News Roundup: New and Noteworthy Information

Patients with Alzheimer’s disease who underwent repetitive transcranial magnetic stimulation (rTMS) showed improved sentence comprehension compared to baseline, according to a study published in the June 23 online Journal of Neurology, Neurosurgery, and Psychiatry. Researchers randomly assigned 10 patients to either a four-week rTMS protocol or two-week sham treatment followed by two weeks of real rTMS and found a significant difference between the two groups in terms of the percentage of correct responses of auditory sentence comprehension. “Only real treatment induced an improvement in performance with respect to baseline or placebo,” the investigators noted. “Moreover, both groups showed a lasting effect on the improved performance eight weeks after the end of treatment.” The researchers concluded that, in conjunction with other therapeutic interventions, rhythmic rTMS may offer a novel approach to treating Alzheimer’s-related language dysfunction.

Depression is associated with an increased risk of dementia and Alzheimer’s disease, researchers from the Framingham Heart Study reported in the July 6 Neurology. At baseline, 13.2% of the cohort (n = 949) scored 16 or greater on the Center for Epidemiologic Studies Depression Scale (CES-D). During the 17-year follow-up, 21.6% of participants who were depressed at baseline developed dementia, compared with 16.6% of those who were not depressed. “Depressed participants had more than a 50% increased risk for dementia and Alzheimer’s disease,” the investigators noted. “For each 10-point increase on the CES-D, there was a significant increase in the risk of dementia.”

In patients with mild cognitive impairment, baseline fluorodeoxyglucose (FDG)-PET scans and episodic memory performance predict conversion to Alzheimer’s disease better than CSF levels of hyperphosphorylated tau (p-tau181p) and Ab1-42, per research published in Neurology online ahead of print June 30. Using data from the Alzheimer’s Disease Neuroimaging Initiative, investigators evaluated the prognostic accuracy of genetic, CSF, neuroimaging, and cognitive measures for predicting disease progression. The study found that 17.2% of subjects annually converted from mild cognitive impairment to Alzheimer’s disease. Subjects with abnormal baseline results on both FDG-PET and episodic memory were 11.7 times more likely to progress to Alzheimer’s disease than were those with normal results. “Complementary information provided by these biomarkers may aid in future selection of patients for clinical trials or identification of patients likely to benefit from a therapeutic intervention,” the researchers concluded.

A new oral formulation of the antiepileptic drug Vimpat (lacosamide) (C-V) is available as an add-on treatment of partial-onset seizures in patients with epilepsy who are 17 and older. “There are many people for whom swallowing pills is difficult, and the oral solution, which can be substituted milligram for milligram to the oral tablet, will be helpful for adults with swallowing difficulties,” said Ilo E. Leppik, MD, Director of the Epilepsy Research and Education Program, University of Minnesota, in Minneapolis. “This will be particularly useful for elderly in nursing homes who may have gastric tubes in place.” Vimpat is also available in oral tablets and IV injections. The new 10-mg/mL oral formulation is a strawberry-flavored liquid and should be stored at room temperature. Vimpat is manufactured by UCB in Brussels.

Use of the antiepileptic drug (AED) valproic acid in the first trimester of pregnancy greatly increases the risk of birth defects, reported a study in the June 10 New England Journal of Medicine. Researchers combined data from eight cohort studies totaling 1,565 pregnancies exposed to valproic acid and found 118 instances of major malformations. The investigators identified 14 birth defects significantly more common in pregnancies with first-trimester exposure to the AED, and then performed a case–controlled study based on 98,075 live births, stillbirths, or terminations with malformations registered in a European AED database. Using two control groups—those with malformations not previously linked to valproic acid and those with chromosomal abnormalities—the investigators determined that six of the 14 malformations were significantly associated with use of valproic acid monotherapy: spina bifida (odds ratio [OR], 12.7), atrial septal defect (OR, 2.5), cleft palate (OR, 5.2), hypospadias (OR, 4.8), polydactyly (OR, 2.2), and craniosynostosis (OR, 6.8).

