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Aboukarr A, Giudice M. Interaction between Monoamine Oxidase B Inhibitors and Selective Serotonin Reuptake Inhibitors. Can J Hosp Pharm 2018; 71:196-207. [PMID: 29955193 PMCID: PMC6019085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND Monoamine oxidase B (MAO-B) inhibitors are used to treat the motor symptoms of Parkinson disease. Depression is commonly associated with Parkinson disease, and selective serotonin reuptake inhibitors (SSRIs) are often used for its management. Tertiary sources warn that the combination of MAO-B inhibitors and SSRIs can result in increased serotonergic effects, leading to serotonin syndrome. OBJECTIVE To explore the mechanism, clinical significance, and management of this potential drug interaction through a review of the supporting evidence. DATA SOURCES PubMed, MEDLINE (1946 forward), Embase (1947 forward), PsycINFO (1806 forward), and International Pharmaceutical Abstracts (1970 forward) were searched on February 4, 2017. STUDY SELECTION AND DATA EXTRACTION Studies and case reports describing aspects of the potential interaction between MAO-B inhibitors and SSRIs in patients with Parkinson disease and published in English were identified by both title and abstract. DATA SYNTHESIS The search identified 8 studies evaluating the potential interaction between SSRIs and the MAO-B inhibitors selegiline and rasagiline. The largest, a retrospective cohort study of 1504 patients with Parkinson disease, found no cases of serotonin syndrome with coadministration of rasagiline and an SSRI. A survey of 63 investigators in the Parkinson Study Group identified 11 potential cases of serotonin syndrome among 4568 patients treated with the combination of selegiline and antidepressants (including SSRIs). In addition, 17 case reports describing the onset of serotonin syndrome with coadministration of an SSRI and either selegiline or rasagiline were identified. Following discontinuation or dose reduction of one or both of the agents, the symptoms of serotonin syndrome gradually resolved in most cases, with none being fatal. CONCLUSIONS According to the literature, serotonin syndrome occurs rarely, and the combination of SSRI and MAO-B inhibitor is well tolerated. Therefore, SSRIs and MAO-B inhibitors can be coadministered, provided that their recommended doses are not exceeded and the SSRI dose is kept at the lower end of the therapeutic range. Among the SSRIs, citalopram and sertraline may be preferred.
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Affiliation(s)
- Abdullah Aboukarr
- , PharmD, was, at the time this review was performed, a PharmD student in the Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario. He is now with Medical Affairs, Purdue Pharma (Canada), Pickering, Ontario
| | - Mirella Giudice
- , BScPharm, is with the Ottawa Valley Regional Drug Information Service, The Ottawa Hospital, Ottawa, Ontario
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52
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Yi ZM, Qiu TT, Zhang Y, Liu N, Zhai SD. Levodopa/carbidopa/entacapone versus levodopa/dopa-decarboxyiase inhibitor for the treatment of Parkinson's disease: systematic review, meta-analysis, and economic evaluation. Ther Clin Risk Manag 2018; 14:709-719. [PMID: 29713179 PMCID: PMC5907888 DOI: 10.2147/tcrm.s163190] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Aims To review the evidence for efficacy, safety, and cost-effectiveness of levodopa/carbidopa/entacapone (LCE) compared with levodopa/dopa-decarboxyiase inhibitor (DDCI) for Parkinson’s disease (PD). Methods PubMed, Embase, the Cochrane Library, and Chinese databases WangFang Data, Chinese Sci-tech Journals Database and China National Knowledge Infrastructure, as well as ClinicalTrials.gov, were searched for randomized controlled trials with “levodopa/carbidopa/entacapone” as keywords. The search period was from inception to August 2017. We conducted meta-analyses to synthesize the evidence quantitatively. Results A total of 5,693 records were obtained. We included seven randomized controlled trials and one cost-effectiveness study after the screening process. Compared with levodopa–DDCI, LCE improved patient Unified Parkinson’s Disease Rating Scale (UPDRS) II score (mean difference [MD] −1.17, 95% CI −1.64 to −0.71), UPDRS III score (MD −1.55, 95% CI −2.29 to −0.81), and Schwab and England daily activity rating (MD 2.05, 95% CI 0.85–3.26). There was no statistically significant difference in the risk of serious adverse events (AEs) or discontinuation due to AEs in patients with LCE, and the risk of total AEs was higher in the LCE group (risk ratio [RR] 1.33, 95% CI 1.05–1.70). The incremental cost-effectiveness ratio of LCE was £3,105 per quality-adjusted life-year (QALY) gained in the UK. Conclusion LCE can improve PD patients’ motor symptoms and daily living functioning when compared with levodopa/DDCI.
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Affiliation(s)
- Zhan-Miao Yi
- Department of Pharmacy, Peking University Third Hospital.,Department of Pharmacy Administration and Clinical Pharmacy, Peking University School of Pharmaceutical Science.,Institute for Drug Evaluation, Peking University Health Science Center, Beijing, China
| | - Ting-Ting Qiu
- Department of Pharmacy, Peking University Third Hospital.,Public Health Department, Aix-Marseille University, Marseille, France
| | - Yuan Zhang
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Na Liu
- Department of Neurology, Peking University Third Hospital, Beijing, China
| | - Suo-Di Zhai
- Department of Pharmacy, Peking University Third Hospital.,Institute for Drug Evaluation, Peking University Health Science Center, Beijing, China
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53
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Fox SH, Katzenschlager R, Lim SY, Barton B, de Bie RMA, Seppi K, Coelho M, Sampaio C. International Parkinson and movement disorder society evidence-based medicine review: Update on treatments for the motor symptoms of Parkinson's disease. Mov Disord 2018; 33:1248-1266. [DOI: 10.1002/mds.27372] [Citation(s) in RCA: 406] [Impact Index Per Article: 67.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 01/26/2018] [Accepted: 02/05/2018] [Indexed: 01/05/2023] Open
Affiliation(s)
- Susan H. Fox
- Edmund J. Safra Program, Movement Disorder Clinic; Toronto Western Hospital; Toronto Ontario Canada
- University of Toronto Department of Medicine; Toronto Ontario Canada
| | - Regina Katzenschlager
- Department of Neurology and Karl Landsteiner Institute for Neuroimmunological and Neurodegenerative Disorders; Danube Hospital; Vienna Austria
| | - Shen-Yang Lim
- Division of Neurology and the Mah Pooi Soo & Tan Chin Nam Centre for Parkinson's & Related Disorders; University of Malaya; Kuala Lumpur Malaysia
| | - Brandon Barton
- Rush University Medical Center; Chicago Illinois USA
- Jesse Brown VA Medical Center; Chicago Illinois USA
| | - Rob M. A. de Bie
- Department of Neurology, Academic Medical Center; University of Amsterdam; Amsterdam The Netherlands
| | - Klaus Seppi
- Department of Neurology; Medical University Innsbruck; Innsbruck Austria
| | - Miguel Coelho
- Department of Neurology, Santa Maria Hospital, Instituto de Medicina Molecular; University of Lisbon; Lisbon Portugal
| | - Cristina Sampaio
- Cure Huntington's Disease Initiative (CHDI) Management/CHDI Foundation, Princeton, NJ; USA
- Instituto de Medicina Molecular; University of Lisbon; Lisbon Portugal
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Pedrosa Carrasco AJ, Timmermann L, Pedrosa DJ. Management of constipation in patients with Parkinson's disease. NPJ Parkinsons Dis 2018; 4:6. [PMID: 29560414 PMCID: PMC5856748 DOI: 10.1038/s41531-018-0042-8] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 01/30/2018] [Accepted: 02/06/2018] [Indexed: 12/13/2022] Open
Abstract
A considerable body of research has recently emerged around nonmotor symptoms in Parkinson's disease (PD) and their substantial impact on patients' well-being. A prominent example is constipation which occurs in up to two thirds of all PD-patients thereby effecting psychological and social distress and consequently reducing quality of life. Despite the significant clinical relevance of constipation, unfortunately little knowledge exists on effective treatments. Therefore this systematic review aims at providing a synopsis on clinical effects and safety of available treatment options for constipation in PD. For this purpose, three electronic databases (MEDLINE, EMBASE, PsycINFO) were searched for experimental and quasi-experimental studies investigating the efficacy/effectiveness of interventions in the management of PD-associated constipation. Besides, adverse events were analyzed as secondary outcome. In total, 18 publications were identified involving 15 different interventions, of which none can be attributed sufficient evidence to derive strong recommendations. Nevertheless, some evidence indicates that dietetic interventions with probiotics and prebiotics may reduce symptom burden while providing a very favorable side-effects profile. Furthermore, the use of lubiprostone, macrogol and in the specific case of isolated or prominent outlet obstruction constipation injections of botulinum neurotoxin A into the puborectal muscles may as well be moderately supported. In summary, too little attention has been paid to treatment options for constipation in PD leaving abundant room for further research addressing this topic.
