NeurologyLive® Staff

New research supports a significant and causative relationship between infection with Epstein Barr virus and the development of multiple sclerosis. This expert-led panel discussion, moderated by Scott Newsome, DO, will review the findings and discuss the implications for patients with multiple sclerosis, the health care providers who treat them, and the greater neurology community.

Videos

This expert-led discussion will premier on January 28, 2022 at 4:00PM ET. 

Demystifying Multiple Sclerosis Etiology: The Role of Epstein Barr Virus

 staff prepares this preview of what to expect from our coverage. This week on 

, there are a number of hot topics that we will be posting on the website. As always, our weekly coverage extends beyond just these topics, so make sure to check out the rest of the site!

Click through the slides below to see what you can expect from our team this week:

This Week on NeurologyLive — January 24, 2022

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ONLY A FEW DAYS LEFT TO NOMINATE! 
Giants of Multiple Sclerosis™

Recognize and celebrate the individuals who have achieved landmark successes within multiple sclerosis! Giants of Multiple Sclerosis™ is a premier neuroscience award that celebrates pioneers, innovators, and future generations of leaders who have been selected by their peers for their remarkable achievements in Multiple Sclerosis.

Nominate Someone Today for a 2022 Giants of Multiple Sclerosis™ Award

The Giants of Multiple Sclerosis™ Steering Committee will vet all nominations and vote to determine the 2022 inductees

Nominees will be selected on the merits of their lifetime work.

One honoree in each category who makes a measurable difference in the lives of patients will be awarded.

The 2022 Giants of Multiple Sclerosis™ inaugural class will be announced in Spring of 2022

Articles

Here's what is coming soon to NeurologyLive®.

This Week on NeurologyLive® — January 24, 2022

This content was courtesy of the National Headache Foundation. To view the original post, 

National Headache Foundation Position Statement on the Treatment of Migraine

The vision of the National Headache Foundation (NHF) is “a world without headache.” In support of this mission, the NHF focuses on four key goals: Awareness, Advocacy, Education, and Research. These goals place patients at the heart of everything we do.

In keeping with our mission and vision, we believe headache and migraine patients are best served by a patient-centric model of care, in which the clinician is empowered to select the right treatment for the right patient at the right time. NHF also endorses and advocates for the right of the patient’s voice and opinion to be included in determining the most appropriate treatment.

To that end, our position is that the selection of a migraine therapy:

 determined by the clinician, in collaboration with the patient, based on the individual needs of that patient and that patient’s outcomes

 be determined solely by a step-care model

 be determined by a one-size-fits-all algorithm, including models focused predominantly on costs instead of outcomes

This Position Statement describes our reasoning for these three key messages and offers our specific recommendations for a patient-centric, stratified approach to migraine care.

In the future, NHF will expand upon this Position Statement and propose specific treatment guidelines.

Care models for migraine must reflect scientific and clinical advances

The scientific understanding of migraine has advanced considerably in recent years, bringing better tolerated and better-studied treatments to patients – most notably, anti-CGRP monoclonal antibodies (mAbs), oral CGRP antagonists (gepants), and agents targeting serotonin receptors. There is also growing awareness among clinicians that what was once thought sufficient efficacy for successful migraine control is, in fact, inadequate.

Unfortunately, the care models set by payers and the consequent treatment paradigms have not kept pace with these advances. For patients who are highly impacted or disabled by migraine, clinicians should not be directed to deliver outdated models of care that apply a predetermined algorithm in a stepwise approach to all patients, without considering the needs of the individual patient, and that encourage the use of older preventive drugs when targeted and migraine-specific therapies now exist. Many of the older preventive drugs have never been studied in large, randomized, double-blind placebo-controlled trials

 and/or do not have FDA approval for their use in the treatment of migraine.

 Many of these preventive drugs have lower tolerability than the newer agents (

 Furthermore, their side effects have often been found to result in high discontinuation rates, which, ultimately, may prolong the impact of migraine and put many patients at risk of transformation to chronic migraine or, at the very least, higher frequencies and severity of their attacks.

