The edition · Neurology
Ten years of OPERA: a two-year delay in high-efficacy MS treatment was not made up
Patients who started ocrelizumab two years later than their randomised peers still carried more disability a decade on. Also: delirium in hospital and later dementia, which genetic epilepsies respond to surgery, and α-synuclein in Alzheimer biomarker trajectories.
The edition in brief
Today's neurology edition closes on the ten-year follow-up of OPERA I and II, in which 1656 people with relapsing multiple sclerosis were randomised to ocrelizumab or interferon beta-1a for two years before all moved to ocrelizumab. Those treated with ocrelizumab from the start had a 24% lower hazard of 48-week confirmed disability progression (hazard ratio 0.76, 95% CI 0.61 to 0.95) and a 43% lower hazard of reaching EDSS 6.0, with no rise in serious adverse events. In a population cohort of 3501 older adults without dementia, delirium during a hospital stay was associated with more than three times the risk of mild cognitive impairment and five times the risk of dementia. A pooled analysis of 272 people with germline genetic epilepsies found seizure freedom after surgery in about two-thirds of GATOR-pathway and vascular disorders but only 22–30% of channelopathies and synaptopathies, even with an MRI lesion. A Barcelona memory-clinic cohort found plasma p-tau217 rose fastest in Alzheimer disease with co-existing α-synuclein. The pearl covers rapid delirium screening.
Delirium in hospital was followed by a five-fold higher dementia risk in older adults
Treat an episode of hospital delirium as a flag for future cognitive decline, and arrange cognitive follow-up after discharge.
Epilepsy surgery in genetic epilepsies: the pathway predicts seizure freedom better than the lesion
Consider surgery in genetic epilepsies, but weigh the gene pathway: GATOR-pathway and vascular disorders fared much better than channelopathies.
Alzheimer disease with α-synuclein: plasma p-tau217 and NfL rose fastest
Plasma p-tau217 tracks Alzheimer progression and appears to rise faster with α-synuclein co-pathology; use it for diagnosis, not yet for individual prognosis.
Screen for delirium with a two-minute test, not an impression
Screen older inpatients with a two-minute structured delirium test at admission and with any change in behaviour.
Ocrelizumab from the start beat a two-year delay on disability at ten years
Discuss early high-efficacy therapy at diagnosis of active relapsing MS, since a two-year delay was associated with more disability ten years on.
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