

Short stature at ages 7 to 13 is associated with increased risk of stroke in adulthood, according to a study published online ahead of print February 15 in Stroke. Data were examined for 311,009 schoolchildren born between 1930 and 1989. Cox proportional hazards regressions were performed to estimate hazard ratios. Among the participants, 10,412 were diagnosed with ischemic stroke, and 2,546 were diagnosed with intracerebral hemorrhage. Height at age 7 was inversely and significantly associated with ischemic stroke in both sexes and with intracerebral hemorrhage in men, but not in women. Associations were similar at older childhood ages and were stable throughout the study period. No statistically significant associations for growth from ages 7 to 13 were observed for ischemic stroke or intracerebral hemorrhage.

Gjærde LK, Truelsen TC, Baker JL. Childhood stature and growth in relation to first ischemic stroke or intracerebral hemorrhage. Stroke. 2018 Feb 15 [Epub ahead of print].

FDA Expands Treatment Window for Trevo Device

The FDA has cleared the use of the Trevo clot-retrieval device to treat certain patients with stroke as long as 24 hours after symptom onset, thus expanding its indications. The device is cleared as an initial therapy for acute ischemic stroke to reduce paralysis, speech difficulties, and other disabilities. It is to be used in addition to t-PA. Trevo was previously cleared for use in patients six hours after symptom onset. The agency evaluated data from a clinical trial comparing 107 patients treated with Trevo and medical management with 99 patients receiving medical management alone. About 48% of patients treated with Trevo were functionally independent three months after stroke, compared with 13% of patients receiving medical management. Stryker, headquartered in Kalamazoo, Michigan, markets the device.

Positive Views on Aging May Reduce Dementia Risk

Older adults who gain positive beliefs about old age from their culture are less likely to develop dementia, according to a study published February 7 in PLoS One. The cohort included 4,765 Health and Retirement Study participants age 60 or older who were dementia-free at baseline. In the total sample, people with positive age beliefs at baseline were significantly less likely to develop dementia, after adjusting for relevant covariates. Among people with APOE ε4, participants with positive age beliefs were 49.8% less likely to develop dementia than people with negative age beliefs. The results of this study suggest that positive age beliefs, which are modifiable and reduce stress, can be protective, even for older individuals at high risk of dementia, said the investigators.

Levy BR, Slade MD, Pietrzak RH, Ferrucci L. Positive age beliefs protect against dementia even among elders with high-risk gene. PLoS One. 2018 Feb 7;13(2):e0191004.

Should Women Stop MS Treatment During Pregnancy?

Natalizumab exposure for as long as 12 weeks of gestation increases the risk of spontaneous abortion, compared with exposure to injectable treatments or no treatment, in women with multiple sclerosis (MS), according to a study published online ahead of print February 7 in Neurology. Data for all pregnancies occurring between 2009 and 2015 in patients with MS treated with natalizumab were collected and compared with data for pregnancies in untreated patients and patients treated with injectable immunomodulatory agents. A total of 92 pregnancies were tracked in 83 women. In the multivariable analysis, natalizumab exposure was associated with spontaneous abortion. The rate of spontaneous abortion was within the estimates for the general population, however, as was the rate of major congenital anomalies.

Portaccio E, Annovazzi P, Ghezzi A, et al. Pregnancy decision-making in women with multiple sclerosis treated with natalizumab: I: Fetal risks. Neurology. 2018 Feb 7 [Epub ahead of print].

Walking Ability After Stroke Improves With Arm Exercise

Arm exercise may improve walking ability after stroke, according to a study published online ahead of print December 6, 2017, in the Journal of Neurophysiology. Researchers worked with a group of older adults who had had a stroke between seven months and 17 years before the study. Participants underwent three 30-minute, moderate-intensity arm cycling training sessions each week for five weeks. Bilateral soleus stretch reflexes were elicited at rest and during 1-Hz arm cycling. Investigators measured physical abilities before and after arm training using several standardized scales and tests of physical function. Performance significantly improved on all walking tests and improved as much as 28% on the Timed Up and Go test. Several subjects had less tightness in their muscles after completing the arm cycling trial.

Kaupp C, Pearcey GE, Klarner T, et al. Rhythmic arm cycling training improves walking and neurophysiological integrity in chronic stroke-the arms can give legs a helping hand in rehabilitation. J Neurophysiol. 2017 Dec 6 [Epub ahead of print].

CSF May Indicate Parkinson’s Disease Phenotype

Lower CSF alpha-synuclein level is associated with diagnosis and motor phenotype in moderate and advanced Parkinson’s disease, according to a study published in the February issue of Movement Disorders. Researchers analyzed data from BioFIND, a cross-sectional, observational study that examines clinical and biomarker characteristics in moderate and advanced Parkinson’s disease and matched healthy controls. Investigators compared alpha-synuclein concentrations across diagnosis, biofluids, and CSF biomarkers. Correlations of CSF biomarkers and Movement Disorders Society Unified Parkinson’s Disease Rating Scale, motor phenotype, Montreal Cognitive Assessment, and REM sleep behavior disorder questionnaire scores in Parkinson’s disease were examined. CSF alpha-synuclein level was lower in Parkinson’s disease versus controls. Plasma and saliva alpha-synuclein levels did not differ between Parkinson’s disease and controls, and alpha-synuclein did not significantly correlate among biofluids.

Goldman JG, Andrews H, Amara A, et al. Cerebrospinal fluid, plasma, and saliva in the BioFIND study: relationships among biomarkers and Parkinson’s disease features. Mov Disord. 2018;33(2):282-288.

Social Interaction May Improve Quality of Life in Dementia

Increasing the amount of social interaction for people with dementia living in care homes to one hour a week improves quality of life when combined with personalized care, according to a study published February 6 in PLoS Med. In all, 847 people with dementia in 69 care homes were included in this study, which compared a psychosocial intervention plus antipsychotic treatment review with standard treatment using an intention-to-treat analysis. The primary outcome was quality of life. Staff were trained in person-centered care, social interaction, and education in antipsychotic medications. A total of 553 participants completed the nine-month randomized controlled trial. The intervention significantly improved quality of life, agitation, and overall neuropsychiatric symptoms. Benefits were greatest in people with moderately severe dementia.

Ballard C, Corbett A, Orrell M, et al. Impact of person-centred care training and person-centred activities on quality of life, agitation, and antipsychotic use in people with dementia living in nursing homes: a cluster-randomised controlled trial. PLoS Med. 2018 Feb 6;15(2):e1002500.

Adjunctive Cetirizine Reduces Relapses in Neuromyelitis Optica

In patients with neuromyelitis optica, adding cetirizine to standard therapy is safe and well tolerated and may reduce relapses, according to a study published online ahead of print February 2 in Neurology Neuroimmunology & Neuroinflammation. This pilot, open-label, add-on trial of cetirizine followed 16 patients with neuromyelitis optica taking 10 mg/day of oral cetirizine for one year in addition to their usual treatment. The primary end point was the annualized relapse rate while on the same disease-modifying therapy before starting cetirizine, compared with that while taking cetirizine. Participants were monitored for new neurologic episodes and potential adverse events related to the study drug. Annualized relapse rate was 0.4 before cetirizine treatment and 0.1 afterward. Cetirizine did not affect participants’ Expanded Disability Status Scale scores.

Katz Sand I, Fabian MT, Telford R, et al. Open-label, add-on trial of cetirizine for neuromyelitis optica. Neurol Neuroimmunol Neuroinflamm. 2018 Feb 2 [Epub ahead of print].

Stroke Risk Factors Specific to Women Identified

Investigators have identified stroke risk factors specific to women, according to a study published online ahead of print February 8 in Stroke. A literature review found risk factors in the three main categories of endogenous hormones, exogenous hormones, and pregnancy-related exposures. These factors include early age of menarche, early age at menopause, low levels of dehydroepiandrosterone, and taking oral estrogen or combined oral contraceptives. The risk factors are common, and not all women who have one or more of them will have a stroke. Clinicians should consider history of pregnancy complications, including gestational diabetes, pre-eclampsia, or hypertension during or immediately following pregnancy, when evaluating a patient for stroke risk, said the investigators. These women should be monitored carefully and told that they are at higher risk, they added.

Demel SL, Kittner S, Ley SH, et al. Stroke risk factors unique to women. Stroke. 2018 Feb 8 [Epub ahead of print].

FDA Clears Embrace for Monitoring Seizure Activity

The FDA has cleared the Embrace smart watch for detecting generalized tonic-clonic seizures. The device uses advanced machine learning and measures multiple indicators, including electrodermal activity. It also sends alerts to summon caregivers when it detects seizures. In a multisite clinical study, 135 patients with epilepsy were admitted to epilepsy monitoring units for continuous monitoring with video-EEG while they wore the device. A total of 6,530 hours of data were recorded over 272 days, including data for 40 generalized tonic-clonic seizures. The device’s algorithm detected 100% of the seizures. The trial used the gold standard of defining seizures as those clinically labelled by at least two out of three independent epileptologists, who examined the video-EEG data without seeing any data used by Embrace. The Embrace watch was approved in Europe in April 2017 as a medical device for seizure monitoring and alert. Empatica, which markets the watch, is located in Cambridge, Massachusetts.

FDA Approves Glatopa for Relapsing Forms of MS

The FDA has approved Glatopa (glatiramer acetate injection) 40 mg/mL, as a thrice-weekly generic treatment option for relapsing forms of multiple sclerosis (MS). Doses should be administered at 48-hour intervals. The treatment is intended to be fully substitutable for Copaxone. A 20-mg/mL formulation of the drug has been available since June 2015. Glatopa is contraindicated in patients with known hypersensitivity to glatiramer acetate or mannitol. The most common adverse reactions with glatiramer acetate injection 40 mg/mL versus placebo are injection-site reactions such as erythema (22% vs 2%). The most common side effects of glatiramer acetate injection 20 mg/mL versus placebo are erythema, vasodilatation, rash, dyspnea, and chest pain. Sandoz, which markets Glatopa, is headquartered in Holzkirchen, Germany.

—Kimberly Williams

Short Stature in Children Linked to Future Stroke

Short stature at ages 7 to 13 is associated with increased risk of stroke in adulthood, according to a study published online ahead of print February 15 in Stroke. Data were examined for 311,009 schoolchildren born between 1930 and 1989. Cox proportional hazards regressions were performed to estimate hazard ratios. Among the participants, 10,412 were diagnosed with ischemic stroke, and 2,546 were diagnosed with intracerebral hemorrhage. Height at age 7 was inversely and significantly associated with ischemic stroke in both sexes and with intracerebral hemorrhage in men, but not in women. Associations were similar at older childhood ages and were stable throughout the study period. No statistically significant associations for growth from ages 7 to 13 were observed for ischemic stroke or intracerebral hemorrhage.

Gjærde LK, Truelsen TC, Baker JL. Childhood stature and growth in relation to first ischemic stroke or intracerebral hemorrhage. Stroke. 2018 Feb 15 [Epub ahead of print].

FDA Expands Treatment Window for Trevo Device

The FDA has cleared the use of the Trevo clot-retrieval device to treat certain patients with stroke as long as 24 hours after symptom onset, thus expanding its indications. The device is cleared as an initial therapy for acute ischemic stroke to reduce paralysis, speech difficulties, and other disabilities. It is to be used in addition to t-PA. Trevo was previously cleared for use in patients six hours after symptom onset. The agency evaluated data from a clinical trial comparing 107 patients treated with Trevo and medical management with 99 patients receiving medical management alone. About 48% of patients treated with Trevo were functionally independent three months after stroke, compared with 13% of patients receiving medical management. Stryker, headquartered in Kalamazoo, Michigan, markets the device.

Positive Views on Aging May Reduce Dementia Risk

Older adults who gain positive beliefs about old age from their culture are less likely to develop dementia, according to a study published February 7 in PLoS One. The cohort included 4,765 Health and Retirement Study participants age 60 or older who were dementia-free at baseline. In the total sample, people with positive age beliefs at baseline were significantly less likely to develop dementia, after adjusting for relevant covariates. Among people with APOE ε4, participants with positive age beliefs were 49.8% less likely to develop dementia than people with negative age beliefs. The results of this study suggest that positive age beliefs, which are modifiable and reduce stress, can be protective, even for older individuals at high risk of dementia, said the investigators.

Levy BR, Slade MD, Pietrzak RH, Ferrucci L. Positive age beliefs protect against dementia even among elders with high-risk gene. PLoS One. 2018 Feb 7;13(2):e0191004.

Should Women Stop MS Treatment During Pregnancy?

Natalizumab exposure for as long as 12 weeks of gestation increases the risk of spontaneous abortion, compared with exposure to injectable treatments or no treatment, in women with multiple sclerosis (MS), according to a study published online ahead of print February 7 in Neurology. Data for all pregnancies occurring between 2009 and 2015 in patients with MS treated with natalizumab were collected and compared with data for pregnancies in untreated patients and patients treated with injectable immunomodulatory agents. A total of 92 pregnancies were tracked in 83 women. In the multivariable analysis, natalizumab exposure was associated with spontaneous abortion. The rate of spontaneous abortion was within the estimates for the general population, however, as was the rate of major congenital anomalies.

Portaccio E, Annovazzi P, Ghezzi A, et al. Pregnancy decision-making in women with multiple sclerosis treated with natalizumab: I: Fetal risks. Neurology. 2018 Feb 7 [Epub ahead of print].

Walking Ability After Stroke Improves With Arm Exercise

Arm exercise may improve walking ability after stroke, according to a study published online ahead of print December 6, 2017, in the Journal of Neurophysiology. Researchers worked with a group of older adults who had had a stroke between seven months and 17 years before the study. Participants underwent three 30-minute, moderate-intensity arm cycling training sessions each week for five weeks. Bilateral soleus stretch reflexes were elicited at rest and during 1-Hz arm cycling. Investigators measured physical abilities before and after arm training using several standardized scales and tests of physical function. Performance significantly improved on all walking tests and improved as much as 28% on the Timed Up and Go test. Several subjects had less tightness in their muscles after completing the arm cycling trial.

Kaupp C, Pearcey GE, Klarner T, et al. Rhythmic arm cycling training improves walking and neurophysiological integrity in chronic stroke-the arms can give legs a helping hand in rehabilitation. J Neurophysiol. 2017 Dec 6 [Epub ahead of print].

CSF May Indicate Parkinson’s Disease Phenotype

Lower CSF alpha-synuclein level is associated with diagnosis and motor phenotype in moderate and advanced Parkinson’s disease, according to a study published in the February issue of Movement Disorders. Researchers analyzed data from BioFIND, a cross-sectional, observational study that examines clinical and biomarker characteristics in moderate and advanced Parkinson’s disease and matched healthy controls. Investigators compared alpha-synuclein concentrations across diagnosis, biofluids, and CSF biomarkers. Correlations of CSF biomarkers and Movement Disorders Society Unified Parkinson’s Disease Rating Scale, motor phenotype, Montreal Cognitive Assessment, and REM sleep behavior disorder questionnaire scores in Parkinson’s disease were examined. CSF alpha-synuclein level was lower in Parkinson’s disease versus controls. Plasma and saliva alpha-synuclein levels did not differ between Parkinson’s disease and controls, and alpha-synuclein did not significantly correlate among biofluids.

Goldman JG, Andrews H, Amara A, et al. Cerebrospinal fluid, plasma, and saliva in the BioFIND study: relationships among biomarkers and Parkinson’s disease features. Mov Disord. 2018;33(2):282-288.

Social Interaction May Improve Quality of Life in Dementia

Increasing the amount of social interaction for people with dementia living in care homes to one hour a week improves quality of life when combined with personalized care, according to a study published February 6 in PLoS Med. In all, 847 people with dementia in 69 care homes were included in this study, which compared a psychosocial intervention plus antipsychotic treatment review with standard treatment using an intention-to-treat analysis. The primary outcome was quality of life. Staff were trained in person-centered care, social interaction, and education in antipsychotic medications. A total of 553 participants completed the nine-month randomized controlled trial. The intervention significantly improved quality of life, agitation, and overall neuropsychiatric symptoms. Benefits were greatest in people with moderately severe dementia.

