New and Noteworthy Information—September 2014
HIV infection is associated with a significantly lower risk of developing multiple sclerosis (MS), according to a study published online ahead of print August 4 in the Journal of Neurology, Neurosurgery, & Psychiatry. Researchers investigated episodes of hospital care between 1999 and 2011 for patients with HIV. Compared with people who did not have HIV, patients with HIV were 62% less likely to develop MS. After more than a year between the two diagnoses, HIV-positive patients were 75% less likely to develop MS. “If subsequent studies demonstrate [that] there is a causal protective effect of HIV or its treatment, and if the magnitude of it proves to be similar … this would be the largest protective effect of any factor yet observed in relation to the development of MS,” the investigators concluded.
Colds and other minor infections may temporarily increase stroke risk in children, according to a study published online ahead of print August 20 in Neurology. Using the Kaiser Permanente database of 2.5 million children, researchers identified 102 children who had had an acute ischemic stroke and compared them with 306 children without stroke. Medical records for the children who had had a stroke were reviewed for minor infections for two years before their strokes. Ten (9.8%) of the 102 children with stroke had visited a physician for an infection within three days of the stroke. In comparison, two controls (0.7%) had an infection during the same time period. “Proposed mechanisms for the link between minor infection and stroke in adults include an inflammatory-mediated prothrombotic state and chronic endothelial injury,” the investigators theorized.
Peripheral pulse monitoring in patients with stroke accurately distinguishes atrial fibrillation from normal heart rhythm, investigators reported in the August 12 issue of Neurology. The prospective study included 256 patients with acute ischemic stroke, as well as the patients’ relatives. Subjects were taught to measure the patient’s pulse to detect atrial fibrillation; measurements from the participants and health care professionals were compared with recordings of electrical activity in the heart. Fifty-seven patients had irregular heartbeats. Measurement of the peripheral pulse by health care professionals had a diagnostic sensitivity of 96.5%, compared with 76.5% for the patients’ relatives, regarding the detection of atrial fibrillation. The specificity was 94.0% for health care professionals and 92.9% for patients’ relatives. Self-measurements were performed by 89.1% of patients with a diagnostic sensitivity of 54.1% and 96.2% specificity.
Reducing smoking among people in a low socioeconomic position and among those with hypertension may reduce social inequality stroke incidence, researchers reported online ahead of print August 14 in Stroke. The findings are based on data from 68,643 adults between ages 30 and 70 who were grouped into low, medium, and high education levels and assessed for smoking status and blood pressure level. About 16% of men and 11% of women had a high risk of stroke because of low education level, high blood pressure, and smoking. Smokers with low education had a greater risk of stroke than smokers with high education, regardless of their blood pressure. About 10% of men and 9% of women at high risk had an ischemic stroke during follow-up. Overall, men had a higher risk of stroke than women, and their risk increased with age.
Motoric cognitive risk syndrome (MCR), a predementia syndrome characterized by slow gait and cognitive complaints, is common in older adults and is a strong and early risk factor for cognitive decline, according to a study published online ahead of print July 16 in Neurology. Among 26,802 participants from 22 cohorts, 2,808 subjects met MCR criteria. MCR prevalence was higher among older individuals, but there were no sex differences. MCR predicted the risk of developing incident cognitive impairment (adjusted hazard ratio, 2.0); in individual cohorts the adjusted hazard ratios ranged from 1.5 to 2.7. MCR also predicted dementia in the pooled sample (adjusted hazard ratio, 1.9). “MCR criteria can be easily applied in clinical settings with simple questions about cognitive complaints and timing gait; 90% of participants had walking timed over fixed distances without requiring major resource commitments,” the investigators stated.
The FDA has approved Plegridy (peginterferon beta-1a) for patients with relapsing forms of multiple sclerosis (MS). Approval of the drug is based on results from the ADVANCE study of more than 1,500 patients with MS. The drug can be administered subcutaneously with an autoinjector or a prefilled syringe. Dosed once every two weeks, the drug significantly reduced annualized relapse rate at one year by 36%, compared with placebo. Plegridy reduced the risk of 12-week confirmed disability progression by 38%, compared with placebo. The drug also significantly reduced the number of new gadolinium-enhancing lesions by 86% and decreased the number of new or newly enlarging T2-hyperintense lesions by 67%, compared with placebo. Common adverse reactions include injection-site reaction and flu-like illness. The drug is manufactured by Biogen Idec, which is headquartered in Cambridge, Massachusetts.
