The Bacille Calmette-Guérin (BCG) vaccine may benefit patients with clinically isolated syndrome (CIS), according to research published online ahead of print December 4, 2013, in Neurology. A total of 82 participants with CIS were randomized to BCG or placebo and monitored monthly with brain MRI for six months. All patients subsequently received IM interferon β-1a for 12 months. In an open-label extension phase, patients received disease-modifying therapies (DMTs) recommended by their neurologists. During the initial six months, the number of cumulative lesions was significantly lower among vaccinated subjects. The number of total T1-hypointense lesions was lower in the BCG group at months 6, 12, and 18. After 60 months, the probability of clinically definite multiple sclerosis was lower in the BCG plus DMT arm, and more vaccinated people remained DMT-free.
Exercise programs may significantly improve the ability of people with dementia to perform activities of daily living, according to a study published online ahead of print December 4, 2013, in the Cochrane Library. Exercise also may improve cognition in these patients, but may not affect depression. Investigators reviewed randomized controlled trials in which older people diagnosed with dementia were allocated to exercise programs or to control groups, which received standard care or social contact. Sixteen trials with 937 participants met the inclusion criteria. The trials were highly heterogeneous in terms of subtype and severity of participants’ dementia, and type, duration, and frequency of exercise. The researchers found that informal caregivers’ burden may be reduced when the family member with dementia participates in an exercise program.
Thrombin activity may enable neurologists to detect multiple sclerosis (MS) before clinical signs of the disease are present, according to research published online ahead of print November 29, 2013, in Annals of Neurology. Using a novel molecular probe, investigators characterized the activity pattern of thrombin, the central protease of the coagulation cascade, in experimental autoimmune encephalomyelitis. Thrombin activity preceded the onset of neurologic signs; increased at disease peak; and correlated with fibrin deposition, microglial activation, demyelination, axonal damage, and clinical severity. Mice with a genetic deficit in prothrombin confirmed the specificity of the thrombin probe. Scientists may be able to use thrombin activity to develop sensitive probes for the preclinical detection and monitoring of neuroinflammation and MS progression, according to the investigators.
An athlete with concussion symptoms should not be allowed to return to play on the same day, according to the latest consensus statement on sports-related concussion, which was summarized in the December 2013 issue of Neurosurgery. The Concussion in Sport Group (CISG 4) based its recommendations on the advice of an expert panel that was sponsored by five international sports governing bodies. Between 80% and 90% of concussions resolve within seven to 10 days, but recovery may take longer in children and adolescents, according to the consensus statement. The updated statement emphasizes the distinction between concussion and mild traumatic brain injury. The CISG 4 suggests that patients with concussion have normal findings on brain neuroimaging studies (eg, CT scan), but those with traumatic brain injury have abnormal imaging findings.
Vitamin D may prevent multiple sclerosis (MS) by blocking T helper (TH) cells from migrating into the CNS, according to research published online ahead of print December 9, 2013, in Proceedings of the National Academy of Sciences. Investigators administered 1,25-dihydroxyvitamin D3 [1,25(OH)2D3], the bioactive form of vitamin D, to animals with experimental autoimmune encephalomyelitis, a mouse model of MS. Myelin-reactive TH cells were generated in the presence of 1,25(OH)2D3, secreted proinflammatory cytokines, and did not preferentially differentiate into suppressor T cells. The cells left the lymph node, entered the peripheral circulation, and migrated to the immunization sites. TH cells from 1,25(OH)2D3-treated mice were unable to enter the CNS parenchyma, however. Instead, the cells were maintained in the periphery. The mice developed experimental autoimmune encephalomyelitis when treatment ceased.
Among people with type 2 diabetes, dementia incidence may be highest among Native Americans and African Americans and lowest among Asians, according to a study published online ahead of print November 22, 2013, in Diabetes Care. Scientists identified 22,171 patients age 60 or older with diabetes and without preexisting dementia in the Kaiser Permanente Northern California Diabetes Registry. The investigators abstracted prevalent medical history and dementia incidence from medical records and calculated age-adjusted incidence densities. Dementia was diagnosed in 17.1% of patients. Age-adjusted dementia incidence densities were 34/1,000 person-years among Native Americans, 27/1,000 person-years among African Americans, and 19/1,000 person-years among Asians. Hazard ratios (relative to Asians) were 1.64 for Native Americans, 1.44 for African Americans, 1.30 for non-Hispanic whites, and 1.19 for Latinos.