Author: Rachael Hansford

Neurosurgeons at The Walton Centre, Liverpool, UK, have recently carried out their first two stereoelectroencephalography (SEEG) procedures with the assistance of the Renishaw neuromatestereotactic robot. The Walton Centre is the only NHS Trust in the UK dedicated to neuroscience, and the staff includes many leaders in their areas of expertise. The procedures with a neuromaterobot marks a transition to robot assisted neurosurgery which should see both patients and staff benefitting from reduced procedure times.

SEEG is a procedure used in the treatment of epilepsy. Multiple intracerebral electrodes are inserted into the brain in preplanned trajectories to gather data and map brain activity. By doing this, neurosurgeons aim to identify the region responsible for generating epileptic seizures. Once the epileptogenic region has been identified neurosurgeons can follow up with a tailored resection to remove the problematic tissue.

The epilepsy neurosurgery team at The Walton Centre is led by consultant neurosurgeons Prof. Paul Eldridge and Mr Jibril Osman-Farah, who estimate that the use of the neuromaterobot will reduce procedure times significantly. Following the recent procedures, Prof. Eldridge and Mr Osman-Farah commented: “Accurate targeting by multiple electrodes is essential to understand the location of the epileptic focus, prior to consideration of its excision or ablation. Since there are multiple trajectories to be both planned and executed it is highly suited to a robotic system fulfilling the requirement for a repetitive stereotyped activity. Without the robot it becomes impractical to consider such a series of multiple electrodes in a reasonable length of time for the procedure.”

Renishaw’s neuromate robot can bring benefit to SEEG procedures by assisting with time-efficient positioning of electrodes and dramatically reducing overall procedure time. By accurately aligning the electrodes according to the neurosurgeons pre-planned trajectory, the neuromate robot helps ensure that neurosurgeons safely reach the targeted anatomy.

The Walton Centre, which was able to acquire the robot through charitable support, is now one of a growing number of hospitals worldwide benefitting from improved accuracy and reduced procedure times by working with the neuromate robot. Stuart Campbell, Clinical Sales Development Manager at Renishaw, added: “The time saved during this latest procedure is a great result for the neurosurgeons and for the patient. We look forward to working closely with the team so that patients can continue to benefit from this innovative technology.”

Merck will be presenting data for MAVENCLAD® (Cladribine Tablets) a treatment for highly active relapsing multiple sclerosis (RMS) as defined by clinical or imaging features, and Rebif®(interferon beta-1a) at the American Academy of Neurology (AAN) 70th Annual Meeting, April 21-27, 2018, in Los Angeles.

MAVENCLAD® data to be presented includes poster presentations highlighting post-hoc analyses of the CLARITY, CLARITY Extension and ORACLE-MS trials evaluating safety and use in patients with multiple sclerosis (MS), as well as the impact on B- and T-cells. MAVENCLAD® is a short-course oral therapy that is thought to preferentially target lymphocytes which may be integral to the pathological process of relapsing forms of MS (RMS). MAVENCLAD® is currently under clinical investigation and is not approved in the US.

MAVENCLAD® has received marketing authorisation in 35 countries including European Union member countries, Canada, Australia, Argentina, Israel, and the United Arab Emirates. MAVENCLAD® is now available in Germany, UK, Canada, Netherlands, Norway, Denmark, Sweden, Israel, and other markets. The Company plans additional filings for regulatory approval in other countries, including the United States.

Rebif data includes presentations analysing no evidence of disease activity (NEDA), long-term disease activity assessed by the Magnetic Resonance Imaging in MS (MAGNIMS) score, new data on pregnancy outcomes for women being treated with interferon beta, as well as real-world evidence evaluating treatment adherence rates for patients treated with Rebif compared with dimethyl fumarate.

We look forward to presenting data demonstrating advancement in our knowledge of MS, including further scientific information about Mavenclad and Rebif at the 2018 AAN Annual Meeting

said Luciano Rossetti, Head of Global R&D for the biopharma business of Merck.

