Risk Factors Identified for Posttraumatic Seizures, Acupuncture Benefits in Insomnia, Erenumab Improves Migraine in Patients Unresponsive to Prophylactics

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This week Neurology News Network covered a study on severe TBI and factors associated with posttraumatic seizures, as well as the benefits of acupuncture in primary insomnia, and the use of erenumab in patients with prior prophylactic failures.

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

Newly published data from a large cohort study identified multiple clinical risk factors of traumatic brain injury (TBI) that may be used to predict early posttraumatic seizures (EPS), specifically the presence of prior medical comorbidities, subarachnoid hemorrhage (SAH) and subdural hemorrhage (SDH), and injury severity.In addition to these risk factors, investigators concluded that EPS were associated with significant in-hospital mortality, poorer outcomes, and subsequent risk of mortality at 24 months on follow-up Glasgow Outcome Scale-Extended (GOS-E) score. In total, the long-term mortality rate was 14% (n = 1658) for the group of patients without EPS and 24% (n = 76) for patients who had EPS. "Identifying patients at high risk of developing EPS may allow a precision medicine diagnostic approach, focusing management strategies and targeting clinical trials of antiepileptogenic therapies," the study authors concluded.

Multiple acupuncture therapies, especially acupoints catgut embedding (ACE), auricular acupuncture plus manual acupuncture (AP + MA), and electroacupuncture plus acupoint application (EA + APA) may benefit patients with primary insomnia (PI), a recent meta-analysis suggests. With moderate to low certainty of evidence, investigators found better effects on Pittsburgh Sleep Quality Index (PSQI) scores for acupuncture-treated patients compared with those on usual treatment. Additionally, with low or very low certainty of evidence, there were small or insignificant differences between the several therapies evaluated. Due to the sparse data and heterogeneity, investigators did not perform meta-analysis for adverse events (AEs); however, they did summarize the incidence of what was observed among a larger cohort of 22 RCTs enrolling 3382 participants. Of these, the most common AEs from acupuncture interventions included hematoma, pain, headache, and bleeding. No serious AEs related to acupuncture were observed, leaving the study investigators to conclude that “the safety of acupuncture is reliable."

Real-world data from the MAGIC study suggest that, when administered in patients with chronic (CM) and episodic (EM) migraine who experienced repeated ineffective prophylactic migraine therapy, erenumab (Aimovig; Amgen) treatment was safe and resulted in at least 50% reduction in monthly migraine days (MMD) in more than one-third of the cohort. MAGIC was a prospective, open-label, observational study that assessed the real-world effectiveness of erenumab, a calcitonin gene-related peptide (CGRP) targeting therapy, in Canadian patients with migraine. In the study, participants received 70 mg or 140 mg of erenumab monthly based on physicians’ assessment and recorded migraine attacks using an electronic diary. In total, 89 individuals (93.7%) initiated erenumab at 140 mg. In the primary outcome analysis, 32 participants (33.7%) experienced a reduction of at least 50% in MMD at the end of the 12-week treatment period. This reduction was similar to other randomized controlled trials, including the STR1VE trial (NCT0245670; 70 mg: 41.3%; 140 mg: 48.1%) and was higher than that reported in the LIBERTY trial.

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