Read on below for our highlighted selection of recent papers from the scientific press for April 2022.
For our highlighted Covid-19-related papers and studies, please explore the Breaking News category on EANpages, here.
- Patient-Centered Treatment of Chronic Migraine With Medication Overuse: A Prospective, Randomized, Pragmatic Clinical Trial
- Whole genome sequencing for the diagnosis of neurological repeat expansion disorders in the UK: a retrospective diagnostic accuracy and prospective clinical validation study
- Safety and efficacy of riluzole in spinocerebellar ataxia type 2 in France (ATRIL): a multicentre, randomised, double-blind, placebo-controlled trial
- Effect of Intra-arterial Alteplase vs Placebo Following Successful Thrombectomy on Functional Outcomes in Patients With Large Vessel Occlusion Acute Ischemic Stroke The CHOICE Randomized Clinical Trial
- Cerebrospinal Fluid Biomarkers in Autopsy-Confirmed Alzheimer Disease and Frontotemporal Lobar Degeneration
Patient-Centered Treatment of Chronic Migraine With Medication Overuse: A Prospective, Randomized, Pragmatic Clinical Trial
This randomised study, conducted on 720 people with chronic migraine with medication overuse, aimed to investigate whether migraine preventive treatment without switching (or limiting the use of) the overused symptomatic medication was non-inferior to migraine preventive treatment associated with the switching (or limiting the use of) the overused symptomatic medication. The results of this study indicate that migraine preventive medication results in clinically meaningful reductions in moderate-to-severe headache days, with no difference in the degree of improvement whether the symptomatic medication use continues or there is switching to an alternative symptomatic medication used with a maximum limit of two treatment days/week.
Schwedt T, Hentz J, Sahai-Srivastava S et al. Patient-Centered Treatment of Chronic Migraine With Medication Overuse: A Prospective, Randomized, Pragmatic Clinical Trial. Neurology. 2022 Feb 15;10.1212/WNL.0000000000200117. doi: 10.1212/WNL.0000000000200117. Online ahead of print.
Whole genome sequencing for the diagnosis of neurological repeat expansion disorders in the UK: a retrospective diagnostic accuracy and prospective clinical validation study
This very interesting study aimed to assess the clinical accuracy of whole genome sequencing to detect repeat expansions in previously genetically tested and undiagnosed patients recruited in 2013–17 in the 100,000 Genomes Project in the UK, who were suspected of having a genetic neurological disorder. If a repeat expansion call was made using whole genome sequencing, PCR was used to confirm the result. The results of this study show that whole genome sequencing is both sensitive and specific when compared against previously gold standard tested positive and negative controls, and that this technique can lead to a diagnosis in previously undiagnosed patients with suspected neurological disorders.
Ibañez K, Polke J, Hagelstrom T, et al. Whole genome sequencing for the diagnosis of neurological repeat expansion disorders in the UK: a retrospective diagnostic accuracy and prospective clinical validation study. Lancet Neurol. 2022 Mar;21(3):234-245. doi: 10.1016/S1474-4422(21)00462-2.
Safety and efficacy of riluzole in spinocerebellar ataxia type 2 in France (ATRIL): a multicentre, randomised, double-blind, placebo-controlled trial
This randomised, double-blind, placebo-controlled study investigated the safety and efficacy of riluzole in 45 patients with spinocerebellar ataxia type 2. The results of this study indicate the absence of improvement of clinical or radiological outcomes under riluzole treatment, despite satisfactory treatment compliance and absence of serious adverse events.
Coarelli G, Heinzmann A, Ewenczyk C, et al. Safety and efficacy of riluzole in spinocerebellar ataxia type 2 in France (ATRIL): a multicentre, randomised, double-blind, placebo-controlled trial. Lancet Neurol. 2022 Mar;21(3):225-233. doi: 10.1016/S1474-4422(21)00457-9. Epub 2022 Jan 18.
Effect of Intra-arterial Alteplase vs Placebo Following Successful Thrombectomy on Functional Outcomes in Patients With Large Vessel Occlusion Acute Ischemic Stroke The CHOICE Randomized Clinical Trial
Endovascular thrombectomy is the optimal treatment for acute ischaemic stroke due to large vessel occlusion. Nonetheless, it has been reported that only 27% of patients who undergo successful reperfusion after mechanical thrombectomy are disability free at 90 days; it can be speculated that an incomplete microcirculatory reperfusion might be responsible for this suboptimal clinical efficacy. This study is a phase 2b randomised, double-blind, placebo-controlled trial which has been performed in seven stroke centres in Spain. One-hundred-and-twenty study participants were randomised to receive intra-arterial alteplase (n=61) or placebo (n=52). All patients underwent thrombectomy within 24 hours after stroke onset, which resulted in an expanded Treatment in Cerebral Ischemia angiographic score of 2b50 to 3. The authors found that the treatment with adjunct intra-arterial alteplase compared with placebo was associated with greater likelihood of excellent neurological outcome at 90 days. Symptomatic intracranial haemorrhage within 24 hours occurred in 0% and in 3.8% of patients who received intra-arterial alteplase and placebo, respectively. Mortality at 90 days was higher in the placebo than in the alteplase group (alteplase=8% vs placebo =15%). This study supports the use of adjunct intra-arterial alteplase after successful thrombectomy; however, because of the limitations of the study, further works are needed to confirm these results.
Renú A, Millán M, San Román L et al. Effect of Intra-arterial Alteplase vs Placebo Following Successful Thrombectomy on Functional Outcomes in Patients With Large Vessel Occlusion Acute Ischemic Stroke: The CHOICE Randomized Clinical Trial. JAMA. 2022 Mar 1;327(9):826-835. doi: 10.1001/jama.2022.1645.
Cerebrospinal Fluid Biomarkers in Autopsy-Confirmed Alzheimer Disease and Frontotemporal Lobar Degeneration
Alzheimer’s disease (AD) and frontotemporal lobar degeneration (FTLD) are common causes of dementia. Reliable biomarkers are needed in order to ameliorate diagnosis and develop new therapeutic options. This study investigated the association between cerebrospinal fluid (CSF) biomarkers and neuropathological changes typical of AD and FTLD. The study enrolled 101 patients with clinical diagnosis of AD or FTLD; for each patient, antemortem CSF biomarkers (P-tau, T-tau, Aβ42, Aβ40 and NFL) and neuropathological data (Thal phases, Braak stages, CERAD scores, Alzheimer’s disease Neuropathological Change, and primary and contributory pathological diagnoses) were available. The authors found that CSF biomarkers related to neuropathological measures of Aβ (Thal, CERAD), tau (Braak) and overall AD neuropathologic change. Aβ42/Aβ40 and P-tau/Aβ42 ratios measured in CSF showed very high overall accuracy in the identification of AD pathology. Furthermore, different biomarker patterns were found in the FTLD subtypes; the authors reported increased NFL and reduced P-tau/T-tau levels in FTLD-TDP, and reduced CSF tau values in progressive supranuclear palsy. In conclusion, this study showed that the use of CSF biomarkers may play a crucial role in the characterisation of the underlying neuropathological changes in patients with AD and FTLD.
Mattsson-Carlgren N, Grinberg LT, Boxer A, et al. Cerebrospinal Fluid Biomarkers in Autopsy-Confirmed Alzheimer Disease and Frontotemporal Lobar Degeneration.Neurology. 2022 Mar 15;98(11):e1137-e1150. doi: 10.1212/WNL.0000000000200040. Epub 2022 Feb 16.