New and Noteworthy Information—August 2016

People with epilepsy are at increased risk of autism spectrum disorder, especially if epilepsy appears in childhood, according to a study published July 12 in Neurology. Researchers used the Swedish Patient Register to identify 85,201 individuals with epilepsy, their siblings, and their offspring. Each person with epilepsy was compared with five controls matched for age, sex, calendar period, and county. Patients' siblings and offspring were compared with siblings and offspring of controls. During follow-up, 1.6% of people with epilepsy and 0.2% of controls were diagnosed with autism spectrum disorder. People with epilepsy were at increased risk of future autism spectrum disorder, with the highest risk seen in individuals diagnosed with epilepsy in childhood. Siblings and offspring of patients were at increased risk of autism spectrum disorder, compared with controls.

Among patients with chorea associated with Huntington's disease, deutetrabenazine, compared with placebo, results in improved motor signs at 12 weeks, according to a study published July 5 in JAMA. For this study, 90 adults (mean age, 53.7; 44.4% women) with Huntington's disease and a baseline total maximal chorea score of eight or higher were enrolled from August 2013 to August 2014. Participants were randomized to receive deutetrabenazine or placebo. In the deutetrabenazine group, the mean total maximal chorea scores improved from 12.1 to 7.7, whereas in the placebo group, scores improved from 13.2 to 11.3. In the deutetrabenazine group, the mean 36-Item Short Form physical functioning subscale scores decreased from 47.5 to 47.4, whereas in the placebo group, scores decreased from 43.2 to 39.9.

The estimated suicide rate among people with epilepsy in a large US population exceeds that in the general population, according to a study published online ahead of print June 30 in Epilepsy & Behavior. Among people age 10 and older, researchers identified 972 suicide cases with epilepsy and 81,529 suicide cases without epilepsy in 17 states from 2003 through 2011. Investigators estimated their suicide rates, evaluated suicide risk among people with epilepsy, and investigated suicide risk factors specific to epilepsy by comparing those with and without epilepsy. The estimated annual suicide mortality rate among people with epilepsy was 22% higher than that in the general population. Overall, compared with people without epilepsy, those with epilepsy were more likely to have died from suicide and were twice as likely to poison themselves.

Low-dose methylene blue increases functional MRI (fMRI) activity during sustained attention and short-term memory tasks and enhances memory retrieval, according to a study published online ahead of print June 28 in Radiology. Twenty-six people ages 22 to 62 were enrolled. Researchers performed fMRI imaging with a psychomotor vigilance task and delayed match-to-sample tasks before and one hour after administration of low-dose methylene blue or placebo. Cerebrovascular reactivity effects were measured with the carbon dioxide challenge. Multiple comparison correction also was applied. Administration of methylene blue increased response in the bilateral insular cortex during the psychomotor vigilance task and fMRI response during the short-term memory task involving the prefrontal, parietal, and occipital cortex. Methylene blue also was associated with a 7% increase in correct responses during memory retrieval.

Traumatic brain injury (TBI) with loss of consciousness is associated with an increased risk for clinical and neuropathologic findings of Parkinson's disease, but not Alzheimer's disease, according to a study published online ahead of print July 11 in JAMA Neurology. Researchers retrospectively analyzed data from three prospective cohort studies that included annual or biennial cognitive and clinical testing to identify incident cases of dementia and Alzheimer's disease. Of 7,130 participants, 865 reported a history of TBI with loss of consciousness. In 45,190 person-years of follow-up, 1,537 incident cases of dementia and 117 of Parkinson's disease were identified. No association was found between TBI with loss of consciousness and incident dementia or Alzheimer's disease. TBI with loss of consciousness was associated with incident Parkinson's disease, progression of parkinsonian signs, Lewy bodies, and microinfarcts.