Ballard C, Corbett A, Orrell M, et al. Impact of person-centred care training and person-centred activities on quality of life, agitation, and antipsychotic use in people with dementia living in nursing homes: a cluster-randomised controlled trial. PLoS Med. 2018 Feb 6;15(2):e1002500.

Adjunctive Cetirizine Reduces Relapses in Neuromyelitis Optica

In patients with neuromyelitis optica, adding cetirizine to standard therapy is safe and well tolerated and may reduce relapses, according to a study published online ahead of print February 2 in Neurology Neuroimmunology & Neuroinflammation. This pilot, open-label, add-on trial of cetirizine followed 16 patients with neuromyelitis optica taking 10 mg/day of oral cetirizine for one year in addition to their usual treatment. The primary end point was the annualized relapse rate while on the same disease-modifying therapy before starting cetirizine, compared with that while taking cetirizine. Participants were monitored for new neurologic episodes and potential adverse events related to the study drug. Annualized relapse rate was 0.4 before cetirizine treatment and 0.1 afterward. Cetirizine did not affect participants’ Expanded Disability Status Scale scores.

Katz Sand I, Fabian MT, Telford R, et al. Open-label, add-on trial of cetirizine for neuromyelitis optica. Neurol Neuroimmunol Neuroinflamm. 2018 Feb 2 [Epub ahead of print].

Stroke Risk Factors Specific to Women Identified

Investigators have identified stroke risk factors specific to women, according to a study published online ahead of print February 8 in Stroke. A literature review found risk factors in the three main categories of endogenous hormones, exogenous hormones, and pregnancy-related exposures. These factors include early age of menarche, early age at menopause, low levels of dehydroepiandrosterone, and taking oral estrogen or combined oral contraceptives. The risk factors are common, and not all women who have one or more of them will have a stroke. Clinicians should consider history of pregnancy complications, including gestational diabetes, pre-eclampsia, or hypertension during or immediately following pregnancy, when evaluating a patient for stroke risk, said the investigators. These women should be monitored carefully and told that they are at higher risk, they added.

Demel SL, Kittner S, Ley SH, et al. Stroke risk factors unique to women. Stroke. 2018 Feb 8 [Epub ahead of print].

FDA Clears Embrace for Monitoring Seizure Activity

The FDA has cleared the Embrace smart watch for detecting generalized tonic-clonic seizures. The device uses advanced machine learning and measures multiple indicators, including electrodermal activity. It also sends alerts to summon caregivers when it detects seizures. In a multisite clinical study, 135 patients with epilepsy were admitted to epilepsy monitoring units for continuous monitoring with video-EEG while they wore the device. A total of 6,530 hours of data were recorded over 272 days, including data for 40 generalized tonic-clonic seizures. The device’s algorithm detected 100% of the seizures. The trial used the gold standard of defining seizures as those clinically labelled by at least two out of three independent epileptologists, who examined the video-EEG data without seeing any data used by Embrace. The Embrace watch was approved in Europe in April 2017 as a medical device for seizure monitoring and alert. Empatica, which markets the watch, is located in Cambridge, Massachusetts.

FDA Approves Glatopa for Relapsing Forms of MS

The FDA has approved Glatopa (glatiramer acetate injection) 40 mg/mL, as a thrice-weekly generic treatment option for relapsing forms of multiple sclerosis (MS). Doses should be administered at 48-hour intervals. The treatment is intended to be fully substitutable for Copaxone. A 20-mg/mL formulation of the drug has been available since June 2015. Glatopa is contraindicated in patients with known hypersensitivity to glatiramer acetate or mannitol. The most common adverse reactions with glatiramer acetate injection 40 mg/mL versus placebo are injection-site reactions such as erythema (22% vs 2%). The most common side effects of glatiramer acetate injection 20 mg/mL versus placebo are erythema, vasodilatation, rash, dyspnea, and chest pain. Sandoz, which markets Glatopa, is headquartered in Holzkirchen, Germany.

—Kimberly Williams

The Food and Drug Administration approved a new blood test on Feb. 14 – the Banyan Brain Trauma Indicator – for assessing patients with mild traumatic brain injuries, also known as concussions.

Most traumatic brain injuries are classified as “mild,” and the majority of patients have negative CT scans, according to an FDA announcement. Within a matter of hours, this test can help predict which patients will have negative scans by measuring certain proteins released by brain tissue, thereby potentially eliminating unnecessary imaging – and the costs and radiation exposure that would go along with it.

[email protected]

The Food and Drug Administration approved a new blood test on Feb. 14 – the Banyan Brain Trauma Indicator – for assessing patients with mild traumatic brain injuries, also known as concussions.

Most traumatic brain injuries are classified as “mild,” and the majority of patients have negative CT scans, according to an FDA announcement. Within a matter of hours, this test can help predict which patients will have negative scans by measuring certain proteins released by brain tissue, thereby potentially eliminating unnecessary imaging – and the costs and radiation exposure that would go along with it.

[email protected]

The Food and Drug Administration approved a new blood test on Feb. 14 – the Banyan Brain Trauma Indicator – for assessing patients with mild traumatic brain injuries, also known as concussions.

Most traumatic brain injuries are classified as “mild,” and the majority of patients have negative CT scans, according to an FDA announcement. Within a matter of hours, this test can help predict which patients will have negative scans by measuring certain proteins released by brain tissue, thereby potentially eliminating unnecessary imaging – and the costs and radiation exposure that would go along with it.

[email protected]

Device May Predict Seizure Risk

The NeuroPace RNS System may enable clinicians to identify when patients are at highest risk for seizures, thus allowing patients to plan around these events, according to a study published January 8 in Nature Communications. In 37 subjects with the implanted brain stimulation device, which detected interictal epileptiform activity (IEA) and seizures over years, researchers found that IEA oscillates with circadian and subject-specific multiday periods. Multiday periodicities, most commonly 20–30 days in duration, are robust and relatively stable for as long as 10 years in men and women. Investigators also found that seizures occur preferentially during the rising phase of multiday IEA rhythms. Combining phase information from circadian and multiday IEA rhythms could be a biomarker for determining relative seizure risk with a large effect size in most subjects.

Baud MO, Kleen JK, Mirro EA, et al. Multi-day rhythms modulate seizure risk in epilepsy. Nat Commun. 2018;9(1):88.

DBS May Improve Survival in Parkinson’s Disease

Deep brain stimulation (DBS) is associated with a modest survival advantage when compared with medical management alone, according to a study published in the December 2017 issue of Movement Disorders. Investigators conducted a retrospective analysis of Veterans Affairs and Medicare administrative data of veterans with Parkinson’s disease between 2007 and 2013. They used propensity-score matching to pair patients who received DBS with those who received medical management alone. Veterans with Parkinson’s disease who received DBS had a longer survival measured in days than veterans who did not undergo DBS (2,291 days vs 2,064 days). Mean age at death was similar for both groups (76.5 vs 75.9), and the most common cause of death was Parkinson’s disease. The study groups may have differed in ways that are not measured.

Weaver FM, Stroupe KT, Smith B, et al. Survival in patients with Parkinson’s disease after deep brain stimulation or medical management. Mov Disord. 2017;32(12):1756-1763.

Idalopirdine May Not Decrease Cognitive Loss in Alzheimer’s Disease

In patients with mild to moderate Alzheimer’s disease, the use of idalopirdine, compared with placebo, does not improve cognition over 24 weeks of treatment, according to a study published January 9 in JAMA. The study examined three randomized clinical trials with 2,525 patients age 50 or older with mild to moderate Alzheimer’s disease. The 24-week studies were conducted from October 2013 to January 2017. Six months of 10 mg/day, 30 mg/day, or 60 mg/day idalopirdine treatment added to cholinesterase inhibitor therapy did not improve cognition or decrease cognitive loss. There was no requirement for evidence of Alzheimer’s disease biomarker positivity for inclusion in the trials, however, which may have allowed some patients to be included without having Alzheimer’s disease pathology.

Atri A, Frölich L, Ballard C, et al. Effect of idalopirdine as adjunct to cholinesterase inhibitors on change in cognition in patients with Alzheimer disease: three randomized clinical trials. JAMA. 2018;319(2):130-142.

New Biomarker May Identify Huntington’s Disease

A potential biomarker for Huntington’s disease could mean a more effective way of evaluating treatments for this neurologic disease, according to a study published online ahead of print December 27, 2017, in Neurology. Researchers studied miRNA levels in CSF from 30 asymptomatic carriers of the mutation that causes Huntington’s disease. They also studied CSF from participants diagnosed with Huntington’s disease, and from healthy controls. In all, 2,081 miRNAs were detected, and six were significantly increased in asymptomatic carriers versus controls. When the researchers evaluated the miRNA levels in each of the three patient groups, they found that all six had a pattern of increasing abundance from control to low risk, and from low risk to medium risk. The miRNA levels increase years before symptoms arise.

Reed ER, Latourelle JC, Bockholt JH, et al. MicroRNAs in CSF as prodromal biomarkers for Huntington disease in the PREDICT-HD study. Neurology. 2017 Dec 27 [Epub ahead of print].

Higher Topiramate Dose May Increase Risk of Cleft Lip or Palate

Topiramate increases the risk of cleft lip or cleft palate in offspring in a dose-dependent manner, according to a study published online ahead of print December 27, 2017, in Neurology. Researchers examined Medicaid data and identified approximately 1.4 million women who gave birth to live babies over 10 years. They compared women who filled a prescription for topiramate during their first trimester with women who did not fill a prescription for any antiseizure drug and women who filled a prescription for lamotrigine. The risk of oral clefts at birth was 4.1 per 1,000 in infants born to women exposed to topiramate, compared with 1.1 per 1,000 in the group unexposed to antiseizure drugs, and 1.5 per 1,000 among women exposed to lamotrigine.

Hernandez-Diaz S, Huybrechts KF, Desai RJ, et al. Topiramate use early in pregnancy and the risk of oral clefts: A pregnancy cohort study. Neurology. 2017 Dec 27 [Epub ahead of print].

Genetic Factors That Contribute to Alzheimer’s Disease Identified

Researchers have identified several new genes responsible for Alzheimer’s disease, including genes leading to functional and structural changes in the brain and elevated levels of Alzheimer’s disease proteins in CSF, according to a study published online ahead of print December 20, 2017, in Alzheimer’s & Dementia. Researchers tested the association between Alzheimer’s disease-related brain MRI measures, logical memory test scores, and CSF levels of amyloid beta and tau with millions of single-nucleotide polymorphisms (SNPs) in 1,189 participants in the Alzheimer Disease Neuroimaging Initiative study. Among people with normal cognitive functioning, SRRM4 was associated with total tau, and MTUS1 was associated with hippocampal volume. In participants with mild cognitive impairment, SNPs near ZNF804B were associated with logical memory test of delayed recall scores.

Chung J, Wang X, Maruyama T, et al. Genome-wide association study of Alzheimer’s disease endophenotypes at prediagnosis stages. Alzheimers Dement. 2017 Dec 20 [Epub ahead of print].

Fish Consumption May Improve Intelligence and Sleep

Children who eat fish at least once per week sleep better and have higher IQ scores than children who consume fish less frequently or not at all, according to a study published December 21, 2017, in Scientific Reports. The study included a cohort of 541 children (54% boys) between ages 9 and 11. The children took an IQ test and completed a questionnaire about fish consumption in the previous month. Options ranged from “never” to “at least once per week.” Their parents also answered the standardized Children Sleep Habits Questionnaire. Children who reported eating fish weekly scored 4.8 points higher on the IQ exams than those who said they “seldom” or “never” consumed fish. In addition, increased fish consumption was associated with fewer sleep disturbances.

Liu J, Cui Y, Li L, et al. The mediating role of sleep in the fish consumption - cognitive functioning relationship: a cohort study. Sci Rep. 2017;7(1):17961.

Rating Scales Predict Discharge Destination in Stroke

Outcome measure scores strongly predict discharge destination among patients with stroke and provide an objective means of early discharge planning, according to a study published in the January issue of the Journal of Neurologic Physical Therapy. A systematic review indicated that for every one-point increase on the Functional Independence Measure, a patient was approximately 1.08 times more likely to be discharged home than to institutionalized care. Patients with stroke who performed above average were 12 times more likely to be discharged home. Patients who performed poorly were 3.4 times more likely to be discharged to institutionalized care than home, and skilled nursing facility admission was more likely than admission to an inpatient rehabilitation facility. Patients with average performance were 1.9 times more likely to be discharged to institutionalized care.

Thorpe ER, Garrett KB, Smith AM, et al. Outcome measure scores predict discharge destination in patients with acute and subacute stroke: a systematic review and series of meta-analyses. J Neurol Phys Ther. 2018;42(1):2-11.

Do Green Leafy Vegetables Slow Brain Aging?

Eating about one serving per day of green, leafy vegetables may be linked to a slower rate of brain aging, according to a study published online ahead of print December 20, 2017, in Neurology. Researchers followed 960 cognitively normal people with an average age of 81 for an average of 4.7 years. In a linear mixed model adjusted for age, sex, education, cognitive activities, physical activities, smoking, and seafood and alcohol consumption, consumption of green, leafy vegetables was associated with slower cognitive decline. Participants in the highest quintile of vegetable intake were the equivalent of 11 years younger, compared with people who never ate vegetables. Higher intake of phylloquinone, lutein, nitrate, folate, kaempferol, and alpha-tocopherol were associated with slower cognitive decline.

Morris MC, Wang Y, Barnes LL, et al. Nutrients and bioactives in green leafy vegetables and cognitive decline: prospective study. Neurology. 2017 Dec 20 [Epub ahead of print].

Data Clarify the Genetic Profile of Dementia With Lewy Bodies

Research has increased understanding of the unique genetic profile of dementia with Lewy bodies. In a study published January 17 in Lancet Neurology, researchers genotyped 1,743 patients with dementia with Lewy bodies and 4,454 controls. APOE and GBA had the same associations with dementia with Lewy bodies as they do with Alzheimer’s disease and Parkinson’s disease, respectively. SNCA, which is associated with Parkinson’s disease, also was associated with dementia with Lewy bodies, but through a different part of the gene. Evidence suggested that CNTN1 is associated with dementia with Lewy bodies, but the result was not statistically significant. The authors estimated that the heritable component of the disorder is approximately 36%. Common genetic variability has a role in the disease, said the authors.

Guerreiro R, Ross OA, Kun-Rodrigues C, et al. Investigating the genetic architecture of dementia with Lewy bodies: a two-stage genome-wide association study. Lancet Neurol. 2018;17(1):64-74.

Preterm Newborns Have Altered Cerebral Perfusion

Altered regional cortical blood flow (CBF) in infants born very preterm at term-equivalent age may reflect early brain dysmaturation despite the absence of cerebral cortical injury, according to a study published online ahead of print November 30, 2017 in the Journal of Pediatrics. In this prospective, cross-sectional study, researchers used noninvasive 3T arterial spin labeling MRI to quantify regional CBF in the cerebral cortex of 202 infants, 98 of whom were born preterm. Analyses were performed controlling for sex, gestational age, and age at MRI. Infants born preterm had greater global CBF and greater absolute regional CBF in all brain regions except the insula. Relative CBF in the insula, anterior cingulate cortex, and auditory cortex were decreased significantly in infants born preterm, compared with infants born at full term.

Bouyssi-Kobar M, Murnick J, Brossard-Racine M, et al. Altered cerebral perfusion in infants born preterm compared with infants born full term. J Pediatr. 2017 Nov 30 [Epub ahead of print].

—Kimberly Williams

Device May Predict Seizure Risk

The NeuroPace RNS System may enable clinicians to identify when patients are at highest risk for seizures, thus allowing patients to plan around these events, according to a study published January 8 in Nature Communications. In 37 subjects with the implanted brain stimulation device, which detected interictal epileptiform activity (IEA) and seizures over years, researchers found that IEA oscillates with circadian and subject-specific multiday periods. Multiday periodicities, most commonly 20–30 days in duration, are robust and relatively stable for as long as 10 years in men and women. Investigators also found that seizures occur preferentially during the rising phase of multiday IEA rhythms. Combining phase information from circadian and multiday IEA rhythms could be a biomarker for determining relative seizure risk with a large effect size in most subjects.

