Literature Review

There may be a benefit to exclusive breastfeeding for women with multiple sclerosis (MS). Women with MS who breastfed their infants exclusively for two months had a lower risk of relapse during the first six months after giving birth, compared with women who did not breastfeed exclusively, according to an article published online ahead of print August 31 in JAMA Neurology.

Previous investigations found that about 20% to 30% of women with MS experience a relapse within three to four months post partum. Currently, there are no therapies or interventions to prevent a relapse, and data on the effect of breastfeeding on postpartum MS relapse are conflicting.

Kerstin Hellwig, MD, a neurologist at St. Josef-Hospital at Ruhr-University Bochum in Germany, and colleagues collected data from 201 pregnant women with relapsing-remitting MS. Each woman was monitored for any relapse for as long as one year after birth. Of these participants, 120 (59.7%) chose to breastfeed exclusively for at least two months, while 42 (20.9%) opted for a combined breastfeeding–supplemental regimen, and 39 (19.4%) did not intend to breastfeed at all. Most of the women (88.6%) in the study cohort had used disease-modifying therapies (DMTs) before pregnancy.

Of the women who breastfed exclusively, 29 (24.2%) experienced a relapse within six months post partum, compared with 31 (38.3%) of those who did not breastfeed exclusively. The effect of exclusive breastfeeding “seems to be plausible,” Dr. Hellwig and coauthors said, since disease activity returned in the second half of the postpartum year in exclusively breastfeeding women, corresponding to the introduction of supplemental feedings and the return of menses.

Dr. Hellwig and colleagues also reported that, compared with women who breastfed exclusively, those who resumed DMTs early had a higher risk of postpartum relapse.

“Relapse in the first six months post partum may be diminished by exclusive breastfeeding, but once regular feedings are introduced, disease activity is likely to return,” Dr. Hellwig and colleagues said. “Taken together, our findings suggest that exclusive breastfeeding acts like a modestly effective treatment with a natural end date.” The researchers concluded that “Women with MS should be supported if they choose to breastfeed exclusively, since it clearly does not increase the risk of postpartum relapse.”

—Ashley Payton

There may be a benefit to exclusive breastfeeding for women with multiple sclerosis (MS). Women with MS who breastfed their infants exclusively for two months had a lower risk of relapse during the first six months after giving birth, compared with women who did not breastfeed exclusively, according to an article published online ahead of print August 31 in JAMA Neurology.

Previous investigations found that about 20% to 30% of women with MS experience a relapse within three to four months post partum. Currently, there are no therapies or interventions to prevent a relapse, and data on the effect of breastfeeding on postpartum MS relapse are conflicting.

Kerstin Hellwig, MD, a neurologist at St. Josef-Hospital at Ruhr-University Bochum in Germany, and colleagues collected data from 201 pregnant women with relapsing-remitting MS. Each woman was monitored for any relapse for as long as one year after birth. Of these participants, 120 (59.7%) chose to breastfeed exclusively for at least two months, while 42 (20.9%) opted for a combined breastfeeding–supplemental regimen, and 39 (19.4%) did not intend to breastfeed at all. Most of the women (88.6%) in the study cohort had used disease-modifying therapies (DMTs) before pregnancy.

Of the women who breastfed exclusively, 29 (24.2%) experienced a relapse within six months post partum, compared with 31 (38.3%) of those who did not breastfeed exclusively. The effect of exclusive breastfeeding “seems to be plausible,” Dr. Hellwig and coauthors said, since disease activity returned in the second half of the postpartum year in exclusively breastfeeding women, corresponding to the introduction of supplemental feedings and the return of menses.

Dr. Hellwig and colleagues also reported that, compared with women who breastfed exclusively, those who resumed DMTs early had a higher risk of postpartum relapse.

“Relapse in the first six months post partum may be diminished by exclusive breastfeeding, but once regular feedings are introduced, disease activity is likely to return,” Dr. Hellwig and colleagues said. “Taken together, our findings suggest that exclusive breastfeeding acts like a modestly effective treatment with a natural end date.” The researchers concluded that “Women with MS should be supported if they choose to breastfeed exclusively, since it clearly does not increase the risk of postpartum relapse.”

—Ashley Payton

There may be a benefit to exclusive breastfeeding for women with multiple sclerosis (MS). Women with MS who breastfed their infants exclusively for two months had a lower risk of relapse during the first six months after giving birth, compared with women who did not breastfeed exclusively, according to an article published online ahead of print August 31 in JAMA Neurology.

