News Roundup

New and Noteworthy Information—September 2018


Intrathecal Baclofen Reduces Pain in Poststroke Spasticity

Intrathecal baclofen (ITB) therapy improves pain and quality of life in patients with poststroke spasticity, according to a study published August 14 in Stroke. Patients with poststroke spasticity in two or more extremities and an Ashworth Scale score of 3 or higher in two or more affected lower extremity muscle groups were randomized to ITB or conventional medical management. At six months, ITB effectively reduced Numeric Pain Rating Scale scores for actual and least spasticity-related pain and improved quality of life, compared with medical management. In addition, 73% of patients given ITB therapy reported satisfaction with spasticity reduction at month six, versus 48% of patients given medical management. The researchers found no statistically significant differences between groups in reduction of worst pain.

Creamer M, Cloud G, Kossmehl P, et al. Effect of intrathecal baclofen on pain and quality of life in poststroke spasticity. Stroke. 2018 Aug 14 [Epub ahead of print].

FDA Approves Diacomit for Seizures Associated With Dravet Syndrome

The FDA has approved Diacomit (stiripentol) for the treatment of seizures associated with Dravet syndrome in patients age 2 and older who are taking clobazam. Diacomit will be available in 250-mg and 500-mg capsules and in fruit-flavored powder packets for oral suspension. In two studies of patients between ages 3 and 17 with Dravet syndrome, patients were randomized to Diacomit or placebo, along with their previous treatment with clobazam and valproate. In Study 1, 71% of patients in the Diacomit group were 50% responders versus 5% in the placebo group. In Study 2, 67% of patients treated with Diacomit were 50% responders versus 9.1% of controls. Diacomit is marketed by Biocodex, which is headquartered in Gentilly, France.

Retinal Thinning Is Associated With Dopaminergic Cell Loss

Retinal thinning is linked to the loss of brain cells in Parkinson’s disease, according to a study published online ahead of print August 15 in Neurology. Researchers examined 49 participants (average age, 69) who had been diagnosed with Parkinson’s disease an average of two years earlier, but who had not yet started medication. Participants were compared with 54 healthy controls who were matched for age. Participants underwent a complete eye exam and high-resolution eye scans. Patients with Parkinson’s disease had retinal layer thinning in the temporal and inferior 2.22-mm sectors. The thickness of these layers in the inferior 2.22-mm sector correlated negatively with Hoehn and Yahr stage. Retinal thinning was associated with dopaminergic loss in the left substantia nigra.

Ahn J, Lee JY, Kim TW, et al. Retinal thinning associates with nigral dopaminergic loss in de novo Parkinson disease. Neurology. 2018 Aug 15 [Epub ahead of print].

Contact Sports Linked to Vascular Risk Factors and Depression

Athletes with a history of playing professional contact sports have more vascular risk factors and higher depression scores, according to a study published online ahead of print August 3 in the Journal of Head Trauma Rehabilitation. This case–control study included 21 retired National Football League and National Hockey League players and 21 age-matched noncontact athlete controls. The investigators assessed participants for mild cognitive impairment (MCI) and measured depression using the Beck Depression Inventory-II (BDI). Eight contact sport athletes and three noncontact athletes met criteria for MCI. Contact sport athletes’ scores were significantly worse on Letter Fluency and List B Immediate Recall. Contact athletes were more obese, had more vascular risk factors, and had higher BDI scores.

Baker JG, Leddy JJ, Hinds AL, et al. An exploratory study of mild cognitive impairment of retired professional contact sport athletes. J Head Trauma Rehabil. 2018 Aug 3 [Epub ahead of print].

Managing Vegetative and Minimally Conscious States

The American Academy of Neurology; the American Congress of Rehabilitative Medicine; and the National Institute on Disability, Independent Living, and Rehabilitation Research have published a practice guideline on the diagnosis and ongoing medical and rehabilitative care of patients in a vegetative or minimally conscious state caused by brain injury. The guideline was published online ahead of print August 8 in Neurology. The authors based their recommendations on a systematic review of the evidence using a modified Delphi consensus process. Clinicians should advise families that for adults, a minimally conscious state and traumatic etiology are associated with more favorable outcomes, according to the guideline. Structural MRI, SPECT, and the Coma Recovery Scale-Revised can assist prognostication in adults, but no tests improve prognostic accuracy in children, said the authors.

Giacino JT, Katz DI, Schiff ND, et al. Practice guideline update recommendations summary: Disorders of consciousness: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology; the American Congress of Rehabilitation Medicine; and the National Institute on Disability, Independent Living, and Rehabilitation Research. Neurology. 2018 Aug 8 [Epub ahead of print].

FDA Approves Onpattro

The FDA has approved Onpattro (patisiran) lipid complex injection for the treatment of polyneuropathy of hereditary transthyretin-mediated (hATTR) amyloidosis in adults. The approval of Onpattro was based on results from a randomized, double-blind, placebo-controlled phase III study. Of 225 patients, 148 were randomized to Onpattro infusion once every three weeks for 18 months. The other participants were randomized to placebo infusion at the same frequency. The patients who received Onpattro had better outcomes on measures of polyneuropathy, including muscle strength, sensation, reflexes, and autonomic symptoms, compared with participants receiving placebo infusions. Patients receiving Onpattro also scored better on assessments of walking, nutritional status, and the ability to perform activities of daily living. Alnylam Pharmaceuticals, which markets Onpattro, is headquartered in Cambridge, Massachusetts.

Ophthalmic Conditions May Indicate Increased Risk of Alzheimer’s Disease

People with recent diagnoses of glaucoma, established age-related macular degeneration, and recent and established diabetic retinopathy may have increased risk of Alzheimer’s disease, according to a study published online ahead of print August 2 in Alzheimer’s & Dementia. The investigators included 3,877 participants selected randomly from the Adult Changes in Thought study in their analysis. Participants were age 65 or older and did not have Alzheimer’s disease at the time of enrollment. During the five-year study, a committee of dementia experts diagnosed Alzheimer’s disease in 792 people. Patients with age-related macular degeneration, diabetic retinopathy, or glaucoma were at 40% to 50% greater risk of developing Alzheimer’s disease, compared with people without these eye conditions. Cataract diagnosis was not a risk factor for Alzheimer’s disease.

Lee CS, Larson EB, Gibbons LE, et al. Associations between recent and established ophthalmic conditions and risk of Alzheimer’s disease. Alzheimers Dement. 2018 Aug 2 [Epub ahead of print].

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