Genetically elevated BMI is associated with risk of multiple sclerosis (MS), which suggests a causal role for obesity in MS etiology, according to an article published June 28 in PLOS Medicine. Researchers used summary statistics from the Genetic Investigation of Anthropometric Traits (GIANT) consortium and the International MS Genetics Consortium (IMSGC). The effect of each single-nucleotide polymorphism (SNP) on MS was weighted by its effect on BMI. Seventy SNPs had genome-wide significance for BMI in GIANT and were investigated for their association with MS risk in the IMSGC. It was found that increased BMI influences MS susceptibility, where a one-standard-deviation increase in genetically determined BMI increased odds of MS by 41%. Sensitivity analyses, including MR-Egger regression, and the weighted median approach provided no evidence of pleiotropic effects.

The FDA has accepted the Biologics License Application for Ocrevus (ocrelizumab) for the treatment of relapsing multiple sclerosis and primary progressive multiple sclerosis. The agency granted the application Priority Review Designation with a targeted action date of December 28, 2016. The Ocrevus Marketing Authorization Application has also been validated by the European Medicines Agency. The Ocrevus marketing applications are based on results from three phase III studies that met primary and key secondary end points. Data from OPERA I and OPERA II in people with relapsing multiple sclerosis showed superior efficacy of Ocrevus in reducing annualized relapse rates and disability progression sustained for at least three and for at least six months, respectively, compared with interferon beta-1a. Genentech, which will manufacture the drug, is headquartered in South San Francisco, California.

Thirty-eight independent genomic regions are associated with migraine, according to a study published online ahead of print June 20 in Nature Genetics. The identified loci showed enrichment for genes expressed in vascular and smooth muscle tissues, which is consistent with a predominant theory of migraine that highlights vascular etiologies. To identify new genomic loci associated with susceptibility to migraine, researchers carried out a genetic study of migraine on 59,674 subjects with migraine and 316,078 controls who participated in 22 genome-wide association studies. Investigators identified 44 independent single-nucleotide polymorphisms significantly associated with migraine risk that mapped to 38 distinct genomic loci, including 28 loci not previously reported and a locus that is the first to be identified on chromosome X. The findings may promote the development of personalized treatments for migraine.

Long-term risks of recurrent stroke and poststroke dementia remain high after stroke and are substantially influenced by prestroke risk factors, emphasizing the need for optimizing primary prevention, according to a study published online ahead of print July 14 in Stroke. Researchers monitored 1,237 patients with first-ever stroke and 4,928 stroke-free participants, matched by age, sex, examination round, and stroke date, for the occurrence of stroke or dementia. Beyond one year after stroke, patients retained a threefold increased risk of recurrent stroke and an almost twofold increased risk of dementia, compared with people without stroke. In all, 39% of recurrent strokes and 10% of poststroke dementia cases were attributable to prestroke cardiovascular risk factors. These percentages were similar for first-ever stroke and dementia in the matched stroke-free population.

Molecular evidence indicates that nilotinib significantly increases brain dopamine and reduces toxic proteins linked to disease progression in patients with Parkinson's disease or dementia with Lewy bodies, according to a phase I study published July 11 in the Journal of Parkinson's Disease. Twelve participants were randomized to 150  mg/day or 300  mg/day of oral nilotinib for 24 weeks. The CSF levels of homovanillic acid were significantly increased between baseline and 24 weeks of treatment. The researchers found that nilotinib is safe and well tolerated for people with advanced Parkinson's disease. In addition, nilotinib is detectable in the CSF and engages the target ABL1. Improvements in motor and cognitive function suggest that nilotinib may have clinical benefits. Nilotinib should be evaluated in larger randomized trials, said the researchers.

The FDA has approved ExAblate Neuro, the first focused ultrasound device to treat essential tremor in patients who have not responded to medication. ExAblate Neuro uses MRI to deliver focused ultrasound to destroy brain tissue in a small area thought to be responsible for causing tremors. Of 76 patients with essential tremor, 56 randomly received the ExAblate Neuro treatment in one study. Patients in the control group were able to cross over into the treatment group three months later. Patients treated with ExAblate Neuro showed a nearly 50% improvement in tremor and motor function three months after treatment, compared with their baseline scores. To determine whether ExAblate Neuro treatment is appropriate, patients should first have MRI and CT scans. InSightec, the device's manufacturer, is headquartered in Tirat Carmel, Israel.