High consumption of alcoholic beverages, smoking, and a lack of physical activity were significantly associated with migraine and tension-type headaches in high school students, researchers reported in the June 7 online ahead of print Headache . A total of 1,260 adolescents filled out questionnaires regarding their intake of food and beverages (including coffee, alcohol, and nonalcoholic drinks), smoking habits, and physical activity. Students who drank more alcohol were 3.4 times more likely to have headaches than those who did not. Likewise, those who drank coffee had 2.4 times greater odds of headaches, while those who smoked cigarettes had a 2.7 higher likelihood of headaches. “Diet and lifestyle are seen as factors which influence headache in adults,” the researchers noted. “However, population-based studies on this issue in adolescents are rare.” No link was found between headaches and skipping meals or insufficient fluid intake.

Disease-specific and balance- and mobility-related measures can accurately predict which patients with Parkinson’s disease are at greater risk of falls, according to a study published online ahead of print June 23 in Neurology. In a study of 101 subjects with early-stage Parkinson’s disease, investigators administered a battery of neurologic and functional tests, including Tinetti, Berg, Timed Up and Go, Functional Reach, and the Physiological Profile Assessment of Falls Risk, which includes visual function, proprioception, strength, cutaneous sensitivity, reaction time, and postural sway assessments. In the six months following assessment, 48% of subjects reported at least one fall, while 24% of subjects reported more than one fall. The multivariate model revealed that the most accurate fall predictor was a combination of the Unified Parkinson’s Disease Rating Scale total score, total freezing of gait score, occurrence of symptomatic postural orthostasis, Tinetti total score, and extent of postural sway in the anterior-posterior direction.

A link between genetic variants, pesticide exposure, and Parkinson’s disease was reported in the June Archives of Neurology. Researchers tested for two ABCB1 polymorphisms associated with altered P-glycoprotein function in 207 subjects with Parkinson’s disease who were enrolled in the French health system for agricultural workers and 482 matched controls. Study participants also filled out questionnaires about their pesticide use, and subjects who used pesticides professionally were interviewed by an occupational health physician. Parkinson’s disease was not associated with the genetic variants in the full cohort; however, when separated by sex (101 male cases, 234 controls), investigators found a 3.5-fold higher incidence of organochlorine exposure in men with the variant G2677 (A, T) alleles. Among patients only, researchers noted an association between carrying two of the variant alleles and organochlorine exposure (odds ratio, 5.4), as well as with the cumulative lifetime number of hours of exposure.

Poststroke complications can shorten a patient’s optimum health span by about two years, per a study in the July 1 online Stroke. Using three-month outcome data from 1,233 patients with acute ischemic stroke in South Korea, researchers calculated the disability-adjusted life-year (DALY) loss from the stroke itself and then analyzed additional DALY lost from complications. Complications were reported in 34% of patients, with 20.8% of patients experiencing neurologic complications and 24.0% experiencing medical complications. The average DALY lost due to index stroke was 3.82. Patients with one complication lost an additional 1.52 DALY, while those with two or more complications lost an additional 2.69 DALY. “DALY analysis quantifies the burden of poststroke complications with a uniform metric potentially useful for healthy system planners,” the researchers stated.

—Rebecca K. Abma

Patients with Alzheimer’s disease who underwent repetitive transcranial magnetic stimulation (rTMS) showed improved sentence comprehension compared to baseline, according to a study published in the June 23 online Journal of Neurology, Neurosurgery, and Psychiatry. Researchers randomly assigned 10 patients to either a four-week rTMS protocol or two-week sham treatment followed by two weeks of real rTMS and found a significant difference between the two groups in terms of the percentage of correct responses of auditory sentence comprehension. “Only real treatment induced an improvement in performance with respect to baseline or placebo,” the investigators noted. “Moreover, both groups showed a lasting effect on the improved performance eight weeks after the end of treatment.” The researchers concluded that, in conjunction with other therapeutic interventions, rhythmic rTMS may offer a novel approach to treating Alzheimer’s-related language dysfunction.

Depression is associated with an increased risk of dementia and Alzheimer’s disease, researchers from the Framingham Heart Study reported in the July 6 Neurology. At baseline, 13.2% of the cohort (n = 949) scored 16 or greater on the Center for Epidemiologic Studies Depression Scale (CES-D). During the 17-year follow-up, 21.6% of participants who were depressed at baseline developed dementia, compared with 16.6% of those who were not depressed. “Depressed participants had more than a 50% increased risk for dementia and Alzheimer’s disease,” the investigators noted. “For each 10-point increase on the CES-D, there was a significant increase in the risk of dementia.”