Previous investigations found that about 20% to 30% of women with MS experience a relapse within three to four months post partum. Currently, there are no therapies or interventions to prevent a relapse, and data on the effect of breastfeeding on postpartum MS relapse are conflicting.

Kerstin Hellwig, MD, a neurologist at St. Josef-Hospital at Ruhr-University Bochum in Germany, and colleagues collected data from 201 pregnant women with relapsing-remitting MS. Each woman was monitored for any relapse for as long as one year after birth. Of these participants, 120 (59.7%) chose to breastfeed exclusively for at least two months, while 42 (20.9%) opted for a combined breastfeeding–supplemental regimen, and 39 (19.4%) did not intend to breastfeed at all. Most of the women (88.6%) in the study cohort had used disease-modifying therapies (DMTs) before pregnancy.

Of the women who breastfed exclusively, 29 (24.2%) experienced a relapse within six months post partum, compared with 31 (38.3%) of those who did not breastfeed exclusively. The effect of exclusive breastfeeding “seems to be plausible,” Dr. Hellwig and coauthors said, since disease activity returned in the second half of the postpartum year in exclusively breastfeeding women, corresponding to the introduction of supplemental feedings and the return of menses.

Dr. Hellwig and colleagues also reported that, compared with women who breastfed exclusively, those who resumed DMTs early had a higher risk of postpartum relapse.

“Relapse in the first six months post partum may be diminished by exclusive breastfeeding, but once regular feedings are introduced, disease activity is likely to return,” Dr. Hellwig and colleagues said. “Taken together, our findings suggest that exclusive breastfeeding acts like a modestly effective treatment with a natural end date.” The researchers concluded that “Women with MS should be supported if they choose to breastfeed exclusively, since it clearly does not increase the risk of postpartum relapse.”

—Ashley Payton

Longer durations of nonexercise physical activity such as walking, cleaning, or doing laundry can significantly improve motor impairments across a range of Parkinson’s disease stages, according to a study published online ahead of print August 28 in Parkinsonism and Related Disorders.

Motor dysfunctions in patients with Parkinson’s disease result in severe postural and gait difficulties, which frequently result in a fear of falling. As a means of coping, many patients adopt a sedentary way of life, which contributes to worsening symptoms that in turn decrease physical activity.

Jonathan Snider, MD, Clinical Lecturer of Neurology at the University of Michigan in Ann Arbor, and colleagues investigated the relationship between the severity of parkinsonian motor dysfunctions, caused by a lack of dopamine signals in the brain, and the duration of time spent in nonexercise physical activity or in vigorous activity.

In this cross-sectional study, 40 men and eight women were examined over a four-week period. Dopamine levels were measured using PET brain imaging technology, and physical activity was assessed using the Community Healthy Activities Model Program for Seniors (CHAMPS) questionnaire. Researchers found that more severe parkinsonism motor symptoms were associated with lower amounts of nonexercise physical activities, independent of dopamine levels. Conversely, no correlation was found between loss of motor functioning and intense physical activity in these patients. Vigorous periodic workouts showed no benefit in motor symptoms if the individual was inactive the gross remainder of the time. These conclusions support indications that physical activity and general inactivity have independent effects on health outcomes.

“What we found was it’s not so much the exercise, but the routine activities from daily living that were protecting motor skills,” said Nicolaas Bohnen, MD, PhD, principal investigator in this study and Professor of Neurology at the University of Michigan. Even among patients with differing levels of dopamine, nonexercise physical activity was shown to protect against motor skill degradation in comparison with sedentary behavior.

“I tell my patients to stand up, sit less, and move more,” said Dr. Bohnen. “Sitting is bad for anybody, but it’s even worse for Parkinson’s patients.”

These findings have considerable implications for patients with Parkinson’s disease, according to the researchers, because they suggest that severe motor symptoms in advanced Parkinson’s disease may result from a combination of the disease progression and an increase in sedentary behavior.

—Adaeze Stephanie Onyechi

Longer durations of nonexercise physical activity such as walking, cleaning, or doing laundry can significantly improve motor impairments across a range of Parkinson’s disease stages, according to a study published online ahead of print August 28 in Parkinsonism and Related Disorders.

Motor dysfunctions in patients with Parkinson’s disease result in severe postural and gait difficulties, which frequently result in a fear of falling. As a means of coping, many patients adopt a sedentary way of life, which contributes to worsening symptoms that in turn decrease physical activity.

