New and Noteworthy Information—April 2014
Little evidence suggests that most complementary or alternative medicine therapies treat the symptoms of multiple sclerosis (MS), according to an American Academy of Neurology guideline published March 25 in Neurology. Oral cannabis and oral medical marijuana spray, however, may ease patients’ reported symptoms of spasticity, pain related to spasticity, and frequent urination in MS. Not enough evidence is available to show whether smoking marijuana helps treat MS symptoms, according to the guideline. The authors concluded that magnetic therapy is probably effective for fatigue and probably ineffective for depression. Fish oil is probably ineffective for relapses, disability, fatigue, MRI lesions, and quality of life, according to the guideline. In addition, evidence indicates that ginkgo biloba is ineffective for cognition and possibly effective for fatigue, said the authors.
People who develop diabetes and high blood pressure in middle age are more likely to have brain cell loss and problems with memory and thinking skills than people who never have diabetes or high blood pressure or who develop them in old age, according to a study published online ahead of print March 19 in Neurology. Investigators evaluated the thinking and memory skills of 1,437 people (average age, 80), conducted brain scans, and reviewed participants’ medical records to determine whether the latter had been diagnosed with diabetes or high blood pressure in middle age or later. Midlife diabetes was associated with subcortical infarctions, reduced hippocampal volume, reduced whole brain volume, and prevalent mild cognitive impairment. Midlife hypertension was associated with infarctions and white matter hyperintensity volume.
Each 15-minute decrease in treatment delay may provide a patient an average equivalent of one month of additional disability-free life, according to a study published online ahead of print March 13 in Stroke. Researchers examined observational prospective data for 2,258 consecutive stroke patients treated with IV thrombolysis to determine distributions of age, sex, stroke severity, onset-to-treatment times, and three-month modified Rankin Scale score in daily clinical practice. The investigators found that for every one-minute reduction in onset-to-treatment time, patients gained an average 1.8 days of healthy life. Although all patients benefited from faster treatment, younger patients with longer life expectancies gained a little more than older patients. Women gained slightly more than men throughout their longer lifetimes. The awareness of the importance of speed could promote practice change, said the authors.
The FDA has approved extended-release Qudexy XR (topiramate) capsules as initial monotherapy in patients 10 or older with partial-onset seizures or primary generalized tonic-clonic seizures. The drug also received approval as adjunctive therapy in patients age 2 or older with partial-onset seizures, primary generalized tonic-clonic seizures, and seizures associated with Lennox–Gastaut syndrome. In a randomized, double-blind, placebo-controlled study, the drug demonstrated favorable safety and tolerability in patients with refractory partial-onset seizures. The extended-release formulation was associated with a significantly greater median percent reduction from baseline in seizure frequency, compared with placebo (39.5% vs 21.7%) after 11 weeks of treatment. Upsher-Smith Laboratories, headquartered in Maple Grove, Minnesota, manufactures the drug and expects it to be available during the second quarter of 2014.
The FDA has approved the Cefaly medical device as a preventive treatment for migraine headaches. The product is the first transcutaneous electrical nerve stimulation device specifically authorized for use before the onset of pain. The product is a small, portable, battery-powered unit resembling a plastic headband worn across the forehead once per day for 20 minutes. The device applies an electric current to the skin and underlying tissues to stimulate branches of the trigeminal nerve. In a study including 67 participants, patients who used Cefaly had significantly fewer days with migraines per month and used less migraine attack medication, compared with patients who used a placebo device. STX-Med, which is headquartered in Herstal, Liege, Belgium, manufactures the device, which is indicated for patients 18 and older.
Children with autism who are fed infant formula containing soy protein rather than milk protein may have a higher rate of seizures, according to research published March 12 in PLOS One. Researchers analyzed medical record data for 1,949 children with autism, including information on infant formula use, seizure incidence, the specific type of seizure exhibited, and IQ. Soy-based formula was given in 17.5% of the study population. About 13% of the subjects were female. The researchers found a 2.6-fold higher rate of febrile seizures (4.2% vs 1.6%), a 2.1-fold higher rate of epilepsy comorbidity (3.6% vs 1.7%), and a fourfold higher rate of simple partial seizures (1.2% vs 0.3%) in the children with autism who were fed soy-based formula. No statistically significant associations were found with other outcomes.
