Monday, June 5, 2023
More than 2500 abstracts were presented at the conference. Among some of the key presentations and reports were:
• New guidelines on the management of diabetic neuropathy
• A phase 3 trial of oral laquinimod for multiple sclerosis (MS)
• The first long-term results on safinamide add-on therapy in Parkinson's disease (PD)
• A phase 3 trial of a novel, extended-release carbidopa-levodopa formulation in early PD
• That brain and nervous system disorders in Iraqi refugees were "surprisingly" common
• That cancer survivors have lower Alzheimer's risk.
For more highlights, see: What's Hot at AAN 2011?
Evidence-based guidelines on the treatment of painful diabetic neuropathy were unveiled at this year's meeting. The guidelines, published online April 11 in Neurology, cover the use of a range of pharmacologic agents, including anticonvulsants, antidepressants, opioids, and others, as well as nondrug treatments such as transcutaneous electrical nerve stimulation and magnetic field treatment. "We were pleased to see so many of the pain treatments had high-quality studies that support their use," said Vera Bril, MD, from the University of Toronto, Ontario, Canada, who was the lead author of the guidelines. "Still, it is important that more research be done to show how well these treatments can be tolerated over time."
Full news coverage: New AAN Guidelines on Painful Diabetic Neuropathy
In a phase 3 study of MS, the investigational oral agent laquinimod reduced annualized relapse rates, delayed disability progression, and decreased disease activity on neuroimaging compared with placebo. Giancarlo Comi, MD, director of the Department of Neurology and Institute of Experimental Neurology at the Scientific Institute and University Vita-Salute San Raffaele in Milan, Italy, reported the ALLEGRO trial results here. "In this trial, what I think was surprising was that the effect on disability is larger than the effect on relapses," Dr. Comi said. "This is really a new therapeutic strategy for MS," he concluded.
Full news coverage: Laquinimod Reduces Relapses, Slows Disability in MS
An investigational extended-release formulation of carbidopa-levodopa (IPX066, Impax Laboratories) yielded promising safety and efficacy data in 2 phase 3 trials, reported Rajesh Pahwa, MD, from the University of Kansas Medical Center in Kansas City. Improvements from baseline in motor symptoms were seen with IPX066 in patients with early PD and in patients with more advanced PD. In the trials, adverse effects were consistent with other levodopa preparations.
Full news coverage: Positive Results With Extended-Release Carbidopa-Levodopa
The combination of low-intensity treadmill training plus stretching and resistance training is likely to yield the greatest improvements in gait, mobility, and cardiovascular fitness in patients with PD, Lisa M. Shulman, MD, from the University of Maryland School of Medicine, Baltimore, told conference attendees. She led a randomized, single-blinded clinical trial of 3 models of exercise with the aim of improving gait and mobility. A total of 67 patients participated. Their average age was 66 years, and they had had PD for an average of 6 years. "We believe for most people, unless they are really rather advanced, they can probably do this kind of exercise routine — probably after some initial monitoring — on their own," Dr. Shulman said.
Full news coverage: Low-Intensity Exercise Improves Gait, Mobility in PD
Phase 3 results suggest that perampanel (Eisai Inc), 12 mg once daily, reduces partial-onset seizures, reported Jacqueline French, MD, from New York University, New York City. Perampanel is a first-in-class, highly selective, noncompetitive AMPA-type glutamate receptor antagonist that targets excitatory damage. "This is a completely different mechanism," Dr. French noted. The company plans to submit the new drug for regulatory approval simultaneously in the United States and Europe this year. Dr. French said she has "every reason to believe it will be approved."
Full news coverage: Perampanel Add-On Reduces Partial-Onset Seizures
Results of a large national pilot project by the United Nations have found that a surprisingly high number of Iraqi refugees have brain and nervous system disorders. Farrah Mateen, MD, from Johns Hopkins University in Baltimore, Maryland, reported the data here, which she called "eye-opening." Epilepsy, back pain, and headache are the most common neurologic disorders seen in Iraqi refugees.
Full news coverage: Iraqi Refugees at High Risk for Neurologic Disorders
Patients with PD who continue to experience tremors and involuntary movement problems despite receiving levodopa and other dopaminergic treatments may benefit from adding the investigational agent safinamide, according to a phase 3 study. Safinamide, 50 and 100 mg per day, improved "on time" with no minor dyskinesia, and "the benefits were still present after 2 years," Ravi Anand, MD, from Anand Pharma Consulting in St. Moritz, Switzerland, reported in a late-breaking poster presentation. The investigational new drug could be submitted to regulators as early as next year.
Full news coverage: Safinamide Add-On Reduces Motor Fluctuations in Parkinson's
Cancer survivors appear to have a reduced risk for Alzheimer's disease, according to a new analysis of data from the Framingham Heart Study. Jane A. Driver, MD, from Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts, said the key implication is that there may be biological pathways driving the association that may help illuminate both pathologic processes.
Full news coverage: Cancer History Linked to Reduced Alzheimer's Risk
A gene therapy approach to treating PD that failed to reduce "off" time in a phase 2a study is back on track after a change in dosing strategy, conference attendees heard. The therapy injects an adeno-associated virus vector carrying the gene for neurturin, a neurotrophic factor that enhances the function and survival of dopaminergic neurons (CERE-120, Ceregene Inc). In the failed phase 2a trial, CERE-120 was injected only in the putamen. In the latest phase 1 study, injections in the subthalamic nucleus and putamen proved safe and feasible, reported Joao Siffert, MD, chief medical officer at Ceregene. A new phase 2b study is underway.
