The 56th Annual Meeting of the American Academy of Neurology, San Francisco, California, April 24-30, 2004

There were 1344 scientific papers and poster presentations at the 56th Annual Meeting of the American Academy of Neurology held in San Francisco from April 24 to 30, 2004. The scientific abstracts may be found in Neurology (2004;62[Suppl 5]). We have summarized the material most interesting to neuro-ophthalmologists. OPTIC NEURITIS/MULTIPLE SCLEROSIS A double-blind, randomized, placebo-controlled study of intravenous immunoglobulin (IVIG) administered within 30 days of onset of optic neuritis (ON) enrolled 68 patients and studied contrast sensitivity, visual acuity, color vision, visual evoked potential, magnetic resonance imaging (MRI), and relapse rate at 6 months. There was no difference between the two groups in visual parameters at 7 days, 30 days, or 6 months. The authors appropriately concluded that IVIG does not affect the course or outcome of acute ON, although the time to recovery was not reported (Roed HG, Hvidovre, Denmark, S29.005). A study of IVIG in relapsing-remitting multiple sclerosis (MS) was performed in patients whose visual acuities were worse than 20/200 at 60 to 90 days after an episode of ON, despite an initial course of pulsed intravenous methylprednisolone. Patients examined within 3 months of ON onset were treated with IVIG at 400 mg/kg per day for 5 consecutive days, followed by monthly IVIG at the same dose for five additional monthly infusions while continuing previous immune therapy. Patients examined after 3 months after ON onset were followed clinically while maintaining previous therapy. Six months after onset of IVIG therapy, 21 of 23 patients improved in visual acuity to 20/30 or better. In five patients, visual evoked potential also showed reversal of previous delayed conduction. In the untreated group, only 3 of 24 patients improved in visual acuity to 20/70 or better. In six patients, visual evoked potential repeated more than 6 months after onset showed no significant improvement in P100 latencies. Although this study suggests that IVIG may help refractory ON, the results must be interpreted in the context of a nonrandomized, open-label study (Khan O, Detroit, Michigan, P02.121). For patients with ON and other clinically isolated demyelinating syndromes, the brain MRI is known to be a predictor of the development of future neurologic events consistent with MS. Although brain atrophy was not evident by MRI at baseline among patients in the Controlled High-Risk Avonex MS Prevention Study (CHAMPS), follow-up analyses of treated (interferon β-1a) and placebo patients have demonstrated that brain atrophy does develop within 5 years after first demyelinating events (including ON). The median baseline brain parenchymal fraction (BPF, brain volume/[brain + cerebrospinal fluid volume]) in CHAMPSwas 0.857. BPF decreased by 1.146% between the 6-month and 5-year follow-up assessments. Although this rate of change is significant, it is less than that reported previously in cohorts of patients with relapsing-remitting MS in phase III clinical trials, suggesting a potential benefit of early immunomodulatory therapy in reducing the development of brain atrophy, which is an imaging marker for axonal/neuronal loss. Baseline T2 lesion volume was an independent predictor of decline in BPF, emphasizing the value of early MRI findings in determining prognosis (Kinkel R, Boston, Massachusetts, S46.002). The risk of progressing to MS was described for a prospective cohort of patients with ON recruited in 1969 to 1981 (before MRI) and followed-up for up to 31 years or until MS was diagnosed. MRI, cerebrospinal fluid examination, and HLA typing were performed. The estimated 15-year risk of MS was 40% (confidence interval [CI]: 31%-52%). In most cases (60%), MS developed within 3 years. Among factors present at onset, inflammatory cerebral spinal fluid findings significantly increased the risk (P = 0.02) from 23% (CI: 12%-44%) to 49% (CI: 38%-65%). Recurrence of ON similarly elevated the risk significantly (P < 0.001). Younger patients and those with winter onset had greater risk. The presence of HLA DR2 did not increase the risk significantly. After 19 to −31 years, two or more MRI lesions suggestive of demyelinating disease were detected in 20 of 30 individuals in whom no clinical manifestations of MS had occurred. Although the authors point out that the 15-year risk of MS in this cohort was only 40%, this study was initiated in the pre-MRI era, when diagnoses of AION and neuroretinitis were not common. These cases may therefore have accounted for a substantial proportion of patients purported to have ON. Inclusion of these patients may, therefore, have artificially decreased the reported rate of conversion to MS (Sandberg-Wollheim M, Lund, Sweden, S40.003). CHAMPS was a randomized, double-blind, placebo-controlled trial of interferon beta (IFNb)-1a 30 μg intramuscularly once weekly in patients who experienced a first clinical demyelinating event. Results showed that IFNb-1a significantly slowed the rate of development of clinically definite MS (CDMS) and new MRI abnormalities over 2 years compared with placebo. The study was continued as an open-label extension study (CHAMPIONS). CHAMPS patients were offered intramuscular IFNb-1a for up to 5 years (timed from randomization into CHAMPS) and were followed-up every 6 months. Patients who received placebo in CHAMPS were considered the delayed treatment (DT) group and patients who received IFNb-1a in CHAMPS were considered the immediate treatment (IT) group. Outcomes included rate of development of CDMS, relapses, measures of disability, and MRI measures. Seventy percent (203/290) of patients