In patients with mild cognitive impairment, baseline fluorodeoxyglucose (FDG)-PET scans and episodic memory performance predict conversion to Alzheimer’s disease better than CSF levels of hyperphosphorylated tau (p-tau181p) and Ab1-42, per research published in Neurology online ahead of print June 30. Using data from the Alzheimer’s Disease Neuroimaging Initiative, investigators evaluated the prognostic accuracy of genetic, CSF, neuroimaging, and cognitive measures for predicting disease progression. The study found that 17.2% of subjects annually converted from mild cognitive impairment to Alzheimer’s disease. Subjects with abnormal baseline results on both FDG-PET and episodic memory were 11.7 times more likely to progress to Alzheimer’s disease than were those with normal results. “Complementary information provided by these biomarkers may aid in future selection of patients for clinical trials or identification of patients likely to benefit from a therapeutic intervention,” the researchers concluded.

A new oral formulation of the antiepileptic drug Vimpat (lacosamide) (C-V) is available as an add-on treatment of partial-onset seizures in patients with epilepsy who are 17 and older. “There are many people for whom swallowing pills is difficult, and the oral solution, which can be substituted milligram for milligram to the oral tablet, will be helpful for adults with swallowing difficulties,” said Ilo E. Leppik, MD, Director of the Epilepsy Research and Education Program, University of Minnesota, in Minneapolis. “This will be particularly useful for elderly in nursing homes who may have gastric tubes in place.” Vimpat is also available in oral tablets and IV injections. The new 10-mg/mL oral formulation is a strawberry-flavored liquid and should be stored at room temperature. Vimpat is manufactured by UCB in Brussels.

Use of the antiepileptic drug (AED) valproic acid in the first trimester of pregnancy greatly increases the risk of birth defects, reported a study in the June 10 New England Journal of Medicine. Researchers combined data from eight cohort studies totaling 1,565 pregnancies exposed to valproic acid and found 118 instances of major malformations. The investigators identified 14 birth defects significantly more common in pregnancies with first-trimester exposure to the AED, and then performed a case–controlled study based on 98,075 live births, stillbirths, or terminations with malformations registered in a European AED database. Using two control groups—those with malformations not previously linked to valproic acid and those with chromosomal abnormalities—the investigators determined that six of the 14 malformations were significantly associated with use of valproic acid monotherapy: spina bifida (odds ratio [OR], 12.7), atrial septal defect (OR, 2.5), cleft palate (OR, 5.2), hypospadias (OR, 4.8), polydactyly (OR, 2.2), and craniosynostosis (OR, 6.8).

High consumption of alcoholic beverages, smoking, and a lack of physical activity were significantly associated with migraine and tension-type headaches in high school students, researchers reported in the June 7 online ahead of print Headache . A total of 1,260 adolescents filled out questionnaires regarding their intake of food and beverages (including coffee, alcohol, and nonalcoholic drinks), smoking habits, and physical activity. Students who drank more alcohol were 3.4 times more likely to have headaches than those who did not. Likewise, those who drank coffee had 2.4 times greater odds of headaches, while those who smoked cigarettes had a 2.7 higher likelihood of headaches. “Diet and lifestyle are seen as factors which influence headache in adults,” the researchers noted. “However, population-based studies on this issue in adolescents are rare.” No link was found between headaches and skipping meals or insufficient fluid intake.

Disease-specific and balance- and mobility-related measures can accurately predict which patients with Parkinson’s disease are at greater risk of falls, according to a study published online ahead of print June 23 in Neurology. In a study of 101 subjects with early-stage Parkinson’s disease, investigators administered a battery of neurologic and functional tests, including Tinetti, Berg, Timed Up and Go, Functional Reach, and the Physiological Profile Assessment of Falls Risk, which includes visual function, proprioception, strength, cutaneous sensitivity, reaction time, and postural sway assessments. In the six months following assessment, 48% of subjects reported at least one fall, while 24% of subjects reported more than one fall. The multivariate model revealed that the most accurate fall predictor was a combination of the Unified Parkinson’s Disease Rating Scale total score, total freezing of gait score, occurrence of symptomatic postural orthostasis, Tinetti total score, and extent of postural sway in the anterior-posterior direction.

