American Academy of Neurology (AAN) 62nd Annual Meeting: Top Research Highlights

With Toronto's CN Tower soaring overhead, more than 10,000 neurologists, neuroscientists, and related professionals met at the Metro Toronto Convention Center to hear the latest findings in neurological research at the American Academy of Neurology (AAN) 62nd Annual Meeting. April 10 - 17, 2010, was proclaimed "Stop Brain Disorders Week" by Toronto Mayor David Miller to support the AAN Foundation in raising awareness of brain disorders.

Among this year's highlights:

- New guidelines were presented for assessing patients with mild cognitive impairment for their ability to drive safely — the new guidelines are less stringent, allowing some patients to continue to drive;

- Residents are no more rested or prepared now, after implementation of new Institute of Medicine recommendations designed to reduce work hours and encourage sufficient sleep;

- A new gene for late-onset Alzheimer's disease (LOAD) has been identified; the gene is involved in folate metabolism;

- Treatment with intravenous immunoglobulin is associated with a reduction in ventricular enlargement rates and cognitive decline in patients with mild to moderate Alzheimer's disease; and

- The number of cases of Guillain-Barré syndrome associated with the 2009 H1N1 vaccine is low, according to a new analysis of data from the Vaccine Adverse Event Reporting System.

On the opening day of the meeting, new driving guidelines for patients with mild dementia were announced by Donald Iverson, MD, from the Humboldt Neurological Medical Group, Eureka, California. The guidelines encourage clinicians to identify mild dementia patients who are at risk for unsafe driving without restricting those who may still be able to commute safely. As many as 76% of patients with mild dementia are still able to pass an on-road driving test. Previous recommendations, published a decade ago, discouraged driving by all patients with mild cognitive impairment. See New Guidelines on Driving Risk in Dementia Presented for more information.

Residents are no more rested or prepared now than before implementation of new Institute of Medicine recommendations designed to reduce work hours and encourage sufficient sleep. An added effect is that residents are complaining that their work is less satisfying now. There are no data showing that the recommendations have improved patient safety.

"Residents are checking in and out on patients like shift workers and are feeling less connected," said Andrew Southerland, MD, from the University of Virginia, Charlottesville. "There is less continuity of care, and our program is not running as smoothly." Residents Andrew Southerland, Heather Harle, and William Hicks, from the University of Virginia, Charlottesville are pictured here. See Restrictions on Residents' Work Hours Not Helping, Study Suggests for more information.

A new gene for late-onset Alzheimer's disease (LOAD) that is involved in folate metabolism has been identified. It appears to confirm biological research indicating that homocysteine is a strong risk factor for the disease, said principal investigator Margaret Pericak-Vance, PhD, director of the University of Miami Miller School of Medicine's John P. Hussman Institute for Human Genomics in Florida. See New Gene for Late-Onset Alzheimer's Disease Identified for more information.

New phase 2 results suggest that treatment with intravenous immunoglobulin (IVIG) is associated with a reduction in ventricular enlargement rates and cognitive decline in patients with mild to moderate Alzheimer's disease (AD), according to researchers at New York-Presbyterian Weill Cornell Medical College in New York City. Uninterrupted IVIG treatment for 18 months was associated with about half the rate of ventricular enlargement, indicating a slowing of brain atrophy, vs placebo, along with better scores on neuropsychological testing. See IVIG Slows Ventricular Enlargement, Cognitive Decline in Alzheimer's for more information.

The number of cases of Guillain-Barré syndrome (GBS) associated with the 2009 H1N1 vaccine is low, according to a new analysis of data from the Vaccine Adverse Event Reporting System (VAERS), established by the US Centers for Disease Control and Prevention (CDC) and the US Food and Drug Administration.

Still, 62 cases of GBS thought to be related to H1N1 vaccination were identified from the database compared with 51 cases seen with the seasonal flu vaccine in 2009, Nizar Souayah, MD, from the New Jersey Medical School in Newark, reported.

VAERS serves as an "early warning system" for any signal of risk with a particular vaccine. Current data need to be interpreted in light of these limitations, said James Sejvar, MD, from the CDC, Atlanta, Georgia. See Reports of Guillain-Barré Syndrome Low After 2009 H1N1 Vaccination for more information.

Combining moderate physical exercise with computer use, even in late life, may help reduce the risk of mild cognitive impairment (MCI). "Each of these is independently beneficial, but when you do them in combination, the effect is even better," said Yonas E. Geda, MD, MSc, neuropsychiatrist and associate professor of psychiatry and neurology, Mayo Clinic, Rochester, Minnesota. See Combination of Physical Exercise and Computer Use Protective Against MCI in Late Life for more information.