from 32 participating sites were enrolled in CHAMPIONS (n = 100, IT group; n = 103, DT group). Overall, 36% of the IT group and 48% of the DT group had CDMS by 5 years. Mean number of relapses over 5 years (±SD) was 0.9 (±1.3) in the IT group compared with 1.7 (±2.7) in the DT group (P = 0.008), representing a 47% reduction in the IT group. In both groups combined, 13% of patients had an Expanded Disability Status Scale score of 3.0 or more at their 5-year visit (IT group 11%, DT group 14%). The median number of new or enlarging T2 lesions at 5 years was significantly lower in the IT group than in the DT group (3.5 vs. 6.0, P = 0.05). Initiation of IM IFNb-1a at the time of a first clinical demyelinating event slowed the rate of conversion to CDMS over 5 years compared with therapy initiated a median of 2.5 years later. These results support the recommendation to initiate disease-modifying therapy in high-risk patients at the time of a first demyelinating event (Kinkel RP, Boston, Massachusetts, S29.006). To assess the bioavailability of oral high-dose prednisone, 16 MS patients were randomized to receive 1 g intravenous methylprednisolone (IVMP) or 1,250 mg of oral prednisone. Serum prednisolone and methylprednisolone levels were determined at 0, 1, 2, 4, 8, 24, and 48 hours after the first dose. There was no statistically significant difference in corticosteroid serum levels at 24 or 48 hours, but there was at 8 hours, consistent with an earlier peak in the intravenous group. This small study suggests that there is no substantial difference in the bioavailability of methylprednisolone and prednisolone at 24 hours after intravenous or oral dosing. Results are consistent with previous studies that have shown no differences in visual outcome but indicated reasonable tolerability for high-dose oral steroids as an alternative to IVMP (Morrow SA, London, Ontario, Canada, P02.117). A 5-year study to determine whether regular pulses of IVMP affect the evolution of T2 lesions into confluent T2 lesions was undertaken. Eighty-eight relapsing-remitting MS patients were randomly assigned to regular pulses of IVMP (1 g/d for 5 days with an oral prednisone taper) or IVMP at the same dose schedule administered only for relapses. The patients were not treated with other disease-modifying drugs. Confluent T2 lesions were defined as lesions larger than 20 mm in strategically important areas of the brain or areas of white matter abnormalities consisting of two or more than two interconnected T2 lesions. Patients who received IVMP pulses every 4 to 6 months for 5 years had significantly fewer confluent T2 lesions (105 versus 270, P < 0.0001) and fewer large T2 lesions (>10 mm) (165 vs. 541, P < 0.00001) compared with those who received IVMP for relapses alone (Zivadinov R, Buffalo, New York, P04.035). To evaluate the effects of neutralizing antibodies (NAbs) on the clinical efficacy of IFNb during treatment of MS, an open-label study of 78 patients prescribed any of the three main IFNb medications were studied. Of 78 patients enrolled in the study, 13 (17%) had persistent NAbs. The incidence of persistent Nab-positive patients was 35% for IFNb-1b, 20% for IFNb-1a-Rebif, and 3% for IFNb-1a-Avonex. NAb+ and NAb− patients showed reductions from baseline in relapse rate over the 3-year follow-up period. However, this reduction was not significant in NAb+ patients P = but was significant P < 0.0001) in NAb− In the relapse rate was significantly (P = and the time between first and relapse was significantly vs. 21 P = in NAb+ compared with The of was significantly lower (P = in NAb+ than in NAb− A significantly of NAb+ patients had of Expanded Disability Status Scale during follow-up (P = Results of this study, by that be considered in patients with continued relapses or despite therapy with IFNb is in the of for in of the with in and and is considered a risk for The of to MS risk and disease Patients with MS (n = and ON (n = in were examined for as as Expanded Disability Status Scale disease and disease of the were to those found in the but patients with the and MS for less than years had significantly greater of disease than did those who that may be among the factors that neurologic prognosis in patients with ON and MS Denmark, to of the is a of MS. patients who an of of and visual demonstrated significant improvement in as by the as compared with a group (n = that an of patients who the demonstrated improvement compared with results of this study that of are not only in patients with but also in patients with MS and other of the Buffalo, New York, is an inflammatory demyelinating disease by of the optic and spinal A cerebral spinal fluid in patients, MS patients, and that a immune in the cerebral spinal fluid of patients with of and of were factors more with than MS or The potential for these findings in the of to be studies demonstrated potential for as as of 1 and 2 in the cerebral spinal fluid of patients with R, The known of immune in and MS a for at The and tolerability of a that to was in patients with and MS patients with infusions of weekly for 4 were to 0, and were with recovery of the to and improvement of visual acuity in two of These results a potential for in patients with and MS with a are to the and efficacy of this new therapy in MS San OPTIC In by is to a in of a that was shown to of and of optic in a of is also a of optic atrophy patients with this have a in the with of and A study the of in the of in R, these studies a potential future for therapy in patients with optic In to the three most that in patients with are in cases and in cases in which known are not have reported within the of the a point that an within the In these a change was in of and in a with