COMMENTARY

Four New and Promising Neurology Studies

Hans-Christoph Diener, MD, PhD

Disclosures

January 26, 2017

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Dear colleagues, I am Christoph Diener, a neurologist from the Department of Neurology at the University of Essen in Germany. Today I will report on four very exciting new studies that came out in the past month, all of which have consequences for how we practice medicine in neurology.

The first was published in JAMA.[1] It is a study from Canada which looked at more than 3000 children and adolescents who had a concussion, usually due to contact sports like ice hockey or football. The authors investigated whether the old recommendation—that after a concussion you should rest and not move around or exercise—is really true. They separated children and adolescents in groups who early on started to exercise again, and compared them with children who did not exercise. Overall, they observed a rate of persistent postconcussive symptoms in about 30% of the children and adolescents. The prevalence of these symptoms was clearly correlated with early start of activity. The earlier and the more they took part in physical activity, the less likely they were to have these symptoms.

The next study was published in the New England Journal of Medicine[2] and deals with progressive multiple sclerosis (MS). You are all aware that we have great treatments for relapsing MS but nothing yet for progressive MS. Ocrelizumab is a new drug that was compared with placebo in 732 patients. Confirmed disability progression for more than 12 weeks was noted in 33% in the active treatment arm, compared with 39% in the placebo group. Researchers also observed benefit in terms of progression of the disease on brain imaging. There were only a few side effects. I agree that the treatment effect is small, but it is the first time in history that we see a positive result in a study investigating progressive MS.

The next study, published in the Lancet,[3] is even more exciting. You all know that infantile-onset spinal muscular atrophy is a terrible disease resulting in death of the patient. For the first time, there is a treatment with an antisense, nusinersen. There were 20 participants in this study who received the antisense, which promotes a protective protein intrathecally. It turned out that this treatment is safe, and in the majority of children it was also effective. There is a second, not-yet-published trial in adults that was also positive, leading the US Food and Drug Administration to grant approval to this exciting new therapy.

The last study is again from the New England Journal of Medicine.[4] It is with only one patient who had a multifocal glioblastoma, with manifestation in the brain and along the spinal cord. The investigators developed a tumor-associated antigen against interleukin-13 receptor alpha. They administered this antibody into the tumor cavity and into the ventricular system. With a time period of 220 days, they saw a persistent regression of the tumor. It is only one patient, but I think this could be a very exciting new treatment for glioblastoma.

Ladies and gentleman, there have been four important studies published in the past 4 weeks which will change the way we practice medicine.

I am Christoph Diener from the Department of Neurology at the University of Essen, Germany. Thank you very much for watching.

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