Baud MO, Kleen JK, Mirro EA, et al. Multi-day rhythms modulate seizure risk in epilepsy. Nat Commun. 2018;9(1):88.

DBS May Improve Survival in Parkinson’s Disease

Deep brain stimulation (DBS) is associated with a modest survival advantage when compared with medical management alone, according to a study published in the December 2017 issue of Movement Disorders. Investigators conducted a retrospective analysis of Veterans Affairs and Medicare administrative data of veterans with Parkinson’s disease between 2007 and 2013. They used propensity-score matching to pair patients who received DBS with those who received medical management alone. Veterans with Parkinson’s disease who received DBS had a longer survival measured in days than veterans who did not undergo DBS (2,291 days vs 2,064 days). Mean age at death was similar for both groups (76.5 vs 75.9), and the most common cause of death was Parkinson’s disease. The study groups may have differed in ways that are not measured.

Weaver FM, Stroupe KT, Smith B, et al. Survival in patients with Parkinson’s disease after deep brain stimulation or medical management. Mov Disord. 2017;32(12):1756-1763.

Idalopirdine May Not Decrease Cognitive Loss in Alzheimer’s Disease

In patients with mild to moderate Alzheimer’s disease, the use of idalopirdine, compared with placebo, does not improve cognition over 24 weeks of treatment, according to a study published January 9 in JAMA. The study examined three randomized clinical trials with 2,525 patients age 50 or older with mild to moderate Alzheimer’s disease. The 24-week studies were conducted from October 2013 to January 2017. Six months of 10 mg/day, 30 mg/day, or 60 mg/day idalopirdine treatment added to cholinesterase inhibitor therapy did not improve cognition or decrease cognitive loss. There was no requirement for evidence of Alzheimer’s disease biomarker positivity for inclusion in the trials, however, which may have allowed some patients to be included without having Alzheimer’s disease pathology.

Atri A, Frölich L, Ballard C, et al. Effect of idalopirdine as adjunct to cholinesterase inhibitors on change in cognition in patients with Alzheimer disease: three randomized clinical trials. JAMA. 2018;319(2):130-142.

New Biomarker May Identify Huntington’s Disease

A potential biomarker for Huntington’s disease could mean a more effective way of evaluating treatments for this neurologic disease, according to a study published online ahead of print December 27, 2017, in Neurology. Researchers studied miRNA levels in CSF from 30 asymptomatic carriers of the mutation that causes Huntington’s disease. They also studied CSF from participants diagnosed with Huntington’s disease, and from healthy controls. In all, 2,081 miRNAs were detected, and six were significantly increased in asymptomatic carriers versus controls. When the researchers evaluated the miRNA levels in each of the three patient groups, they found that all six had a pattern of increasing abundance from control to low risk, and from low risk to medium risk. The miRNA levels increase years before symptoms arise.

Reed ER, Latourelle JC, Bockholt JH, et al. MicroRNAs in CSF as prodromal biomarkers for Huntington disease in the PREDICT-HD study. Neurology. 2017 Dec 27 [Epub ahead of print].

Higher Topiramate Dose May Increase Risk of Cleft Lip or Palate

Topiramate increases the risk of cleft lip or cleft palate in offspring in a dose-dependent manner, according to a study published online ahead of print December 27, 2017, in Neurology. Researchers examined Medicaid data and identified approximately 1.4 million women who gave birth to live babies over 10 years. They compared women who filled a prescription for topiramate during their first trimester with women who did not fill a prescription for any antiseizure drug and women who filled a prescription for lamotrigine. The risk of oral clefts at birth was 4.1 per 1,000 in infants born to women exposed to topiramate, compared with 1.1 per 1,000 in the group unexposed to antiseizure drugs, and 1.5 per 1,000 among women exposed to lamotrigine.

Hernandez-Diaz S, Huybrechts KF, Desai RJ, et al. Topiramate use early in pregnancy and the risk of oral clefts: A pregnancy cohort study. Neurology. 2017 Dec 27 [Epub ahead of print].

Genetic Factors That Contribute to Alzheimer’s Disease Identified

Researchers have identified several new genes responsible for Alzheimer’s disease, including genes leading to functional and structural changes in the brain and elevated levels of Alzheimer’s disease proteins in CSF, according to a study published online ahead of print December 20, 2017, in Alzheimer’s & Dementia. Researchers tested the association between Alzheimer’s disease-related brain MRI measures, logical memory test scores, and CSF levels of amyloid beta and tau with millions of single-nucleotide polymorphisms (SNPs) in 1,189 participants in the Alzheimer Disease Neuroimaging Initiative study. Among people with normal cognitive functioning, SRRM4 was associated with total tau, and MTUS1 was associated with hippocampal volume. In participants with mild cognitive impairment, SNPs near ZNF804B were associated with logical memory test of delayed recall scores.

Chung J, Wang X, Maruyama T, et al. Genome-wide association study of Alzheimer’s disease endophenotypes at prediagnosis stages. Alzheimers Dement. 2017 Dec 20 [Epub ahead of print].

Fish Consumption May Improve Intelligence and Sleep

Children who eat fish at least once per week sleep better and have higher IQ scores than children who consume fish less frequently or not at all, according to a study published December 21, 2017, in Scientific Reports. The study included a cohort of 541 children (54% boys) between ages 9 and 11. The children took an IQ test and completed a questionnaire about fish consumption in the previous month. Options ranged from “never” to “at least once per week.” Their parents also answered the standardized Children Sleep Habits Questionnaire. Children who reported eating fish weekly scored 4.8 points higher on the IQ exams than those who said they “seldom” or “never” consumed fish. In addition, increased fish consumption was associated with fewer sleep disturbances.

Liu J, Cui Y, Li L, et al. The mediating role of sleep in the fish consumption - cognitive functioning relationship: a cohort study. Sci Rep. 2017;7(1):17961.

Rating Scales Predict Discharge Destination in Stroke

Outcome measure scores strongly predict discharge destination among patients with stroke and provide an objective means of early discharge planning, according to a study published in the January issue of the Journal of Neurologic Physical Therapy. A systematic review indicated that for every one-point increase on the Functional Independence Measure, a patient was approximately 1.08 times more likely to be discharged home than to institutionalized care. Patients with stroke who performed above average were 12 times more likely to be discharged home. Patients who performed poorly were 3.4 times more likely to be discharged to institutionalized care than home, and skilled nursing facility admission was more likely than admission to an inpatient rehabilitation facility. Patients with average performance were 1.9 times more likely to be discharged to institutionalized care.

Thorpe ER, Garrett KB, Smith AM, et al. Outcome measure scores predict discharge destination in patients with acute and subacute stroke: a systematic review and series of meta-analyses. J Neurol Phys Ther. 2018;42(1):2-11.

Do Green Leafy Vegetables Slow Brain Aging?

Eating about one serving per day of green, leafy vegetables may be linked to a slower rate of brain aging, according to a study published online ahead of print December 20, 2017, in Neurology. Researchers followed 960 cognitively normal people with an average age of 81 for an average of 4.7 years. In a linear mixed model adjusted for age, sex, education, cognitive activities, physical activities, smoking, and seafood and alcohol consumption, consumption of green, leafy vegetables was associated with slower cognitive decline. Participants in the highest quintile of vegetable intake were the equivalent of 11 years younger, compared with people who never ate vegetables. Higher intake of phylloquinone, lutein, nitrate, folate, kaempferol, and alpha-tocopherol were associated with slower cognitive decline.

Morris MC, Wang Y, Barnes LL, et al. Nutrients and bioactives in green leafy vegetables and cognitive decline: prospective study. Neurology. 2017 Dec 20 [Epub ahead of print].

Data Clarify the Genetic Profile of Dementia With Lewy Bodies

Research has increased understanding of the unique genetic profile of dementia with Lewy bodies. In a study published January 17 in Lancet Neurology, researchers genotyped 1,743 patients with dementia with Lewy bodies and 4,454 controls. APOE and GBA had the same associations with dementia with Lewy bodies as they do with Alzheimer’s disease and Parkinson’s disease, respectively. SNCA, which is associated with Parkinson’s disease, also was associated with dementia with Lewy bodies, but through a different part of the gene. Evidence suggested that CNTN1 is associated with dementia with Lewy bodies, but the result was not statistically significant. The authors estimated that the heritable component of the disorder is approximately 36%. Common genetic variability has a role in the disease, said the authors.

Guerreiro R, Ross OA, Kun-Rodrigues C, et al. Investigating the genetic architecture of dementia with Lewy bodies: a two-stage genome-wide association study. Lancet Neurol. 2018;17(1):64-74.

Preterm Newborns Have Altered Cerebral Perfusion

Altered regional cortical blood flow (CBF) in infants born very preterm at term-equivalent age may reflect early brain dysmaturation despite the absence of cerebral cortical injury, according to a study published online ahead of print November 30, 2017 in the Journal of Pediatrics. In this prospective, cross-sectional study, researchers used noninvasive 3T arterial spin labeling MRI to quantify regional CBF in the cerebral cortex of 202 infants, 98 of whom were born preterm. Analyses were performed controlling for sex, gestational age, and age at MRI. Infants born preterm had greater global CBF and greater absolute regional CBF in all brain regions except the insula. Relative CBF in the insula, anterior cingulate cortex, and auditory cortex were decreased significantly in infants born preterm, compared with infants born at full term.

Bouyssi-Kobar M, Murnick J, Brossard-Racine M, et al. Altered cerebral perfusion in infants born preterm compared with infants born full term. J Pediatr. 2017 Nov 30 [Epub ahead of print].

—Kimberly Williams

Device May Predict Seizure Risk

The NeuroPace RNS System may enable clinicians to identify when patients are at highest risk for seizures, thus allowing patients to plan around these events, according to a study published January 8 in Nature Communications. In 37 subjects with the implanted brain stimulation device, which detected interictal epileptiform activity (IEA) and seizures over years, researchers found that IEA oscillates with circadian and subject-specific multiday periods. Multiday periodicities, most commonly 20–30 days in duration, are robust and relatively stable for as long as 10 years in men and women. Investigators also found that seizures occur preferentially during the rising phase of multiday IEA rhythms. Combining phase information from circadian and multiday IEA rhythms could be a biomarker for determining relative seizure risk with a large effect size in most subjects.

Baud MO, Kleen JK, Mirro EA, et al. Multi-day rhythms modulate seizure risk in epilepsy. Nat Commun. 2018;9(1):88.

DBS May Improve Survival in Parkinson’s Disease

Deep brain stimulation (DBS) is associated with a modest survival advantage when compared with medical management alone, according to a study published in the December 2017 issue of Movement Disorders. Investigators conducted a retrospective analysis of Veterans Affairs and Medicare administrative data of veterans with Parkinson’s disease between 2007 and 2013. They used propensity-score matching to pair patients who received DBS with those who received medical management alone. Veterans with Parkinson’s disease who received DBS had a longer survival measured in days than veterans who did not undergo DBS (2,291 days vs 2,064 days). Mean age at death was similar for both groups (76.5 vs 75.9), and the most common cause of death was Parkinson’s disease. The study groups may have differed in ways that are not measured.

Weaver FM, Stroupe KT, Smith B, et al. Survival in patients with Parkinson’s disease after deep brain stimulation or medical management. Mov Disord. 2017;32(12):1756-1763.

Idalopirdine May Not Decrease Cognitive Loss in Alzheimer’s Disease

In patients with mild to moderate Alzheimer’s disease, the use of idalopirdine, compared with placebo, does not improve cognition over 24 weeks of treatment, according to a study published January 9 in JAMA. The study examined three randomized clinical trials with 2,525 patients age 50 or older with mild to moderate Alzheimer’s disease. The 24-week studies were conducted from October 2013 to January 2017. Six months of 10 mg/day, 30 mg/day, or 60 mg/day idalopirdine treatment added to cholinesterase inhibitor therapy did not improve cognition or decrease cognitive loss. There was no requirement for evidence of Alzheimer’s disease biomarker positivity for inclusion in the trials, however, which may have allowed some patients to be included without having Alzheimer’s disease pathology.

Atri A, Frölich L, Ballard C, et al. Effect of idalopirdine as adjunct to cholinesterase inhibitors on change in cognition in patients with Alzheimer disease: three randomized clinical trials. JAMA. 2018;319(2):130-142.

New Biomarker May Identify Huntington’s Disease

A potential biomarker for Huntington’s disease could mean a more effective way of evaluating treatments for this neurologic disease, according to a study published online ahead of print December 27, 2017, in Neurology. Researchers studied miRNA levels in CSF from 30 asymptomatic carriers of the mutation that causes Huntington’s disease. They also studied CSF from participants diagnosed with Huntington’s disease, and from healthy controls. In all, 2,081 miRNAs were detected, and six were significantly increased in asymptomatic carriers versus controls. When the researchers evaluated the miRNA levels in each of the three patient groups, they found that all six had a pattern of increasing abundance from control to low risk, and from low risk to medium risk. The miRNA levels increase years before symptoms arise.

Reed ER, Latourelle JC, Bockholt JH, et al. MicroRNAs in CSF as prodromal biomarkers for Huntington disease in the PREDICT-HD study. Neurology. 2017 Dec 27 [Epub ahead of print].

Higher Topiramate Dose May Increase Risk of Cleft Lip or Palate

Topiramate increases the risk of cleft lip or cleft palate in offspring in a dose-dependent manner, according to a study published online ahead of print December 27, 2017, in Neurology. Researchers examined Medicaid data and identified approximately 1.4 million women who gave birth to live babies over 10 years. They compared women who filled a prescription for topiramate during their first trimester with women who did not fill a prescription for any antiseizure drug and women who filled a prescription for lamotrigine. The risk of oral clefts at birth was 4.1 per 1,000 in infants born to women exposed to topiramate, compared with 1.1 per 1,000 in the group unexposed to antiseizure drugs, and 1.5 per 1,000 among women exposed to lamotrigine.

Hernandez-Diaz S, Huybrechts KF, Desai RJ, et al. Topiramate use early in pregnancy and the risk of oral clefts: A pregnancy cohort study. Neurology. 2017 Dec 27 [Epub ahead of print].

Genetic Factors That Contribute to Alzheimer’s Disease Identified

Researchers have identified several new genes responsible for Alzheimer’s disease, including genes leading to functional and structural changes in the brain and elevated levels of Alzheimer’s disease proteins in CSF, according to a study published online ahead of print December 20, 2017, in Alzheimer’s & Dementia. Researchers tested the association between Alzheimer’s disease-related brain MRI measures, logical memory test scores, and CSF levels of amyloid beta and tau with millions of single-nucleotide polymorphisms (SNPs) in 1,189 participants in the Alzheimer Disease Neuroimaging Initiative study. Among people with normal cognitive functioning, SRRM4 was associated with total tau, and MTUS1 was associated with hippocampal volume. In participants with mild cognitive impairment, SNPs near ZNF804B were associated with logical memory test of delayed recall scores.

Chung J, Wang X, Maruyama T, et al. Genome-wide association study of Alzheimer’s disease endophenotypes at prediagnosis stages. Alzheimers Dement. 2017 Dec 20 [Epub ahead of print].

Fish Consumption May Improve Intelligence and Sleep

Children who eat fish at least once per week sleep better and have higher IQ scores than children who consume fish less frequently or not at all, according to a study published December 21, 2017, in Scientific Reports. The study included a cohort of 541 children (54% boys) between ages 9 and 11. The children took an IQ test and completed a questionnaire about fish consumption in the previous month. Options ranged from “never” to “at least once per week.” Their parents also answered the standardized Children Sleep Habits Questionnaire. Children who reported eating fish weekly scored 4.8 points higher on the IQ exams than those who said they “seldom” or “never” consumed fish. In addition, increased fish consumption was associated with fewer sleep disturbances.

Liu J, Cui Y, Li L, et al. The mediating role of sleep in the fish consumption - cognitive functioning relationship: a cohort study. Sci Rep. 2017;7(1):17961.

Rating Scales Predict Discharge Destination in Stroke

Outcome measure scores strongly predict discharge destination among patients with stroke and provide an objective means of early discharge planning, according to a study published in the January issue of the Journal of Neurologic Physical Therapy. A systematic review indicated that for every one-point increase on the Functional Independence Measure, a patient was approximately 1.08 times more likely to be discharged home than to institutionalized care. Patients with stroke who performed above average were 12 times more likely to be discharged home. Patients who performed poorly were 3.4 times more likely to be discharged to institutionalized care than home, and skilled nursing facility admission was more likely than admission to an inpatient rehabilitation facility. Patients with average performance were 1.9 times more likely to be discharged to institutionalized care.

