VOL. 23 • NO. 2 • JULY 2008 World Neurology THE OFFICIAL NEWSLETTER OF THE WORLD FEDERATION OF NEUROLOGY Welcome to the New WORLD NEUROLOGY! INSIDE From Germany: tarting with this is- scientific advances. What view of a brief, little-known top- As the German sue, WORLD NEUROL- interests you may well in- ic of interest in clinical neurolo- Society for Neurology SOGY will have new terest others. gy. The first installment is on turns 100, a look content and a new look. As In this inaugural issue, the Ramsay Hunt syndromes. back on the history the newsletter of the World you will find some new fea- Can you describe all four with- of the specialty in Federation of Neurology tures. One of these is “Pro- out cheating? Deutschland. PAGE 8 (WFN), WORLD NEUROLO- files in Neurology.” In it, I We also will publish cases. GY is the only publication hope to spotlight different Some of these may be disorders going to all neurologists in medical care practices from that are seen only in certain parts the world. around the world, giving of the world or that are more The newsletter will con- one neurologist his or her common in particular places. From Brazil: tinue to feature news from chance at “fifteen minutes Others may be rare but important EWS A case series of N the WFN. However, the of fame,” as the expression to keep in mind. So send in your dengue fever shows new version will have other goes. I am grateful to Dr. suggestions! EDICAL why neurologists content of interest to neu- M Rawiphan Witoonpanich We expect that cases, as well as should be wary rologists, including some of Mahidol University, the other articles, will be illus- LOBAL of this infectious neurology news, and will G Bangkok (Thailand), for trated with photographs or oth- disease. PAGE 10 be published by Elsevier. starring in the first of er images—an interesting MRI, LSEVIER We are all grateful to Prof. E these. for example. And with all articles, Jagjit Chopra, who has New WORLD NEUROLOGY editor in chief Dr. We’re also interested in we will want to have a photo- done a spectacular job of Mark Hallett plans to revamp the newsletter. news from the National So- graph of you, too. editing WORLD NEUROLOGY cieties that make up the WORLD NEUROLOGY should be a From Thailand: for the past decade. Neurophysiology. Presently, I WFN. For example, the German useful and educational newsletter. Dr. Rawiphan So who am I? I am a neurolo- served as an associate editor for Society just celebrated its 100th Send your feedback and ideas to Witoonpanich gist at the National Institute of the journal Brain as well as for a anniversary. In this issue, Dr. [email protected]. writes about her Neurological Disorders and new journal, Brain Stimulation. Günther Deuschl and his col- Let’s keep each other informed practice in Thailand, Stroke, at the National Institutes Although I hope to assemble leagues present a brief history of and knowledgeable, so we can home of the 2009 of Health in Bethesda, Md., an editorial board to help me in the society. We will highlight oth- bring good neurologic practice to World Congress on where I do clinical research. My the coming months, as the new er national societies in upcoming our patients and have some fun Neurology. PAGE 12 interests are clinical neurophysi- medical editor, I will be looking issues. along the way. ology and movement disorders. I for input from everyone. So This issue also includes the Mark Hallett recently completed an 8-year please send in local news, or first “Neurologic Pearl.” This Editor in Chief term as editor in chief of Clinical news of interesting medical and column will give an in-depth World Neurology Oral Agent for Form of Multiple Sclerosis Shows Promise BY DOUG BRUNK Comi of the institute of experi- terview, “This is a first step in the study was the mean cumulative surprised the researchers, con- Elsevier Global Medical News mental neurology at the Vita- direction of identifying a therapy number of GdE lesions per scan sidering that the 0.3-mg dose Salute San Raffaele University, for use early in the course of mul- in the last four scans. demonstrated efficacy, compared atients with relapsing remit- Milan. tiple sclerosis which is convenient, The researchers reported that with placebo, in a previous study Pting multiple sclerosis who Developed by Teva Pharma- safe, and effective. Whether oral patients in the laquinimod 0.6 (Neurology 2005;64:987-91). took daily oral laquinimod over a ceutical Industries Ltd., laquini- laquinimod meets these charac- mg daily group demonstrated a One possible explanation could 36-week period achieved a 40% mod is an oral immunomodula- teristics remains to be seen.” 40% reduction in the mean num- be that the previous study used a reduction in