Neurosurgery & Trauma

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

ANAHEIM, CALIF. – Withdrawal of life-sustaining systemic therapies in comatose patients after out-of-hospital cardiac arrest as advised in current guidelines often occurs too early, resulting in the death of many patients who could potentially survive with good outcome, according to the results of NORCAST, the Norwegian Cardiorespiratory Arrest Study.

“The take-home message is to be patient and wait. Three days may be too early to make decisions on the patient,” Kjetil Sunde, MD, said in presenting the study findings at the Resuscitation Science Symposium held during the American Heart Association scientific sessions.

Bruce Jancin/Frontline Medical News

Key findings

Out of 259 patients who were comatose upon admission, 54% were alive at 6 months – and 91% of them had a CPC of 1 or 2.

The final tally at 6 months: 44% of patients were CPC 1, 5.5% were CPC 2, 4% were CPC 3, meaning severely disabled, and 46.5% were CPC 5, which is brain dead.

Withdrawal of life-supporting therapies occurred in 73 patients, or 28%, and 71% of those patients died, few of them in the early days.

Among patients with a CPC score of 1 or 2 at 6 months, only 20% were awake on day 1-3 following admission. Fifty-seven percent awoke on day 4-7, but importantly, 23% of patients with a good outcome at 6 months were not yet awake on day 8.

Three days after withdrawal of sedation, 49% of patients were rated as having a Glasgow Coma Scale score of 3-8, while 51% were Glasgow Coma Scale 9-15. Moreover, at that time 26% of patients with a good outcome as defined by a CPC of 1 or 2 at 6 months were still in a coma.

“So a lot of patients were still affected by their disease or by sedation at that point. That’s an important finding,” Dr. Sunde said.
 

Some prognostic tests were highly unreliable

A standout in poor performance was the widely utilized standard of a time to return of spontaneous circulation greater than 25 minutes as a predictor of poor cerebral outcome. In fact, it had a 34% false-positive rate.

“I think it’s really useless to use that. I would rather have return to spontaneous circulation after 40 minutes of good-quality CPR than not have it with 25 minutes of lesser-quality CPR,” he commented.

Similarly, a Glasgow Coma Scale score of 9 or less or a Glasgow Coma Scale-Motor score of 1-3 upon assessment 3 days after sedation withdrawal had false-positive rates of 30% and 34%, respectively.

During hypothermia, EEG abnormalities had a high false-positive rate, and sensory-evoked potential findings were difficult to interpret.
 

Predictors showing utility

Several clinical factors predicted poor cerebral outcome with low false-positive rates: Unwitnessed cardiac arrest had a false-positive rate of only 4%; initial presentation in asystole or with pulseless electrical activity had a false-positive rate of 6%; and no bystander CPR had a false-positive rate of 13%.

Abnormal sensory-evoked potential or EEG findings 3 days after sedation withdrawal had low false-positive rates as prognosticators of poor cerebral outcome. An EEG showing burst suppression or epileptiform activity had a “pretty good” false-positive rate of only 7%, Dr. Sunde noted. Bilaterally absent N20 sensory-evoked potential findings, while uncommon, had a false-positive rate of zero. A serum neuron-specific enolase level greater than 80 mcg/mL had a 3% false-positive rate, in sharp contrast to the previously recommended cutoff of more than 33 mcg/mL, which had an unacceptable 38% false-positive rate.

“We should avoid using single predictors in decision making and be patient, especially if we have a witnessed ventricular fibrillation with bystander CPR, independent of time to return of spontaneous circulation,” he concluded.

Dr. Sunde and his coinvestigators plan to present numerous further follow-up studies from NORCAST, including the results of comprehensive cognitive function testing 6-9 months after cardiac arrest in all survivors, coupled with interviews with their close relatives, as well as cognitive function and quality-of-life measurements 3-6 years after cardiac arrest along with interviews with relatives.

Several audience members rose to declare that they’ve been waiting for data such as this for a long time. Session chair Karl B. Kern, MD, professor of medicine at the University of Arizona, Tucson, and codirector of the University of Arizona Sarver Heart Center, commented, “We’ve been talking about whether 3 days is too early for a number of years, and clearly from your data it is. It was twice as long before most of them woke up.”

Dr. Sunde reported having no financial conflicts of interest regarding the NORCAST study, which was sponsored by Oslo University Hospital.

[email protected]

ANAHEIM, CALIF. – Withdrawal of life-sustaining systemic therapies in comatose patients after out-of-hospital cardiac arrest as advised in current guidelines often occurs too early, resulting in the death of many patients who could potentially survive with good outcome, according to the results of NORCAST, the Norwegian Cardiorespiratory Arrest Study.

“The take-home message is to be patient and wait. Three days may be too early to make decisions on the patient,” Kjetil Sunde, MD, said in presenting the study findings at the Resuscitation Science Symposium held during the American Heart Association scientific sessions.

Bruce Jancin/Frontline Medical News

Key findings

Out of 259 patients who were comatose upon admission, 54% were alive at 6 months – and 91% of them had a CPC of 1 or 2.

The final tally at 6 months: 44% of patients were CPC 1, 5.5% were CPC 2, 4% were CPC 3, meaning severely disabled, and 46.5% were CPC 5, which is brain dead.

Withdrawal of life-supporting therapies occurred in 73 patients, or 28%, and 71% of those patients died, few of them in the early days.

Among patients with a CPC score of 1 or 2 at 6 months, only 20% were awake on day 1-3 following admission. Fifty-seven percent awoke on day 4-7, but importantly, 23% of patients with a good outcome at 6 months were not yet awake on day 8.

Three days after withdrawal of sedation, 49% of patients were rated as having a Glasgow Coma Scale score of 3-8, while 51% were Glasgow Coma Scale 9-15. Moreover, at that time 26% of patients with a good outcome as defined by a CPC of 1 or 2 at 6 months were still in a coma.

“So a lot of patients were still affected by their disease or by sedation at that point. That’s an important finding,” Dr. Sunde said.
 

Some prognostic tests were highly unreliable

A standout in poor performance was the widely utilized standard of a time to return of spontaneous circulation greater than 25 minutes as a predictor of poor cerebral outcome. In fact, it had a 34% false-positive rate.

“I think it’s really useless to use that. I would rather have return to spontaneous circulation after 40 minutes of good-quality CPR than not have it with 25 minutes of lesser-quality CPR,” he commented.

Similarly, a Glasgow Coma Scale score of 9 or less or a Glasgow Coma Scale-Motor score of 1-3 upon assessment 3 days after sedation withdrawal had false-positive rates of 30% and 34%, respectively.

During hypothermia, EEG abnormalities had a high false-positive rate, and sensory-evoked potential findings were difficult to interpret.
 

Predictors showing utility

Several clinical factors predicted poor cerebral outcome with low false-positive rates: Unwitnessed cardiac arrest had a false-positive rate of only 4%; initial presentation in asystole or with pulseless electrical activity had a false-positive rate of 6%; and no bystander CPR had a false-positive rate of 13%.

Abnormal sensory-evoked potential or EEG findings 3 days after sedation withdrawal had low false-positive rates as prognosticators of poor cerebral outcome. An EEG showing burst suppression or epileptiform activity had a “pretty good” false-positive rate of only 7%, Dr. Sunde noted. Bilaterally absent N20 sensory-evoked potential findings, while uncommon, had a false-positive rate of zero. A serum neuron-specific enolase level greater than 80 mcg/mL had a 3% false-positive rate, in sharp contrast to the previously recommended cutoff of more than 33 mcg/mL, which had an unacceptable 38% false-positive rate.

“We should avoid using single predictors in decision making and be patient, especially if we have a witnessed ventricular fibrillation with bystander CPR, independent of time to return of spontaneous circulation,” he concluded.

Dr. Sunde and his coinvestigators plan to present numerous further follow-up studies from NORCAST, including the results of comprehensive cognitive function testing 6-9 months after cardiac arrest in all survivors, coupled with interviews with their close relatives, as well as cognitive function and quality-of-life measurements 3-6 years after cardiac arrest along with interviews with relatives.

Several audience members rose to declare that they’ve been waiting for data such as this for a long time. Session chair Karl B. Kern, MD, professor of medicine at the University of Arizona, Tucson, and codirector of the University of Arizona Sarver Heart Center, commented, “We’ve been talking about whether 3 days is too early for a number of years, and clearly from your data it is. It was twice as long before most of them woke up.”

Dr. Sunde reported having no financial conflicts of interest regarding the NORCAST study, which was sponsored by Oslo University Hospital.

[email protected]

ANAHEIM, CALIF. – Withdrawal of life-sustaining systemic therapies in comatose patients after out-of-hospital cardiac arrest as advised in current guidelines often occurs too early, resulting in the death of many patients who could potentially survive with good outcome, according to the results of NORCAST, the Norwegian Cardiorespiratory Arrest Study.

“The take-home message is to be patient and wait. Three days may be too early to make decisions on the patient,” Kjetil Sunde, MD, said in presenting the study findings at the Resuscitation Science Symposium held during the American Heart Association scientific sessions.

Bruce Jancin/Frontline Medical News

Key findings

Out of 259 patients who were comatose upon admission, 54% were alive at 6 months – and 91% of them had a CPC of 1 or 2.

The final tally at 6 months: 44% of patients were CPC 1, 5.5% were CPC 2, 4% were CPC 3, meaning severely disabled, and 46.5% were CPC 5, which is brain dead.

Withdrawal of life-supporting therapies occurred in 73 patients, or 28%, and 71% of those patients died, few of them in the early days.

Among patients with a CPC score of 1 or 2 at 6 months, only 20% were awake on day 1-3 following admission. Fifty-seven percent awoke on day 4-7, but importantly, 23% of patients with a good outcome at 6 months were not yet awake on day 8.

Three days after withdrawal of sedation, 49% of patients were rated as having a Glasgow Coma Scale score of 3-8, while 51% were Glasgow Coma Scale 9-15. Moreover, at that time 26% of patients with a good outcome as defined by a CPC of 1 or 2 at 6 months were still in a coma.

“So a lot of patients were still affected by their disease or by sedation at that point. That’s an important finding,” Dr. Sunde said.
 

Some prognostic tests were highly unreliable

A standout in poor performance was the widely utilized standard of a time to return of spontaneous circulation greater than 25 minutes as a predictor of poor cerebral outcome. In fact, it had a 34% false-positive rate.

“I think it’s really useless to use that. I would rather have return to spontaneous circulation after 40 minutes of good-quality CPR than not have it with 25 minutes of lesser-quality CPR,” he commented.

Similarly, a Glasgow Coma Scale score of 9 or less or a Glasgow Coma Scale-Motor score of 1-3 upon assessment 3 days after sedation withdrawal had false-positive rates of 30% and 34%, respectively.

During hypothermia, EEG abnormalities had a high false-positive rate, and sensory-evoked potential findings were difficult to interpret.
 

Predictors showing utility

Several clinical factors predicted poor cerebral outcome with low false-positive rates: Unwitnessed cardiac arrest had a false-positive rate of only 4%; initial presentation in asystole or with pulseless electrical activity had a false-positive rate of 6%; and no bystander CPR had a false-positive rate of 13%.

Abnormal sensory-evoked potential or EEG findings 3 days after sedation withdrawal had low false-positive rates as prognosticators of poor cerebral outcome. An EEG showing burst suppression or epileptiform activity had a “pretty good” false-positive rate of only 7%, Dr. Sunde noted. Bilaterally absent N20 sensory-evoked potential findings, while uncommon, had a false-positive rate of zero. A serum neuron-specific enolase level greater than 80 mcg/mL had a 3% false-positive rate, in sharp contrast to the previously recommended cutoff of more than 33 mcg/mL, which had an unacceptable 38% false-positive rate.

“We should avoid using single predictors in decision making and be patient, especially if we have a witnessed ventricular fibrillation with bystander CPR, independent of time to return of spontaneous circulation,” he concluded.

Dr. Sunde and his coinvestigators plan to present numerous further follow-up studies from NORCAST, including the results of comprehensive cognitive function testing 6-9 months after cardiac arrest in all survivors, coupled with interviews with their close relatives, as well as cognitive function and quality-of-life measurements 3-6 years after cardiac arrest along with interviews with relatives.

Several audience members rose to declare that they’ve been waiting for data such as this for a long time. Session chair Karl B. Kern, MD, professor of medicine at the University of Arizona, Tucson, and codirector of the University of Arizona Sarver Heart Center, commented, “We’ve been talking about whether 3 days is too early for a number of years, and clearly from your data it is. It was twice as long before most of them woke up.”

Dr. Sunde reported having no financial conflicts of interest regarding the NORCAST study, which was sponsored by Oslo University Hospital.

[email protected]

Can a Fatty Diet Increase Relapse Risk in Children With MS?

In children with multiple sclerosis (MS), high energy intake from fat, especially saturated fat, may increase the hazard of relapse, while vegetable intake may be independently protective, according to a study published online ahead of print October 9 in the Journal of Neurology, Neurosurgery & Psychiatry. A total of 219 patients with pediatric relapsing-remitting MS or clinically isolated syndrome with disease onset before age 18 and duration of less than four years were enrolled in a multicenter study that was completed at 11 pediatric MS centers. Investigators used the Block Kids Food Screener to examine dietary intake during the week before enrollment. Each 10% increase in energy intake from fat increased the hazard of relapse by 56%, and each 10% increase in saturated fat tripled this hazard.

Azary S, Schreiner T, Graves J, et al. Contribution of dietary intake to relapse rate in early paediatric multiple sclerosis. J Neurol Neurosurg Psychiatry. 2017 Oct 9 [Epub ahead of print].

Cooling Reduces Risk of Epilepsy After Perinatal Asphyxia

Administering therapeutic hypothermia to babies with perinatal asphyxia can reduce their risk of epilepsy in childhood, according to a study published online ahead of print September 29 in Epilepsia. From 2006 to 2013, 151 infants with perinatal asphyxia underwent 72 hours of cooling. Clinical and amplitude-integrated EEG with single-channel EEG-verified neonatal seizures were treated with antiepileptic drugs (AEDs). MRI was assessed using a severity score that ranged from 0 to 11. One hundred thirty-four children were assessed at 18–24 months. Babies born after 2007 who received therapeutic hypothermia had a lower rate of epilepsy than those born before this method was introduced. At two years, 6% of the children had epilepsy, and 2% were receiving AEDs. Before therapeutic hypothermia was introduced, the rate of death or moderate or severe disability was about 66%.

Liu X, Jary S, Cowan F, Thoresen M. Reduced infancy and childhood epilepsy following hypothermia-treated neonatal encephalopathy. Epilepsia. 2017 Sep 29 [Epub ahead of print].

Risk Factors Are Increasing in People With Stroke

The prevalence of hypertension, diabetes, dyslipidemia, smoking, and drug abuse in acute ischemic stroke increased between 2004 and 2014, according to a study published online ahead of print October 11 in Neurology. Researchers used the National Inpatient Sample to identify 922,451 adult hospitalizations for ischemic stroke. In all, 92.5% of patients with stroke had one or more risk factors. Age- and sex-adjusted prevalence of hypertension, diabetes, dyslipidemia, smoking, and drug abuse were 79%, 34%, 47%, 15%, and 2%, respectively. The prevalence of carotid stenosis, chronic renal failure, and coronary artery disease were 13%, 12%, and 27%, respectively. Risk factor prevalence varied by age, race, and sex. The prevalence of hypertension, diabetes, dyslipidemia, smoking, and drug abuse increased annually by 1.4%, 2%, 7%, 5%, and 7%, respectively.