Full news coverage: Neurotrophic Factor Promising for PD in Early Phase – Again
A new study comparing intravenous immunoglobulin to plasma exchange in patients with myasthenia gravis has found the 2 approaches comparable. "The duration of treatment effect and the tolerability of both treatments is very similar," Vera Bril, MD, from the University of Toronto in Ontario, Canada, said at the meeting. "Either treatment may be offered to patients depending on availability of resources." The results are considered to provide class 1 evidence and are scheduled to be published in Neurology later this year, she added.
Full news coverage: Immunoglobulin Similar to Plasma Exchange in Myasthenia Gravis
A new study using a sensitive assay shows a time-dependent rise in amyloid beta-42 (Aβ-42) in the blood of patients resuscitated after cardiac arrest. A strong correlation was seen between the rise and fall of Aβ-42 and clinical outcomes, suggesting that elevated Aβ-42 is derived from the brain of these patients and might be used as a measure of damage. "It can be a prognostic indicator of outcome over 6 months, but from a more basic research standpoint, it provides evidence that hypoxic stress in the human brain triggers the amyloid cascade, and this could be important for Alzheimer's disease pathogenesis," said lead author David H. Wilson, MD, from Quanterix Corporation, the company developing the assay.
Full news coverage: Amyloid Beta 1-42 in Serum Linked to Outcome After Cardiac Arrest
"Valproate is a poor first choice drug in women of childbearing potential," Kimford Meador, MD, from Emory University in Atlanta, Georgia, told conference attendees. He reported the latest results from the ongoing Neurodevelopmental Effects of Antiepileptic Drugs study, which show that the adverse cognitive effects of fetal valproate exposure continue into childhood. The study found that weak performance at 3 years of age persists to 4.5 years of age.
Full news coverage: Children Exposed to Valproate In Utero Have Persistent Cognitive Delay
Everolimus, the drug fast-tracked through approval for tuberous sclerosis, appears to reduce brain lesions and seizure frequency, according to a phase 2 trial data discussed at the conference. "Everolimus offers patients with tuberous sclerosis–associated subependymal giant cell astrocytoma a viable alternative to surgical resection," David Franz, MD, from the Cincinnati Children's Hospital in Ohio, told attendees. However, one conference attendee told Medscape Medical News that it remains unclear which patients with tuberous sclerosis should receive treatment. "The patient population has yet to be clearly defined," Cecil Hahn, MD, from the Hospital for Sick Children in Toronto, Ontario, Canada, noted.
Full news coverage: Everolimus for Tuberous Sclerosis Alternative to Surgery for Some
People with MS may find it harder to think clearly and remember things on warmer days of the year, according to a study presented here by Victoria M. Leavitt, PhD, postdoctoral fellow in the Neuropsychology & Neuroscience Laboratory, Kessler Foundation Research Center in West Orange, New Jersey. She hopes the study will generate increased awareness of the potential effect of warmer temperatures on cognitive function in patients with MS.
Full news coverage: Cognitive Status of MS Patients May Fluctuate With Outdoor Temperature
Regular consumption of flavonoids, especially anthocyanins — found mainly in berries, may help protect against PD, Xiang Gao, MD, PhD, from the Harvard School of Public Health and Brigham & Women's Hospital, reported here. The finding is based on more than 2 decades of follow-up data on 49,281 men in the Health Professional Follow-Up Study and 80,336 women in the Nurses' Health Study. "More studies are needed to examine potential neuroprotective effects of anthocyanins and other flavonoids," he concluded.
Full news coverage: Diet Rich in Flavonoids May Guard Against Parkinson's Disease
Fingolimod (Gilenya, Novartis), the first oral agent for MS, increases the risk for hypertension, pooled phase 3 clinical trial data confirm. At initiation, patients may also experience transient heart rate and atrioventricular conduction slowing, John DiMarco, MD, from the University of Virginia Medical Center in Charlottesville, noted. Prescribing information for the drug already states these potential effects and advises monitoring for them.
Full news coverage: Cardiovascular Risks With Oral Fingolimod for Multiple Sclerosis
Autopsy findings in patients diagnosed with Alzheimer's disease and other dementias often reveal insufficient pathology for the original clinical diagnosis made during life, and sometimes point to other or even additional dementias operating together, according to a report by Lon White, MD, MPH, from the Pacific Health Research Institute and Kuakini Medical System in Honolulu, Hawaii. "We are shockingly ignorant of what's really going on in the brain," he said. "There's a lot more pathology than we thought." Untangling the different processes that contribute to dementia is an important first step in designing more effective treatments, the researcher noted.
Full news coverage: Dementia Diagnosis Often Refined at Autopsy
Photography by Luci Pemoni; Honolulu, Hawaii
Susan Jeffrey, News Editor, Medscape Neurology, Toronto, Canada
Susan Jeffrey has disclosed no relevant financial relationships.
Allison Gandey, Senior Journalist; Ottawa, Canada
Allison Gandey has disclosed no relevant financial relationships.
Martha Kerr, Medscape Conference News Editor, East Haddam, Connecticut
Martha Kerr has disclosed no relevant financial relationships.
Jane Hwang, Senior Editor/Photo, Medscape New York City
Jane Hwang has disclosed no relevant financial relationships.
Megan Brooks, Freelance Journalist, Weston, Connecticut
Megan Brooks has disclosed no relevant financial relationships.
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