Jonathan Snider, MD, Clinical Lecturer of Neurology at the University of Michigan in Ann Arbor, and colleagues investigated the relationship between the severity of parkinsonian motor dysfunctions, caused by a lack of dopamine signals in the brain, and the duration of time spent in nonexercise physical activity or in vigorous activity.

In this cross-sectional study, 40 men and eight women were examined over a four-week period. Dopamine levels were measured using PET brain imaging technology, and physical activity was assessed using the Community Healthy Activities Model Program for Seniors (CHAMPS) questionnaire. Researchers found that more severe parkinsonism motor symptoms were associated with lower amounts of nonexercise physical activities, independent of dopamine levels. Conversely, no correlation was found between loss of motor functioning and intense physical activity in these patients. Vigorous periodic workouts showed no benefit in motor symptoms if the individual was inactive the gross remainder of the time. These conclusions support indications that physical activity and general inactivity have independent effects on health outcomes.

“What we found was it’s not so much the exercise, but the routine activities from daily living that were protecting motor skills,” said Nicolaas Bohnen, MD, PhD, principal investigator in this study and Professor of Neurology at the University of Michigan. Even among patients with differing levels of dopamine, nonexercise physical activity was shown to protect against motor skill degradation in comparison with sedentary behavior.

“I tell my patients to stand up, sit less, and move more,” said Dr. Bohnen. “Sitting is bad for anybody, but it’s even worse for Parkinson’s patients.”

These findings have considerable implications for patients with Parkinson’s disease, according to the researchers, because they suggest that severe motor symptoms in advanced Parkinson’s disease may result from a combination of the disease progression and an increase in sedentary behavior.

—Adaeze Stephanie Onyechi

Longer durations of nonexercise physical activity such as walking, cleaning, or doing laundry can significantly improve motor impairments across a range of Parkinson’s disease stages, according to a study published online ahead of print August 28 in Parkinsonism and Related Disorders.

Motor dysfunctions in patients with Parkinson’s disease result in severe postural and gait difficulties, which frequently result in a fear of falling. As a means of coping, many patients adopt a sedentary way of life, which contributes to worsening symptoms that in turn decrease physical activity.

Jonathan Snider, MD, Clinical Lecturer of Neurology at the University of Michigan in Ann Arbor, and colleagues investigated the relationship between the severity of parkinsonian motor dysfunctions, caused by a lack of dopamine signals in the brain, and the duration of time spent in nonexercise physical activity or in vigorous activity.

In this cross-sectional study, 40 men and eight women were examined over a four-week period. Dopamine levels were measured using PET brain imaging technology, and physical activity was assessed using the Community Healthy Activities Model Program for Seniors (CHAMPS) questionnaire. Researchers found that more severe parkinsonism motor symptoms were associated with lower amounts of nonexercise physical activities, independent of dopamine levels. Conversely, no correlation was found between loss of motor functioning and intense physical activity in these patients. Vigorous periodic workouts showed no benefit in motor symptoms if the individual was inactive the gross remainder of the time. These conclusions support indications that physical activity and general inactivity have independent effects on health outcomes.

“What we found was it’s not so much the exercise, but the routine activities from daily living that were protecting motor skills,” said Nicolaas Bohnen, MD, PhD, principal investigator in this study and Professor of Neurology at the University of Michigan. Even among patients with differing levels of dopamine, nonexercise physical activity was shown to protect against motor skill degradation in comparison with sedentary behavior.

“I tell my patients to stand up, sit less, and move more,” said Dr. Bohnen. “Sitting is bad for anybody, but it’s even worse for Parkinson’s patients.”

These findings have considerable implications for patients with Parkinson’s disease, according to the researchers, because they suggest that severe motor symptoms in advanced Parkinson’s disease may result from a combination of the disease progression and an increase in sedentary behavior.

—Adaeze Stephanie Onyechi

Researchers examined records of 176 patients (45 with and 131 without invasive EEG) who underwent left temporal lobe resection (TLR) at Cleveland Clinic. There were no clinically meaningful changes in naming performance or verbal memory. Patients with invasive monitoring showed greater declines in working memory, which were no longer apparent using reliable change indices to define change. Overall results suggest that invasive EEG monitoring prior to left TLR is not associated with greater cognitive morbidity.