A link between genetic variants, pesticide exposure, and Parkinson’s disease was reported in the June Archives of Neurology. Researchers tested for two ABCB1 polymorphisms associated with altered P-glycoprotein function in 207 subjects with Parkinson’s disease who were enrolled in the French health system for agricultural workers and 482 matched controls. Study participants also filled out questionnaires about their pesticide use, and subjects who used pesticides professionally were interviewed by an occupational health physician. Parkinson’s disease was not associated with the genetic variants in the full cohort; however, when separated by sex (101 male cases, 234 controls), investigators found a 3.5-fold higher incidence of organochlorine exposure in men with the variant G2677 (A, T) alleles. Among patients only, researchers noted an association between carrying two of the variant alleles and organochlorine exposure (odds ratio, 5.4), as well as with the cumulative lifetime number of hours of exposure.

Poststroke complications can shorten a patient’s optimum health span by about two years, per a study in the July 1 online Stroke. Using three-month outcome data from 1,233 patients with acute ischemic stroke in South Korea, researchers calculated the disability-adjusted life-year (DALY) loss from the stroke itself and then analyzed additional DALY lost from complications. Complications were reported in 34% of patients, with 20.8% of patients experiencing neurologic complications and 24.0% experiencing medical complications. The average DALY lost due to index stroke was 3.82. Patients with one complication lost an additional 1.52 DALY, while those with two or more complications lost an additional 2.69 DALY. “DALY analysis quantifies the burden of poststroke complications with a uniform metric potentially useful for healthy system planners,” the researchers stated.

—Rebecca K. Abma

Patients with Alzheimer’s disease who underwent repetitive transcranial magnetic stimulation (rTMS) showed improved sentence comprehension compared to baseline, according to a study published in the June 23 online Journal of Neurology, Neurosurgery, and Psychiatry. Researchers randomly assigned 10 patients to either a four-week rTMS protocol or two-week sham treatment followed by two weeks of real rTMS and found a significant difference between the two groups in terms of the percentage of correct responses of auditory sentence comprehension. “Only real treatment induced an improvement in performance with respect to baseline or placebo,” the investigators noted. “Moreover, both groups showed a lasting effect on the improved performance eight weeks after the end of treatment.” The researchers concluded that, in conjunction with other therapeutic interventions, rhythmic rTMS may offer a novel approach to treating Alzheimer’s-related language dysfunction.

Depression is associated with an increased risk of dementia and Alzheimer’s disease, researchers from the Framingham Heart Study reported in the July 6 Neurology. At baseline, 13.2% of the cohort (n = 949) scored 16 or greater on the Center for Epidemiologic Studies Depression Scale (CES-D). During the 17-year follow-up, 21.6% of participants who were depressed at baseline developed dementia, compared with 16.6% of those who were not depressed. “Depressed participants had more than a 50% increased risk for dementia and Alzheimer’s disease,” the investigators noted. “For each 10-point increase on the CES-D, there was a significant increase in the risk of dementia.”

In patients with mild cognitive impairment, baseline fluorodeoxyglucose (FDG)-PET scans and episodic memory performance predict conversion to Alzheimer’s disease better than CSF levels of hyperphosphorylated tau (p-tau181p) and Ab1-42, per research published in Neurology online ahead of print June 30. Using data from the Alzheimer’s Disease Neuroimaging Initiative, investigators evaluated the prognostic accuracy of genetic, CSF, neuroimaging, and cognitive measures for predicting disease progression. The study found that 17.2% of subjects annually converted from mild cognitive impairment to Alzheimer’s disease. Subjects with abnormal baseline results on both FDG-PET and episodic memory were 11.7 times more likely to progress to Alzheimer’s disease than were those with normal results. “Complementary information provided by these biomarkers may aid in future selection of patients for clinical trials or identification of patients likely to benefit from a therapeutic intervention,” the researchers concluded.

A new oral formulation of the antiepileptic drug Vimpat (lacosamide) (C-V) is available as an add-on treatment of partial-onset seizures in patients with epilepsy who are 17 and older. “There are many people for whom swallowing pills is difficult, and the oral solution, which can be substituted milligram for milligram to the oral tablet, will be helpful for adults with swallowing difficulties,” said Ilo E. Leppik, MD, Director of the Epilepsy Research and Education Program, University of Minnesota, in Minneapolis. “This will be particularly useful for elderly in nursing homes who may have gastric tubes in place.” Vimpat is also available in oral tablets and IV injections. The new 10-mg/mL oral formulation is a strawberry-flavored liquid and should be stored at room temperature. Vimpat is manufactured by UCB in Brussels.

