Patients with multiple sclerosis (MS) disease activity have a higher rate of thinning of the ganglion cell/inner plexiform (GCIP) layer of the eye, researchers reported in the January 1 Neurology. Annual rates of GCIP thinning may be highest among patients with new gadolinium-enhancing lesions, new T2 lesions, and disease duration of less than five years. The investigators performed spectral-domain optical coherence tomography scans every six months on 164 patients with MS and 59 healthy controls. The mean follow-up time was 21.1 months. Annual GCIP thinning occurred 42% faster in patients with relapses, 54% faster in patients with new gadolinium-enhanced lesions, and 36% faster in patients with new T2 lesions.
Vaccination with a monovalent AS03 adjuvanted pandemic A/H1N1 2009 influenza vaccine does not appear to be associated with an increased risk of epileptic seizures, according to research published in the December 28, 2012, BMJ. Researchers studied 373,398 people with and without epilepsy who had received the vaccine. The primary end point was admission to a hospital or outpatient hospital care with epileptic seizures. The investigators found no increased risk of seizures in patients with epilepsy and a nonsignificantly decreased risk of seizures in persons without epilepsy during the initial seven-day risk period. During the subsequent 23-day risk period, people without epilepsy had a nonsignificantly increased risk of seizures, but patients with epilepsy had no increase in risk of seizures.
Variations in some genes associated with risk for psychiatric disorders may be observed as differences in brain structure in neonates, according to a study published in the January 2 online Cerebral Cortex. Investigators performed automated region-of-interest volumetry and tensor-based morphometry on 272 newborns who had had high-resolution MRI scans. The group found that estrogen receptor alpha (rs9340799) predicted intracranial volume. Polymorphisms in estrogen receptor alpha (rs9340799), as well as in disrupted-in-schizophrenia 1 (DISC1, rs821616), catechol-O-methyltransferase (COMT), neuregulin 1, apolipoprotein E, and brain-derived neurotrophic factor, were significantly associated with local variation in gray matter volume. “The results highlight the importance of prenatal brain development in mediating psychiatric risk,” noted the authors.
Four months after mild traumatic brain injury (TBI), white matter abnormalities may persist in children, even if cognitive symptoms have resolved, according to research published in the December 12, 2012, Journal of Neuroscience. The magnitude and duration of these abnormalities also appear to be greater in children with mild TBI than in adults with mild TBI. Researchers performed fractional anisotropy, axial diffusivity, and radial diffusivity on 15 children with semiacute mild TBI and 15 matched controls. Post-TBI cognitive dysfunction was observed in the domains of attention and processing speed. Increased anisotropy identified patients with pediatric mild TBI with 90% accuracy but was not associated with neuropsychologic deficits. Anisotropic diffusion may provide an objective biomarker of pediatric mild TBI.
The FDA has approved Eliquis (apixaban) for reducing the risk of stroke and systemic embolism in patients with nonvalvular atrial fibrillation. In a phase III clinical trial, Eliquis, an oral anticoagulant, reduced the risk of stroke or systemic embolism by 21%, compared with warfarin. The drug primarily reduced the risk of hemorrhagic stroke and ischemic stroke that converted to hemorrhagic stroke, and it also decreased the risks of major bleeding and all-cause mortality, compared with warfarin. Eliquis inhibits Factor Xa, a blood-clotting protein, thus decreasing thrombin generation and blood clots. The recommended dose is 5 mg twice daily. For patients age 80 or older and those who weigh 60 kg or less, the recommended dose is 2.5 mg twice daily. Eliquis is manufactured by Bristol-Myers Squibb (New York City) and comarketed with Pfizer (New York City).
Intermittent fasting, together with a ketogenic diet, may reduce seizures in children with epilepsy to a greater extent than the ketogenic diet alone, investigators reported in the November 30, 2012, online Epilepsy Research. The researchers placed six children with an incomplete response to a ketogenic diet on an intermittent fasting regimen. The children, ages 2 to 7, fasted on alternate days. Four children had transient improvement in seizure control, but they also had hunger-related adverse reactions. Three patients adhered to the combined intermittent fasting and ketogenic diet regimen for two months. The ketogenic diet and intermittent fasting may not share the same anticonvulsant mechanisms, noted the authors.
The available evidence does not support the use of cannabis extract to treat multiple sclerosis (MS), according to a review published in the December 2012 Drug and Therapeutics Bulletin. Researchers concluded that the trial data for nabiximols, a mouth spray for patients with MS containing dronabinol and cannabidiol, were limited. In the trials, which were the basis for the drug’s approval, symptoms decreased in a slightly higher number of patients taking nabiximols, compared with patients taking placebo. The drug was used for relatively short periods (ie, six weeks to four months) in many of these studies, however, and no study compared nabiximols with another active ingredient. One properly designed trial with a sufficient number of patients showed no difference in symptom relief between participants who took nabiximols and those who did not.