six of these patients were for known from this that the a to for in patients and with that may be for M, of the by which in to in is important in potential for groups in showed that in and that the by in on a of in than with at and demonstrated that of may be more than previously in the of In from six patients with the potential of that on the The for this study was on the the of the in only of and of with the three most additional or factors as are to be important of on these that or effects of or that potential for in and other The and of future to be A of cases of optic studied the of neurologic and There were and with with with and with patients had or There was a clinical neurologic in of patients and of patients and abnormalities in of patients was present in cerebral in and in Of patients with imaging had with of the or white or with of the with and with is as a of in patients with of clinical findings in these patients, to between the of of A of patients, examined during or after an acute demonstrated the of in the of acute or Although clinical of the were showed consistent suggesting a that were from of patients with is a for into the of were from a study of two patients who a The first had in to and with of 1 studies during the showed in the on from the the of the on MRI, and of the contrast material in the of the on The findings with the clinical The who had with and as a studies that showed in the cerebral on of the cerebral on and of the cerebral spinal fluid in the of the on delayed recovery 2 hours after The authors that from the with may the of recovery or the of in patients with A study of patients in found that were were were and were The most was isolated of patients were Detroit, Michigan, The of 20 patients of a of were compared with the other who did have were were and had compared with those with the patients had fewer visual and acuity was in both visual showed in both but there were more visual in those to be lower in vs. P < patients with visual from were were with a of 23 years. Six were and was had had as an initial and of from acuity was 20/200 or worse in at at initial had visual and patients at and were treated with to early in the course with of visual despite optic in in or improved in patients but were not The authors that alone may be and that may be indicated to M, In of an treatment baseline and 6-month follow-up was on patients with at multiple at was 30 years were were and 13% were were visual visual or other had visual acuity worse than at baseline and 24 had visual acuity worse than at visual were found in of at baseline and of at The at baseline was and the was significantly improved at and (P = There was a between the at baseline and at follow-up = for and = for New York, A compared patients with treated with or to patients with that was not treatment increased the risk of and acute clinical compared with no lesion in a 5-year risk of to that of untreated The authors that their findings support the for a randomized trial for treatment of brain New York, New York, is that by are not with In a from the of five in a 5-year six patients were with by of of or within the of or in most cases and the outcome was The To the of and a prospective cohort study of participating in the Study was performed. and were as but incidence of and was after an of years of and 4 occurred. with who reported had no increased risk for or who reported with had a significant increase in risk for with an of interval [CI]: for the and and for who were than years had the increased risk of and There was no increase in the risk of among with a reported of any was not with an increased risk of and alone or alone that with is with an increase in and and among and are not with increased risk of with was not with an increased risk of To determine the of for of compared with two in consecutive and patients who had both studies over a period. a and were in in of The value of a less than was of by as greater than were found to be less than by was by to The authors appropriately that is a for significant and be in the initial of SA, San In a of at showed that in a or significantly decreased O, To assess whether disease consisting of or was with or follow-up of to years who in the and was Of the had baseline disease on an of years of the rate of was 35% in patients with disease and in patients After for differences in serum and the risk of was increased in with disease risk The and risk of and was among with disease A study of 90 consecutive cases with isolated from was with a median follow-up of 2 years. was in 8 and in After onset of the risk of and was and the risk of alone was cerebral within the first days and 36% within the first 24 patients with had was a trial of patients with and at risk who were randomized to treatment with oral mg or The were and oral was found to be at as as in of and and was with less the results of the earlier open-label III This the and to patients does not have to be followed Patients with for A that elevated levels of may be with is an fraction and demonstrated in patients with and levels of were in of patients with but five of these patients also had and for the These results that of be to the in patients with and other of this may a potential for therapy with to A study of patients with cerebral and 90 levels of and after and of the was also performed. of and levels were with an increased risk of cerebral in this whose and may be Although there was a incidence of in cerebral patients vs. the difference did not is the most of studies have shown during studies of for were In the first study, patients 2 years, received a follow-up of patients were and three had more than reduction in In the was and the time of of to was days The