Stroke Common Cause of Seizures, Inebilizumab Demonstrates Continued Benefits, Fremanezumab Safe in Patients With CV Risk

This week Neurology News Network covered a study examining the prevalence of post-stroke seizures and the most common anti-seizure medications used, 2-year data from the N-MOmentum study of inebilizumab, and a pair of abstracts that further confirm safety and efficacy of fremanezumab.

Welcome to this special edition of Neurology News Network. I’m Marco Meglio. Please excuse our appearance this week as a majority of the US workforce, including the NeurologyLive team, moves to working remote as we come together to help reduce the spread of the novel coronavirus. This week’s episode is centered around the recently concluded American Academy of Neurology Annual Meeting.

Research using a retrospective epilepsy database revealed that cerebrovascular disease is a common cause of seizures, most notably in the middle cerebral artery (MCA) territory. Among this database, levetiracetam was the most commonly used anti-seizure medication. Sidra Saleem and colleagues aimed to identify the prevalence of post-stroke seizures (PSS) and role of various ASDs in the management of PSS using a cohort of 2721 patients from the database. Among these patients, cerebrovascular disease was found to be common cause of seizures, occurring in 180 (6.61%) patients, with a mean age of 62.85 years and a median age of seizure onset of 54.44 years. Late-onset seizures were more common, occurring in 89.4% of patients compared to 10.55% of those with early-onset seizures. The types of stroke varied, with 77.22% of patients experiencing ischemic stroke, 18.88% with hemorrhagic stroke, and 3.33% reporting ischemic with hemorrhagic transformation.

Two-year data from the open-label extension of the N-MOmentum trial showed that inebilizumab, an FDA-approved treatment for neuromyelitis optica spectrum disorder, continued to provide benefits similar to those seen in the randomized controlled period. In total, 216 of the 230 participants initially randomized and dosed opted to enter the OLE where they received inebilizumab 300 mg every 28 weeks for at least 2 years. In both the RCP and the OLE, 87.7% of patients receiving inebilizumab remained attack-free; however, those in the OLE remained attack-free for up to 4 years. In comparison, 60.7% and 83.4% of those on placebo remained attack-free in the RCP and OLE, respectively. At OLE baseline, mean Expanded Disability Status Scale scores were lower in the group randomized to inebilizumab compared to those in the placebo group. By OLE week 78, patients randomized to either group demonstrated lower EDSS scores than recorded at baseline.

Data from a pair of studies revealed that treatment with fremanezumab is similarly effective in patients with higher-frequency episodic migraine (HFEM) and moderate-frequency episodic migraine (MFEM), as well as safe for patients with a previous history of cardiovascular (CV) risk. The data included in both abstracts were from 2 double-blind phase 3 trials which randomized patients 1:1:1 to quarterly fremanezumab, monthly fremanezumab, or placebo for 12 weeks. The first included 1174 patients with episodic migraine (EM), 659 of which had MFEM and 515 with HFEM at baseline.From baseline, least-square mean (SE) reductions in monthly migraine days (MMDs) were significantly greater with fremanezumab versus placebo in the MFEM group and HFEM group, indicating similar therapeutic gains.

For more direct access to expert insight as well as the top stories from AAN 2021, head to NeurologyLive.com. This has been Neurology News Network. Thanks for watching.