10th Congress of the European Academy of Neurology, Helsinki, Finland, June 29-July 2, 2024
The following summarizes some of the data presented at EAN 2024.
NfL higher in MOGAD vs. MS
Cenobamate for different epilepsy etiologies
Frexalimab reduces NfL
New T2 lesions: is treatment escalation justified?
Greater psychological impairment in comorbid MS and epilepsy
Sun exposure lowers risk of pediatric-onset MS
CONGRESS HIGHLIGHTS – TUESDAY EDITION
NfL higher in MOGAD vs. MS
The MULTIMOGAD study compared serum samples obtained within three months of disease onset from patients with MOG antibody disease (MOGAD) and MS (Villacieros-Alvarez et al. EAN 2024;OPR-065). Baseline NfL levels were higher in MOGAD; higher sNfL values were associated with a higher risk of a second relapse in MOGAD patients with optic neuritis. In contrast, OCBs were more common at onset in MS patients.
Cenobamate for different epilepsy etiologies
The placebo-controlled C017 trial examined the efficacy of adjunctive cenobamate in patients with epilepsy with different etiologies. Etiologies included stroke, infection, traumatic brain injury (TBI), encephalopathies, cortical malformations and neurodegenerative diseases. A total of 354 patients completing the double-blind phase entered the open-label extension (Serratosa et al. EAN 2024;EPR-186). The median seizure frequency at baseline ranged from 6/28 days for TBI to 11.5/28 days for cortical malformation. At five years, cenobamate produced a long-term response (≥50% seizure reduction) across the range of epilepsy etiologies. Response rates were 73.3% for hypoxic/ischemic encephalopathy, 64.7% for mesial temporal sclerosis, 60.7% for CNS infection, 60.0% for stroke/intraventricular hemorrhage and 58.5% for TBI.
Frexalimab reduces NfL
Frexalimab is an anti-CD40L MAb in development for the treatment of MS (see Novel treatments: targeting CD40 ligand, NeuroSens, November 1, 2023). Data from the 48-week extension of the 12-week phase II trial were presented at AAN (Giovannoni et al. AAN 2024;S31.007). Plasma NfL was obtained at baseline and at weeks 12, 24 and 48 and have now been analysed (Kuhle et al. EAN 2024;EPR-230). The four patient groups were frexalimab-high dose, frexalimab-low dose, and the two placebo-switch groups. Baseline pNfL levels were similar in the four groups. At week 48, pNfL was reduced from 11.9 pg/mL to 6.7 pg/mLin the frexalimab-high group (-41%), and from 12.7 pg/mL to 8.1 pg/mL in the frexalimab-low group (-35%).
[For prior efficacy results see Report from AAN 2024 – Tuesday, April 16, NeuroSens, April 16, 2024).
New T2 lesions: is treatment escalation justified?
The Vienna MS group looked at 131 MS patients receiving a moderate-efficacy DMT and who were clinically stable for at least a year (Bsteh et al. EAN 2024;EPR-113). Over a median six-year follow-up, 47% experienced a relapse. Patients with 2 new T2 lesions had a three-fold increased risk of relapse; patients with ≥3 new T2 lesions had a four-fold higher risk of relapses. In patients with 2 new T2 lesions, the risk of relapse was reduced by 80% if they were switched to a higher-efficacy DMT. In the group with ≥3 new T2 lesions, relapse risk was lowered 65% after treatment escalation. The authors concluded that isolated MRI activity is sufficient reason to escalate treatment if ≥2 new lesions are identified.
Greater psychological impairment in comorbid MS and epilepsy
The estimated prevalence of comorbid MS and epilepsy is 2-3%, about 3-6-fold higher than in the general population, although the reasons for this association are not known (Poser & Brinar. Epilepsy Behav 2003;4:6-12). The impact of epilepsy on cognitive and neuropsychological function was examined in MS patients versus comorbid MS + epilepsy patients (Pozzilli et al. EAN 2024;EPO-783). Tests included the brief cognitive assessment (BICAMS), Beck Depression Inventory and the Symptom Checklist-90. MS patients with comorbid epilepsy had lower processing speed and visuospatial memory scores. Patients with their first seizure within one year of MS diagnosis had a higher rate of being seizure-free. Epileptic activity was associated with significant psychological distress, which was associated with poorer verbal learning test scores. Comorbid patients had higher symptom scores compared to healthy controls, most notably for phobia, somatization, and depression/anxiety.
Sun exposure lowers risk of pediatric-onset MS
The Italian PEDIGREE study examined the effect of sun exposure on pediatric-onset MS (Pilotto et al. EAN 2024;EPR- 104). Subjects completed questionnaires about time spent outside during childhood. Less time spent outside (<60 minutes/week) in the first five years of life was associated with a significantly higher risk of developing pediatric-onset MS (odds ratio 2.26). Less time outside from ages 3-5 was associated with the highest risk of developing MS (OR 4.82).