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Affiliation(s)
- Anna J. Pedrosa Carrasco
- Sir Michael Sobell House, Oxford University Hospitals, Oxford, UK
- King’s College London, Cicely Saunders Institute, Department of Palliative Care, Policy and Rehabilitation, London, UK
- Department of Internal Medicine V, University Hospital of Gießen and Marburg, Gießen, Germany
| | - Lars Timmermann
- Department of Neurology, University Hospital of Gießen and Marburg, Marburg, Germany
| | - David J. Pedrosa
- Department of Neurology, University Hospital of Gießen and Marburg, Marburg, Germany
- Department of Psychiatry, University Hospital of Gießen and Marburg, Marburg, Germany
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55
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Elie D, Rej S. Pharmacological management of neuropsychiatric symptoms in patients with major neurocognitive disorders. J Psychiatry Neurosci 2018; 43:69-70. [PMID: 29252167 PMCID: PMC5747538 DOI: 10.1503/jpn.170117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Dominique Elie
- From the Geri-PARTy Research Group, Department of Psychiatry, Jewish General Hospital, McGill University, Montreal, Que., Canada
| | - Soham Rej
- From the Geri-PARTy Research Group, Department of Psychiatry, Jewish General Hospital, McGill University, Montreal, Que., Canada
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56
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The treatment of migraine patients within chiropractic: analysis of a nationally representative survey of 1869 chiropractors. BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE 2017; 17:519. [PMID: 29202816 PMCID: PMC5715542 DOI: 10.1186/s12906-017-2026-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 11/22/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND While the clinical role of manual therapies in migraine management is unclear, the use of chiropractors for this condition is considerable. The aim of this study is to evaluate the prevalence and characteristics of chiropractors who frequently manage patients with migraine. METHODS A national cross-sectional survey of chiropractors collected information on practitioner characteristics, clinical management characteristics and practice settings. A secondary analysis was conducted on 1869 respondents who reported on their migraine caseload to determine the predictors associated with the frequent management of patients with migraine. RESULTS A large proportion of chiropractors report having a high migraine caseload (HMC) (n = 990; 53.0%). The strongest factors predicting a chiropractor having a HMC include the frequent treatment of patients with axial neck pain (OR = 2.89; 95%CI: 1.18, 7.07), thoracic pain (referred/radicular) (OR = 2.52; 95%CI: 1.58, 3.21) and non-musculoskeletal disorders (OR = 3.06; 95%CI: 2.13, 4.39). CONCLUSIONS Several practice-setting and clinical management characteristics are associated with chiropractors managing a HMC. These findings raise key questions about the therapeutic approach to chiropractic migraine management that deserves further examination. There is a need for more primary research to assess the approach to headache and migraine management provided by chiropractors and to understand the prevalence, burden and comorbidities associated with migraine found within chiropractic patient populations. This information is vital in helping to inform safe, effective and coordinated care for migraine sufferers within the wider health system.
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57
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Nomoto M, Iwaki H, Kondo H, Sakurai M. Efficacy and safety of rotigotine in elderly patients with Parkinson's disease in comparison with the non-elderly: a post hoc analysis of randomized, double-blind, placebo-controlled trials. J Neurol 2017; 265:253-265. [PMID: 29164312 PMCID: PMC5808069 DOI: 10.1007/s00415-017-8671-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 11/07/2017] [Accepted: 11/07/2017] [Indexed: 12/04/2022]
Abstract
Rotigotine—a non-ergot dopamine agonist—has two advantages; it can stimulate all dopamine receptors (D1–D5) like innate dopamine, and its transdermal administration provides continuous dopaminergic stimulation. The age of the patient impacts the effect and adverse events of anti-parkinsonian treatment. We conducted a post hoc analysis on three randomized, double-blind, placebo-controlled trials performed in Japan to clarify the difference of anti-parkinsonian treatment in elderly and non-elderly patients. Data from two combination therapy trials (with levodopa) in advanced stage Parkinson’s disease patients and one monotherapy trial in early stage patients were pooled and grouped by age (non-elderly aged < 70, elderly aged 70 +). In each age group, efficacy of rotigotine was compared to placebo. In the combination therapy, total Unified Parkinson’s Disease Rating Scale Part III scores and some subtotal scores, including those for tremor, akinesia and gait disturbance, significantly improved in both elderly and non-elderly patients. Regarding safety, the incidence of total adverse event tended to be lower in elderly patients than non-elderly patients, although it was not significant. No difference was observed in maintenance dosage of rotigotine between the two groups. In conclusion, the improvement in motor symptoms and frequency of adverse events were shown to be similar in elderly and non-elderly patients with rotigotine–levodopa combination therapy. Further, there was no major difference in maintenance dosage of rotigotine between the age groups. These results suggest good tolerability of rotigotine among elderly patients.
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Affiliation(s)
- Masahiro Nomoto
- Department of Neurology and Clinical Pharmacology, Ehime University Hospital, Shitsukawa, Toon, Ehime, Japan.
| | - Hirotaka Iwaki
- Department of Neurology and Clinical Pharmacology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, Japan
| | - Hiroyuki Kondo
- Department of Medical Affairs, Otsuka Pharmaceutical Co., Ltd, Tokyo, Japan
| | - Masaya Sakurai
- Department of Medical Affairs, Otsuka Pharmaceutical Co., Ltd, Tokyo, Japan
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Dietrichs E, Odin P. Algorithms for the treatment of motor problems in Parkinson's disease. Acta Neurol Scand 2017; 136:378-385. [PMID: 28133726 PMCID: PMC5655734 DOI: 10.1111/ane.12733] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2017] [Indexed: 12/17/2022]
Abstract
Several different strategies are effective for medical treatment of motor problems in Parkinson's disease (PD). Many guidelines and evidence-based reviews are available, but there is no documentation or consensus in favor of just one treatment strategy. This review presents two algorithms that may be helpful when deciding how to treat a PD patient at various stages of the disease. The first algorithm suggests one way to treat PD from the first onset of motor symptoms. It is largely based on treatment recommendations from the Scandinavian countries and Germany. The other algorithm is meant as assistance for choosing among the different device-aided treatments for advanced PD. There is not sufficient comparative data to recommend one particular line of treatment, neither in early PD nor in advanced disease with motor complications. Individualized treatment is needed for each patient. The current algorithms only represent an alternative for aiding treatment decisions.
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Affiliation(s)
- E. Dietrichs
- Department of NeurologyOslo University Hospital and University of OsloOsloNorway
| | - P. Odin
- Department of NeurologySkåne University HospitalUniversity of LundLundSweden
- Department of NeurologyKlinikum‐BremerhavenBremerhavenGermany
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59
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60
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Chen LWH, Chen MYS, Lian ZP, Lin HS, Chien CC, Yin HL, Chu YH, Chen KY. Amitriptyline and Sexual Function: A Systematic Review Updated for Sexual Health Practice. Am J Mens Health 2017; 12:370-379. [PMID: 29019272 PMCID: PMC5818113 DOI: 10.1177/1557988317734519] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Amitriptyline is an old drug but is still prevalently used as the first-line treatment for a variety of common diseases. Surprisingly, knowledge of sexual risks with amitriptyline comes from only one clinical trial and several case reports from three decades ago. In the current study, a systematic review of the literature following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) related to amitriptyline and sexual dysfunction (SD) was performed. The frequency, gender-difference, types, disease-specificity and time course of SD, and the relationship between SD and nonsexual adversity were studied. A total of 14 publications, including 8 qualified randomized clinical trials, were eligible. The frequency of SD in overall, male and female patients was 5.7, 11.9 and 1.7%, respectively. SD was six-fold higher in men than women. The frequency of SD was 6.9% in depressive patients compared with 0.8% in non-depressive patients ( p = .008), and gradually decreased at 8 weeks after treatment ( p = .02). Amitriptyline impacted arousal and libido more than orgasm and ejaculation in male patients but mainly libido in female patients. SD was significantly correlated with insomnia linearly whereas somnolence and nausea dually. Therefore, amitriptyline-associated SD mainly occurs in depressive and male patients, disturbs each phase of the sexual response cycle in men but mainly libido in women, gradually decreases under long-term treatment, and can be predicted by the co-existence of insomnia, somnolence or nausea during treatment. Clinicians should caution and tailor the gender and disease vulnerability of amitriptyline in their practice.
