Trial’s Early Use of an Interferon Therapy Markedly Slows MS

Early treatment with a type of interferon can sharply reduce the progression of multiple sclerosis, researchers have found. The effects of the treatment were so dramatic that a clinical trial was halted prematurely so that all patients could receive the drug.

Multiple sclerosis arises when the patient’s own immune system attacks the myelin sheaths surrounding nerves, effectively short-circuiting the transmission of nerve impulses. The first indication that a patient may have MS is a single, clinically apparent attack on the optic nerve, spinal cord or brain stem. A person is not officially considered to have MS, however, until two such attacks, called demyelinating events, have occurred, and researchers have been unsure how--or even whether--patients who have suffered only one event should be treated.

A team headed by Dr. Lawrence Jacobs of the State University of New York at Buffalo enrolled 383 patients who had had a single demyelinating event. Half received weekly injections of interferon beta-1a (trade-named Avonex) and half received a placebo. During three years of follow up, the team reported in the Sept. 28 New England Journal of Medicine (https://www.nejm.com), the rate of development of MS was 44% lower in the group receiving the drug than in the group receiving a placebo.

Two other trials of potential MS drugs were less successful, however. Those trials involved different forms of a synthetic protein called altered peptide ligand, or APL, which is a modified form of a protein segment found in myelin. Researchers had hoped that administering APL would moderate the immune system’s attack on myelin.

That proved not to be the case, however. Those two teams reported in the October issue of Nature Medicine (https://www.medicine.nature.com) that both trials were terminated prematurely because patients could not tolerate the drugs.

Whole Grains Lower Stroke Risk, Study Says

Eating foods containing whole grains rather than refined grains, already known to reduce the risk of cardiovascular disease, can sharply reduce the risk of stroke as well, according to Boston researchers.

The new results come from a long-term study of 75,521 nurses between the ages of 38 and 63. They were enrolled in 1984 and have been followed ever since.

Dr. Simin Liu of Harvard Medical School and colleagues reported in the Sept. 27 issue of the Journal of the American Medical Assn. (https://jama.ama-assn.org) that women who had the highest consumption of whole-grain foods--an average of 2.7 servings per day--had a 43% lower risk of stroke than those who had the lowest consumption. That improvement was independent of all other risk factors. For purposes of the study, whole-grain foods were defined to include dark bread, whole-grain breakfast cereals, popcorn, cooked oatmeal, wheat germ, brown rice, bran and other grains, such as bulgur, kasha and couscous.

About 600,00 strokes occur in the United States every year, resulting in 160,000 deaths. At all ages, more women than men die. Survivors often suffer serious permanent disabilities.

Troubling Numbers on Breast Cancer Therapy

The proportion of women receiving inappropriate treatment for early-stage breast cancer nearly doubled during the 1990s, to the point where more than one in every five is not receiving the recommended therapy, according to researchers at the Medical College of Wisconsin.

Most of the affected women underwent breast-conserving surgery, which, under guidelines established by the National Cancer Institute in 1990, should include a lumpectomy (removal of the tumor and surrounding tissue), examination of the lymph nodes under the arm to be sure the cancer has not spread, and a course of radiation therapy following surgery. Failure to perform the lymph node examination or the radiation can lead to a recurrence of the tumor, but many doctors apparently choose to omit one or both procedures, according to Dr. Ann Butler Nattinger.

Nattinger and her associates studied 144,759 women age 30 and older who underwent surgery for early-stage breast cancer between 1983 and 1995. They reported in the Oct. 1 Lancet (https://www.thelancet.com) that the proportion of women receiving appropriate therapy--that is, therapy following accepted guidelines--was 88% in 1983-89, but fell to 78% by the end of 1995. The proportion receiving inappropriate breast-conserving surgery rose from 10% in 1989 to 19% at the end of 1995.

Epilepsy Device Does Well in UCLA Study

A UCLA study of epileptics who did not respond to drug therapy has found that the seizure-reducing benefits of a pacemaker-like device called a vagus nerve stimulator continue to increase over time.

The battery-powered device, implanted in the chest, delivers electrical signals to the vagus nerve through a wire leading to the neck. The stimulation reduces seizures by changing blood flow in the brain.

A study headed by Dr. Christopher DeGiorgio of UCLA is the first to examine long-term effects of the device. The team reported in the September issue of the journal Epilepsia that only 11% of the subjects sustained a 75% to 100% reduction in seizures after three months, but that the proportion rose to 20% after a year. Overall, the number of seizures dropped by more than 45%.

The device may be even more effective in children, according to another study performed by Dr. Ravish V. Patwardhan of the University of Alabama at Birmingham. He told a San Antonio meeting of the Congress of Neurological Surgeons on Sept. 25 that nearly two-thirds of the 38 children he treated with vagus nerve stimulation experienced a reduction in seizures of 50% or more.

An estimated 2.3 million Americans have epilepsy, including 300,000 children. In about a quarter of them, symptoms cannot be adequately controlled with medication.

Swedish Study Logs Older Mortality Ages

The oldest age at death has been rising for more than a century and shows no sign of leveling off, according to researchers from UC Berkeley.

Demographer John Wilmoth and his colleagues studied death records in Sweden and reported in the Sept. 29 issue of Science (https://www.science.org) that, in the 1860s, the oldest ages at death for men and women clustered around 101. That average age moved up to about 105 in the 1960s and then accelerated to 108 in the 1990s.

Sweden keeps very accurate health records, including data about death, and researchers believe that trends there reflect global trends.

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Medical writer Thomas H. Maugh II can be reached at thomas.maugh@latimes.com.