Large volume anesthetic suboccipital nerve blocks show potential as a treatment option for patients suffering from refractory chronic cluster headache, according to an observational case series study published in Headache.
For this 7-year retrospective study, the researchers followed 10 patients (9 men and 1 woman) who did not respond to treatment for their chronic cluster headaches. During this period, patients were injected at least twice with a solution of 9 ml of 1% lidocaine and 1 ml of triamcinolone 40 mg into the suboccipital fossa. A complete response to the treatments was defined as no cluster headache, and a partial response was defined as either fewer seizures, lower intensity seizures, or shorter lasting seizures.
Complete responses were seen in 9 patients with relief occurring in less than 24 hours. One patient showed no reaction. In responders, the mean duration of response was 10.3 weeks (mean range = 1.5 to 31 weeks), with 2 patients experiencing pain relief for 44 weeks. The patient’s reaction time was very constant after each injection and only varied up to 7 days. Serial injections improved the quality of life for many patients. The woman in the study had a long period of remission and as the study progressed her headache turned into episodic cluster headaches. One participant who received the most injections developed avascular necrosis and the causal relationship with the suboccipital injections was not established. The rest of the participants did not see any serious adverse events and doctors only noted a slight loss of bone at the injection site.
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Future studies will need a standard protocol for describing pain and assessing whether corticosteroids are needed for relief in addition to the block, or whether the anesthetic block alone is effective.
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In summary, it was shown that patients with chronic cluster headaches in the cafeteria found reliable pain relief through high-volume suboccipital nerve blocks over a long-term follow-up period.
The author did not identify any conflicts of interest.
reference
Rozen, TD. High anesthetic suboccipital nerve blocks for the treatment of refractory chronic cluster headaches with long-term efficacy data: an observational case series study. [published online August 24, 2018]. Headache. doi: 10.1111 / head.13394
Patients with geographic atrophy due to age-related macular degeneration (AMD) can potentially benefit from monthly or bi-monthly intravitreal pegcetacoplan, an investigational C3-targeted inhibitor, to control lesion growth, according to a paper presented at the American Academy of Ophthalmology Annual Meeting 2021, November 12-15, 2021 in New Orleans.
In geographic atrophy, lesion growth is irreversible. Researchers believe that pegcetacoplan, an investigational therapy that targets the complement overactivation that creates the progression of geographic atrophy, may prevent lesion growth and reduce the likelihood of serious illness.
The aim of the research was to evaluate the efficacy and safety of intravitreal pegacetacoplan in geographic atrophy from the 24-month Phase 3 clinical trials DERBY (ClinicalTrials.gov Identifier: NCT03525613) and OAKS (ClinicalTrials.gov Identifier: NCT03525600).
DERBY and OAKS were two randomized, double-blind, sham-controlled clinical trials that compared the efficacy and safety of monthly or bi-monthly intravitreal pegacetacoplan with sham in this patient population. Enrollment was completed for DERBY in June 2020 and July 2020 for OAKS. The studies included patients (DERBY, N = 621; OAKS, N = 638) who were at least 60 years old, a best-corrected visual acuity of 24 letters or better, and a geographic atrophy area between 2.5 and 17.5 mm² or 1 focus lesion 1.25. showed mm² with multifocal geographic atrophy at baseline.
Fundus autofluorescence change in lesion size in geographic atrophy from baseline to month 12 was the primary endpoint for both studies. Secondary endpoints included change in visual function from baseline. Safety was measured by the frequency of ocular and systemic adverse events.
The researchers shared their results of the 12-month efficacy and safety data in both phase 3 studies at the American Academy of Ophthalmology’s annual 2021 meeting on Monday, November 15.
“Pegcetacoplan is the only C3 targeted inhibitor being studied in patients to control lesion growth in GA [geographic trophy]“Reported moderators.
According to study results published in Lancet Neurology, about a third of patients with herpes simplex encephalitis will develop autoimmune encephalitis within 3 months of completing antiviral treatment. Age appears to be related to neurological symptoms, immunotherapy response, and long-term outcome in these patients, with older patients having poorer outcomes compared to younger patients.
Researchers included patients with clinically confirmed herpes simplex encephalitis who were treated in 19 secondary and tertiary centers in Spain (n = 54). The patients were followed up for up to 2 months, 6 months and 12 months after the onset of the disease. In another cohort, the researchers retrospectively included patients who developed autoimmune encephalitis after herpes (n = 51). Clinical and demographic characteristics were compared between patients who developed autoimmune encephalitis and those who did not. The comparisons were also stratified by age, with patients 4 versus patients> 4 years old. In the retrospective cohort, risk factors for autoimmune encephalitis after herpes were also examined.
In the retrospective cohort, a total of 14 patients (27%) developed autoimmune encephalitis after herpes simplex encephalitis, 100% of these patients exhibiting neuronal antibodies at or before the onset of symptoms. Of the remaining 37 patients who did not develop autoimmune encephalitis, a total of 11 (30%) patients had antibodies to NMDAR (n = 3) or unknown antigens (n = 8) (P <0.001).
A significant risk factor for autoimmune encephalitis was the detection of antibodies within a 3-week period of herpes simplex encephalitis (odds ratio [OR] 11.5; 95% CI, 2.7-48.8; P. <.001). Patients age ≤4 were significantly more likely to experience a shorter median of days between herpes onset and autoimmune encephalitis onset when compared with patients age >4 (26 days) [interquartile range 24-32] vs 43 days [interquartile range 25-54], respectively; P = 0.0073). In addition, people aged ≤ 4 years were more likely to have choreoathetosis (27 [100%] of 27 and 0 of 31, respectively; P <.001), decreased level of consciousness (96% vs. 23%; P <.001), NMDAR antibodies (89% vs. 61%; p = .033) and significantly worse 1-year result (median modified Rankin Scale 4 [IQR 4-4] against 2 [2-3], respectively; P <0.0010; Seizures 63% and 13% respectively; P = 0.001) compared to patients <4 years of age.
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Limitations of the analysis include the relatively small number of patients in each cohort and the use of a clinic-based questionnaire to obtain retrospective data for any of the cohorts.
“Autoimmune encephalitis should be given strong consideration in patients who develop new neurological or psychiatric symptoms characterized by choreoathetosis in younger children,” the researchers wrote, “and in older children and adults with cognitive and behavioral disorders or psychoses. “
reference
Armangue T, Spatola M, Vlagea A, et al. Frequency, symptoms, risk factors, and outcomes of autoimmune encephalitis after herpes simplex encephalitis: a prospective observational study and retrospective analysis [published online July 23, 2018]. Lancet Neurol. doi: 10.1016 / S1474-4422 (18) 30244-8
reference
RP Singh, NC Steinle, DS Boyer et al. Efficacy and Safety of Intravitreal Pegcetacoplan in GA: Results from Phase 3 DERBY and OAKS studies. Presentation at the American Academy of Ophthalmology Annual Meeting 2021; 12-15 November 2021; New Orleans. Summary PA064.
This article originally appeared on Ophthalmology Advisor
