News in brief: Anhedonia in FTD; Treatment options for MS in pregnancy; Epilepsy drugs and bone health

Neurodegenerative disorders

19 Apr 2021

Profound anhedonia a feature of FTD

Anhedonia should be considered as a primary presenting feature in patients with behavioural variant frontotemporal dementia (FTD),  Australian research suggests.

Sydney University researchers found clinically significant anhedonia in a group of 87 patients with FTD,  but not in comparable patients with Alzheimers disease or healthy controls

The researchers from the university’s Brain and Mind Centre also found marked atrophy in frontal and striatal areas of the brain related to diminished reward-seeking, in patients with frontotemporal dementia (FTD).

The paper’s senior author, Professor Muireann Irish from the University of Sydney’s Brain and Mind Centre and School of Psychology in the Faculty of Science, said despite increasing evidence of motivational disturbances, no study had previously explored the capacity to experience pleasure in people with FTD.

“This has stark implications for the wellbeing of people affected by these neurodegenerative disorders, she said.

The findings are published in Brain.

Epilepsy drugs may impact bone health

Children with epilepsy treated with anti-epilepsy drugs (AEDs) have a three-fold higher fracture prevalence than their healthy siblings, an Australian study has shown.

Data from 133 children with epilepsy (average age 11 years old) and 128 siblings of similar age found that there were 49 non-seizure-related fractures in children taking AEDs, compared with 21 lifetime fractures in the sibling control group, giving a 2.7 (95% CI 1.3–5.3, p = 0.007) times greater fracture prevalence. Duration of AED use and generalised tonic–clonic seizures (GTCS) were independent predictors of fractures (Odds Ratios 1.55 and 2.50, respectively).

The researchers led by Dr Sunita Kumar and Dr Peter Simm of the Department of Endocrinology and Diabetes, Royal Children’s Hospital, Melbourne, said further longitudinal prospective studies were required to further explore risk and the direct impact of epilepsy on bone health.

Kidney disease affects stroke risk prediction 

The Modified CHADS2 score to estimate risk of ischaemic stroke (IS) in AF patients has the best, most consistent discrimination and calibration across the spectrum of kidney function.

Six commonly used risk scores for stroke were externally validated in a Swedish cohort study of 36,004 patients with AF.

Although most risk scores showed moderate to good discrimination in patients with normal kidney function, the predictive performance of the majority of risk scores was poor in the most clinically relevant stages of CKD.

The researchers said this poor performance increases the risk of misclassification and of over- or undertreatment.

“Underprediction of IS risk, when weighed with bleeding risk, will result in less patients being treated with anticoagulation and consequently, an increased IS incidence, while overprediction will result in overtreatment and increased bleeding incidence.”

“These findings can inform the choice of risk scores in clinical practice, particularly in patients with mild to severe forms of CKD, which have not always been considered when these scores were developed,” they concluded.

European Heart Journal

MS treatments and pregnancy: new recommendations

Treatment recommendations for women with MS who are planning pregnancy have been published by a group of international experts including Australian specialists.

The recommendations, co-authored by Dr Vilija Jokubaitis of the Department of Neurology, Alfred Health, Melbourne, note that  observational data support the safety of injectable DMTs (glatiramer acetate, interferon-beta) for use in pregnancy, while some oral DMTs might be associated with fetal risk.

Monoclonal antibodies (mAbs) before pregnancy such as rituximab or natalizumab likely do not pose significant fetal risks, but can cross the placenta with neonatal haematological abnormalities if given in the second trimester or later. likely have low transfer into breastmilk.

They recommend that for women with highly active MS, cell-depleting therapies could be given before conception, or natalizumab could be continued through pregnancy, with monitoring of the fetus. Women should be encouraged to breastfeed, and those with higher relapse risk could consider injectables or mAbs while breastfeeding.

The guidance is published in Current Treatment Options in Neurology.

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