authors concluded that of the is an and treatment of M, A study of for included five patients of five patients experienced which after a follow-up of 8 months. experienced two relapses that be by and but was by In the two patients, were by or and The had a 4 hours after the a that this is not M, with and is a of per a are experienced the first of the and are by as and on to and a previous of MRI a with received brain months after the was M, open-label trial of in the treatment of and was of patients with after days, two had an reduction of and two did not at of patients with were days after the the had at The reported in the three first days, with a reduction of after 21 days Results of this study that may be in the treatment of There have previous of to an in the A who had to per day 1 to 2 have and and between was A enlarging lesion was The and a lesion was was but was not performed on the lesions Although patients with not the manifestations of and and may be are known to clinical improvement in patients with but their efficacy as compared with for not A of clinical from patients who received oral prednisone with taper) or with dose as in a showed a significant benefit for in reducing and The proportion of patients in decreased within 1 of treatment from to in the prednisone group; this was for at 2 years in of The group, in in in at baseline and in at 1 therapy also demonstrated significantly more than did Although patients in this study were not randomized to treatment the results in support of future randomized to tolerability and efficacy of in patients with The potential for to or the onset of in patients also be in M, New York, New York, In contrast to previous a study found that only of patients to be is a that is in during the development of the patients were and were and with or of these patients experienced and had showed to despite patients had only decreased and two of six had immune at the which was than that of the on these the authors that the of may be a of that a group of from in or at the patients have but in the have shown to be an additional with two and patients were with and with had from or and were with patients did not have but (n = (n = and during early (n = had between and improvement in (n = to was in those with but in the group. A of less than on at 2 to 3 in at was demonstrated in of 13 patients with but only in 4 of in the group. Although both in differences are are with in a to and is with a to and less The authors that of these and of treatment in be London, Ontario, Canada, in the the 2 with and other and A of the at was described cases were reported of 2 a new to a to and for a The disease with and between 16 and 19 in was showed an and MRI atrophy M, In and accounted for to of patients with There were five in and in was by an early of onset with brain atrophy on MRI, at onset and that to neurologic in the of the was by a at onset less and less as as were to these Although is a of both differences in the at onset, as as the and of and between and A of cases of atrophy in was five percent had groups with findings were 2 patients of had with and in cases of 7 of had and decreased visual acuity San A study patients to those with and 2 was performed. Although these patients have a of only patients have This was with significant atrophy of the in three groups had atrophy of the The visual and of patients with disease were There were and six between 24 and years of visual and was there was although occurred. also showed and decreased peak showed during which had of was present both and but was not during There was decreased and and were and there was no patients with a MRI lesion whose was for clinical course was also consistent with disease A study of by in disease was was significantly in the of patients than in P = the the was the as compared with (P = followed by the (P = The was (P was not with disease or This be for follow-up of R, The for in patients with is not A study demonstrated that abnormalities of visual contrast may to the of and that a to visual in the visual may an important findings of visual contrast at and may of in the visual and other in patients with disease with is a described clinical The first was and showed the but also of in the the of the This may be to other These are patients previous or to the M, to the to the of a in the of that may be by a to a new in the of a This was to had this a of a In a study of and 8 to 19 years, had MS, Ontario, Canada, To support their that isolated and are a group of performed on three of a with There was a in the number and of in the with small with or was not The were developed and no abnormalities of the and were In is known to have of the the and other brain abnormalities The The same group reported of the on MRI in six patients with despite This that other be the The To assess the efficacy of the patients with were studied. Of patients who were followed-up for an of had recovery M, by is with disease as and cases with were is an by an acute or with HLA were not in of the and at the time of in showed and of in the and consistent with a immune San The of is in neurologic A with more findings to this and a in was in a included a of with had with and had a more than of the of a the of may be by other in the A was experienced in their and in their early of individuals had of and per and a of and showed a of in the and A of with was by a and who had a of this described for the first days after the visual and on during the prescribed increased and to a improved from day to after the with of Boston, Massachusetts, In an to determine whether an be to five were to be while the Although abnormalities were disease of of

Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.