The 2012 American Academy of Neurology Annual Meeting

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Mark Elms

Associate Editor
Physician’s Weekly


Mark Elms (click to view)

Mark Elms

Associate Editor
Physician’s Weekly

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New research was presented at the American Academy of Neurology’s 64th annual meeting from April 21-28, 2012 in New Orleans. The features below highlight just some of the studies that emerged from the conference, including diagnosing Alzheimer’s earlier, an investigational drug to reduce MS lesions, a new drug formulation benefits Parkinson’s, and determining the threshold for head trauma.

Diagnosing Alzheimer’s Earlier

The Particulars: Alzheimer’s disease (AD) currently can only be confirmed definitively upon autopsies after patients have died or with brain tissue biopsies to detect amyloid plaques, tangles, or both. Florbetaben is an investigational agent that may be beneficial when used as a tracer during PET scans to detect amyloid plaques in patients living with AD.

Data Breakdown: In a study, more than 200 patients with and without known dementia who were nearing death and willing to donate their brain to science underwent MRI and florbetaben PET scans. Amyloid plaque levels among those who reached autopsy were compared with scan results. Florbetaben scans were found to have 77% sensitivity and 94% specificity in detecting beta-amyloid.

Take Home Pearl: Florbetaben, when used as a PET scan tracer to visualize amyloid plaques in the brain, appears to help diagnose AD in those living with the disease.

Investigational Drug May Reduce MS Lesions

The Particulars: Patients with multiple sclerosis (MS) who have Gd-enhancing brain lesions have limited treatment options. ONO-4641 is an investigational drug that may help reduce lesions in this patient population.

Data Breakdown: Researchers randomized patients with relapsing-remitting MS to placebo or 0.05 mg, 0.10 mg, or 0.15 mg of ONO-4641 once daily for 26 weeks in a study. When compared with those who received placebo, patients who received 0.05 mg, 0.10 mg, and 0.15 mg of ONO-4641 had 82%, 92%, and 77% fewer Gd-enhancing brain lesions, respectively.

Take Home Pearl: Among patients with MS, the investigational drug ONO-4641 appears to reduce the number of Gd-enhancing brain lesions when compared with placebo.

New Drug Formulation Benefits Patients With Parkinson’s

The Particulars: Previous research has suggested that the oral formulation of the levodopacarbidopa combination drug helps patients with Parkinson’s disease achieve reduced “off” time—when symptoms are present. However, oral agents have been associated with fluctuating levels between dosages. An infused intestinal gel formulation of levodopa-carbidopa (LCIG) may help reduce these fluctuations.

Data Breakdown: In a 3-month trial, researchers analyzed patients with Parkinson’s disease for an average of 11 years with a mean of 6.6 hours of “off” time per day. Participants were randomized to LCIG and oral placebo or placebo intestinal gel and oral levodopa-carbidopa. Those who received LCIG experienced an average of nearly 2 fewer hours per day of “off” time and 2 additional hours of “on” time without troublesome movements when compared with those who received oral levodopa-carbidopa. LCIG was not associated with increased troublesome dyskinesia.

Take Home Pearl: LCIG appears to perform better than the standard oral formulation of the combination drug by safely reducing “off” time in patients with Parkinson’s disease.

Determining the Threshold for Head Trauma

The Particulars: Studies have established that boxing and other combat sports are associated with brain damage. However, data are lacking on how brain damage develops in this population.

Data Breakdown: A study of boxers and mixed martial arts athletes was conducted in which participants underwent computer tests to measure memory and thinking skills. Participants also received MRI brain scans. Researchers split participants into those who fought for 9 years or less and those who fought for more than 9 years. For those who fought more than 9 years, fighters with more fights per year were found to perform worse on thinking and memory tests than those with fewer fights per year.

Take Home Pearls: A threshold may exist at which head trauma experienced by combat sport participants begins to affect memory and thinking. The effects of this breaking point appear to occur despite brain volume changes that can be recorded earlier.

Limiting Progression to MS

The Particulars: Research suggests that it is beneficial to start medical treatment for multiple sclerosis (MS) as early as possible. The benefits of early injections of interferon beta-1a treatment at 3 years are not well established.

Data Breakdown: A 3-year clinical trial was performed. It included patients who had experienced a first clinical episode suggestive of a demyelinating event and had at least two clinically silent brain lesions. Participants received 44 mcg of interferon beta-1a three times a week or once a week for 2 years, or placebo for 2 years or until experiencing a second clinical episode (at which point they were switched to three-times-a-week dosing). At 3 years, researchers found that patients who received the study drug three times a week or once weekly from the beginning of the trial were less likely to be diagnosed with clinically definite MS than those who initially received placebo (27%, 28%, and 41%, respectively).

Take Home Pearl:
Beginning interferon beta-1a therapy soon after the first signs of possible MS appears to reduce the likelihood of disease progression when compared with switching from placebo to interferon beta-1a after 2 years or when a second clinical episode is experienced.

Readings & Resources (click to view)

For more information on these studies and others that were presented at the American Academy of Neurology’s 64th annual meeting, go to www.aan.com/go/am12.

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