Use of the antiepileptic drug (AED) valproic acid in the first trimester of pregnancy greatly increases the risk of birth defects, reported a study in the June 10 New England Journal of Medicine. Researchers combined data from eight cohort studies totaling 1,565 pregnancies exposed to valproic acid and found 118 instances of major malformations. The investigators identified 14 birth defects significantly more common in pregnancies with first-trimester exposure to the AED, and then performed a case–controlled study based on 98,075 live births, stillbirths, or terminations with malformations registered in a European AED database. Using two control groups—those with malformations not previously linked to valproic acid and those with chromosomal abnormalities—the investigators determined that six of the 14 malformations were significantly associated with use of valproic acid monotherapy: spina bifida (odds ratio [OR], 12.7), atrial septal defect (OR, 2.5), cleft palate (OR, 5.2), hypospadias (OR, 4.8), polydactyly (OR, 2.2), and craniosynostosis (OR, 6.8).

High consumption of alcoholic beverages, smoking, and a lack of physical activity were significantly associated with migraine and tension-type headaches in high school students, researchers reported in the June 7 online ahead of print Headache . A total of 1,260 adolescents filled out questionnaires regarding their intake of food and beverages (including coffee, alcohol, and nonalcoholic drinks), smoking habits, and physical activity. Students who drank more alcohol were 3.4 times more likely to have headaches than those who did not. Likewise, those who drank coffee had 2.4 times greater odds of headaches, while those who smoked cigarettes had a 2.7 higher likelihood of headaches. “Diet and lifestyle are seen as factors which influence headache in adults,” the researchers noted. “However, population-based studies on this issue in adolescents are rare.” No link was found between headaches and skipping meals or insufficient fluid intake.

Disease-specific and balance- and mobility-related measures can accurately predict which patients with Parkinson’s disease are at greater risk of falls, according to a study published online ahead of print June 23 in Neurology. In a study of 101 subjects with early-stage Parkinson’s disease, investigators administered a battery of neurologic and functional tests, including Tinetti, Berg, Timed Up and Go, Functional Reach, and the Physiological Profile Assessment of Falls Risk, which includes visual function, proprioception, strength, cutaneous sensitivity, reaction time, and postural sway assessments. In the six months following assessment, 48% of subjects reported at least one fall, while 24% of subjects reported more than one fall. The multivariate model revealed that the most accurate fall predictor was a combination of the Unified Parkinson’s Disease Rating Scale total score, total freezing of gait score, occurrence of symptomatic postural orthostasis, Tinetti total score, and extent of postural sway in the anterior-posterior direction.

A link between genetic variants, pesticide exposure, and Parkinson’s disease was reported in the June Archives of Neurology. Researchers tested for two ABCB1 polymorphisms associated with altered P-glycoprotein function in 207 subjects with Parkinson’s disease who were enrolled in the French health system for agricultural workers and 482 matched controls. Study participants also filled out questionnaires about their pesticide use, and subjects who used pesticides professionally were interviewed by an occupational health physician. Parkinson’s disease was not associated with the genetic variants in the full cohort; however, when separated by sex (101 male cases, 234 controls), investigators found a 3.5-fold higher incidence of organochlorine exposure in men with the variant G2677 (A, T) alleles. Among patients only, researchers noted an association between carrying two of the variant alleles and organochlorine exposure (odds ratio, 5.4), as well as with the cumulative lifetime number of hours of exposure.

Poststroke complications can shorten a patient’s optimum health span by about two years, per a study in the July 1 online Stroke. Using three-month outcome data from 1,233 patients with acute ischemic stroke in South Korea, researchers calculated the disability-adjusted life-year (DALY) loss from the stroke itself and then analyzed additional DALY lost from complications. Complications were reported in 34% of patients, with 20.8% of patients experiencing neurologic complications and 24.0% experiencing medical complications. The average DALY lost due to index stroke was 3.82. Patients with one complication lost an additional 1.52 DALY, while those with two or more complications lost an additional 2.69 DALY. “DALY analysis quantifies the burden of poststroke complications with a uniform metric potentially useful for healthy system planners,” the researchers stated.

—Rebecca K. Abma