Rigid step-care models of migraine treatment require patients to try two established medications in succession, which may include drugs not developed specifically for migraine or FDA-approved as migraine preventives and require use for a period of 1-4 months each. If the patient has shown inadequate responses to the two drugs after the trial periods have expired, only then may they be prescribed treatments based on the clinician’s discretion.

For preventive care, NHF believes it is inappropriate to require all patients to follow this “try two and fail” model before they may be offered treatment with any FDA-approved migraine preventive, including neuromodulation devices, with established lower adverse event profiles. Patients and their clinicians will be able to discern whether or not a newer preventive agent is providing the expected benefit much sooner, as that is a characteristic of these newer agents, 

Tolerability may also be assessed more quickly. Furthermore, the older preventive medications have established contraindications that often preclude their use in some migraine patients, 

, cognitive capacity, reproductive status, tremor, and renal insufficiency. As noted previously, some of these non-specific preventive medications may have intolerable and unacceptable side effects for the migraine patient population, 

, exercise intolerance, weight gain, orthostasis, or bradycardia.

NHF has other specific concerns and objections regarding the “try two and fail” policy which:

Ignores the evidence that migraine is a genetic, heterogeneous disease and instead treats all patients as if they were the same by applying a single set of criteria to the entire spectrum of migraine phenotypes, which can vary both in treatment response and tolerance of side effects.

Lacks or is inadequately supported by data showing a positive impact for many commonly used preventive medications on healthcare utilization (HCU) and costs incurred because of ineffective preventive treatment of migraine (

, outpatient care, hospital admissions, ER visits); whereas recent studies have showing CGRP-targeting therapies can reduce HCU.

Does not consider the disability patients may potentially suffer in their work, social, and family lives when migraine treatment is ineffective or inadequate.

May not effectively manage the symptoms that patients have reported as most bothersome to them, such as photophobia, nausea, tinnitus, cognitive performance, vertigo, and dizziness.

May not enable patients to achieve meaningful outcomes, which are defined by more than a simple reduction in days with migraine, 

, reduction in lost workdays, productivity on the job, increased participation in social and family life, and a greater sense of control over their disease.

Additionally, the “try two and fail” policy uses language that stigmatizes 

 as having failed when they do not receive the expected benefit of a drug. Instead, NHF endorses the use of language acknowledging the reality that, when the patient does not receive the expected benefit of a drug, 

it is the drug that has failed the patient.

NHF recommendations for preventive and acute migraine care

NHF endorses care models that are patient-centric, where the clinician, in collaboration with the patient, is the 

 decision-maker and selects a treatment that addresses the patient’s treatment goals and needs.

Preventive care model with defined thresholds for migraine-related impairment

For preventive therapies, NHF endorses a patient-centric, stratified care model that takes into account the degree to which migraine episodes adversely affect a patient’s ability to function, work and interact with others. Specifically, the greater the number of migraine days per month (as defined below) that the patient experiences, the greater the discretion that the clinician should have in selecting an appropriate preventive therapy.

NHF supports the ability of primary care clinicians, which in some states include nurse practitioners and physician assistants, to prescribe preventive drugs. Further, given the paucity of headache specialists in the United States, we do not endorse a requirement that newer FDA-approved migraine preventive and acute therapies be limited to use by specialists alone.

 as a standard 24-hour day during which a patient’s ability to function is interrupted or impaired by any symptom or group of symptoms of migraine, including aura, headache pain, photophobia, phonophobia, nausea, vomiting, and/or other prodromal or postdromal symptoms. This acknowledges that (1) headache pain is not the only symptom that causes patient impairment; (2) migraine symptoms lasting more than one day can result in multiple days of impairment; and (3) the definition of “migraine day” should include patients who manage to function despite severe pain, as well as patients who have no pain but still cannot function because of associated migraine features.

