Transient ischemic attack (TIA) is linked with a substantial risk of disability, researchers reported in the September 13 online Stroke. The 510 consecutive patients prospectively enrolled in the study had minor stroke or TIA, were not previously disabled, and had a CT or CT angiography completed within 24 hours of symptom onset. After assessing disability 90 days following the event, the investigators found that 15% of patients had a disabled outcome. Those who experienced recurrent strokes were more likely to be disabled—53% of patients with recurrent strokes were disabled, compared with 12% of those who did not have a recurrent stroke. “In terms of absolute numbers, most patients have disability as a result of their presenting event; however, recurrent events have the largest relative impact on outcome,” the study authors concluded.
Persons with high plasma glucose levels that are still within the normal range are more likely to have atrophy of brain structures associated with neurodegenerative processes, according to a study published in the September 4 Neurology. Investigators used MRI scans to assess hippocampal and amygdalar volumes in a sample of 266 cognitively healthy persons ages 60 to 64 who did not have type 2 diabetes. Results showed that plasma glucose levels were significantly linked with hippocampal and amygdalar atrophy. After controlling for age, sex, BMI, hypertension, alcohol, and smoking, the researchers found that plasma glucose levels accounted for a 6% to 10% change in volume. “These findings suggest that even in the subclinical range and in the absence of diabetes, monitoring and management of plasma glucose levels could have an impact on cerebral health,” the study authors wrote.
The FDA has approved once-a-day tablet Aubagio (teriflunomide) for treatment of adults with relapsing forms of multiple sclerosis (MS). During a clinical trial, patients taking teriflunomide had a relapse rate that was 30% lower than that of patients taking placebo. The most common side effects observed during clinical trials were diarrhea, abnormal liver tests, nausea, and hair loss, and physicians should conduct blood tests to check patients’ liver function before the drug is prescribed as well as periodically during treatment, researchers said. In addition, because of a risk of fetal harm, women of childbearing age must have a negative pregnancy test before beginning teriflunomide and should use birth control throughout treatment. Teriflunomide is the second oral treatment therapy for MS to be approved in the United States.
Patients who appear likely to have sporadic Creutzfeldt-Jakob disease may benefit from CSF 14-3-3 assays to clarify the diagnosis, researchers reported in the online September 19 Neurology. In a systematic literature review, the investigators identified articles from 1995 to January 1, 2011, that involved patients who had CSF analysis for protein 14-3-3. Based on data from 1,849 patients, the researchers determined that assays for CSF 14-3-3 are probably moderately accurate in diagnosing Creutzfeldt-Jakob—the assays had a sensitivity of 92%, specificity of 80%, likelihood ratio of 4.7, and negative likelihood ratio of 0.10. The study authors recommend CSF 14-3-3 assays “for patients who have rapidly progressive dementia and are strongly suspected of having sporadic Creutzfeldt-Jakob and for whom diagnosis remains uncertain (pretest probably of between 20% and 90%).”
Children with migraine and children with tension-type headaches are significantly more likely to have behavioral and emotional symptoms, and the frequency of headaches affects the likelihood of these symptoms, according to a study published in the online September 17 Cephalagia. After examining a sample of 1,856 children ages 5 to 11, investigators found that those with migraine were significantly more likely to experience abnormalities in somatic, anxiety-depressive, social, attention, internalizing, and total score domains of the Child Behavior Checklist. Children with tension-type headaches had a lower rate of abnormalities than children with migraine, but those with tension-type headaches still had significantly more abnormalities than controls. Children with headaches are more likely to have internalizing symptoms than externalizing symptoms such as rule breaking and aggressivity, the researchers found.
Heavy alcohol intake is associated with experiencing intracerebral hemorrhage at a younger age, according to a study published in the September 11 Neurology. Researchers prospectively followed 562 adults with spontaneous intracerebral hemorrhage and recorded information about their alcohol intake. A total of 137 patients were heavy alcohol drinkers, and these patients were more likely to be younger (median age, 60), to have a history of ischemic heart disease, and to be smokers. Furthermore, heavy alcohol drinkers had significantly lower platelet counts and prothrombin ratio. The investigators noted that although heavy alcohol intake is associated with intracerebral hemorrhage at a younger age, “the underlying vasculopathy remains unexplored in these patients. Indirect markers suggest small-vessel disease at an early stage that might be enhanced by moderate hemostatic disorders,” the authors concluded.
Long-term use of ginkgo biloba extract does not prevent the onset of Alzheimer’s disease in older patients, according to a study published in the online September 5 Lancet Neurology. Researchers enrolled 2,854 participants in a parallel-group, double-blind clinical trial in which 1,406 persons were randomized to receive ginkgo biloba extract and 1,414 persons were randomized to placebo. After five years of follow-up, 61 participants taking ginkgo biloba were diagnosed with probable Alzheimer’s disease, while 73 participants in the placebo group received a diagnosis of probable Alzheimer’s disease, though the risk was not proportional over time. The incidence of adverse events, as well as hemorrhagic or cardiovascular events, did not differ between groups. “Long-term use of standardized ginkgo biloba extract in this trial did not reduce the risk of progression to Alzheimer’s disease compared with placebo,” the researchers concluded.
The 13.3–mg/24 h dosage strength of the Exelon Patch (rivastigmine transdermal system) has been approved by the FDA for treatment of mild to moderate Alzheimer’s disease. Approval was based on the performance of the 13.3–mg/24 h dosage in the 48-week, double-blind phase of the OPTIMA study, which analyzed patients with mild to moderate Alzheimer’s disease who met predefined functional and cognitive decline criteria for the 9.5–mg/24 h dose. Compared with patients taking the 9.5–mg/24 h dose, patients taking the 13.3–mg/24 h dose showed statistically significant improvement in overall function. In addition, the overall safety profile of the 13.3–mg/24 h dose was the same as that of the lower dose, and fewer patients on the 13.3–mg/24 h dose needed to discontinue treatment than patients on the 9.5–mg/24 h dose.