Otite FO, Liaw N, Khandelwal P, et al. Increasing prevalence of vascular risk factors in patients with stroke: a call to action. Neurology. 2017 Oct 11 [Epub ahead of print].

Transcranial Direct-Current Stimulation for MS-Related Fatigue

People with multiple sclerosis (MS) who undergo a noninvasive form of electrical brain stimulation have significantly reduced fatigue, according to a study published online ahead of print September 1 in the Multiple Sclerosis Journal. Twenty-seven people with MS were randomized to receive transcranial direct-current stimulation or a placebo while playing a cognitive training game that targets processing speed and working memory. After 20 sessions, participants reported their level of fatigue using the Patient-Reported Outcomes Measurement Information System. Higher numbers correlated with greater fatigue. The researchers reported a statistically significant reduction in the group that underwent transcranial direct-current stimulation, compared with the placebo group. Intervention participants had a 5.6-point drop in fatigue on average, while control participants had a 0.9-point increase in fatigue.

Charvet LE, Dobbs B, Shaw MT, et al. Remotely supervised transcranial direct current stimulation for the treatment of fatigue in multiple sclerosis: results from a randomized, sham-controlled trial. Mult Scler. 2017 Sep 1 [Epub ahead of print].

New Genetic Risk Variants for RLS Identified

Thirteen previously unknown genetic risk variants for restless legs syndrome (RLS) have been identified, according to a study published in the November issue of Lancet Neurology. Researchers combined three genome-wide association studies’ datasets with diagnosis data collected from 2003 to 2017. The latter data came from interviews and questionnaires and included 15,126 cases and 95,725 controls. Significant genome-wide signals were tested for replication in an independent genome-wide association study of 30,770 cases and 286,913 controls. Investigators identified and replicated 13 new risk loci for RLS and confirmed six previously identified risk loci. MEIS1 was confirmed as the strongest genetic risk factor for RLS. Gene prioritization, enrichment, and genetic correlation analyses showed that identified pathways were related to neurodevelopment and highlighted genes linked to axon guidance, synapse formation, and neuronal specification.

Schormair B, Zhao C, Bell S, et al. Identification of novel risk loci for restless legs syndrome in genome-wide association studies in individuals of European ancestry: a meta-analysis. Lancet Neurol. 2017;16(11):898-907.

High Blood Pressure Associated With Increased Dementia Risk in Women

Hypertension is more common in men, but is only associated with dementia risk in women, according to a study published online ahead of print October 4 in Neurology. Researchers evaluated 5,646 members of a diverse integrated health care delivery system who had clinical examinations and health survey data from 1964 to 1973 (mean age, 32.7) and 1978 to 1985 (mean age, 44.3) and were members as of January 1, 1996 (mean age, 59.8). A total of 532 people were diagnosed with dementia. Mid-adulthood (circa age 44) hypertension was associated with 65% increased dementia risk among women, but not among men. Onset of hypertension in mid-adulthood predicted 73% higher dementia risk in women, compared with stable normotension. There was no evidence that hypertension or changes in hypertension increased dementia risk among men.

Gilsanz P, Mayeda ER, Glymour MM, et al. Female sex, early-onset hypertension, and risk of dementia. Neurology. 2017 Oct 4 [Epub ahead of print].

A Risk Factor for Major Bleeding During Treatment With NOACs

Among patients taking non-vitamin K oral anticoagulants (NOACs) for nonvalvular atrial fibrillation, concurrent use of amiodarone, fluconazole, rifampin, and phenytoin, compared with the use of NOACs alone, is associated with increased risk of major bleeding, according to a study published October 3 in JAMA. Researchers retrospectively examined data for 91,330 patients with nonvalvular atrial fibrillation who received at least one NOAC prescription of dabigatran, rivaroxaban, or apixaban from 2012 through 2016. They analyzed the bleeding risk associated with the concurrent use of 12 commonly prescribed medications. A total of 4,770 major bleeding events occurred. The incidence rate of major bleeding was significantly lower for concurrent use of atorvastatin, digoxin, and erythromycin or clarithromycin. Physicians prescribing NOACs should consider the potential risks associated with concomitant use of other drugs, the researchers said.

Chang SH, Chou IJ, Yeh YH, et al. Association between use of non-vitamin K oral anticoagulants with and without concurrent medications and risk of major bleeding in nonvalvular atrial fibrillation. JAMA. 2017;318(13):1250-1259.

Discontinuing Aspirin Therapy May Increase Cardiovascular Risk

In long-term users, discontinuation of low-dose aspirin in the absence of major surgery or bleeding is associated with a greater-than-30% increased risk of cardiovascular events, according to a study published September 26 in Circulation. Researchers performed a cohort study of 601,527 participants taking low-dose aspirin for heart attack and stroke prevention between 2005 and 2009. Participants were older than 40, cancer-free, and had an adherence rate of 80% or greater during the first year of treatment. During a median of 3.0 years of follow-up, 62,690 cardiovascular events were reported. Patients who discontinued aspirin had a higher rate of cardiovascular events than those who continued (multivariable-adjusted hazard ratio, 1.37), corresponding to an additional cardiovascular event observed per year in one of every 74 patients who discontinued aspirin.

Sundström J, Hedberg J, Thuresson M, et al. Low-dose aspirin discontinuation and risk of cardiovascular events: a Swedish nationwide, population-based cohort study. Circulation. 2017;136(13):1183-1192.

FDA Approves 80-mg Ingrezza Capsule for Tardive Dyskinesia

The FDA has approved an 80-mg capsule of Ingrezza (valbenazine) for the treatment of adults with tardive dyskinesia. In clinical studies, Ingrezza 80 mg provided significant, rapid, and meaningful improvement in tardive dyskinesia severity, compared with placebo, at six weeks. Results were seen as early as two weeks, and continued reductions were observed through 48 weeks of treatment. The drug was FDA-approved in April and has been available as 40-mg capsules. Neurocrine Biosciences markets Ingrezza.

FDA Approves Generic Version of Copaxone

The FDA has approved Mylan’s glatiramer acetate injection 40 mg/mL for thrice-weekly injection. The drug is a substitutable generic version of Teva’s Copaxone 40 mg/mL. The agency also approved Mylan’s glatiramer acetate injection 20 mg/mL for once-daily injection, a substitutable generic version of Teva’s Copaxone 20 mg/mL. Both products are indicated for the treatment of patients with relapsing forms of multiple sclerosis. As part of its applications, Mylan submitted side-by-side analyses demonstrating that its glatiramer acetate injections have the same active ingredient, dosage form, route of administration, and strength as their branded counterpart.

FDA Approves Gocovri for Dyskinesia in Parkinson’s Disease

The FDA has approved Gocovri (amantadine) extended-release capsules for the treatment of dyskinesia in patients with Parkinson’s disease receiving levodopa-based therapy with or without concomitant dopaminergic medications. Gocovri, previously granted orphan drug status by the FDA, is the first medicine approved by the FDA for this indication. Gocovri is a high-dose (274 mg) formulation of amantadine (equivalent to 340 mg of amantadine HCl) taken once-daily at bedtime that delivers consistently high levels of amantadine from the morning and throughout the day. Adamas Pharmaceuticals markets the drug.

FDA Has Approved Lyrica CR for Two Indications

The FDA has approved Lyrica CR (pregabalin) extended-release tablets CV as once-daily therapy for the management of neuropathic pain associated with diabetic peripheral neuropathy and the management of postherpetic neuralgia. The efficacy and safety of Lyrica CR in postherpetic neuralgia was established in a randomized placebo-controlled clinical trial conducted in 801 patients with postherpetic neuralgia who entered single-blind treatment with Lyrica CR. In the study, 73.6% of patients in the Lyrica CR group achieved at least 50% improvement in pain intensity, compared with 54.6% in the placebo group. The postherpetic neuralgia data also supported the diabetic peripheral neuropathy indication. Pfizer markets Lyrica CR.

—Kimberly Williams

Can a Fatty Diet Increase Relapse Risk in Children With MS?

In children with multiple sclerosis (MS), high energy intake from fat, especially saturated fat, may increase the hazard of relapse, while vegetable intake may be independently protective, according to a study published online ahead of print October 9 in the Journal of Neurology, Neurosurgery & Psychiatry. A total of 219 patients with pediatric relapsing-remitting MS or clinically isolated syndrome with disease onset before age 18 and duration of less than four years were enrolled in a multicenter study that was completed at 11 pediatric MS centers. Investigators used the Block Kids Food Screener to examine dietary intake during the week before enrollment. Each 10% increase in energy intake from fat increased the hazard of relapse by 56%, and each 10% increase in saturated fat tripled this hazard.

Azary S, Schreiner T, Graves J, et al. Contribution of dietary intake to relapse rate in early paediatric multiple sclerosis. J Neurol Neurosurg Psychiatry. 2017 Oct 9 [Epub ahead of print].

Cooling Reduces Risk of Epilepsy After Perinatal Asphyxia

Administering therapeutic hypothermia to babies with perinatal asphyxia can reduce their risk of epilepsy in childhood, according to a study published online ahead of print September 29 in Epilepsia. From 2006 to 2013, 151 infants with perinatal asphyxia underwent 72 hours of cooling. Clinical and amplitude-integrated EEG with single-channel EEG-verified neonatal seizures were treated with antiepileptic drugs (AEDs). MRI was assessed using a severity score that ranged from 0 to 11. One hundred thirty-four children were assessed at 18–24 months. Babies born after 2007 who received therapeutic hypothermia had a lower rate of epilepsy than those born before this method was introduced. At two years, 6% of the children had epilepsy, and 2% were receiving AEDs. Before therapeutic hypothermia was introduced, the rate of death or moderate or severe disability was about 66%.

Liu X, Jary S, Cowan F, Thoresen M. Reduced infancy and childhood epilepsy following hypothermia-treated neonatal encephalopathy. Epilepsia. 2017 Sep 29 [Epub ahead of print].

Risk Factors Are Increasing in People With Stroke

The prevalence of hypertension, diabetes, dyslipidemia, smoking, and drug abuse in acute ischemic stroke increased between 2004 and 2014, according to a study published online ahead of print October 11 in Neurology. Researchers used the National Inpatient Sample to identify 922,451 adult hospitalizations for ischemic stroke. In all, 92.5% of patients with stroke had one or more risk factors. Age- and sex-adjusted prevalence of hypertension, diabetes, dyslipidemia, smoking, and drug abuse were 79%, 34%, 47%, 15%, and 2%, respectively. The prevalence of carotid stenosis, chronic renal failure, and coronary artery disease were 13%, 12%, and 27%, respectively. Risk factor prevalence varied by age, race, and sex. The prevalence of hypertension, diabetes, dyslipidemia, smoking, and drug abuse increased annually by 1.4%, 2%, 7%, 5%, and 7%, respectively.

Otite FO, Liaw N, Khandelwal P, et al. Increasing prevalence of vascular risk factors in patients with stroke: a call to action. Neurology. 2017 Oct 11 [Epub ahead of print].

Transcranial Direct-Current Stimulation for MS-Related Fatigue

People with multiple sclerosis (MS) who undergo a noninvasive form of electrical brain stimulation have significantly reduced fatigue, according to a study published online ahead of print September 1 in the Multiple Sclerosis Journal. Twenty-seven people with MS were randomized to receive transcranial direct-current stimulation or a placebo while playing a cognitive training game that targets processing speed and working memory. After 20 sessions, participants reported their level of fatigue using the Patient-Reported Outcomes Measurement Information System. Higher numbers correlated with greater fatigue. The researchers reported a statistically significant reduction in the group that underwent transcranial direct-current stimulation, compared with the placebo group. Intervention participants had a 5.6-point drop in fatigue on average, while control participants had a 0.9-point increase in fatigue.

Charvet LE, Dobbs B, Shaw MT, et al. Remotely supervised transcranial direct current stimulation for the treatment of fatigue in multiple sclerosis: results from a randomized, sham-controlled trial. Mult Scler. 2017 Sep 1 [Epub ahead of print].

New Genetic Risk Variants for RLS Identified

Thirteen previously unknown genetic risk variants for restless legs syndrome (RLS) have been identified, according to a study published in the November issue of Lancet Neurology. Researchers combined three genome-wide association studies’ datasets with diagnosis data collected from 2003 to 2017. The latter data came from interviews and questionnaires and included 15,126 cases and 95,725 controls. Significant genome-wide signals were tested for replication in an independent genome-wide association study of 30,770 cases and 286,913 controls. Investigators identified and replicated 13 new risk loci for RLS and confirmed six previously identified risk loci. MEIS1 was confirmed as the strongest genetic risk factor for RLS. Gene prioritization, enrichment, and genetic correlation analyses showed that identified pathways were related to neurodevelopment and highlighted genes linked to axon guidance, synapse formation, and neuronal specification.

Schormair B, Zhao C, Bell S, et al. Identification of novel risk loci for restless legs syndrome in genome-wide association studies in individuals of European ancestry: a meta-analysis. Lancet Neurol. 2017;16(11):898-907.

High Blood Pressure Associated With Increased Dementia Risk in Women

Hypertension is more common in men, but is only associated with dementia risk in women, according to a study published online ahead of print October 4 in Neurology. Researchers evaluated 5,646 members of a diverse integrated health care delivery system who had clinical examinations and health survey data from 1964 to 1973 (mean age, 32.7) and 1978 to 1985 (mean age, 44.3) and were members as of January 1, 1996 (mean age, 59.8). A total of 532 people were diagnosed with dementia. Mid-adulthood (circa age 44) hypertension was associated with 65% increased dementia risk among women, but not among men. Onset of hypertension in mid-adulthood predicted 73% higher dementia risk in women, compared with stable normotension. There was no evidence that hypertension or changes in hypertension increased dementia risk among men.

Gilsanz P, Mayeda ER, Glymour MM, et al. Female sex, early-onset hypertension, and risk of dementia. Neurology. 2017 Oct 4 [Epub ahead of print].

A Risk Factor for Major Bleeding During Treatment With NOACs

Among patients taking non-vitamin K oral anticoagulants (NOACs) for nonvalvular atrial fibrillation, concurrent use of amiodarone, fluconazole, rifampin, and phenytoin, compared with the use of NOACs alone, is associated with increased risk of major bleeding, according to a study published October 3 in JAMA. Researchers retrospectively examined data for 91,330 patients with nonvalvular atrial fibrillation who received at least one NOAC prescription of dabigatran, rivaroxaban, or apixaban from 2012 through 2016. They analyzed the bleeding risk associated with the concurrent use of 12 commonly prescribed medications. A total of 4,770 major bleeding events occurred. The incidence rate of major bleeding was significantly lower for concurrent use of atorvastatin, digoxin, and erythromycin or clarithromycin. Physicians prescribing NOACs should consider the potential risks associated with concomitant use of other drugs, the researchers said.

