News Roundup: New and Noteworthy Information

Comprehensive cardiac rehabilitation may be effective for prevention of future stroke in patients who have had a transient ischemic stroke (TIA) or a mild, nondisabling stroke, according to a study published in the online September 22 Stroke. Researchers tested the effectiveness of the rehabilitation program, which integrates structured lifestyle interventions and medications, in 80 participants who had at least one vascular risk factor. After six months of intervention, the investigators reported favorable and significant changes in aerobic capacity, cholesterol levels, triglycerides, waist circumference, body mass index, and body weight. “Comprehensive cardiac rehabilitation is feasible and effective for secondary prevention after transient ischemic attack or mild, nondisabling stroke, offering a promising model for vascular protection across chronic disease entities,” the authors concluded.

Two separate teams of investigators have identified a new human genetic mutation that may be the most common cause of amyotrophic lateral sclerosis (ALS) and frontotemporal dementia (FTD). Both studies appear in the online September 21 Neuron. Previous research has linked the 9p21 region of chromosome 9 with both ALS and FTD; using this theory, each research group performed a genetic analysis in patients with 9p21-associated ALS or FTD. Both groups discovered a large hexanucleotide repeat expansion in the C9ORF72 gene, which may accumulate as abnormal RNA foci inside neurons and promote disease pathogenesis and neurodegeneration. The investigators reported that this mutation may explain at least one-third of all familial cases of ALS and FTD, as well as some noninherited cases.

Depression is associated with a significant increase in fatal and ischemic stroke, but not hemorrhagic stroke, according to a study published in the September 21 JAMA. Investigators conducted a systematic review and meta-analysis of 28 prospective studies (8,478 cases of stroke) that reported risk estimates of stroke morbidity or mortality. Individuals with depression had a 45% higher risk for total stroke, 55% higher risk for fatal stroke, and 25% higher risk for ischemic stroke. The corresponding absolute risk differences were 106 cases for total stroke, 53 cases for ischemic stroke, and 22 cases for fatal stroke per 100,000 individuals per year. “Depression is associated with a significantly increased risk of stroke morbidity and mortality,” the investigators wrote. “More studies are needed to explore the underlying mechanisms and elucidate the causal pathways that link depression and stroke.”

Patients with refractory epilepsy who receive adjunctive treatment with antiepileptic drugs have nearly a seven times lower risk of sudden unexpected death in epilepsy (SUDEP) compared to those that receive placebo treatments, according to a meta-analysis published September 19 online in Lancet Neurology.  The researchers analyzed 33 deaths reported in a collection of randomized placebo-controlled trials involving patients with refractory epilepsy to determine if adjunctive antiepileptic drugs in efficacious doses lowered the incidence of sudden unexpected death. “Definite or probable SUDEP, all SUDEP, and all causes of death were significantly less frequent in the efficacious antiepileptic drug group than in the placebo group,” the researchers concluded. “This result provides evidence in favor of active treatment revision for patients with refractory epilepsy.”

Investigators have identified a strong bidirectional relationship between epilepsy and schizophrenia, according to a study appearing in the September 19 Epilepsia. The investigators analyzed the incidence and risk of developing epilepsy in a group of 5,195 patients with schizophrenia, as well as the incidence and risk of developing schizophrenia in a group of 11,527 patients with epilepsy; they then compared these results to healthy controls. “The incidence of epilepsy was higher in the schizophrenia cohort than in the nonschizophrenia cohort with an adjusted hazard ratio of 5.88,” the investigators reported. “The incidence of schizophrenia was higher in the epilepsy cohort than in the nonepilepsy comparison cohort with an adjusted hazard ratio of 7.65.” The researchers concluded that the two conditions may share a mutual susceptibility, but noted that further studies on the mechanisms for this relationship are necessary.

