Background: Low back pain (LBP) is a common cause of disability and decreased quality of life. The Saskatchewan Spine Pathway classification (SSPc) is a method for triaging patients who are candidates for surgery. Methods: Consecutive patients who underwent lumbosacral instrumented fusion for degenerative spinal pathology from Jan 1, 2012, to Sept 20, 2018, by a single surgeon at our institution were retrospectively reviewed. Patients were stratified by SSPc into 4 groups based on pain pattern. Demographic and clinical data were collected. Outcomes were compared between cohorts both for absolute values and achieving MCID. Results: 169 consecutive patients were included in our study. After stratifying by SSPc grouping, there were 61 SSPc I patients, 45 SSPc III patients, and 63 SSPc IV patients. Patients in all groups had clinical improvement following surgery. Patients classified as SSPc III had superior outcomes in ODI, EQ-5D and EQ-VAS, and were more likely to achieve the MCID for ED-5D. Multivariate analysis demonstrated that SSPc grouping is an independent predictor of final VAS back, ODI, EQ-5D, and EQ-VAS as well as achieving the MCID for EQ-5D. Conclusions: The SSPc classification is associated with outcomes following lumbosacral fusion. In particular, patients with SSPc pattern 3 had better outcomes and improved QALY.
{"title":"P.149 Saskatchewan spine pathway classification is associated with post-operative outcome and improved quality-adjusted life years following lumbosacral fusion","authors":"B. Ridha, E. Liu, A. Persad, DR Fourney","doi":"10.1017/cjn.2024.248","DOIUrl":"https://doi.org/10.1017/cjn.2024.248","url":null,"abstract":"Background: Low back pain (LBP) is a common cause of disability and decreased quality of life. The Saskatchewan Spine Pathway classification (SSPc) is a method for triaging patients who are candidates for surgery. Methods: Consecutive patients who underwent lumbosacral instrumented fusion for degenerative spinal pathology from Jan 1, 2012, to Sept 20, 2018, by a single surgeon at our institution were retrospectively reviewed. Patients were stratified by SSPc into 4 groups based on pain pattern. Demographic and clinical data were collected. Outcomes were compared between cohorts both for absolute values and achieving MCID. Results: 169 consecutive patients were included in our study. After stratifying by SSPc grouping, there were 61 SSPc I patients, 45 SSPc III patients, and 63 SSPc IV patients. Patients in all groups had clinical improvement following surgery. Patients classified as SSPc III had superior outcomes in ODI, EQ-5D and EQ-VAS, and were more likely to achieve the MCID for ED-5D. Multivariate analysis demonstrated that SSPc grouping is an independent predictor of final VAS back, ODI, EQ-5D, and EQ-VAS as well as achieving the MCID for EQ-5D. Conclusions: The SSPc classification is associated with outcomes following lumbosacral fusion. In particular, patients with SSPc pattern 3 had better outcomes and improved QALY.","PeriodicalId":9571,"journal":{"name":"Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques","volume":"74 12","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141101629","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
SJ Pittock, M. Barnett, J. Bennett, A. Berthele, J. de Sèze, M Levy, I. Nakashima, C. Oreja-Guevara, J. Palace, F. Paul, C. Pozzilli, Y. Mashhoon, K. Allen, B. Parks, H Kim, G. Vorobeychik
Background: CHAMPION-NMOSD (NCT04201262) is an ongoing global, open-label, phase 3 study evaluating ravulizumab in AQP4+ NMOSD. Methods: Adult patients received an intravenous, weight-based loading dose of ravulizumab on day 1 and a maintenance dose on day 15 and every 8 weeks thereafter. Following a primary treatment period (PTP; up to 2.5 years), patients could enter a long-term extension (LTE). Results: 58 patients completed the PTP; 56/2 entered/completed the LTE. As of June 16, 2023, median (range) follow-up was 138.4 (11.0-183.1) weeks for ravulizumab (n=58), with 153.9 patient-years. Across the PTP and LTE, no patients had an adjudicated on-trial relapse during ravulizumab treatment. 91.4% (53/58 patients) had stable or improved Hauser Ambulation Index score. 91.4% (53/58 patients) had no clinically important worsening in Expanded Disability Status Scale score. The incidence of treatment-emergent adverse events (TEAEs) and serious adverse events was 94.8% and 25.9%, respectively. Most TEAEs were mild to moderate in severity and unrelated to ravulizumab. TEAEs leading to withdrawal from ravulizumab occurred in 1 patient. Conclusions: Ravulizumab demonstrated long-term clinical benefit in the prevention of relapses in AQP4+ NMOSD with a safety profile consistent with prior analyses.
