Remote Ischemic Conditioning Improves Post Stroke Outcomes, Opiate Use High in Idiopathic Intracranial Hypertension, Drug Resistant Epilepsy and Increased Mortality

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

Findings from the RICAMIS trial of adults with acute ischemic stroke demonstrated that treatment with remote ischemic conditioning significantly improved the odds patients achieved excellent functional outcomes at 90 days. Following treatment, the proportion of patients with a modified Rankin Scale (mRS) score of 0 to 1, considered excellent functional outcome, was 67.4% in the RIC group and 62.0% in the control group, yielding an unadjusted odds ratio of 1.27 and risk ratio of 1.17. RIC was also shown to be safe, as indicated by a similar proportion of patients who experienced adverse events (6.8%) relative to the control group (5.6%).On secondary outcomes, 79.6% of patients in the RIC group had mRS score of 0 to 2 within 90 days, compared with 75.5% in the control group, yielding an unadjusted OR of 1.20 and an adjusted OR of 1.22. All other secondary outcomes, which included early neurologic deterioration within 7 days, stroke-associated pneumonia within 12 days, change in National Institute of Health Stroke Scale (NIHSS) score at day 12, stroke or other vascular events within 90 days, and death within 90 days, were not significant.

Cross-sectional analyses from a population-based, retrospective cohort study showed that women with idiopathic intracranial hypertension (IIH) were more likely to be prescribed opiate compared with migraine or population controls. All told, these data may point towards a refractory nature of IIH headache.The analysis included data on 3411 women with IIH, 13,966 women with migraine as controls, and 33,495 population controls from 1995 to 2019. Considered the largest national study of its kind, the findings showed that twice as many women with IIH were prescribed opiates compared with migraine controls and 3 times as many women with IIH were prescribed opiates compared with population controls. Similar odds were observed for prescribing preventive drugs in women with IIH relative to the other groups. Senior investigator Alexandra J. Sinclair, PhD, and colleagues concluded that these findings are a “major concern,” adding that, "there are likely to be multiple contributing factors, including the major burden of headache these patients experience. However, the consequences of such dominant opiate use in IIH are likely to be extensive and contribute to the poor quality of life that has previously been noted."

According to data from an observational cohort study, US veterans with drug-resistant epilepsy (DRE) have higher rates of mortality than the general population, prompting the critical need for appropriate management of DRE in this population. Although used sparingly, those who did utilize comprehensive epilepsy care and diagnostic services had reduced mortality.The standardized mortality rate (SMR) for individuals with DRE compared with the general US population data was 1.50, with female individuals having higher mortality than male individuals. Furthermore, the SMR for individuals with DRE compared with a cohort of all veterans in Veterans Health Administration (VHA) data was found to be even higher, at 1.56. Most patients with DRE had been seen by a neurology specialist; however, only 15% of those were seen within an Epilepsy Center of Excellence (ECoE) and only 6% had an epilepsy monitoring study. Slightly less than half of the patients had EEG performed and about two-third of the cohort had MRI.

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