Thorpe ER, Garrett KB, Smith AM, et al. Outcome measure scores predict discharge destination in patients with acute and subacute stroke: a systematic review and series of meta-analyses. J Neurol Phys Ther. 2018;42(1):2-11.

Do Green Leafy Vegetables Slow Brain Aging?

Eating about one serving per day of green, leafy vegetables may be linked to a slower rate of brain aging, according to a study published online ahead of print December 20, 2017, in Neurology. Researchers followed 960 cognitively normal people with an average age of 81 for an average of 4.7 years. In a linear mixed model adjusted for age, sex, education, cognitive activities, physical activities, smoking, and seafood and alcohol consumption, consumption of green, leafy vegetables was associated with slower cognitive decline. Participants in the highest quintile of vegetable intake were the equivalent of 11 years younger, compared with people who never ate vegetables. Higher intake of phylloquinone, lutein, nitrate, folate, kaempferol, and alpha-tocopherol were associated with slower cognitive decline.

Morris MC, Wang Y, Barnes LL, et al. Nutrients and bioactives in green leafy vegetables and cognitive decline: prospective study. Neurology. 2017 Dec 20 [Epub ahead of print].

Data Clarify the Genetic Profile of Dementia With Lewy Bodies

Research has increased understanding of the unique genetic profile of dementia with Lewy bodies. In a study published January 17 in Lancet Neurology, researchers genotyped 1,743 patients with dementia with Lewy bodies and 4,454 controls. APOE and GBA had the same associations with dementia with Lewy bodies as they do with Alzheimer’s disease and Parkinson’s disease, respectively. SNCA, which is associated with Parkinson’s disease, also was associated with dementia with Lewy bodies, but through a different part of the gene. Evidence suggested that CNTN1 is associated with dementia with Lewy bodies, but the result was not statistically significant. The authors estimated that the heritable component of the disorder is approximately 36%. Common genetic variability has a role in the disease, said the authors.

Guerreiro R, Ross OA, Kun-Rodrigues C, et al. Investigating the genetic architecture of dementia with Lewy bodies: a two-stage genome-wide association study. Lancet Neurol. 2018;17(1):64-74.

Preterm Newborns Have Altered Cerebral Perfusion

Altered regional cortical blood flow (CBF) in infants born very preterm at term-equivalent age may reflect early brain dysmaturation despite the absence of cerebral cortical injury, according to a study published online ahead of print November 30, 2017 in the Journal of Pediatrics. In this prospective, cross-sectional study, researchers used noninvasive 3T arterial spin labeling MRI to quantify regional CBF in the cerebral cortex of 202 infants, 98 of whom were born preterm. Analyses were performed controlling for sex, gestational age, and age at MRI. Infants born preterm had greater global CBF and greater absolute regional CBF in all brain regions except the insula. Relative CBF in the insula, anterior cingulate cortex, and auditory cortex were decreased significantly in infants born preterm, compared with infants born at full term.

Bouyssi-Kobar M, Murnick J, Brossard-Racine M, et al. Altered cerebral perfusion in infants born preterm compared with infants born full term. J Pediatr. 2017 Nov 30 [Epub ahead of print].

—Kimberly Williams

Patients with spastic arm paralysis who received a contralateral C7 nerve graft from their nonparalyzed side to their paralyzed side led to greater improvement in arm function and reduction in spasticity after a year, compared with rehabilitation alone, investigators from Huashan Hospital in China reported online Jan. 3 in the New England Journal of Medicine.

The researchers randomly assigned 36 patients who had unilateral arm paralysis for at least 5 years to either surgical C7 nerve transfer plus rehabilitation or rehabilitation only. Results of the trial’s primary outcome – arm function using the Fugl-Meyer score – showed that those in the surgery group had an average increase of 17.7, while those in the rehabilitation-only group had an average increase of 2.6 (P less than .001). This 15.1-point difference had a 95% confidence interval ranging from 12.2 to 17.9.

To evaluate spasticity, the researchers used the Modified Ashworth Scale, which is a 0-5 scale to score spasticity; a higher score means more spasticity. Surgery patients saw improvement from baseline in all five areas measured across the board, and none saw worsening in scores. The smallest difference between the two groups was in thumb extension, with 15 surgery patients having a 1- and 2-unit improvement and 3 having no change, while 7 controls showed a 1- or 2-unit improvement, another 7 showed no improvement, and 4 had a 1-unit worsening in score (P less than .001). At 1 year, 16 (89%) of surgery patients could accomplish three or more of the functional tasks researchers gave them, whereas none of the controls could.

“The majority of clinical improvements coincided with physiological evidence of connectivity between the hemisphere on the side of the donor nerve and the paralyzed arm,” said lead author Mou-Xiong Zheng, MD, PhD, of the department of hand surgery at Huashan Hospital at Fudan University in Shanghai, and colleagues.

The research by Dr. Zheng and coauthors arises from what is known about hand paralysis after stroke, that damage to the contralateral cerebral hemisphere arises from interruption of the inhibitory activity of upper motor neurons, which causes spasticity, along with hand weakness and loss of fractionated fine motor control. Other studies have noted activity in the cerebral hemisphere on the same side of paralysis during recovery (Neuroimage. 2004;22:1775-83; J Neurophysiol. 2005;93:1209-22; J Neurosci. 2006;26:6096-102; Front Neurol. 2015;6:214), but Dr. Zheng and coauthors noted “sparse” connections between the hand and that part of the brain limit the body’s ability to compensate for spasticity and functional loss.

The latest study followed earlier studies, including one by Dr. Zheng’s coauthors (J Hand Surg Br. 1992;17:518-21), that reported the paralyzed hand could be connected to the unaffected hemisphere by transferring a cervical spine nerve from the nonparalyzed side, a treatment previously reported for injuries of the brachial plexus. Of the five nerves of the brachial plexus, Dr. Zheng and coauthors chose the C7 nerve because it accounts for about 20% of the nerve fibers in the brachial bundle and severing the nerve typically results in transient weakness and numbness in the arm or leg on the same side. Hence, when evaluating the hand on the side of the donor graft, the researchers found no significant changes in power, tactile threshold, or two-point discrimination as a result of surgery.

Their surgical approach was a modification of the C7 nerve transfer method that Dr. Zheng and coauthors had previously reported (Microsurgery. 2011;31:404-8; Neurosurgery. 2015;76:187-95). The operation involved making an incision at the superior aspect of the sternum, mobilizing the donor C7 nerve on the nonparalyzed side, and routing it between the spinal column and esophagus. Then, an anastomosis was performed directly with the C7 nerve on the paralyzed side.

Rehabilitation therapy for both the surgery group and controls was identical, administered four times weekly for 12 months at a single facility, although surgery patients wore an immobilizing cast after their operations.

The nature of the study population – men of varying ages with varying causes of the underlying cerebral lesions – makes it difficult to generalize the findings, Dr. Zheng and coauthors noted. “A larger cohort, followed for a longer period, would be necessary to determine whether cervical nerve transfer results in safe, consistent, and long-term improvements in the function of an arm that is chronically paralyzed as a result of a cerebral lesion,” the authors concluded.

Grants from the following supported the study: National Natural Science Foundation of China; Science and Technology Commission of Shanghai Municipality; Health and Family Planning Commission of Shanghai; and Shanghai Shen-Kang Hospital Development Center. 

SOURCE: Zheng M et al. N Engl J Med. 2018;378:22-34

Patients with spastic arm paralysis who received a contralateral C7 nerve graft from their nonparalyzed side to their paralyzed side led to greater improvement in arm function and reduction in spasticity after a year, compared with rehabilitation alone, investigators from Huashan Hospital in China reported online Jan. 3 in the New England Journal of Medicine.

The researchers randomly assigned 36 patients who had unilateral arm paralysis for at least 5 years to either surgical C7 nerve transfer plus rehabilitation or rehabilitation only. Results of the trial’s primary outcome – arm function using the Fugl-Meyer score – showed that those in the surgery group had an average increase of 17.7, while those in the rehabilitation-only group had an average increase of 2.6 (P less than .001). This 15.1-point difference had a 95% confidence interval ranging from 12.2 to 17.9.

To evaluate spasticity, the researchers used the Modified Ashworth Scale, which is a 0-5 scale to score spasticity; a higher score means more spasticity. Surgery patients saw improvement from baseline in all five areas measured across the board, and none saw worsening in scores. The smallest difference between the two groups was in thumb extension, with 15 surgery patients having a 1- and 2-unit improvement and 3 having no change, while 7 controls showed a 1- or 2-unit improvement, another 7 showed no improvement, and 4 had a 1-unit worsening in score (P less than .001). At 1 year, 16 (89%) of surgery patients could accomplish three or more of the functional tasks researchers gave them, whereas none of the controls could.

“The majority of clinical improvements coincided with physiological evidence of connectivity between the hemisphere on the side of the donor nerve and the paralyzed arm,” said lead author Mou-Xiong Zheng, MD, PhD, of the department of hand surgery at Huashan Hospital at Fudan University in Shanghai, and colleagues.

The research by Dr. Zheng and coauthors arises from what is known about hand paralysis after stroke, that damage to the contralateral cerebral hemisphere arises from interruption of the inhibitory activity of upper motor neurons, which causes spasticity, along with hand weakness and loss of fractionated fine motor control. Other studies have noted activity in the cerebral hemisphere on the same side of paralysis during recovery (Neuroimage. 2004;22:1775-83; J Neurophysiol. 2005;93:1209-22; J Neurosci. 2006;26:6096-102; Front Neurol. 2015;6:214), but Dr. Zheng and coauthors noted “sparse” connections between the hand and that part of the brain limit the body’s ability to compensate for spasticity and functional loss.

The latest study followed earlier studies, including one by Dr. Zheng’s coauthors (J Hand Surg Br. 1992;17:518-21), that reported the paralyzed hand could be connected to the unaffected hemisphere by transferring a cervical spine nerve from the nonparalyzed side, a treatment previously reported for injuries of the brachial plexus. Of the five nerves of the brachial plexus, Dr. Zheng and coauthors chose the C7 nerve because it accounts for about 20% of the nerve fibers in the brachial bundle and severing the nerve typically results in transient weakness and numbness in the arm or leg on the same side. Hence, when evaluating the hand on the side of the donor graft, the researchers found no significant changes in power, tactile threshold, or two-point discrimination as a result of surgery.

Their surgical approach was a modification of the C7 nerve transfer method that Dr. Zheng and coauthors had previously reported (Microsurgery. 2011;31:404-8; Neurosurgery. 2015;76:187-95). The operation involved making an incision at the superior aspect of the sternum, mobilizing the donor C7 nerve on the nonparalyzed side, and routing it between the spinal column and esophagus. Then, an anastomosis was performed directly with the C7 nerve on the paralyzed side.

Rehabilitation therapy for both the surgery group and controls was identical, administered four times weekly for 12 months at a single facility, although surgery patients wore an immobilizing cast after their operations.

The nature of the study population – men of varying ages with varying causes of the underlying cerebral lesions – makes it difficult to generalize the findings, Dr. Zheng and coauthors noted. “A larger cohort, followed for a longer period, would be necessary to determine whether cervical nerve transfer results in safe, consistent, and long-term improvements in the function of an arm that is chronically paralyzed as a result of a cerebral lesion,” the authors concluded.

Grants from the following supported the study: National Natural Science Foundation of China; Science and Technology Commission of Shanghai Municipality; Health and Family Planning Commission of Shanghai; and Shanghai Shen-Kang Hospital Development Center. 

SOURCE: Zheng M et al. N Engl J Med. 2018;378:22-34

Patients with spastic arm paralysis who received a contralateral C7 nerve graft from their nonparalyzed side to their paralyzed side led to greater improvement in arm function and reduction in spasticity after a year, compared with rehabilitation alone, investigators from Huashan Hospital in China reported online Jan. 3 in the New England Journal of Medicine.

The researchers randomly assigned 36 patients who had unilateral arm paralysis for at least 5 years to either surgical C7 nerve transfer plus rehabilitation or rehabilitation only. Results of the trial’s primary outcome – arm function using the Fugl-Meyer score – showed that those in the surgery group had an average increase of 17.7, while those in the rehabilitation-only group had an average increase of 2.6 (P less than .001). This 15.1-point difference had a 95% confidence interval ranging from 12.2 to 17.9.

To evaluate spasticity, the researchers used the Modified Ashworth Scale, which is a 0-5 scale to score spasticity; a higher score means more spasticity. Surgery patients saw improvement from baseline in all five areas measured across the board, and none saw worsening in scores. The smallest difference between the two groups was in thumb extension, with 15 surgery patients having a 1- and 2-unit improvement and 3 having no change, while 7 controls showed a 1- or 2-unit improvement, another 7 showed no improvement, and 4 had a 1-unit worsening in score (P less than .001). At 1 year, 16 (89%) of surgery patients could accomplish three or more of the functional tasks researchers gave them, whereas none of the controls could.

“The majority of clinical improvements coincided with physiological evidence of connectivity between the hemisphere on the side of the donor nerve and the paralyzed arm,” said lead author Mou-Xiong Zheng, MD, PhD, of the department of hand surgery at Huashan Hospital at Fudan University in Shanghai, and colleagues.

The research by Dr. Zheng and coauthors arises from what is known about hand paralysis after stroke, that damage to the contralateral cerebral hemisphere arises from interruption of the inhibitory activity of upper motor neurons, which causes spasticity, along with hand weakness and loss of fractionated fine motor control. Other studies have noted activity in the cerebral hemisphere on the same side of paralysis during recovery (Neuroimage. 2004;22:1775-83; J Neurophysiol. 2005;93:1209-22; J Neurosci. 2006;26:6096-102; Front Neurol. 2015;6:214), but Dr. Zheng and coauthors noted “sparse” connections between the hand and that part of the brain limit the body’s ability to compensate for spasticity and functional loss.

The latest study followed earlier studies, including one by Dr. Zheng’s coauthors (J Hand Surg Br. 1992;17:518-21), that reported the paralyzed hand could be connected to the unaffected hemisphere by transferring a cervical spine nerve from the nonparalyzed side, a treatment previously reported for injuries of the brachial plexus. Of the five nerves of the brachial plexus, Dr. Zheng and coauthors chose the C7 nerve because it accounts for about 20% of the nerve fibers in the brachial bundle and severing the nerve typically results in transient weakness and numbness in the arm or leg on the same side. Hence, when evaluating the hand on the side of the donor graft, the researchers found no significant changes in power, tactile threshold, or two-point discrimination as a result of surgery.

Their surgical approach was a modification of the C7 nerve transfer method that Dr. Zheng and coauthors had previously reported (Microsurgery. 2011;31:404-8; Neurosurgery. 2015;76:187-95). The operation involved making an incision at the superior aspect of the sternum, mobilizing the donor C7 nerve on the nonparalyzed side, and routing it between the spinal column and esophagus. Then, an anastomosis was performed directly with the C7 nerve on the paralyzed side.

Rehabilitation therapy for both the surgery group and controls was identical, administered four times weekly for 12 months at a single facility, although surgery patients wore an immobilizing cast after their operations.

The nature of the study population – men of varying ages with varying causes of the underlying cerebral lesions – makes it difficult to generalize the findings, Dr. Zheng and coauthors noted. “A larger cohort, followed for a longer period, would be necessary to determine whether cervical nerve transfer results in safe, consistent, and long-term improvements in the function of an arm that is chronically paralyzed as a result of a cerebral lesion,” the authors concluded.

Grants from the following supported the study: National Natural Science Foundation of China; Science and Technology Commission of Shanghai Municipality; Health and Family Planning Commission of Shanghai; and Shanghai Shen-Kang Hospital Development Center. 

