Sara Pez

Aim: Rimegepant is an effective acute migraine treatment, with limited evidence regarding its consistency across multiple migraine attacks. The primary aim is to assess rimegepant effectiveness across multiple migraine attacks. Methods: In this real-world, prospective, multicentric study we assessed participants who treated up to four different migraine attacks with rimegepant 75 mg orally disintegrating tablet. Data was collected every 30 min from migraine onset up to 2 h post dose using an electronic diary. Our primary outcome was 2-h pain freedom across all-treated attacks; secondary outcomes were: consistency of response (percentage of participants who achieved 2-h pain freedom in at least two treated attacks), safety and tolerability. Results: We enrolled 191 participants (80.1% females, age 44.8 [43.2–46.5] years, disease duration 28.4 [25.0–31.8] years, 27.7% with chronic migraine, 9.6 [8.9–10.9] baseline monthly migraine days-MMDs). We collected data from 377 migraine attacks (191 first-treated, 110 s-treated, 46 third-treated and 30 fourth-treated). Two-hour pain freedom was achieved in 44.6% (168/377) of treated attacks [39.3–49.6]. After correction for age, timing of rimegepant intake, baseline pain intensity, ongoing preventive treatment, and number of preventive drug classes that previously proved ineffective, 2-h pain freedom was associated with female sex (odds ratio (OR) = 2.3 [1.2–4.3], p = 0.012), no ongoing mAbs treatment (OR = 3.2 [1.6–6.4], p = 0.001), and lower MMDs (OR = 1.05 [1.0–1.1], p = 0.002). Consistency of response was 36.4% [27.3–45.5] (40/110). Participants reporting at least one adverse event were 11.5% (22/191). Conclusion: Our study confirms the effectiveness of rimegepant in nearly half of treated attacks and describe the consistency of response in a relatively large real-world population where one out of five participants achieved 2-h pain freedom in all-treated migraine attacks. No new safety signals were identified.

Background/Objectives: Migraine is three times more common in women and worsens during perimenopause, a phase in which estrogen fluctuations are accompanied by deterioration in body composition — increased fat mass (FM) and reduced fat-free mass (FFM) — amplifying systemic inflammation. Despite this biological link, body composition is not systematically assessed in perimenopausal migraine management. This pre-specified exploratory analysis of the MEDEA study evaluates whether body composition, measured by bioelectrical impedance analysis (BIA), is associated with migraine disability in perimenopausal women, and secondarily describes changes in body composition during an anti-inflammatory nutritional intervention with prebiotics and probiotics. Methods: Single-arm, single-center, prospective interventional study (MEDEA study, Neurological Clinic ASUFC, Udine); the present work is a pre-specified exploratory secondary analysis. Seventeen women (mean age 52 ± 2.6 years) with episodic or chronic migraine, intestinal dysbiosis, and perimenopausal status (STRAW classification) were assessed with Akern BIA at baseline (T0), 3 months (T3), and 6 months (T6). Changes over time were analyzed with the Wilcoxon signed-rank test; correlations with migraine disability with Spearman's rho. Results: Over the intervention period, FM decreased selectively (median −1.60 kg at T3, p = 0.001; median −3.00 kg at T6, p < 0.001), with FFM remaining broadly stable. At baseline, higher FFM correlated with lower migraine disability (MIDAS: rho = −0.667, p = 0.009, n = 14). Longitudinal Δ-Δ associations (ECW, phase angle) are reported as exploratory. Conclusions: These exploratory findings suggest that fat-free mass is associated with migraine disability in perimenopause and warrant confirmation, with multivariable adjustment, in the complete sample (n = 54).