gadolin- tory drug that is In a study conducted at 51 cen- ber of GdE lesions over the last triple dose of gadolinium, “which ium-enhancing le- believed to exert anti- ters in nine countries, Dr. Comi four scans, compared with those increases the harvest of active sions compared with inflammatory activity and his associates randomized in the placebo group (a mean of multiple sclerosis lesions by 60%, patients who took in the relapsing re- 102 patients with relapsing re- 2.6 vs 4.2, respectively). Patients and, as a consequence, increases placebo, according to mitting form of MS mitting multiple sclerosis to in the laquinimod 0.3 mg daily the statistical power of MRI- phase II trial results. by the Th1-Th2 shift. placebo, 98 to laquinimod 0.3 mg group had a mean number of monitored trials,” the researchers “Overall, the effi- To date, approved daily, and 106 to laquinimod 0.6 GdE lesions similar to the place- cacy and safety pro- drugs for MS are all mg daily for 36 weeks (Lancet bo group (3.9). The latter finding See Multiple Sclerosis • page 2 file emerging from injectable and in- 2008;37:2085-92). this and from a pre- clude glatiramer ac- Patients were aged 18-50 years vious phase II clini- DR. GIANCARLO etate, interferon-β, and underwent brain MRI and cal trial, in combina- COMI natalizumab, and mi- clinical assessments 4 weeks be- tion with the oral toxantrone. fore the study started, at baseline, route of administration, make Prof. Alastair Compston, head and then every 4 weeks for 9 laquinimod a promising thera- of the department of Clinical months. The researchers mea- peutic opportunity for patients Neurosciences at the University sured the number of gadolinium- with relapse remitting multiple of Cambridge (England), who enhancing (GdE) lesions at weeks sclerosis,” reported the re- was unaffiliated with the study, 12, 16, 20, 24, 28, 32, and 36. searchers, led by Dr. Giancarlo told WORLD NEUROLOGY in an in- The primary end point of the 2 • WORLD NEUROLOGY WWW.WFNEUROLOGY.ORG • JULY 2008 GdE Lesions In an accompanying editorial, Dr. B. Mark New Editor in Chief Keegan and Dr. Brian G. Weinshenker of the Fell 40% department of neurology at the Mayo Clinic, Mark Hallett Takes Over Rochester, Minn., noted that many patients Multiple Sclerosis • from page 1 would prefer an oral medication such as he process of reformatting world. WORLD NEUROLOGY will explained. “GdE lesions visible only on triple- laquinimod and recommended that a head-to- WORLD NEUROLOGY is over, serve as a support mechanism to a dose scans are usually smaller and with a less- head analysis of the drug with existing im- Tand the inaugural issue, which sense of solidarity, of knowing what severe blood-brain barrier dysfunction than munomodulatory medications be conducted you now hold in your hand, is the is going on in neurology every- those enhanced after a standard dose.” (Lancet 2008;37:2059-60). They also called for new link that will connect neurolo- where. The current trial used a standard dose of careful investigations of safety, “because seri- gists all over the world. Therefore, WORLD NEUROLOGY gadolinium. Until the Chinese Society of Neu- will provide information about cur- In terms of safety, two adverse events po- rology joined the World Federation of rent developments in modern neu- tentially attributable to laquinimod occurred. THIS IS THE FIRST STEP Neurology last year, we served a rology, with dissemination of thera- One patient in the laquinimod 0.6 mg daily TOWARD DEVELOPING A membership of about 25,000. peutic advances and discussions on group had Budd-Chiari syndrome and was That number is now considerably hot topics in the neurologic com- found be heterozygous for the factor V Leiden CONVENIENT, SAFE, AND EFFECTIVE higher, and I am proud to say that the munity. mutation, “which is associated with up to THERAPY FOR MS. We are delighted to have Mark 30% of cases of venous thrombosis,” the re- Hallett as our new editor in chief. searchers noted. “This case highlighted the THE NEWSLETTER’S Because he was the chair of the fi- possibility of an increased risk for thrombosis ous adverse effects are commonly not evident nance committee until he took over in patients with pre-existing thrombophilia until phase II studies are started (as with lino- FUNCTION IS TO CONVEY his new position, Mark Hallett exposed to laquinimod, which needs to be fur- mide) or until after approval (as with natal- INFORMATION FROM AND TO knows the World Federation of ther explored.” izumab).” WFN’S CENTRAL Neurology very well. Dr. Hallett did One patient in the laquinimod 0.3 mg daily Teva Pharmaceuticals sponsored and fund- his neurology training at Massachu- group had persistent elevation in liver enzymes ed the study.