Video Highlights From the American Neurological Association 133rd Annual Meeting

September 21 - 24, 2008, Salt Lake City, Utah

October 16, 2008

September 21 - 24, 2008, Salt Lake City, Utah

Transcript

Introduction:

Salt Lake City, Utah.... The site for the American Neurological Association's 133rd Annual Meeting.

Delegates came together at the stately Grand America Hotel, boasting spectacular views of the surrounding mountains and Great Salt Lake.

Medscape Neurology & Neurosurgery was there reporting on site.

SEGMENT 1: Neurologic War Injuries

Against the more austere backdrop of America at war, one timely session focused on neurologic injuries arising from the conflicts in Iraq and Afghanistan.

Dr. Daniel Lowenstein of the University of California at San Francisco says the potential costs associated with these injuries will be staggering.

He says blast injuries are the "signature injury" of this war and are having serious consequences.

Lowenstein: "If you consider moderate and importantly mild traumatic brain injury, the estimates vary, but the latest numbers indicate that as many as a third of combatants who are in actual field operations have been exposed to concussive forces that can lead to TBI and this is being reflected In the type of disability claims that are being seen now in the VA system."

Voiceover: Dr. Lowenstein is exploring the link between such trauma and acquired epilepsy, warning that the potential consequences for soldiers and civilians could be substantial.

Prospective cohort studies are now underway to establish the true extent of this problem.

SEGMENT 2: Early Rasagiline Therapy in Parkinson's

Voiceover: Other research presented at the ANA included results from the ADAGIO study. The trial compared early versus later treatment with rasagiline in Parkinson's disease.

Olanow: "This was a study trying to determine if rasagiline had a disease-modifying property. The studies we've done so far have failed to be able to detect this because of what we call a symptomatic confound where we can't be sure whether any benefit we see is because of a protective or symptomatic effect."

Voiceover: To get around this problem, investigators conducted a delayed-start study.

Patients were first randomized to begin either the active drug or placebo. Then, after 36 weeks, researchers put all groups on rasagiline and compared the progression of disease.

Olanow: "What we found was that with 1 mg of rasagiline, we met those goals and early treatment gave better outcomes than delayed treatment."

Voiceover: However, the higher 2-mg dose failed to meet the primary endpoint for the trial.

Dr. Olanow told the meeting that the investigators are uncertain why this happened and many questions remain.

SEGMENT 3: Vitamin D Linked to MS Risk

Voiceover: Dr. George Ebers from the University of Oxford reported new data linking vitamin D to genetic and environmental risks for multiple sclerosis.

Ebers: "It turns out that vitamin D–related genes are actually fairly common about 1 out of every 30 genes have a vitamin D response element as it's called and we found one not only within the MHC, but also immediately adjacent to the gene that is clearly having the biggest effect on risk."

Voiceover: The study confirms a connection between vitamin D and genetic and environmental risk for MS, but the exact mechanism behind this connection is not yet clear.

SEGMENT 4: Higher MRI Burden in Kids With MS

Voiceover: In other multiple sclerosis news, Dr. Emmanuelle Waubant from the University of California at San Francisco presented MRI findings suggesting that pediatric patients tend to have a higher disease burden at onset.

Waubant: "What I would like physicians to take away from this study is that pediatric MS exists and probably in young patients it looks a little different and to keep their minds open about the type of MRI features they see so that diagnosis can be made early."

Voiceover: The clinical course of disease is often similar between pediatric and adult patients, but onset can be very different.

Waubant: "I would say that in young patients who tend to look different from adults and teenagers, if you see patients with monosymptomatic onset of symptoms such as optic neuritis or partial transverse acute myelitis or other CNS involvement, you probably should be careful if you see extensive lesions and they're young not to think in terms of acute demyelinating encephalomyelitis, but to keep multiple sclerosis in the differential."

SEGMENT 5: Risks for Dementia in Parkinson's

Voiceover: Researchers also presented long-term follow up of patients who participated in the DATATOP trial — a previously published study of deprenyl in early Parkinson's disease. This long-term data has allowed researchers to look at the incidence of dementia over time, and determine factors that could signal future risk.

Uc: "In our study, we found that 5.8% of our cohort got demented in 5 years, and this is slightly higher than the general population for that same age group, but lower than reported for community-based studies."

Voiceover: Dr. Uc says clinicians should be aware that Parkinson's disease is much more than a motor illness.

Uc: "We also found that early difficulties with speech and swallowing can be risk factors for dementia in the future."

SEGMENT 6: Statins May Unmask ALS

Voiceover: In other work presented at the ANA, Dr. Benjamin Brooks from the Carolinas Neuromuscular Center in Charlotte described a possible link between the use of statins and amyotrophic lateral sclerosis.

At his institution, a high number of patients with sporadic ALS who were exposed to statin therapy before diagnosis reported muscle pain and weakness associated with treatment.

The researchers are not suggesting statins cause ALS. But they speculate that statins may unmask ALS or accelerate the disease, leading to diagnosis.

Brooks: "What I think our study shows is it complements other studies from France and from Canada showing that the use of statins by patients who have ALS may accelerate disease progression and in this particular case, it appears that those patients who are at risk for ALS, may have it occur more quickly in the presence of statins and so we have to be careful about the use of statins and pay attention to the pain and muscle weakness that may occur in these people so that we get proper diagnostic evaluation."

SEGMENT 7: Memantine in Alzheimer's Disease

Voiceover: New data in Alzheimer's disease suggest that high-dose extended-release memantine appears to be safe and effective.

Dr. George Grossberg from St. Louis University in Missouri presented these findings from a randomized trial.

Grossberg: "This was looked at in individuals with moderate to severe Alzheimer's disease who were already on a cholinesterase inhibitor compared to individuals on the cholinesterase inhibitor and placebo. And over 6 months, it was found that there were highly statistically significant benefits both cognitively as well as in global measures in individuals that were on this new high-dose memantine versus those on placebo."

Voiceover: The safety of this higher dose was a concern, but treatment appeared to be well-tolerated.

Grossberg: "Even though this is almost a 50% higher daily dose of memantine than we currently use, the safety and tolerability was equivalent to placebo, was very very high, which means that once this new preparation is approved, which will be sometime in the coming year in 2009, I think clinicians will have another tool to use in individuals with moderate to severe Alzheimer's disease."

Voiceover: For full reports on these and other studies from the American Neurological Association's 133rd Annual Meeting, visit Medscape Neurology & Neurosurgery at neurology dot medscape dot com.

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