 per month, which constitutes high-frequency or chronic migraine, NHF recommends that the clinician have the ability to select the most suitable preventive therapy, with unfettered access to FDA-approved preventive drugs, because: (1) eight or more migraine days constitutes a significant fraction (25% or more) of the month; (2) patients with less time to recover between incidents are more likely to experience a transformation to chronic migraine (more than 15 days per month), and (3) studies suggest patients with 8-14 headache days/month have a level of disability similar to those with 15-19 headache days/month.

 per month, NHF recommends a modified step-care model, in which patients must first try one generic drug for migraine prevention from the following list, unless a patient has a contraindication or, in the clinician’s judgment, the patient should not receive it:

where * denotes those drugs that are FDA-approved for migraine prevention,

 and the remaining drugs are commonly used, but not FDA-approved, for that indication.

If a drug from this list has failed to provide the patient with benefits in the severity and/or frequency of migraine, or is found to have intolerable side effects, the clinician should be free to select the next most suitable FDA approved preventive therapy, based on the individual patient’s needs and situation. In the NHF-recommended model for preventive care, a patient is considered to have “tried and been failed by” a given drug if at least one of the following applies:

The patient does not experience an adequate treatment response after a 2-4 month trial, where response is defined as a 50% reduction in the number migraine days per month during preventive therapy compared with the number of migraine days per month prior to the start of therapy.

The patient cannot tolerate the drug due to its side effects, 

, hypotension on beta-blockers, impaired cognition on topiramate, weight gain on amitriptyline.

At the time of decision, the patient has a previously documented history of having “tried and been failed by” the drug due to intolerability or lack of treatment benefit.

The patient has a comorbidity and/or other contraindications that preclude the clinician from prescribing the drug, 

, kidney stones would preclude the use of topiramate; diabetes would preclude the use of beta-blockers.

A modified step-care model for acute migraine treatment that optimizes time to pain-free and functional status

For the treatment of acute migraine, NHF endorses a modified step-care model, in which patients must try two generic drugs: first a generic triptan, then any other generic drug, including another triptan or NSAID.

After a patient has “tried and been failed by” two such drugs, the clinician can select another suitable therapy based on the individual patient’s needs and situation, including FDA-approved acute agents such as lasmiditan or a gepant.

As with the NHF-recommended preventive care model, a patient is considered to have “tried and been failed by” a drug for acute migraine if at least one of the following applies:

The patient is not migraine pain-free and functional within two (2) hours of treatment after the majority of attacks OR the patient has recurrence of migraine symptoms within 24 hours after treatment.

, tightness in the throat and/or chest on triptans.

The patient has a documented history of the drug having proved either lacking in efficacy or intolerable due to side effects.

, uncontrolled hypertension, coronary artery disease (CAD), reversible cerebral vasoconstriction syndrome (RCVS) for triptans or gastric ulcer disease, renal insufficiency for NSAIDs.

Endorsement for migraine treatment decision-making

NHF endorses the role of the clinician as the primary decision-maker, in collaboration with the migraine patient, for both preventive and acute care. We unequivocally support clinicians as the final arbiters of decision-making based on sound medical evaluation of their patients and their attestation in determining appropriate care for a migraine patient.

1. Silberstein SD, et al. Evidence-based guideline update: pharmacologic treatment for episodic migraine prevention in adults. 

2012;78(17):1337-45. doi:10.1212/WNL.0B013E3182535D20

2. Schrader H, Stovner LJ, Sand T, Bovim G. Prophylactic treatment of migraine with angiotensin converting enzyme inhibitor: randomized, placebo controlled, crossover study. 

. 2001;322(7277):19. doi.10.1136/BMJ322.7277.19

3. Tronvik E, Stovner LJ, Helde G, Sand T, Bovim G. Prophylactic treatment of migraine with an angiotensin II receptor blocker: a randomized controlled trial. 

2003;289(1):65-69. doi:10.1001/jama.289.1.65

4. Ozyalcin SN, Talu GK, Kizitan E, Yucel B, Ertas M, Disci R. The efficacy and safety of venlafaxine in the prophylaxis of migraine. 