Chang SH, Chou IJ, Yeh YH, et al. Association between use of non-vitamin K oral anticoagulants with and without concurrent medications and risk of major bleeding in nonvalvular atrial fibrillation. JAMA. 2017;318(13):1250-1259.

Discontinuing Aspirin Therapy May Increase Cardiovascular Risk

In long-term users, discontinuation of low-dose aspirin in the absence of major surgery or bleeding is associated with a greater-than-30% increased risk of cardiovascular events, according to a study published September 26 in Circulation. Researchers performed a cohort study of 601,527 participants taking low-dose aspirin for heart attack and stroke prevention between 2005 and 2009. Participants were older than 40, cancer-free, and had an adherence rate of 80% or greater during the first year of treatment. During a median of 3.0 years of follow-up, 62,690 cardiovascular events were reported. Patients who discontinued aspirin had a higher rate of cardiovascular events than those who continued (multivariable-adjusted hazard ratio, 1.37), corresponding to an additional cardiovascular event observed per year in one of every 74 patients who discontinued aspirin.

Sundström J, Hedberg J, Thuresson M, et al. Low-dose aspirin discontinuation and risk of cardiovascular events: a Swedish nationwide, population-based cohort study. Circulation. 2017;136(13):1183-1192.

FDA Approves 80-mg Ingrezza Capsule for Tardive Dyskinesia

The FDA has approved an 80-mg capsule of Ingrezza (valbenazine) for the treatment of adults with tardive dyskinesia. In clinical studies, Ingrezza 80 mg provided significant, rapid, and meaningful improvement in tardive dyskinesia severity, compared with placebo, at six weeks. Results were seen as early as two weeks, and continued reductions were observed through 48 weeks of treatment. The drug was FDA-approved in April and has been available as 40-mg capsules. Neurocrine Biosciences markets Ingrezza.

FDA Approves Generic Version of Copaxone

The FDA has approved Mylan’s glatiramer acetate injection 40 mg/mL for thrice-weekly injection. The drug is a substitutable generic version of Teva’s Copaxone 40 mg/mL. The agency also approved Mylan’s glatiramer acetate injection 20 mg/mL for once-daily injection, a substitutable generic version of Teva’s Copaxone 20 mg/mL. Both products are indicated for the treatment of patients with relapsing forms of multiple sclerosis. As part of its applications, Mylan submitted side-by-side analyses demonstrating that its glatiramer acetate injections have the same active ingredient, dosage form, route of administration, and strength as their branded counterpart.

FDA Approves Gocovri for Dyskinesia in Parkinson’s Disease

The FDA has approved Gocovri (amantadine) extended-release capsules for the treatment of dyskinesia in patients with Parkinson’s disease receiving levodopa-based therapy with or without concomitant dopaminergic medications. Gocovri, previously granted orphan drug status by the FDA, is the first medicine approved by the FDA for this indication. Gocovri is a high-dose (274 mg) formulation of amantadine (equivalent to 340 mg of amantadine HCl) taken once-daily at bedtime that delivers consistently high levels of amantadine from the morning and throughout the day. Adamas Pharmaceuticals markets the drug.

FDA Has Approved Lyrica CR for Two Indications

The FDA has approved Lyrica CR (pregabalin) extended-release tablets CV as once-daily therapy for the management of neuropathic pain associated with diabetic peripheral neuropathy and the management of postherpetic neuralgia. The efficacy and safety of Lyrica CR in postherpetic neuralgia was established in a randomized placebo-controlled clinical trial conducted in 801 patients with postherpetic neuralgia who entered single-blind treatment with Lyrica CR. In the study, 73.6% of patients in the Lyrica CR group achieved at least 50% improvement in pain intensity, compared with 54.6% in the placebo group. The postherpetic neuralgia data also supported the diabetic peripheral neuropathy indication. Pfizer markets Lyrica CR.

—Kimberly Williams

Can a Fatty Diet Increase Relapse Risk in Children With MS?

In children with multiple sclerosis (MS), high energy intake from fat, especially saturated fat, may increase the hazard of relapse, while vegetable intake may be independently protective, according to a study published online ahead of print October 9 in the Journal of Neurology, Neurosurgery & Psychiatry. A total of 219 patients with pediatric relapsing-remitting MS or clinically isolated syndrome with disease onset before age 18 and duration of less than four years were enrolled in a multicenter study that was completed at 11 pediatric MS centers. Investigators used the Block Kids Food Screener to examine dietary intake during the week before enrollment. Each 10% increase in energy intake from fat increased the hazard of relapse by 56%, and each 10% increase in saturated fat tripled this hazard.

Azary S, Schreiner T, Graves J, et al. Contribution of dietary intake to relapse rate in early paediatric multiple sclerosis. J Neurol Neurosurg Psychiatry. 2017 Oct 9 [Epub ahead of print].

Cooling Reduces Risk of Epilepsy After Perinatal Asphyxia

Administering therapeutic hypothermia to babies with perinatal asphyxia can reduce their risk of epilepsy in childhood, according to a study published online ahead of print September 29 in Epilepsia. From 2006 to 2013, 151 infants with perinatal asphyxia underwent 72 hours of cooling. Clinical and amplitude-integrated EEG with single-channel EEG-verified neonatal seizures were treated with antiepileptic drugs (AEDs). MRI was assessed using a severity score that ranged from 0 to 11. One hundred thirty-four children were assessed at 18–24 months. Babies born after 2007 who received therapeutic hypothermia had a lower rate of epilepsy than those born before this method was introduced. At two years, 6% of the children had epilepsy, and 2% were receiving AEDs. Before therapeutic hypothermia was introduced, the rate of death or moderate or severe disability was about 66%.

Liu X, Jary S, Cowan F, Thoresen M. Reduced infancy and childhood epilepsy following hypothermia-treated neonatal encephalopathy. Epilepsia. 2017 Sep 29 [Epub ahead of print].

Risk Factors Are Increasing in People With Stroke

The prevalence of hypertension, diabetes, dyslipidemia, smoking, and drug abuse in acute ischemic stroke increased between 2004 and 2014, according to a study published online ahead of print October 11 in Neurology. Researchers used the National Inpatient Sample to identify 922,451 adult hospitalizations for ischemic stroke. In all, 92.5% of patients with stroke had one or more risk factors. Age- and sex-adjusted prevalence of hypertension, diabetes, dyslipidemia, smoking, and drug abuse were 79%, 34%, 47%, 15%, and 2%, respectively. The prevalence of carotid stenosis, chronic renal failure, and coronary artery disease were 13%, 12%, and 27%, respectively. Risk factor prevalence varied by age, race, and sex. The prevalence of hypertension, diabetes, dyslipidemia, smoking, and drug abuse increased annually by 1.4%, 2%, 7%, 5%, and 7%, respectively.

Otite FO, Liaw N, Khandelwal P, et al. Increasing prevalence of vascular risk factors in patients with stroke: a call to action. Neurology. 2017 Oct 11 [Epub ahead of print].

Transcranial Direct-Current Stimulation for MS-Related Fatigue

People with multiple sclerosis (MS) who undergo a noninvasive form of electrical brain stimulation have significantly reduced fatigue, according to a study published online ahead of print September 1 in the Multiple Sclerosis Journal. Twenty-seven people with MS were randomized to receive transcranial direct-current stimulation or a placebo while playing a cognitive training game that targets processing speed and working memory. After 20 sessions, participants reported their level of fatigue using the Patient-Reported Outcomes Measurement Information System. Higher numbers correlated with greater fatigue. The researchers reported a statistically significant reduction in the group that underwent transcranial direct-current stimulation, compared with the placebo group. Intervention participants had a 5.6-point drop in fatigue on average, while control participants had a 0.9-point increase in fatigue.

Charvet LE, Dobbs B, Shaw MT, et al. Remotely supervised transcranial direct current stimulation for the treatment of fatigue in multiple sclerosis: results from a randomized, sham-controlled trial. Mult Scler. 2017 Sep 1 [Epub ahead of print].

New Genetic Risk Variants for RLS Identified

Thirteen previously unknown genetic risk variants for restless legs syndrome (RLS) have been identified, according to a study published in the November issue of Lancet Neurology. Researchers combined three genome-wide association studies’ datasets with diagnosis data collected from 2003 to 2017. The latter data came from interviews and questionnaires and included 15,126 cases and 95,725 controls. Significant genome-wide signals were tested for replication in an independent genome-wide association study of 30,770 cases and 286,913 controls. Investigators identified and replicated 13 new risk loci for RLS and confirmed six previously identified risk loci. MEIS1 was confirmed as the strongest genetic risk factor for RLS. Gene prioritization, enrichment, and genetic correlation analyses showed that identified pathways were related to neurodevelopment and highlighted genes linked to axon guidance, synapse formation, and neuronal specification.

Schormair B, Zhao C, Bell S, et al. Identification of novel risk loci for restless legs syndrome in genome-wide association studies in individuals of European ancestry: a meta-analysis. Lancet Neurol. 2017;16(11):898-907.

High Blood Pressure Associated With Increased Dementia Risk in Women

Hypertension is more common in men, but is only associated with dementia risk in women, according to a study published online ahead of print October 4 in Neurology. Researchers evaluated 5,646 members of a diverse integrated health care delivery system who had clinical examinations and health survey data from 1964 to 1973 (mean age, 32.7) and 1978 to 1985 (mean age, 44.3) and were members as of January 1, 1996 (mean age, 59.8). A total of 532 people were diagnosed with dementia. Mid-adulthood (circa age 44) hypertension was associated with 65% increased dementia risk among women, but not among men. Onset of hypertension in mid-adulthood predicted 73% higher dementia risk in women, compared with stable normotension. There was no evidence that hypertension or changes in hypertension increased dementia risk among men.

Gilsanz P, Mayeda ER, Glymour MM, et al. Female sex, early-onset hypertension, and risk of dementia. Neurology. 2017 Oct 4 [Epub ahead of print].

A Risk Factor for Major Bleeding During Treatment With NOACs

Among patients taking non-vitamin K oral anticoagulants (NOACs) for nonvalvular atrial fibrillation, concurrent use of amiodarone, fluconazole, rifampin, and phenytoin, compared with the use of NOACs alone, is associated with increased risk of major bleeding, according to a study published October 3 in JAMA. Researchers retrospectively examined data for 91,330 patients with nonvalvular atrial fibrillation who received at least one NOAC prescription of dabigatran, rivaroxaban, or apixaban from 2012 through 2016. They analyzed the bleeding risk associated with the concurrent use of 12 commonly prescribed medications. A total of 4,770 major bleeding events occurred. The incidence rate of major bleeding was significantly lower for concurrent use of atorvastatin, digoxin, and erythromycin or clarithromycin. Physicians prescribing NOACs should consider the potential risks associated with concomitant use of other drugs, the researchers said.

Chang SH, Chou IJ, Yeh YH, et al. Association between use of non-vitamin K oral anticoagulants with and without concurrent medications and risk of major bleeding in nonvalvular atrial fibrillation. JAMA. 2017;318(13):1250-1259.

Discontinuing Aspirin Therapy May Increase Cardiovascular Risk

In long-term users, discontinuation of low-dose aspirin in the absence of major surgery or bleeding is associated with a greater-than-30% increased risk of cardiovascular events, according to a study published September 26 in Circulation. Researchers performed a cohort study of 601,527 participants taking low-dose aspirin for heart attack and stroke prevention between 2005 and 2009. Participants were older than 40, cancer-free, and had an adherence rate of 80% or greater during the first year of treatment. During a median of 3.0 years of follow-up, 62,690 cardiovascular events were reported. Patients who discontinued aspirin had a higher rate of cardiovascular events than those who continued (multivariable-adjusted hazard ratio, 1.37), corresponding to an additional cardiovascular event observed per year in one of every 74 patients who discontinued aspirin.

Sundström J, Hedberg J, Thuresson M, et al. Low-dose aspirin discontinuation and risk of cardiovascular events: a Swedish nationwide, population-based cohort study. Circulation. 2017;136(13):1183-1192.

FDA Approves 80-mg Ingrezza Capsule for Tardive Dyskinesia

The FDA has approved an 80-mg capsule of Ingrezza (valbenazine) for the treatment of adults with tardive dyskinesia. In clinical studies, Ingrezza 80 mg provided significant, rapid, and meaningful improvement in tardive dyskinesia severity, compared with placebo, at six weeks. Results were seen as early as two weeks, and continued reductions were observed through 48 weeks of treatment. The drug was FDA-approved in April and has been available as 40-mg capsules. Neurocrine Biosciences markets Ingrezza.

FDA Approves Generic Version of Copaxone

The FDA has approved Mylan’s glatiramer acetate injection 40 mg/mL for thrice-weekly injection. The drug is a substitutable generic version of Teva’s Copaxone 40 mg/mL. The agency also approved Mylan’s glatiramer acetate injection 20 mg/mL for once-daily injection, a substitutable generic version of Teva’s Copaxone 20 mg/mL. Both products are indicated for the treatment of patients with relapsing forms of multiple sclerosis. As part of its applications, Mylan submitted side-by-side analyses demonstrating that its glatiramer acetate injections have the same active ingredient, dosage form, route of administration, and strength as their branded counterpart.

FDA Approves Gocovri for Dyskinesia in Parkinson’s Disease

The FDA has approved Gocovri (amantadine) extended-release capsules for the treatment of dyskinesia in patients with Parkinson’s disease receiving levodopa-based therapy with or without concomitant dopaminergic medications. Gocovri, previously granted orphan drug status by the FDA, is the first medicine approved by the FDA for this indication. Gocovri is a high-dose (274 mg) formulation of amantadine (equivalent to 340 mg of amantadine HCl) taken once-daily at bedtime that delivers consistently high levels of amantadine from the morning and throughout the day. Adamas Pharmaceuticals markets the drug.

FDA Has Approved Lyrica CR for Two Indications

The FDA has approved Lyrica CR (pregabalin) extended-release tablets CV as once-daily therapy for the management of neuropathic pain associated with diabetic peripheral neuropathy and the management of postherpetic neuralgia. The efficacy and safety of Lyrica CR in postherpetic neuralgia was established in a randomized placebo-controlled clinical trial conducted in 801 patients with postherpetic neuralgia who entered single-blind treatment with Lyrica CR. In the study, 73.6% of patients in the Lyrica CR group achieved at least 50% improvement in pain intensity, compared with 54.6% in the placebo group. The postherpetic neuralgia data also supported the diabetic peripheral neuropathy indication. Pfizer markets Lyrica CR.

—Kimberly Williams

SAN DIEGO – Patients who were on statins prior to sustaining a traumatic brain injury doubled their survival rate over those who were not on the drugs in a retrospective analysis.

The study provides preliminary data that can help set a framework to conduct larger, randomized, controlled trials to further evaluate the role of statins, which have been shown in animal models to improve outcomes after traumatic brain injury (TBI).

[email protected]

SAN DIEGO – Patients who were on statins prior to sustaining a traumatic brain injury doubled their survival rate over those who were not on the drugs in a retrospective analysis.

