7 New Updates in Neurology: Autism, MS, CBD, and More

Autism diagnostic stability starts early, much MS misdiagnosis and unnecessary medications, CBD reduces seizures in children-these are some of the latest research findings in neurology, many reported at the American Academy of Neurology’s 71st Annual Meeting in Philadelphia earlier this month.

Following are concise summaries of recent studies.

Autism diagnostic stability starts early

An autism spectrum disorder (ASD) diagnosis becomes stable starting at age 14 months and overall is more stable than language, developmental delay, and other diagnostic categories. In a prospective cohort study, only 1.8% of toddlers initially considered to have ASD transitioned into a final diagnosis of typical development. Accurate diagnosis at earlier than 18 months is feasible, and there may be opportunities to test the usefulness of treatment at an early age.

Much MS misdiagnosis and unnecessary medication

In this study, close to one-fifth of new patients referred with an established diagnosis of multiple sclerosis (MS) had received a misdiagnosis. The most common alternative diagnosis was migraine (16%), followed by radiologically isolated syndrome (9%), spondylopathy (7%), and neuropathy (7%). Misdiagnosis was associated with clinical syndromes and radiographic findings atypical for MS. Those with misdiagnosis received about 110 patient-years of unnecessary MS medications.

CBD reduces seizures in children

Taking a liquid form of cannabidiol (CBD) cut seizures almost in half for children with Dravet syndrome in a recent study. After 14 weeks, seizures with convulsions had decreased for those taking high and lower doses of CBD by 46% and 49%, respectively, compared with 27% for placebo. Total seizures were reduced by 47% and 56% for the high and lower dose groups, compared with 30% for placebo. In the high dose group, 49% seizures were cut in half or more vs 44% and 26% in the low dose and placebo groups.

Metabolic syndrome tied to history of migraine in women

Women enrolled in the Women’s Health Study who had a past history of migraine had 1.22 times the odds of having metabolic syndrome compared with those who had no history of migraine. Women who experience active migraine, especially active migraine without aura, had a nonsignificant increased odds of metabolic syndrome. Researchers concluded that the association is limited to women with a past history of migraine.

Alzheimer disease pathologies pipeline

Researchers reported a proof-of-concept deep learning pipeline that identifies amyloid plaques and cerebral amyloid angiopathy in immunohistochemically stained archival slides. With chronic, daily gamma entrainment using sensory stimuli (GENUS), they showed a preservation of neuronal and synaptic density across multiple brain areas and modified cognitive performance from the early stages of neurodegeneration in mice.

Patients with Parkinson get no help from blood pressure drug

After showing promise in small early studies, the blood pressure drug isradipine did not benefit patients with Parkinson disease in a phase 3 study. As part of the Parkinson Study Group, patients with early Parkinson disease at 54 sites in the United States and Canada received 10 mg/d of isradipine or placebo. After 3 years, there was no difference in Parkinson symptoms between those receiving isradipine and those receiving placebo.Promising experimental drug for ALS

Patients with amyotrophic lateral sclerosis (ALS) may be able to tolerate the experimental drug tofersen (BIIB067), which was linked to possible slower progression in patients with a genetic form of ALS caused by mutations in the superoxide dismutase 1 (SOD1) gene. The treatment, an antisense oligonucleotide, works by targeting and reducing protein created by the mutated gene.

Cognitive phenotypes and white matter in epilepsy

Researchers sought to identify distinct cognitive phenotypes in temporal lobe epilepsy (TLE) and evaluate patterns of white matter network alterations. They found a differential pattern of white matter microstructural abnormalities across 4 cognitive phenotypes-language and memory impaired, memory impaired only, language impaired only, and no impairment. Their findings could help establish cognitive taxonomies or predict cognitive course in TLE.

References:

1. Pierce K, Gazestani VH, Bacon E, et al. Evaluation of the diagnostic stability of the early autism spectrum disorder phenotype in the general population starting at 12 months.JAMA Pediatr. 2019 Apr 29. doi: 10.1001/jamapediatrics.2019.0624. [Epub ahead of print]

2. Kaisey M, Solomon AJ, Luu M, et al. Incidence of multiple sclerosis misdiagnosis in referrals to two academic centers.Mult Scler Relat Disord. 2019;30:51-56. doi: 10.1016/j.msard.2019.01.048. Epub 2019 Feb 2.

3. Cannabis-based medicine may reduce seizures for children with difficult-to-treat epilepsy [press release]. Minneapolis, MN: American Academy of Neurology. April 30, 2019. Accessed May 17, 2019.

4. Rist P, Buring J, Chasman D, Kurth T. Migraine and the prevalence of metabolic syndrome among women. Poster presented at: 2019 American Academy of Neurology Annual Meeting; May 8, 2019; Philadelphia, PA.

5. Adaikkan C, Middleton SJ, Marco A, et al. Gamma entrainment binds higher-order brain regions and offers neuroprotection.Neuron. 2019 May 2. pii: S0896-6273(19)30346-0. doi: 10.1016/j.neuron.2019.04.011. [Epub ahead of print]

6. Blood pressure drug shows no benefit in Parkinson’s disease [press release]. Minneapolis, MN: American Academy of Neurology. May 2, 2019. Accessed May 17, 2019.

7. Experimental drug shows promise for genetic form of ALS [press release]. Minneapolis, MN: American Academy of Neurology. May 1, 2019. Accessed May 17, 2019.

8. Reyes A, Kaestner E, Bahrami N, et al. Cognitive phenotypes in temporal lobe epilepsy are associated with distinct patterns of white matter network abnormalities.Neurology. 2019;92:e1957-e1968. doi: 10.1212/WNL.0000000000007370. Epub 2019 Mar 27.