Multiple sclerosis (MS) and type 1 diabetes co-occur within individuals and, to a lesser extent, within families, researchers reported in the July Archives of Neurology. Investigators included 6,078 patients with type 1 diabetes, 11,862 patients with MS, and 14,771 first-degree relatives of patients with MS. Patients with type 1 diabetes had a greater than threefold increased risk of MS, and first-degree relatives of patients with MS had a 63% increased risk of developing type 1 diabetes. Adjustment for familial relationship to patients with type 1 diabetes lowered the excess risk to 44%.

Variability in a-synuclein (SNCA) is associated with an increased risk of Parkinson’s disease, according to a study published in the August 9 JAMA. After performing genotyping in 2,692 patients with Parkinson’s disease and 2,652 controls, researchers found no heterogeneity across multiple study sites. However, variability in frequency was found in the SNCA dinucleotide repeat sequence alleles of both Parkinson’s disease patients and controls. Multilocus haplotypes also varied in frequency for both patients and controls, and genotypes defined by the 263 base-pair allele were associated with Parkinson’s disease. The researchers stated, "Our study demonstrates that the SNCA gene is not only a rare cause of autosomal dominant Parkinson disease in some families but also a susceptibility gene for Parkinson disease at the population level."

Mild to moderate closed head injury may increase the risk of Parkinson’s disease later in life, as reported in the July Annals of Neurology. A case-control study of 93 twin pairs discordant for Parkinson’s disease was conducted. An increased risk of Parkinson’s disease was associated with a prior head injury with amnesia or loss of consciousness; this association was magnified if only observations made 10 years before onset of Parkinson’s disease were included. No association was found between Parkinson’s disease and duration of loss of consciousness. The risk of Parkinson’s disease increased further with a subsequent head injury and with head injuries that required hospitalization.

According to a study in the August Stroke, high-dose human albumin may have a neuroprotective effect after ischemic stroke. Eighty-two subjects with acute ischemic stroke received 25% albumin within 16 hours of stroke onset, and 42 of these patients also received standard-of-care IV tissue plasminogen activator (t-PA). Among the highest three albumin dose tiers, the probability of good outcome was 81% greater than in the lower-dose tiers. In addition, the participants who received t-PA and higher-dose albumin were three times more likely to experience a good outcome than were patients treated with lower-dose albumin. This finding suggests "a positive synergistic effect between albumin and t-PA," noted the researchers.

IV application of acetylsalicylic acid is feasible and safe during interventional aneurysm embolization, as reported in the July Stroke. IV administration of 250 mg of acetylsalicylic acid began two years after the start of endovascular coil embolization in 247 patients with 261 aneurysms. Thromboembolic events during embolization occurred in 17.6% of patients before acetylsalicylic acid administration, compared to 8.8% of patients after acetylsalicylic acid administration. Aneurysm perforation occurring during or immediately after embolization was reported in 6.9% and 6.3% of patients before and after administration of acetylsalicylic acid, respectively. The researchers pointed out that acetylsalicylic acid "seems to be associated with a significant reduction in the rate of thromboembolic events without increase in the rate or severity of intraoperative bleedings."

After long-term stable deep brain stimulation, most patients with Parkinson’s disease can have further improved outcomes, as reported in the September Archives of Neurology. Twenty-four of 44 consecutive Parkinson’s disease patients with long-term stable response to subthalamic nucleus deep brain stimulation had significantly improved scores on the Unified Parkinson’s Disease Rating Scale parts II and III, by 15.0% and 25.9%, respectively. There was no improvement in 16 patients, and the condition of four patients declined. The researchers noted that improved outcomes "are obtained when postoperative care is personally managed by a neurologist expert in movement disorders and deep brain stimulation who is directly responsible for stimulation programming and simultaneous drug adjustments based on observed clinical responses to changing stimulation parameters."

Further evidence supports the concept of lessening features of migraine with age, according to a report in the July/August Headache. Investigators assessed 1,009 consecutive patients with migraine and found no significant age differences in gender or frequency of prodrome, aura, or postdrome. The percentage of headaches with aura decreased significantly with age. There were no age differences, generally, regarding headache triggers, although statistical differences were noted among specific triggers. For example, alcohol, smoke, and neck pain as triggers increased with age, while stress as a trigger decreased with age. No statistical difference in age was found regarding aching, but with age, decreasing throbbing, pressure, and stabbing were observed. These findings show a lower prevalence of migraine in older patients, the team concluded.

The FDA has approved IV Keppra® (levetiracetam) 100 mg/mL for adjunctive therapy in the treatment of partial-onset seizures in adults with epilepsy. An alternative for patients with epilepsy for whom oral administration is temporarily not an option, levetiracetam must be diluted prior to administration and given as a 15-minute IV infusion. The therapy is associated with somnolence and fatigue, behavioral abnormalities, and hematologic abnormalities, as well as coordination difficulties in adults. Previously, the European Commission approved IV levetiracetam for adjunctive therapy in the treatment of partial-onset seizures with or without secondary generalization in adults and children 4 and older with epilepsy.

The FDA has issued a warning not to use bismacine—also known as chromacine—to treat Lyme disease. Reports of serious adverse events related to the administration of bismacine, including one report of death and one report of hospitalization, are currently under investigation. Bismacine has not been approved as treatment for any condition.

The FDA has recommended that patients receiving a triptan combined with an SSRI or selective serotonin/norepinephrine reuptake inhibitor (SNRI) should be informed of the possibility of serotonin syndrome and be carefully monitored. From a review of 27 reports in which patients had serotonin syndrome associated with concomitant triptan and SSRI or SNRI use, two studies described life-threatening events and 13 stated that hospitalizations were required. The highly variable signs and symptoms reported in patients with serotonin syndrome included respiratory failure, coma, mania, hallucinations, confusion, dizziness, hyperthermia, hypertension, sweating, trembling, weakness, and ataxia.

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