The study provides preliminary data that can help set a framework to conduct larger, randomized, controlled trials to further evaluate the role of statins, which have been shown in animal models to improve outcomes after traumatic brain injury (TBI).

[email protected]

SAN DIEGO – Patients who were on statins prior to sustaining a traumatic brain injury doubled their survival rate over those who were not on the drugs in a retrospective analysis.

The study provides preliminary data that can help set a framework to conduct larger, randomized, controlled trials to further evaluate the role of statins, which have been shown in animal models to improve outcomes after traumatic brain injury (TBI).

[email protected]

SAN DIEGO – It’s been possible for over 15 years for neurointensivists to measure the partial pressure of oxygen in the brain of patients following traumatic brain injury.

But the technology has not been widely adopted because there have been no high-quality data showing that it’s useful. As a result, in most hospitals, TBI treatment is guided mostly by intracranial pressure.

The evidence gap is being filled. In a recent phase 2 trial, there was a trend towards benefit when treatment was guided by both intracranial pressure and the brain oxygenation (Crit Care Med. 2017 Nov;45[11]:1907-14). The study was powered for nonfutility, not clinically meaningful change, but the National Institute of Neurological Disorders and Stroke has recently funded a 45-site, phase 3 trial that will definitively answer whether treatment protocols informed by both pressure and oxygen improve neurologic outcomes, said principal investigator Ramon Diaz-Arrastia, MD, PhD, a professor of neurology at the University of Pennsylvania, Philadelphia.

In an interview at the annual meeting of the American Neurological Association, he explained the work, and exactly how paying attention to brain oxygen levels changed treatment in the phase 2 study. It didn’t take anything unusual to maintain oxygen partial pressure above 20 mm Hg.

[email protected]

SAN DIEGO – It’s been possible for over 15 years for neurointensivists to measure the partial pressure of oxygen in the brain of patients following traumatic brain injury.

But the technology has not been widely adopted because there have been no high-quality data showing that it’s useful. As a result, in most hospitals, TBI treatment is guided mostly by intracranial pressure.

The evidence gap is being filled. In a recent phase 2 trial, there was a trend towards benefit when treatment was guided by both intracranial pressure and the brain oxygenation (Crit Care Med. 2017 Nov;45[11]:1907-14). The study was powered for nonfutility, not clinically meaningful change, but the National Institute of Neurological Disorders and Stroke has recently funded a 45-site, phase 3 trial that will definitively answer whether treatment protocols informed by both pressure and oxygen improve neurologic outcomes, said principal investigator Ramon Diaz-Arrastia, MD, PhD, a professor of neurology at the University of Pennsylvania, Philadelphia.

In an interview at the annual meeting of the American Neurological Association, he explained the work, and exactly how paying attention to brain oxygen levels changed treatment in the phase 2 study. It didn’t take anything unusual to maintain oxygen partial pressure above 20 mm Hg.

[email protected]

SAN DIEGO – It’s been possible for over 15 years for neurointensivists to measure the partial pressure of oxygen in the brain of patients following traumatic brain injury.

But the technology has not been widely adopted because there have been no high-quality data showing that it’s useful. As a result, in most hospitals, TBI treatment is guided mostly by intracranial pressure.

The evidence gap is being filled. In a recent phase 2 trial, there was a trend towards benefit when treatment was guided by both intracranial pressure and the brain oxygenation (Crit Care Med. 2017 Nov;45[11]:1907-14). The study was powered for nonfutility, not clinically meaningful change, but the National Institute of Neurological Disorders and Stroke has recently funded a 45-site, phase 3 trial that will definitively answer whether treatment protocols informed by both pressure and oxygen improve neurologic outcomes, said principal investigator Ramon Diaz-Arrastia, MD, PhD, a professor of neurology at the University of Pennsylvania, Philadelphia.

In an interview at the annual meeting of the American Neurological Association, he explained the work, and exactly how paying attention to brain oxygen levels changed treatment in the phase 2 study. It didn’t take anything unusual to maintain oxygen partial pressure above 20 mm Hg.

[email protected]

SAN DIEGO – The healthy brain is a master of autoregulation, continuously adjusting blood flow to meet metabolic demand.

But in traumatic brain injury, cerebrovascular reactivity (CVR) breaks down; blood vessels don’t dilate as they should to deliver nutrients and oxygen, leading to progressive neurologic decline.

Sildenafil (Viagra) – a vasodilator in injured blood vessels – might help, according to ongoing research at the University of Pennsylvania, Philadelphia.

Researchers there gave sildenafil to inpatients with persistent symptoms at least 6 months after traumatic brain injury and measured CVR by a novel MRI technique an hour later. “Sildenafil was able to correct the deficit in CVR in many cases. We are hopeful this could be a useful therapy,” said principal investigator Ramon Diaz-Arrastia, MD, a professor of neurology at the university.

He explained the work in an interview at annual meeting of the American Neurological Association. The next step is to see if sildenafil helps CVR in acute traumatic brain injury, and in people who have had multiple, mild brain traumas, including professional athletes.

[email protected]

SAN DIEGO – The healthy brain is a master of autoregulation, continuously adjusting blood flow to meet metabolic demand.

But in traumatic brain injury, cerebrovascular reactivity (CVR) breaks down; blood vessels don’t dilate as they should to deliver nutrients and oxygen, leading to progressive neurologic decline.

Sildenafil (Viagra) – a vasodilator in injured blood vessels – might help, according to ongoing research at the University of Pennsylvania, Philadelphia.

Researchers there gave sildenafil to inpatients with persistent symptoms at least 6 months after traumatic brain injury and measured CVR by a novel MRI technique an hour later. “Sildenafil was able to correct the deficit in CVR in many cases. We are hopeful this could be a useful therapy,” said principal investigator Ramon Diaz-Arrastia, MD, a professor of neurology at the university.

He explained the work in an interview at annual meeting of the American Neurological Association. The next step is to see if sildenafil helps CVR in acute traumatic brain injury, and in people who have had multiple, mild brain traumas, including professional athletes.

[email protected]

SAN DIEGO – The healthy brain is a master of autoregulation, continuously adjusting blood flow to meet metabolic demand.

But in traumatic brain injury, cerebrovascular reactivity (CVR) breaks down; blood vessels don’t dilate as they should to deliver nutrients and oxygen, leading to progressive neurologic decline.

Sildenafil (Viagra) – a vasodilator in injured blood vessels – might help, according to ongoing research at the University of Pennsylvania, Philadelphia.

Researchers there gave sildenafil to inpatients with persistent symptoms at least 6 months after traumatic brain injury and measured CVR by a novel MRI technique an hour later. “Sildenafil was able to correct the deficit in CVR in many cases. We are hopeful this could be a useful therapy,” said principal investigator Ramon Diaz-Arrastia, MD, a professor of neurology at the university.

He explained the work in an interview at annual meeting of the American Neurological Association. The next step is to see if sildenafil helps CVR in acute traumatic brain injury, and in people who have had multiple, mild brain traumas, including professional athletes.

[email protected]

SAN DIEGO – Earlier this month, an article in Lancet Psychiatry reported the results of a prospective, randomized, sham-controlled trial that tested deep brain stimulation of the Brodmann area 25 within the subcallosal cingulate white matter in 90 patients with treatment-resistant depression. Unfortunately, the study showed no significant benefit at 6 months.

The approach had shown promise in some previous open-label studies, which prompted the multicenter trial (Lancet Psychiatry. 2017 Oct 4. doi: 10.1016/S2215-0366(17)30371-1).

Although the 6-month results were disappointing, the open-label phase of the study told a different story. At 2 years, 48% of patients in the stimulation group achieved an antidepressant response, higher than what would be expected from treatment as usual in this difficult population.

In this video interview at the annual meeting of the American Neurological Association, Helen Mayberg, MD, one of the study authors and professor of psychiatry, neurology, and radiology at Emory University, Atlanta, discusses these long-term results and their implications, as well as lessons learned and how they might inform future research.

SAN DIEGO – Earlier this month, an article in Lancet Psychiatry reported the results of a prospective, randomized, sham-controlled trial that tested deep brain stimulation of the Brodmann area 25 within the subcallosal cingulate white matter in 90 patients with treatment-resistant depression. Unfortunately, the study showed no significant benefit at 6 months.

The approach had shown promise in some previous open-label studies, which prompted the multicenter trial (Lancet Psychiatry. 2017 Oct 4. doi: 10.1016/S2215-0366(17)30371-1).

Although the 6-month results were disappointing, the open-label phase of the study told a different story. At 2 years, 48% of patients in the stimulation group achieved an antidepressant response, higher than what would be expected from treatment as usual in this difficult population.

In this video interview at the annual meeting of the American Neurological Association, Helen Mayberg, MD, one of the study authors and professor of psychiatry, neurology, and radiology at Emory University, Atlanta, discusses these long-term results and their implications, as well as lessons learned and how they might inform future research.

SAN DIEGO – Earlier this month, an article in Lancet Psychiatry reported the results of a prospective, randomized, sham-controlled trial that tested deep brain stimulation of the Brodmann area 25 within the subcallosal cingulate white matter in 90 patients with treatment-resistant depression. Unfortunately, the study showed no significant benefit at 6 months.

The approach had shown promise in some previous open-label studies, which prompted the multicenter trial (Lancet Psychiatry. 2017 Oct 4. doi: 10.1016/S2215-0366(17)30371-1).

Although the 6-month results were disappointing, the open-label phase of the study told a different story. At 2 years, 48% of patients in the stimulation group achieved an antidepressant response, higher than what would be expected from treatment as usual in this difficult population.

In this video interview at the annual meeting of the American Neurological Association, Helen Mayberg, MD, one of the study authors and professor of psychiatry, neurology, and radiology at Emory University, Atlanta, discusses these long-term results and their implications, as well as lessons learned and how they might inform future research.

Is Vitamin D Deficiency a Risk Factor for MS?

Vitamin D deficiency is a risk factor for multiple sclerosis (MS), according to a study published online ahead of print September 13 in Neurology. Researchers conducted a prospective nested case-control study among more than 800,000 women in the Finnish Maternity Cohort who had blood samples taken during pregnancy. Investigators identified 1,092 women with MS diagnosed an average of nine years after giving the blood samples. Researchers compared their vitamin D levels with those of 2,123 women who did not develop MS. Each 50 nmol/L increase in vitamin D levels in the blood was associated with a 39% reduced risk of developing MS. In addition, women who had deficient levels of vitamin D (ie, < 30 nmol/L) had a 43% higher risk of MS, compared with women who had adequate levels of vitamin D (ie, ≥ 50 nmol/L).

Munger KL, Hongell K, Åivo J, et al. 25-Hydroxyvitamin D deficiency and risk of MS among women in the Finnish Maternity Cohort. Neurology. 2017 Sep 13 [Epub ahead of print].

Can Eye Changes Signal Frontotemporal Degeneration?

Frontotemporal degeneration (FTD) is associated with outer retina thinning, and this thinning correlates with disease severity, according to a cross-sectional study published online ahead of print September 8 in Neurology. Researchers examined retinal structure using standard spectral-domain optical coherence tomography in 38 consecutively enrolled patients with FTD and 44 controls. The researchers excluded patients with presumed Alzheimer’s disease, eyes with poor image quality, or confounding diseases. Adjusting for age, sex, and race, patients with FTD had a thinner outer retina, compared with controls. Patients with FTD also had a thinner outer nuclear layer and ellipsoid zone, compared with controls. The groups had similar thicknesses for inner retinal layers.

Kim BJ, Irwin DJ, Song D, et al. Optical coherence tomography identifies outer retina thinning in frontotemporal degeneration. Neurology. 2017 Sep 8 [Epub ahead of print].

A New Diagnostic Test for Alzheimer’s Disease

Blood sample analysis may help diagnose Alzheimer’s disease and distinguish between different types of neurodegenerative disorders, according to a study published online ahead of print September 5 in the Proceedings of the National Academy of Sciences. Investigators used attenuated total reflection FTIR spectroscopy combined with chemometric techniques to analyze blood plasma samples from 347 participants with neurodegenerative diseases and 202 age-matched healthy individuals. Alzheimer’s disease (n = 164) was identified with 70% sensitivity and specificity, which after the incorporation of APOE ε4 information, increased to 86% when individuals carried one or two alleles of ε4, and to 72% sensitivity and 77% specificity when individuals did not carry ε4 alleles. The test segregated Alzheimer’s disease from dementia with Lewy bodies (n = 34) with 90% sensitivity and specificity.

Paraskevaidi M, Morais CLM, Lima KMG, et al. Differential diagnosis of Alzheimer’s disease using spectrochemical analysis of blood. Proc Natl Acad Sci U S A. 2017 Sep 5 [Epub ahead of print].

New Indication for Briviact CV

The FDA has approved a supplemental new drug application for Briviact (brivaracetam) CV as monotherapy for partial-onset seizures in patients age 16 and older with epilepsy. Briviact previously was approved as adjunctive treatment for partial-onset seizures in this age group. UCB, which markets Briviact, applied for the monotherapy indication after the FDA advised that it is acceptable to extrapolate the efficacy and safety of drugs approved as adjunctive therapy for the treatment of partial-onset seizures to their use as monotherapy for the treatment of partial-onset seizures. Gradual dose escalation is not required when initiating treatment with Briviact for monotherapy or adjunctive therapy, which allows clinicians to initiate treatment at a therapeutic dose. Briviact formulations include film-coated tablets, oral solution, and injection. UCB is headquartered in Brussels.

Less REM Sleep Is Associated With Greater Dementia Risk

REM sleep may be associated with risk of dementia, according to a study published online ahead of print August 23 in Neurology. Researchers examined associations between sleep architecture and the prospective risk of incident dementia in a subset of 321 Framingham Heart Study Offspring participants who participated in the Sleep Heart Health Study between 1995 and 1998, and were older than 60 at the time of sleep assessment (mean age, 67; 50% male). Stages of sleep were quantified using home-based polysomnography. Participants were followed for up to 19 years for incident dementia. Researchers observed 32 cases of incident dementia. Each percentage reduction in REM sleep was associated with an approximately 9% increase in the risk of incident dementia (hazard ratio, 0.91).

Pase MP, Himali JJ, Grima NA, et al. Sleep architecture and the risk of incident dementia in the community. Neurology. 2017 Aug 23 [Epub ahead of print].

Mononucleosis May Increase Risk of MS

Epstein-Barr nuclear antigen-1 seropositivty is independently associated with increased risk of multiple sclerosis (MS) or clinically isolated syndrome (CIS), according to a study published online ahead of print August 30 in Neurology. Researchers recruited 1,090 black, Hispanic, and white people with MS or CIS and matched controls over a three-year period. Participants were tested for the Epstein-Barr virus antibody and were asked whether they had ever had mononucleosis. Blacks who had had mononucleosis were more than four times more likely to develop MS, compared with those who had not had mononucleosis. Hispanics and whites who had had mononucleosis were nearly four times and two times, respectively, more likely to develop MS or CIS, compared with those who had not had mononucleosis.

Langer-Gould A, Wu J, Lucas R, et al. Epstein-Barr virus, cytomegalovirus, and multiple sclerosis susceptibility: a multiethnic study. Neurology. 2017 Aug 30 [Epub ahead of print].