Busch RM, Love TE, Jehi LE, et al. Effect of invasive EEG monitoring on cognitive outcome after left temporal lobe epilepsy surgery.  Neurology. 2015;85(17):1475-1481.

Researchers examined records of 176 patients (45 with and 131 without invasive EEG) who underwent left temporal lobe resection (TLR) at Cleveland Clinic. There were no clinically meaningful changes in naming performance or verbal memory. Patients with invasive monitoring showed greater declines in working memory, which were no longer apparent using reliable change indices to define change. Overall results suggest that invasive EEG monitoring prior to left TLR is not associated with greater cognitive morbidity.

Busch RM, Love TE, Jehi LE, et al. Effect of invasive EEG monitoring on cognitive outcome after left temporal lobe epilepsy surgery.  Neurology. 2015;85(17):1475-1481.

Researchers examined records of 176 patients (45 with and 131 without invasive EEG) who underwent left temporal lobe resection (TLR) at Cleveland Clinic. There were no clinically meaningful changes in naming performance or verbal memory. Patients with invasive monitoring showed greater declines in working memory, which were no longer apparent using reliable change indices to define change. Overall results suggest that invasive EEG monitoring prior to left TLR is not associated with greater cognitive morbidity.

Busch RM, Love TE, Jehi LE, et al. Effect of invasive EEG monitoring on cognitive outcome after left temporal lobe epilepsy surgery.  Neurology. 2015;85(17):1475-1481.

This meta-analysis examined 16 studies of nonvenous drugs used in randomized controlled trials for the treatment of acute convulsive seizures and convulsive status epilepticus. Intramuscular midazolam was superior to other nonvenous medications for time to seizure termination after administration, time to seizure cessation after arrival at the hospital, and the time to initiate treatment. Intranasal midazolam was found most effective for seizure cessation within 10 minutes of administration.

Arya R, Kothari H, Zhang Z, Han B, Horn PS, Glauser TA. Efficacy of nonvenous medications for acute convulsive seizures: a network meta-analysis. Neurology 2015: doi: 10.1212/WNL.0000000000002142.

This meta-analysis examined 16 studies of nonvenous drugs used in randomized controlled trials for the treatment of acute convulsive seizures and convulsive status epilepticus. Intramuscular midazolam was superior to other nonvenous medications for time to seizure termination after administration, time to seizure cessation after arrival at the hospital, and the time to initiate treatment. Intranasal midazolam was found most effective for seizure cessation within 10 minutes of administration.

Arya R, Kothari H, Zhang Z, Han B, Horn PS, Glauser TA. Efficacy of nonvenous medications for acute convulsive seizures: a network meta-analysis. Neurology 2015: doi: 10.1212/WNL.0000000000002142.

This meta-analysis examined 16 studies of nonvenous drugs used in randomized controlled trials for the treatment of acute convulsive seizures and convulsive status epilepticus. Intramuscular midazolam was superior to other nonvenous medications for time to seizure termination after administration, time to seizure cessation after arrival at the hospital, and the time to initiate treatment. Intranasal midazolam was found most effective for seizure cessation within 10 minutes of administration.

Arya R, Kothari H, Zhang Z, Han B, Horn PS, Glauser TA. Efficacy of nonvenous medications for acute convulsive seizures: a network meta-analysis. Neurology 2015: doi: 10.1212/WNL.0000000000002142.

In this study, researchers surveyed 90 patients with intractable epilepsy who underwent vagus nerve stimulation (VNS). This is the first study to assess both seizure and psychosocial outcomes in this population. The authors found no significant differences in psychosocial metrics before and after VNS implantation. Seizure outcomes were favorable with 68% of patients experience greater than 50% seizure reduction and 20% of patients identifying as seizure-free. The majority of patients surveyed (80%) expressed satisfaction with VNS therapy.

Wasade VS, Schultz L, Mohanarangan K, Gaddam A, Schwalb JM, Spanaki-Varelas M. Long-term seizure and psychosocial outcomes of vagus nerve stimulation for intractable epilepsy. Epilepsy Behav. 2015;53:31-36.

In this study, researchers surveyed 90 patients with intractable epilepsy who underwent vagus nerve stimulation (VNS). This is the first study to assess both seizure and psychosocial outcomes in this population. The authors found no significant differences in psychosocial metrics before and after VNS implantation. Seizure outcomes were favorable with 68% of patients experience greater than 50% seizure reduction and 20% of patients identifying as seizure-free. The majority of patients surveyed (80%) expressed satisfaction with VNS therapy.