2005.45:144-152. doi:10.1111/j.1526-4610.2005.05029.x

5. Loder E, Rizzoli P. Pharmacologic prevention of migraine: a narrative review of the state of the art in 2018. 

2018;58 Suppl 3:218-229. doi:10.1111/head.13375

6. Reuter U, Ehrlich M, Gendolla A, et al. Erenumab versus topiramate for the prevention of migraine–a randomized, double-blind, active-controlled phase 4 trial. 

Published online November 7, 2021. doi:10.1177/03331024211053571. 

7. Hepp Z, Dodick DW, Varon SF, et al. Persistence and switching patterns of oral migraine prophylactic medications among patients with chronic migraine: a retrospective claims analysis. 

2017;37(5):470-485. doi:10.1177/0333102416678382.

8. Blumenfeld AM, Bloudek LM, Becker WJ, et al. Patterns of use and reasons for discontinuation of prophylactic medications for episodic migraine and chronic migraine: results from the second international burden of migraine study (IBMS-II). 

2013;53(4):644-55. doi:10.1111/HEAD.12055.

9. Faust E, Pivneva I, Yang K, et al. Real-World Treatment Profiles, Clinical Outcomes, and Healthcare Resource Utilization of Patients with Migraine Prescribed Erenumab: A Multicenter Chart-Review Study of US Headache Centers. 

2021;10(1):293-306. doi:10.1007/S40120-021-00245-4.

10. Sussman M, Benner J, Neumann P, Menzin P. Cost-effectiveness analysis of erenumab for the preventive treatment of episodic and chronic migraine: Results from the US societal and payer perspectives. 

2018;38(10):1644-57. doi:10.1177/0333102418796842.

11. Tepper SJ, Fang J, Vo P, et al. Impact of erenumab on acute medication usage and health care resource utilization among migraine patients: a US claims database study. 

2021;22(27). April 19, 2021. Published online January 20, 2022. doi:10.1186/S10194-021-01238-2.

12. Tepper SJ, Fang J, Zhou L, et al. Effectiveness of erenumab and onabotulinumtoxinA on acute medication usage and health care resource utilization as migraine prevention in the United States. 

2021;27(9):1157-70. doi:10.18553/JMCP.2021.21060.

13. Lipton RB, Dodick DW, Ailani J, McGIll L, Hirman J, Cady R. Patient-identified most bothersome symptom in preventive migraine treatment with eptinezumab: A novel patient-centered outcome. 

2021;61(5):766-776. doi:10.1111/HEAD.14120.

14. Ishii R, Schwedt TJ, Dumkrieger G, et al. Chronic versus episodic migraine: The 15-day threshold does not adequately reflect substantial differences in disability across the full spectrum of headache frequency. 

2021;61(7):992-1003. doi:10.1111/HEAD.14154.

15. Loder E, Rizzoli P. Pharmacologic Prevention of Migraine: A Narrative Review of the State of the Art in 2018. 

2018;58 SUPPL 3:218-229. doi:10.1111/HEAD.13375.

Years of mounting data has led the National Headache Foundation to release recommendations on how patients and clinicians come to the right decisions on migraine therapy. 

National Headache Foundation Announces Position Statement on Treatment of Migraine

Welcome to this special edition of Neurology News Network. I’m Marco Meglio.

 on multidose clinical trials of YTX-7739, a disease-modifying therapy for the treatment of 

, Yumanity Therapeutics recently announced. The hold was initiated in response to the company’s investigational new drug (IND) application, which was submitted in December 2021.The hold suspends initiation of multiple dose trials of the treatment in the US until questions from the FDA have been addressed, with Yumanity anticipating additional detail from the FDA in the next 30 days. YTX-7739 has previously been assessed in healthy patients, with results reported from 14- and 28-day multiple dosing studies, as well as in patients with PD in a 28-day multiple dose clinical study. The treatment is designed to penetrate the blood-brain barrier (BBB), then inhibiting the activity of stearoyl-CoA desaturase (SCD), a novel target. By inhibiting SCD, YTX-7739 controls and upstream process in the α-synuclein pathological cascade, and in preclinical cellular and animal models, it has been shown to rescue or prevent toxicity, according to Yumanity.