SOURCE: Zheng M et al. N Engl J Med. 2018;378:22-34

Sleep Improves After Retirement

Transition to statutory retirement is associated with a decrease in sleep difficulties, especially waking up too early in the morning and nonrestorative sleep, according to a study published online ahead of print November 16, 2017, in Sleep. The study included 5,807 public sector employees who retired between 2000 and 2011. Participants were administered the Jenkins Sleep Problem Scale Questionnaire before and after retirement in surveys conducted every four years. At the last study wave before retirement, 30% of the participants had sleep difficulties. The risk ratio for having sleep difficulties in the first study wave following retirement, compared with the last study wave preceding retirement, was 0.89. The decreases in sleep difficulties occurred primarily among people with psychologic distress, suboptimal self-rated health, short sleep duration, and job strain before retirement.

Myllyntausta S, Salo P, Kronholm E, et al. Changes in sleep difficulties during the transition to statutory retirement. Sleep. 2017 Nov 16 [Epub ahead of print].

Vigorous Exercise May Delay Parkinson’s Disease Progression

High-intensity treadmill exercise may be feasible and prescribed safely for patients with Parkinson’s disease, according to a study published online ahead of print December 11, 2017, in JAMA Neurology. The randomized clinical trial included 128 participants between ages 40 and 80. Participants were at an early stage of the disease and not taking Parkinson’s disease medication. Investigators randomized the population to high-intensity exercise, moderate-intensity exercise, or a control condition. At baseline and six months, clinicians assessed the participants using the Unified Parkinson’s Disease Rating Scale (UPDRS). Participants in the study had a UPDRS score of about 20 at baseline. At six months, the high-intensity group’s score stayed at 20, and the moderate exercise group worsened by 1.5 points. The control group’s score worsened by three points.

Schenkman M, Moore CG, Kohrt WM, et al. Effect of high-intensity treadmill exercise on motor symptoms in patients with de novo Parkinson disease: a phase 2 randomized clinical trial. JAMA Neurol. 2017 Dec 11 [Epub ahead of print].

Can Exposure to Terror Raise the Risk of Headache?

Exposure to terror increases the risk of persistent weekly and daily migraine and tension-type headache in adolescent survivors above expected levels, according to a study published online ahead of print December 13, 2017, in Neurology. Investigators interviewed 213 survivors of a terror attack in Norway. Half were male, the mean age was 17.7, and 13 survivors were severely injured. Participants provided information about their headache frequency four to five months after the attack. For each survivor, eight matched controls were drawn from the Young-HUNT3 Study. After exposure to terror, the odds ratio for migraine was 4.27, and that for tension-type headache was 3.39, as estimated in multivariable logistic regression models adjusted for injury, sex, age, family structure and economy, prior exposure to physical or sexual violence, and psychologic distress.

Stensland SØ, Zwart JA, Wentzel-Larsen T, Dyb G. The headache of terror: a matched cohort study of adolescents from the Utøya and the HUNT Study. Neurology. 2017 Dec 13 [Epub ahead of print].

Diet Reduces Disability and Symptoms of MS

A healthy diet and a composite healthy lifestyle are associated with less disability and symptom burden in multiple sclerosis (MS), according to a study published online ahead of print December 6, 2017, in Neurology. The study involved 6,989 people with MS who completed questionnaires about their diet as part of the North American Research Committee registry. The questionnaire estimated intake of fruits, vegetables and legumes, whole grains, added sugars, and red and processed meats. Researchers constructed an overall diet quality score for each individual based on the food groups. Participants with diet quality scores in the highest quintile had lower levels of disability and lower depression scores. Individuals reporting a composite healthy lifestyle had lower odds of reporting severe fatigue, depression, pain, or cognitive impairment.

Fitzgerald KC, Tyry T, Salter A, et al. Diet quality is associated with disability and symptom severity in multiple sclerosis. Neurology. 2017 Dec 6 [Epub ahead of print].

What Are the Effects of Childhood Convulsive Status Epilepticus?

Childhood convulsive status epilepticus (CSE) is associated with substantial long-term neurologic morbidity, but primarily in people who have epilepsy, neurologic abnormalities, or both before the episode of CSE, according to a study published online ahead of print December 5, 2017, in Lancet Child & Adolescent Health. Researchers followed a population-based childhood CSE cohort. Of 203 survivors, 134 were assessed at a median follow-up of 8.9 years. Lasting neurologic conditions, including epilepsy, learning disabilities, and movement problems, were more common among participants than expected for children from the general population. Children who had existing neurologic or developmental issues at the time of CSE were more likely to have a neurologic problem at follow-up. Children without a neurologic or developmental issue tended to have better outcomes.

Pujar SS, Martinos MM, Cortina-Borja M, et al. Long-term prognosis after childhood convulsive status epilepticus: a prospective cohort study. Lancet Child Adolesc Health. 2017 Dec 5 [Epub ahead of print].

Protein Aggregation May Not Affect Cognition in Parkinson’s Disease

Patterns of cortical β-amyloid and tau do not differ between people with Parkinson’s disease who are cognitively normal (PD-CN), people with Parkinson’s disease with mild cognitive impairment (PD-MCI), and healthy older adults, according to a study published online ahead of print December 11, 2017, in JAMA Neurology. This cross-sectional study included 29 patients with Parkinson’s disease from a tertiary care medical center and research institutions. Imaging measures were compared with those of 49 healthy control participants. Outcomes were tau PET measurements of groups of patients with PD-CN and PD-MCI. Of the participants, 47 were female, and the mean age was 71.1. Voxelwise contrasts of whole-brain tau PET uptake between patients with PD-CN and patients with PD-MCI, and between patients with Parkinson’s disease and β-amyloid-negative controls, did not reveal significant differences.

Winer JR, Maass A, Pressman P, et al. Associations between tau, β-amyloid, and cognition in Parkinson disease. JAMA Neurol. 2017 Dec 11 [Epub ahead of print].

Hormone Therapy Not Linked to Increased Stroke Risk

Postmenopausal hormone therapy is not associated with increased risk of stroke, provided that it is started early, according to a study published November 17 in PLoS Medicine. Researchers analyzed data on postmenopausal hormone therapy from five cohort studies including 88,914 women, combined with data from national registries on diagnoses and causes of death during a follow-up period. During a median follow-up of 14.3 years, 6,371 first-time stroke events (1,080 hemorrhagic) were recorded. Hormone therapy was not linked to increased risk of stroke if the therapy was initiated within five years of menopausal onset, regardless of means of administration, type of therapy, active substance, and treatment duration. In subanalyses, researchers observed an increase in risk for hemorrhagic stroke if the therapy contained the active substance conjugated equine estrogens.

Carrasquilla GD, Frumento P, Berglund A, et al. Postmenopausal hormone therapy and risk of stroke: a pooled analysis of data from population-based cohort studies. PLoS Med. 2017;14(11):e1002445.

Restless Sleep May Be Linked to Parkinson’s Disease

In patients with idiopathic REM sleep behavior disorder (IRBD), PET shows increased microglial activation in the substantia nigra, along with reduced dopaminergic function in the putamen, according to a study published in the October 2017 issue of Lancet Neurology. This prospective, case–control PET study included 20 patients with IRBD and no clinical evidence of parkinsonism and cognitive impairment recruited from tertiary sleep centers and 19 healthy controls. ¹¹C-PK11195 binding was increased on the left side of the substantia nigra in patients with IRBD, compared with controls, but not on the right side. ¹¹C-PK11195 binding was not significantly increased in the putamen and caudate of patients with IRBD. ¹⁸F-DOPA uptake was reduced in IRBD in the left putamen and right putamen, but not in the caudate.

Stokholm MG, Iranzo A, Østergaard K, et al. Assessment of neuroinflammation in patients with idiopathic rapid-eye-movement sleep behaviour disorder: a case-control study. Lancet Neurol. 2017;16(10):789-796.

Can Playing Video Games Benefit the Brains of Older Adults?

Playing 3D video games may prevent mild cognitive impairment and, perhaps, Alzheimer’s disease, according to a study published December 6, 2017, in PLoS One. In two separate studies, adults in their 20s played 3D video games on platforms such as Super Mario 64. The gray matter in their hippocampus increased after training. Researchers examined whether the results could be replicated in healthy seniors. Thirty-three people, ages 55 to 75, were randomly assigned to one of three groups. The video game experimental group engaged in 3D-platform video game training over six months. An active control group took a series of self-directed, computerized piano lessons, and a no-contact control group did not engage in any intervention. Participants in the video-game cohort had increases in gray matter volume in the hippocampus and cerebellum. Their short-term memory also improved.

West GL, Zendel BR, Konishi K, et al. Playing Super Mario 64 increases hippocampal grey matter in older adults. PLoS One. 2017;12(12):e0187779.

FDA Approves Vercise Deep Brain Stimulation System

The FDA has approved the Vercise Deep Brain Stimulation System (DBS) to treat symptoms of Parkinson’s disease. The approval is based on the INTREPID study, a multicenter, prospective, double-blind, randomized, sham-controlled trial of DBS for Parkinson’s disease in the US. The study evaluated the system’s safety and efficacy in 292 patients at 23 sites. The Vercise DBS System successfully met its primary end point of mean change in waking hours with good symptom control. The filing also was supported by safety data from the VANTAGE study, in which 40 patients treated with the system demonstrated a 63% improvement in motor function at 52 weeks from baseline, as measured by the Unified Parkinson’s Disease Rating Scale III. Boston Scientific markets Vercise.

Can Social Relationships Aid Cognitive Function?

Although superagers (ie, people older than 80 with episodic memory as good as that of a middle-aged adult) and their cognitively average-for-age peers report similarly high levels of psychological well-being, superagers demonstrate greater levels of positive social relationships, according to a study published October 23, 2017, in PLoS One. Thirty-one superagers and 19 cognitively average-for-age peers completed the Ryff 42-item Psychological Well-Being questionnaire, which includes subscales of autonomy, positive relations with others, environmental mastery, personal growth, purpose in life, and self-acceptance. The groups did not differ on demographic factors, including estimated premorbid intelligence. Compared with cognitively average-for-age peers, superagers endorsed greater levels of positive relations with others. Superagers had a median overall score of 40 in positive relations with others, compared with 36 in the control group.

Cook Maher A, Kielb S, Loyer E, et al. Psychological well-being in elderly adults with extraordinary episodic memory. PLoS One. 2017;12(10):e0186413.

—Kimberly Williams

Sleep Improves After Retirement

Transition to statutory retirement is associated with a decrease in sleep difficulties, especially waking up too early in the morning and nonrestorative sleep, according to a study published online ahead of print November 16, 2017, in Sleep. The study included 5,807 public sector employees who retired between 2000 and 2011. Participants were administered the Jenkins Sleep Problem Scale Questionnaire before and after retirement in surveys conducted every four years. At the last study wave before retirement, 30% of the participants had sleep difficulties. The risk ratio for having sleep difficulties in the first study wave following retirement, compared with the last study wave preceding retirement, was 0.89. The decreases in sleep difficulties occurred primarily among people with psychologic distress, suboptimal self-rated health, short sleep duration, and job strain before retirement.

Myllyntausta S, Salo P, Kronholm E, et al. Changes in sleep difficulties during the transition to statutory retirement. Sleep. 2017 Nov 16 [Epub ahead of print].

Vigorous Exercise May Delay Parkinson’s Disease Progression

High-intensity treadmill exercise may be feasible and prescribed safely for patients with Parkinson’s disease, according to a study published online ahead of print December 11, 2017, in JAMA Neurology. The randomized clinical trial included 128 participants between ages 40 and 80. Participants were at an early stage of the disease and not taking Parkinson’s disease medication. Investigators randomized the population to high-intensity exercise, moderate-intensity exercise, or a control condition. At baseline and six months, clinicians assessed the participants using the Unified Parkinson’s Disease Rating Scale (UPDRS). Participants in the study had a UPDRS score of about 20 at baseline. At six months, the high-intensity group’s score stayed at 20, and the moderate exercise group worsened by 1.5 points. The control group’s score worsened by three points.

Schenkman M, Moore CG, Kohrt WM, et al. Effect of high-intensity treadmill exercise on motor symptoms in patients with de novo Parkinson disease: a phase 2 randomized clinical trial. JAMA Neurol. 2017 Dec 11 [Epub ahead of print].

Can Exposure to Terror Raise the Risk of Headache?

Exposure to terror increases the risk of persistent weekly and daily migraine and tension-type headache in adolescent survivors above expected levels, according to a study published online ahead of print December 13, 2017, in Neurology. Investigators interviewed 213 survivors of a terror attack in Norway. Half were male, the mean age was 17.7, and 13 survivors were severely injured. Participants provided information about their headache frequency four to five months after the attack. For each survivor, eight matched controls were drawn from the Young-HUNT3 Study. After exposure to terror, the odds ratio for migraine was 4.27, and that for tension-type headache was 3.39, as estimated in multivariable logistic regression models adjusted for injury, sex, age, family structure and economy, prior exposure to physical or sexual violence, and psychologic distress.

Stensland SØ, Zwart JA, Wentzel-Larsen T, Dyb G. The headache of terror: a matched cohort study of adolescents from the Utøya and the HUNT Study. Neurology. 2017 Dec 13 [Epub ahead of print].

Diet Reduces Disability and Symptoms of MS

A healthy diet and a composite healthy lifestyle are associated with less disability and symptom burden in multiple sclerosis (MS), according to a study published online ahead of print December 6, 2017, in Neurology. The study involved 6,989 people with MS who completed questionnaires about their diet as part of the North American Research Committee registry. The questionnaire estimated intake of fruits, vegetables and legumes, whole grains, added sugars, and red and processed meats. Researchers constructed an overall diet quality score for each individual based on the food groups. Participants with diet quality scores in the highest quintile had lower levels of disability and lower depression scores. Individuals reporting a composite healthy lifestyle had lower odds of reporting severe fatigue, depression, pain, or cognitive impairment.

Fitzgerald KC, Tyry T, Salter A, et al. Diet quality is associated with disability and symptom severity in multiple sclerosis. Neurology. 2017 Dec 6 [Epub ahead of print].

What Are the Effects of Childhood Convulsive Status Epilepticus?

Childhood convulsive status epilepticus (CSE) is associated with substantial long-term neurologic morbidity, but primarily in people who have epilepsy, neurologic abnormalities, or both before the episode of CSE, according to a study published online ahead of print December 5, 2017, in Lancet Child & Adolescent Health. Researchers followed a population-based childhood CSE cohort. Of 203 survivors, 134 were assessed at a median follow-up of 8.9 years. Lasting neurologic conditions, including epilepsy, learning disabilities, and movement problems, were more common among participants than expected for children from the general population. Children who had existing neurologic or developmental issues at the time of CSE were more likely to have a neurologic problem at follow-up. Children without a neurologic or developmental issue tended to have better outcomes.

Pujar SS, Martinos MM, Cortina-Borja M, et al. Long-term prognosis after childhood convulsive status epilepticus: a prospective cohort study. Lancet Child Adolesc Health. 2017 Dec 5 [Epub ahead of print].

Protein Aggregation May Not Affect Cognition in Parkinson’s Disease

Patterns of cortical β-amyloid and tau do not differ between people with Parkinson’s disease who are cognitively normal (PD-CN), people with Parkinson’s disease with mild cognitive impairment (PD-MCI), and healthy older adults, according to a study published online ahead of print December 11, 2017, in JAMA Neurology. This cross-sectional study included 29 patients with Parkinson’s disease from a tertiary care medical center and research institutions. Imaging measures were compared with those of 49 healthy control participants. Outcomes were tau PET measurements of groups of patients with PD-CN and PD-MCI. Of the participants, 47 were female, and the mean age was 71.1. Voxelwise contrasts of whole-brain tau PET uptake between patients with PD-CN and patients with PD-MCI, and between patients with Parkinson’s disease and β-amyloid-negative controls, did not reveal significant differences.

Winer JR, Maass A, Pressman P, et al. Associations between tau, β-amyloid, and cognition in Parkinson disease. JAMA Neurol. 2017 Dec 11 [Epub ahead of print].

Hormone Therapy Not Linked to Increased Stroke Risk

Postmenopausal hormone therapy is not associated with increased risk of stroke, provided that it is started early, according to a study published November 17 in PLoS Medicine. Researchers analyzed data on postmenopausal hormone therapy from five cohort studies including 88,914 women, combined with data from national registries on diagnoses and causes of death during a follow-up period. During a median follow-up of 14.3 years, 6,371 first-time stroke events (1,080 hemorrhagic) were recorded. Hormone therapy was not linked to increased risk of stroke if the therapy was initiated within five years of menopausal onset, regardless of means of administration, type of therapy, active substance, and treatment duration. In subanalyses, researchers observed an increase in risk for hemorrhagic stroke if the therapy contained the active substance conjugated equine estrogens.