{"title":"P.011 Efficacy and safety of ravulizumab in adults with AQP4+ NMOSD: interim analysis from the ongoing phase 3 CHAMPION-NMOSD trial","authors":"SJ Pittock, M. Barnett, J. Bennett, A. Berthele, J. de Sèze, M Levy, I. Nakashima, C. Oreja-Guevara, J. Palace, F. Paul, C. Pozzilli, Y. Mashhoon, K. Allen, B. Parks, H Kim, G. Vorobeychik","doi":"10.1017/cjn.2024.119","DOIUrl":"https://doi.org/10.1017/cjn.2024.119","url":null,"abstract":"Background: CHAMPION-NMOSD (NCT04201262) is an ongoing global, open-label, phase 3 study evaluating ravulizumab in AQP4+ NMOSD. Methods: Adult patients received an intravenous, weight-based loading dose of ravulizumab on day 1 and a maintenance dose on day 15 and every 8 weeks thereafter. Following a primary treatment period (PTP; up to 2.5 years), patients could enter a long-term extension (LTE). Results: 58 patients completed the PTP; 56/2 entered/completed the LTE. As of June 16, 2023, median (range) follow-up was 138.4 (11.0-183.1) weeks for ravulizumab (n=58), with 153.9 patient-years. Across the PTP and LTE, no patients had an adjudicated on-trial relapse during ravulizumab treatment. 91.4% (53/58 patients) had stable or improved Hauser Ambulation Index score. 91.4% (53/58 patients) had no clinically important worsening in Expanded Disability Status Scale score. The incidence of treatment-emergent adverse events (TEAEs) and serious adverse events was 94.8% and 25.9%, respectively. Most TEAEs were mild to moderate in severity and unrelated to ravulizumab. TEAEs leading to withdrawal from ravulizumab occurred in 1 patient. Conclusions: Ravulizumab demonstrated long-term clinical benefit in the prevention of relapses in AQP4+ NMOSD with a safety profile consistent with prior analyses.","PeriodicalId":9571,"journal":{"name":"Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques","volume":"62 22","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141102001","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Pedicle screw fixation is an important technique in spine surgery. Violation of the pedicle can lead to neurovascular injury. Due to excellent pose repeatability, robotic technology may improve accuracy. Existing surgical spine robots use surgical assist architecture. This work explores the performance of a supervisory-control architecture robot (8i Robotics) for autonomous pedicle instrumentation. Methods: 3 porcine subjects underwent pedicle instrumentation utilizing the 7dof robot and were observed for 24 hours. Post-operative CT assessed screw location. Screws were graded clinically with the Gertzbein-Robbins Scale (GRS). Precision was assessed by a customized image processing pipeline. Euclidean error was calculated at screw head and screw tip. All points were normalized to a nominal screw, and confidence ellipses generated. Results: All animals were neurologically intact at 24 hours. All screws where GRS A. Mean tip and head Euclidean error where 2.47+/−1.25mm and 2.25+/-1.25mm respectively. Major and minor axes of the confidence ellipse at 99% was 2.19mm, and 1.28mm, and 2.07mm, and 0.42mm for tip and head respectively. Conclusions: 100% of screws obtained satisfactory clinical grading, with intact function in all animals post-operatively. This shows the capability of a supervisory-controlled 7DOF robot with OCT registration. Further investigation is warranted to further explore robotic capabilities, safety, and cost effectiveness.
