COMMENTARY

New Findings Stroke, Migraine, MS, and More

Hans-Christoph Diener, MD, PhD

Disclosures

May 07, 2019

This transcript has been edited for clarity.

Dear colleagues, I am Christoph Diener, a neurologist from the Faculty of Medicine at the University of Duisburg-Essen in Essen, Germany. For this month, I identified six interesting studies in neurology.

Let's start with sonothrombolysis in acute ischemic stroke, which was published in Lancet Neurology.[1] This method basically uses transcranial Doppler sonography with high intensity to dissolve a clot in patients who undergo thrombolysis with recombinant tissue plasminogen activator (rtPA). This randomized study had 335 patients in the active treatment group, who received sonothrombolysis on top of thrombolysis, and 341 patients who were treated with sham ultrasound.

The primary outcome was an improvement in the modified Rankin Scale at 19 days. Unfortunately, this study was negative for the functional outcome. There was no difference in mortality, which was between 13% and 16%, and there were no differences in serious adverse events. Unfortunately, this was another negative study for the treatment of acute ischemic stroke, which means we are basically restricted to thrombolysis and thrombectomy at the moment.

The second study, published in Lancet Neurology, is a pooled analysis of individual patient data from four randomized trials, which compared stenting with carotid endarterectomy in patients with symptomatic carotid stenosis in a 10-year follow up.[2] This analysis showed what we already knew, which was that the complication rate of stenting is higher than that of endarterectomy. In the long term, there is no difference in the rate of ipsilateral stroke on the side that was operated or stented. This rate is only 0.62% per year, which is an extremely low event rate. This would overall favor cardiac endarterectomy over stenting.

The third study investigated the relationship between alcohol and migraine attack. This study, conducted in Leiden in the Netherlands, was published in the European Journal of Neurology and is based on web-based questionnaires among 2197 migraine patients.[3]

Approximately 36% of these patients reported that alcohol sometimes or regularly is a trigger factor for migraine attacks. In those patients who reported this occurrence, red wine caused migraine attacks in 80% of patients. Interestingly, there is a very rapid onset of some migraine attack after intake of red wine in one third of patients. This also explains why many patients with migraine don't drink alcohol at all.

The fourth study, published in Neurology, investigated the possible relationship among pregnancy, breastfeeding, menarche, and multiple sclerosis.[4] This study was based on 501 female participants who had clinically isolated syndrome. The good news for these women is that there was no relationship between pregnancy, breastfeeding, or menarche and the activity or progression of multiple sclerosis.

In the Journal of Clinical Oncology, there are now recommendations for how to deal with complications reported in patients with brain metastasis.[5] There are two important recommendations. First, there is no justification for prophylactic, anticonvulsive treatment in these patients, so it's worthwhile to wait and see whether a seizure occurs. Second, dexamethasone is recommended for the symptomatic relief of neurologic symptoms or mass effect of metastases.

The last study, which was published in Nature Scientific Reports, might threaten you.[6] They looked at data from the English Longitudinal Study of Ageing in 3600 patients above the age of 50 years. They analyzed the possible relationship between TV watching and cognitive decline over a period of 6 years. Even if they corrected for all confounding factors, watching TV for more than 3.5 hours per day was associated with cognitive decline.

The good news for physicians is that we don't have time to watch TV for 3.5 hours per day, but this is another topic.

Ladies and gentlemen, I'm Christoph Diener, a neurologist from the Faculty of Medicine at the University of Duisburg-Essen in Essen, Germany. Thank you very much for watching and listening.

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