Risk of persistent disability falls by 50-70% in paediatric onset MS 

The risk of developing persistent disability following a multiple sclerosis diagnosis in childhood  has more than halved with greater availability and earlier use of the newer disease-modifying therapies (DMTs), suggests new international research.

In the largest paediatric onset Multiple Sclerosis (POMS) cohort analysis, including more than 3000 patients, researchers from the Multiple Sclerosis Center, Gallarate Hospital in Italy compared time to reach disability milestones in POM patients from 1993 to 2013.

Investigators say the gradual decrease of disability risk of between 50-70% corresponded to an increased use of DMTs over time, especially the most efficacious agents like natalizumab and fingolimod.

They also note that patients with POMS diagnosed in more recent time periods were started on DMTs earlier and continued taking the agents longer compared with the past.

Investigators say the findings suggest improvement of POMS prognosis “probably depends on changing therapeutic standards in MS”.

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Stroke location impact score predicts risk of long term cognitive impairment 

The first comprehensive map of strategic infarct locations predicting risk of post stroke cognitive impairment (PSCI) has been established, according to findings from a large multi cohort study.

Investigators from the international investigation, led by Professor Weaver and colleagues from the Utrecht Brain Center in the Netherlands, carried out a detailed analysis of imaging findings from 2950 patients, 1286 (43·6%) of who were found to have PSCI. They found that infarcts in the left frontotemporal lobes, left thalamus, and right parietal lobe were strongly associated with cognitive impairment, findings confirmed by computer analyses.

Investigators derived a validated location impact score from the map that robustly predicted PSCI across cohorts. The team also developed what they say is a ‘quick and reliable’ visual rating scale that might in the future be applied by clinicians to help identify
patients who should undergo cognitive assessment, and early intervention with rehabilitative treatment strategies.

Commenting on the paper in a linked editorial Professor Leonardo Pantoni from the University of Milan said the study provides a ‘substantial contribution in advancing current knowledge about the relevance of lesion location for PSCI. He also noted that other, potential early, predictors should also be considered. For instance, a brief cognitive examination in the stroke unit in the acute phase after the event can predict a medium-term diagnosis of cognitive impairment and at low cost, he said.

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Opioid prescribing falls after doctors sent warning letters

A controversial Department of Health initiative has had modest success in curbing opioid use by sending warning  letters to high prescribing GPs. In June 2018, letters were sent to 4,679 GPs in the top 20% of prescribers of opioids. Their prescribing rate over the following 12 months fell 4% compared with a control group of 1,178 similarly high prescribers of opioids, who did not receive the letter. The intervention had significant effect on reducing prescribing of oxycodone – by 5.6% – but the impact was not seen among GPs in rural and regional areas. The developers of the program said it supported guidelines against the use of opioids for non-cancer chronic pain.