{"title":"P.152 In-vivo accuracy of pedicle screws utilizing a supervisory controlled 7DOF robot with OCT guidance","authors":"R. Johnston, M. Oppermann, V. Yang","doi":"10.1017/cjn.2024.251","DOIUrl":"https://doi.org/10.1017/cjn.2024.251","url":null,"abstract":"Background: Pedicle screw fixation is an important technique in spine surgery. Violation of the pedicle can lead to neurovascular injury. Due to excellent pose repeatability, robotic technology may improve accuracy. Existing surgical spine robots use surgical assist architecture. This work explores the performance of a supervisory-control architecture robot (8i Robotics) for autonomous pedicle instrumentation. Methods: 3 porcine subjects underwent pedicle instrumentation utilizing the 7dof robot and were observed for 24 hours. Post-operative CT assessed screw location. Screws were graded clinically with the Gertzbein-Robbins Scale (GRS). Precision was assessed by a customized image processing pipeline. Euclidean error was calculated at screw head and screw tip. All points were normalized to a nominal screw, and confidence ellipses generated. Results: All animals were neurologically intact at 24 hours. All screws where GRS A. Mean tip and head Euclidean error where 2.47+/−1.25mm and 2.25+/-1.25mm respectively. Major and minor axes of the confidence ellipse at 99% was 2.19mm, and 1.28mm, and 2.07mm, and 0.42mm for tip and head respectively. Conclusions: 100% of screws obtained satisfactory clinical grading, with intact function in all animals post-operatively. This shows the capability of a supervisory-controlled 7DOF robot with OCT registration. Further investigation is warranted to further explore robotic capabilities, safety, and cost effectiveness.","PeriodicalId":9571,"journal":{"name":"Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques","volume":"50 11","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141102216","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Aromatic l-amino acid decarboxylase (AADC) deficiency is a metabolic disorder that causes deficient serotonin, dopamine, and catecholamine synthesis. How children respond to neurological insult post intracranial gene therapy remains underreported. We present a 10 year old girl with profound neurological injury after a brief in-hospital cardiac arrest, secondary to viral infection-induced respiratory failure, 4 years after gene therapy. Methods: Patient’s chart review included brain imaging, clinical notes, laboratory results, and treatment. Results: MRI showed symmetric abnormalities in the basal ganglia, thalami, cortex, and cerebellar hemispheres. CSF analysis showed homovanillic acid 27 nmol/L (reference range 167-563) and 5-hydroxyindoleacetic acid 7 nmol/L (reference range 67-189). She developed generalized dystonia and oculogyric crises which were not seen since before gene therapy. There was poor catecholamine production causing refractory hypotension. She required a one-month stay in ICU for hypotension and status dystonicus. Dystonia was controlled with high doses of 6 agents. Conclusions: We describe a patient with AADC deficiency post gene therapy who experienced disproportionately severe neurological injury and decreased AADC activity after hypoxic neurological insult. There may be unique considerations of dopaminergic neuron integrity, AADC gene promoter sensitivity, and cerebrovascular autoregulation in children with AADC deficiency post gene therapy.
{"title":"P.037 Refractory status dystonicus and hypotension after cardiac arrest in a child with AADC deficiency post gene therapy: a case report","authors":"D. Peacock, G. Horvath","doi":"10.1017/cjn.2024.144","DOIUrl":"https://doi.org/10.1017/cjn.2024.144","url":null,"abstract":"Background: Aromatic l-amino acid decarboxylase (AADC) deficiency is a metabolic disorder that causes deficient serotonin, dopamine, and catecholamine synthesis. How children respond to neurological insult post intracranial gene therapy remains underreported. We present a 10 year old girl with profound neurological injury after a brief in-hospital cardiac arrest, secondary to viral infection-induced respiratory failure, 4 years after gene therapy. Methods: Patient’s chart review included brain imaging, clinical notes, laboratory results, and treatment. Results: MRI showed symmetric abnormalities in the basal ganglia, thalami, cortex, and cerebellar hemispheres. CSF analysis showed homovanillic acid 27 nmol/L (reference range 167-563) and 5-hydroxyindoleacetic acid 7 nmol/L (reference range 67-189). She developed generalized dystonia and oculogyric crises which were not seen since before gene therapy. There was poor catecholamine production causing refractory hypotension. She required a one-month stay in ICU for hypotension and status dystonicus. Dystonia was controlled with high doses of 6 agents. Conclusions: We describe a patient with AADC deficiency post gene therapy who experienced disproportionately severe neurological injury and decreased AADC activity after hypoxic neurological insult. There may be unique considerations of dopaminergic neuron integrity, AADC gene promoter sensitivity, and cerebrovascular autoregulation in children with AADC deficiency post gene therapy.","PeriodicalId":9571,"journal":{"name":"Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques","volume":"1 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141100319","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Spinal Muscular Atrophy (SMA) is a rare, genetic disorder marked by motor neuron degeneration, causing progressive muscle weakness. SMA significantly impacts patients and their families. This study investigates HRQOL in a longitudinal SMA cohort. Methods: The study used the Canadian Neuromuscular Disease Registry to examine HRQOL in children aged 6-10 years with genetically confirmed SMA. HRQOL was evaluated using the PedsQL™ Measurement Model. This tool is validated in children and adolescents with various health conditions. The PedsQL Neuromuscular Module which has been validated in SMA was also used. Results: Eight participants completed the PedsQL generic and Neuromuscular Module at timepoint 1 (TP1) and 2 (TP2). The mean scores at TP1 were 49.66 (SD=5.05) for the generic PedsQL and 61.06 (SD=18.37) for the Neuromuscular Module. At TP2, mean scores increased to 59.32 (SD=13.08) and 74.86 (SD=9.88), respectively. The overall mean change over the two timepoints was +9.66 (SD=15.16) for the Generic PedQL and +13.80 (SD=23.03) for the Neuromuscular Module. Six participants were on disease modifying treatment. Conclusions: HRQOL scores in SMA patients improved over the study period. The enhancement in HRQOL may indicate the positive impact of diseases modifying treatments of SMA that became available during that time.
