WASHINGTON — The FDA has approved the restless legs syndrome drug gabapentin enacarbil (Horizant) to treat postherpetic neuralgia.

The drug is administered in one 600 mg dose for the first 3 days of treatment, followed by 600 mg doses twice daily on day four and onward, a statement from makers GlaxoSmithKline and XenoPort said.

Patients with renal impairment should have adjusted doses, the statement added.

Safety and efficacy for the new indication were evaluated in a 12-week principal efficacy trial and two supportive studies of a combined 574 patients.

Adverse events in the studies included somnolence, dizziness, headache, nausea, and fatigue.

Patients taking anti-epileptic drugs, including other gabapentin formulations, may be at increased risk for suicidal ideation and behavior, as well as potentially fatal multi-organ hypersensitivity, symptoms of which include fever, rash, and lymphadenopathy.

The drug should be tapered to once daily for a week before ceasing treatment to reduce risk of withdrawal seizure, the statement said.

The drug was initially approved for the treatment of moderate-to-severe primary restless legs syndrome in April 2011.

New criteria for the diagnosis of multiple sclerosis (MS) were published as the result of an internationally formed committee. To increase the specificity of diagnosis and to minimize the number of false diagnoses, the committee recommended the use of both clinical and paraclinical criteria, the latter involving information obtained from magnetic resonance imaging, evoked potentials, and cerebrospinal fluid (CSF) analysis. Although rigorous magnetic resonance imaging requirements were provided, the “new criteria paper” fell short in terms of guidelines as to how the CSF analysis should be performed and simply equated the IgG index with isoelectric focusing, without any justification. The spectrum of parameters analyzed and methods for CSF analysis differ worldwide and often yield variable results in terms of sensitivity, specificity, accuracy, and reliability, with no decided “optimal” CSF test for the diagnosis of MS. To address this question specifically, an international panel of experts in MS and CSF diagnostic techniques was convened and the result was this article, representing a consensus of all the participants. These recommendations for establishing a standard for the evaluation of CSF in patients suspected of having MS should greatly complement the new criteria in ensuring that a correct diagnosis of MS is being made.… [Continue Reading]

Which Foods Are Best for the Brain?

Diet is inextricably linked to conditions such as heart disease, obesity, and diabetes. However, what we consume also seems to have significant implications for the brain: Unhealthy diets may increase risk for psychiatric and neurologic conditions, such as depression and dementia, whereas healthy diets may be protective. Based primarily on recent Medscape News coverage, the following slideshow collects some of the more prominent investigations on nutrition and the brain into a single resource to aid in counseling your patients.

Make for Malta in Depression, Stroke, and Dementia

A 2009 study published in Archives of General Psychiatry found that people who follow Mediterranean dietary patterns — that is, a diet high in fruits, vegetables, nuts, whole grains, fish, and unsaturated fat (common in olive and other plant oils) — are up to 30% less likely to develop depression than those who typically consume meatier, dairy-heavy fare.[1] The olive oil-inclined also show a lower risk for ischemic stroke[2,3] and are less likely to develop mild cognitive impairment and Alzheimer disease, particularly when they engage in higher levels of physical activity.… [Continue Reading]

Results of a randomized trial confirm that treatment with amantadine can accelerate functional recovery among patients in vegetative or minimally conscious states after a traumatic brain injury (TBI).

Compared with placebo, amantadine effectively accelerated the pace of recovery of cognitively mediated behaviors, such as recognition of objects or verbalization, activities that form the foundation for functional independence, the researchers report. At week 4, more patients in the amantadine than the placebo group had recovery of all 6 behaviors.

“I do think this is going to influence practice,” lead author Joseph T. Giacino, PhD, from the Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts, told Medscape Medical News. “This is first time we have convincing evidence in a Class I study, for any treatment — at all — for brain injury.”… [Continue Reading]

For patients with drug-resistant temporal lobe epilepsy, surgery soon after failure of 2 antiepileptic drug (AED) trials is more effective than continued medical management in controlling seizures and improving quality of life, according to results of the Early Randomized Surgical Epilepsy Trial (ERSET).

“Despite reported success, surgery for pharmacoresistant seizures is often seen as a last resort,” the study team notes in a new report published March 7 in the Journal of the American Medical Association. “Patients are typically referred for surgery after 20 years of seizures, often too late to avoid significant disability and premature death.”… [Continue Reading]