Asthma Medicine May Decrease Risk of Parkinson’s Disease

Salbutamol, a brain-penetrant asthma medication, is associated with reduced risk of Parkinson’s disease, according to a study published September 1 in Science. Researchers used an unbiased screen targeting endogenous gene expression to discover that the β2-adrenoreceptor (β2AR) is a regulator of the α-synuclein gene. Research has indicated that excess production of α-synuclein may be a causative factor in Parkinson’s disease. Over 11 years of follow-up in four million Norwegians, the β2AR agonist salbutamol was associated with reduced risk of Parkinson’s disease (rate ratio, 0.66). A β2AR antagonist correlated with increased risk.

Mittal S, Bjørnevik K, Im DS, et al. β2-Adrenoreceptor is a regulator of the α-synuclein gene driving risk of Parkinson’s disease. Science. 2017;357(6354):891-898 [Epub ahead of print].

Odds of Developing Alzheimer’s Disease Same for Men and Women With APOE Genotype

Men and women with the APOE ε3/ε4 genotype have nearly the same odds of developing Alzheimer’s disease from age 55 to 85, but women have an increased risk at younger ages, according to a study published online ahead of print August 28 in JAMA Neurology. Researchers analyzed data from 27 studies with nearly 58,000 participants. Homogeneous data sets were pooled in case-control analyses, and logistic regression models were used to compute risks. Age-adjusted odds ratios and 95% confidence intervals for developing mild cognitive impairment and Alzheimer’s disease were calculated for men and women across APOE genotypes. Men and women with the APOE ε3/ε4 genotype from ages 55 to 85 did not show a difference in Alzheimer’s disease risk. Women had an increased risk of Alzheimer’s disease compared with men between the ages of 65 and 75.

Neu SC, Pa J, Kukull W, et al. Apolipoprotein e genotype and sex risk factors for Alzheimer disease: a meta-analysis. JAMA Neurol. 2017 Aug 28 [Epub ahead of print].

Does Dimethyl Fumarate Prevent MS Reactivation After Natalizumab Discontinuation?

Dimethyl fumarate appears generally safe and may be a promising drug for patients at high risk of progressive multifocal leukoencephalopathy (PML) who discontinue natalizumab, according to an article published online ahead of print August 26 in the Journal of Neurology, Neurosurgery and Psychiatry. Thirty-nine patients with relapsing-remitting multiple sclerosis (MS) at high risk of PML were switched from natalizumab to dimethyl fumarate and underwent neurologic and 3T MRI monitoring for two years. Clinical and MRI data regarding the two-year period preceding natalizumab treatment, the two years of natalizumab treatment, and the two years of dimethyl fumarate treatment were collected. During the dimethyl fumarate phase, one or more relapses occurred in five patients (12.8%), increased disability progression occurred in four patients (10.3%), and MRI activity occurred in eight patients (20.5%). Post-natalizumab rebound effect was observed in one patient. Almost 80% of the patients had no evidence of disease activity after two years of dimethyl fumarate treatment. No carryover PML among investigated cases was observed.

Calabrese M, Pitteri M, Farina G, et al. Dimethyl fumarate: a possible exit strategy from natalizumab treatment in patients with multiple sclerosis at risk for severe adverse events. J Neurol Neurosurg Psychiatry. 2017 Aug 26 [Epub ahead of print].

Austedo Approved for Treatment of Tardive Dyskinesia in Adults

The FDA has approved Austedo (deutetrabenazine) tablets for the treatment of tardive dyskinesia in adults. The approval was based on results from two phase III randomized, double-blind, placebo-controlled, parallel group studies assessing the efficacy and safety of Austedo in reducing the severity of abnormal involuntary movements associated with tardive dyskinesia. Austedo was previously approved in April for the treatment of chorea associated with Huntington’s disease. The most common adverse reactions (ie, 4% of Austedo-treated patients and greater than placebo) in controlled clinical studies of patients with tardive dyskinesia were nasopharyngitis and insomnia. Teva Pharmaceutical Industries, which markets Austedo, is headquartered in Jerusalem.

Orphan Drug Designation Granted for EPX-300

The FDA has granted Orphan Drug Designation for EPX-300 for the treatment of patients with Dravet syndrome. EPX-300 is a repurposed antidepressant that acts via modulation of serotonin signaling pathways. Researchers discovered its potential as a treatment for patients with Dravet syndrome using a phenotype-based zebrafish drug screening platform. Using the zebrafish model for Dravet syndrome, investigators identified drug candidates from a screen of more than 3,000 drugs that suppress seizures and other symptoms associated with neurologic diseases. Epygenix Therapeutics, which is developing EPX-300, is headquartered in Paramus, New Jersey.

FDA Approves Expanded Indication for Aptiom

The FDA has approved a supplemental new drug application to expand the indication for Aptiom (eslicarbazepine acetate) to include treatment of partial-onset seizures in children age 4 to 17. The safety and efficacy of Aptiom as monotherapy and adjunctive therapy for the treatment of partial-onset seizures in adults was established in five multicenter, randomized, controlled clinical trials. Data from three clinical trials supported the safety and tolerability of Aptiom for the treatment of partial-onset seizures in pediatric patients. Pharmacokinetic analyses of adult and pediatric data supported its use in the pediatric population. Aptiom is a once-daily, immediate release drug that can be taken whole or crushed, with or without food. Sunovion Pharmaceuticals, which markets Aptiom, is headquartered in Marlborough, Massachusetts.

—Kimberly Williams

Is Vitamin D Deficiency a Risk Factor for MS?

Vitamin D deficiency is a risk factor for multiple sclerosis (MS), according to a study published online ahead of print September 13 in Neurology. Researchers conducted a prospective nested case-control study among more than 800,000 women in the Finnish Maternity Cohort who had blood samples taken during pregnancy. Investigators identified 1,092 women with MS diagnosed an average of nine years after giving the blood samples. Researchers compared their vitamin D levels with those of 2,123 women who did not develop MS. Each 50 nmol/L increase in vitamin D levels in the blood was associated with a 39% reduced risk of developing MS. In addition, women who had deficient levels of vitamin D (ie, < 30 nmol/L) had a 43% higher risk of MS, compared with women who had adequate levels of vitamin D (ie, ≥ 50 nmol/L).

Munger KL, Hongell K, Åivo J, et al. 25-Hydroxyvitamin D deficiency and risk of MS among women in the Finnish Maternity Cohort. Neurology. 2017 Sep 13 [Epub ahead of print].

Can Eye Changes Signal Frontotemporal Degeneration?

Frontotemporal degeneration (FTD) is associated with outer retina thinning, and this thinning correlates with disease severity, according to a cross-sectional study published online ahead of print September 8 in Neurology. Researchers examined retinal structure using standard spectral-domain optical coherence tomography in 38 consecutively enrolled patients with FTD and 44 controls. The researchers excluded patients with presumed Alzheimer’s disease, eyes with poor image quality, or confounding diseases. Adjusting for age, sex, and race, patients with FTD had a thinner outer retina, compared with controls. Patients with FTD also had a thinner outer nuclear layer and ellipsoid zone, compared with controls. The groups had similar thicknesses for inner retinal layers.

Kim BJ, Irwin DJ, Song D, et al. Optical coherence tomography identifies outer retina thinning in frontotemporal degeneration. Neurology. 2017 Sep 8 [Epub ahead of print].

A New Diagnostic Test for Alzheimer’s Disease

Blood sample analysis may help diagnose Alzheimer’s disease and distinguish between different types of neurodegenerative disorders, according to a study published online ahead of print September 5 in the Proceedings of the National Academy of Sciences. Investigators used attenuated total reflection FTIR spectroscopy combined with chemometric techniques to analyze blood plasma samples from 347 participants with neurodegenerative diseases and 202 age-matched healthy individuals. Alzheimer’s disease (n = 164) was identified with 70% sensitivity and specificity, which after the incorporation of APOE ε4 information, increased to 86% when individuals carried one or two alleles of ε4, and to 72% sensitivity and 77% specificity when individuals did not carry ε4 alleles. The test segregated Alzheimer’s disease from dementia with Lewy bodies (n = 34) with 90% sensitivity and specificity.

Paraskevaidi M, Morais CLM, Lima KMG, et al. Differential diagnosis of Alzheimer’s disease using spectrochemical analysis of blood. Proc Natl Acad Sci U S A. 2017 Sep 5 [Epub ahead of print].

New Indication for Briviact CV

The FDA has approved a supplemental new drug application for Briviact (brivaracetam) CV as monotherapy for partial-onset seizures in patients age 16 and older with epilepsy. Briviact previously was approved as adjunctive treatment for partial-onset seizures in this age group. UCB, which markets Briviact, applied for the monotherapy indication after the FDA advised that it is acceptable to extrapolate the efficacy and safety of drugs approved as adjunctive therapy for the treatment of partial-onset seizures to their use as monotherapy for the treatment of partial-onset seizures. Gradual dose escalation is not required when initiating treatment with Briviact for monotherapy or adjunctive therapy, which allows clinicians to initiate treatment at a therapeutic dose. Briviact formulations include film-coated tablets, oral solution, and injection. UCB is headquartered in Brussels.

Less REM Sleep Is Associated With Greater Dementia Risk

REM sleep may be associated with risk of dementia, according to a study published online ahead of print August 23 in Neurology. Researchers examined associations between sleep architecture and the prospective risk of incident dementia in a subset of 321 Framingham Heart Study Offspring participants who participated in the Sleep Heart Health Study between 1995 and 1998, and were older than 60 at the time of sleep assessment (mean age, 67; 50% male). Stages of sleep were quantified using home-based polysomnography. Participants were followed for up to 19 years for incident dementia. Researchers observed 32 cases of incident dementia. Each percentage reduction in REM sleep was associated with an approximately 9% increase in the risk of incident dementia (hazard ratio, 0.91).

Pase MP, Himali JJ, Grima NA, et al. Sleep architecture and the risk of incident dementia in the community. Neurology. 2017 Aug 23 [Epub ahead of print].

Mononucleosis May Increase Risk of MS

Epstein-Barr nuclear antigen-1 seropositivty is independently associated with increased risk of multiple sclerosis (MS) or clinically isolated syndrome (CIS), according to a study published online ahead of print August 30 in Neurology. Researchers recruited 1,090 black, Hispanic, and white people with MS or CIS and matched controls over a three-year period. Participants were tested for the Epstein-Barr virus antibody and were asked whether they had ever had mononucleosis. Blacks who had had mononucleosis were more than four times more likely to develop MS, compared with those who had not had mononucleosis. Hispanics and whites who had had mononucleosis were nearly four times and two times, respectively, more likely to develop MS or CIS, compared with those who had not had mononucleosis.

Langer-Gould A, Wu J, Lucas R, et al. Epstein-Barr virus, cytomegalovirus, and multiple sclerosis susceptibility: a multiethnic study. Neurology. 2017 Aug 30 [Epub ahead of print].

Asthma Medicine May Decrease Risk of Parkinson’s Disease

Salbutamol, a brain-penetrant asthma medication, is associated with reduced risk of Parkinson’s disease, according to a study published September 1 in Science. Researchers used an unbiased screen targeting endogenous gene expression to discover that the β2-adrenoreceptor (β2AR) is a regulator of the α-synuclein gene. Research has indicated that excess production of α-synuclein may be a causative factor in Parkinson’s disease. Over 11 years of follow-up in four million Norwegians, the β2AR agonist salbutamol was associated with reduced risk of Parkinson’s disease (rate ratio, 0.66). A β2AR antagonist correlated with increased risk.

Mittal S, Bjørnevik K, Im DS, et al. β2-Adrenoreceptor is a regulator of the α-synuclein gene driving risk of Parkinson’s disease. Science. 2017;357(6354):891-898 [Epub ahead of print].

Odds of Developing Alzheimer’s Disease Same for Men and Women With APOE Genotype

Men and women with the APOE ε3/ε4 genotype have nearly the same odds of developing Alzheimer’s disease from age 55 to 85, but women have an increased risk at younger ages, according to a study published online ahead of print August 28 in JAMA Neurology. Researchers analyzed data from 27 studies with nearly 58,000 participants. Homogeneous data sets were pooled in case-control analyses, and logistic regression models were used to compute risks. Age-adjusted odds ratios and 95% confidence intervals for developing mild cognitive impairment and Alzheimer’s disease were calculated for men and women across APOE genotypes. Men and women with the APOE ε3/ε4 genotype from ages 55 to 85 did not show a difference in Alzheimer’s disease risk. Women had an increased risk of Alzheimer’s disease compared with men between the ages of 65 and 75.

Neu SC, Pa J, Kukull W, et al. Apolipoprotein e genotype and sex risk factors for Alzheimer disease: a meta-analysis. JAMA Neurol. 2017 Aug 28 [Epub ahead of print].

Does Dimethyl Fumarate Prevent MS Reactivation After Natalizumab Discontinuation?

Dimethyl fumarate appears generally safe and may be a promising drug for patients at high risk of progressive multifocal leukoencephalopathy (PML) who discontinue natalizumab, according to an article published online ahead of print August 26 in the Journal of Neurology, Neurosurgery and Psychiatry. Thirty-nine patients with relapsing-remitting multiple sclerosis (MS) at high risk of PML were switched from natalizumab to dimethyl fumarate and underwent neurologic and 3T MRI monitoring for two years. Clinical and MRI data regarding the two-year period preceding natalizumab treatment, the two years of natalizumab treatment, and the two years of dimethyl fumarate treatment were collected. During the dimethyl fumarate phase, one or more relapses occurred in five patients (12.8%), increased disability progression occurred in four patients (10.3%), and MRI activity occurred in eight patients (20.5%). Post-natalizumab rebound effect was observed in one patient. Almost 80% of the patients had no evidence of disease activity after two years of dimethyl fumarate treatment. No carryover PML among investigated cases was observed.

Calabrese M, Pitteri M, Farina G, et al. Dimethyl fumarate: a possible exit strategy from natalizumab treatment in patients with multiple sclerosis at risk for severe adverse events. J Neurol Neurosurg Psychiatry. 2017 Aug 26 [Epub ahead of print].

Austedo Approved for Treatment of Tardive Dyskinesia in Adults

The FDA has approved Austedo (deutetrabenazine) tablets for the treatment of tardive dyskinesia in adults. The approval was based on results from two phase III randomized, double-blind, placebo-controlled, parallel group studies assessing the efficacy and safety of Austedo in reducing the severity of abnormal involuntary movements associated with tardive dyskinesia. Austedo was previously approved in April for the treatment of chorea associated with Huntington’s disease. The most common adverse reactions (ie, 4% of Austedo-treated patients and greater than placebo) in controlled clinical studies of patients with tardive dyskinesia were nasopharyngitis and insomnia. Teva Pharmaceutical Industries, which markets Austedo, is headquartered in Jerusalem.