{"title":"P.041 3 year longitudinal health related quality of life in a spinal muscular atrophy cohort","authors":"DO Daudu, C. Campbell, J. Reilly, J Arocha Perez","doi":"10.1017/cjn.2024.148","DOIUrl":"https://doi.org/10.1017/cjn.2024.148","url":null,"abstract":"Background: Spinal Muscular Atrophy (SMA) is a rare, genetic disorder marked by motor neuron degeneration, causing progressive muscle weakness. SMA significantly impacts patients and their families. This study investigates HRQOL in a longitudinal SMA cohort. Methods: The study used the Canadian Neuromuscular Disease Registry to examine HRQOL in children aged 6-10 years with genetically confirmed SMA. HRQOL was evaluated using the PedsQL™ Measurement Model. This tool is validated in children and adolescents with various health conditions. The PedsQL Neuromuscular Module which has been validated in SMA was also used. Results: Eight participants completed the PedsQL generic and Neuromuscular Module at timepoint 1 (TP1) and 2 (TP2). The mean scores at TP1 were 49.66 (SD=5.05) for the generic PedsQL and 61.06 (SD=18.37) for the Neuromuscular Module. At TP2, mean scores increased to 59.32 (SD=13.08) and 74.86 (SD=9.88), respectively. The overall mean change over the two timepoints was +9.66 (SD=15.16) for the Generic PedQL and +13.80 (SD=23.03) for the Neuromuscular Module. Six participants were on disease modifying treatment. Conclusions: HRQOL scores in SMA patients improved over the study period. The enhancement in HRQOL may indicate the positive impact of diseases modifying treatments of SMA that became available during that time.","PeriodicalId":9571,"journal":{"name":"Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques","volume":"2 12","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141100686","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
JG Pascual, D. Ben-Israel, M. de Lotbiniere-Bassett, F. Costello, JM Clark, YP Starreveld
Background: Reporting extent of resection (EOR) in pituitary adenoma (PA) surgery via endoscopic endonasal approaches (EEA) is not standardized. The use of 3-dimensional volumetric analysis is proposed for measurement of tumor volumes and EOR. Their relationship with visual outcomes is explored. Methods: A retrospective analysis of PA patients presenting with visual disturbances and treated surgically via EEA by a single surgeon between 2006 and 2021. The main outcome was visual function at 12 months post-operatively. Results: 142 patients were included. Majority were male, with mean age of 57.1 years. Most (58.2%) presented with bitemporal hemianopsia. The mean tumor size was 11.3 cm3. The mean EOR was 84.5% (range 21.5-99.8%), with a mean post-operative tumor volume of 1.9 cm3. Visual function improved in 92.2%. Re-resection for visual deterioration was performed in 5.7% of patients, (mean time 2.4 years). No clinical, pathologic, or imaging factors were significantly associated with visual outcome. A significant association was found between EOR and re-resection (mean EOR 66.7% vs 85.6%, p=0.002). Conclusions: For patients with PA presenting with visual deficits, treatment with EEA led to improvement in visual function in the majority of patients, without the need for gross total resection. EOR was significantly associated with the need for re-resection.
