New and Noteworthy Information—May 2014
PET is a promising tool for determining which severely brain damaged individuals in vegetative states have the potential to recover consciousness, according to research published online ahead of print April 16 in Lancet. Investigators examined 81 patients in a minimally conscious state, 41 patients with unresponsive wakefulness syndrome, and four patients with locked-in syndrome. The researchers performed repeated standardized clinical assessments with the Coma Recovery Scale–Revised (CRS-R), cerebral 18F-fluorodeoxyglucose (FDG) PET, and fMRI while the patients performed mental activation tasks. Mental imagery fMRI was less sensitive at diagnosing a minimally conscious state than FDG-PET (45% vs 93%) and had less agreement with behavioral CRS-R scores than FDG-PET (63% vs 85%). 18F-FDG PET correctly predicted outcome in 75 of 102 patients, and fMRI in 36 of 65 patients.
The risk of epilepsy may be heightened significantly among patients with autoimmune diseases, especially children, according to data published online ahead of print March 31 in JAMA Neurology. Researchers conducted a retrospective population-based study using claims from a nationwide employer-provided health insurance plan in the United States. All 2,518,034 participants included in the study were beneficiaries enrolled between 1999 and 2006. The investigators examined the relationship between epilepsy and type 1 diabetes mellitus, psoriasis, rheumatoid arthritis, Graves disease, Hashimoto thyroiditis, Crohn disease, ulcerative colitis, systemic lupus erythematosus, antiphospholipid syndrome, Sjögren syndrome, myasthenia gravis, and celiac disease. The odds ratio of epilepsy was 3.8 among patients with autoimmune diseases and 5.2 among children. Based on their findings, the authors recommended that patients with epilepsy undergo surveillance for autoimmune disease, and vice versa.
Migraineurs whose stress decreases from one day to the next have a significantly increased risk of migraine onset on the subsequent day, according to a study published online ahead of print March 26 in Neurology. Twenty-two patients with migraine participated in a three-month electronic diary study. Participants entered data daily regarding migraine attack experience, as well as subjective stress ratings. Stress was assessed using the Perceived Stress Scale and the Self-Reported Stress Scale. Level of stress was generally not associated with migraine occurrence. Decline in stress from one evening diary to the next was associated with increased migraine onset during the subsequent six, 12, and 18 hours for the Perceived Stress Scale. Decline in stress was associated with migraine onset after controlling for level of stress for all time points.
Patients older than 60 with stroke resulting from blockage of the middle cerebral artery (MCA) benefit from hemicraniectomy, researchers reported March 20 in the New England Journal of Medicine. Investigators randomly assigned 112 patients age 61 or older with malignant MCA infarction to conservative treatment in the ICU or hemicraniectomy. The primary end point was survival without severe disability (defined as a score of 0 to 4 on the modified Rankin scale). The proportion of patients who survived without severe disability was 38% in the hemicraniectomy group, compared with 18% in the control group. This difference resulted from lower mortality in the surgery group (33% vs 70%). Infections were more frequent in the hemicraniectomy group, and herniation was more frequent in the control group.
The FDA has approved Topamax (topiramate) for the prevention of migraine headaches in adolescents ages 12 to 17. Topamax is the first drug with FDA approval for migraine prevention in this age group. The medication is taken daily to reduce the frequency of migraine headaches. A clinical trial that enrolled 103 participants established the safety and effectiveness of Topamax in preventing migraine headaches in adolescents ages 12 to 17. Participants treated with Topamax had a decrease in migraine frequency of approximately 72%, compared with 44% in participants who took placebo. The most common adverse reactions with the approved dose of Topamax (100 mg) were paresthesia, upper respiratory infection, anorexia, and abdominal pain. Topamax is manufactured by Janssen Pharmaceuticals of Titusville, New Jersey.
The FDA has approved Evzio (naloxone hydrochloride injection), a prescription treatment that family members or caregivers can use to treat a person suspected to have had an opioid overdose. Evzio rapidly delivers a single dose of naloxone through a handheld autoinjector that can be carried in a pocket or stored in a medicine cabinet. Evzio provides intramuscular or subcutaneous administration. Once turned on, the device provides verbal instruction about how to deliver the medication. In one pharmacokinetic study of 30 patients, a single Evzio injection provided equivalent naloxone, compared with a single dose of naloxone injection using a standard syringe. Administering Evzio to patients who are opioid dependent may result in severe opioid withdrawal. Evzio is manufactured by kaléo, which is based in Richmond, Virginia.
