News Roundup: New and Noteworthy Information
IV aspirin is safe, effective, and useful for the treatment of severe headache, per a report in the September 21 Neurology. “IV lysine acetylsalicylate (aspirin) has been shown to be effective in the treatment of acute migraine attacks, but little is known about its effectiveness and safety in patients hospitalized for management of severe headache, typically arising from abrupt withdrawal of other acute attack medications,” researchers wrote. The study of 168 patients in a tertiary referral setting found improvements in pain scores, with a decrease of three or more points on a 10-point scale in more than 25% of cases. Side effect rates were also low (5.9%), and there were no serious adverse events.
Men who experience insomnia with short sleep duration have an increased risk of death, according to research in the September 1 Sleep. The longitudinal study of 1,741 men and women from central Pennsylvania found that men with insomnia who sleep for less than six hours have a fourfold increased risk of death when compared with those with normal sleep, “a risk that has been underestimated,” investigators reported. Insomnia was determined by complaint of sleep difficulty lasting one year or more, and short sleep duration was defined as less than six hours. Patients were seen in the sleep laboratory, and researchers tracked participants for 10 years (males) or 14 years (female). Mortality rates were 21% for men and 5% for women. Men with diabetes or hypertension had an even greater risk than men without these comorbidities. However, in women, mortality was not associated with insomnia or sleep duration.
IV dexamethasone reduces the number of unfavorable outcomes in patients with pneumococcal meningitis, researchers reported in the September 29 Neurology. The Dutch study compared outcomes of 357 episodes of the illness between 2006 and 2009, when 84% of patients received dexamethasone with or before the first dose of antibiotics, to 352 similar cases between 1998 and 2002, when 3% received dexamethasone. Outcomes were based on the 5-point Glasgow Outcome Scale, where a discharge score of 1 to 4 points was deemed unfavorable. Unfavorable outcomes decreased from 50% in the earlier cohort to 39%; rates of hearing loss dropped from 22% to 12%; and death rates declined from 30% to 20%. “The prognosis of pneumococcal meningitis on a national level has substantially improved after the introduction of adjunctive dexamethasone therapy,” the investigators reported.
The FDA approved Gilenya (fingolimod) 0.5 mg daily as a first-line treatment for relapsing forms of multiple sclerosis (MS). The approval makes Gilenya the first oral treatment for relapsing forms of MS. In clinical studies, fingolimod reduced relapses by 52% at one year, compared with interferon beta-1a. A two-year, placebo-controlled study showed that fingolimod significantly reduced the risk of disability progression. The oral therapy, which is marketed by Novartis Pharmaceuticals Corporation, is the first in a new class of drugs called sphingosine 1-phosphate receptor modulators. While fingolimod’s exact mechanism of action is unknown, it is thought to work by reducing the immune system’s attack on the CNS by retaining lymphocytes in the lymph nodes.
Age at disease onset is one of many clues to life expectancy for patients with Parkinson’s disease, according to a report that was published in the October 5 Neurology. Results of a 12-year study that included 230 patients indicate that the average time from symptom onset to death was 16 years. The average age at death was 81. The risk of earlier death was increased about 1.4 times for every 10-year increase in age at symptom onset. Patients with psychotic symptoms were also 1.5 times more likely to die sooner, compared with those without such symptoms. For patients with dementia symptoms, odds of dying earlier were nearly two times higher compared with patients with no memory problems. Men were 1.6 times more likely to die earlier, compared with women. Patients who scored worst on movement tests also had a higher risk of earlier death, compared with those with the highest scores.
A new understanding of the interaction between c-Abl and parkin offers a new target for neuroprotective therapies in Parkinson’s disease, according to research published in the September 7 online issue of theProceedings of the National Academy of Sciences. The over-activation of the c-Abl protein may shut down the brain-protective effects of parkin’s ubiquitin E3 ligase and contribute to a buildup of toxic proteins in the brain that enables the progression of sporadic Parkinson’s disease. The cancer drug imatinib is a c-Abl family kinase inhibitor, and investigators hope that it may help to maintain parkin’s normal protective functions. “The testing of these already approved, well-tolerated drugs for a new use—as a neuroprotective treatment for Parkinson’s disease—is a potentially exciting therapeutic arc that should be pursued,” the investigators reported.