Evidence is slim, but hope remains among investigators who presented the highly anticipated but ultimately negative STAYCIS trial of atorvastatin in the treatment of multiple sclerosis.

STAYCIS investigator Emmanuelle Waubant, MD, from the University of California–San Francisco, pointed to imaging data suggesting the drug may reduce the risk for new brain lesions. The percentage of patients who did not develop new T2 lesions within 12 months or when starting interferon was 55.3% in the atorvastatin group and 27.6% in the placebo group (P = .032).

"This was a situation where there was a paradigm change right in the middle of the trial. Treatments shifted and recruiting became untenable," said AAN session moderator Benjamin Greenberg, MD, from the University of Texas Southwestern Medical Center, Dallas. See Neurologists Debating Statins in Multiple Sclerosis for more information.

The Randomized Trial of Robot-Assisted Rehabilitation in Chronic Stroke (VA ROBOTICS) showed that high-intensity repetitive therapy can contribute to improved function and quality of life for patients with severe upper limb impairment even years after a stroke, reported lead investigator Albert Lo, MD, PhD, from the Providence Veterans Affairs Medical Center, Brown University, Rhode Island. Intensity, not mode, of therapy was important in this trial. See VA ROBOTICS Published: High-Intensity Therapy Aids Recovery of Function, QOL in Chronic Stroke for more information.

"Approximately 2 out of 3 out of hospital cardiac arrest survivors with ventricular fibrillation as the presenting rhythm are cognitively unimpaired in long-term follow-up," announced Farrah Mateen, MD, from the Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland. "There were no patients who entered a permanently vegetative or minimally conscious state, and nearly all survivors in this study were functionally independent." See Positive Cognitive Outcomes for Survivors of Out-of-Hospital Cardiac Arrest for more information.

Neurologists with the AAN are working on an amendment to healthcare reform to include their services. Pictured on Capitol Hill are Walter Panis, Pushpa Narayanaswami, Anna Hohler, Zongqi Xia, and Luzma Cardona.

"Neurologists are the only specialty with primary care services accounting for at least 60% of their charges not eligible for a Medicare payment increase," lawyer Michael Amery, legislative council for the AAN, told Medscape Neurology in discussing healthcare reform laws.

"When a specialty is not highly reimbursed, it's not attractive to medical school graduates with large student debt," said Elaine Jones, MD, cochair of the academy's government relations committee. "There is already a shortage of neurologists in many parts of the country." See Neurologists Left Out of Healthcare Reform, Proposing Amendment for more information.

"Mild to moderate alcohol use may reduce risk of stroke, but according to our results heavy drinkers will not experience a reduced risk and in fact may increase their risk of stroke," reported study investigator Yangmei Li, MPhil, from the University of Cambridge, United Kingdom.

However, any potential beneficial effect of moderate alcohol consumption on stroke risk appears to be negated if individuals also smoke. "Smoking in combination with moderate drinking seems to counteract [its] potential benefit," Ms. Li told Medscape Neurology. See Smoking Negates Positive Effect of Moderate Alcohol Use on Stroke Risk for more information.

A combination of dextromethorphan and quinidine (Zenvia, Avanir Pharmaceuticals) showed efficacy in the treatment of pseudobulbar affect (PBA).

A 12-week, open-label extension study showed that the 30/10-mg dose was associated with a 47.2% reduction in episode rates vs placebo (P < .0001). The 20/10-mg dose was also associated with a significant reduction in crying or laughing episodes vs placebo.

"There's a continued incremental improvement," announced Erik P. Pioro, MD, PhD, director of the Section for ALS and Related Disorders at the Cleveland Clinic in Ohio. See Continued Efficacy for Dextromethorphan/Quinidine Combination for Pseudobulbar Affect for more information.

Any history of severe headache, not just migraine, is associated with a significantly increased risk for white matter hyperintensities in older individuals, a new brain imaging study presented here suggests.

The latest findings from the Epidemiology of Vascular Aging (EVA) magnetic resonance imaging (MRI) cohort study, conducted by investigators at the Institut National de la Santé et de la Recherché Medical in Paris, France, confirm previous research showing that migraine with aura is strongly associated with deep white matter lesions.

Although the study has no immediate clinical implications, lead investigator Tobias Kurth, MD, said the data add to a growing body of research that is attempting to elucidate the potential link between these lesions — which are sometimes referred to as "brain rust" — and migraine, stroke, and possibly dementia. See History of Severe Headache Linked to Increased Risk for White Matter Lesions in the Elderly for more information.

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For More Information

• Medscape Neurology
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• Expert Video Commentary
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Photos by Ron Zimmerman, San Antonio, Texas

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