The Genesis implanted neurostimulation device (St. Jude Medical, Inc; St. Paul, Minnesota) has received European regulatory approval for the treatment of intractable chronic migraine. The peripheral nerve stimulation system delivers mild electrical pulses to the occipital nerves to help manage the pain and disability associated with this condition. Approval was achieved based on the results of a randomized, double-blind, controlled study of 157 patients with chronic migraine. After one year of peripheral nerve stimulation therapy, 65% of participants reported excellent or good pain relief, 68% expressed an improvement in their quality of life, and 67% were satisfied with the results of their procedure. The system developers hope that this approval will expand treatment options for patients who have exhausted all other treatment options for chronic migraine

Compared to civilians, veterans experience a greater delay in diagnosis of psychogenic nonepileptic seizures (PNES), according to a study published in the September 6 Neurology. “PNES are frequently encountered in epilepsy monitoring units and can result in significant long-term disability,” the investigators wrote. “We reviewed our experience with veterans undergoing seizure evaluation in the epilepsy monitoring units to determine the time delay to diagnosis of PNES, the frequency of PNES, and cumulative antiepileptic drug treatment.” They found that PNES were identified in 25% of veterans and 26% of civilians admitted to epilepsy monitoring units, and that the average delay from onset to diagnosis was about five years for veterans and one year for civilians. In addition, treatment with antiepileptic drugs was four times greater for veterans with PNES compared with civilians.

Rates of hospitalizations for ischemic stroke in adolescents and young adults increased up to 37% between 1995 and 2008, according to a study published in the September 2 online Annals of Neurology. Investigators analyzed discharge data for patients between the ages of 5 and 44 hospitalized for ischemic stroke, as well as information about comorbidites and stroke risk factors. The prevalence of hospitalizations increased among all age and gender groups, except females ages 5 to 14 years, the researchers reported. The most common coexisting conditions among the study population were hypertension, diabetes, obesity, lipid disorders, and tobacco use; these were increased among patients hospitalized with acute ischemic stroke. “Our results … accentuate the need for public health initiatives to reduce risk factors for stroke among adolescents and young adults,” the investigators concluded.

Researchers have identified a mutation in the sigma-1 receptor that is responsible for the development of juvenile amyotrophic lateral sclerosis (ALS). The results of the study, appearing in the August 12 online Annals of Neurology, could lead to the development of potential therapeutic targets for the disease. “We performed homozygosity and direct sequencing to detect the genetic variant and tested the effect of this variant on a motor neuron-like cell line model expressing the wild-type or mutant gene,” the investigators explained. They identified a shared homozygosity region in persons with the disease; they also observed that cells expressing the mutant protein were less resistant to apoptosis induced by endoplasmic reticulum stress. “Sigma-1 receptors are known to have neuroprotective properties,” the authors concluded. “Our findings emphasize the role of sigma-1 receptors in motor neuron function and disease.”

Comprehensive cardiac rehabilitation may be effective for prevention of future stroke in patients who have had a transient ischemic stroke (TIA) or a mild, nondisabling stroke, according to a study published in the online September 22 Stroke. Researchers tested the effectiveness of the rehabilitation program, which integrates structured lifestyle interventions and medications, in 80 participants who had at least one vascular risk factor. After six months of intervention, the investigators reported favorable and significant changes in aerobic capacity, cholesterol levels, triglycerides, waist circumference, body mass index, and body weight. “Comprehensive cardiac rehabilitation is feasible and effective for secondary prevention after transient ischemic attack or mild, nondisabling stroke, offering a promising model for vascular protection across chronic disease entities,” the authors concluded.

Two separate teams of investigators have identified a new human genetic mutation that may be the most common cause of amyotrophic lateral sclerosis (ALS) and frontotemporal dementia (FTD). Both studies appear in the online September 21 Neuron. Previous research has linked the 9p21 region of chromosome 9 with both ALS and FTD; using this theory, each research group performed a genetic analysis in patients with 9p21-associated ALS or FTD. Both groups discovered a large hexanucleotide repeat expansion in the C9ORF72 gene, which may accumulate as abnormal RNA foci inside neurons and promote disease pathogenesis and neurodegeneration. The investigators reported that this mutation may explain at least one-third of all familial cases of ALS and FTD, as well as some noninherited cases.