Wasade VS, Schultz L, Mohanarangan K, Gaddam A, Schwalb JM, Spanaki-Varelas M. Long-term seizure and psychosocial outcomes of vagus nerve stimulation for intractable epilepsy. Epilepsy Behav. 2015;53:31-36.

In this study, researchers surveyed 90 patients with intractable epilepsy who underwent vagus nerve stimulation (VNS). This is the first study to assess both seizure and psychosocial outcomes in this population. The authors found no significant differences in psychosocial metrics before and after VNS implantation. Seizure outcomes were favorable with 68% of patients experience greater than 50% seizure reduction and 20% of patients identifying as seizure-free. The majority of patients surveyed (80%) expressed satisfaction with VNS therapy.

Wasade VS, Schultz L, Mohanarangan K, Gaddam A, Schwalb JM, Spanaki-Varelas M. Long-term seizure and psychosocial outcomes of vagus nerve stimulation for intractable epilepsy. Epilepsy Behav. 2015;53:31-36.

In this study, researchers surveyed 90 patients with intractable epilepsy who underwent vagus nerve stimulation (VNS). This is the first study to assess both seizure and psychosocial outcomes in this population. The authors found no significant differences in psychosocial metrics before and after VNS implantation. Seizure outcomes were favorable with 68% of patients experience greater than 50% seizure reduction and 20% of patients identifying as seizure-free. The majority of patients surveyed (80%) expressed satisfaction with VNS therapy.

Wasade VS, Schultz L, Mohanarangan K, Gaddam A, Schwalb JM, Spanaki-Varelas M. Long-term seizure and psychosocial outcomes of vagus nerve stimulation for intractable epilepsy. Epilepsy Behav. 2015;53:31-36.

In this study, researchers surveyed 90 patients with intractable epilepsy who underwent vagus nerve stimulation (VNS). This is the first study to assess both seizure and psychosocial outcomes in this population. The authors found no significant differences in psychosocial metrics before and after VNS implantation. Seizure outcomes were favorable with 68% of patients experience greater than 50% seizure reduction and 20% of patients identifying as seizure-free. The majority of patients surveyed (80%) expressed satisfaction with VNS therapy.

Wasade VS, Schultz L, Mohanarangan K, Gaddam A, Schwalb JM, Spanaki-Varelas M. Long-term seizure and psychosocial outcomes of vagus nerve stimulation for intractable epilepsy. Epilepsy Behav. 2015;53:31-36.

In this study, researchers surveyed 90 patients with intractable epilepsy who underwent vagus nerve stimulation (VNS). This is the first study to assess both seizure and psychosocial outcomes in this population. The authors found no significant differences in psychosocial metrics before and after VNS implantation. Seizure outcomes were favorable with 68% of patients experience greater than 50% seizure reduction and 20% of patients identifying as seizure-free. The majority of patients surveyed (80%) expressed satisfaction with VNS therapy.

Wasade VS, Schultz L, Mohanarangan K, Gaddam A, Schwalb JM, Spanaki-Varelas M. Long-term seizure and psychosocial outcomes of vagus nerve stimulation for intractable epilepsy. Epilepsy Behav. 2015;53:31-36.

Anti-tumor necrosis factor (TNF) therapy for inflammatory bowel disease appears to double the relative risk of developing central demyelinating disease, though the absolute risk remains small, according to a preliminary report published online ahead of print October 5 in JAMA Internal Medicine.

Previous case reports have suggested a possible association between anti-TNF agents taken for inflammatory bowel disease and later development of demyelinating diseases, but a definitive link has been difficult to establish because of the rarity of these disorders and the suspicion that there already may be an underlying association between inflammatory bowel disease and demyelinating disease.

Researchers examined the issue by analyzing data from nationwide Danish health registries for patients with inflammatory bowel disease and medication exposure. They identified 4,504 patients treated during a 14-year period who had inflammatory bowel disease and took anti-TNF agents, and 16,429 patients with inflammatory bowel disease matched for sex, age, and disease duration who did not take the medications, according to Nynne Nyboe Andersen, MD, a doctoral student in the Department of Epidemiology Research at Statens Serum Institut in Copenhagen, and her associates.

Eleven patients in the group exposed to medication had central demyelinating events. Two patients had multiple sclerosis, five patients had optic neuritis, and four patients had other central demyelinating disease. Medication-exposed patients had 7.5 events per 10,000 person-years.