The driving ability of patients with mild cognitive impairment (MCI) and Alzheimer's disease is related to their degree of cognitive impairment, according to a systematic review published May 11 in the Journal of Alzheimer's Disease. Researchers investigated the predictive utility of cognitive tests and domains, and the areas and degree of driving impairment in patients with MCI and Alzheimer's disease. Effect sizes were derived and analyzed in a random effects model. Executive function, attention, visuospatial function, and global cognition significantly predicted driving performance. Trail Making Test Part B and Maze test were the best single predictors of driving performance. Patients with very mild Alzheimer's disease and mild Alzheimer's disease were more likely to fail an on-road test than healthy control drivers, with failure rates of 13.6%, 33.3%, and 1.6%, respectively.

Functional brain scans may help predict recovery and guide treatment after stroke, according to a study published online ahead of print July 11 in the Proceedings of the National Academy of Sciences. Researchers investigated whether functional connectivity MRI (fcMRI) could provide useful information for assessing stroke damage. They used fcMRI to assess communication between brain areas in 132 patients with stroke and 31 people without stroke. The technology allowed the authors to identify large disruptions in brain communication that occurred as a result of stroke. Each participant also underwent a battery of neuropsychologic tests. Network-specific patterns of dysfunction predicted specific behavioral deficits, and loss of interhemispheric communication across a set of regions was associated with impairment across multiple behavioral domains.

—Kimberly Williams

People with epilepsy are at increased risk of autism spectrum disorder, especially if epilepsy appears in childhood, according to a study published July 12 in Neurology. Researchers used the Swedish Patient Register to identify 85,201 individuals with epilepsy, their siblings, and their offspring. Each person with epilepsy was compared with five controls matched for age, sex, calendar period, and county. Patients' siblings and offspring were compared with siblings and offspring of controls. During follow-up, 1.6% of people with epilepsy and 0.2% of controls were diagnosed with autism spectrum disorder. People with epilepsy were at increased risk of future autism spectrum disorder, with the highest risk seen in individuals diagnosed with epilepsy in childhood. Siblings and offspring of patients were at increased risk of autism spectrum disorder, compared with controls.

Among patients with chorea associated with Huntington's disease, deutetrabenazine, compared with placebo, results in improved motor signs at 12 weeks, according to a study published July 5 in JAMA. For this study, 90 adults (mean age, 53.7; 44.4% women) with Huntington's disease and a baseline total maximal chorea score of eight or higher were enrolled from August 2013 to August 2014. Participants were randomized to receive deutetrabenazine or placebo. In the deutetrabenazine group, the mean total maximal chorea scores improved from 12.1 to 7.7, whereas in the placebo group, scores improved from 13.2 to 11.3. In the deutetrabenazine group, the mean 36-Item Short Form physical functioning subscale scores decreased from 47.5 to 47.4, whereas in the placebo group, scores decreased from 43.2 to 39.9.

The estimated suicide rate among people with epilepsy in a large US population exceeds that in the general population, according to a study published online ahead of print June 30 in Epilepsy & Behavior. Among people age 10 and older, researchers identified 972 suicide cases with epilepsy and 81,529 suicide cases without epilepsy in 17 states from 2003 through 2011. Investigators estimated their suicide rates, evaluated suicide risk among people with epilepsy, and investigated suicide risk factors specific to epilepsy by comparing those with and without epilepsy. The estimated annual suicide mortality rate among people with epilepsy was 22% higher than that in the general population. Overall, compared with people without epilepsy, those with epilepsy were more likely to have died from suicide and were twice as likely to poison themselves.

Low-dose methylene blue increases functional MRI (fMRI) activity during sustained attention and short-term memory tasks and enhances memory retrieval, according to a study published online ahead of print June 28 in Radiology. Twenty-six people ages 22 to 62 were enrolled. Researchers performed fMRI imaging with a psychomotor vigilance task and delayed match-to-sample tasks before and one hour after administration of low-dose methylene blue or placebo. Cerebrovascular reactivity effects were measured with the carbon dioxide challenge. Multiple comparison correction also was applied. Administration of methylene blue increased response in the bilateral insular cortex during the psychomotor vigilance task and fMRI response during the short-term memory task involving the prefrontal, parietal, and occipital cortex. Methylene blue also was associated with a 7% increase in correct responses during memory retrieval.

