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.
Anti-CD20s effective after alemtuzumab
Status epilepticus worsens brain tumour outcomes
Choroid plexus volume as an imaging marker in AD
Fluid biomarkers in AD, PD
Siponimod reduces CD20 B cells in SPMS
MS misdiagnosis common in practice
CONGRESS HIGHLIGHTS – WEDNESDAY EDITION
Anti-CD20s effective after alemtuzumab
A retrospective study in Spain examined 12 patients with high disease activity after treatment with alemtuzumab who were subsequently treated with an anti-CD20 agent (Ferrer et al. EAN 2024;EPO-169). Mean age was 35.8 years, median number of alemtuzumab cycles was two. Anti-CD20 therapy (ocrelizumab, ofatumumab, rituximab) was started because of disease worsening (severe relapse and/or new MRI lesions). sNfL was elevated in 4 of 10 patients and normalized after six months of anti-CD20 therapy. At one year, 5 of 8 had no new T2 lesions, 7 of 8 were relapse-free and none experienced disability progression. Five patients achieved no evidence of disease activity (NEDA).
Status epilepticus worsens brain tumour outcomes
A German study examined the impact of status epilepticus (SE) on function and mortality in 208 patients with brain tumours (Strzelczyk et al. EAN 2024). Mean age was 61.5 years; the most frequent tumour type was adult-type diffuse gliomas. A decline in functional status, as assessed with the modified Rankin scale, occurred independently of tumour progression signs, tumour category or refractoriness of the SE. Refractory SE was associated with higher mortality. The authors concluded that SE prevention may preserve functional status and improve survival in patients with brain tumours.
Choroid plexus volume as an imaging marker in AD
A prospective study examined the relationship between choroid plexus (ChP) volume, CSF markers (Aβ42, Aβ40, tTau and pTau) and neuropsychological tests (e.g. MMSE, MOCA) in 497 patients (mean age 66 years) with mild cognitive impairment or Alzheimer dementia (Jiang et al. EAN 2024;OPR-108). Baseline ChP volume was larger in AD patients compared with MCI patients or healthy controls. ChP volume enlargement was correlated with lower Aβ42 and Aβ40 levels, as well as lower MMSE and MoCA scores. ChP volume was a better indicator of the presence or absence of cerebral Aβ42 deposition than hippocampal volume. Baseline ChP volume was also predictive of a faster worsening in MMSE, MOCA and ADL scores at 10-month follow-up.
Fluid biomarkers in AD, PD
A Norwegian group examined a series of plasma biomarkers for their potential utility in Alzheimer disease and Parkinson disease (Gomes et al. EAN 2024;EPO-428). Levels of NfL, glial fibrillary acidic protein (GFAP), phospho-tau217 and brain-derived (BD)-tau were evaluated in 338 patients with AD or PD and 157 healthy controls. AD was characterized by elevated levels of p-tau217 and BD-tau; both markers were lower in PD vs. healthy controls. GFAP levels were elevated in AD but not in PD. NfL levels were substantially increased in PD and were noteworthy for large variability within the group; NfL was correlated with Unified PD Rating Scale (UPDRS) scores.
Siponimod reduces CD20 B cells in SPMS
An Italian study examined lymphocyte kinetics in 46 active SPMS patients treated with siponimod over a two-year period (Spiezia et al. EAN 2024;EPO-174). Starting in month 3, siponimod treatment was associated with decreases in CD4+ T cells and the CD4+/CD8+ ratio. There was a reduction in CD20+ B cells at month 12. Patients with no disability progression showed an earlier reduction in memory B cells. In contrast, patients who progressed during treatment showed less of a treatment effect on T and B cells.
MS misdiagnosis common in practice
A meta-analysis of 62 studies reported that the pooled frequency of patients incorrectly diagnosed with MS was 15% (range 5-41%) (Zurrer et al. EAN 2024;EPR-227). The mean time to correct the MS misdiagnosis ranged from 0.3 to 15.9 years. The frequency of MS underdiagnosis was 36% (range 3-58%), with a mean delay of 1.5 years before MS was diagnosed. Women were two-fold more likely to be misdiagnosed than men.