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Fear of multiple sclerosis should not restrain vaccination efforts

MD-FM Thursday May 8, 2014

 

 

SARAH:

MD-FM: the latest medical news from around the world… Here’s Peter Goodwin.

 

SEGMENT 1: NEUROLOGY: Vaccination not associated with long-term risk of multiple sclerosis

 

PETER:

Hello! And in this edition we have news from three different congresses that took place over the last two weeks...With me is Sarah Maxwell.

 

To begin with, the controversial topic of vaccination was discussed at the 2014 meeting of the American Academy of Neurology in Philadelphia. A new study reported there was no long-term association between vaccination and multiple sclerosis or other demyelinating diseases…

 

SARAH:

Yes, these are the results of a study looking at very detailed data on symptom-onset after vaccination. The investigators actually did find an increase in the risk of MS onset in young adults over the few weeks following vaccination but no long-term association. Dr. Langer-Gould presented the data at the AAN meeting:

 

GOULD:

We found that, in people under the age of 50, if you take any vaccination, two to four weeks after vaccination there is an increase in risk of multiple sclerosis and clinically isolated syndrome, but this risk goes away if you look at any further time point so: six weeks up to three years later, there is no increase in risk. So there’s no long-term increase in risk even in the people under 50. And in people over the age of 50, there’s no increase in risk even in the short term following any type of vaccination.

 

SARAH:

That was Annette Langer-Gould, from Kaiser Permanente in Pasadena, California who said these findings argue against a causal association between vaccine administration and demyelinating diseases. Her group also looked at particular vaccines:

 

GOULD:

We also looked at hepatitis B because there’s some controversy around this vaccine, and we did not find any increase in MS or clinically isolated syndrome at any time point with that vaccine. We also looked at human papillomavirus, because that’s a new vaccine, and we looked only at women between the ages of nine and 26, because that’s the initial target population for this vaccine. We had a small number of cases: only 96 females in our study fell into that age category. We did see an increase in risk in multiple sclerosis, it wasn’t statistically significant, but we did not see an increase in risk in clinically isolated syndrome, which is a curious finding. It makes me a little concerned that this could be a chance finding and it’s certainly something that needs to be followed up on in future studies in much larger series.

 

SARAH:

That was Dr. Langer-Gould, from Pasadena, who concluded that there should not be a change in vaccine policy.

 

SEGMENT 2: Half of all strokes are attributable to established causal and modifiable factors

 

PETER:

About one half of all strokes are due to established causal and modifiable factors, like hypertension and smoking. That’s according to a population-based cohort study, published in PLOS Medicine, that shows these appear to be the most important etiological risk factors. The authors of this study said their findings encourage not only interventions on established etiological factors, but also further studies of less well-established factors.

 

SEGMENT 3: Insulin resistance and type-2-diabetes more common in patients with bipolar disorders

 

PETER:

And now, news from the annual congress of the American Psychiatric Association, that just ended in New York: insulin resistance and type-2 diabetes are apparently much more common in patients with bipolar disorders than in the general population...

 

SARAH:

Yes, and the big problem is that both often go undiagnosed in these patients. Lead author, Cynthia Calkin, presented study findings in New York, and gave MD-FM the details:

 

CALKIN:

We looked at insulin-resistance and type-2-diabetes in bipolar patients and we found that there was significantly high rates of insulin resistance –about one-third of all patients –and we also found high rates of type 2 diabetes –about 21.5 percent of patients –and we also found that 40 percent of the diabetic patients were not previously diagnosed with diabetes, so there’s high rates of occult type 2 diabetes and as well high rates of insulin resistance, which is not something that we normally test for clinically.

 

SARAH:

Dr. Calkin, from Dalhousie University in Halifax. She said these differences persisted even after controlling for the use of antipsychotic medication; so pharmacotherapy didn’t explain the higher prevalence of metabolic syndromes in patients with bipolar disorders.

 

CALKIN:

It’s hard to say what the exact mechanism is, the effects of hyperglycemia on the brain and hyperinsulinemia may have an effect on the hippocampus and other brain regions so there may be a direct effect that can affect course of illness or treatment response.

 

SARAH:

Her team also found that, insulin resistance and type-2 diabetes worsened the prognosis of bipolar disorders:

 

CALKIN:

What we found is that patients with insulin-resistance and type-2-diabetes had significantly higher rates of chronic course compared to episodic course of illness, as well as higher rates of rapid cycling and poor response to lithium. So there were many more euglycemic patients who would have complete response with lithium and many more insulin-resistant and type-2-diabetic patients who have complete non-response.

 

SARAH:

That was Dr. Cynthia Calkin, from Nova Scotia.

 

SEGMENT 4: High calcium intake can reduce the risk of obesity in children with genetic vulnerabilities

 

PETER:

And the final congress MD-FM attended this week was the annual meeting of Experimental Biology, held in San Diego. The conference heard that, for children who carry a genetic vulnerability to developing obesity and type-2-diabetes, a high calcium intake can reduce the risk of obesity...

 

SARAH:

Yes, the total calcium intake normalized for body weight was a highly significant predictor for body fat in a study looking at 142 African-American children. They were all genotyped for alleles associated with an increased risk of developing obesity and type-2-diabetes. Joseph Devaney, from the Center of Genetic Medicine at the Children's National Medical Center, in Washington DC:

 

DEVANEY:

It seems that if you have this predisposition to type-2-diabetes, that then if you have calcium on top of that, you can actually modulate your BMI with that. So it’s kind of an interesting way to look at the genetic variants that seem to be predisposing you to type-2-diabetes but then, what else can interact with them so that you can hopefully get a good healthy individual.

 

SARAH:

So, different patterns of nutrition and, in particular, high calcium intakes could be helpful for preventing obesity in individuals with risk alleles associated with the development type-2-diabetes…

 

DEVANEY:

We see an interaction between diet, genetic polymorphisms and BMI and body fat. So it would be interesting to see if those interactions can be modulated by more calcium intake or if we add physical activity on top of that... That’s really some of the other things we want look out with this, to see if we can expand this, how can we use this to really affect health.

 

SARAH:

That was Joseph Devaney, from Washington DC.

 

IN BRIEF 1: Evaluating the risk of hip fracture in post-menopausal women who discontinue bisphosphonate therapy

 

PETER:

Finally, in brief: when postmenopausal women discontinue bisphosphonate therapy, age and testing of bone mineral density (BMD) of the hip, can help predict their likelihood of subsequent fractures. That’s according to a new randomized placebo-controlled study, published in JAMA Internal Medicine. Older age and lower hip BMD, at the time of therapy discontinuation, were associated with higher rates of clinical fractures during the following five years.

 

 IN BRIEF 2: Antipsychotic medication associated with reduced rate of violent crime

 

PETER:

When Patients take the antipsychotic medications they’re prescribed, they are only half as likely to commit a violent crime, compared to when they’re not taking such drugs. That’s the finding of a population-based study, published in The Lancet, that showed the use of mood-stabilizing drugs was also associated with a reduced overall rate of violent crime, albeit less pronounced, and only in men with bipolar disorder.

 

PETER:

That's all from MDFM for now. Sarah Maxwell and I will be back with more next week, so until then, from me, Peter Goodwin, goodbye!

 

 

 

 

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