Traumatic brain injury (TBI) with loss of consciousness is associated with an increased risk for clinical and neuropathologic findings of Parkinson's disease, but not Alzheimer's disease, according to a study published online ahead of print July 11 in JAMA Neurology. Researchers retrospectively analyzed data from three prospective cohort studies that included annual or biennial cognitive and clinical testing to identify incident cases of dementia and Alzheimer's disease. Of 7,130 participants, 865 reported a history of TBI with loss of consciousness. In 45,190 person-years of follow-up, 1,537 incident cases of dementia and 117 of Parkinson's disease were identified. No association was found between TBI with loss of consciousness and incident dementia or Alzheimer's disease. TBI with loss of consciousness was associated with incident Parkinson's disease, progression of parkinsonian signs, Lewy bodies, and microinfarcts.

Genetically elevated BMI is associated with risk of multiple sclerosis (MS), which suggests a causal role for obesity in MS etiology, according to an article published June 28 in PLOS Medicine. Researchers used summary statistics from the Genetic Investigation of Anthropometric Traits (GIANT) consortium and the International MS Genetics Consortium (IMSGC). The effect of each single-nucleotide polymorphism (SNP) on MS was weighted by its effect on BMI. Seventy SNPs had genome-wide significance for BMI in GIANT and were investigated for their association with MS risk in the IMSGC. It was found that increased BMI influences MS susceptibility, where a one-standard-deviation increase in genetically determined BMI increased odds of MS by 41%. Sensitivity analyses, including MR-Egger regression, and the weighted median approach provided no evidence of pleiotropic effects.

The FDA has accepted the Biologics License Application for Ocrevus (ocrelizumab) for the treatment of relapsing multiple sclerosis and primary progressive multiple sclerosis. The agency granted the application Priority Review Designation with a targeted action date of December 28, 2016. The Ocrevus Marketing Authorization Application has also been validated by the European Medicines Agency. The Ocrevus marketing applications are based on results from three phase III studies that met primary and key secondary end points. Data from OPERA I and OPERA II in people with relapsing multiple sclerosis showed superior efficacy of Ocrevus in reducing annualized relapse rates and disability progression sustained for at least three and for at least six months, respectively, compared with interferon beta-1a. Genentech, which will manufacture the drug, is headquartered in South San Francisco, California.

Thirty-eight independent genomic regions are associated with migraine, according to a study published online ahead of print June 20 in Nature Genetics. The identified loci showed enrichment for genes expressed in vascular and smooth muscle tissues, which is consistent with a predominant theory of migraine that highlights vascular etiologies. To identify new genomic loci associated with susceptibility to migraine, researchers carried out a genetic study of migraine on 59,674 subjects with migraine and 316,078 controls who participated in 22 genome-wide association studies. Investigators identified 44 independent single-nucleotide polymorphisms significantly associated with migraine risk that mapped to 38 distinct genomic loci, including 28 loci not previously reported and a locus that is the first to be identified on chromosome X. The findings may promote the development of personalized treatments for migraine.

Long-term risks of recurrent stroke and poststroke dementia remain high after stroke and are substantially influenced by prestroke risk factors, emphasizing the need for optimizing primary prevention, according to a study published online ahead of print July 14 in Stroke. Researchers monitored 1,237 patients with first-ever stroke and 4,928 stroke-free participants, matched by age, sex, examination round, and stroke date, for the occurrence of stroke or dementia. Beyond one year after stroke, patients retained a threefold increased risk of recurrent stroke and an almost twofold increased risk of dementia, compared with people without stroke. In all, 39% of recurrent strokes and 10% of poststroke dementia cases were attributable to prestroke cardiovascular risk factors. These percentages were similar for first-ever stroke and dementia in the matched stroke-free population.