Orphan Drug Designation Granted for EPX-300

The FDA has granted Orphan Drug Designation for EPX-300 for the treatment of patients with Dravet syndrome. EPX-300 is a repurposed antidepressant that acts via modulation of serotonin signaling pathways. Researchers discovered its potential as a treatment for patients with Dravet syndrome using a phenotype-based zebrafish drug screening platform. Using the zebrafish model for Dravet syndrome, investigators identified drug candidates from a screen of more than 3,000 drugs that suppress seizures and other symptoms associated with neurologic diseases. Epygenix Therapeutics, which is developing EPX-300, is headquartered in Paramus, New Jersey.

FDA Approves Expanded Indication for Aptiom

The FDA has approved a supplemental new drug application to expand the indication for Aptiom (eslicarbazepine acetate) to include treatment of partial-onset seizures in children age 4 to 17. The safety and efficacy of Aptiom as monotherapy and adjunctive therapy for the treatment of partial-onset seizures in adults was established in five multicenter, randomized, controlled clinical trials. Data from three clinical trials supported the safety and tolerability of Aptiom for the treatment of partial-onset seizures in pediatric patients. Pharmacokinetic analyses of adult and pediatric data supported its use in the pediatric population. Aptiom is a once-daily, immediate release drug that can be taken whole or crushed, with or without food. Sunovion Pharmaceuticals, which markets Aptiom, is headquartered in Marlborough, Massachusetts.

—Kimberly Williams

Is Vitamin D Deficiency a Risk Factor for MS?

Vitamin D deficiency is a risk factor for multiple sclerosis (MS), according to a study published online ahead of print September 13 in Neurology. Researchers conducted a prospective nested case-control study among more than 800,000 women in the Finnish Maternity Cohort who had blood samples taken during pregnancy. Investigators identified 1,092 women with MS diagnosed an average of nine years after giving the blood samples. Researchers compared their vitamin D levels with those of 2,123 women who did not develop MS. Each 50 nmol/L increase in vitamin D levels in the blood was associated with a 39% reduced risk of developing MS. In addition, women who had deficient levels of vitamin D (ie, < 30 nmol/L) had a 43% higher risk of MS, compared with women who had adequate levels of vitamin D (ie, ≥ 50 nmol/L).

Munger KL, Hongell K, Åivo J, et al. 25-Hydroxyvitamin D deficiency and risk of MS among women in the Finnish Maternity Cohort. Neurology. 2017 Sep 13 [Epub ahead of print].

Can Eye Changes Signal Frontotemporal Degeneration?

Frontotemporal degeneration (FTD) is associated with outer retina thinning, and this thinning correlates with disease severity, according to a cross-sectional study published online ahead of print September 8 in Neurology. Researchers examined retinal structure using standard spectral-domain optical coherence tomography in 38 consecutively enrolled patients with FTD and 44 controls. The researchers excluded patients with presumed Alzheimer’s disease, eyes with poor image quality, or confounding diseases. Adjusting for age, sex, and race, patients with FTD had a thinner outer retina, compared with controls. Patients with FTD also had a thinner outer nuclear layer and ellipsoid zone, compared with controls. The groups had similar thicknesses for inner retinal layers.

Kim BJ, Irwin DJ, Song D, et al. Optical coherence tomography identifies outer retina thinning in frontotemporal degeneration. Neurology. 2017 Sep 8 [Epub ahead of print].

A New Diagnostic Test for Alzheimer’s Disease

Blood sample analysis may help diagnose Alzheimer’s disease and distinguish between different types of neurodegenerative disorders, according to a study published online ahead of print September 5 in the Proceedings of the National Academy of Sciences. Investigators used attenuated total reflection FTIR spectroscopy combined with chemometric techniques to analyze blood plasma samples from 347 participants with neurodegenerative diseases and 202 age-matched healthy individuals. Alzheimer’s disease (n = 164) was identified with 70% sensitivity and specificity, which after the incorporation of APOE ε4 information, increased to 86% when individuals carried one or two alleles of ε4, and to 72% sensitivity and 77% specificity when individuals did not carry ε4 alleles. The test segregated Alzheimer’s disease from dementia with Lewy bodies (n = 34) with 90% sensitivity and specificity.

Paraskevaidi M, Morais CLM, Lima KMG, et al. Differential diagnosis of Alzheimer’s disease using spectrochemical analysis of blood. Proc Natl Acad Sci U S A. 2017 Sep 5 [Epub ahead of print].

New Indication for Briviact CV

The FDA has approved a supplemental new drug application for Briviact (brivaracetam) CV as monotherapy for partial-onset seizures in patients age 16 and older with epilepsy. Briviact previously was approved as adjunctive treatment for partial-onset seizures in this age group. UCB, which markets Briviact, applied for the monotherapy indication after the FDA advised that it is acceptable to extrapolate the efficacy and safety of drugs approved as adjunctive therapy for the treatment of partial-onset seizures to their use as monotherapy for the treatment of partial-onset seizures. Gradual dose escalation is not required when initiating treatment with Briviact for monotherapy or adjunctive therapy, which allows clinicians to initiate treatment at a therapeutic dose. Briviact formulations include film-coated tablets, oral solution, and injection. UCB is headquartered in Brussels.

Less REM Sleep Is Associated With Greater Dementia Risk

REM sleep may be associated with risk of dementia, according to a study published online ahead of print August 23 in Neurology. Researchers examined associations between sleep architecture and the prospective risk of incident dementia in a subset of 321 Framingham Heart Study Offspring participants who participated in the Sleep Heart Health Study between 1995 and 1998, and were older than 60 at the time of sleep assessment (mean age, 67; 50% male). Stages of sleep were quantified using home-based polysomnography. Participants were followed for up to 19 years for incident dementia. Researchers observed 32 cases of incident dementia. Each percentage reduction in REM sleep was associated with an approximately 9% increase in the risk of incident dementia (hazard ratio, 0.91).

Pase MP, Himali JJ, Grima NA, et al. Sleep architecture and the risk of incident dementia in the community. Neurology. 2017 Aug 23 [Epub ahead of print].

Mononucleosis May Increase Risk of MS

Epstein-Barr nuclear antigen-1 seropositivty is independently associated with increased risk of multiple sclerosis (MS) or clinically isolated syndrome (CIS), according to a study published online ahead of print August 30 in Neurology. Researchers recruited 1,090 black, Hispanic, and white people with MS or CIS and matched controls over a three-year period. Participants were tested for the Epstein-Barr virus antibody and were asked whether they had ever had mononucleosis. Blacks who had had mononucleosis were more than four times more likely to develop MS, compared with those who had not had mononucleosis. Hispanics and whites who had had mononucleosis were nearly four times and two times, respectively, more likely to develop MS or CIS, compared with those who had not had mononucleosis.

Langer-Gould A, Wu J, Lucas R, et al. Epstein-Barr virus, cytomegalovirus, and multiple sclerosis susceptibility: a multiethnic study. Neurology. 2017 Aug 30 [Epub ahead of print].

Asthma Medicine May Decrease Risk of Parkinson’s Disease

Salbutamol, a brain-penetrant asthma medication, is associated with reduced risk of Parkinson’s disease, according to a study published September 1 in Science. Researchers used an unbiased screen targeting endogenous gene expression to discover that the β2-adrenoreceptor (β2AR) is a regulator of the α-synuclein gene. Research has indicated that excess production of α-synuclein may be a causative factor in Parkinson’s disease. Over 11 years of follow-up in four million Norwegians, the β2AR agonist salbutamol was associated with reduced risk of Parkinson’s disease (rate ratio, 0.66). A β2AR antagonist correlated with increased risk.

Mittal S, Bjørnevik K, Im DS, et al. β2-Adrenoreceptor is a regulator of the α-synuclein gene driving risk of Parkinson’s disease. Science. 2017;357(6354):891-898 [Epub ahead of print].

Odds of Developing Alzheimer’s Disease Same for Men and Women With APOE Genotype

Men and women with the APOE ε3/ε4 genotype have nearly the same odds of developing Alzheimer’s disease from age 55 to 85, but women have an increased risk at younger ages, according to a study published online ahead of print August 28 in JAMA Neurology. Researchers analyzed data from 27 studies with nearly 58,000 participants. Homogeneous data sets were pooled in case-control analyses, and logistic regression models were used to compute risks. Age-adjusted odds ratios and 95% confidence intervals for developing mild cognitive impairment and Alzheimer’s disease were calculated for men and women across APOE genotypes. Men and women with the APOE ε3/ε4 genotype from ages 55 to 85 did not show a difference in Alzheimer’s disease risk. Women had an increased risk of Alzheimer’s disease compared with men between the ages of 65 and 75.

Neu SC, Pa J, Kukull W, et al. Apolipoprotein e genotype and sex risk factors for Alzheimer disease: a meta-analysis. JAMA Neurol. 2017 Aug 28 [Epub ahead of print].

Does Dimethyl Fumarate Prevent MS Reactivation After Natalizumab Discontinuation?

Dimethyl fumarate appears generally safe and may be a promising drug for patients at high risk of progressive multifocal leukoencephalopathy (PML) who discontinue natalizumab, according to an article published online ahead of print August 26 in the Journal of Neurology, Neurosurgery and Psychiatry. Thirty-nine patients with relapsing-remitting multiple sclerosis (MS) at high risk of PML were switched from natalizumab to dimethyl fumarate and underwent neurologic and 3T MRI monitoring for two years. Clinical and MRI data regarding the two-year period preceding natalizumab treatment, the two years of natalizumab treatment, and the two years of dimethyl fumarate treatment were collected. During the dimethyl fumarate phase, one or more relapses occurred in five patients (12.8%), increased disability progression occurred in four patients (10.3%), and MRI activity occurred in eight patients (20.5%). Post-natalizumab rebound effect was observed in one patient. Almost 80% of the patients had no evidence of disease activity after two years of dimethyl fumarate treatment. No carryover PML among investigated cases was observed.

Calabrese M, Pitteri M, Farina G, et al. Dimethyl fumarate: a possible exit strategy from natalizumab treatment in patients with multiple sclerosis at risk for severe adverse events. J Neurol Neurosurg Psychiatry. 2017 Aug 26 [Epub ahead of print].

Austedo Approved for Treatment of Tardive Dyskinesia in Adults

The FDA has approved Austedo (deutetrabenazine) tablets for the treatment of tardive dyskinesia in adults. The approval was based on results from two phase III randomized, double-blind, placebo-controlled, parallel group studies assessing the efficacy and safety of Austedo in reducing the severity of abnormal involuntary movements associated with tardive dyskinesia. Austedo was previously approved in April for the treatment of chorea associated with Huntington’s disease. The most common adverse reactions (ie, 4% of Austedo-treated patients and greater than placebo) in controlled clinical studies of patients with tardive dyskinesia were nasopharyngitis and insomnia. Teva Pharmaceutical Industries, which markets Austedo, is headquartered in Jerusalem.

Orphan Drug Designation Granted for EPX-300

The FDA has granted Orphan Drug Designation for EPX-300 for the treatment of patients with Dravet syndrome. EPX-300 is a repurposed antidepressant that acts via modulation of serotonin signaling pathways. Researchers discovered its potential as a treatment for patients with Dravet syndrome using a phenotype-based zebrafish drug screening platform. Using the zebrafish model for Dravet syndrome, investigators identified drug candidates from a screen of more than 3,000 drugs that suppress seizures and other symptoms associated with neurologic diseases. Epygenix Therapeutics, which is developing EPX-300, is headquartered in Paramus, New Jersey.

FDA Approves Expanded Indication for Aptiom

The FDA has approved a supplemental new drug application to expand the indication for Aptiom (eslicarbazepine acetate) to include treatment of partial-onset seizures in children age 4 to 17. The safety and efficacy of Aptiom as monotherapy and adjunctive therapy for the treatment of partial-onset seizures in adults was established in five multicenter, randomized, controlled clinical trials. Data from three clinical trials supported the safety and tolerability of Aptiom for the treatment of partial-onset seizures in pediatric patients. Pharmacokinetic analyses of adult and pediatric data supported its use in the pediatric population. Aptiom is a once-daily, immediate release drug that can be taken whole or crushed, with or without food. Sunovion Pharmaceuticals, which markets Aptiom, is headquartered in Marlborough, Massachusetts.

—Kimberly Williams

CHICAGO – Children who experience concussion can develop deficits in auditory processing that could impair long-term academic performance and carry implications for return-to-play strategies, according to a study.

Investigators assessed 40 children aged 8-15 years, half of whom experienced concussion. The postconcussion group of 20 children had slower and smaller neural responses to speech, compared with 20 control children, on the noninvasive frequency-following response measure.

monkeybusinessimages/Thinkstock

[email protected]

CHICAGO – Children who experience concussion can develop deficits in auditory processing that could impair long-term academic performance and carry implications for return-to-play strategies, according to a study.

Investigators assessed 40 children aged 8-15 years, half of whom experienced concussion. The postconcussion group of 20 children had slower and smaller neural responses to speech, compared with 20 control children, on the noninvasive frequency-following response measure.

monkeybusinessimages/Thinkstock

[email protected]

CHICAGO – Children who experience concussion can develop deficits in auditory processing that could impair long-term academic performance and carry implications for return-to-play strategies, according to a study.

Investigators assessed 40 children aged 8-15 years, half of whom experienced concussion. The postconcussion group of 20 children had slower and smaller neural responses to speech, compared with 20 control children, on the noninvasive frequency-following response measure.

monkeybusinessimages/Thinkstock

[email protected]

Statin Prescription Varies in Stroke Belt

Less than half of patients with stroke discharged from the hospital receive a prescription for statins, and the likelihood of a prescription varies by patients’ location, sex, age, and race, according to a study published August 2 in the Journal of the American Heart Association. Researchers analyzed discharge medications for 323 participants hospitalized for an ischemic stroke during follow-up of the Reasons for Geographic and Racial Differences in Stroke study. In the Stroke Belt, participants ages 65 and older were 47% less likely to be discharged on a statin, compared with people younger than 65. Compared with women, men in the Stroke Belt were 31% less likely to be discharged on a statin, while men outside the Stroke Belt were more likely to be discharged on a statin.

Albright KC, Howard VJ, Howard G, et al. Age and sex disparities in discharge statin prescribing in the stroke belt: evidence from the Reasons for Geographic and Racial Differences in Stroke Study. J Am Heart Assoc. 2017;6(8).

Midlife Vascular Risk Factors Increase Risk of Dementia

Midlife vascular risk factors are associated with increased risk of dementia in blacks and whites, according to a study published online ahead of print August 7 in JAMA Neurology. In the Atherosclerosis Risk in Communities study, investigators measured demographic and vascular risk factors at baseline (ie, obesity, smoking, diabetes, prehypertension, hypertension, and hypercholesterolemia), along with the presence of the APOE ε4 genotype. After the baseline visit, participants had four additional in-person visits. In all, 1,516 cases of dementia (57.0% female and 34.9% black, with a mean age at visit 1 of 57.4) were identified among 15,744 participants. Black race, older age, lower educational attainment, and APOE ε4 genotype were associated with increased risk of dementia, as were midlife smoking, diabetes, prehypertension, and hypertension.

Gottesman RF, Albert MS, Alonso A, et al. Associations between midlife vascular risk factors and 25-year incident dementia in the Atherosclerosis Risk in Communities (ARIC) Cohort. JAMA Neurol. 2017 August 7 [Epub ahead of print].