Depression is associated with a significant increase in fatal and ischemic stroke, but not hemorrhagic stroke, according to a study published in the September 21 JAMA. Investigators conducted a systematic review and meta-analysis of 28 prospective studies (8,478 cases of stroke) that reported risk estimates of stroke morbidity or mortality. Individuals with depression had a 45% higher risk for total stroke, 55% higher risk for fatal stroke, and 25% higher risk for ischemic stroke. The corresponding absolute risk differences were 106 cases for total stroke, 53 cases for ischemic stroke, and 22 cases for fatal stroke per 100,000 individuals per year. “Depression is associated with a significantly increased risk of stroke morbidity and mortality,” the investigators wrote. “More studies are needed to explore the underlying mechanisms and elucidate the causal pathways that link depression and stroke.”

Patients with refractory epilepsy who receive adjunctive treatment with antiepileptic drugs have nearly a seven times lower risk of sudden unexpected death in epilepsy (SUDEP) compared to those that receive placebo treatments, according to a meta-analysis published September 19 online in Lancet Neurology.  The researchers analyzed 33 deaths reported in a collection of randomized placebo-controlled trials involving patients with refractory epilepsy to determine if adjunctive antiepileptic drugs in efficacious doses lowered the incidence of sudden unexpected death. “Definite or probable SUDEP, all SUDEP, and all causes of death were significantly less frequent in the efficacious antiepileptic drug group than in the placebo group,” the researchers concluded. “This result provides evidence in favor of active treatment revision for patients with refractory epilepsy.”

Investigators have identified a strong bidirectional relationship between epilepsy and schizophrenia, according to a study appearing in the September 19 Epilepsia. The investigators analyzed the incidence and risk of developing epilepsy in a group of 5,195 patients with schizophrenia, as well as the incidence and risk of developing schizophrenia in a group of 11,527 patients with epilepsy; they then compared these results to healthy controls. “The incidence of epilepsy was higher in the schizophrenia cohort than in the nonschizophrenia cohort with an adjusted hazard ratio of 5.88,” the investigators reported. “The incidence of schizophrenia was higher in the epilepsy cohort than in the nonepilepsy comparison cohort with an adjusted hazard ratio of 7.65.” The researchers concluded that the two conditions may share a mutual susceptibility, but noted that further studies on the mechanisms for this relationship are necessary.

The Genesis implanted neurostimulation device (St. Jude Medical, Inc; St. Paul, Minnesota) has received European regulatory approval for the treatment of intractable chronic migraine. The peripheral nerve stimulation system delivers mild electrical pulses to the occipital nerves to help manage the pain and disability associated with this condition. Approval was achieved based on the results of a randomized, double-blind, controlled study of 157 patients with chronic migraine. After one year of peripheral nerve stimulation therapy, 65% of participants reported excellent or good pain relief, 68% expressed an improvement in their quality of life, and 67% were satisfied with the results of their procedure. The system developers hope that this approval will expand treatment options for patients who have exhausted all other treatment options for chronic migraine

Compared to civilians, veterans experience a greater delay in diagnosis of psychogenic nonepileptic seizures (PNES), according to a study published in the September 6 Neurology. “PNES are frequently encountered in epilepsy monitoring units and can result in significant long-term disability,” the investigators wrote. “We reviewed our experience with veterans undergoing seizure evaluation in the epilepsy monitoring units to determine the time delay to diagnosis of PNES, the frequency of PNES, and cumulative antiepileptic drug treatment.” They found that PNES were identified in 25% of veterans and 26% of civilians admitted to epilepsy monitoring units, and that the average delay from onset to diagnosis was about five years for veterans and one year for civilians. In addition, treatment with antiepileptic drugs was four times greater for veterans with PNES compared with civilians.