Molecular evidence indicates that nilotinib significantly increases brain dopamine and reduces toxic proteins linked to disease progression in patients with Parkinson's disease or dementia with Lewy bodies, according to a phase I study published July 11 in the Journal of Parkinson's Disease. Twelve participants were randomized to 150  mg/day or 300  mg/day of oral nilotinib for 24 weeks. The CSF levels of homovanillic acid were significantly increased between baseline and 24 weeks of treatment. The researchers found that nilotinib is safe and well tolerated for people with advanced Parkinson's disease. In addition, nilotinib is detectable in the CSF and engages the target ABL1. Improvements in motor and cognitive function suggest that nilotinib may have clinical benefits. Nilotinib should be evaluated in larger randomized trials, said the researchers.

The FDA has approved ExAblate Neuro, the first focused ultrasound device to treat essential tremor in patients who have not responded to medication. ExAblate Neuro uses MRI to deliver focused ultrasound to destroy brain tissue in a small area thought to be responsible for causing tremors. Of 76 patients with essential tremor, 56 randomly received the ExAblate Neuro treatment in one study. Patients in the control group were able to cross over into the treatment group three months later. Patients treated with ExAblate Neuro showed a nearly 50% improvement in tremor and motor function three months after treatment, compared with their baseline scores. To determine whether ExAblate Neuro treatment is appropriate, patients should first have MRI and CT scans. InSightec, the device's manufacturer, is headquartered in Tirat Carmel, Israel.

The driving ability of patients with mild cognitive impairment (MCI) and Alzheimer's disease is related to their degree of cognitive impairment, according to a systematic review published May 11 in the Journal of Alzheimer's Disease. Researchers investigated the predictive utility of cognitive tests and domains, and the areas and degree of driving impairment in patients with MCI and Alzheimer's disease. Effect sizes were derived and analyzed in a random effects model. Executive function, attention, visuospatial function, and global cognition significantly predicted driving performance. Trail Making Test Part B and Maze test were the best single predictors of driving performance. Patients with very mild Alzheimer's disease and mild Alzheimer's disease were more likely to fail an on-road test than healthy control drivers, with failure rates of 13.6%, 33.3%, and 1.6%, respectively.

Functional brain scans may help predict recovery and guide treatment after stroke, according to a study published online ahead of print July 11 in the Proceedings of the National Academy of Sciences. Researchers investigated whether functional connectivity MRI (fcMRI) could provide useful information for assessing stroke damage. They used fcMRI to assess communication between brain areas in 132 patients with stroke and 31 people without stroke. The technology allowed the authors to identify large disruptions in brain communication that occurred as a result of stroke. Each participant also underwent a battery of neuropsychologic tests. Network-specific patterns of dysfunction predicted specific behavioral deficits, and loss of interhemispheric communication across a set of regions was associated with impairment across multiple behavioral domains.

—Kimberly Williams

People with epilepsy are at increased risk of autism spectrum disorder, especially if epilepsy appears in childhood, according to a study published July 12 in Neurology. Researchers used the Swedish Patient Register to identify 85,201 individuals with epilepsy, their siblings, and their offspring. Each person with epilepsy was compared with five controls matched for age, sex, calendar period, and county. Patients' siblings and offspring were compared with siblings and offspring of controls. During follow-up, 1.6% of people with epilepsy and 0.2% of controls were diagnosed with autism spectrum disorder. People with epilepsy were at increased risk of future autism spectrum disorder, with the highest risk seen in individuals diagnosed with epilepsy in childhood. Siblings and offspring of patients were at increased risk of autism spectrum disorder, compared with controls.

Among patients with chorea associated with Huntington's disease, deutetrabenazine, compared with placebo, results in improved motor signs at 12 weeks, according to a study published July 5 in JAMA. For this study, 90 adults (mean age, 53.7; 44.4% women) with Huntington's disease and a baseline total maximal chorea score of eight or higher were enrolled from August 2013 to August 2014. Participants were randomized to receive deutetrabenazine or placebo. In the deutetrabenazine group, the mean total maximal chorea scores improved from 12.1 to 7.7, whereas in the placebo group, scores improved from 13.2 to 11.3. In the deutetrabenazine group, the mean 36-Item Short Form physical functioning subscale scores decreased from 47.5 to 47.4, whereas in the placebo group, scores decreased from 43.2 to 39.9.

