Identified risk factors for post-traumatic seizures, benefits of acupuncture in insomnia, erenumab improves migraine in patients unresponsive to prophylaxis

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WATCHING TIME: 3 minutes

This week, Neurology News Network covered a study on severe head trauma and factors associated with post-traumatic seizures, as well as the benefits of acupuncture in primary insomnia and the use of erenumab in patients with previous prophylactic failures.

Welcome to this special edition of Neurology News Network. I am Marco Meglio.

Recently published data from a large cohort study identified several clinical risk factors for traumatic brain injury (TBI) that can be used to predict early post-traumatic seizures (PTS), particularly the presence of prior medical comorbidities, d subarachnoid hemorrhage (SAH) and subdural hemorrhage (SDH) and injury severity. In addition to these risk factors, the researchers concluded that MS was associated with significant in-hospital mortality, poorer outcomes, and subsequent risk of mortality at 24 months on the Glasgow Outcome-Extended Follow-up Scale (GOS – E) note. In total, the long-term mortality rate was 14% (n=1658) for the group of patients without MS and 24% (n=76) for the patients with MS. “Identifying patients at high risk of developing EPS may enable a precision medicine diagnostic approach, targeting management strategies and targeting clinical trials of antiepileptogenic therapies,” the study authors concluded.

Several acupuncture therapies, in particular the integration of catgut with acupuncture points (ACE), auricular acupuncture plus manual acupuncture (AP + MA) and electroacupuncture plus the application of acupuncture points ( EA + APA) may benefit patients with primary insomnia (PI), according to a recent meta-analysis. With moderate to low-certainty evidence, researchers found better effects on Pittsburgh Sleep Quality Index (PSQI) scores for patients treated with acupuncture compared to those on usual treatment. Additionally, with low or very low certainty of evidence, there were small or insignificant differences between the different therapies assessed. Due to sparse data and heterogeneity, the investigators did not perform a meta-analysis of adverse events (AEs); however, they summarized the incidence of what was observed among a larger cohort of 22 RCTs recruiting 3382 participants. Of these, the most common AEs of acupuncture procedures included hematoma, pain, headache, and bleeding. No serious AEs related to acupuncture were observed, leaving study investigators to conclude that “the safety of acupuncture is reliable.”

Real-world data from the MAGIC study suggest that, when given to patients with chronic (CM) and episodic (EM) migraine who have undergone repeated and ineffective migraine prophylaxis, treatment with erenumab (Aimovig; Amgen) was safe and resulted in at least a 50% reduction in monthly migraine days (MMDs) in more than a third of the cohort. MAGIC was a prospective, open-label, observational study that evaluated the efficacy of erenumab, a treatment targeting the calcitonin gene-related peptide (CGRP), in Canadian patients with migraine. In the study, participants received 70 mg or 140 mg of erenumab monthly depending on doctors’ assessment and recorded migraine attacks using an electronic diary. A total of 89 individuals (93.7%) started erenumab at 140 mg. In the primary outcome analysis, 32 participants (33.7%) experienced at least a 50% reduction in MMD at the end of the 12-week treatment period. This reduction was similar to other randomized controlled trials, including the STR1VE trial (NCT0245670; 70 mg: 41.3%; 140 mg: 48.1%) and was greater than that reported in the LIBERTY trial.

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