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Affiliation(s)
- Louis Wei-Hsi Chen
- 1 Graduate School of Human Sexuality, Shu-Te University, Kaohsiung City, Taiwan.,2 Department of Neurology, Kaohsiung Chang Gang Memorial Hospital, and College of Medicine, Chang Gung Memorial Hospital, Kaohsiung City, Taiwan
| | - Melody Yun-Si Chen
- 3 Department of Psychology, College of Social Sciences and Management, Fo Guang University, Yilan County, Taiwan
| | - Zhi-Ping Lian
- 1 Graduate School of Human Sexuality, Shu-Te University, Kaohsiung City, Taiwan
| | - Hung-Sheng Lin
- 2 Department of Neurology, Kaohsiung Chang Gang Memorial Hospital, and College of Medicine, Chang Gung Memorial Hospital, Kaohsiung City, Taiwan
| | - Chia-Chang Chien
- 1 Graduate School of Human Sexuality, Shu-Te University, Kaohsiung City, Taiwan.,4 Department of Psychiatry, E-Da Hospital, and College of Medicine, E-Shou University, Kaohsiung City, Taiwan
| | - Hsin-Ling Yin
- 5 Department of Clinical Forensic Medicine, Kaohsiung Medical University Hospital, and College of Medicine, Kaohsiung Medical University, Kaohsiung City, Taiwan
| | - Yuan-Hsiang Chu
- 1 Graduate School of Human Sexuality, Shu-Te University, Kaohsiung City, Taiwan
| | - Kuo-Yen Chen
- 1 Graduate School of Human Sexuality, Shu-Te University, Kaohsiung City, Taiwan
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Abstract
Migraine and Major Depressive Disorder (MDD) are highly prevalent conditions that can lead to significant disability. These conditions are often comorbid, and several studies shed light on the underlying reasons for this comorbidity. The purpose of this review article is to have a closer look at the epidemiology, pathophysiology, genetic and environmental factors, temporal association, treatment options, and prognosis of patients suffering from both conditions, to allow a better understanding of what factors underlie this comorbidity. Studies show that patients with migraine are 2-4-times more likely to develop lifetime MDD, predominantly due to similar underlying pathophysiologic and genetic mechanisms. There appears to be a bidirectional temporal association between the two conditions, although longitudinal studies are needed to determine this more definitively. Quality-of-life and health-related outcomes are worse for patients that suffer from both conditions. Thus, a careful assessment of the patient with access to appropriate resources and follow-up is paramount. Future studies in genetics and brain imaging will be helpful in further elucidating the underlying mechanisms in these comorbid conditions, which will hopefully lead to better treatment options.
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Affiliation(s)
- Farnaz Amoozegar
- a Department of Clinical Neurosciences & Hotchkiss Brain Institute, Cumming School of Medicine , University of Calgary , Calgary , AB , Canada
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62
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Affiliation(s)
- Andrew Charles
- From the UCLA Goldberg Migraine Program, Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles
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Bélanger M, Phillips EW, O’Rielly C, Mallet B, Aubé S, Doucet M, Couturier J, Mallet M, Martin J, Gaudet C, Murphy N, Brunet J. Longitudinal qualitative study describing family physicians' experiences with attempting to integrate physical activity prescriptions in their practice: 'It's not easy to change habits'. BMJ Open 2017; 7:e017265. [PMID: 28710228 PMCID: PMC5541616 DOI: 10.1136/bmjopen-2017-017265] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE Physical activity (PA) prescriptions provided by family physicians can promote PA participation among patients, but few physicians regularly write PA prescriptions. The objective of this study was to describe family physicians' experiences of trying to implement written PA prescriptions into their practice. DESIGN Longitudinal qualitative study where participants were interviewed four times during a 12-month period. After the first interview, they were provided with PA prescription pads. Data were analysed using thematic analysis. SETTING Family medicine clinics in New Brunswick, Canada. PARTICIPANTS Family physicians (n=11) with no prior experience writing PA prescriptions, but who expressed interest in changing their practice to implement written PA prescriptions. RESULTS Initially, participants exhibited confidence in their ability to write PA prescriptions in the future and intended to write prescriptions. However, data from the follow-up interviews indicated that the rate of implementation was lower than anticipated by participants and prescriptions were not part of their regular practice. Two themes emerged as factors explaining the gap between their intentions and behaviours: (1) uncertainty about the effectiveness of written PA prescription, and (2) practical concerns (eg, changing well-established habits, time constraints, systemic institutional barriers). CONCLUSION It may be effective to increase awareness among family physicians about the effectiveness of writing PA prescriptions and address barriers related to how their practice is organised in order to promote written PA prescription rates.
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Affiliation(s)
- Mathieu Bélanger
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke, Quebec, Canada
- Centre de Formation Médicale du Nouveau-Brunswick, Moncton, New Brunswick, Canada
- Vitalité Health Network, Moncton, New Brunswick, Canada
| | | | - Connor O’Rielly
- Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Bertin Mallet
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Shane Aubé
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Marylène Doucet
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Jonathan Couturier
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Maxime Mallet
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Jessica Martin
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Christine Gaudet
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Nathalie Murphy
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Jennifer Brunet
- Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
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64
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Antipsychotic Prescribing Practices in Those with Parkinsonism: Adherence to Guidelines. Can J Neurol Sci 2017; 44:603-606. [PMID: 28478793 DOI: 10.1017/cjn.2017.36] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Several evidence-informed treatment guidelines recommend against the use of typical antipsychotics in patients with Parkinson's disease; of the atypical antipsychotics, clozapine and quetiapine are preferred. The purpose of this study is to determine the frequency with which potentially inappropriate antipsychotics are dispensed to older adults in Nova Scotia who are on levodopa-containing medications. In this cohort, 59.9% were dispensed a preferred atypical antipsychotic and 12.6% a potentially harmful typical antipsychotic. Our results suggest that potentially inappropriate prescribing practices are common in the neuropsychiatric management of patients with parkinsonism and that there is an opportunity for education and improvement in prescribing practices.
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65
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Tfelt-Hansen P, Ågesen FN, Pavbro A, Tfelt-Hansen J. Pharmacokinetic Variability of Drugs Used for Prophylactic Treatment of Migraine. CNS Drugs 2017; 31:389-403. [PMID: 28405886 DOI: 10.1007/s40263-017-0430-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
In this review, we evaluate the variability in the pharmacokinetics of 11 drugs with established prophylactic effects in migraine to facilitate 'personalized medicine' with these drugs. PubMed was searched for 'single-dose' and 'steady-state' pharmacokinetic studies of these 11 drugs. The maximum plasma concentration was reported in 248 single-dose and 115 steady-state pharmacokinetic studies, and the area under the plasma concentration-time curve was reported in 299 single-dose studies and 112 steady-state pharmacokinetic studies. For each study, the coefficient of variation was calculated for maximum plasma concentration and area under the plasma concentration-time curve, and we divided the drug variability into two categories; high variability, coefficient of variation >40%, or low or moderate variability, coefficient of variation <40%. Based on the area under the plasma concentration-time curve in steady-state studies, the following drugs have high pharmacokinetic variability: propranolol in 92% (33/36), metoprolol in 85% (33/39), and amitriptyline in 60% (3/5) of studies. The following drugs have low or moderate variability: atenolol in 100% (2/2), valproate in 100% (15/15), topiramate in 88% (7/8), and naproxen and candesartan in 100% (2/2) of studies. For drugs with low or moderate pharmacokinetic variability, treatment can start without initial titration of doses, whereas titration is used to possibly enhance tolerability of topiramate and amitriptyline. The very high pharmacokinetic variability of metoprolol and propranolol can result in very high plasma concentrations in a small minority of patients, and those drugs should therefore be titrated up from a low initial dose, depending mainly on the occurrence of adverse events.