The estimated suicide rate among people with epilepsy in a large US population exceeds that in the general population, according to a study published online ahead of print June 30 in Epilepsy & Behavior. Among people age 10 and older, researchers identified 972 suicide cases with epilepsy and 81,529 suicide cases without epilepsy in 17 states from 2003 through 2011. Investigators estimated their suicide rates, evaluated suicide risk among people with epilepsy, and investigated suicide risk factors specific to epilepsy by comparing those with and without epilepsy. The estimated annual suicide mortality rate among people with epilepsy was 22% higher than that in the general population. Overall, compared with people without epilepsy, those with epilepsy were more likely to have died from suicide and were twice as likely to poison themselves.

Low-dose methylene blue increases functional MRI (fMRI) activity during sustained attention and short-term memory tasks and enhances memory retrieval, according to a study published online ahead of print June 28 in Radiology. Twenty-six people ages 22 to 62 were enrolled. Researchers performed fMRI imaging with a psychomotor vigilance task and delayed match-to-sample tasks before and one hour after administration of low-dose methylene blue or placebo. Cerebrovascular reactivity effects were measured with the carbon dioxide challenge. Multiple comparison correction also was applied. Administration of methylene blue increased response in the bilateral insular cortex during the psychomotor vigilance task and fMRI response during the short-term memory task involving the prefrontal, parietal, and occipital cortex. Methylene blue also was associated with a 7% increase in correct responses during memory retrieval.

Traumatic brain injury (TBI) with loss of consciousness is associated with an increased risk for clinical and neuropathologic findings of Parkinson's disease, but not Alzheimer's disease, according to a study published online ahead of print July 11 in JAMA Neurology. Researchers retrospectively analyzed data from three prospective cohort studies that included annual or biennial cognitive and clinical testing to identify incident cases of dementia and Alzheimer's disease. Of 7,130 participants, 865 reported a history of TBI with loss of consciousness. In 45,190 person-years of follow-up, 1,537 incident cases of dementia and 117 of Parkinson's disease were identified. No association was found between TBI with loss of consciousness and incident dementia or Alzheimer's disease. TBI with loss of consciousness was associated with incident Parkinson's disease, progression of parkinsonian signs, Lewy bodies, and microinfarcts.

Genetically elevated BMI is associated with risk of multiple sclerosis (MS), which suggests a causal role for obesity in MS etiology, according to an article published June 28 in PLOS Medicine. Researchers used summary statistics from the Genetic Investigation of Anthropometric Traits (GIANT) consortium and the International MS Genetics Consortium (IMSGC). The effect of each single-nucleotide polymorphism (SNP) on MS was weighted by its effect on BMI. Seventy SNPs had genome-wide significance for BMI in GIANT and were investigated for their association with MS risk in the IMSGC. It was found that increased BMI influences MS susceptibility, where a one-standard-deviation increase in genetically determined BMI increased odds of MS by 41%. Sensitivity analyses, including MR-Egger regression, and the weighted median approach provided no evidence of pleiotropic effects.

The FDA has accepted the Biologics License Application for Ocrevus (ocrelizumab) for the treatment of relapsing multiple sclerosis and primary progressive multiple sclerosis. The agency granted the application Priority Review Designation with a targeted action date of December 28, 2016. The Ocrevus Marketing Authorization Application has also been validated by the European Medicines Agency. The Ocrevus marketing applications are based on results from three phase III studies that met primary and key secondary end points. Data from OPERA I and OPERA II in people with relapsing multiple sclerosis showed superior efficacy of Ocrevus in reducing annualized relapse rates and disability progression sustained for at least three and for at least six months, respectively, compared with interferon beta-1a. Genentech, which will manufacture the drug, is headquartered in South San Francisco, California.