Background/Objectives: Fatigue is a frequent, disabling and difficult-to-treat symptom of multiple sclerosis (MS). Low-grade inflammation and energetic dysfunction have been proposed as mechanisms underlying the pathogenesis of this symptom. Owing to its anti-inflammatory and metabolic properties, there is a rationale for ketogenic diet (KD) application in this setting. The aim of this study was to evaluate the effects of KD on fatigue and other frequently associated symptoms in a carefully selected group of patients with MS. Methods: We conducted a single-arm open-label interventional study on a strictly selected group of 16 non-obese patients with multiple sclerosis who were prescribed KD for three months. Fatigue, sleep quality, daytime somnolence, mood, and quality of life were assessed at baseline (T0), 1 month (T1), and 3 months (T3) using validated scales. Results: With respect to baseline, at 3 months we observed a significant reduction in Fatigue Severity Scale (5.18 ± 1.02 vs. 4.16 ± 0.98; p = 0.042), Epworth Sleepiness Scale (8.46 ± 3.05 vs. 5.64 ± 2.46; p < 0.001), Pittsburgh Sleep Quality Index (5.64 ± 3.53 vs. 7.62 ± 2.59; p = 0.009), Depression Anxiety Stress Scales-21 depression (3.18 ± 2.93 vs. 6.15 ± 3.81; p = 0.036) and anxiety (5.15 ± 4.10 vs. 1.55 ± 1.92; p = 0.019) sub-scales, and an improvement in energy sub-scale of multiple sclerosis Quality of Life-54 (52.49 ± 12.83 vs. 37.43 ± 14.26; p = 0.042). Conclusions: These findings suggest that KD might be useful for the treatment of fatigue, and they raise interest in the use of KD in the treatment of other symptoms frequently encountered in multiple sclerosis. Larger randomized controlled studies are needed to confirm these preliminary results.

Fatigue is a frequent, disabling and difficult to treat symptom of multiple sclerosis (MS). Low grade inflammation and energetic dysfunction have been proposed as mechanisms underlying the pathogenesis of this symptom. Owing to its anti-inflammatory and metabolic properties, there is a rational for ketogenic diet (KD) application in this setting. We conducted a single arm open label interventional study on a strictly selected group of 16 non-obese patients with multiple sclerosis who were prescribed KD for three months. With respect to baseline, at 3 months we observed a significant reduction of fatigue severity scale (5.18 ± 1.02 vs. 4.16 ± 0.98; p = 0.042), Epworth Sleepiness Scale (5.64 ± 2.46 vs. 8.46 ± 3.05; p < 0.001), Pittsburgh Sleep Quality Index (5.64 ± 3.53 vs. 7.62 ± 2.59; p = 0.009), Depression Anxiety Stress Scales-21 depression (3.18 ± 2.93 vs. 6.15 ± 3.81; p = 0.036) and anxiety (5.15 ± 4.10 vs. 1.55 ± 1.92; p = 0.019) sub-scales, and an improvement in energy sub-scale of Multiple Sclerosis Quality of Life-54 (52.49 ± 12.83 vs. 37.43 ± 14.26; p = 0.042). These findings suggest that KD might be useful for the treatment of fatigue and they raise the interest for the use of KD in the treatment of other symptoms frequently encountered in multiple sclerosis.

Some patients with large vessel occlusion (LVO) achieve insufficient clinical improvement (futile recanalization, FR) after intravenous thrombolysis (IVT) during inter-hospital transfer for thrombectomy, while others show good outcomes (effective recanalization, ER). This study assessed FR and ER rates among patients treated with IVT at non-thrombectomy primary stroke centers (PSCs) and aimed to identify predictors of FR. We analyzed data from two PSC registries (2016–2022). Inclusion criteria: IVT treatment, anterior circulation LVO, NIHSS ≥ 6, ASPECTS ≥ 5, and documented recanalization at thrombectomy centers. FR was defined as a 90-day poor outcome (mRS 3–6) despite LVO recanalization on initial angiography. Among 190 PSC patients with documented recanalization post-IVT, 113 (59.5%) had FR. Multivariable analysis identified age (OR = 1.03, 95%CI = 1.01–1.07, p = 0.021), NIHSS at the PSC (OR = 1.13, 95%CI = 1.05–1.22, p = 0.026), and collateral status (OR = 0.54, 95%CI = 0.39–0.75, p = 0.001) as independent predictors of FR and 90-day mortality. A model combining age, NIHSS, and collateral score provided the highest predictive accuracy for FR and mortality. FR is common in LVO-related ischemic stroke treated with IVT at non-thrombectomy centers. FR is common in LVO-related ischemic stroke treated with IVT at non-thrombectomy centers. Identifying predictors of FR can guide clinicians in early decision-making, allowing for tailored interventions and informed discussions about expected outcomes, potentially leading to more optimized patient management. The GOTIC-VTE trial Unique identifier, jRCTs031180124; Registration date, April 06, 2017. Graphical Abstract

