Awake vs Asleep DBS Impact, Worsened MS Following DMT Discontinuation, Anticoagulation Noninferior to Avoiding it


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

WATCH TIME: 3 minutes

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

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 underwent deep brain stimulation (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 oral anticoagulation was noninferior 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.

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