In comparison, 17 patients in the unexposed group had central demyelinating events. Five patients had multiple sclerosis, six patients had optic neuritis, one patient had transverse myelitis, and five patients had other central demyelinating disease. The unexposed group had 3.3 events per 10,000 person-years.

The hazard ratio for developing central demyelinating disease after exposure to anti-TNF agents was 2.19, according to the investigators. These preliminary findings represent the first report of this association and must be confirmed in future studies, according to the researchers. “If true, the observed association could either be attributed to the unmasking of a latent demyelinating disease or to the emergence of a de novo demyelinating disease,” said Dr. Nyboe Andersen.

—Mary Ann Moon

Anti-tumor necrosis factor (TNF) therapy for inflammatory bowel disease appears to double the relative risk of developing central demyelinating disease, though the absolute risk remains small, according to a preliminary report published online ahead of print October 5 in JAMA Internal Medicine.

Previous case reports have suggested a possible association between anti-TNF agents taken for inflammatory bowel disease and later development of demyelinating diseases, but a definitive link has been difficult to establish because of the rarity of these disorders and the suspicion that there already may be an underlying association between inflammatory bowel disease and demyelinating disease.

Researchers examined the issue by analyzing data from nationwide Danish health registries for patients with inflammatory bowel disease and medication exposure. They identified 4,504 patients treated during a 14-year period who had inflammatory bowel disease and took anti-TNF agents, and 16,429 patients with inflammatory bowel disease matched for sex, age, and disease duration who did not take the medications, according to Nynne Nyboe Andersen, MD, a doctoral student in the Department of Epidemiology Research at Statens Serum Institut in Copenhagen, and her associates.

Eleven patients in the group exposed to medication had central demyelinating events. Two patients had multiple sclerosis, five patients had optic neuritis, and four patients had other central demyelinating disease. Medication-exposed patients had 7.5 events per 10,000 person-years.

In comparison, 17 patients in the unexposed group had central demyelinating events. Five patients had multiple sclerosis, six patients had optic neuritis, one patient had transverse myelitis, and five patients had other central demyelinating disease. The unexposed group had 3.3 events per 10,000 person-years.

The hazard ratio for developing central demyelinating disease after exposure to anti-TNF agents was 2.19, according to the investigators. These preliminary findings represent the first report of this association and must be confirmed in future studies, according to the researchers. “If true, the observed association could either be attributed to the unmasking of a latent demyelinating disease or to the emergence of a de novo demyelinating disease,” said Dr. Nyboe Andersen.

—Mary Ann Moon

Anti-tumor necrosis factor (TNF) therapy for inflammatory bowel disease appears to double the relative risk of developing central demyelinating disease, though the absolute risk remains small, according to a preliminary report published online ahead of print October 5 in JAMA Internal Medicine.

Previous case reports have suggested a possible association between anti-TNF agents taken for inflammatory bowel disease and later development of demyelinating diseases, but a definitive link has been difficult to establish because of the rarity of these disorders and the suspicion that there already may be an underlying association between inflammatory bowel disease and demyelinating disease.

Researchers examined the issue by analyzing data from nationwide Danish health registries for patients with inflammatory bowel disease and medication exposure. They identified 4,504 patients treated during a 14-year period who had inflammatory bowel disease and took anti-TNF agents, and 16,429 patients with inflammatory bowel disease matched for sex, age, and disease duration who did not take the medications, according to Nynne Nyboe Andersen, MD, a doctoral student in the Department of Epidemiology Research at Statens Serum Institut in Copenhagen, and her associates.

Eleven patients in the group exposed to medication had central demyelinating events. Two patients had multiple sclerosis, five patients had optic neuritis, and four patients had other central demyelinating disease. Medication-exposed patients had 7.5 events per 10,000 person-years.

In comparison, 17 patients in the unexposed group had central demyelinating events. Five patients had multiple sclerosis, six patients had optic neuritis, one patient had transverse myelitis, and five patients had other central demyelinating disease. The unexposed group had 3.3 events per 10,000 person-years.

The hazard ratio for developing central demyelinating disease after exposure to anti-TNF agents was 2.19, according to the investigators. These preliminary findings represent the first report of this association and must be confirmed in future studies, according to the researchers. “If true, the observed association could either be attributed to the unmasking of a latent demyelinating disease or to the emergence of a de novo demyelinating disease,” said Dr. Nyboe Andersen.

—Mary Ann Moon