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Affiliation(s)
- Peer Tfelt-Hansen
- Danish Headache Center, Department of Neurology, Rigshospitalet-Glostrup Hospital, University of Copenhagen, Glostrup, Denmark
| | - Frederik Nybye Ågesen
- Department of Cardiology, University of Copenhagen, Rigshospitalet, Copenhagen, Denmark.
| | - Agniezka Pavbro
- Danish Headache Center, Department of Neurology, Rigshospitalet-Glostrup Hospital, University of Copenhagen, Glostrup, Denmark
| | - Jacob Tfelt-Hansen
- Department of Cardiology, University of Copenhagen, Rigshospitalet, Copenhagen, Denmark
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Tarakita N, Nishijima H, Yasui-Furukori N. Levodopa-responsive depression associated with corticobasal degeneration: a case report. Neuropsychiatr Dis Treat 2017; 13:1107-1110. [PMID: 28458551 PMCID: PMC5402995 DOI: 10.2147/ndt.s136706] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
A 60-year-old female was treated for depression with the antidepressant paroxetine for 13 years. The patient had experienced clumsiness and mild rigidity in the left hand, and had agraphia and mild subjective memory complaints for 3 years prior to admission in our hospital. She experienced exacerbated depression that included worsened depressive mood, lowered motivation, and suicidal ideation without precipitating stressful life events for 2 years prior to admission, and although she had continued taking the antidepressant, these symptoms were not ameliorated by increasing the dose of paroxetine. Following the development of myoclonus and pain in her left arm, we performed magnetic resonance imaging of her head, that revealed diffuse atrophy and right parietal lobe atrophy. The patient was ultimately diagnosed with corticobasal degeneration (CBD). Her left arm myoclonus and depression improved following levodopa administration. Therefore, we concluded that the recurrent depression may have been induced by CBD.
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Affiliation(s)
- Natsumi Tarakita
- Department of Neuropsychiatry, Graduate School of Medicine, Hirosaki University, Hirosaki
| | - Haruo Nishijima
- Department of Neurology, Aomori Prefectural Central Hospital, Aomori, Japan
| | - Norio Yasui-Furukori
- Department of Neuropsychiatry, Graduate School of Medicine, Hirosaki University, Hirosaki
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Goodarzi Z, Mele B, Guo S, Hanson H, Jette N, Patten S, Pringsheim T, Holroyd-Leduc J. Guidelines for dementia or Parkinson's disease with depression or anxiety: a systematic review. BMC Neurol 2016; 16:244. [PMID: 27887589 PMCID: PMC5124305 DOI: 10.1186/s12883-016-0754-5] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 11/10/2016] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Depression and anxiety remain under-diagnosed and under-treated in those with neurologic diseases such as dementia or Parkinson's Disease (PD). Our objectives were to first, to provide a synthesis of high quality guidelines available for the identification and management of depression or anxiety in those with dementia or PD. Second, to identify areas for improvement for future guidelines. METHODS We searched MEDLINE, PsycINFO, and EMBASE (2009 to July 24, 2015), grey literature (83 sources; July 24-Sept 6, 2015), and bibliographies of included studies. Included studies were evaluated for quality by four independent reviewers the AGREE II tool. Guideline characteristics, statements and recommendations relevant to depression or anxiety for dementia and PD were then extracted. (PROSPERO CRD: 42016014584) RESULTS: 8121 citations were reviewed with 31 full text articles included for assessment with the AGREE II tool. 17 were of sufficient quality for inclusion. Mean overall quality scores were between 4.25 to 6.5. Domain scores were lowest in the areas of stakeholder involvement, applicability, and editorial independence. Recommendations for the screening and diagnosis of depression were found for PD and dementia. There was little evidence to guide diagnosis or management of anxiety. Non-pharmacologic therapies were recommended for dementia patients. Most advocated pharmacologic treatment for depression, for both PD and dementia, but did not specify an agent due to lack of evidence. CONCLUSIONS The available recent high quality guidelines outline several recommendations for the management of comorbid depression or anxiety in PD or dementia. However there remain significant gaps in the evidence.
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Affiliation(s)
- Zahra Goodarzi
- Department of Community Health Sciences, University of Calgary, Calgary, Canada
- Department of Medicine, University of Calgary and Alberta Health Services, Calgary, Canada
- #1104-South Tower. Foothills Medical Centre 3301 Hospital Drive, Calgary, NW T2N 2T9 Canada
| | - Bria Mele
- Department of Community Health Sciences, University of Calgary, Calgary, Canada
| | - Selynne Guo
- Faculty of Medicine, Undergraduate Medical Education, University of Toronto, Toronto, Canada
| | - Heather Hanson
- Department of Community Health Sciences, University of Calgary, Calgary, Canada
- Seniors Health Strategic Clinical Network, Alberta Health Services, Alberta, Canada
| | - Nathalie Jette
- Department of Community Health Sciences, University of Calgary, Calgary, Canada
- Department of Clinical Neurosciences, University of Calgary, Calgary, Canada
- Hotchkiss Brain Institute, and O’Brien Institute for Public Health, University of Calgary and Alberta Health Services, Calgary, Canada
| | - Scott Patten
- Department of Community Health Sciences, University of Calgary, Calgary, Canada
- Department of Psychiatry, University of Calgary and Alberta Health Services, Calgary, Canada
- Mathison Centre for Mental Health Research and Education, University of Calgary, Calgary, Canada
| | - Tamara Pringsheim
- Department of Community Health Sciences, University of Calgary, Calgary, Canada
- Department of Clinical Neurosciences, University of Calgary, Calgary, Canada
- Hotchkiss Brain Institute, and O’Brien Institute for Public Health, University of Calgary and Alberta Health Services, Calgary, Canada
- Department of Psychiatry and Pediatrics, University of Calgary and Alberta Health Services, Calgary, Canada
| | - Jayna Holroyd-Leduc
- Department of Community Health Sciences, University of Calgary, Calgary, Canada
- Department of Medicine, University of Calgary and Alberta Health Services, Calgary, Canada
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Liu HY, Chou KH, Lee PL, Fuh JL, Niddam DM, Lai KL, Hsiao FJ, Lin YY, Chen WT, Wang SJ, Lin CP. Hippocampus and amygdala volume in relation to migraine frequency and prognosis. Cephalalgia 2016; 37:1329-1336. [PMID: 27919022 DOI: 10.1177/0333102416678624] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives To investigate the structural changes of hippocampus and amygdala and their relationships with migraine frequency and prognosis. Methods Hippocampus and amygdala volumes were measured by 3-T brain magnetic resonance imaging (MRI) in 31 controls and 122 migraine patients who were categorized into eight groups by headache frequency: group 1 (1-2 headache days/month), 2 (3-4), 3 (5-7), 4 (8-10), 5 (11-14), 6 (15-19), 7 (20-24), and 8 (25-30). Headache frequency was reassessed 2 years later and a frequency reduction ≥50% was regarded a good outcome. Results Hippocampus and amygdala volumes fluctuated in patient groups but did not differ from the controls. In migraine patients, the bilateral hippocampus volumes peaked in group 3. The volumes and headache frequencies correlated positively in groups 2-3 on bilateral sides (L: r = 0.44, p = 0.007; R: r = 0.35, p = 0.037), and negatively in groups 3-7 on the left side (5-24 days/month; L: r = -0.31, p = 0.004) and groups 3-8 on the right side ( r = -0.31, p = 0.002). The left amygdala volume also peaked in group 3, and correlated with headache frequency in groups 1-3 ( r = 0.34, p = 0.020) and groups 3-6 ( r = -0.30, p = 0.012). The volumetric changes of the right amygdala with headache frequency did not reach statistical significance. At 2-year follow-up, the right hippocampus volume was positively associated with a good migraine outcome after adjustment of headache frequency (OR 4.72, p = 0.024). Conclusions Hippocampus and amygdala display a structural plasticity linked to both headache frequency and clinical outcome of migraine.
