Conference Highlights: AAN 2016

New research was presented at AAN 2016, the annual meeting of the American Academy of Neurology, from April 15 to 21 in Vancouver. The features below highlight some of the studies that emerged from the conference.

PD Caregivers & Health Literacy

About 30% of non-demented, community-dwelling patients with Parkinson’s disease (PD) have low health literacy. With caregivers of patients with PD possibly serving as a safety net for vulnerable patients, American investigators sought to determine the prevalence of low health literacy among this population. Among caregivers, 72% had a college degree or higher, and 73% were women. Low health literacy was detected in 26% of patients and 15% of caregivers, with low concordance between pairs. No significant association was determined between education level and health literacy. Among patients with low health literacy, 22% had a caregiver with low health literacy. According to the study investigators, recognizing the prevalence and consequences of low health literacy is necessary to better educating and addressing the concerns of patients with PD and their caregivers.

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MS Misdiagnosis & Morbidity

Administration of unnecessary disease-modifying therapy and unnecessary morbidity among patients with definite or probable misdiagnoses of multiple sclerosis (MS) have been noted in unusual case reports and decades-old studies. To determine the current spectrum of misdiagnosis, researchers conducted a 13-month study at four MS centers. About 46% of misdiagnosed patients had a “definite” misdiagnosis because an alternate diagnosis was determined following clinical laboratory and neuroimaging data assessment. A “probable” misdiagnosis was found in nearly 54% of patients. The following was also observed:

Objective evidence of a lesion was not used to corroborate historical symptoms in 48% of cases.
Evidence of missing red flags that could have led to a correct diagnosis occurred in 72% of cases.
Nearly 30% had been misdiagnosed for 3 to 9 years, and 33% had been misdiagnosed for 10 years or more.

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Birth Complications in Pregnant Migraineurs

Some women experience migraine during pregnancy due to various causes. Researchers in New York assessed delivery data on women who presented to a hospital with acute migraine and received a neurologic consultation while pregnant. More than 40% had migraine with aura, about 13% had chronic migraine, and more than 31% presented in status migrainosus. Women aged 35 or older had higher rates of birth complications. The prevalence of birth complications far exceeded national averages:

	Study participants	National averages
Preeclampsia	19.5%	3% to 4%
Preterm delivery	28.2%	11.4%
Low-birthweight babies	19.2%	8.0%

The study authors suggest that pregnant women who experience migraines should be considered high risk, particularly those who are older.

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Conception Not Affected by Epilepsy

For a study, researchers enrolled women with and without epilepsy who wanted to become pregnant and had discontinued contraception within 6 months. Participants were followed for 1 year. Women with epilepsy had a cumulative pregnancy rate of 70%, compared with a rate of about 67% that was seen in healthy controls. The average times to achieve pregnancy were 6.03 months for women with epilepsy and 9.05 for those without it. No significant differences were found between the groups in rates of live births and miscarriages. The researchers concluded that women with epilepsy who are trying to become pregnant can probably be advised that their chances of achieving pregnancy are as good as those for women without epilepsy.

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Post-Concussion Cognitive & Physical Rest

Collegiate student-athletes with diagnosed concussions were enrolled in a study to assess outcomes before and after a policy change that incorporated cognitive and physical rest. Patients in the rest group were withheld from activities, including classes, for the rest of the day that the injury occurred and for the following day. Those in the no-rest group were given no post-injury accommodations. The no-rest group achieved asymptomatic status sooner than the rest group. No differences were seen between groups for a balance test and during computerized neuropsychological tests. The investigators concluded that among collegiate student-athletes, a day of cognitive and physical rest during the acute post-concussion period does not appear to improve concussion recovery.

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News from AAN 2016

New AAN Guideline on Botulinum Neurotoxins in Neurologic Disease

Computerized Spoon as Good as Neurologists at Rating Tremor

Fingolimod Easier to Swallow Than Dimethyl Fumarate?

Sleep Problems Linked to Reduced Brain Volume

New Transcranial Doppler Device May Diagnose Concussion

OTC Antihistamine Promotes Remyelination in MS

DTI Flags Traumatic Brain Injury in NFL Players

Zika Virus Now Linked to Autoimmune Neurologic Conditions

Alzheimer’s Disease: Study Patients With Amyloid and Tau Markers

VIDEO: SAGE-547 and Super-refractory Status Epilepticus