Thirty-eight independent genomic regions are associated with migraine, according to a study published online ahead of print June 20 in Nature Genetics. The identified loci showed enrichment for genes expressed in vascular and smooth muscle tissues, which is consistent with a predominant theory of migraine that highlights vascular etiologies. To identify new genomic loci associated with susceptibility to migraine, researchers carried out a genetic study of migraine on 59,674 subjects with migraine and 316,078 controls who participated in 22 genome-wide association studies. Investigators identified 44 independent single-nucleotide polymorphisms significantly associated with migraine risk that mapped to 38 distinct genomic loci, including 28 loci not previously reported and a locus that is the first to be identified on chromosome X. The findings may promote the development of personalized treatments for migraine.

Long-term risks of recurrent stroke and poststroke dementia remain high after stroke and are substantially influenced by prestroke risk factors, emphasizing the need for optimizing primary prevention, according to a study published online ahead of print July 14 in Stroke. Researchers monitored 1,237 patients with first-ever stroke and 4,928 stroke-free participants, matched by age, sex, examination round, and stroke date, for the occurrence of stroke or dementia. Beyond one year after stroke, patients retained a threefold increased risk of recurrent stroke and an almost twofold increased risk of dementia, compared with people without stroke. In all, 39% of recurrent strokes and 10% of poststroke dementia cases were attributable to prestroke cardiovascular risk factors. These percentages were similar for first-ever stroke and dementia in the matched stroke-free population.

Molecular evidence indicates that nilotinib significantly increases brain dopamine and reduces toxic proteins linked to disease progression in patients with Parkinson's disease or dementia with Lewy bodies, according to a phase I study published July 11 in the Journal of Parkinson's Disease. Twelve participants were randomized to 150  mg/day or 300  mg/day of oral nilotinib for 24 weeks. The CSF levels of homovanillic acid were significantly increased between baseline and 24 weeks of treatment. The researchers found that nilotinib is safe and well tolerated for people with advanced Parkinson's disease. In addition, nilotinib is detectable in the CSF and engages the target ABL1. Improvements in motor and cognitive function suggest that nilotinib may have clinical benefits. Nilotinib should be evaluated in larger randomized trials, said the researchers.

The FDA has approved ExAblate Neuro, the first focused ultrasound device to treat essential tremor in patients who have not responded to medication. ExAblate Neuro uses MRI to deliver focused ultrasound to destroy brain tissue in a small area thought to be responsible for causing tremors. Of 76 patients with essential tremor, 56 randomly received the ExAblate Neuro treatment in one study. Patients in the control group were able to cross over into the treatment group three months later. Patients treated with ExAblate Neuro showed a nearly 50% improvement in tremor and motor function three months after treatment, compared with their baseline scores. To determine whether ExAblate Neuro treatment is appropriate, patients should first have MRI and CT scans. InSightec, the device's manufacturer, is headquartered in Tirat Carmel, Israel.

The driving ability of patients with mild cognitive impairment (MCI) and Alzheimer's disease is related to their degree of cognitive impairment, according to a systematic review published May 11 in the Journal of Alzheimer's Disease. Researchers investigated the predictive utility of cognitive tests and domains, and the areas and degree of driving impairment in patients with MCI and Alzheimer's disease. Effect sizes were derived and analyzed in a random effects model. Executive function, attention, visuospatial function, and global cognition significantly predicted driving performance. Trail Making Test Part B and Maze test were the best single predictors of driving performance. Patients with very mild Alzheimer's disease and mild Alzheimer's disease were more likely to fail an on-road test than healthy control drivers, with failure rates of 13.6%, 33.3%, and 1.6%, respectively.

Functional brain scans may help predict recovery and guide treatment after stroke, according to a study published online ahead of print July 11 in the Proceedings of the National Academy of Sciences. Researchers investigated whether functional connectivity MRI (fcMRI) could provide useful information for assessing stroke damage. They used fcMRI to assess communication between brain areas in 132 patients with stroke and 31 people without stroke. The technology allowed the authors to identify large disruptions in brain communication that occurred as a result of stroke. Each participant also underwent a battery of neuropsychologic tests. Network-specific patterns of dysfunction predicted specific behavioral deficits, and loss of interhemispheric communication across a set of regions was associated with impairment across multiple behavioral domains.

—Kimberly Williams