Meeting attendees can learn more about the Company and participate in the following MS-specific interactive activities by visiting booth #1847:

• “I’m Balancing MS”: Individuals can understand the balance between healthcare and lifestyle for those facing MS through a mobile art activity. For each participant, we will donate $100 to MS Fitness Challenge, a charity organisation dedicated to educating and training people with MS on the benefits of exercise and nutrition.
•  “Shine a Light”: Individuals can create their own Light Trail art symbolising what drives their commitment to fighting MS. Participation in the activity will drive a donation to MS Fitness Challenge.

Additionally, Exhibit Hall booth #1957 will host hands-on activities which will allow attendees to gain a better understanding of what it’s like to have MS through virtual reality pods and simulation stations.

The company will also be hosting an Industry Therapeutic Update event entitled Evolving Perspectives and Innovations in Multiple Sclerosis on Wednesday, April 25 from 7:00 p.m.-10:00 pm PDT at the Platinum Ballroom in the JW Marriott Hotel in Los Angeles. Speakers include, Professor Amit Bar-Or, University of Pennsylvania, Philadelphia, PA, Professor Dusan Stefoski, Rush University Medical Center, Chicago, IL and Professor Anthony Traboulsee, University of British Columbia, Vancouver, CA.

AAN Brain Health Fair

The MS InsideOut experience will be exhibited at the AAN Brain Health Fair, a one-day-only event where attendees can learn about the brain and the field of neurology. The event takes place on Friday, April 20 from 10:00 a.m.-4:00 pm PDT at the Los Angeles Convention Center.

Presentations at AAN 2018 include the following accepted abstracts:

Full session details and data presentation listings for the 2018 AAN Annual Meeting can be found at the meeting website: https://www.aan.com/conferences-community/annual-meeting

Genentech, a member of the Roche Group, will present new data on its approved and investigational medicines for neurological conditions during the 70^th American Academy of Neurology (AAN) Annual Meeting from April 21-27 in Los Angeles, California. These data will reinforce the efficacy and safety of OCREVUS® (ocrelizumab) and expand the clinical understanding of disability progression in multiple sclerosis (MS). They will also represent investigational research from the Genentech neuroscience pipeline in Alzheimer’s disease, Huntington’s disease, Spinal muscular atrophy (SMA) and Duchenne muscular dystrophy (DMD).

“Our neuroscience pipeline is one of the deepest and most diverse in the industry, spanning both common and rare neurological conditions with the greatest unmet need

said Sandra Horning, M.D., chief medical officer and head of Global Product Development. “OCREVUS is now approved in over 55 countries with more than 40,000 people treated. We remain committed to continuing our research and development to understand MS progression further and help those living with MS and their physicians.”

OCREVUS data will show significant and sustained efficacy as well as benefits in cognition in people with relapsing MS (RMS). The early impact of OCREVUS on biomarkers of inflammation and neurodegeneration in people with RMS will be shared for the first time through the OBOE (Ocrelizumab Biomarker Outcome Evaluation) study.

Additional MS presentations include updated safety analyses for OCREVUS, which will further inform and reinforce its continued favourable benefit-risk profile. New data from the FLOODLIGHT pilot study, which support mobile technology as a complement to in-clinic testing to provide a more complete and real-time picture of a patient’s underlying disease activity, will also be presented.

Encouraging data from other investigational medicines in Genentech’s neuroscience pipeline will also be presented:

• Alzheimer’s disease is an important area of focus for Genentech. Four presentations on investigational anti-amyloid beta antibodies crenezumab and gantenerumab show promise in Genentech’s Alzheimer’s disease pipeline, and the findings have informed the design for both the CREAD and GRADUATE pivotal Phase III trial programs, respectively. In a platform session, data on gantenerumab will be presented showing a significant reduction in brain amyloid beta plaques with a higher dosing regimen (1200 mg) in two Phase III, open label extension studies. Data from these two studies guided the dose and titration regimen selection for the recently initiated Phase III GRADUATE pivotal program investigating gantenerumab for the treatment of early Alzheimer’s disease. Two posters on crenezumab will be presented; one will focus on preclinical data and will discuss its proposed mechanism of action, including data supporting its preferential binding to neurotoxic amyloid beta oligomers. A second poster will describe the results from a safety, tolerability and pharmacokinetics Phase Ib study in doses up to 120 mg. Data from this study were used to determine an optimal dose now used in the ongoing CREAD pivotal program investigating crenezumab for the treatment of early Alzheimer’s disease.
• Data from a Phase I/IIa multiple-ascending dose study of RG6042 (formerly known as IONIS HTTRx) in Huntington’s disease will be presented in a plenary session. These data will highlight the safety and tolerability of this investigational medicine over four monthly doses, demonstrate dose-dependent lowering of the mutant huntingtin protein (mHTT), and show additional exploratory analyses from this first-in-human study. These results for RG6042 are the first data demonstrating lowering of mHTT, the disease-causing protein in people with Huntington’s disease.
• The SMA presentations include late-breaking interim data on the increase in survival of motor neuron (SMN) protein levels following treatment with RG7916 in infants with Type 1 SMA. SMA, the leading genetic cause of mortality in infants and toddlers, is a rare neuromuscular disease caused by a deficiency of SMN protein. RG7916 is an investigational oral SMN2 splicing modifier being developed in collaboration with PTC Therapeutics, Inc. and the SMA Foundation.
• Results from a Phase Ib/II study of the investigational adnectin fusion protein RG6206 in young male adolescents with DMD will also be presented. These data will highlight the myostatin suppression levels achieved and its potential effect in increasing lean body mass volume.

Investigators will present the following plenary, platform and poster presentations:

Full session details and data presentation listings for the 2018 AAN Annual Meeting can be found at the meeting website: https://www.aan.com/conferences-community/annual-meeting

MS in the 21^st Century, an initiative sponsored by Merck KGaA, Darmstadt, Germany, involving healthcare professionals (HCPs) and patients, have published their new manuscript ‘Unmet needs, burden of treatment, and patient engagement in multiple sclerosis: a combined perspective from the MS in the 21^st Century Steering Group’ in the peer reviewed journal, Multiple Sclerosis and Related Disorders (MSARD).  

The paper was developed jointly by clinical and patient experts to discuss how the different perspectives of people with MS and their healthcare providers may have an effect on MS and its treatment burden.  One of the authors, Professor Gavin Giovannoni, Chair of Neurology, Blizard Institute of Neurology, Barts and The London School of Medicine and Dentistry, explains: 

This manuscript is distinct in the field as it is co-authored by healthcare professionals and people with the disease. This does not only represent the ‘patient voice’ but rather gives equal importance to the patient and HCP perspective. Most importantly, it recognises the need to start from a place of mutual understanding of each other’s priorities. I anticipate that the group’s recommendations on unmet needs and treatment burden will help to pave the way for more collaborative and holistic MS care.

Despite the large number of advances in the field of MS over the last 20 years, a cure remains elusive, and unmet patient needs that affect quality of life continue to exist. The limited opportunities for collaboration between healthcare professionals and patients to share priorities and drive patient-centred solutions is reflected by the lack of jointly-produced papers available on the issues. Birgit Bauer, a person with MS, believes that is why the impact of this paper will be huge:

As a person with MS, I cannot overstate the significance of this publication. Just as the authors of the paper have done, I am hopeful patients everywhere and their healthcare teams will recognise the need for better communication and partnership with the ultimate goal of more effective and personalised care.

The aim of the paper is to highlight the varying priorities between healthcare professionals and patients, whilst the practical recommendations documented will bridge the gaps in perception and enable better collaboration, ultimately improving patient care. Professor of psychology, Dawn Langdon, said:

The publication of this paper is a key step towards ensuring that MS care addresses patient expectations, priorities and needs, and it is vital that we work together to enhance shared decision-making and therefore increase patient engagement.