Rates of hospitalizations for ischemic stroke in adolescents and young adults increased up to 37% between 1995 and 2008, according to a study published in the September 2 online Annals of Neurology. Investigators analyzed discharge data for patients between the ages of 5 and 44 hospitalized for ischemic stroke, as well as information about comorbidites and stroke risk factors. The prevalence of hospitalizations increased among all age and gender groups, except females ages 5 to 14 years, the researchers reported. The most common coexisting conditions among the study population were hypertension, diabetes, obesity, lipid disorders, and tobacco use; these were increased among patients hospitalized with acute ischemic stroke. “Our results … accentuate the need for public health initiatives to reduce risk factors for stroke among adolescents and young adults,” the investigators concluded.

Researchers have identified a mutation in the sigma-1 receptor that is responsible for the development of juvenile amyotrophic lateral sclerosis (ALS). The results of the study, appearing in the August 12 online Annals of Neurology, could lead to the development of potential therapeutic targets for the disease. “We performed homozygosity and direct sequencing to detect the genetic variant and tested the effect of this variant on a motor neuron-like cell line model expressing the wild-type or mutant gene,” the investigators explained. They identified a shared homozygosity region in persons with the disease; they also observed that cells expressing the mutant protein were less resistant to apoptosis induced by endoplasmic reticulum stress. “Sigma-1 receptors are known to have neuroprotective properties,” the authors concluded. “Our findings emphasize the role of sigma-1 receptors in motor neuron function and disease.”

Comprehensive cardiac rehabilitation may be effective for prevention of future stroke in patients who have had a transient ischemic stroke (TIA) or a mild, nondisabling stroke, according to a study published in the online September 22 Stroke. Researchers tested the effectiveness of the rehabilitation program, which integrates structured lifestyle interventions and medications, in 80 participants who had at least one vascular risk factor. After six months of intervention, the investigators reported favorable and significant changes in aerobic capacity, cholesterol levels, triglycerides, waist circumference, body mass index, and body weight. “Comprehensive cardiac rehabilitation is feasible and effective for secondary prevention after transient ischemic attack or mild, nondisabling stroke, offering a promising model for vascular protection across chronic disease entities,” the authors concluded.

Two separate teams of investigators have identified a new human genetic mutation that may be the most common cause of amyotrophic lateral sclerosis (ALS) and frontotemporal dementia (FTD). Both studies appear in the online September 21 Neuron. Previous research has linked the 9p21 region of chromosome 9 with both ALS and FTD; using this theory, each research group performed a genetic analysis in patients with 9p21-associated ALS or FTD. Both groups discovered a large hexanucleotide repeat expansion in the C9ORF72 gene, which may accumulate as abnormal RNA foci inside neurons and promote disease pathogenesis and neurodegeneration. The investigators reported that this mutation may explain at least one-third of all familial cases of ALS and FTD, as well as some noninherited cases.

Depression is associated with a significant increase in fatal and ischemic stroke, but not hemorrhagic stroke, according to a study published in the September 21 JAMA. Investigators conducted a systematic review and meta-analysis of 28 prospective studies (8,478 cases of stroke) that reported risk estimates of stroke morbidity or mortality. Individuals with depression had a 45% higher risk for total stroke, 55% higher risk for fatal stroke, and 25% higher risk for ischemic stroke. The corresponding absolute risk differences were 106 cases for total stroke, 53 cases for ischemic stroke, and 22 cases for fatal stroke per 100,000 individuals per year. “Depression is associated with a significantly increased risk of stroke morbidity and mortality,” the investigators wrote. “More studies are needed to explore the underlying mechanisms and elucidate the causal pathways that link depression and stroke.”

Patients with refractory epilepsy who receive adjunctive treatment with antiepileptic drugs have nearly a seven times lower risk of sudden unexpected death in epilepsy (SUDEP) compared to those that receive placebo treatments, according to a meta-analysis published September 19 online in Lancet Neurology.  The researchers analyzed 33 deaths reported in a collection of randomized placebo-controlled trials involving patients with refractory epilepsy to determine if adjunctive antiepileptic drugs in efficacious doses lowered the incidence of sudden unexpected death. “Definite or probable SUDEP, all SUDEP, and all causes of death were significantly less frequent in the efficacious antiepileptic drug group than in the placebo group,” the researchers concluded. “This result provides evidence in favor of active treatment revision for patients with refractory epilepsy.”