背景：通过内窥镜鼻内径（EEA）进行垂体腺瘤（PA）手术的切除范围（EOR）报告尚未标准化。建议使用三维容积分析来测量肿瘤体积和切除范围。探讨它们与视觉结果的关系。方法：对2006年至2021年间出现视力障碍并由一名外科医生通过EEA进行手术治疗的PA患者进行回顾性分析。主要结果是术后 12 个月的视觉功能。结果：共纳入 142 名患者。大部分为男性，平均年龄为 57.1 岁。大多数患者（58.2%）伴有双颞侧偏盲。肿瘤平均大小为 11.3 立方厘米。平均EOR为84.5%（范围21.5-99.8%），术后肿瘤体积平均为1.9立方厘米。92.2%的患者视功能得到改善。5.7%的患者因视力恶化而再次切除肿瘤（平均时间为 2.4 年）。没有临床、病理或成像因素与视力结果有明显关联。EOR与再次切除之间存在明显关联（平均EOR为66.7% vs 85.6%，P=0.002）。结论：对于出现视力障碍的 PA 患者，使用 EEA 治疗可使大多数患者的视功能得到改善，而无需进行全切。EOR与再次切除的需要明显相关。
{"title":"P.089 Volumetric extent of resection and visual outcomes in pituitary adenoma patients presenting with visual compromise undergoing the endoscopic endonasal approach","authors":"JG Pascual, D. Ben-Israel, M. de Lotbiniere-Bassett, F. Costello, JM Clark, YP Starreveld","doi":"10.1017/cjn.2024.194","DOIUrl":"https://doi.org/10.1017/cjn.2024.194","url":null,"abstract":"Background: Reporting extent of resection (EOR) in pituitary adenoma (PA) surgery via endoscopic endonasal approaches (EEA) is not standardized. The use of 3-dimensional volumetric analysis is proposed for measurement of tumor volumes and EOR. Their relationship with visual outcomes is explored. Methods: A retrospective analysis of PA patients presenting with visual disturbances and treated surgically via EEA by a single surgeon between 2006 and 2021. The main outcome was visual function at 12 months post-operatively. Results: 142 patients were included. Majority were male, with mean age of 57.1 years. Most (58.2%) presented with bitemporal hemianopsia. The mean tumor size was 11.3 cm3. The mean EOR was 84.5% (range 21.5-99.8%), with a mean post-operative tumor volume of 1.9 cm3. Visual function improved in 92.2%. Re-resection for visual deterioration was performed in 5.7% of patients, (mean time 2.4 years). No clinical, pathologic, or imaging factors were significantly associated with visual outcome. A significant association was found between EOR and re-resection (mean EOR 66.7% vs 85.6%, p=0.002). Conclusions: For patients with PA presenting with visual deficits, treatment with EEA led to improvement in visual function in the majority of patients, without the need for gross total resection. EOR was significantly associated with the need for re-resection.","PeriodicalId":9571,"journal":{"name":"Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques","volume":"6 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141100945","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
C. Argoff, SP Herzog, RM Smith, S. Soni-Brahmbhatt, SF Awad, D. Asher, F. Khan, JK Bougie, J. Miron
Background: Since 2018, several CGRP-targeted therapies have entered the migraine market, including eptinezumab. Minimal evidence exists evaluating the real-world effectiveness of switching from a subcutaneous to an intravenous anti-CGRP mAb. Methods: An observational, multi-site (n=4), US-based study, REVIEW evaluated real-world experiences of patients with chronic migraine (CM) treated with eptinezumab using a chart review, patient survey, and physician interviews. Adults (≥18 years) with a diagnosis of CM who had completed ≥2 consecutive eptinezumab infusion cycles were eligible. Results: Enrolled patients were primarily female (83%, 78/94), had a mean age of 49 years and a mean migraine diagnosis duration of 15.4 years. All patients (94/94) self-reported prior preventive therapy with 89% (84/94) reporting prior subcutaneous anti-CGRP mAb use (i.e., fremanezumab, galcanezumab, or erenumab). Regardless of prior exposure to a CGRP ligand or receptor blocker, the number of “good” days/month more than doubled following eptinezumab. Patients experienced a similar mean change in the number of “good” days/month regardless of the number and type of previous subcutaneous anti-CGRP mAb used. Conclusions: This real-world, patient survey showed that patients with prior exposure to subcutaneous anti-CGRP mAbs had high overall satisfaction with the effectiveness of eptinezumab treatment regardless of the number and type of previous therapies used.