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Affiliation(s)
- Hung-Yu Liu
- 1 Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan
- 2 School of Medicine, National Yang-Ming University, Taipei, Taiwan
- 3 Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Kun-Hsien Chou
- 4 Brain Research Center, National Yang-Ming University, Taipei, Taiwan
| | - Pei-Lin Lee
- 5 Department of Biomedical Imaging and Radiological Sciences, National Yang-Ming University, Taipei, Taiwan
| | - Jong-Ling Fuh
- 2 School of Medicine, National Yang-Ming University, Taipei, Taiwan
- 3 Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
| | - David M Niddam
- 1 Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan
- 4 Brain Research Center, National Yang-Ming University, Taipei, Taiwan
- 6 Laboratory of Integrated Brain Research, Department of Medical Research and Education, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Kuan-Lin Lai
- 2 School of Medicine, National Yang-Ming University, Taipei, Taiwan
- 7 Department of Neurology, Taipei Municipal Gandau Hospital, Taipei, Taiwan
| | - Fu-Jung Hsiao
- 4 Brain Research Center, National Yang-Ming University, Taipei, Taiwan
| | - Yung-Yang Lin
- 1 Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan
- 2 School of Medicine, National Yang-Ming University, Taipei, Taiwan
- 3 Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- 4 Brain Research Center, National Yang-Ming University, Taipei, Taiwan
| | - Wei-Ta Chen
- 1 Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan
- 2 School of Medicine, National Yang-Ming University, Taipei, Taiwan
- 3 Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- 4 Brain Research Center, National Yang-Ming University, Taipei, Taiwan
| | - Shuu-Jiun Wang
- 1 Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan
- 2 School of Medicine, National Yang-Ming University, Taipei, Taiwan
- 3 Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- 4 Brain Research Center, National Yang-Ming University, Taipei, Taiwan
| | - Ching-Po Lin
- 5 Department of Biomedical Imaging and Radiological Sciences, National Yang-Ming University, Taipei, Taiwan
- 8 Institute of Neuroscience, National Yang-Ming University, Taipei, Taiwan
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Farhan SMK, Dilliott AA, Ghani M, Sato C, Liang E, Zhang M, McIntyre AD, Cao H, Racacho L, Robinson JF, Strong MJ, Masellis M, St George-Hyslop P, Bulman DE, Rogaeva E, Hegele RA. The ONDRISeq panel: custom-designed next-generation sequencing of genes related to neurodegeneration. NPJ Genom Med 2016; 1:16032. [PMID: 29263818 PMCID: PMC5685311 DOI: 10.1038/npjgenmed.2016.32] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 08/01/2016] [Accepted: 08/05/2016] [Indexed: 12/13/2022] Open
Abstract
The Ontario Neurodegenerative Disease Research Initiative (ONDRI) is a multimodal, multi-year, prospective observational cohort study to characterise five diseases: (1) Alzheimer's disease (AD) or amnestic single or multidomain mild cognitive impairment (aMCI) (AD/MCI); (2) amyotrophic lateral sclerosis (ALS); (3) frontotemporal dementia (FTD); (4) Parkinson's disease (PD); and (5) vascular cognitive impairment (VCI). The ONDRI Genomics subgroup is investigating the genetic basis of neurodegeneration. We have developed a custom next-generation-sequencing-based panel, ONDRISeq that targets 80 genes known to be associated with neurodegeneration. We processed DNA collected from 216 individuals diagnosed with one of the five diseases, on ONDRISeq. All runs were executed on a MiSeq instrument and subjected to rigorous quality control assessments. We also independently validated a subset of the variant calls using NeuroX (a genome-wide array for neurodegenerative disorders), TaqMan allelic discrimination assay, or Sanger sequencing. ONDRISeq consistently generated high-quality genotyping calls and on average, 92% of targeted bases are covered by at least 30 reads. We also observed 100% concordance for the variants identified via ONDRISeq and validated by other genomic technologies. We were successful in detecting known as well as novel rare variants in 72.2% of cases although not all variants are disease-causing. Using ONDRISeq, we also found that the APOE E4 allele had a frequency of 0.167 in these samples. Our optimised workflow highlights next-generation sequencing as a robust tool in elucidating the genetic basis of neurodegenerative diseases by screening multiple candidate genes simultaneously.
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Affiliation(s)
- Sali M K Farhan
- Robarts Research Institute, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.,Department of Biochemistry, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Allison A Dilliott
- Robarts Research Institute, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.,Department of Biochemistry, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Mahdi Ghani
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, ON, Canada
| | - Christine Sato
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, ON, Canada
| | - Eric Liang
- Robarts Research Institute, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Ming Zhang
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, ON, Canada
| | - Adam D McIntyre
- Robarts Research Institute, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Henian Cao
- Robarts Research Institute, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Lemuel Racacho
- Department of Microbiology and Immunology, Faculty of Medicine, Department of Biochemistry, University of Ottawa, Ottawa, ON, Canada.,Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - John F Robinson
- Robarts Research Institute, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Michael J Strong
- Robarts Research Institute, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.,Department of Clinical Neurological Sciences, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Mario Masellis
- Department of Medicine (Neurology), Sunnybrook Health Sciences Centre, LC Campbell Cognitive Neurology Research Unit, Hurvitz Brain Science Research Program, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada
| | - Peter St George-Hyslop
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, ON, Canada.,Department of Clinical Neurosciences, Cambridge Institute for Medical Research, University of Cambridge, Cambridge, UK
| | - Dennis E Bulman
- Department of Microbiology and Immunology, Faculty of Medicine, Department of Biochemistry, University of Ottawa, Ottawa, ON, Canada.,Department of Pediatrics, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Ekaterina Rogaeva
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, ON, Canada
| | - Robert A Hegele
- Robarts Research Institute, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.,Department of Biochemistry, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
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MacGregor EA, Evers S. The role of methysergide in migraine and cluster headache treatment worldwide - A survey in members of the International Headache Society. Cephalalgia 2016; 37:1106-1108. [PMID: 27449673 DOI: 10.1177/0333102416660551] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Methysergide has been as an effective treatment for migraine and cluster headache for over 50 years but has recently been investigated by the European Medicines Agency due to safety concerns. Methods To assess the need for continuing availability of methysergide, the International Headache Society performed an electronic survey among their members. Results The survey revealed that 71.3% of all respondents had ever prescribed methysergide and 79.8% would prescribe it if it were to become available. Respondents used it more in cluster headache than migraine, and reserved it for use in refractory patients. Conclusion The vast majority of headache experts in this survey regarded methysergide a unique treatment option for specific populations for which there are no alternatives, with an urgent need to continue its availability. This position was supported by the International Headache Society.
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Affiliation(s)
- E Anne MacGregor
- 1 Centre for Neuroscience and Trauma, BICMS, Barts and the London School of Medicine and Dentistry, London, UK
| | - Stefan Evers
- 2 University of Münster, Medical Faculty, Germany.,3 Department of Neurology, Krankenhaus Lindenbrunn, Germany
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Rizek P, Kumar N, Jog MS. An update on the diagnosis and treatment of Parkinson disease. CMAJ 2016; 188:1157-1165. [PMID: 27221269 DOI: 10.1503/cmaj.151179] [Citation(s) in RCA: 219] [Impact Index Per Article: 27.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Affiliation(s)
- Philippe Rizek
- Department of Clinical Neurological Sciences, Western University, London, Ont
| | - Niraj Kumar
- Department of Clinical Neurological Sciences, Western University, London, Ont
| | - Mandar S Jog
- Department of Clinical Neurological Sciences, Western University, London, Ont.
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Tod AM, Kennedy F, Stocks AJ, McDonnell A, Ramaswamy B, Wood B, Whitfield M. Good-quality social care for people with Parkinson's disease: a qualitative study. BMJ Open 2016; 6:e006813. [PMID: 26883233 PMCID: PMC4762087 DOI: 10.1136/bmjopen-2014-006813] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES The study examines the meaning of good-quality social care for people with Parkinson's disease and their carers. It identifies, from their perspective, the impact of good-quality social care on health and well-being. DESIGN Qualitative case study methodology, interview and framework analysis techniques were used. SETTING community locations in the north and midlands of England. PARTICIPANTS Data were collected from 43 participants including individual interviews with people with Parkinson's disease (n=4), formal and informal social care providers (n=13), 2 focus groups, 1 with people with Parkinson's disease and their carers (n=17), and 1 with professionals (n=8), plus a telephone interview with a former commissioner. FINDINGS Good-quality social care, delivered in a timely fashion, was reported to have a positive impact on health. Furthermore, there is an indication that good-quality social care can prevent untoward events, such as infections, symptom deterioration and deterioration in mental health. The concept of the 'Impact Gap' developed from the findings, illustrates how the costs of care may be reduced by delivering good-quality social care. Control, choice and maintaining independence emerged as indicators of good-quality social care, irrespective of clinical condition. Participants identified characteristics indicative of good-quality social care specific to Parkinson's disease, including understanding Parkinson's disease, appropriate administration of medication, timing of care and reassessment. 'Parkinson's aware' social care was seen to generate psychological, physical and social benefits that were inter-related. CONCLUSIONS The findings indicate how maximising quality in social care delivery for people with Parkinson's disease can impact on health and well-being. Long-term or short-term benefits may result in prevented events and reductions in health and social care resource. Health professionals can be instrumental in early detection of and signposting to social care.
