News Roundup

New and Noteworthy Information—October 2017


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

Recommended Reading

VIDEO: Further CTE correlation found in deceased American football players
MDedge Neurology
New and Noteworthy Information—August 2017
MDedge Neurology
Small study advances noninvasive ICP monitoring
MDedge Neurology
New and Noteworthy Information—September 2017
MDedge Neurology
Subtle hearing loss after concussion could impair learning
MDedge Neurology