7 New Neurology Studies to Know

Hans-Christoph Diener, MD, PhD


November 04, 2021

This transcript has been edited for clarity.

Dear colleagues, I'm Christoph Diener from the faculty of medicine at the University of Duisburg-Essen in Germany. Today I'd like to report on several new studies in neurology published in the literature in September 2021.

When to Initiate Disease-Modifying Treatment in Multiple Sclerosis (MS)

There's an ongoing debate about whether patients should or should not receive a highly effective disease-modifying treatment upon first being diagnosed with MS. As you know, there are no randomized trials addressing this topic. However, there are now data from national MS registries in two Nordic countries: Sweden, where the majority of patients initially receive mild or moderately effective disease-modifying treatments; and Denmark, where only about one third of patients initially do.

The registry data show that there is obviously a benefit to initiating MS-modifying therapy with more aggressive therapies in the beginning. However, this is associated with more adverse events and an increased need for monitoring.

The Latest on COVID-19 Vaccinations

A study from the United States analyzed complications of the COVID-19 vaccination. Researchers surveyed data from 11 million doses of the mRNA vaccine from either Moderna or Pfizer-BioNTech. They compared rates of any kind of disease that developed within the first 14 days after vaccination. They observed no increased risk for any kind of disease, like thrombosis, myocardial infarction, ischemic stroke, Guillain-Barré syndrome, pericarditis, and myocarditis. This is clearly in contrast to viral vector vaccination from, for example, Johnson & Johnson and AstraZeneca, so this is very reassuring for mRNA vaccination.

The Serious Implications of Sleepless Nights

There were two interesting studies showing an association between short sleep duration and other diseases. The first is from the Whitehall II study in the United Kingdom and was published in Nature Communications. Researchers followed 8000 people age 50-60 years for 25 years. They found an increased risk for dementia if the sleep duration was 6 hours or less.

A second study, in the European Heart Journal, investigated the relationship between sleep duration and cardiovascular diseases. Researchers observed an increased risk for any kind of cardiovascular disease if you sleep 6 hours or less, or if you sleep 9 hours or more.

I think both of these studies offer an indirect sign that we should care more about our sleep duration. Even if you're a very busy physician, most probably it's not a good idea to sleep less than 6 hours every night.

Limited Efficacy of a New Migraine Prevention Treatment

We now have new drugs for the prevention of migraine, including the recently introduced monoclonal antibodies against calcitonin gene-related peptide (CGRP) and drugs that act directly on the CGRP receptor. Atogepant is among this latter group of drugs. For the first time, atogepant was investigated for the prevention of migraine and not for the treatment of acute migraine attacks.

Investigators recruited 910 patients who were randomly assigned to received three daily doses of atogepant (10, 30, or 60 mg) or placebo. The mean reduction of monthly migraine days over 12 weeks was somewhere between 3.7 and 4.2 days for atogepant compared with 2.5 days for placebo, representing a very small treatment effect.

The only benefit of this drug is that it has almost no side effects, beyond a little bit of constipation. The biggest problem, however, will be the price tag, which is assumed to be around $8000-$10,000 per year, at least in the United States.

A Genetic Basis for Cluster Headache

Recently, we've had lots of data about genetic components in migraine. But now we have two new publications in the Annals of Neurology telling us that cluster headache has a genetic component too.

In a study from the Netherlands, researchers found four gene loci in patients with cluster headache. And in a separate study from the United Kingdom and Sweden, researchers observed two gene loci on chromosome 2.

This is very important, as most probably it will allow us in the future to learn more about the pathophysiology of cluster headache through genetics.

Dear colleagues, September was an interesting month for several different fields of neurology. Thank you very much for listening and watching. I am Christoph Diener from the University of Duisburg-Essen in Germany.

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