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Affiliation(s)
- Angela Mary Tod
- School of Nursing and Midwifery, The University of Sheffield, Sheffield, UK
| | - Fiona Kennedy
- Psychosocial Oncology & Clinical Practice Research Group, University of Leeds, Leeds, UK
| | | | - Ann McDonnell
- Centre for Health and Social Care Research, Sheffield Hallam University, Sheffield, UK
| | - Bhanu Ramaswamy
- Centre for Health and Social Care Research, Sheffield Hallam University, Sheffield, UK
| | - Brendan Wood
- Department of Social Work, Social Care and Community, Sheffield Hallam University, Sheffield, UK
| | - Malcolm Whitfield
- Centre for Health and Social Care Research, Sheffield Hallam University, Sheffield, UK
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Riboflavin in cyclic vomiting syndrome: efficacy in three children. Eur J Pediatr 2016; 175:131-5. [PMID: 26226892 DOI: 10.1007/s00431-015-2597-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Revised: 07/08/2015] [Accepted: 07/13/2015] [Indexed: 12/13/2022]
Abstract
UNLABELLED Cyclic vomiting syndrome is an episodic disorder considered to be a migraine variant. Riboflavin is efficient in the prophylactic treatment of migraines in adults. We describe the effectiveness and tolerance of riboflavin treatment in three children with cyclic vomiting syndrome. All of them fulfilled the diagnosis criteria for cyclic vomiting syndrome. They received prophylactic monotherapy with riboflavin for at least 12 months. Excellent response and tolerability was observed. CONCLUSION Based on clinical observation in three cases, riboflavin may be an effective and safe prophylactic treatment for children with cyclic vomiting syndrome. WHAT IS KNOWN CVS is one of the "childhood periodic syndromes" classified as a migraine subtype by the International Headache Society. Riboflavin is currently used as a prophylactic treatment in patients with migraine. WHAT IS NEW Riboflavin may be an effective and safe prophylactic treatment for children with CVS. Increasing doses of riboflavin and long periods of prophylaxis may be needed in some children..
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Crispo JA, Fortin Y, Sikora L, Kohen DE, Bjerre LM, Mattison DR, Perez-Lloret S, Hessian RC, Willis AW, Krewski D. Non-ergot dopamine agonists and the risk of heart failure and other adverse cardiovascular reactions in Parkinson's disease. Hippokratia 2015. [DOI: 10.1002/14651858.cd011843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- James A.G. Crispo
- University of Ottawa; McLaughlin Centre for Population Health Risk Assessment; 850 Peter Morand Crescent Room 118 Ottawa ON Canada K1G 3Z7
| | - Yannick Fortin
- University of Ottawa; McLaughlin Centre for Population Health Risk Assessment; 850 Peter Morand Crescent Room 118 Ottawa ON Canada K1G 3Z7
| | - Lindsey Sikora
- University of Ottawa; Health Sciences Library; 451 Smyth Road Ottawa ON Canada K1H 8M5
| | - Dafna E. Kohen
- Public Health and Preventive Medicine, University of Ottawa; School of Epidemiology; Ottawa ON Canada K1H 8M5
| | - Lise M Bjerre
- University of Ottawa; Department of Family Medicine, Bruyere Research Institute; 43 Bruyere St, Annex E Room 206 Ottawa ON Canada K1N 5C8
| | - Donald R. Mattison
- University of Ottawa; McLaughlin Centre for Population Health Risk Assessment; 850 Peter Morand Crescent Room 118 Ottawa ON Canada K1G 3Z7
- Risk Sciences International; Ottawa Canada
| | - Santiago Perez-Lloret
- Toulouse University; Department of Pharmacology; 37 Allées Jules Guesde Toulouse France 31000
| | - Renée C Hessian
- University of Ottawa; University of Ottawa Heart Institute; 40 Ruskin Street Ottawa ON Canada K1Y 4W7
| | - Allison W Willis
- University of Pennsylvania Perelman School of Medicine; Department of Neurology, Department of Biostatistics & Epidemiology; 423 Guardian Drive Office 723, Blockley Hall Philadelphia PA USA 19104
| | - Daniel Krewski
- University of Ottawa; McLaughlin Centre for Population Health Risk Assessment; 850 Peter Morand Crescent Room 118 Ottawa ON Canada K1G 3Z7
- Risk Sciences International; Ottawa Canada
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Vécsei L, Majláth Z, Szok D, Csáti A, Tajti J. Drug safety and tolerability in prophylactic migraine treatment. Expert Opin Drug Saf 2015; 14:667-81. [DOI: 10.1517/14740338.2015.1014797] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- László Vécsei
- 1University of Szeged, Department of Neurology, Semmelweis u. 6, H-6725 Szeged, Hungary ;
- 2University of Szeged, Department of Neurology, Semmelweis u. 6, H-6725 Szeged, Hungary
- 3MTA – SZTE Neuroscience Research Group, Semmelweis u. 6, H-6725 Szeged, Hungary
| | - Zsófia Majláth
- 4University of Szeged, Department of Neurology, Semmelweis u. 6, H-6725 Szeged, Hungary
| | - Délia Szok
- 5University of Szeged, Department of Neurology, Semmelweis u. 6, H-6725 Szeged, Hungary
| | - Anett Csáti
- 4University of Szeged, Department of Neurology, Semmelweis u. 6, H-6725 Szeged, Hungary
| | - János Tajti
- 5University of Szeged, Department of Neurology, Semmelweis u. 6, H-6725 Szeged, Hungary
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Teigen L, Boes CJ. An evidence-based review of oral magnesium supplementation in the preventive treatment of migraine. Cephalalgia 2014; 35:912-22. [DOI: 10.1177/0333102414564891] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Accepted: 11/10/2014] [Indexed: 12/22/2022]
Abstract
Background Migraine is an incompletely understood, debilitating disorder that lacks a universally effective treatment. Magnesium participates in a variety of biochemical processes related to migraine pathophysiology, and a deficiency could contribute to migraine development. Methods A review of the literature from 1990 to the present on magnesium and migraine was conducted. Review The authors identified 16 studies aimed at magnesium status assessment in migraine, and four intervention trials assessing the efficacy of oral magnesium supplementation, independent of other therapies, in the prevention of migraine. Conclusion The strength of evidence supporting oral magnesium supplementation is limited at this time. With such limited evidence, a more advantageous alternative to magnesium supplementation, in patients willing to make lifestyle changes, may be to focus on increasing dietary magnesium intake.
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Affiliation(s)
- Levi Teigen
- Mayo Clinic College of Medicine, USA
- Mayo Clinic Department of Clinical Dietetics, USA
| | - Christopher J Boes
- Mayo Clinic College of Medicine, USA
- Mayo Clinic Department of Neurology, USA
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Abstract
This Hospital Pharmacy feature is extracted from Off-Label Drug Facts, a publication available from Wolters Kluwer Health. Off-Label Drug Facts is a practitioner-oriented resource for information about specific drug uses that are unapproved by the US Food and Drug Administration. This new guide to the literature enables the health care professional or clinician to quickly identify published studies on off-label uses and determine if a specific use is rational in a patient care scenario. References direct the reader to the full literature for more comprehensive information before patient care decisions are made. Direct questions or comments regarding Off-Label Drug Uses to jgeneral@ku.edu.