背景：自2018年以来，包括eptinezumab在内的几种CGRP靶向疗法已进入偏头痛市场。评估从皮下注射转为静脉注射抗 CGRP mAb 实际效果的证据极少。研究方法REVIEW是一项基于美国的多站点（n=4）观察性研究，通过病历回顾、患者调查和医生访谈，评估了接受eptinezumab治疗的慢性偏头痛（CM）患者的实际体验。研究对象为确诊为慢性偏头痛且已完成≥2个连续eptinezumab输注周期的成人（≥18岁）。研究结果入组患者主要为女性（83%，78/94），平均年龄为49岁，平均偏头痛诊断持续时间为15.4年。所有患者（94/94）均自述曾接受过预防性治疗，其中89%（84/94）的患者自述曾使用过皮下抗CGRP mAb（即fremanezumab、galcanezumab或erenumab）。无论患者之前是否使用过 CGRP 配体或受体阻断剂，使用埃妥珠单抗后，每月 "好 "天数增加了一倍多。无论之前使用的皮下抗 CGRP mAb 的数量和类型如何，患者每月 "好 "天数的平均变化相似。结论这项真实世界的患者调查显示，无论以前使用过多少种皮下注射抗CGRP mAb，以前使用过皮下注射抗CGRP mAb的患者对eptinezumab治疗效果的总体满意度都很高。
{"title":"P.004 Real-world effectiveness of intravenous eptinezumab in patients with chronic migraine and previous subcutaneous preventive migraine treatment","authors":"C. Argoff, SP Herzog, RM Smith, S. Soni-Brahmbhatt, SF Awad, D. Asher, F. Khan, JK Bougie, J. Miron","doi":"10.1017/cjn.2024.112","DOIUrl":"https://doi.org/10.1017/cjn.2024.112","url":null,"abstract":"Background: Since 2018, several CGRP-targeted therapies have entered the migraine market, including eptinezumab. Minimal evidence exists evaluating the real-world effectiveness of switching from a subcutaneous to an intravenous anti-CGRP mAb. Methods: An observational, multi-site (n=4), US-based study, REVIEW evaluated real-world experiences of patients with chronic migraine (CM) treated with eptinezumab using a chart review, patient survey, and physician interviews. Adults (≥18 years) with a diagnosis of CM who had completed ≥2 consecutive eptinezumab infusion cycles were eligible. Results: Enrolled patients were primarily female (83%, 78/94), had a mean age of 49 years and a mean migraine diagnosis duration of 15.4 years. All patients (94/94) self-reported prior preventive therapy with 89% (84/94) reporting prior subcutaneous anti-CGRP mAb use (i.e., fremanezumab, galcanezumab, or erenumab). Regardless of prior exposure to a CGRP ligand or receptor blocker, the number of “good” days/month more than doubled following eptinezumab. Patients experienced a similar mean change in the number of “good” days/month regardless of the number and type of previous subcutaneous anti-CGRP mAb used. Conclusions: This real-world, patient survey showed that patients with prior exposure to subcutaneous anti-CGRP mAbs had high overall satisfaction with the effectiveness of eptinezumab treatment regardless of the number and type of previous therapies used.","PeriodicalId":9571,"journal":{"name":"Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques","volume":"3 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141099305","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Obesity is increasingly implicated in the development of multiple sclerosis (MS), but its effect on disease disability is less well-established. This study aims to investigate the association between obesity and MS severity utilizing Mendelian Randomization (MR). Methods: Employing a two-sample MR setting, we examined the effects of various obesity measures and adiposity distribution metrics on MS severity. Genetic proxies for body mass index (BMI) were selected from a study of 806,834 participants, with MS severity determined from a genetic study of age-related MS severity scores in 12,584 individuals with MS. Results: The main analysis reveals an association between elevated BMI and increased MS severity (P = 0.03). This is supported by a significant effect of whole body fat (P = 0.04), aligning with the hypothesis that obesity exacerbates MS disability. Sensitivity analyses suggest minimal heterogeneity and bias, indicating a potential causal effect. Conclusions: Our findings suggest that obesity adversely influences long-term disability outcomes in MS. The convergence of this genetic evidence with some of the prior observational studies strengthens the argument for a causal relationship between obesity and MS severity. These insights highlight obesity as a potentially modifiable risk factor in managing MS, underscoring the importance of weight management in MS treatment strategies.