‘Unmet needs, burden of treatment, and patient engagement in multiple sclerosis: a combined perspective from the MS in the 21^st Century Steering Group’ is published in the peer reviewed journal, Multiple Sclerosis and Related Disorders (MSARD), and is available online now at: https://doi.org/10.1016/j.msard.2017.11.013

About MS in the 21^st Century

An initiative of Merck established in 2011, the members of the steering group include: 14 HCPs (including neurologists, a neuropsychologist, a health economist, an MS nurse, an MS rehabilitation specialist) as well as 11 people with MS (PwMS) and patient advocacy group representatives.

The group meets regularly to discuss the creation of programmes and awareness to achieve the following objectives:

• improve communication between patients and HCPs through joint education and interaction
• improve awareness of, and access to, treatment and care
• improve provision/access to information by: ensuring high-quality information from credible sources, increasing public awareness of MS, and focusing on e-medicine and e-education
• promote patient activation and self-management by: highlighting the significance and benefits of self-management, empowering patients through education and communication, and improving the social well-being and integration of MS patients.

Thousands of people helped in developing nations at the same time as UK patients reap the benefits of innovative medical diagnostic systems

Canon Medical Systems UK, has announced a sustainable milestone offsetting 20,000 tonnes of carbon dioxide (CO2) from ultrasound, X-ray, CT or MRI systems installed into UK hospitals over the past 3.5 years. The scheme means that more than 22,000 people, including 12,000 children, in rural Uganda and Kenya have received practical help to improve mortality, health, quality of life and female empowerment.

Achieving this carbon offset milestone also means that Canon Medical Systems is the only UK medical equipment provider to be a Carbon neutral business meeting all PAS2060 requirements by the British Standards Institute. It is now working towards becoming a United Nations Sustainability partner.

The carbon footprint of each Canon Medical Systems imaging product used in the daily prevention, diagnosis and treatment of patients in NHS and private hospitals has been calculated. This takes into account the elements involved in manufacture, packaging, shipping and average energy usage for the standard lifetime of a system. Each month, UK sales figures are translated into tonnes of carbon and offset to a high impact project in a developing country.

For example, a Canon Medical 1.5T MRI system has a carbon offset footprint of 226.78 tonnes which then helps 245 people in Kenya and Uganda via cooking stoves and water borehole projects. Cooking on open stoves is a big health issue in developing nations with World Health Organisation figures stating that there are 3.8 million premature deaths per year from non-communicable diseases such as stroke, ischaemic heart disease, chronic obstructive pulmonary disease (COPD) and lung cancer¹.

The Canon Medical Systems UK carbon offset scheme, managed by specialists CO2balance and monitored by the United Nations, provides 35 modern fuel efficient stoves per MRI system sold. This reduces the amount of smoke particles in a family home, the equivalent to 2 packets of inhaled cigarettes per day. The amount of firewood needed is also halved delivering further environmental and quality of life positives, such as, time savings on wood collection so children do not miss school, and lessening deforestation benefitting wildlife habitats and flood prevention.

We are proud to be a Carbon Zero company helping the environment at the same time as helping people less fortunate than ourselves

Mark Hitchman, UK Managing Director of Canon Medical Systems

“We are aware that the NHS is one of the largest contributors of greenhouse gas emissions in the UK. Our R&D commitment starts with developing systems that use less electricity and thus emit less carbon, at the same time as seeing more patients, delivering the highest quality clinical images at the lowest possible dose. This spirit of innovation then extends to sustainability where we embrace a gold-standard scheme that helps some of the poorest rural communities in East Africa.”

“CO2 in the earth’s atmosphere is a critical problem with 2016 figures showing a record high. If it continues, it will lead to unpredictable changes in the global climate system such as higher temperatures, flooding and other extreme conditions,” states Paul Chiplen, Director at CO2balance.