The first patient has been enrolled in the 

 of IMU-838, a dihydroorotate dehydrogenase inhibitor vidofludimus calcium, for the treatment of relapsing multiple sclerosis (RMS), Immunic recently announced. The trial is a twin of ENSURE-1, with both comprising the 

 to evaluate the efficacy, safety, and tolerability of IMU-838. The FDA cleared an investigational new drug (IND) application for the phase 3 program in July 2021, and both trials are aimed at providing additional reliable data with the potential to speed up regulatory IND approval. In ENSURE-1, which began in November 2021, and ENSURE-2, 30-mg daily doses of IMU-838 are compared with placebo in patients with RMS, enrolling a combined total of 1050 adult participants at over 100 sites in 15 countries. The primary end point is cited as time to first relapse up to 72 weeks. Secondary end points are noted as volume of T2-lesions, time to confirmed disability progression, time to sustained clinically relevant change sin cognition, and percentage of whole brain volume change, grey matter volume, and white matter volume.

Although previous literature has shown overlaps between ALS and frontotemporal dementia (FTD), the 

possible cognitive and/or behavioral involvement of FTD

 may be its own phenotype and not a product of disease worsening, according to new results from a multiparametric study. All told, those with ALS with cognitive and or/behavioral involvement (ALS-ci/bi) showed a rearrangement of the functional networks, which was divergent from those with solely motor deficits (ALS-cn), with the enhanced functional connectivity within motor areas and decreased connectivity in the frontotemporal networks. The concomitant absence of significant structural alterations, compared with the ALS-cn group, supported a maladaptive role of such functional rearrangements in ALS-ci/bi, which had been previously hypothesized. Additional results on the distribution analysis indicated that most patients with ALS-cn-like patterns (81%) were characterized by a greater damage within the motor network, specifically among the sensorimotor– basal ganglia connections, relative to bvFTD cases.

For more direct access to expert insight, head to NeurologyLive.com. This has been Neurology News Network. Thanks for watching.

Neurology News Network for the week ending January 22, 2022. [WATCH TIME: 4 minutes]

YTX-7739 Trials Suspended, ENSURE-2 Study of IMU-838 Initiated, Behavioral Involvement of FTD in ALS

's Friday 5! Every week, the staff compiles 5 highlights of 

's widespread coverage in neurology, ranging from newsworthy study findings and FDA action to expert interviews and peer-to-peer panel discussions.

Bridget A. Bagert, MD, MPH, on Epstein-Barr Virus and Multiple Sclerosis

Following the publication of data suggesting that EBV is a leading cause of MS, the director of the Ochsner MS Center and an investigator in an EBV-specific therapy clinical trial offered her reaction to the data.

Considering Cognitive Behavioral Therapy for Insomnia

Michael J. Thorpy, MD, ChB; Karl Doghramji, MD; Erinn E. Beagin, MD; Nathaniel Fletcher Watson, MD; and Vikas Jain, MD, FAASM, FAAFP, CCSH, CPE offer 

perspectives on the benefits of and limitations to cognitive behavioral therapy for insomnia. 

NeuroVoices: Irene Wang, PhD, on the Future of MR Fingerprinting and its Impact on Epilepsy Surgery

The research director and staff scientist at Cleveland Clinic’s Epilepsy Center 

provided an inside look at the ways MR fingerprinting can provide real-time clinical benefit for physicians and patient care in epilepsy

Future Research for Blood Biomarkers in Patients Hospitalized With COVID-19: Jennifer Frontera, MD

The professor of neurology at NYU Langone Grossman School of Medicine discussed future research for neurological complications in patients hospitalized with COVID-19 infection, f

ollowing the publication of a study evaluating neurological complications in 251 hospitalized patients.