{"title":"GR.2 Obesity and multiple sclerosis severity: a Mendelian randomization study","authors":"F. Alzamanan, Y. Ding, A. Harroud","doi":"10.1017/cjn.2024.69","DOIUrl":"https://doi.org/10.1017/cjn.2024.69","url":null,"abstract":"Background: Obesity is increasingly implicated in the development of multiple sclerosis (MS), but its effect on disease disability is less well-established. This study aims to investigate the association between obesity and MS severity utilizing Mendelian Randomization (MR). Methods: Employing a two-sample MR setting, we examined the effects of various obesity measures and adiposity distribution metrics on MS severity. Genetic proxies for body mass index (BMI) were selected from a study of 806,834 participants, with MS severity determined from a genetic study of age-related MS severity scores in 12,584 individuals with MS. Results: The main analysis reveals an association between elevated BMI and increased MS severity (P = 0.03). This is supported by a significant effect of whole body fat (P = 0.04), aligning with the hypothesis that obesity exacerbates MS disability. Sensitivity analyses suggest minimal heterogeneity and bias, indicating a potential causal effect. Conclusions: Our findings suggest that obesity adversely influences long-term disability outcomes in MS. The convergence of this genetic evidence with some of the prior observational studies strengthens the argument for a causal relationship between obesity and MS severity. These insights highlight obesity as a potentially modifiable risk factor in managing MS, underscoring the importance of weight management in MS treatment strategies.","PeriodicalId":9571,"journal":{"name":"Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques","volume":"1 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141098973","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
F. Khan, V. Yogendrakumar, R. Lun, A. Ganesh, V. Lioutas, N. Vinding, A. Algra, C. Weimar, J. Ögren, J Edwards, R. Swartz, A. Ois, E. Giralt-Steinhauer, H. Bae, M. Kamouchi, F. de Leeuw, J. Verhoeven, T. Uehara, K. Minematsu, S. Fandler-Höfler, M. Foschi, W. Whiteley, F. Purroy, J. Jing, Y. Wang, M. Baik, Y Kim, M. Spampinato, F. Ildstad, Y. Hasegawa, K. Perera, H. Park, D. Dutta, P. Barber, S. Coutts, M. Hill
Background: After a transient ischemic attack (TIA) or minor stroke, the long-term risk of subsequent stroke is uncertain. Methods: Electronic databases were searched for observational studies reporting subsequent stroke during a minimum follow-up of 1 year in patients with TIA or minor stroke. Unpublished data on number of stroke events and exact person-time at risk contributed by all patients during discrete time intervals of follow-up were requested from the authors of included studies. This information was used to calculate the incidence of stroke in individual studies, and results across studies were pooled using random-effects meta-analysis. Results: Fifteen independent cohorts involving 129794 patients were included in the analysis. The pooled incidence rate of subsequent stroke per 100 person-years was 6.4 events in the first year and 2.0 events in the second through tenth years, with cumulative incidences of 14% at 5 years and 21% at 10 years. Based on 10 studies with information available on fatal stroke, the pooled case fatality rate of subsequent stroke was 9.5% (95% CI, 5.9 – 13.8). Conclusions: One in five patients is expected to experience a subsequent stroke within 10 years after a TIA or minor stroke, with every tenth patient expected to die from their subsequent stroke.