Canon Medical Systems UK is a carbon zero hero identifying that our fragile environment is at risk and focusing much time and energy into doing something about it.

Paul Chiplen, Director at CO2balance

Canon Medical Systems’ energy efficiency innovation in medical imaging includes its latest generation CT scanner. It recovers energy when the gantry decelerates from spinning thus drawing less electricity, plus advances of standby functionality further reduces emissions.

For more information see https://uk.medical.canon

March 02, 2018

Biogen and AbbVie have announced the voluntary worldwide withdrawal of ZINBRYTA for relapsing multiple sclerosis. The companies believe that given the nature and complexity of adverse events being reported, characterising the evolving benefit/risk profile of ZINBRYTA will not be possible going forward given the limited number of patients being treated.

Biogen believes the voluntary worldwide withdrawal of ZINBRYTA, a treatment for relapsing multiple sclerosis, is in the best interest of patients. Biogen and AbbVie continue to prioritise patient safety and the care of multiple sclerosis patients worldwide.

Alfred Sandrock, Executive Vice President and Chief Medical Officer at Biogen

Biogen will continue to work collaboratively with regulatory authorities in the withdrawal of product and with healthcare providers worldwide in their support of ZINBRYTA patients

About ZINBRYTA

ZINBRYTA (daclizumab) is currently available in the EU, US, Switzerland, Canada and Australia. ZINBRYTA is a prescription medicine used to treat adults with relapsing forms of multiple sclerosis (MS). Because of its risks, ZINBRYTA is generally used in people who have tried two or more MS medicines that have not worked well enough. It is not known if ZINBRYTA is safe and effective for use in children under 18 years of age.

After the success of the Royal College of Physicians’ (RCP’s) ‘Neurology of systemic disease’ conference in 2017, Professor David Nicholl has put together a programme for the ‘From Holmes to House – 500 years of the diagnostic neurologist’ conference on Tuesday 20 March 2018 (co-badged with the Association of British Neurologists (ABN)).

Commenting on the ‘From Holmes to House’ event, Professor Nicholl said:

I am genuinely excited about this contribution by the ABN to the RCP’s 500th anniversary, which takes place on the birthday of the physician that (many consider) was the founder of British neurology, William Gowers. This is a great opportunity to both reflect back and look forward to pioneering physicians and to hear and discuss the findings of world-class speakers on clinical reasoning, imaging, genetics and overdiagnosis. This conference will be of interest to a very broad range of physicians and (not just) neurologists as we look forward to the next 500 years of the specialty.

Dr Nicholl is clinical lead for neurology at City Hospital Birmingham and an RCP tutor at University Hospitals Birmingham NHS Foundation Trust. He is the honorary secretary of the ABN and he is on the Board of Trustees and Council at the RCP. Dr Nicholl is passionate about clinical reasoning, medical education and clinical neurology. Find more about his research by following @TOSStudyGroup on Twitter, and join the discussion about the conference on Twitter via #HolmesToHouse.

Following a Learning Day for members of the Trigeminal Neuralgia Association UK held at The University of Leeds last year, the hosts from the Cognitive Psychology Department, together with colleagues from Sheffield University and UCLH, set up a project to determine the cognitive and motor effects on patients taking drugs prescribed for TN. It is well known and documented that there are severe side-effects from such drugs as carbamazepine, oxcarbazepine and others which result in patients being unable to think clearly or, as one sufferer put it, being ‘zombified’. Several volunteers from TNA UK have agreed to take part in a study using a series of tests which are displayed on a tablet computer coupled with oral questioning by the researcher. Over the period of the study, the researcher will also spend some time at UCLH with Professor Zakrzewska reviewing the results of her findings with regard to her own patients. Patients will do these tests when on a high dosage of these drugs and then again after they have stopped them – either because surgery has been successful or because they have gone into a remission period. This will improve understanding of the effects of these drugs and highlight the need for potentially newer drugs that result in fewer cognitive side effects.
www.tna.org.uk