Resistance Training May Slow the Progression of MS

Progressive resistance training may have a neuroprotective or neuroregenerative effect in relapsing-remitting multiple sclerosis (MS), according to a study published online ahead of print July 1 in Multiple Sclerosis Journal. This study was a 24-week randomized controlled crossover trial. Participants were assigned to training or to a wait list. Assessments included disability measures and MRI. The MS Functional Composite score improved in the training group, but disability, lesion load, and global brain volumes did not differ between groups. The researchers noted higher absolute cortical thickness values in 19 of 74 investigated cortical regions after progressive resistance training. Observed changes were confirmed and reproduced when comparing relative cortical thickness changes between groups in the anterior cingulate gyrus, temporal pole, orbital sulcus, and inferior temporal sulcus.

Kjølhede T, Siemonsen S, Wenzel D, et al. Can resistance training impact MRI outcomes in relapsing-remitting multiple sclerosis? Mult Scler. 2017 Jul 1 [Epub ahead of print].

Noninvasive Device Measures Intracranial Pressure

A noninvasive device measures intracranial pressure (ICP) accurately, according to research published online ahead of print August 8 in the Journal of Neurosurgery. In patients with traumatic brain injury and subarachnoid hemorrhage who were undergoing treatment in a neurocritical intensive care unit, researchers recorded ICP using the gold-standard method of invasive external ventricular drainage or intraparenchymal monitoring. In addition, the authors simultaneously measured ICP noninvasively with a device that uses advanced signal-analysis algorithms for acoustic signals propagating through the cranium. Data were collected in 14 patients, yielding 2,543 data points of continuous parallel ICP values. For measurements at the ≥ 17-mm Hg cutoff, the sensitivity and specificity of the noninvasive device were 0.7541 and 0.8887, respectively. ICP values obtained using noninvasive and invasive monitoring methods correlated well.

Ganslandt O, Mourtzoukos S, Stadlbauer A, et al. Evaluation of a novel noninvasive ICP monitoring device in patients undergoing invasive ICP monitoring: preliminary results. J Neurosurg. 2017 Aug 8 [Epub ahead of print].

Strokes Decline Among Men, But Not Women

The rate of stroke in the US has declined among men, but not among women, according to a study published online ahead of print August 9 in Neurology. Researchers collected data on 1.3 million adults in Ohio and Kentucky between 1993 and 2010. They used medical records to identify first-ever strokes during four one-year periods. The researchers observed 7,710 incident strokes in the four periods, and 57% of them were among women. The incidence of all strokes decreased over time in men (263 to 192), but not in women (217 to 198). The researchers found a similar sex difference in the change in the rate of ischemic stroke (ie, a decline from 238 to 165 among men, and a change from 193 to 173 among women).

Madsen TE, Khoury J, Alwell K, et al. Sex-specific stroke incidence over time in the Greater Cincinnati/Northern Kentucky Stroke Study. Neurology. 2017 Aug 9 [Epub ahead of print].

Link Between Alcohol Intake and Cognitively Healthy Longevity

Older adults who consume alcohol moderately on a regular basis are more likely to live to age 85 without dementia or other cognitive impairments than nondrinkers, according to a study published in the August issue of the Journal of Alzheimer’s Disease. Researchers examined 1,344 older community-dwelling adults and assessed alcohol intake by questionnaire in 1984–1987. They evaluated cognitive function in approximately four-year intervals between 1988 and 2009. About 49% of participants reported moderate alcohol intake, and 48% reported drinking almost daily. Relative to nondrinkers, moderate and heavy drinkers had significantly higher adjusted odds of survival to age 85 without cognitive impairment. Near-daily drinkers had two- to threefold higher adjusted odds of cognitively healthy longevity versus living to at least age 85 with cognitive impairment or death before age 85.

Richard EL, Kritz-Silverstein D, Laughlin GA, et al. Alcohol intake and cognitively healthy longevity in community-dwelling adults: The Rancho Bernardo Study. J Alzheimers Dis. 2017;59(3):803-814.

MRI Shows Brain Differences in Genetic Autism

In two genetically related cohorts at high risk for autism, reciprocal neuroanatomic abnormalities were associated with cognitive and behavioral impairments, according to a study published online ahead of print August 8 in Radiology. Researchers performed MRI on 79 carriers of a deletion at 16p11.2, 79 carriers of a duplication at 16p11.2, 64 unaffected family members, and 109 controls. The participants completed cognitive and behavioral tests, and neuroradiologists reviewed the images for development-related abnormalities. The researchers found differences in the brain structures of deletion and duplication carriers, compared with noncarriers. Deletion carriers had brain overgrowth, and duplication carriers had brain undergrowth. When investigators compared cognitive assessments to imaging findings, they found that any imaging feature associated with the deletion carriers indicated worse daily living, communication, and social skills.

Owen JP, Bukshpun P, Pojman N, et al. Brain MR imaging findings and associated outcomes in carriers of the reciprocal copy number variation at 16p11.2. Radiology. 2017 Aug 8 [Epub ahead of print].

FDA Clears Stimpod NMS460 for Relief of Chronic Pain

The FDA has cleared Stimpod NMS460, a noninvasive neuromodulation device, for the symptomatic relief and management of chronic intractable pain. The unit also can be used for the adjunctive treatment of postsurgical pain, posttraumatic acute pain, and pain control due to rehabilitation. The device has a pulsed radio frequency waveform that creates electromagnetic effects similar to those of invasive pulsed radio frequency treatments. Treatment is applied transcutaneously. Case studies have shown quick and notable relief of chronic intractable pain. The treatment has no known side effects. The Stimpod NMS460 also incorporates nerve-locating technology that includes a nerve-mapping probe that enables practitioners to evaluate the treatment progress of damaged nerves. Xavant Technology, which markets Stimpod NMS460, is headquartered in Pretoria, South Africa.

Longer Sleep Is Associated With Lower BMI

Adults who have poor sleep patterns are more likely to be overweight or obese and have poorer metabolic health, according to a study published July 27 in PLoS One. Researchers analyzed associations between sleep duration and adiposity, selected metabolic health markers, and diet using National Diet and Nutrition Survey data. In all, 1,615 adults (57.1% female) between ages 19 and 65 completed questions about sleep duration and three to four days of food diaries. Investigators recorded blood pressure and waist circumference. Fasting blood lipids, glucose, glycated hemoglobin, thyroid hormones, and high-sensitivity C-reactive protein were measured in a subset of participants. After adjusting for age, ethnicity, sex, smoking, and socioeconomic status, sleep duration was negatively associated with BMI and waist circumference. Sleep duration was positively associated with high-density lipoprotein cholesterol.

Potter GDM, Cade JE, Hardie LJ. Longer sleep is associated with lower BMI and favorable metabolic profiles in UK adults: findings from the National Diet and Nutrition Survey. PLoS One. 2017; 12(7):e0182195.

Can Bleeding Risk After Stroke Be Predicted?

The S2TOP-BLEED score can estimate three-year major bleeding risk in patients with transient ischemic attack (TIA) or ischemic stroke who use antiplatelet agents, according to a study published online ahead of print August 2 in Neurology. To develop this prediction model, researchers combined data from six trials investigating antiplatelet therapy after TIA or ischemic stroke. They performed Cox regression analyses stratified by trial to study the association between predictors and major bleeding. Major bleeding occurred in 1,530 of the 43,112 patients during 94,833 person-years of follow-up. The observed three-year risk of major bleeding was 4.6%. The investigators identified male sex, smoking, type of antiplatelet agents, outcome on modified Rankin Scale ≥ 3, prior stroke, high blood pressure, lower BMI, elderly status, Asian ethnicity, and diabetes as predictors of major bleeding.

Hilkens NA, Algra A, Diener HC, et al. Predicting major bleeding in patients with noncardioembolic stroke on antiplatelets: S2TOP-BLEED. Neurology. 2017 Aug 2 [Epub ahead of print].

Questionnaires Predict Survival in MS

The way patients with multiple sclerosis (MS) answer questionnaires could help to predict their survival rate from the disease, according to a study published July 10 in PLoS Medicine. From July 15, 2004, onward, 2,126 people with MS completed MS Impact Scale-29 (MSIS-29) questionnaires. By 2014, 264 participants had died. Higher baseline MSIS-29 physical score and higher baseline MSIS-29 psychologic score were associated with reduced survival time. In participants with high baseline MSIS-29 scores, mortality risk was greater if the MSIS-29 score worsened over one year. MSIS-29 physical scores were associated with survival time, independent of age, sex, and patient-reported Expanded Disability Status Scale score in a Cox regression analysis.

Raffel J, Wallace A, Gveric D, et al. Patient-reported outcomes and survival in multiple sclerosis: a 10-year retrospective cohort study using the Multiple Sclerosis Impact Scale-29. PLoS Med. 2017;14(7):e1002346.

—Kimberly Williams

Statin Prescription Varies in Stroke Belt

Less than half of patients with stroke discharged from the hospital receive a prescription for statins, and the likelihood of a prescription varies by patients’ location, sex, age, and race, according to a study published August 2 in the Journal of the American Heart Association. Researchers analyzed discharge medications for 323 participants hospitalized for an ischemic stroke during follow-up of the Reasons for Geographic and Racial Differences in Stroke study. In the Stroke Belt, participants ages 65 and older were 47% less likely to be discharged on a statin, compared with people younger than 65. Compared with women, men in the Stroke Belt were 31% less likely to be discharged on a statin, while men outside the Stroke Belt were more likely to be discharged on a statin.

Albright KC, Howard VJ, Howard G, et al. Age and sex disparities in discharge statin prescribing in the stroke belt: evidence from the Reasons for Geographic and Racial Differences in Stroke Study. J Am Heart Assoc. 2017;6(8).

Midlife Vascular Risk Factors Increase Risk of Dementia

Midlife vascular risk factors are associated with increased risk of dementia in blacks and whites, according to a study published online ahead of print August 7 in JAMA Neurology. In the Atherosclerosis Risk in Communities study, investigators measured demographic and vascular risk factors at baseline (ie, obesity, smoking, diabetes, prehypertension, hypertension, and hypercholesterolemia), along with the presence of the APOE ε4 genotype. After the baseline visit, participants had four additional in-person visits. In all, 1,516 cases of dementia (57.0% female and 34.9% black, with a mean age at visit 1 of 57.4) were identified among 15,744 participants. Black race, older age, lower educational attainment, and APOE ε4 genotype were associated with increased risk of dementia, as were midlife smoking, diabetes, prehypertension, and hypertension.

Gottesman RF, Albert MS, Alonso A, et al. Associations between midlife vascular risk factors and 25-year incident dementia in the Atherosclerosis Risk in Communities (ARIC) Cohort. JAMA Neurol. 2017 August 7 [Epub ahead of print].

Resistance Training May Slow the Progression of MS

Progressive resistance training may have a neuroprotective or neuroregenerative effect in relapsing-remitting multiple sclerosis (MS), according to a study published online ahead of print July 1 in Multiple Sclerosis Journal. This study was a 24-week randomized controlled crossover trial. Participants were assigned to training or to a wait list. Assessments included disability measures and MRI. The MS Functional Composite score improved in the training group, but disability, lesion load, and global brain volumes did not differ between groups. The researchers noted higher absolute cortical thickness values in 19 of 74 investigated cortical regions after progressive resistance training. Observed changes were confirmed and reproduced when comparing relative cortical thickness changes between groups in the anterior cingulate gyrus, temporal pole, orbital sulcus, and inferior temporal sulcus.

Kjølhede T, Siemonsen S, Wenzel D, et al. Can resistance training impact MRI outcomes in relapsing-remitting multiple sclerosis? Mult Scler. 2017 Jul 1 [Epub ahead of print].

Noninvasive Device Measures Intracranial Pressure

A noninvasive device measures intracranial pressure (ICP) accurately, according to research published online ahead of print August 8 in the Journal of Neurosurgery. In patients with traumatic brain injury and subarachnoid hemorrhage who were undergoing treatment in a neurocritical intensive care unit, researchers recorded ICP using the gold-standard method of invasive external ventricular drainage or intraparenchymal monitoring. In addition, the authors simultaneously measured ICP noninvasively with a device that uses advanced signal-analysis algorithms for acoustic signals propagating through the cranium. Data were collected in 14 patients, yielding 2,543 data points of continuous parallel ICP values. For measurements at the ≥ 17-mm Hg cutoff, the sensitivity and specificity of the noninvasive device were 0.7541 and 0.8887, respectively. ICP values obtained using noninvasive and invasive monitoring methods correlated well.

Ganslandt O, Mourtzoukos S, Stadlbauer A, et al. Evaluation of a novel noninvasive ICP monitoring device in patients undergoing invasive ICP monitoring: preliminary results. J Neurosurg. 2017 Aug 8 [Epub ahead of print].

Strokes Decline Among Men, But Not Women

The rate of stroke in the US has declined among men, but not among women, according to a study published online ahead of print August 9 in Neurology. Researchers collected data on 1.3 million adults in Ohio and Kentucky between 1993 and 2010. They used medical records to identify first-ever strokes during four one-year periods. The researchers observed 7,710 incident strokes in the four periods, and 57% of them were among women. The incidence of all strokes decreased over time in men (263 to 192), but not in women (217 to 198). The researchers found a similar sex difference in the change in the rate of ischemic stroke (ie, a decline from 238 to 165 among men, and a change from 193 to 173 among women).

Madsen TE, Khoury J, Alwell K, et al. Sex-specific stroke incidence over time in the Greater Cincinnati/Northern Kentucky Stroke Study. Neurology. 2017 Aug 9 [Epub ahead of print].

Link Between Alcohol Intake and Cognitively Healthy Longevity

Older adults who consume alcohol moderately on a regular basis are more likely to live to age 85 without dementia or other cognitive impairments than nondrinkers, according to a study published in the August issue of the Journal of Alzheimer’s Disease. Researchers examined 1,344 older community-dwelling adults and assessed alcohol intake by questionnaire in 1984–1987. They evaluated cognitive function in approximately four-year intervals between 1988 and 2009. About 49% of participants reported moderate alcohol intake, and 48% reported drinking almost daily. Relative to nondrinkers, moderate and heavy drinkers had significantly higher adjusted odds of survival to age 85 without cognitive impairment. Near-daily drinkers had two- to threefold higher adjusted odds of cognitively healthy longevity versus living to at least age 85 with cognitive impairment or death before age 85.

Richard EL, Kritz-Silverstein D, Laughlin GA, et al. Alcohol intake and cognitively healthy longevity in community-dwelling adults: The Rancho Bernardo Study. J Alzheimers Dis. 2017;59(3):803-814.

MRI Shows Brain Differences in Genetic Autism

In two genetically related cohorts at high risk for autism, reciprocal neuroanatomic abnormalities were associated with cognitive and behavioral impairments, according to a study published online ahead of print August 8 in Radiology. Researchers performed MRI on 79 carriers of a deletion at 16p11.2, 79 carriers of a duplication at 16p11.2, 64 unaffected family members, and 109 controls. The participants completed cognitive and behavioral tests, and neuroradiologists reviewed the images for development-related abnormalities. The researchers found differences in the brain structures of deletion and duplication carriers, compared with noncarriers. Deletion carriers had brain overgrowth, and duplication carriers had brain undergrowth. When investigators compared cognitive assessments to imaging findings, they found that any imaging feature associated with the deletion carriers indicated worse daily living, communication, and social skills.