Carrasquilla GD, Frumento P, Berglund A, et al. Postmenopausal hormone therapy and risk of stroke: a pooled analysis of data from population-based cohort studies. PLoS Med. 2017;14(11):e1002445.

Restless Sleep May Be Linked to Parkinson’s Disease

In patients with idiopathic REM sleep behavior disorder (IRBD), PET shows increased microglial activation in the substantia nigra, along with reduced dopaminergic function in the putamen, according to a study published in the October 2017 issue of Lancet Neurology. This prospective, case–control PET study included 20 patients with IRBD and no clinical evidence of parkinsonism and cognitive impairment recruited from tertiary sleep centers and 19 healthy controls. ¹¹C-PK11195 binding was increased on the left side of the substantia nigra in patients with IRBD, compared with controls, but not on the right side. ¹¹C-PK11195 binding was not significantly increased in the putamen and caudate of patients with IRBD. ¹⁸F-DOPA uptake was reduced in IRBD in the left putamen and right putamen, but not in the caudate.

Stokholm MG, Iranzo A, Østergaard K, et al. Assessment of neuroinflammation in patients with idiopathic rapid-eye-movement sleep behaviour disorder: a case-control study. Lancet Neurol. 2017;16(10):789-796.

Can Playing Video Games Benefit the Brains of Older Adults?

Playing 3D video games may prevent mild cognitive impairment and, perhaps, Alzheimer’s disease, according to a study published December 6, 2017, in PLoS One. In two separate studies, adults in their 20s played 3D video games on platforms such as Super Mario 64. The gray matter in their hippocampus increased after training. Researchers examined whether the results could be replicated in healthy seniors. Thirty-three people, ages 55 to 75, were randomly assigned to one of three groups. The video game experimental group engaged in 3D-platform video game training over six months. An active control group took a series of self-directed, computerized piano lessons, and a no-contact control group did not engage in any intervention. Participants in the video-game cohort had increases in gray matter volume in the hippocampus and cerebellum. Their short-term memory also improved.

West GL, Zendel BR, Konishi K, et al. Playing Super Mario 64 increases hippocampal grey matter in older adults. PLoS One. 2017;12(12):e0187779.

FDA Approves Vercise Deep Brain Stimulation System

The FDA has approved the Vercise Deep Brain Stimulation System (DBS) to treat symptoms of Parkinson’s disease. The approval is based on the INTREPID study, a multicenter, prospective, double-blind, randomized, sham-controlled trial of DBS for Parkinson’s disease in the US. The study evaluated the system’s safety and efficacy in 292 patients at 23 sites. The Vercise DBS System successfully met its primary end point of mean change in waking hours with good symptom control. The filing also was supported by safety data from the VANTAGE study, in which 40 patients treated with the system demonstrated a 63% improvement in motor function at 52 weeks from baseline, as measured by the Unified Parkinson’s Disease Rating Scale III. Boston Scientific markets Vercise.

Can Social Relationships Aid Cognitive Function?

Although superagers (ie, people older than 80 with episodic memory as good as that of a middle-aged adult) and their cognitively average-for-age peers report similarly high levels of psychological well-being, superagers demonstrate greater levels of positive social relationships, according to a study published October 23, 2017, in PLoS One. Thirty-one superagers and 19 cognitively average-for-age peers completed the Ryff 42-item Psychological Well-Being questionnaire, which includes subscales of autonomy, positive relations with others, environmental mastery, personal growth, purpose in life, and self-acceptance. The groups did not differ on demographic factors, including estimated premorbid intelligence. Compared with cognitively average-for-age peers, superagers endorsed greater levels of positive relations with others. Superagers had a median overall score of 40 in positive relations with others, compared with 36 in the control group.

Cook Maher A, Kielb S, Loyer E, et al. Psychological well-being in elderly adults with extraordinary episodic memory. PLoS One. 2017;12(10):e0186413.

—Kimberly Williams

Sleep Improves After Retirement

Transition to statutory retirement is associated with a decrease in sleep difficulties, especially waking up too early in the morning and nonrestorative sleep, according to a study published online ahead of print November 16, 2017, in Sleep. The study included 5,807 public sector employees who retired between 2000 and 2011. Participants were administered the Jenkins Sleep Problem Scale Questionnaire before and after retirement in surveys conducted every four years. At the last study wave before retirement, 30% of the participants had sleep difficulties. The risk ratio for having sleep difficulties in the first study wave following retirement, compared with the last study wave preceding retirement, was 0.89. The decreases in sleep difficulties occurred primarily among people with psychologic distress, suboptimal self-rated health, short sleep duration, and job strain before retirement.

Myllyntausta S, Salo P, Kronholm E, et al. Changes in sleep difficulties during the transition to statutory retirement. Sleep. 2017 Nov 16 [Epub ahead of print].

Vigorous Exercise May Delay Parkinson’s Disease Progression

High-intensity treadmill exercise may be feasible and prescribed safely for patients with Parkinson’s disease, according to a study published online ahead of print December 11, 2017, in JAMA Neurology. The randomized clinical trial included 128 participants between ages 40 and 80. Participants were at an early stage of the disease and not taking Parkinson’s disease medication. Investigators randomized the population to high-intensity exercise, moderate-intensity exercise, or a control condition. At baseline and six months, clinicians assessed the participants using the Unified Parkinson’s Disease Rating Scale (UPDRS). Participants in the study had a UPDRS score of about 20 at baseline. At six months, the high-intensity group’s score stayed at 20, and the moderate exercise group worsened by 1.5 points. The control group’s score worsened by three points.

Schenkman M, Moore CG, Kohrt WM, et al. Effect of high-intensity treadmill exercise on motor symptoms in patients with de novo Parkinson disease: a phase 2 randomized clinical trial. JAMA Neurol. 2017 Dec 11 [Epub ahead of print].

Can Exposure to Terror Raise the Risk of Headache?

Exposure to terror increases the risk of persistent weekly and daily migraine and tension-type headache in adolescent survivors above expected levels, according to a study published online ahead of print December 13, 2017, in Neurology. Investigators interviewed 213 survivors of a terror attack in Norway. Half were male, the mean age was 17.7, and 13 survivors were severely injured. Participants provided information about their headache frequency four to five months after the attack. For each survivor, eight matched controls were drawn from the Young-HUNT3 Study. After exposure to terror, the odds ratio for migraine was 4.27, and that for tension-type headache was 3.39, as estimated in multivariable logistic regression models adjusted for injury, sex, age, family structure and economy, prior exposure to physical or sexual violence, and psychologic distress.

Stensland SØ, Zwart JA, Wentzel-Larsen T, Dyb G. The headache of terror: a matched cohort study of adolescents from the Utøya and the HUNT Study. Neurology. 2017 Dec 13 [Epub ahead of print].

Diet Reduces Disability and Symptoms of MS

A healthy diet and a composite healthy lifestyle are associated with less disability and symptom burden in multiple sclerosis (MS), according to a study published online ahead of print December 6, 2017, in Neurology. The study involved 6,989 people with MS who completed questionnaires about their diet as part of the North American Research Committee registry. The questionnaire estimated intake of fruits, vegetables and legumes, whole grains, added sugars, and red and processed meats. Researchers constructed an overall diet quality score for each individual based on the food groups. Participants with diet quality scores in the highest quintile had lower levels of disability and lower depression scores. Individuals reporting a composite healthy lifestyle had lower odds of reporting severe fatigue, depression, pain, or cognitive impairment.

Fitzgerald KC, Tyry T, Salter A, et al. Diet quality is associated with disability and symptom severity in multiple sclerosis. Neurology. 2017 Dec 6 [Epub ahead of print].

What Are the Effects of Childhood Convulsive Status Epilepticus?

Childhood convulsive status epilepticus (CSE) is associated with substantial long-term neurologic morbidity, but primarily in people who have epilepsy, neurologic abnormalities, or both before the episode of CSE, according to a study published online ahead of print December 5, 2017, in Lancet Child & Adolescent Health. Researchers followed a population-based childhood CSE cohort. Of 203 survivors, 134 were assessed at a median follow-up of 8.9 years. Lasting neurologic conditions, including epilepsy, learning disabilities, and movement problems, were more common among participants than expected for children from the general population. Children who had existing neurologic or developmental issues at the time of CSE were more likely to have a neurologic problem at follow-up. Children without a neurologic or developmental issue tended to have better outcomes.

Pujar SS, Martinos MM, Cortina-Borja M, et al. Long-term prognosis after childhood convulsive status epilepticus: a prospective cohort study. Lancet Child Adolesc Health. 2017 Dec 5 [Epub ahead of print].

Protein Aggregation May Not Affect Cognition in Parkinson’s Disease

Patterns of cortical β-amyloid and tau do not differ between people with Parkinson’s disease who are cognitively normal (PD-CN), people with Parkinson’s disease with mild cognitive impairment (PD-MCI), and healthy older adults, according to a study published online ahead of print December 11, 2017, in JAMA Neurology. This cross-sectional study included 29 patients with Parkinson’s disease from a tertiary care medical center and research institutions. Imaging measures were compared with those of 49 healthy control participants. Outcomes were tau PET measurements of groups of patients with PD-CN and PD-MCI. Of the participants, 47 were female, and the mean age was 71.1. Voxelwise contrasts of whole-brain tau PET uptake between patients with PD-CN and patients with PD-MCI, and between patients with Parkinson’s disease and β-amyloid-negative controls, did not reveal significant differences.

Winer JR, Maass A, Pressman P, et al. Associations between tau, β-amyloid, and cognition in Parkinson disease. JAMA Neurol. 2017 Dec 11 [Epub ahead of print].

Hormone Therapy Not Linked to Increased Stroke Risk

Postmenopausal hormone therapy is not associated with increased risk of stroke, provided that it is started early, according to a study published November 17 in PLoS Medicine. Researchers analyzed data on postmenopausal hormone therapy from five cohort studies including 88,914 women, combined with data from national registries on diagnoses and causes of death during a follow-up period. During a median follow-up of 14.3 years, 6,371 first-time stroke events (1,080 hemorrhagic) were recorded. Hormone therapy was not linked to increased risk of stroke if the therapy was initiated within five years of menopausal onset, regardless of means of administration, type of therapy, active substance, and treatment duration. In subanalyses, researchers observed an increase in risk for hemorrhagic stroke if the therapy contained the active substance conjugated equine estrogens.

Carrasquilla GD, Frumento P, Berglund A, et al. Postmenopausal hormone therapy and risk of stroke: a pooled analysis of data from population-based cohort studies. PLoS Med. 2017;14(11):e1002445.

Restless Sleep May Be Linked to Parkinson’s Disease

In patients with idiopathic REM sleep behavior disorder (IRBD), PET shows increased microglial activation in the substantia nigra, along with reduced dopaminergic function in the putamen, according to a study published in the October 2017 issue of Lancet Neurology. This prospective, case–control PET study included 20 patients with IRBD and no clinical evidence of parkinsonism and cognitive impairment recruited from tertiary sleep centers and 19 healthy controls. ¹¹C-PK11195 binding was increased on the left side of the substantia nigra in patients with IRBD, compared with controls, but not on the right side. ¹¹C-PK11195 binding was not significantly increased in the putamen and caudate of patients with IRBD. ¹⁸F-DOPA uptake was reduced in IRBD in the left putamen and right putamen, but not in the caudate.

Stokholm MG, Iranzo A, Østergaard K, et al. Assessment of neuroinflammation in patients with idiopathic rapid-eye-movement sleep behaviour disorder: a case-control study. Lancet Neurol. 2017;16(10):789-796.

Can Playing Video Games Benefit the Brains of Older Adults?

Playing 3D video games may prevent mild cognitive impairment and, perhaps, Alzheimer’s disease, according to a study published December 6, 2017, in PLoS One. In two separate studies, adults in their 20s played 3D video games on platforms such as Super Mario 64. The gray matter in their hippocampus increased after training. Researchers examined whether the results could be replicated in healthy seniors. Thirty-three people, ages 55 to 75, were randomly assigned to one of three groups. The video game experimental group engaged in 3D-platform video game training over six months. An active control group took a series of self-directed, computerized piano lessons, and a no-contact control group did not engage in any intervention. Participants in the video-game cohort had increases in gray matter volume in the hippocampus and cerebellum. Their short-term memory also improved.

West GL, Zendel BR, Konishi K, et al. Playing Super Mario 64 increases hippocampal grey matter in older adults. PLoS One. 2017;12(12):e0187779.

FDA Approves Vercise Deep Brain Stimulation System

The FDA has approved the Vercise Deep Brain Stimulation System (DBS) to treat symptoms of Parkinson’s disease. The approval is based on the INTREPID study, a multicenter, prospective, double-blind, randomized, sham-controlled trial of DBS for Parkinson’s disease in the US. The study evaluated the system’s safety and efficacy in 292 patients at 23 sites. The Vercise DBS System successfully met its primary end point of mean change in waking hours with good symptom control. The filing also was supported by safety data from the VANTAGE study, in which 40 patients treated with the system demonstrated a 63% improvement in motor function at 52 weeks from baseline, as measured by the Unified Parkinson’s Disease Rating Scale III. Boston Scientific markets Vercise.

Can Social Relationships Aid Cognitive Function?

Although superagers (ie, people older than 80 with episodic memory as good as that of a middle-aged adult) and their cognitively average-for-age peers report similarly high levels of psychological well-being, superagers demonstrate greater levels of positive social relationships, according to a study published October 23, 2017, in PLoS One. Thirty-one superagers and 19 cognitively average-for-age peers completed the Ryff 42-item Psychological Well-Being questionnaire, which includes subscales of autonomy, positive relations with others, environmental mastery, personal growth, purpose in life, and self-acceptance. The groups did not differ on demographic factors, including estimated premorbid intelligence. Compared with cognitively average-for-age peers, superagers endorsed greater levels of positive relations with others. Superagers had a median overall score of 40 in positive relations with others, compared with 36 in the control group.

Cook Maher A, Kielb S, Loyer E, et al. Psychological well-being in elderly adults with extraordinary episodic memory. PLoS One. 2017;12(10):e0186413.

—Kimberly Williams

SAN DIEGO – A history of head injury is associated with increased amyloid deposition in the brain, both globally and in the frontal cortex, according to PET imaging in 329 older adults without dementia.

Previous studies have found an association between head injury and later dementia, but the mechanism isn’t understood. The importance of the new investigation is that it “hints at pathophysiology. We were very excited” to find amyloid in the frontal cortex, “which is also associated with Alzheimer’s disease,” said lead investigator Andrea Schneider, MD, PhD, a neurology resident at Johns Hopkins University, Baltimore.

Increased amyloid deposition was not found in other areas associated with the disease, but frontal cortex involvement “does suggest perhaps a common” denominator, she noted.

M. Alexander Otto/Frontline Medical News

[email protected]

SOURCE: Schneider A et al. ANA 2017 abstract M336WIP

SAN DIEGO – A history of head injury is associated with increased amyloid deposition in the brain, both globally and in the frontal cortex, according to PET imaging in 329 older adults without dementia.

Previous studies have found an association between head injury and later dementia, but the mechanism isn’t understood. The importance of the new investigation is that it “hints at pathophysiology. We were very excited” to find amyloid in the frontal cortex, “which is also associated with Alzheimer’s disease,” said lead investigator Andrea Schneider, MD, PhD, a neurology resident at Johns Hopkins University, Baltimore.

Increased amyloid deposition was not found in other areas associated with the disease, but frontal cortex involvement “does suggest perhaps a common” denominator, she noted.

M. Alexander Otto/Frontline Medical News

[email protected]

SOURCE: Schneider A et al. ANA 2017 abstract M336WIP

SAN DIEGO – A history of head injury is associated with increased amyloid deposition in the brain, both globally and in the frontal cortex, according to PET imaging in 329 older adults without dementia.

