EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, April 19, 2004
To contact Stephen D. Silberstein, M.D., call Jeffrey Baxt at 215/955-5507.

TOPIRAMATE REDUCES FREQUENCY OF MIGRAINES

CHICAGO—Topiramate, a drug used to treat epilepsy, is effective for preventing migraine headaches, according to an article in the April issue of the Archives of Neurology, one of the JAMA/Archives journals.

According to background information in the article, migraines are recurrent, disabling headaches that occur in 17 percent of women, six percent of men, and four percent of children. Approximately 53 percent of patients with severe migraines report that their attacks require bed rest or cause serious impairment. Small studies have suggested that a drug called topiramate may help in preventing migraines.

Stephen D. Silberstein, M.D., of Thomas Jefferson University Hospital, Philadelphia, and colleagues evaluated topiramate in a 26-week, randomized, double-blind, placebo-controlled study of 487 patients aged 12 to 65 years with a history of migraine.

Participants were randomized to receive placebo (n=117) or topiramate, 50 milligrams per day (n=125), 100 milligrams per day (n=128), or 200 milligrams per day (n=117).

The researchers found that the average number of migraines per month among the group taking 100 milligrams of topiramate per day decreased from about 5.4 to 3.3, and among the group taking 200 milligrams per day, the frequency decreased from about 5.6 migraines per month to 3.3. In the placebo group, migraine frequency decreased from 5.6 per month to 4.6 per month. The researchers also found that improvements occurred within the first month of treatment.

The percentage of patients who experienced a 50 percent or more reduction in migraines per month was 35.9 percent in the 50 milligram per day group, 54.0 percent in the 100 milligram per day group, 52.3 percent in the 200 milligram per day group, and 22.6 percent in the placebo group.

Adverse effects included paresthesia (abnormal burning or tingling sensation), fatigue, nausea and loss of appetite.

"Topiramate, 100 or 200 milligrams per day, was effective as a preventive therapy for patients with migraine," the researchers conclude.

EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, April 19, 2004
To contact Hrayr P. Attarian, M.D., call Jennifer Nachbur at 802/656-7875.

PATIENTS WITH MULTIPLE SCLEROSIS AND FATIGUE MAY HAVE ABNORMAL SLEEP CYCLES

CHICAGO—Fatigue in patients with multiple sclerosis may be related to abnormal or disrupted sleep cycles, according to an article in the April issue of the Archives of Neurology, one of the JAMA/Archives journals.

According to the article, fatigue is the most frequent symptom of multiple sclerosis (MS) and is often difficult to treat. Fatigue is experienced by 76 percent to 92 percent of MS patients and is often profoundly debilitating, the article states.

Hrayr P. Attarian, M.D., of the University of Vermont, Burlington, and colleagues investigated whether circadian rhythm abnormalities or sleep disturbances exist in patients with MS and if they correlate with fatigue and daytime sleepiness. Circadian rhythms are the cycles of sleep and wakefulness, controlled by part of the brain.

The researchers studied 15 patients with MS and fatigue compared with 15 patients with MS without fatigue and 15 healthy people without MS.

The researchers found that of the 15 patients with MS, two had delayed sleep phase, ten had disrupted sleep, and three had normal sleep. One of the 15 non-fatigued MS patients had irregular sleep cycles, two others had disrupted sleep and 12 had normal sleep. All 15 participants without MS had normal sleep. Nine patients with MS and fatigue scored high on a sleep scale test, indicating excessive daytime sleepiness. Only two patients with MS without fatigue scored high on this test. None of the participants without MS were fatigued.

The researchers found a relationship between fatigue and abnormal sleep cycles or disrupted sleep, and between excessive daytime sleepiness and fatigue in MS patients.

EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, April 19, 2004
To contact Sameh Said Zaghloul, M.B.B.C.H., D.D.Sc., M.Sc., M.D., e-mail: samehzaghloul{at}yahoo.co.uk

MULTIPLE FACTORS AFFECT PSORIASIS TREATMENT COMPLIANCE

CHICAGO—Psychological, social, and disease-related issues may influence a patient's compliance with psoriasis treatment, according to an article in the April issue of the Archives of Dermatology, one of the JAMA/Archives journals.

According to the article, psoriasis is a common, chronic skin disorder that produces significant illness and can significantly effect quality of life. There are many treatment options for psoriasis ranging from simple topical medication to oral therapy with potentially toxic drugs, but there is no cure. In most patients, the need for treatment is lifelong. "Psoriasis, like many other similar [skin disorders], tends to be more emotionally than physically debilitating for patients. The effect of psoriasis on a patient is multidimensional, including the physical, social, and psychological health of the person, and is based largely on the patient's view of his or her condition," the article states.

Sameh Said Zaghloul, M.B.B.C.H., D.D.Sc., M.Sc., M.D., of The General Infirmary at Leeds, England, and colleagues evaluated compliance with topical and oral therapies in patients with psoriasis and identified factors affecting compliance among 201 patients (average age 45 years; range, 20-65 years) with psoriasis.

Patients completed a brief medical and social history and answered questions about their treatment compliance and their quality of life as related to their psoriasis at the beginning of the study. Patients were reevaluated three months later, and their actual treatment use was compared with the expected use.

The researchers found that on average, medication compliance was 60.6 percent. Women had a significantly higher medication adherence rate (77.9 percent, n=112) than men (38.8 percent, n=89). For single people, adherence was 44.2 percent (n=104), for married persons it was 78.2 percent (n=97), for employed people, it was 68.9 percent (n=134), and for unemployed people, it was 43.9 percent (n=67). The average medication adherence for people who paid for their medication was 45.5 percent (n=102), and for those who did not pay, it was 76.2 percent (n=99).

Medication adherence was greater for topical or combined therapy, for once-daily treatment, and for first-time treatment. Patients with facial disease and with more extensive disease had lower medication adherence. The researchers also found that the major reasons for missing treatment were drinking alcohol, being fed up, forgetfulness, and being too busy.