New and Noteworthy Information—March 2018

Short Stature in Children Linked to Future Stroke

Short stature at ages 7 to 13 is associated with increased risk of stroke in adulthood, according to a study published online ahead of print February 15 in Stroke. Data were examined for 311,009 schoolchildren born between 1930 and 1989. Cox proportional hazards regressions were performed to estimate hazard ratios. Among the participants, 10,412 were diagnosed with ischemic stroke, and 2,546 were diagnosed with intracerebral hemorrhage. Height at age 7 was inversely and significantly associated with ischemic stroke in both sexes and with intracerebral hemorrhage in men, but not in women. Associations were similar at older childhood ages and were stable throughout the study period. No statistically significant associations for growth from ages 7 to 13 were observed for ischemic stroke or intracerebral hemorrhage.

Gjærde LK, Truelsen TC, Baker JL. Childhood stature and growth in relation to first ischemic stroke or intracerebral hemorrhage. Stroke. 2018 Feb 15 [Epub ahead of print].

FDA Expands Treatment Window for Trevo Device

The FDA has cleared the use of the Trevo clot-retrieval device to treat certain patients with stroke as long as 24 hours after symptom onset, thus expanding its indications. The device is cleared as an initial therapy for acute ischemic stroke to reduce paralysis, speech difficulties, and other disabilities. It is to be used in addition to t-PA. Trevo was previously cleared for use in patients six hours after symptom onset. The agency evaluated data from a clinical trial comparing 107 patients treated with Trevo and medical management with 99 patients receiving medical management alone. About 48% of patients treated with Trevo were functionally independent three months after stroke, compared with 13% of patients receiving medical management. Stryker, headquartered in Kalamazoo, Michigan, markets the device.

Positive Views on Aging May Reduce Dementia Risk

Older adults who gain positive beliefs about old age from their culture are less likely to develop dementia, according to a study published February 7 in PLoS One. The cohort included 4,765 Health and Retirement Study participants age 60 or older who were dementia-free at baseline. In the total sample, people with positive age beliefs at baseline were significantly less likely to develop dementia, after adjusting for relevant covariates. Among people with APOE ε4, participants with positive age beliefs were 49.8% less likely to develop dementia than people with negative age beliefs. The results of this study suggest that positive age beliefs, which are modifiable and reduce stress, can be protective, even for older individuals at high risk of dementia, said the investigators.

Levy BR, Slade MD, Pietrzak RH, Ferrucci L. Positive age beliefs protect against dementia even among elders with high-risk gene. PLoS One. 2018 Feb 7;13(2):e0191004.

Should Women Stop MS Treatment During Pregnancy?

Natalizumab exposure for as long as 12 weeks of gestation increases the risk of spontaneous abortion, compared with exposure to injectable treatments or no treatment, in women with multiple sclerosis (MS), according to a study published online ahead of print February 7 in Neurology. Data for all pregnancies occurring between 2009 and 2015 in patients with MS treated with natalizumab were collected and compared with data for pregnancies in untreated patients and patients treated with injectable immunomodulatory agents. A total of 92 pregnancies were tracked in 83 women. In the multivariable analysis, natalizumab exposure was associated with spontaneous abortion. The rate of spontaneous abortion was within the estimates for the general population, however, as was the rate of major congenital anomalies.

Portaccio E, Annovazzi P, Ghezzi A, et al. Pregnancy decision-making in women with multiple sclerosis treated with natalizumab: I: Fetal risks. Neurology. 2018 Feb 7 [Epub ahead of print].

Walking Ability After Stroke Improves With Arm Exercise

Arm exercise may improve walking ability after stroke, according to a study published online ahead of print December 6, 2017, in the Journal of Neurophysiology. Researchers worked with a group of older adults who had had a stroke between seven months and 17 years before the study. Participants underwent three 30-minute, moderate-intensity arm cycling training sessions each week for five weeks. Bilateral soleus stretch reflexes were elicited at rest and during 1-Hz arm cycling. Investigators measured physical abilities before and after arm training using several standardized scales and tests of physical function. Performance significantly improved on all walking tests and improved as much as 28% on the Timed Up and Go test. Several subjects had less tightness in their muscles after completing the arm cycling trial.