New and Noteworthy Information—November 2015
The FDA has approved Betaconnect, an electronic autoinjector for the treatment of relapsing-remitting multiple sclerosis. Bayer HealthCare (Whippany, NJ) manufactures Betaconnect, which will be available to patients receiving Betaseron beginning in early 2016. The autoinjector, which was created based on feedback from patients and caregivers, offers customizable injection speed and depth settings that allow patients to administer injections quietly and precisely. Betaconnect also has an optional backup reminder function that tells patients the time of their next injection. In addition, the automatic needle insertion and retraction and a visual and audio end-of-dose indication tell patients when the injection is complete. Patients should speak with a healthcare provider before making any changes to injection depth or speed settings.
In patients with an intracranial pressure of more than 20 mmHg after traumatic brain injury (TBI), therapeutic hypothermia plus standard care to reduce intracranial pressure do not result in outcomes better than those associated with standard care alone, according to a study published online ahead of print October 7 in New England Journal of Medicine. Investigators enrolled 387 patients with TBI from November 2009 through October 2014 in a study. Barbiturates and decompressive craniectomy were required to control intracranial pressure in 54% of patients who received standard care and in 44% of patients who received hypothermia and standard care. The hypothermia group had worse outcomes in general than the standard-care group. A favorable outcome occurred in 26% of patients in the hypothermia group and in 37% of patients in the control group.
Differing manifestations of postconcussion symptoms on functional MRI (fMRI) between younger and older patients indicate that age influences the activation, modulation, and allocation of working memory processing resources after mild traumatic brain injury (MTBI), according to a study published online ahead of print October 6 in Radiology. Researchers performed fMRI exams on 13 young adults and 13 older adults with MTBI and 26 age- and gender-matched controls. Younger patients performing working-memory tasks had initial hyperactivation in the right precuneus and right inferior parietal gyrus, compared with younger controls. Older patients performing these tasks had hypoactivation in the right precuneus and right inferior frontal gyrus, compared with older controls. Younger patients, but not older patients, had partial recovery of activation pattern and decreased postconcussion symptoms at follow-up.
An immune system gene is associated with higher rates of amyloid plaque buildup in the brains of patients with Alzheimer’s disease and older adults at risk for the disease, according to a study published in the October issue of Brain. Investigators performed a genome-wide association study of longitudinal change in brain amyloid burden measured by 18F-florbetapir PET. They found that interleukin-1 receptor accessory protein (IL1RAP) was associated with higher rates of amyloid accumulation, independent of APOE ε4 status. This novel association was validated by deep sequencing. IL1RAP rs12053868-G carriers were more likely to progress from mild cognitive impairment to Alzheimer’s disease and exhibited greater longitudinal temporal cortex atrophy on MRI. In independent cohorts, rs12053868-G was associated with accelerated cognitive decline and lower cortical 11C-PBR28 PET signal.
For children with tuberous sclerosis complex and medically intractable epilepsy, a greater extent of resection is associated with a greater probability of seizure freedom, according to a study published in the October issue of Neurosurgery. Seventy-four patients were included in this retrospective chart review, and their median age at the time of surgery was 120 months. Engel Class I outcome was achieved in 65% and in 50% of patients at the one- and two-year follow-up, respectively. On univariate analyses, younger age at seizure onset, larger size of predominant tuber, and resection larger than a tuberectomy were associated with a longer duration of seizure freedom. In multivariate analyses, resection larger than a tuberectomy was independently associated with a longer duration of seizure freedom.
A new imaging method that uses a 7-T magnet shows promise in locating hard-to-find epileptic foci by visualizing the neurotransmitter glutamate, according to a study published October 14 in Science Translational Medicine. In a pilot study, researchers applied glutamate chemical exchange saturation transfer (GluCEST) to patients with nonlesional temporal lobe epilepsy based on conventional MRI. GluCEST correctly lateralized the temporal lobe seizure focus on visual and quantitative analyses in all patients. Hippocampal volumes were not significantly different between hemispheres. GluCEST allowed high-resolution functional imaging of brain glutamate and has the potential to identify the epileptic focus in patients previously deemed nonlesional. This method may lead to improved clinical outcomes for temporal lobe epilepsy as well as other localization-related epilepsies, according to the researchers.
—Kimberly Williams