{"title":"B.6 Long-term risk of subsequent stroke after transient ischemic attack or minor stroke: a systematic review and meta-analysis","authors":"F. Khan, V. Yogendrakumar, R. Lun, A. Ganesh, V. Lioutas, N. Vinding, A. Algra, C. Weimar, J. Ögren, J Edwards, R. Swartz, A. Ois, E. Giralt-Steinhauer, H. Bae, M. Kamouchi, F. de Leeuw, J. Verhoeven, T. Uehara, K. Minematsu, S. Fandler-Höfler, M. Foschi, W. Whiteley, F. Purroy, J. Jing, Y. Wang, M. Baik, Y Kim, M. Spampinato, F. Ildstad, Y. Hasegawa, K. Perera, H. Park, D. Dutta, P. Barber, S. Coutts, M. Hill","doi":"10.1017/cjn.2024.85","DOIUrl":"https://doi.org/10.1017/cjn.2024.85","url":null,"abstract":"Background: After a transient ischemic attack (TIA) or minor stroke, the long-term risk of subsequent stroke is uncertain. Methods: Electronic databases were searched for observational studies reporting subsequent stroke during a minimum follow-up of 1 year in patients with TIA or minor stroke. Unpublished data on number of stroke events and exact person-time at risk contributed by all patients during discrete time intervals of follow-up were requested from the authors of included studies. This information was used to calculate the incidence of stroke in individual studies, and results across studies were pooled using random-effects meta-analysis. Results: Fifteen independent cohorts involving 129794 patients were included in the analysis. The pooled incidence rate of subsequent stroke per 100 person-years was 6.4 events in the first year and 2.0 events in the second through tenth years, with cumulative incidences of 14% at 5 years and 21% at 10 years. Based on 10 studies with information available on fatal stroke, the pooled case fatality rate of subsequent stroke was 9.5% (95% CI, 5.9 – 13.8). Conclusions: One in five patients is expected to experience a subsequent stroke within 10 years after a TIA or minor stroke, with every tenth patient expected to die from their subsequent stroke.","PeriodicalId":9571,"journal":{"name":"Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques","volume":"11 8","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141100573","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
N. Pendleton, E. Liu, A. Persad, A. Vitali, J. Radic, J. Norton
Background: Tethered cord syndrome, a condition in which the spinal cord stretches as a child grows, can cause various clinical symptoms. Occult TCS (OTCS) is a condition where a child displays some or many clinical symptoms of TCS, but no radiographic abnormality confirms the presence of a tethered cord (1-4). Diagnosis of OTCS in children is invasive and multi-factorial. The current diagnostic approach involves three main factors- clinical signs and symptoms, radiographic evidence, and motor evoked potentials (MEPs) tested under general anesthesia. Transcranial magnetic stimulation (TMS) is a non-invasive testing method for OTCS. It can replace MEPs, which are conducted under general anesthesia. Methods: We will conduct a case-control series of children at our center who have undergone TMS. We will characterize the children who have TCS and suspected OTCS and detail the children’s current diagnosis methods and outcomes in a technical note. We will then compare their pre-operative and post-operative data. Results: So far, we have conducted TMS on 10 children to help diagnose occult TCS. Conclusions: This approach is a novel and effective way to improve the accuracy of diagnosis in children, potentially preventing unnecessary surgery, or detecting patients who would otherwise suffer from the condition.
{"title":"P.153 Utility of neurophysiology in the diagnosis of tethered cord syndrome (TCS)","authors":"N. Pendleton, E. Liu, A. Persad, A. Vitali, J. Radic, J. Norton","doi":"10.1017/cjn.2024.252","DOIUrl":"https://doi.org/10.1017/cjn.2024.252","url":null,"abstract":"Background: Tethered cord syndrome, a condition in which the spinal cord stretches as a child grows, can cause various clinical symptoms. Occult TCS (OTCS) is a condition where a child displays some or many clinical symptoms of TCS, but no radiographic abnormality confirms the presence of a tethered cord (1-4). Diagnosis of OTCS in children is invasive and multi-factorial. The current diagnostic approach involves three main factors- clinical signs and symptoms, radiographic evidence, and motor evoked potentials (MEPs) tested under general anesthesia. Transcranial magnetic stimulation (TMS) is a non-invasive testing method for OTCS. It can replace MEPs, which are conducted under general anesthesia. Methods: We will conduct a case-control series of children at our center who have undergone TMS. We will characterize the children who have TCS and suspected OTCS and detail the children’s current diagnosis methods and outcomes in a technical note. We will then compare their pre-operative and post-operative data. Results: So far, we have conducted TMS on 10 children to help diagnose occult TCS. Conclusions: This approach is a novel and effective way to improve the accuracy of diagnosis in children, potentially preventing unnecessary surgery, or detecting patients who would otherwise suffer from the condition.","PeriodicalId":9571,"journal":{"name":"Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques","volume":"7 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141100721","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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