There were no differences in side effects between those receiving the drug and those receiving the placebo.
“These results may potentially represent a new era in preventive therapy for migraine,” said Peter Goadsby, MD, PhD, of the University of California, San Francisco, who was an investigator in both studies.
“Migraine remains poorly treated, and there are few effective and well-tolerated treatments approved that prevent attacks from occurring,” said coinvestigator David Dodick, MD, of Mayo Clinic Arizona in Phoenix. “There is a huge treatment need for migraine—the third most common and seventh most disabling medical disorder in the world.”
In the second study, 217 patients who had migraine four to 14 days per month received biweekly subcutaneous injections of either a placebo or a drug called LY2951742 for 12 weeks.
Those who received the drug had an average of 4.2 fewer migraine days per month at 12 weeks, or a 63% decrease, while those who received placebo had three fewer migraine days per month, or a 42% decrease. Those who received the drug were more likely to have side effects including pain at the injection site, upper respiratory tract infections, and abdominal pain, but overall the drug was considered to be safe and well tolerated.
“We’re cautiously optimistic that a new era of mechanism-based migraine prevention is beginning,” Dr. Dodick said.
Botulinum Toxin for Poststroke Spasticity—Could a Higher Dosage Yield Greater Benefit?
Although patients with poststroke spasticity are generally satisfied with their botulinum toxin treatment, many individuals may derive additional benefit with higher dosages and shorter injection intervals than the standard 12-week regimen, researchers reported at the 66th Annual Meeting of the American Academy of Neurology.
Djamel Bensmail, MD, PhD, and colleagues conducted two cross-sectional surveys among patients and physicians in Canada, France, Germany, and the United States. A total of 79 eligible patients had received two or more treatments of abobotulinumtoxinA, incobotulinumtoxinA, or onabotulinumtoxinA for poststroke spasticity. The investigators gathered data regarding current and prior botulinum toxin treatments along with physician and patient treatment satisfaction. All 105 participating physicians had treated patients with poststroke spasticity and had three or more years’ experience of injecting botulinum toxin.
“Botulinum toxin injections are the first-line treatment for patients with poststroke spasticity,” stated Dr. Bensmail, from the Department of Physical Medicine and Rehabilitation, R. Poincaré Hospital, AP-HP, University of Versailles Saint Quentin in Garches, France. “However, for some patients, treatment at the standard-of-care 12‑week interval may result in re-emergence of symptoms before reinjection.”
Sixty-one patients (77%) received onabotulinumtoxinA, 15 patients (19%) received abobotulinumtoxinA, and three patients (4%) received incobotulinumtoxinA. The researchers found that 40.5% of patients were overall very satisfied with the treatment, and 48.1% were somewhat satisfied with their current treatment.
“Satisfaction was highest at the time of peak effect and lowest just before reinjection,” stated the investigators. “While 78.9% of patients preferred injection intervals of less than or equal to 12 weeks, only 45.6% received such intervals. Intervals of 10 weeks or fewer were preferred by 43.4% of patients but received by just 6.3%. The mean interval was 13.7 weeks.”
Among the physicians surveyed, most (57.7%) were moderately or very satisfied (36.5%) with botulinum toxin treatment for poststroke spasticity. However, the physicians also believed, on average, that 16.2% of patients would benefit from shorter injection intervals and that 24.6% would benefit from higher doses than those that are approved.
—Colby Stong
Potential Targets and Interventions for Parkinson’s Disease
A trio of studies from researchers at the Perelman School of Medicine at the University of Pennsylvania in Philadelphia demonstrate new approaches to understanding, treating, and potentially staving off Parkinson’s disease. Studies show that factors such as estrogen exposure and statin use have an impact on the onset of Parkinson’s disease. And a new look at telemedicine demonstrates feasibility in providing care for patients with Parkinson’s disease using remote video visits to expand access and center care around the needs of the patients.
Statins May Delay Onset of Parkinson’s Disease
Research presented by Yosef Berlyand, an undergraduate in the laboratory of Alice Chen-Plotkin, MD, MSc, Assistant Professor of Neurology, suggests that statins may be beneficial in Parkinson’s disease. In collaboration with Roy Alcalay, MD, and colleagues at the Columbia University School of Medicine, members of Dr. Chen-Plotkin’s research group demonstrated that blood levels of the protein apolipoprotein A1 (ApoA1) are lower in people with Parkinson’s disease than in those without the disease. Patients with Parkinson’s disease taking statins, which can elevate levels of ApoA1, had an older age of disease onset, which appears to be driven by taking statins.