by Raphael Wurm and Isabella Colonna
Each month the EANpages editorial team reviews the scientific press for recently published papers of outstanding interest to neurologists. Below we present our selection for April 2024 (for our Paper of the Month for April, see here).
1. Clopidogrel Plus Aspirin vs Aspirin Alone in Patients With Acute Mild to Moderate Stroke: The ATAMIS Randomized Clinical Trial
The ATAMIS trial, a randomisd, open-label, clinical study conducted in China, compared the effects of dual antiplatelet therapy (clopidogrel plus aspirin) to aspirin alone in patients with acute mild to moderate ischaemic stroke within 48 hours of symptom onset. The key inclusion criteria were a baseline NIHSS score of 4-10 with functional independence pre-stroke. Patients who were eligible for intravenous thrombolysis or thrombectomy received it and were excluded from this trial. The primary outcome was early neurological deterioration defined as ≥2 points increase on the NIHSS at 7 days post-treatment. The endpoint occurred in 4.8% of the DAPT group compared to 6.7% in the aspirin alone group (risk difference −1.9%; 95% CI, −3.6 to −0.2; _P_ = .03); bleeding events were similar.
These results suggest dual antiplatelet therapy could be a superior choice for this patient group, though further research in more diverse settings and under blinded treatment allocation is necessary to confirm these findings.
2. Risk of Autism after Prenatal Topiramate, Valproate, or Lamotrigine Exposure
So far, there is limited and conflicting evidence on the risk of autism spectrum disorder associated with topiramate use during pregnancy. This population-based cohort study included 4,292,539 pregnant women. Among this population, 28,952 women were diagnosed with epilepsy. The children who were not exposed to antiseizure medications had an incidence of spectrum disorders at 8 years of age of 1.9%; however, the incidence was higher (=4.21%) when the analysis was restricted to children born to women with epilepsy. When considering the exposure to antiseizure drugs, the incidence was 6.15%, 10.51% and 4.08% in children exposed to topiramate, valproate and lamotrigine, respectively. However, after adjustment for confounders, the risk associated with topiramate and lamotrigine was attenuated, but remained high for valproate.