Previous studies have found an association between head injury and later dementia, but the mechanism isn’t understood. The importance of the new investigation is that it “hints at pathophysiology. We were very excited” to find amyloid in the frontal cortex, “which is also associated with Alzheimer’s disease,” said lead investigator Andrea Schneider, MD, PhD, a neurology resident at Johns Hopkins University, Baltimore.

Increased amyloid deposition was not found in other areas associated with the disease, but frontal cortex involvement “does suggest perhaps a common” denominator, she noted.

M. Alexander Otto/Frontline Medical News

[email protected]

SOURCE: Schneider A et al. ANA 2017 abstract M336WIP

Brain Glucose Level Is Associated With Alzheimer’s Disease Severity

Impaired glucose metabolism due to reduced glycolytic flux may be intrinsic to Alzheimer’s disease pathogenesis, according to a study published online ahead of print October 19 in Alzheimer’s & Dementia. Within the autopsy cohort of the Baltimore Longitudinal Study of Aging, researchers measured brain glucose concentration and assessed the ratios of serine, glycine, and alanine to glucose. Investigators also quantified protein levels of the neuronal and astrocytic glucose transporters. In addition, study authors assessed the relationships between plasma glucose measured before death and brain tissue glucose. Higher brain tissue glucose concentration, reduced glycolytic flux, and lower neuronal glucose transporters were related to severity of Alzheimer’s disease pathology and the expression of Alzheimer’s disease symptoms. Longitudinal increases in fasting plasma glucose levels were associated with higher brain tissue glucose concentrations.

An Y, Varma VR, Varma S, et al. Evidence for brain glucose dysregulation in Alzheimer’s disease. Alzheimers Dement. 2017 Oct 19 [Epub ahead of print].

Is it Better to Be Asleep or Awake for DBS Implantation?

Patients with Parkinson’s disease who undergo deep brain stimulation (DBS) device implantation while asleep have better communication, cognition, and speech outcomes, according to a study published November 7 in Neurology. Thirty DBS candidates with Parkinson’s disease underwent imaging-guided implantation while asleep. Their six-month outcomes were compared to those of 39 patients who previously had undergone implantation while awake. Assessments included an off-levodopa Unified Parkinson’s Disease Rating Scale (UPDRS) II and III, the 39-item Parkinson’s Disease Questionnaire, motor diaries, and speech fluency. No difference was observed in improvement of UPDRS III or UPDRS II. Improvement in on time without dyskinesia was superior in asleep implantation. Quality of life scores improved in both groups. Improvement in summary index and subscores for cognition and communication were superior in implantation while asleep.

Brodsky MA, Anderson S, Murchison C, et al. Clinical outcomes of asleep vs awake deep brain stimulation for Parkinson disease. Neurology. 2017;89(19):1944-1950.

Is Inflammation During Middle Age Linked to Brain Shrinkage Later On?

People with blood biomarkers of inflammation during midlife may have more brain shrinkage decades later than people without these biomarkers, according to a study published online ahead of print November 1 in Neurology. Plasma levels of fibrinogen, albumin, white blood cells, von Willebrand factor, and Factor VIII were assessed at baseline in 1,633 participants in the Atherosclerosis Risk in Communities Study. Each standard deviation increase in midlife inflammation composite score was associated with 1,788 mm³ greater ventricular volume, 110 mm³ smaller hippocampal volume, 519 mm³ smaller occipital volume, and 532 mm³ smaller Alzheimer disease signature region volumes and reduced episodic memory 24 years later. Compared with participants with no elevated midlife inflammatory markers, participants with elevations in three or more markers had 5% smaller hippocampal and Alzheimer’s disease signature region volumes.

Walker KA, Hoogeveen RC, Folsom AR, et al. Midlife systemic inflammatory markers are associated with late-life brain volume: The ARIC study. Neurology. 2017 Nov 1 [Epub ahead of print].

Novel Wristbands Improve Seizure Detection

Wrist-worn convulsive seizure detectors provide more accurate seizure counts than previous automated detectors do, while maintaining tolerable false alarm rates (FAR) for ambulatory monitoring, according to a study published in the November issue of Epilepsia. Hand-annotated video-EEG seizure events were collected from 69 patients at six clinical sites. Two novel wristbands and one current wristband were used to record electrodermal activity and accelerometer signals, obtaining 5,928 hours of data, including 55 convulsive epileptic seizures in 22 patients. The novel wristbands consistently outperformed the current wristband. The best wristband had a sensitivity of 94.55% and an FAR of 0.2 events per day. When increasing the sensitivity to 100%, the FAR was as much as 13 times lower than with the current detector. Automatically estimated seizure durations were correlated with true durations.

Onorati F, Regalia G, Caborni C, et al. Multicenter clinical assessment of improved wearable multimodal convulsive seizure detectors. Epilepsia. 2017;58(11):1870-1879.

Focused Ultrasound Reduces Parkinson’s Disease Tremor

Focused ultrasound thalamotomy for patients with tremor-dominant Parkinson’s disease demonstrates improvement in medication-refractory tremor by Clinical Rating Scale for Tremor assessments, even in the setting of a placebo response, according to a study published online ahead of print October 30 in JAMA Neurology. Researchers randomized 20 patients to unilateral focused ultrasound thalamotomy and seven to a sham procedure. Twenty-six participants were male, and the median age was 67.8. The predefined primary outcomes were safety and difference in improvement between groups at three months in the on-medication treated hand tremor subscore from the Clinical Rating Scale for Tremor. On-medication median tremor scores improved 62% from a baseline of 17 points following focused ultrasound thalamotomy, and 22% from a baseline of 23 points after sham procedures.

Bond AE, Shah BB, Huss DS, et al. Safety and efficacy of focused ultrasound thalamotomy for patients with medication-refractory, tremor-dominant Parkinson disease: a randomized clinical trial. JAMA Neurol. 2017 Oct 30 [Epub ahead of print].

Biomarker of Multiple Sclerosis Identified

MicroRNAs associated with circulating exosomes are informative biomarkers for the diagnosis of multiple sclerosis (MS) and for predicting disease subtype with a high degree of accuracy, according to a study published October 30 in Scientific Reports. Exosome-associated microRNAs in serum samples from 25 patients with MS and 11 matched healthy controls were profiled using small RNA next-generation sequencing. In addition to identifying biomarkers that distinguish healthy people from people with MS, researchers identified nine microRNA molecules that differentiate between relapsing-remitting MS and progressive MS. Study authors also validated eight out of nine microRNA molecules in an independent group of 11 patients with progressive MS. The blood test may enable earlier treatment of MS and help neurologists identify the most appropriate treatment for a patient, said the authors.

Ebrahimkhani S, Vafaee F, Young PE, et al. Exosomal microRNA signatures in multiple sclerosis reflect disease status. Sci Rep. 2017;7(1):14293.

Does Oral Anticoagulation in Atrial Fibrillation Reduce Dementia Risk?

The risk of dementia in patients with atrial fibrillation is higher among those who do not take oral anticoagulants, compared with those who do, according to a study published online ahead of print October 24 in the European Heart Journal. This Swedish retrospective registry study included 444,106 patients with hospital diagnosis of atrial fibrillation and no previous diagnosis of dementia between 2006 and 2014. At baseline, 54% of patients were not taking oral anticoagulants. Investigators performed propensity score matching, used falsification end points, and performed intention-to-treat and on-treatment analyses. Patients on anticoagulant treatment at baseline had a 29% lower risk of dementia than patients without anticoagulant treatment, and a 48% lower risk analyzed on treatment. Direct comparison between new oral anticoagulants and warfarin showed no difference.

Friberg L, Rosenqvist M. Less dementia with oral anticoagulation in atrial fibrillation. Eur Heart J. 2017 Oct 24 [Epub ahead of print].

Dendritic Spine Plasticity May Protect Against Dementia

Dendritic spine plasticity protects older people with Alzheimer’s disease pathology from developing dementia, according to a study published in the October issue of Annals of Neurology. Researchers compared dendritic spines within layer II and III pyramidal neuron dendrites in Brodmann area 46 of the dorsolateral prefrontal cortex in 12 age-matched healthy controls, eight controls with Alzheimer’s disease pathology (CAD), and 21 people with Alzheimer’s disease. The investigators created digital reconstructions of dendritic structure for morphologic analyses. Spine density was similar among control and CAD cases, but was reduced significantly in Alzheimer’s disease. Thin and mushroom spines were reduced significantly in Alzheimer’s disease, compared with CAD brains, and stubby spine density was decreased significantly in CAD and Alzheimer’s disease, compared with controls.

Boros BD, Greathouse KM, Gentry EG, et al. Dendritic spines provide cognitive resilience against Alzheimer’s disease. Ann Neurol. 2017;82(4):602-614.

Opioid Versus Nonopioid Treatment for Acute Migraine

IV hydromorphone is substantially less effective than IV prochlorperazine for the treatment of acute migraine in the emergency department and should not be used as first-line therapy, according to a study published online ahead of print October 18 in Neurology. This study was conducted in two emergency departments and included patients who met international criteria for migraine if they had not used an opioid within the previous month. Participants received hydromorphone (1 mg) or prochlorperazine (10 mg) and diphenhydramine (25 mg). The primary outcome was achieving a headache level of mild or none within two hours of treatment and maintaining that level for 48 hours without rescue medication. Approximately 60% of the prochlorperazine arm achieved the primary outcome, compared with 31% of the hydromorphone arm.

Friedman BW, Irizarry E, Solorzano C, et al. Randomized study of IV prochlorperazine plus diphenhydramine vs IV hydromorphone for migraine. Neurology. 2017 Oct 18 [Epub ahead of print].

Frontotemporal Degeneration Entails High Economic Burden

The economic burden of frontotemporal degeneration may be twice as high as that of Alzheimer’s disease, according to a study published online ahead of print October 4 in Neurology. An Internet survey was administered to 674 primary caregivers of patients with behavioral-variant frontotemporal degeneration, primary progressive aphasia, frontotemporal degeneration with motor neuron disease, corticobasal syndrome, or progressive supranuclear palsy. Direct costs for these disorders equaled $47,916, and indirect costs equaled $71,737. Patients age 65 or older, those with later stages of disease, and those with behavioral-variant frontotemporal degeneration had higher direct costs, while patients younger than 65 and men had higher indirect costs. Mean household income ranged from $75,000 to $99,000 at 12 months before frontotemporal degeneration diagnosis, but declined to $50,000 to $59,999 after diagnosis.

Galvin JE, Howard DH, Denny SS, et al. The social and economic burden of frontotemporal degeneration. Neurology. 2017 Oct 4 [Epub ahead of print].

FDA Approves Vimpat for Partial-Onset Seizures in Pediatric Epilepsy

The FDA has approved a label extension for Vimpat (lacosamide) CV as an oral option for the treatment of partial-onset seizures in pediatric patients age 4 and older. The safety and efficacy profile of Vimpat as monotherapy and adjunctive therapy for the treatment of partial-onset seizures in adults was previously established in four multicenter, randomized, controlled clinical trials. The expanded indication for Vimpat is based on extrapolation of efficacy data from adults to children and is supported by safety and pharmacokinetics data collected in children. Adverse reactions in pediatric patients are similar to those in adult patients. UCB, which markets Vimpat, is headquartered in Brussels.

—Kimberly Williams

Brain Glucose Level Is Associated With Alzheimer’s Disease Severity

Impaired glucose metabolism due to reduced glycolytic flux may be intrinsic to Alzheimer’s disease pathogenesis, according to a study published online ahead of print October 19 in Alzheimer’s & Dementia. Within the autopsy cohort of the Baltimore Longitudinal Study of Aging, researchers measured brain glucose concentration and assessed the ratios of serine, glycine, and alanine to glucose. Investigators also quantified protein levels of the neuronal and astrocytic glucose transporters. In addition, study authors assessed the relationships between plasma glucose measured before death and brain tissue glucose. Higher brain tissue glucose concentration, reduced glycolytic flux, and lower neuronal glucose transporters were related to severity of Alzheimer’s disease pathology and the expression of Alzheimer’s disease symptoms. Longitudinal increases in fasting plasma glucose levels were associated with higher brain tissue glucose concentrations.

An Y, Varma VR, Varma S, et al. Evidence for brain glucose dysregulation in Alzheimer’s disease. Alzheimers Dement. 2017 Oct 19 [Epub ahead of print].

Is it Better to Be Asleep or Awake for DBS Implantation?

Patients with Parkinson’s disease who undergo deep brain stimulation (DBS) device implantation while asleep have better communication, cognition, and speech outcomes, according to a study published November 7 in Neurology. Thirty DBS candidates with Parkinson’s disease underwent imaging-guided implantation while asleep. Their six-month outcomes were compared to those of 39 patients who previously had undergone implantation while awake. Assessments included an off-levodopa Unified Parkinson’s Disease Rating Scale (UPDRS) II and III, the 39-item Parkinson’s Disease Questionnaire, motor diaries, and speech fluency. No difference was observed in improvement of UPDRS III or UPDRS II. Improvement in on time without dyskinesia was superior in asleep implantation. Quality of life scores improved in both groups. Improvement in summary index and subscores for cognition and communication were superior in implantation while asleep.

Brodsky MA, Anderson S, Murchison C, et al. Clinical outcomes of asleep vs awake deep brain stimulation for Parkinson disease. Neurology. 2017;89(19):1944-1950.

Is Inflammation During Middle Age Linked to Brain Shrinkage Later On?

People with blood biomarkers of inflammation during midlife may have more brain shrinkage decades later than people without these biomarkers, according to a study published online ahead of print November 1 in Neurology. Plasma levels of fibrinogen, albumin, white blood cells, von Willebrand factor, and Factor VIII were assessed at baseline in 1,633 participants in the Atherosclerosis Risk in Communities Study. Each standard deviation increase in midlife inflammation composite score was associated with 1,788 mm³ greater ventricular volume, 110 mm³ smaller hippocampal volume, 519 mm³ smaller occipital volume, and 532 mm³ smaller Alzheimer disease signature region volumes and reduced episodic memory 24 years later. Compared with participants with no elevated midlife inflammatory markers, participants with elevations in three or more markers had 5% smaller hippocampal and Alzheimer’s disease signature region volumes.

Walker KA, Hoogeveen RC, Folsom AR, et al. Midlife systemic inflammatory markers are associated with late-life brain volume: The ARIC study. Neurology. 2017 Nov 1 [Epub ahead of print].

Novel Wristbands Improve Seizure Detection

Wrist-worn convulsive seizure detectors provide more accurate seizure counts than previous automated detectors do, while maintaining tolerable false alarm rates (FAR) for ambulatory monitoring, according to a study published in the November issue of Epilepsia. Hand-annotated video-EEG seizure events were collected from 69 patients at six clinical sites. Two novel wristbands and one current wristband were used to record electrodermal activity and accelerometer signals, obtaining 5,928 hours of data, including 55 convulsive epileptic seizures in 22 patients. The novel wristbands consistently outperformed the current wristband. The best wristband had a sensitivity of 94.55% and an FAR of 0.2 events per day. When increasing the sensitivity to 100%, the FAR was as much as 13 times lower than with the current detector. Automatically estimated seizure durations were correlated with true durations.

Onorati F, Regalia G, Caborni C, et al. Multicenter clinical assessment of improved wearable multimodal convulsive seizure detectors. Epilepsia. 2017;58(11):1870-1879.

Focused Ultrasound Reduces Parkinson’s Disease Tremor

Focused ultrasound thalamotomy for patients with tremor-dominant Parkinson’s disease demonstrates improvement in medication-refractory tremor by Clinical Rating Scale for Tremor assessments, even in the setting of a placebo response, according to a study published online ahead of print October 30 in JAMA Neurology. Researchers randomized 20 patients to unilateral focused ultrasound thalamotomy and seven to a sham procedure. Twenty-six participants were male, and the median age was 67.8. The predefined primary outcomes were safety and difference in improvement between groups at three months in the on-medication treated hand tremor subscore from the Clinical Rating Scale for Tremor. On-medication median tremor scores improved 62% from a baseline of 17 points following focused ultrasound thalamotomy, and 22% from a baseline of 23 points after sham procedures.

