American Academy of Neurology, April 25-May 2, 2009

American Academy of Neurology 61st Annual Meeting

The American Academy of Neurology's 61st annual meeting took place April 25 to May 2 in Seattle, and attracted about 11,000 attendees from around the world. The meeting featured 2,000 presentations and highlighted advances in Alzheimer's disease and multiple sclerosis, as well as in lesser-known conditions such as tuberous sclerosis complex and chronic demyelinating polyneuropathy.

"We had some major highlights in Alzheimer's disease, including updates on a very large biomarker development project called the Alzheimer's Disease Neuroimaging Initiative, which identifies imaging and biomarkers for clinical trials," said Stefan Pulst, M.D., of the University of Utah in Salt Lake City and chair of the AAN's Science Committee and the Scientific Program Subcommittee. Supported by the National Institutes of Health and pharmaceutical companies, the multi-center project quickly uploads data and can be accessed almost instantaneously. "Researchers are now accessing the Web sites from all over the world," Pulst said.

Breaking research on Alzheimer's disease included a study presented by Stephanie Debette, M.D., of Boston University, who analyzed 1999 to 2005 data on 715 enrollees in the Framingham Offspring study, including 282 middle-aged subjects (average age 59 years) who had either one or two parents with diagnosed dementia. All subjects were tested to see if they carried the APoE-ε4 allele, which is strongly associated with dementia.

Among APoE-ε4 carriers, the researchers found that those whose parents had diagnosed dementia had a doubled to tripled risk of poor verbal and visual memory scores compared to those whose parents did not have Alzheimer's disease.

"This result in people with parents who have Alzheimer's disease is equivalent to about 15 years of brain aging," Debette said in a statement. "The effect was largely limited to those who have the APoE-ε4 gene, which supports the idea that the gene is probably at least partially responsible for the transmission of Alzheimer's disease risk between generations. However, all of these individuals were functioning normally, and only further testing can determine whether the poorer performance on memory testing in middle age would lead to an increased risk of developing Alzheimer's disease or other dementia later in life."

"This study is important because it looked at family history in addition to known genetic variants and showed that if you have a parent with Alzheimer's disease, it has an effect on your memory function even if you have not developed classic signs of Alzheimer's disease," Pulst said.

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Other significant research, announced during a late-breaking oral presentation by Gavin Giovannoni, Ph.D., of the Barts and The London School of Medicine and Dentistry in the United Kingdom, presented full results of the Cladribine Tablets Treating Multiple Sclerosis (CLARITY) trial, partial results of which had been presented earlier in 2009.

During the two-year study, which was supported by Merck, 1,326 patients with relapsing-remitting multiple sclerosis were randomly assigned to either low-dose or high-dose cladribine or placebo. The researchers found that cladribine was associated with significant reductions in annualized relapse rates (58 percent for the low-dose regimen and 55 percent for the high-dose regimen), disability progression, and brain lesions.

"All primary and secondary endpoints of the CLARITY study were statistically significant and demonstrate that annual short-course treatment with Cladribine Tablets in this study was effective across multiple important clinical and MRI efficacy measures," Giovannoni said in a statement.

"Many multiple sclerosis treatments are delivered intravenously, so an effective oral treatment is something we've always looked for," Pulst said.

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During a plenary session, David N. Franz, M.D., of the University of Cincinnati, presented data on the use of a mammalian target of rapamycin (mTOR) inhibitor. "It related to a relatively common syndrome called tuberous sclerosis complex, which is a major cause of epilepsy, mental retardation, and autism in children," Pulst said. "The compound was identified by basic molecular studies showing that a protein involved in a specific pathway can be targeted by a rapamycin inhibitor."

Other important research included a study presented by Ingemar Merkies, M.D., of the Erasmus Medical Center in Rotterdam, Netherlands, in which 117 patients with chronic inflammatory demyelinating polyneuropathy were randomly assigned to receive either immune globulin intravenous, 10 percent caprylate/chromatography purified (Gamunex®) or placebo every three weeks for up to 24 weeks. The researchers found that Gamunex® was associated with multiple improvements in physical disability levels and quality-of-life measures compared to placebo.

"Until now, there has been no FDA-approved dosing regimen for an effective course of intravenous immune globulin therapy to reduce neuromuscular disability and improve quality of life in patients with chronic inflammatory demyelinating polyneuropathy," Merkies said in a statement. "Data from this trial provide an effective regimen with Gamunex® to achieve improvements."

This study was supported by Talecris Biotherapeutics.

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AAN: Multiple Sclerosis Drugs Show Harm, Benefit

THURSDAY, April 30 (HealthDay News) -- In multiple sclerosis, mitoxantrone treatment is associated with a higher-than-expected risk of leukemia, but combined treatment with methylprednisolone and interferon-beta 1a is associated with more beneficial effects on disease activity than interferon alone, according to two studies presented at the annual meeting of the American Academy of Neurology, held April 25 to May 2 in Seattle, and a study published online April 30 in The Lancet Neurology.

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AAN: Lipid and Blood-Pressure Control Has Cumulative Effect

THURSDAY, April 30 (HealthDay News) -- In patients with recent stroke or transient ischemic attack and no known coronary heart disease, optimal lipid and blood-pressure control significantly reduces the risk of stroke and other major cardiovascular events, according to research presented at the annual meeting of the American Academy of Neurology, held April 25 to May 2 in Seattle.

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AAN: Pregabalin Effective for Restless Legs Syndrome

THURSDAY, April 30 (HealthDay News) -- In patients with idiopathic restless legs syndrome, pregabalin significantly reduces symptoms and improves sleep, according to research presented at the annual meeting of the American Academy of Neurology, held April 25 to May 2 in Seattle.

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AAN: Pregnancy Is Usually Safe for Epileptics

TUESDAY, April 28 (HealthDay News) -- Female epileptics of childbearing age can expect good pregnancy outcomes if they avoid valproate during pregnancy and take other precautions, according to new guidelines presented at the 61st annual meeting of the American Academy of Neurology held April 25 to May 2 in Seattle and published online April 27 in Neurology.

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