Collins, Thomas R.
Each year, the American Academy of Neurology (AAN)—an association of more than 27,000 neurologists and neuroscientists dedicated to promoting the highest quality patient-centered care—convenes an Annual Meeting in which the latest neuroscience research is presented to more than 11,000 clinicians (doctors who treat patients). Many important studies were presented during this year's meeting, which took place from April 26 through May 3, 2014, in Philadelphia, PA.
HYPEROSMOLAR THERAPY QUESTIONED
One of those studies calls into question the use of hyperosmolar therapy for people with bleeding in the brain after a blood vessel bursts, known as intracerebral hemorrhage (ICH).
However, according to the study authors, ICH patients treated with hyperosmolar therapy had significantly worse outcomes than those who were not treated with the approach.
Hyperosmolar therapy involves the use of medicines—in this study, either mannitol or hypertonic saline or both—that are administered by bolus (one dose all at once) or infusion (a dose administered over time) to reduce pressure on the brain caused by excess fluid.
The study was a review of data from ERICH, a clinical trial led by the University of Cincinnati on finding risk factors for ICH. It is thought to be the biggest registry available on people who are followed over time to assess the frequency and outcomes of ICH, which studies have found occurs in 30 to 50 patients per 100,000. ICH is most commonly caused by trauma to the brain or stroke.
“Very few studies have actually looked at the outcomes of hyperosmolar therapy,” says Manan Shah, MD, chief resident at the University of Texas Health Science Center at San Antonio (one of the centers involved in the ERICH study) and a junior member of the AAN. Dr. Shah presented the study results at the AAN Annual Meeting.
Out of 790 ERICH subjects for whom sufficient data was available, 145 had been given hyperosmolar therapy as of the end of 2012. They were matched with a control group considered to have the same odds of being treated with the therapy.
A “good” outcome was considered to be a three-month score of three or lower on the Modified Rankin Scale, which measures a person's degree of disability. A “bad” score was above three.
Of the 145 receiving hyperosmolar therapy, 112 had a bad outcome and 33 had a good outcome. That was worse than those who did not get hyperosmolar treatment—only 92 of them had a bad outcome, with 53 having a good outcome.
“This questions the efficacy and safety of hyperosmolar therapy in ICH,” Dr. Shah says.
According to Natalia Rost, MD, MPH, Fellow of the AAN, director of the Acute Stroke Service at Massachusetts General Hospital, it's an interesting study but has some design drawbacks. For example, 400 of the ERICH subjects weren't included because of incomplete data, she points out.
Dr. Rost, whose research focuses on damage to the brain caused by stroke, says the excluded patients might have had important traits that would have led to different results. “They could have changed the entire equation,” she says.
POSSIBLE TREATMENT FOR FATIGUE IN MULTIPLE SCLEROSIS
In another study presented at the AAN Annual Meeting, alfacalcidol—a synthetic form of vitamin D—was found to significantly improve fatigue among people with multiple sclerosis (MS).
Fatigue related to MS can occur daily, often gets worse as the day goes on, and is intensified by heat and humidity. MS-related fatigue is not directly correlated with either depression or the degree of neurologic disability. In addition, no medication has been approved specifically for fatigue caused by MS.
The study—presented by Anat Achiron, MD, PhD, director of the Multiple Sclerosis Center at Sheba Medical Center in Israel and sponsored by drug-maker Teva Pharmaceuticals—involved 158 MS patients reporting that fatigue impacts their lives and who had poor scores on scales, including the Fatigue Severity Scale and Fatigue Impact Scale (FIS), in which patients answer questions about how fatigue is affecting their lives. Eighty were randomized to receive alfacalcidol, and 78 were randomized to get a placebo over eight months.
Those in the alfacalcidol group improved by 41.6 percent, while those in the placebo group improved by 27.4 percent.
“Alfacalcidol is a safe and effective treatment strategy for treating fatigue in MS,” Dr. Achiron says.
John R. Corboy, MD, Fellow of the AAN, professor of neurology at the University of Colorado, and co-director of the Rocky Mountain MS Center at Anschutz Medical Campus, says the study was interesting but that he isn't ready to fully embrace the results. The placebo effect was large, he notes, with a decrease of 27 percent in FIS scores in the placebo group.
Nonetheless, if the study could be repeated with better controls and analysis, “this would be an additional compelling argument to use vitamin D regularly in all relapsing MS patients,” Dr. Corboy says.
FOR MORE INFORMATION
- ▸ For more Neurology Now coverage of research presented at the AAN Annual Meeting, visit our Breaking News blog at bit.ly/NN_BreakingNewsBlog
- ▸ To watch a panel discussion on hyperosmolar therapy from Neurology Today, go to bit.ly/hyperosmolarNT