Owen JP, Bukshpun P, Pojman N, et al. Brain MR imaging findings and associated outcomes in carriers of the reciprocal copy number variation at 16p11.2. Radiology. 2017 Aug 8 [Epub ahead of print].

FDA Clears Stimpod NMS460 for Relief of Chronic Pain

The FDA has cleared Stimpod NMS460, a noninvasive neuromodulation device, for the symptomatic relief and management of chronic intractable pain. The unit also can be used for the adjunctive treatment of postsurgical pain, posttraumatic acute pain, and pain control due to rehabilitation. The device has a pulsed radio frequency waveform that creates electromagnetic effects similar to those of invasive pulsed radio frequency treatments. Treatment is applied transcutaneously. Case studies have shown quick and notable relief of chronic intractable pain. The treatment has no known side effects. The Stimpod NMS460 also incorporates nerve-locating technology that includes a nerve-mapping probe that enables practitioners to evaluate the treatment progress of damaged nerves. Xavant Technology, which markets Stimpod NMS460, is headquartered in Pretoria, South Africa.

Longer Sleep Is Associated With Lower BMI

Adults who have poor sleep patterns are more likely to be overweight or obese and have poorer metabolic health, according to a study published July 27 in PLoS One. Researchers analyzed associations between sleep duration and adiposity, selected metabolic health markers, and diet using National Diet and Nutrition Survey data. In all, 1,615 adults (57.1% female) between ages 19 and 65 completed questions about sleep duration and three to four days of food diaries. Investigators recorded blood pressure and waist circumference. Fasting blood lipids, glucose, glycated hemoglobin, thyroid hormones, and high-sensitivity C-reactive protein were measured in a subset of participants. After adjusting for age, ethnicity, sex, smoking, and socioeconomic status, sleep duration was negatively associated with BMI and waist circumference. Sleep duration was positively associated with high-density lipoprotein cholesterol.

Potter GDM, Cade JE, Hardie LJ. Longer sleep is associated with lower BMI and favorable metabolic profiles in UK adults: findings from the National Diet and Nutrition Survey. PLoS One. 2017; 12(7):e0182195.

Can Bleeding Risk After Stroke Be Predicted?

The S2TOP-BLEED score can estimate three-year major bleeding risk in patients with transient ischemic attack (TIA) or ischemic stroke who use antiplatelet agents, according to a study published online ahead of print August 2 in Neurology. To develop this prediction model, researchers combined data from six trials investigating antiplatelet therapy after TIA or ischemic stroke. They performed Cox regression analyses stratified by trial to study the association between predictors and major bleeding. Major bleeding occurred in 1,530 of the 43,112 patients during 94,833 person-years of follow-up. The observed three-year risk of major bleeding was 4.6%. The investigators identified male sex, smoking, type of antiplatelet agents, outcome on modified Rankin Scale ≥ 3, prior stroke, high blood pressure, lower BMI, elderly status, Asian ethnicity, and diabetes as predictors of major bleeding.

Hilkens NA, Algra A, Diener HC, et al. Predicting major bleeding in patients with noncardioembolic stroke on antiplatelets: S2TOP-BLEED. Neurology. 2017 Aug 2 [Epub ahead of print].

Questionnaires Predict Survival in MS

The way patients with multiple sclerosis (MS) answer questionnaires could help to predict their survival rate from the disease, according to a study published July 10 in PLoS Medicine. From July 15, 2004, onward, 2,126 people with MS completed MS Impact Scale-29 (MSIS-29) questionnaires. By 2014, 264 participants had died. Higher baseline MSIS-29 physical score and higher baseline MSIS-29 psychologic score were associated with reduced survival time. In participants with high baseline MSIS-29 scores, mortality risk was greater if the MSIS-29 score worsened over one year. MSIS-29 physical scores were associated with survival time, independent of age, sex, and patient-reported Expanded Disability Status Scale score in a Cox regression analysis.

Raffel J, Wallace A, Gveric D, et al. Patient-reported outcomes and survival in multiple sclerosis: a 10-year retrospective cohort study using the Multiple Sclerosis Impact Scale-29. PLoS Med. 2017;14(7):e1002346.

—Kimberly Williams

Statin Prescription Varies in Stroke Belt

Less than half of patients with stroke discharged from the hospital receive a prescription for statins, and the likelihood of a prescription varies by patients’ location, sex, age, and race, according to a study published August 2 in the Journal of the American Heart Association. Researchers analyzed discharge medications for 323 participants hospitalized for an ischemic stroke during follow-up of the Reasons for Geographic and Racial Differences in Stroke study. In the Stroke Belt, participants ages 65 and older were 47% less likely to be discharged on a statin, compared with people younger than 65. Compared with women, men in the Stroke Belt were 31% less likely to be discharged on a statin, while men outside the Stroke Belt were more likely to be discharged on a statin.

Albright KC, Howard VJ, Howard G, et al. Age and sex disparities in discharge statin prescribing in the stroke belt: evidence from the Reasons for Geographic and Racial Differences in Stroke Study. J Am Heart Assoc. 2017;6(8).

Midlife Vascular Risk Factors Increase Risk of Dementia

Midlife vascular risk factors are associated with increased risk of dementia in blacks and whites, according to a study published online ahead of print August 7 in JAMA Neurology. In the Atherosclerosis Risk in Communities study, investigators measured demographic and vascular risk factors at baseline (ie, obesity, smoking, diabetes, prehypertension, hypertension, and hypercholesterolemia), along with the presence of the APOE ε4 genotype. After the baseline visit, participants had four additional in-person visits. In all, 1,516 cases of dementia (57.0% female and 34.9% black, with a mean age at visit 1 of 57.4) were identified among 15,744 participants. Black race, older age, lower educational attainment, and APOE ε4 genotype were associated with increased risk of dementia, as were midlife smoking, diabetes, prehypertension, and hypertension.

Gottesman RF, Albert MS, Alonso A, et al. Associations between midlife vascular risk factors and 25-year incident dementia in the Atherosclerosis Risk in Communities (ARIC) Cohort. JAMA Neurol. 2017 August 7 [Epub ahead of print].

Resistance Training May Slow the Progression of MS

Progressive resistance training may have a neuroprotective or neuroregenerative effect in relapsing-remitting multiple sclerosis (MS), according to a study published online ahead of print July 1 in Multiple Sclerosis Journal. This study was a 24-week randomized controlled crossover trial. Participants were assigned to training or to a wait list. Assessments included disability measures and MRI. The MS Functional Composite score improved in the training group, but disability, lesion load, and global brain volumes did not differ between groups. The researchers noted higher absolute cortical thickness values in 19 of 74 investigated cortical regions after progressive resistance training. Observed changes were confirmed and reproduced when comparing relative cortical thickness changes between groups in the anterior cingulate gyrus, temporal pole, orbital sulcus, and inferior temporal sulcus.

Kjølhede T, Siemonsen S, Wenzel D, et al. Can resistance training impact MRI outcomes in relapsing-remitting multiple sclerosis? Mult Scler. 2017 Jul 1 [Epub ahead of print].

Noninvasive Device Measures Intracranial Pressure

A noninvasive device measures intracranial pressure (ICP) accurately, according to research published online ahead of print August 8 in the Journal of Neurosurgery. In patients with traumatic brain injury and subarachnoid hemorrhage who were undergoing treatment in a neurocritical intensive care unit, researchers recorded ICP using the gold-standard method of invasive external ventricular drainage or intraparenchymal monitoring. In addition, the authors simultaneously measured ICP noninvasively with a device that uses advanced signal-analysis algorithms for acoustic signals propagating through the cranium. Data were collected in 14 patients, yielding 2,543 data points of continuous parallel ICP values. For measurements at the ≥ 17-mm Hg cutoff, the sensitivity and specificity of the noninvasive device were 0.7541 and 0.8887, respectively. ICP values obtained using noninvasive and invasive monitoring methods correlated well.

Ganslandt O, Mourtzoukos S, Stadlbauer A, et al. Evaluation of a novel noninvasive ICP monitoring device in patients undergoing invasive ICP monitoring: preliminary results. J Neurosurg. 2017 Aug 8 [Epub ahead of print].

Strokes Decline Among Men, But Not Women

The rate of stroke in the US has declined among men, but not among women, according to a study published online ahead of print August 9 in Neurology. Researchers collected data on 1.3 million adults in Ohio and Kentucky between 1993 and 2010. They used medical records to identify first-ever strokes during four one-year periods. The researchers observed 7,710 incident strokes in the four periods, and 57% of them were among women. The incidence of all strokes decreased over time in men (263 to 192), but not in women (217 to 198). The researchers found a similar sex difference in the change in the rate of ischemic stroke (ie, a decline from 238 to 165 among men, and a change from 193 to 173 among women).

Madsen TE, Khoury J, Alwell K, et al. Sex-specific stroke incidence over time in the Greater Cincinnati/Northern Kentucky Stroke Study. Neurology. 2017 Aug 9 [Epub ahead of print].

Link Between Alcohol Intake and Cognitively Healthy Longevity

Older adults who consume alcohol moderately on a regular basis are more likely to live to age 85 without dementia or other cognitive impairments than nondrinkers, according to a study published in the August issue of the Journal of Alzheimer’s Disease. Researchers examined 1,344 older community-dwelling adults and assessed alcohol intake by questionnaire in 1984–1987. They evaluated cognitive function in approximately four-year intervals between 1988 and 2009. About 49% of participants reported moderate alcohol intake, and 48% reported drinking almost daily. Relative to nondrinkers, moderate and heavy drinkers had significantly higher adjusted odds of survival to age 85 without cognitive impairment. Near-daily drinkers had two- to threefold higher adjusted odds of cognitively healthy longevity versus living to at least age 85 with cognitive impairment or death before age 85.

Richard EL, Kritz-Silverstein D, Laughlin GA, et al. Alcohol intake and cognitively healthy longevity in community-dwelling adults: The Rancho Bernardo Study. J Alzheimers Dis. 2017;59(3):803-814.

MRI Shows Brain Differences in Genetic Autism

In two genetically related cohorts at high risk for autism, reciprocal neuroanatomic abnormalities were associated with cognitive and behavioral impairments, according to a study published online ahead of print August 8 in Radiology. Researchers performed MRI on 79 carriers of a deletion at 16p11.2, 79 carriers of a duplication at 16p11.2, 64 unaffected family members, and 109 controls. The participants completed cognitive and behavioral tests, and neuroradiologists reviewed the images for development-related abnormalities. The researchers found differences in the brain structures of deletion and duplication carriers, compared with noncarriers. Deletion carriers had brain overgrowth, and duplication carriers had brain undergrowth. When investigators compared cognitive assessments to imaging findings, they found that any imaging feature associated with the deletion carriers indicated worse daily living, communication, and social skills.

Owen JP, Bukshpun P, Pojman N, et al. Brain MR imaging findings and associated outcomes in carriers of the reciprocal copy number variation at 16p11.2. Radiology. 2017 Aug 8 [Epub ahead of print].

FDA Clears Stimpod NMS460 for Relief of Chronic Pain

The FDA has cleared Stimpod NMS460, a noninvasive neuromodulation device, for the symptomatic relief and management of chronic intractable pain. The unit also can be used for the adjunctive treatment of postsurgical pain, posttraumatic acute pain, and pain control due to rehabilitation. The device has a pulsed radio frequency waveform that creates electromagnetic effects similar to those of invasive pulsed radio frequency treatments. Treatment is applied transcutaneously. Case studies have shown quick and notable relief of chronic intractable pain. The treatment has no known side effects. The Stimpod NMS460 also incorporates nerve-locating technology that includes a nerve-mapping probe that enables practitioners to evaluate the treatment progress of damaged nerves. Xavant Technology, which markets Stimpod NMS460, is headquartered in Pretoria, South Africa.

Longer Sleep Is Associated With Lower BMI

Adults who have poor sleep patterns are more likely to be overweight or obese and have poorer metabolic health, according to a study published July 27 in PLoS One. Researchers analyzed associations between sleep duration and adiposity, selected metabolic health markers, and diet using National Diet and Nutrition Survey data. In all, 1,615 adults (57.1% female) between ages 19 and 65 completed questions about sleep duration and three to four days of food diaries. Investigators recorded blood pressure and waist circumference. Fasting blood lipids, glucose, glycated hemoglobin, thyroid hormones, and high-sensitivity C-reactive protein were measured in a subset of participants. After adjusting for age, ethnicity, sex, smoking, and socioeconomic status, sleep duration was negatively associated with BMI and waist circumference. Sleep duration was positively associated with high-density lipoprotein cholesterol.

Potter GDM, Cade JE, Hardie LJ. Longer sleep is associated with lower BMI and favorable metabolic profiles in UK adults: findings from the National Diet and Nutrition Survey. PLoS One. 2017; 12(7):e0182195.

Can Bleeding Risk After Stroke Be Predicted?

The S2TOP-BLEED score can estimate three-year major bleeding risk in patients with transient ischemic attack (TIA) or ischemic stroke who use antiplatelet agents, according to a study published online ahead of print August 2 in Neurology. To develop this prediction model, researchers combined data from six trials investigating antiplatelet therapy after TIA or ischemic stroke. They performed Cox regression analyses stratified by trial to study the association between predictors and major bleeding. Major bleeding occurred in 1,530 of the 43,112 patients during 94,833 person-years of follow-up. The observed three-year risk of major bleeding was 4.6%. The investigators identified male sex, smoking, type of antiplatelet agents, outcome on modified Rankin Scale ≥ 3, prior stroke, high blood pressure, lower BMI, elderly status, Asian ethnicity, and diabetes as predictors of major bleeding.

Hilkens NA, Algra A, Diener HC, et al. Predicting major bleeding in patients with noncardioembolic stroke on antiplatelets: S2TOP-BLEED. Neurology. 2017 Aug 2 [Epub ahead of print].

Questionnaires Predict Survival in MS

The way patients with multiple sclerosis (MS) answer questionnaires could help to predict their survival rate from the disease, according to a study published July 10 in PLoS Medicine. From July 15, 2004, onward, 2,126 people with MS completed MS Impact Scale-29 (MSIS-29) questionnaires. By 2014, 264 participants had died. Higher baseline MSIS-29 physical score and higher baseline MSIS-29 psychologic score were associated with reduced survival time. In participants with high baseline MSIS-29 scores, mortality risk was greater if the MSIS-29 score worsened over one year. MSIS-29 physical scores were associated with survival time, independent of age, sex, and patient-reported Expanded Disability Status Scale score in a Cox regression analysis.

Raffel J, Wallace A, Gveric D, et al. Patient-reported outcomes and survival in multiple sclerosis: a 10-year retrospective cohort study using the Multiple Sclerosis Impact Scale-29. PLoS Med. 2017;14(7):e1002346.

—Kimberly Williams