The Changing Landscape of Preventative Migraine Treatments

A panel of expert neurologists, including 

Stephanie J. Nahas, MD, MSEd, FAHS, FAAN; 

neurologists on preventive migraine treatment and exciting therapies to look forward to in e

The Changing Landscape of Preventive Treatment of Migraine

Introducing: Giants of Multiple Sclerosis™

Take 5 minutes to catch up on NeurologyLive®'s highlights from the week ending January 21, 2022.

NeurologyLive® Friday 5 — January 21, 2022

This Week on NeurologyLive — January 17, 2022

This Week on NeurologyLive® — January 17, 2022

showed that lower 39-item Parkinson’s Disease Questionnaire (PDQ-39) scores and worse long-term motor outcomes occurred for patients with Parkinson disease (PD) who took COMT inhibitors as an adjunctive treatment compared with those on MAO-B inhibitors or dopamine agonists. Findings also showed a slightly worse patient-rated quality of life on MAO-B inhibitors compared with dopamine agonists, although the differences were not significant. These medications did, however, produce equivalent disease control, with the study authors concluding that MAO-B inhibitors may be underused as an adjuvant therapy. The primary end point was change in PDQ-39 mobility scores. Outcomes were assessed before study entry, at 6 and 12 months after randomization, and annually thereafter. After a median of 4.5 years (range, 0-13 years) of follow-up, PDQ-39 mobility scores were a mean of 2.4 points better for those in the dopamine agonist group compared with the combined MAO-B and COMT groups; however, this difference was not significant.

The Centers for Medicare and Medicaid Services (CMS) 

 that the government’s health insurance program will cover the administration of 

 in the treatment of Alzheimer disease (AD) only for those patients who are partaking in CMS-approved randomized controlled trials that satisfy its coverage criteria, and those in trials supported by the National Institutes of Health (NIH), according to a recently published proposed decision memo.1 The 100 mg/mL intravenous injection was 

approved for use in Alzheimer disease in June 2021

 with the accelerated pathway based on biomarker data, driving much discussion in the field about its potential efficacy and costs. Authored by a group including Joseph Chin, MD, MS, deputy director, Coverage and Analysis Group, and 6 others, the conclusion reached as it pertained to the clinical evidence of the monoclonal antibody (mAb) class was that “to date, no trial of an antiamyloid mAb has confidently demonstrated a clinically meaningful improvement in health outcomes (i.e., cognition and function) for AD patients.

Findings from the double-blind, sham-controlled 

 further reinforced the efficacy and safety of gammaCore (electrocore), a noninvasive vagus nerve stimulation (nVNS) device designed as a portable, easy-to-use technology, for the prevention of migraine, and in particular, those who have migraine with aura. The newly published data in 

continued to build on the growing efficacy profile of gammaCore since its FDA approval for the 

. The study was originally powered to be randomized to 400 patients with migraine, but was closed early due to COVID-19 after enrolling 231 individuals. Those included in the study completed a 4-week diary run-in period, followed by a 12-week double-blind period where they were randomized to gammaCore nVNS. At the end of the study period, patients who were treated with the device recorded a decrease of 4.6 monthly headache days, whereas those on sham showed an increase of 3.0 days per month (

= .05). Furthermore, 44.87% of those on gammaCore demonstrated at least a 50% reduction in these days, compared with 26.81% of those in the sham group

Neurology News Network for the week ending January 15, 2022. [WATCH TIME: 4 minutes]

MAO-B Inhibitors Underused in PD, CMS Proposes Decision on Aducanumab Coverage, PREMIUM II Trial of gammaCore Published

1: CMS Releases Proposed Decision for Aducanumab Coverage in Alzheimer Disease

The Centers for Medicare and Medicaid Services issued a proposed decision memo detailing the coverage criteria for patients with Alzheimer disease to be covered by the federal health insurance platform when administered aducanumab (Aduhelm; Biogen)..

2: Podcast Episode 55: Treating Headache in the Emergency Department

, brings you an exclusive interview with Anne-Maree Kelly, MD, MClinEd, FACEM, who shared her clinical experience treating patients with headache and migraine in the emergency department (ED), offering insight into the factors that influence patient outcomes and the vital need for consensus international guidelines for ED migraine care.

