RapidAI Detects ICH With High Accuracy, Fenfluramine Plasma Levels Low, Nerivio More Effective With Behavioral Intervention

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This week Neurology News Network covered 2 abstracts from ISC 2022 on RapidAI and its ability to detect intracranial hemorrhage, the plasma concentration levels of fenfluramine, and why acute migraine treatment with the Nerivio REN device is improved with a behavioral intervention.

Welcome to this special edition of Neurology News Network. I’m Marco Meglio.

RapidAI, a telehealth software designed to improve clinical decision making and patient workflow, showed relatively high sensitivity and very high specificity in detecting intracranial hemorrhage (ICH), as well as demonstrated high accuracy in detecting high grade stenosis (HGS) and large vessel occlusion (LVO). These findings were presented at the 2022 International Stroke Conference. Of the 2 abstracts presented, the first included data from a study of 1388 patients, 1251 from the emergency department (ED) and 137 inpatients (IP) who received head CTs on the ED scanner at a level 1 trauma center. Rapid ICH, an imaging tool derived from RapidAI, was accessed by initial interpreting emergency radiologists or neuroradiologists. Each case was reviewed by a board certified neuroradiologist who had access to their initial report Rapid ICH output, and prior exams. If there was a disagreement between readers, a third reader adjundicated the result and their decision was considered final. Rapid ICH showed an overall sensitivity of 79%, overall specificity of 95%, overall positive predictive value of 76% and overall negative predictive value of 96%.

Venous blood samples collected from patients treated with fenfluramine (Fintepla; Zogenix), an FDA-approved antiseizure medication (ASM), showed that most plasma concentration levels are in the lower range (<50 µg/L), although a high interpatient and intrapatient variability was present. The study aimed at understanding more about the plasma concentration and pharmacokinetic variability of fenfluramine and its main active metabolite norfenfluramine (norFFA) in relation to the prevalence of adverse events (AE) in patients with refractory epilepsy treated with the medication. Investigators found that patients were using fenfluramine for a mean daily dose of 0.33 mg/kg/day (SD, 0.16), with median plasma concentrations of 41.4 µg/L (range, 5.1-712.5) and median norFFA concentration of 28.1 µg/L.

By combining the Nerivio remote electrical neuromodulation (REN) device with Nerivio’s Guided Imagery, Education and Relaxation (GIER) optional in-app behavioral intervention, a higher proportion of patients achieved consistent pain relief and improvement of their acute migraine compared with those on REN treatment alone. The dual-arm study, published in Pain Medicine, examined 85 patients with migraine at least 18 years of age who treated their attacks with REN in parallel with the GIER intervention (REN+GIER) and individually matched them on age and sex with 85 patients who used REN alone. At 2 hours post-treatment, the REN+GIER group displayed statistically significantly higher proportion of patients achieving consistent pain relief (P = .008), consistent improvement in function (P = .014), and consistent return to normal function (P = .005) than the REN-only group.

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