Bond AE, Shah BB, Huss DS, et al. Safety and efficacy of focused ultrasound thalamotomy for patients with medication-refractory, tremor-dominant Parkinson disease: a randomized clinical trial. JAMA Neurol. 2017 Oct 30 [Epub ahead of print].

Biomarker of Multiple Sclerosis Identified

MicroRNAs associated with circulating exosomes are informative biomarkers for the diagnosis of multiple sclerosis (MS) and for predicting disease subtype with a high degree of accuracy, according to a study published October 30 in Scientific Reports. Exosome-associated microRNAs in serum samples from 25 patients with MS and 11 matched healthy controls were profiled using small RNA next-generation sequencing. In addition to identifying biomarkers that distinguish healthy people from people with MS, researchers identified nine microRNA molecules that differentiate between relapsing-remitting MS and progressive MS. Study authors also validated eight out of nine microRNA molecules in an independent group of 11 patients with progressive MS. The blood test may enable earlier treatment of MS and help neurologists identify the most appropriate treatment for a patient, said the authors.

Ebrahimkhani S, Vafaee F, Young PE, et al. Exosomal microRNA signatures in multiple sclerosis reflect disease status. Sci Rep. 2017;7(1):14293.

Does Oral Anticoagulation in Atrial Fibrillation Reduce Dementia Risk?

The risk of dementia in patients with atrial fibrillation is higher among those who do not take oral anticoagulants, compared with those who do, according to a study published online ahead of print October 24 in the European Heart Journal. This Swedish retrospective registry study included 444,106 patients with hospital diagnosis of atrial fibrillation and no previous diagnosis of dementia between 2006 and 2014. At baseline, 54% of patients were not taking oral anticoagulants. Investigators performed propensity score matching, used falsification end points, and performed intention-to-treat and on-treatment analyses. Patients on anticoagulant treatment at baseline had a 29% lower risk of dementia than patients without anticoagulant treatment, and a 48% lower risk analyzed on treatment. Direct comparison between new oral anticoagulants and warfarin showed no difference.

Friberg L, Rosenqvist M. Less dementia with oral anticoagulation in atrial fibrillation. Eur Heart J. 2017 Oct 24 [Epub ahead of print].

Dendritic Spine Plasticity May Protect Against Dementia

Dendritic spine plasticity protects older people with Alzheimer’s disease pathology from developing dementia, according to a study published in the October issue of Annals of Neurology. Researchers compared dendritic spines within layer II and III pyramidal neuron dendrites in Brodmann area 46 of the dorsolateral prefrontal cortex in 12 age-matched healthy controls, eight controls with Alzheimer’s disease pathology (CAD), and 21 people with Alzheimer’s disease. The investigators created digital reconstructions of dendritic structure for morphologic analyses. Spine density was similar among control and CAD cases, but was reduced significantly in Alzheimer’s disease. Thin and mushroom spines were reduced significantly in Alzheimer’s disease, compared with CAD brains, and stubby spine density was decreased significantly in CAD and Alzheimer’s disease, compared with controls.

Boros BD, Greathouse KM, Gentry EG, et al. Dendritic spines provide cognitive resilience against Alzheimer’s disease. Ann Neurol. 2017;82(4):602-614.

Opioid Versus Nonopioid Treatment for Acute Migraine

IV hydromorphone is substantially less effective than IV prochlorperazine for the treatment of acute migraine in the emergency department and should not be used as first-line therapy, according to a study published online ahead of print October 18 in Neurology. This study was conducted in two emergency departments and included patients who met international criteria for migraine if they had not used an opioid within the previous month. Participants received hydromorphone (1 mg) or prochlorperazine (10 mg) and diphenhydramine (25 mg). The primary outcome was achieving a headache level of mild or none within two hours of treatment and maintaining that level for 48 hours without rescue medication. Approximately 60% of the prochlorperazine arm achieved the primary outcome, compared with 31% of the hydromorphone arm.

Friedman BW, Irizarry E, Solorzano C, et al. Randomized study of IV prochlorperazine plus diphenhydramine vs IV hydromorphone for migraine. Neurology. 2017 Oct 18 [Epub ahead of print].

Frontotemporal Degeneration Entails High Economic Burden

The economic burden of frontotemporal degeneration may be twice as high as that of Alzheimer’s disease, according to a study published online ahead of print October 4 in Neurology. An Internet survey was administered to 674 primary caregivers of patients with behavioral-variant frontotemporal degeneration, primary progressive aphasia, frontotemporal degeneration with motor neuron disease, corticobasal syndrome, or progressive supranuclear palsy. Direct costs for these disorders equaled $47,916, and indirect costs equaled $71,737. Patients age 65 or older, those with later stages of disease, and those with behavioral-variant frontotemporal degeneration had higher direct costs, while patients younger than 65 and men had higher indirect costs. Mean household income ranged from $75,000 to $99,000 at 12 months before frontotemporal degeneration diagnosis, but declined to $50,000 to $59,999 after diagnosis.

Galvin JE, Howard DH, Denny SS, et al. The social and economic burden of frontotemporal degeneration. Neurology. 2017 Oct 4 [Epub ahead of print].

FDA Approves Vimpat for Partial-Onset Seizures in Pediatric Epilepsy

The FDA has approved a label extension for Vimpat (lacosamide) CV as an oral option for the treatment of partial-onset seizures in pediatric patients age 4 and older. The safety and efficacy profile of Vimpat as monotherapy and adjunctive therapy for the treatment of partial-onset seizures in adults was previously established in four multicenter, randomized, controlled clinical trials. The expanded indication for Vimpat is based on extrapolation of efficacy data from adults to children and is supported by safety and pharmacokinetics data collected in children. Adverse reactions in pediatric patients are similar to those in adult patients. UCB, which markets Vimpat, is headquartered in Brussels.

—Kimberly Williams

Brain Glucose Level Is Associated With Alzheimer’s Disease Severity

Impaired glucose metabolism due to reduced glycolytic flux may be intrinsic to Alzheimer’s disease pathogenesis, according to a study published online ahead of print October 19 in Alzheimer’s & Dementia. Within the autopsy cohort of the Baltimore Longitudinal Study of Aging, researchers measured brain glucose concentration and assessed the ratios of serine, glycine, and alanine to glucose. Investigators also quantified protein levels of the neuronal and astrocytic glucose transporters. In addition, study authors assessed the relationships between plasma glucose measured before death and brain tissue glucose. Higher brain tissue glucose concentration, reduced glycolytic flux, and lower neuronal glucose transporters were related to severity of Alzheimer’s disease pathology and the expression of Alzheimer’s disease symptoms. Longitudinal increases in fasting plasma glucose levels were associated with higher brain tissue glucose concentrations.

An Y, Varma VR, Varma S, et al. Evidence for brain glucose dysregulation in Alzheimer’s disease. Alzheimers Dement. 2017 Oct 19 [Epub ahead of print].

Is it Better to Be Asleep or Awake for DBS Implantation?

Patients with Parkinson’s disease who undergo deep brain stimulation (DBS) device implantation while asleep have better communication, cognition, and speech outcomes, according to a study published November 7 in Neurology. Thirty DBS candidates with Parkinson’s disease underwent imaging-guided implantation while asleep. Their six-month outcomes were compared to those of 39 patients who previously had undergone implantation while awake. Assessments included an off-levodopa Unified Parkinson’s Disease Rating Scale (UPDRS) II and III, the 39-item Parkinson’s Disease Questionnaire, motor diaries, and speech fluency. No difference was observed in improvement of UPDRS III or UPDRS II. Improvement in on time without dyskinesia was superior in asleep implantation. Quality of life scores improved in both groups. Improvement in summary index and subscores for cognition and communication were superior in implantation while asleep.

Brodsky MA, Anderson S, Murchison C, et al. Clinical outcomes of asleep vs awake deep brain stimulation for Parkinson disease. Neurology. 2017;89(19):1944-1950.

Is Inflammation During Middle Age Linked to Brain Shrinkage Later On?

People with blood biomarkers of inflammation during midlife may have more brain shrinkage decades later than people without these biomarkers, according to a study published online ahead of print November 1 in Neurology. Plasma levels of fibrinogen, albumin, white blood cells, von Willebrand factor, and Factor VIII were assessed at baseline in 1,633 participants in the Atherosclerosis Risk in Communities Study. Each standard deviation increase in midlife inflammation composite score was associated with 1,788 mm³ greater ventricular volume, 110 mm³ smaller hippocampal volume, 519 mm³ smaller occipital volume, and 532 mm³ smaller Alzheimer disease signature region volumes and reduced episodic memory 24 years later. Compared with participants with no elevated midlife inflammatory markers, participants with elevations in three or more markers had 5% smaller hippocampal and Alzheimer’s disease signature region volumes.

Walker KA, Hoogeveen RC, Folsom AR, et al. Midlife systemic inflammatory markers are associated with late-life brain volume: The ARIC study. Neurology. 2017 Nov 1 [Epub ahead of print].

Novel Wristbands Improve Seizure Detection

Wrist-worn convulsive seizure detectors provide more accurate seizure counts than previous automated detectors do, while maintaining tolerable false alarm rates (FAR) for ambulatory monitoring, according to a study published in the November issue of Epilepsia. Hand-annotated video-EEG seizure events were collected from 69 patients at six clinical sites. Two novel wristbands and one current wristband were used to record electrodermal activity and accelerometer signals, obtaining 5,928 hours of data, including 55 convulsive epileptic seizures in 22 patients. The novel wristbands consistently outperformed the current wristband. The best wristband had a sensitivity of 94.55% and an FAR of 0.2 events per day. When increasing the sensitivity to 100%, the FAR was as much as 13 times lower than with the current detector. Automatically estimated seizure durations were correlated with true durations.

Onorati F, Regalia G, Caborni C, et al. Multicenter clinical assessment of improved wearable multimodal convulsive seizure detectors. Epilepsia. 2017;58(11):1870-1879.

Focused Ultrasound Reduces Parkinson’s Disease Tremor

Focused ultrasound thalamotomy for patients with tremor-dominant Parkinson’s disease demonstrates improvement in medication-refractory tremor by Clinical Rating Scale for Tremor assessments, even in the setting of a placebo response, according to a study published online ahead of print October 30 in JAMA Neurology. Researchers randomized 20 patients to unilateral focused ultrasound thalamotomy and seven to a sham procedure. Twenty-six participants were male, and the median age was 67.8. The predefined primary outcomes were safety and difference in improvement between groups at three months in the on-medication treated hand tremor subscore from the Clinical Rating Scale for Tremor. On-medication median tremor scores improved 62% from a baseline of 17 points following focused ultrasound thalamotomy, and 22% from a baseline of 23 points after sham procedures.

Bond AE, Shah BB, Huss DS, et al. Safety and efficacy of focused ultrasound thalamotomy for patients with medication-refractory, tremor-dominant Parkinson disease: a randomized clinical trial. JAMA Neurol. 2017 Oct 30 [Epub ahead of print].

Biomarker of Multiple Sclerosis Identified

MicroRNAs associated with circulating exosomes are informative biomarkers for the diagnosis of multiple sclerosis (MS) and for predicting disease subtype with a high degree of accuracy, according to a study published October 30 in Scientific Reports. Exosome-associated microRNAs in serum samples from 25 patients with MS and 11 matched healthy controls were profiled using small RNA next-generation sequencing. In addition to identifying biomarkers that distinguish healthy people from people with MS, researchers identified nine microRNA molecules that differentiate between relapsing-remitting MS and progressive MS. Study authors also validated eight out of nine microRNA molecules in an independent group of 11 patients with progressive MS. The blood test may enable earlier treatment of MS and help neurologists identify the most appropriate treatment for a patient, said the authors.

Ebrahimkhani S, Vafaee F, Young PE, et al. Exosomal microRNA signatures in multiple sclerosis reflect disease status. Sci Rep. 2017;7(1):14293.

Does Oral Anticoagulation in Atrial Fibrillation Reduce Dementia Risk?

The risk of dementia in patients with atrial fibrillation is higher among those who do not take oral anticoagulants, compared with those who do, according to a study published online ahead of print October 24 in the European Heart Journal. This Swedish retrospective registry study included 444,106 patients with hospital diagnosis of atrial fibrillation and no previous diagnosis of dementia between 2006 and 2014. At baseline, 54% of patients were not taking oral anticoagulants. Investigators performed propensity score matching, used falsification end points, and performed intention-to-treat and on-treatment analyses. Patients on anticoagulant treatment at baseline had a 29% lower risk of dementia than patients without anticoagulant treatment, and a 48% lower risk analyzed on treatment. Direct comparison between new oral anticoagulants and warfarin showed no difference.

Friberg L, Rosenqvist M. Less dementia with oral anticoagulation in atrial fibrillation. Eur Heart J. 2017 Oct 24 [Epub ahead of print].

Dendritic Spine Plasticity May Protect Against Dementia

Dendritic spine plasticity protects older people with Alzheimer’s disease pathology from developing dementia, according to a study published in the October issue of Annals of Neurology. Researchers compared dendritic spines within layer II and III pyramidal neuron dendrites in Brodmann area 46 of the dorsolateral prefrontal cortex in 12 age-matched healthy controls, eight controls with Alzheimer’s disease pathology (CAD), and 21 people with Alzheimer’s disease. The investigators created digital reconstructions of dendritic structure for morphologic analyses. Spine density was similar among control and CAD cases, but was reduced significantly in Alzheimer’s disease. Thin and mushroom spines were reduced significantly in Alzheimer’s disease, compared with CAD brains, and stubby spine density was decreased significantly in CAD and Alzheimer’s disease, compared with controls.

Boros BD, Greathouse KM, Gentry EG, et al. Dendritic spines provide cognitive resilience against Alzheimer’s disease. Ann Neurol. 2017;82(4):602-614.

Opioid Versus Nonopioid Treatment for Acute Migraine

IV hydromorphone is substantially less effective than IV prochlorperazine for the treatment of acute migraine in the emergency department and should not be used as first-line therapy, according to a study published online ahead of print October 18 in Neurology. This study was conducted in two emergency departments and included patients who met international criteria for migraine if they had not used an opioid within the previous month. Participants received hydromorphone (1 mg) or prochlorperazine (10 mg) and diphenhydramine (25 mg). The primary outcome was achieving a headache level of mild or none within two hours of treatment and maintaining that level for 48 hours without rescue medication. Approximately 60% of the prochlorperazine arm achieved the primary outcome, compared with 31% of the hydromorphone arm.

Friedman BW, Irizarry E, Solorzano C, et al. Randomized study of IV prochlorperazine plus diphenhydramine vs IV hydromorphone for migraine. Neurology. 2017 Oct 18 [Epub ahead of print].

Frontotemporal Degeneration Entails High Economic Burden

The economic burden of frontotemporal degeneration may be twice as high as that of Alzheimer’s disease, according to a study published online ahead of print October 4 in Neurology. An Internet survey was administered to 674 primary caregivers of patients with behavioral-variant frontotemporal degeneration, primary progressive aphasia, frontotemporal degeneration with motor neuron disease, corticobasal syndrome, or progressive supranuclear palsy. Direct costs for these disorders equaled $47,916, and indirect costs equaled $71,737. Patients age 65 or older, those with later stages of disease, and those with behavioral-variant frontotemporal degeneration had higher direct costs, while patients younger than 65 and men had higher indirect costs. Mean household income ranged from $75,000 to $99,000 at 12 months before frontotemporal degeneration diagnosis, but declined to $50,000 to $59,999 after diagnosis.

Galvin JE, Howard DH, Denny SS, et al. The social and economic burden of frontotemporal degeneration. Neurology. 2017 Oct 4 [Epub ahead of print].

FDA Approves Vimpat for Partial-Onset Seizures in Pediatric Epilepsy

The FDA has approved a label extension for Vimpat (lacosamide) CV as an oral option for the treatment of partial-onset seizures in pediatric patients age 4 and older. The safety and efficacy profile of Vimpat as monotherapy and adjunctive therapy for the treatment of partial-onset seizures in adults was previously established in four multicenter, randomized, controlled clinical trials. The expanded indication for Vimpat is based on extrapolation of efficacy data from adults to children and is supported by safety and pharmacokinetics data collected in children. Adverse reactions in pediatric patients are similar to those in adult patients. UCB, which markets Vimpat, is headquartered in Brussels.

—Kimberly Williams