Irene Wang, PhD, on the Clinical Utility of MR Fingerprinting in Epilepsy

The research director and staff scientist at Cleveland Clinic’s Epilepsy Center discussed why MR fingerprinting holds significant clinical potential in epilepsy and epilepsy-related disorders, and discussed how this approach is different from other typical standard MRIs, which may be limited in capacity for some forms of epilepsy.

Michael J. Thorpy, MD, ChB; Karl Doghramji, MD; Erinn E. Beagin, MD; Nathaniel Fletcher Watson, MD; and Vikas Jain, MD, FAASM, FAAFP, CCSH, CPE, offer a brief review of the value of polysomnography, or sleep studies, in diagnosing patients with insomnia,

Pros and Cons of Telemedicine for Multiple Sclerosis: Mitzi Joi Williams, MD

The founder and CEO of Joi Wellness Group Multiple Sclerosis Center explained her experience with telemedicine in her practice and expressed her hope that telemedicine, as well as the collaborative approach within the comprehensive care model generated during the pandemic, are both here to stay.

Take 5 minutes to catch up on NeurologyLive®'s highlights from the week ending January 14, 2022.

NeurologyLive® Friday 5 — January 14, 2022

This Week on NeurologyLive — January 10, 2022

This Week on NeurologyLive® — January 10, 2022

Findings from the single-center, prospective, GALAXY clinical trial (NTR5809) showed no between-group difference in cognitive, mood, and behavioral adverse events, as well as equal improvement in motor function, in patients with Parkinson disease (PD) who 

 (DBS) of the subthalamic nucleus with either general (asleep) anesthesia or local (awake) anesthesia. The primary outcome was a composite score of cognitive, mood, and behavioral adverse events that was composed of findings in 4 areas. Primary outcome data was available for 103 patients at the conclusion of the 6-month period. At this time, no differences in the primary outcome were observed between the general and local anesthesia groups. A composite score of 1 or more occurred in 15 of 52 patients (29%) in the local anesthesia group and in 11 of 51 patients (22%) in the general anesthesia group. These results did not change in a multivariable regression model.

Newly published findings showed that following discontinuation of a disease-modifying therapy (DMT), more than one-third of patients with a stable disease course of multiple sclerosis (MS) 

experienced disability worsening/progression

 (DWP), with no clear relation to age or disease subtype. This longitudinal, retrospective analysis included 216 patients with MS who discontinued DMTs. They had clinical visits before, during, and after DMT use, referred to as time 1, time 2, and time 3, respectively, to assess changes in the clinical course. In the period after DMT discontinuation, 53 (32.9%) previously stable patients with MS experienced DWP, a significantly greater percentage than those that were already experiencing DWP before discontinuation. After demonstrating a minor decrease in EDSS at the time of discontinuation, patients with a stable disease course experienced a significant increase in EDSS after discontinuation of DMT. In comparison, the previously progressing MS patient group, which showed significant increase in EDSS at time of DMT discontinuation had relatively stable EDSS scores.

Results from the Start or Stop Anticoagulants Randomized Trial (SoSTART) were inconclusive as to whether starting 

 to avoiding it in patients with atrial fibrillation after intracranial hemorrhage. Although, rates of recurrent intracranial hemorrhage in the study were lower than anticipated. A total of 203 patients were randomized at a median of 115 days (interquartile range [IQR], 49-265) after intracranial hemorrhage onset. Of these patients, 101 were assigned to start long-term full treatment oral anticoagulation and 102 were assigned to avoid it. Over a median follow-up period of 1 to 2 years (IQR, 0.97-1.96; completeness, 97.2%), investigators found that starting anticoagulation was not noninferior to avoiding it, as 8 participants in the start group (8%) had intracranial hemorrhage recurrences, compared with 4 participants in the avoid group (4%) for an adjusted HR of 2.42.

Neurology News Network for the week ending January 8, 2022. [WATCH TIME: 3 minutes]