Investigators have identified a strong bidirectional relationship between epilepsy and schizophrenia, according to a study appearing in the September 19 Epilepsia. The investigators analyzed the incidence and risk of developing epilepsy in a group of 5,195 patients with schizophrenia, as well as the incidence and risk of developing schizophrenia in a group of 11,527 patients with epilepsy; they then compared these results to healthy controls. “The incidence of epilepsy was higher in the schizophrenia cohort than in the nonschizophrenia cohort with an adjusted hazard ratio of 5.88,” the investigators reported. “The incidence of schizophrenia was higher in the epilepsy cohort than in the nonepilepsy comparison cohort with an adjusted hazard ratio of 7.65.” The researchers concluded that the two conditions may share a mutual susceptibility, but noted that further studies on the mechanisms for this relationship are necessary.

The Genesis implanted neurostimulation device (St. Jude Medical, Inc; St. Paul, Minnesota) has received European regulatory approval for the treatment of intractable chronic migraine. The peripheral nerve stimulation system delivers mild electrical pulses to the occipital nerves to help manage the pain and disability associated with this condition. Approval was achieved based on the results of a randomized, double-blind, controlled study of 157 patients with chronic migraine. After one year of peripheral nerve stimulation therapy, 65% of participants reported excellent or good pain relief, 68% expressed an improvement in their quality of life, and 67% were satisfied with the results of their procedure. The system developers hope that this approval will expand treatment options for patients who have exhausted all other treatment options for chronic migraine

Compared to civilians, veterans experience a greater delay in diagnosis of psychogenic nonepileptic seizures (PNES), according to a study published in the September 6 Neurology. “PNES are frequently encountered in epilepsy monitoring units and can result in significant long-term disability,” the investigators wrote. “We reviewed our experience with veterans undergoing seizure evaluation in the epilepsy monitoring units to determine the time delay to diagnosis of PNES, the frequency of PNES, and cumulative antiepileptic drug treatment.” They found that PNES were identified in 25% of veterans and 26% of civilians admitted to epilepsy monitoring units, and that the average delay from onset to diagnosis was about five years for veterans and one year for civilians. In addition, treatment with antiepileptic drugs was four times greater for veterans with PNES compared with civilians.

Rates of hospitalizations for ischemic stroke in adolescents and young adults increased up to 37% between 1995 and 2008, according to a study published in the September 2 online Annals of Neurology. Investigators analyzed discharge data for patients between the ages of 5 and 44 hospitalized for ischemic stroke, as well as information about comorbidites and stroke risk factors. The prevalence of hospitalizations increased among all age and gender groups, except females ages 5 to 14 years, the researchers reported. The most common coexisting conditions among the study population were hypertension, diabetes, obesity, lipid disorders, and tobacco use; these were increased among patients hospitalized with acute ischemic stroke. “Our results … accentuate the need for public health initiatives to reduce risk factors for stroke among adolescents and young adults,” the investigators concluded.

Researchers have identified a mutation in the sigma-1 receptor that is responsible for the development of juvenile amyotrophic lateral sclerosis (ALS). The results of the study, appearing in the August 12 online Annals of Neurology, could lead to the development of potential therapeutic targets for the disease. “We performed homozygosity and direct sequencing to detect the genetic variant and tested the effect of this variant on a motor neuron-like cell line model expressing the wild-type or mutant gene,” the investigators explained. They identified a shared homozygosity region in persons with the disease; they also observed that cells expressing the mutant protein were less resistant to apoptosis induced by endoplasmic reticulum stress. “Sigma-1 receptors are known to have neuroprotective properties,” the authors concluded. “Our findings emphasize the role of sigma-1 receptors in motor neuron function and disease.”