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Affiliation(s)
- Joyce A Generali
- Editor-in-Chief, Hospital Pharmacy , and Clinical Professor, Emeritus, Department of Pharmacy Practice, University of Kansas, School of Pharmacy , Kansas City/Lawrence, Kansas , e-mail:
| | - Dennis J Cada
- Founder and Contributing Editor, The Formulary , and Editor, Off-Label Drug Facts , e-mail:
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Verdoux H, Pambrun E. Clozapine use pattern in persons with and without treatment for Parkinson's disease in real-world conditions: a naturalistic study in a community-based sample. Acta Psychiatr Scand 2014; 130:487-97. [PMID: 25302631 DOI: 10.1111/acps.12344] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/10/2014] [Indexed: 01/29/2023]
Abstract
OBJECTIVE To explore the pattern of clozapine use in persons with severe mental illness and in persons with Parkinson's disease and the characteristics associated with early discontinuation in naturalistic conditions. METHOD A historical fixed cohort study of persons newly treated with clozapine was performed on a representative community-based sample of persons affiliated to the French health insurance system (n = 611,393). Treatment for Parkinson's disease was used as a proxy for this condition and lack of such treatment as a proxy for severe mental illness (SMI). RESULTS The prevalences of antipsychotic and clozapine use were 4.4% and <0.1% respectively. Of the 237 persons with a new outpatient prescription of clozapine, 25% were prescribed an antiparkinsonian treatment. In persons with SMI, the median duration of the index episode of clozapine treatment was 4.9 months (Interquartile range 1.0-20.5). Longer duration was independently associated with coprescription of anxiolytics or antidepressant. Few new additions of antipsychotics were observed during the clozapine episode. CONCLUSION Efforts have to be made to optimize clozapine treatment in real-world conditions. Considering the high frequency of persons with Parkinson's disease among clozapine users, further studies have to be performed in this population.
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Affiliation(s)
- H Verdoux
- University of Bordeaux, U657, Bordeaux, France; INSERM, U657, Bordeaux, France; Centre Hospitalier Charles Perrens, Bordeaux, France
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Affiliation(s)
- Tejal Patel
- University of Waterloo School of Pharmacy, Waterloo, Ontario
| | - Feng Chang
- University of Waterloo School of Pharmacy, Waterloo, Ontario
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Sturkenboom IHWM, Graff MJL, Hendriks JCM, Veenhuizen Y, Munneke M, Bloem BR, Nijhuis-van der Sanden MW. Efficacy of occupational therapy for patients with Parkinson's disease: a randomised controlled trial. Lancet Neurol 2014; 13:557-66. [PMID: 24726066 DOI: 10.1016/s1474-4422(14)70055-9] [Citation(s) in RCA: 149] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND There is insufficient evidence to support use of occupational therapy interventions for patients with Parkinson's disease. We aimed to assess the efficacy of occupational therapy in improving daily activities of patients with Parkinson's disease. METHODS We did a multicentre, assessor-masked, randomised controlled clinical trial in ten hospitals in nine Dutch regional networks of specialised health-care professionals (ParkinsonNet), with assessment at 3 months and 6 months. Patients with Parkinson's disease with self-reported difficulties in daily activities were included, along with their primary caregivers. Patients were randomly assigned (2:1) to the intervention or control group by a computer-generated minimisation algorithm. The intervention consisted of 10 weeks of home-based occupational therapy according to national practice guidelines; control individuals received usual care with no occupational therapy. The primary outcome was self-perceived performance in daily activities at 3 months, assessed with the Canadian Occupational Performance Measure (score 1-10). Data were analysed using linear mixed models for repeated measures (intention-to-treat principle). Assessors monitored safety by asking patients about any unusual health events during the preceding 3 months. This trial is registered with ClinicalTrials.gov, NCT01336127. FINDINGS Between April 14, 2011, and Nov 2, 2012, 191 patients were randomly assigned to the intervention group (n=124) or the control group (n=67). 117 (94%) of 124 patients in the intervention group and 63 (94%) of 67 in the control group had a participating caregiver. At baseline, the median score on the Canadian Occupational Performance Measure was 4·3 (IQR 3·5-5·0) in the intervention group and 4·4 (3·8-5·0) in the control group. At 3 months, these scores were 5·8 (5·0-6·4) and 4·6 (4·6-6·6), respectively. The adjusted mean difference in score between groups at 3 months was in favour of the intervention group (1·2; 95% CI 0·8-1·6; p<0·0001). There were no adverse events associated with the study. INTERPRETATION Home-based, individualised occupational therapy led to an improvement in self-perceived performance in daily activities in patients with Parkinson's disease. Further work should identify which factors related to the patient, environmental context, or therapist might predict which patients are most likely to benefit from occupational therapy. FUNDING Prinses Beatrix Spierfonds and Parkinson Vereniging.
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Affiliation(s)
| | - Maud J L Graff
- Department of Rehabilitation, Radboud University Medical Center, Nijmegen, Netherlands; Scientific Institute for Quality of Healthcare, Radboud University Medical Center, Nijmegen, Netherlands
| | - Jan C M Hendriks
- Department of Health Evidence, Radboud University Medical Center, Nijmegen, Netherlands
| | - Yvonne Veenhuizen
- Department of Rehabilitation, Radboud University Medical Center, Nijmegen, Netherlands
| | - Marten Munneke
- Department of Neurology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Bastiaan R Bloem
- Department of Neurology, Radboud University Medical Center, Nijmegen, Netherlands; Donders Institute for Brain, Cognition, and Behavior, Radboud University Medical Center, Nijmegen, Netherlands.
| | - Maria W Nijhuis-van der Sanden
- Department of Rehabilitation, Radboud University Medical Center, Nijmegen, Netherlands; Scientific Institute for Quality of Healthcare, Radboud University Medical Center, Nijmegen, Netherlands
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83
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Viana M, Terrazzino S, Genazzani AA, Grieco GS, Cargnin S, Santorelli FM, Pierelli F, Tassorelli C, Nappi G, Di Lorenzo C. Pharmacogenomics of episodic migraine: time has come for a step forward. Pharmacogenomics 2014; 15:541-9. [DOI: 10.2217/pgs.14.20] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Migraine is characterized by heterogeneous behavior in response to drugs. Many resources have been invested in attempting to unravel the genetic basis of migraine, while the role of genetics in responses to currently available drugs has received less attention. We performed a systematic literature search identifying original articles pertaining to pharmacogenomics of episodic migraine. Few primary studies on the pharmacogenomics of symptomatic and preventive medication in episodic migraine were found. The number of patients studied in the individual articles ranged from 40 up to 130. There was a strong heterogeneity among these studies. We believe that pharmacogenomics studies, if properly designed, could contribute towards optimizing the treatment and reducing the burden of migraine, in turn helping patients and optimizing resources. Our knowledge on the pharmacogenomics of migraine is growing too slowly, and concerted measures should be undertaken to speed up the process.
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Affiliation(s)
- Michele Viana
- Headache Science Centre, C. Mondino National Institute of Neurology Foundation, IRCCS, Pavia, Italy
| | | | - Armando A Genazzani
- Dipartimento di Scienze del Farmaco, “A. Avogadro” University, Novara, Italy
| | - Gaetano S Grieco
- Laboratory of Neurogenetics, C. Mondino National Institute of Neurology Foundation, IRCCS, Pavia, Italy
| | - Sarah Cargnin
- Dipartimento di Scienze del Farmaco, “A. Avogadro” University, Novara, Italy
| | - Filippo M Santorelli
- Molecular Medicine & Neurodegenerative Diseases – IRCCS Stella Maris, Pisa, Italy
| | | | - Cristina Tassorelli
- Headache Science Centre, C. Mondino National Institute of Neurology Foundation, IRCCS, Pavia, Italy
- Brain & Behavior Department, University of Pavia, Pavia, Italy
| | - Giuseppe Nappi
- Headache Science Centre, C. Mondino National Institute of Neurology Foundation, IRCCS, Pavia, Italy
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84
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Orr SL, Venkateswaran S. Nutraceuticals in the prophylaxis of pediatric migraine: Evidence-based review and recommendations. Cephalalgia 2014; 34:568-83. [DOI: 10.1177/0333102413519512] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Accepted: 11/13/2013] [Indexed: 12/27/2022]
Abstract
Introduction The literature on complementary and alternative medicine (CAM) is expanding. One of the most common conditions for which CAM is studied in the pediatric population is migraine. Nutraceuticals are a form of CAM that is being used for pediatric migraine prophylaxis. Methods A literature search was carried out in order to identify both observational studies and randomized controlled trials on the use of nutraceuticals for the prophylaxis of pediatric migraine. Adult studies on included nutraceuticals were also reviewed. Review Thirty studies were reviewed on six different nutraceuticals: butterbur, riboflavin, ginkgolide B, magnesium, coenzyme Q10 and polyunsaturated fatty acids. Conclusion Overall, the quality of the evidence for the use of nutraceuticals in pediatric migraine prophylaxis is poor. Further research needs to be done in order to study the efficacy of nutraceuticals for the prophylaxis of pediatric migraine.