Multiple sclerosis is a chronic, autoimmune-mediated, demyelinating disease whose pathogenesis remains to be defined. In past years, in consideration of a constantly growing number of patients diagnosed with multiple sclerosis, the impacts of different environmental factors in the pathogenesis of the disease have been largely studied. Alterations in gut microbiome composition and intestinal barrier permeability have been suggested to play an essential role in the regulation of autoimmunity. Thus, increased efforts are being conducted to demonstrate the complex interplay between gut homeostasis and disease pathogenesis. Numerous results confirm that disease-modifying therapies (DMTs) used for the treatment of MS, in addition to their immunomodulatory effect, could exert an impact on the intestinal microbiota, contributing to the modulation of the immune response itself. However, to date, the direct influence of these treatments on the microbiota is still unclear. This review intends to underline the impact of DMTs on the complex system of the microbiota–gut–brain axis in patients with multiple sclerosis.

Background: Few studies compare the clinical effectiveness of the three anti-CGRP mAbs. Moreover, no studies compare their efficacy during suspension and reprisal. Our study aimed to compare the efficacy of migraine frequency, intensity, and symptomatic medication intake during the first year of therapy, a 1-month suspension period, and a 3-month drug reprisal. Methods: A total of 160 migraineurs (chronic and high-frequency episodic) were treated with anti-CGRP mAbs (49 with fremanezumab, 55 with erenumab, and 55 with galcanezumab) for 12 months. They discontinued the therapy for 1 month and then reprised the therapy. In the three groups, we analyzed and compared the migraine days per month, migraine intensity, and symptomatic medication intake per month at baseline, 3-month, 6-month, and 12-month follow-up. We also compared these variables during the 1-month suspension and 3 months after the reprisal of the therapy. We compared the data and evaluated the response rate (>50% reduction in migraine days per month) at different follow-ups. This comparison was also performed separately for chronic and high-frequency episodic migraineurs. Results: There was no statistical difference in monthly migraine days, intensity, or symptomatic medication intake per month at the different follow-ups. Moreover, there was no difference in the response rate overall. However, in chronic migraineurs treated with galcanezumab, the response rate was higher during the 1-month suspension when compared to fremanezumab and erenumab. In high-frequency episodic migraineurs, fremanezumab had a higher response rate at 12-month follow-up when compared to galcanezumab and erenumab. Conclusions: In our study, the three anti-CGRP mAbs presented a similar response, with no significant differences, during the first year of therapy, the suspension period, and 3 months after the drug reprisal. The response rate during the 1-month suspension period in chronic migraineurs may be higher with galcanezumab.

(1) Background: More than one-third of patients with meningiomas experience at least one seizure during the course of their disease, and in the 20–50% of cases, seizure represents the onset symptom. After surgery, up to 30% of patients continue to have seizures, while others may experience them later; (2) Methods: The study analyzed retrospectively the risk factors for pre-operative seizures in a large cohort of 358 patients who underwent surgery for newly diagnosed brain meningioma; (3) Results: We identified age, peritumor edema, and location as risk factors for seizure at the onset. Patients with seizures differed from patients without seizures for the following characteristics: younger average age, lower pre-operative Karnofsky Performance Status (KPS), location on the convexity, lower Simpson Grade, lower incidence of pre-operative neurological deficits, and higher incidence of pre-operative peritumor edema. After 24 months, 88.2% of patients were classified as Engel class Ia, and no correlation with disease progression was observed; (4) Conclusions: Meningioma-related epilepsy has generally a positive outcome following surgery and it seems not to be linked to disease progression, even if further studies are needed.

Multiple sclerosis (MS) is a chronic, debilitating, autoimmune-mediated, inflammatory disease of the central nervous system (CNS), in which a combination of inflammation, demyelination and axonal degeneration takes place with extreme highly interpersonal variability