[Comment] Withdrawal of antiepileptic drugs: an individualised approach
Epilepsy is defined as a condition in which the brain becomes capable of generating spontaneous seizures.1 In around two-thirds of patients, these seizures can be suppressed with the use of daily antiepileptic drugs. One of the most frustrating aspects of epilepsy, to both patient and doctor, is the absence of indicators of the likelihood that, in the absence of medication, a seizure would happen on any given day. Patients must take daily medication, even if on most days they would be seizure-free without it.
[Articles] Individualised prediction model of seizure recurrence and long-term outcomes after withdrawal of antiepileptic drugs in seizure-free patients: a systematic review and individual participant data meta-analysis
We present evidence-based nomograms with robust performance across populations of children and adults. The nomograms facilitate prediction of outcomes following drug withdrawal for the individual patient, including both the risk of relapse and the chance of long-term freedom from seizures. The main limitations were the absence of a control group continuing antiepileptic drug treatment and a consistent definition of long-term seizure freedom.
[Comment] Another milestone in childhood spinal muscular atrophy
Childhood spinal muscular atrophy (SMA) is one of the most debilitating hereditary neuromuscular disorders. Inheritance of SMA is autosomal recessive, and its ubiquitous incidence is estimated to be about 1:11 000 live births, with a carrier frequency of 1 in 50.1,2 More than 95% of patients with SMA have homozygous deletions of exons 7 and 8 of the survival motor neuron 1 (SMN1) gene that encodes the survival motor neuron (SMN) protein.3 The shortage of SMN protein causes loss of lower motor neurons in the spinal cord and brainstem leading to progressive muscle paralysis and atrophy.
[Articles] Safety and efficacy of olesoxime in patients with type 2 or non-ambulatory type 3 spinal muscular atrophy: a randomised, double-blind, placebo-controlled phase 2 trial
Olesoxime was safe at the doses studied, for the duration of the trial. Although the primary endpoint was not met, secondary endpoints and sensitivity analyses suggest that olesoxime might maintain motor function in patients with type 2 or type 3 SMA over a period of 24 months. Based on these results, olesoxime might provide meaningful clinical benefits for patients with SMA and, given its mode of action, might be used in combination with other drugs targeting other mechanisms of disease, although additional evidence is needed.
[In Context] Henrik Zetterberg: biomarking neurological disorders
Henrik Zetterberg's steady outlook on life could date back to his tranquil upbringing close to the Gothenburg archipelago in Sweden. His parents inspired his love of nature, which would eventually translate into a love of science and a medical degree. Today, he is Professor of Neurochemistry, senior consultant of clinical chemistry, and head of the Department of Psychiatry and Neurochemistry at the University of Gothenburg (Gothenburg, Sweden), where he is also co-lead of the Clinical Neurochemistry Laboratory with long-time friend Kaj Blennow.
[In Context] Greg Albers: changing the face of the stroke stopwatch
Treatment for stroke is determined by the stopwatch. Missing the few hours that are the window of opportunity between stroke onset and the time of diagnosis make many patients ineligible for reperfusion therapy, because of concerns that treatment might be too risky or ineffective. Greg Albers, Professor of Neurology and Neurological Sciences, and Director of the Stanford Stroke Center (Stanford University, CA, USA) is “trying to show that the stopwatch does not make the most sense”. He says: “we have to tailor treatment to the individual, not because the majority of people don't do well if you treat them within a chosen timeframe.