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Affiliation(s)
- Serena L Orr
- Children’s Hospital of Eastern Ontario, ON, Canada
- University of Ottawa, ON, Canada
| | - Sunita Venkateswaran
- Children’s Hospital of Eastern Ontario, ON, Canada
- University of Ottawa, ON, Canada
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85
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Gregson CL, Dennison EM, Compston JE, Adami S, Adachi JD, Anderson FA, Boonen S, Chapurlat R, Díez-Pérez A, Greenspan SL, Hooven FH, LaCroix AZ, Nieves JW, Netelenbos JC, Pfeilschifter J, Rossini M, Roux C, Saag KG, Silverman S, Siris ES, Watts NB, Wyman A, Cooper C. Disease-specific perception of fracture risk and incident fracture rates: GLOW cohort study. Osteoporos Int 2014; 25:85-95. [PMID: 23884437 PMCID: PMC3867337 DOI: 10.1007/s00198-013-2438-y] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Accepted: 06/27/2013] [Indexed: 12/11/2022]
Abstract
UNLABELLED Accurate patient risk perception of adverse health events promotes greater autonomy over, and motivation towards, health-related lifestyles. INTRODUCTION We compared self-perceived fracture risk and 3-year incident fracture rates in postmenopausal women with a range of morbidities in the Global Longitudinal study of Osteoporosis in Women (GLOW). METHODS GLOW is an international cohort study involving 723 physician practices across ten countries (Europe, North America, Australasia); 60,393 women aged ≥55 years completed baseline questionnaires detailing medical history and self-perceived fracture risk. Annual follow-up determined self-reported incident fractures. RESULTS In total 2,945/43,832 (6.8%) sustained an incident fracture over 3 years. All morbidities were associated with increased fracture rates, particularly Parkinson's disease (hazard ratio [HR]; 95% confidence interval [CI], 3.89; 2.78-5.44), multiple sclerosis (2.70; 1.90-3.83), cerebrovascular events (2.02; 1.67-2.46), and rheumatoid arthritis (2.15; 1.53-3.04) (all p < 0.001). Most individuals perceived their fracture risk as similar to (46%) or lower than (36%) women of the same age. While increased self-perceived fracture risk was strongly associated with incident fracture rates, only 29% experiencing a fracture perceived their risk as increased. Under-appreciation of fracture risk occurred for all morbidities, including neurological disease, where women with low self-perceived fracture risk had a fracture HR 2.39 (CI 1.74-3.29) compared with women without morbidities. CONCLUSIONS Postmenopausal women with morbidities tend to under-appreciate their risk, including in the context of neurological diseases, where fracture rates were highest in this cohort. This has important implications for health education, particularly among women with Parkinson's disease, multiple sclerosis, or cerebrovascular disease.
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Affiliation(s)
- C L Gregson
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, SO16 6YD, UK
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Sleeman KE, Ho YK, Verne J, Glickman M, Silber E, Gao W, Higginson IJ. Place of death, and its relation with underlying cause of death, in Parkinson's disease, motor neurone disease, and multiple sclerosis: a population-based study. Palliat Med 2013; 27:840-6. [PMID: 23737036 DOI: 10.1177/0269216313490436] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Little is known about place of death in chronic neurological diseases. Mortality statistics are ideal for examining trends in place of death, but analyses are limited by coding rule changes. AIM To examine the relationship between place of death and underlying cause of death in Parkinson's disease, multiple sclerosis and motor neurone disease and the impact of coding rule changes on analysis of place of death. DESIGN Population-based study. Proportion ratios for death in hospice, home, care home and hospital were calculated according to underlying cause of death, using multivariable Poisson regression. PARTICIPANTS Deaths in England (1993-2010) with any mention of Parkinson's disease, multiple sclerosis or motor neurone disease as a cause of death, identified from national mortality data. RESULTS In this study, 125,242 patients with Parkinson's disease, 23,501 with multiple sclerosis, and 27,030 with motor neurone disease were included. Home deaths ranged from 9.7% (Parkinson's disease) to 27.1% (motor neurone disease), hospice deaths ranged from 0.6% (Parkinson's disease) to 11.2% (motor neurone disease) and hospital deaths ranged from 43.4% (Parkinson's disease) to 55.8% (multiple sclerosis). In Parkinson's disease and multiple sclerosis, cancer as underlying cause of death increased likelihood of hospice death (proportion ratio (PR): 18.8, 95% confidence interval (CI) = 16.1-22.0; 8.88, 95% CI = 7.49-10.5) and home death (PR: 1.91, 95% CI = 1.80-2.04; 1.71, 95% CI = 1.56-1.88). Dementia as underlying cause of death increased likelihood of care home death in Parkinson's disease (PR: 1.25, 95% CI = 1.19-1.32), multiple sclerosis (PR: 1.73, 95% CI = 1.22-2.45) and motor neurone disease (PR: 2.36, 95% CI = 1.31-4.27). CONCLUSIONS Underlying cause of death has a marked effect on place of death. The effects of coding rule changes are an essential consideration for all research using underlying cause of death to study place of death.
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Affiliation(s)
- Katherine E Sleeman
- Department of Palliative Care, Policy & Rehabilitation, Cicely Saunders Institute, King's College London, London, UK
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Richy FF, Pietri G, Moran KA, Senior E, Makaroff LE. Compliance with pharmacotherapy and direct healthcare costs in patients with Parkinson's disease: a retrospective claims database analysis. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2013; 11:395-406. [PMID: 23649891 PMCID: PMC3717155 DOI: 10.1007/s40258-013-0033-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Parkinson's disease (PD) is a progressive neurological disorder for which, at present, there is no cure. Current therapy is largely based on the use of dopamine agonists and dopamine replacement therapy, designed to control the signs and symptoms of the disease. The majority of current treatments are administered in tablet form and can involve multiple daily doses, which may contribute to sub-optimal compliance. Previous studies with small groups of patients suggest that non-compliance with treatment can result in poor response to therapy and may ultimately increase direct and indirect healthcare costs. OBJECTIVE To determine the extent of non-compliance within the general PD population in the USA as well as the patient characteristics and healthcare costs associated with compliance and non-compliance. METHODS A retrospective analysis from a managed care perspective was conducted using data from the USA PharMetrics patient-centric claims database. PharMetrics claims data were complete from 31 December 2005 to 31 December 2009. Patients were included if they had at least two diagnoses for PD between 31 December 2005 and 31 December 2008, were older than 18 years of age, were continuously enrolled for at least 12 months after the date of the most recent PD diagnosis, and had no missing or invalid data. The follow-up period was the most recent 12-month block of continuous enrollment that occurred between 2006 and 2009. Patients were required to have at least one PD-related prescription within the follow-up period. The medication possession ratio (MPR) was used to categorise patients as compliant or non-compliant. Direct all-cause annual healthcare costs for patients with PD were estimated for each patient, and regression analyses were conducted to determine predictors for non-compliance. RESULTS A total of 15,846 patients were included, of whom 46 % were considered to be non-compliant with their prescribed medication (MPR <0.8). Predictors of non-compliance included prescription of a medication administered in multiple daily doses (p < 0.0001), a period of <2 years since the initial PD diagnosis (p = 0.0002), a diagnosis of gastrointestinal disorder (p < 0.0001), and a diagnosis of depression (p < 0.0001). Non-compliance was also found to be related to age, with a lower odds of non-compliance in patients aged 41-80 years than in patients aged ≥81 years (p < 0.05). Although total drug mean costs were higher for compliant patients than non-compliant patients (driven mainly by the cost of PD-related medications), the mean costs associated with emergency room and inpatient visits were higher for patients non-compliant with their prescribed medication. Overall, the total all-cause annual healthcare mean cost was lower for compliant ($77,499) than for non-compliant patients ($84,949; p < 0.0001). CONCLUSION Non-compliance is prevalent within the general USA PD population and is associated with a recent PD diagnosis, certain comorbidities, and multiple daily treatment dosing. Non-compliance may increase the burden on the healthcare system because of greater resource usage compared with the compliant population. Treatments that require fewer daily doses may have the potential to improve compliance, which in turn could reduce the economic burden associated with PD.
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Affiliation(s)
- Florent F. Richy
- UCB Pharma, Allée de la Recherche 60, 1070 Brussels, Belgium
- Liège University, Liège, Belgium
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