Herpes zoster is associated with a short-term increased risk of stroke, and preventing infection may prevent this increased risk, according to a study published online ahead of print December 9, 2015, in Mayo Clinic Proceedings. In a community cohort study, researchers compared the risk of stroke and myocardial infarction at four time points in 4,862 adults with and without herpes zoster. People with herpes zoster had more risk or confounding factors for myocardial infarction and stroke, suggesting that they had worse health status overall. People with herpes zoster were at increased risk for stroke at three months after infection, compared with those without a history of herpes zoster. Herpes zoster was not associated with an increased risk of stroke or myocardial infarction at any point beyond three months.
Supplementation with 10,400 IU of vitamin D3 daily is safe and well-tolerated in patients with multiple sclerosis (MS), according to a study published online ahead of print December 30, 2015, in Neurology. Supplementation also may mitigate patients’ hyperactive immune response. In a double-blind, single-center study, 40 patients with relapsing-remitting MS were randomized to receive 10,400 IU or 800 IU of vitamin D3 daily for six months. Blood tests were performed at baseline and three and six months. In the high-dose group, researchers found a reduction in the proportion of interleukin-17+CD4+ T cells, CD161+CD4+ T cells, and effector memory CD4+ T cells, with a concomitant increase in the proportion of central memory CD4+ T cells and naive CD4+ T cells. These effects were not observed in the low-dose group.
Weight loss is associated with rapid progression of Parkinson’s disease, according to a study published online ahead of print January 11 in JAMA Neurology. Researchers analyzed data for 1,673 participants in the National Institute of Neurological Disorders and Stroke Exploratory Trials in PD Long-term Study-1. Of this cohort, 158 people lost weight, whereas 233 gained weight. After adjusting for covariates, researchers found that mean motor score increased by 1.48 more points per visit among people who lost weight than among people whose weight was stable. Mean motor score decreased by 0.51 points per visit for people who gained weight, relative to participants with stable weight. The observed difference in survival between the three BMI groups was not a significant outcome after data were adjusted for covariates.
Distal flow status is associated with risk for subsequent stroke in patients with symptomatic atherosclerotic vertebrobasilar occlusive disease, according to a study published online ahead of print December 21, 2015, in JAMA Neurology. Researchers conducted a prospective, blinded, longitudinal cohort study of 82 patients with recent vertebrobasilar transient ischemic attack or stroke and 50% or more atherosclerotic stenosis or occlusion in vertebral or basilar arteries. Distal flow status was low in 18 of the 72 participants included in the analysis and was significantly associated with risk for a subsequent vertebrobasilar stroke. The 12- and 24-month event-free survival rates were 78% and 70%, respectively, in the low-flow group, compared with 96% and 87%, respectively, in the normal-flow group. Hazard ratio for stroke was 11.55 among people with low distal flow.
The FDA has approved incobotulinumtoxinA for the treatment of upper limb spasticity in adult patients. The approval is based on the results of a randomized, multicenter, placebo-controlled trial. Treatment with incobotulinumtoxinA for adult upper limb spasticity resulted in statistically and clinically significant improvements in muscle tone. The product’s safety and efficacy were evaluated in multiple phase III clinical studies that included more than 400 patients. The safety profile for this indication is similar to that observed for other indications. FDA first approved incobotulinumtoxinA in August 2010 for the treatment of adults with cervical dystonia and blepharospasm. The most common adverse reactions include seizure, nasopharyngitis, dry mouth, and upper respiratory tract infection. Merz Pharma Group, headquartered in Raleigh, North Carolina, markets the product under the name Xeomin.
Cannabidiol may reduce seizure frequency and have an adequate safety profile in children and young adults with highly treatment-resistant epilepsy, according to a study published online ahead of print December 23, 2015, in Lancet Neurology. Patients received 2 to 5 mg/kg/day of oral cannabidiol, and the dose was increased until intolerance or to a maximum dose of 25 mg/kg/day or 50 mg/kg/day. Adverse events included somnolence, decreased appetite, diarrhea, fatigue, and convulsion. Five patients discontinued treatment because of an adverse event. Serious adverse events were reported in 48 patients, including one death regarded as unrelated to the study drug. Twenty patients had severe adverse events possibly related to cannabidiol use, the most common being status epilepticus. The median reduction in monthly motor seizures was 36.5%.