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Kalaycioglu I, Rioux B, Briard JN, Nehme A, Touma L, Dansereau B, Veilleux-Carpentier A, Keezer MR. Inter-rater reliability of risk of bias tools for non-randomized studies. Syst Rev 2023; 12:227. [PMID: 38057883 PMCID: PMC10702000 DOI: 10.1186/s13643-023-02389-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 11/12/2023] [Indexed: 12/08/2023] Open
Abstract
PURPOSE There is limited knowledge on the reliability of risk of bias (ROB) tools for assessing internal validity in systematic reviews of exposure and frequency studies. We aimed to identify and then compare the inter-rater reliability (IRR) of six commonly used tools for frequency (Loney scale, Gyorkos checklist, American Academy of Neurology [AAN] tool) and exposure (Newcastle-Ottawa scale, SIGN50 checklist, AAN tool) studies. METHODS Six raters independently assessed the ROB of 30 frequency and 30 exposure studies using the three respective ROB tools. Articles were rated as low, intermediate, or high ROB. We calculated an intraclass correlation coefficient (ICC) for each tool and category of ROB tool. We compared the IRR between ROB tools and tool type by inspection of overlapping ICC 95% CIs and by comparing their coefficients after transformation to Fisher's Z values. We assessed the criterion validity of the AAN ROB tools by calculating an ICC for each rater in comparison with the original ratings from the AAN. RESULTS All individual ROB tools had an IRR in the substantial range or higher (ICC point estimates between 0.61 and 0.80). The IRR was almost perfect (ICC point estimate > 0.80) for the AAN frequency tool and the SIGN50 checklist. All tools were comparable in IRR, except for the AAN frequency tool which had a significantly higher ICC than the Gyorkos checklist (p = 0.021) and trended towards a higher ICC when compared to the Loney scale (p = 0.085). When examined by category of ROB tool, scales, and checklists had a substantial IRR, whereas the AAN tools had an almost perfect IRR. For the criterion validity of the AAN ROB tools, the average agreement between our raters and the original AAN ratings was moderate. CONCLUSION All tools had substantial IRRs except for the AAN frequency tool and the SIGN50 checklist, which both had an almost perfect IRR. The AAN ROB tools were the only category of ROB tools to demonstrate an almost perfect IRR. This category of ROB tools had fewer and simpler criteria. Overall, parsimonious tools with clear instructions, such as those from the AAN, may provide more reliable ROB assessments.
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Affiliation(s)
| | - Bastien Rioux
- Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
- Department of Neurosciences, Université de Montréal, Montreal, QC, Canada
- Centre Hospitalier de L'Université de Montréal, Pavillon R R04-700, 1000 Saint-Denis St., Montreal, QC, H2X 0C1, Canada
| | - Joel Neves Briard
- Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
- Department of Neurosciences, Université de Montréal, Montreal, QC, Canada
- Centre Hospitalier de L'Université de Montréal, Pavillon R R04-700, 1000 Saint-Denis St., Montreal, QC, H2X 0C1, Canada
| | - Ahmad Nehme
- Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
- Department of Neurosciences, Université de Montréal, Montreal, QC, Canada
- Centre Hospitalier de L'Université de Montréal, Pavillon R R04-700, 1000 Saint-Denis St., Montreal, QC, H2X 0C1, Canada
| | - Lahoud Touma
- Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
- Department of Neurosciences, Université de Montréal, Montreal, QC, Canada
- Centre Hospitalier de L'Université de Montréal, Pavillon R R04-700, 1000 Saint-Denis St., Montreal, QC, H2X 0C1, Canada
| | - Bénédicte Dansereau
- Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
- Department of Neurosciences, Université de Montréal, Montreal, QC, Canada
- Centre Hospitalier de L'Université de Montréal, Pavillon R R04-700, 1000 Saint-Denis St., Montreal, QC, H2X 0C1, Canada
| | - Ariane Veilleux-Carpentier
- Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
- Department of Neurosciences, Université de Montréal, Montreal, QC, Canada
- Centre Hospitalier de L'Université de Montréal, Pavillon R R04-700, 1000 Saint-Denis St., Montreal, QC, H2X 0C1, Canada
| | - Mark R Keezer
- Faculty of Medicine, Université de Montréal, Montreal, QC, Canada.
- Department of Neurosciences, Université de Montréal, Montreal, QC, Canada.
- Centre Hospitalier de L'Université de Montréal, Pavillon R R04-700, 1000 Saint-Denis St., Montreal, QC, H2X 0C1, Canada.
- School of Public Health, Université de Montréal, Montreal, QC, Canada.
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Couette M, Roy J, Doglioni DO, Bereznyakova O, Stapf C, Jacquin G, Fraïle V, Desmarais P, Desforges SM, Touma L, Nauche B, Bartolucci P, Kuo KHM, Forté S. Screening for cognitive impairment in adults with sickle cell disease: A systematic review and meta-analysis. Presse Med 2023; 52:104207. [PMID: 37979834 DOI: 10.1016/j.lpm.2023.104207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 10/29/2023] [Indexed: 11/20/2023] Open
Abstract
Neurovascular disease such as symptomatic stroke, silent brain infarcts and vascular cognitive impairment are common complications of sickle cell disease (SCD) that can have devastating consequences on quality of life, employment, and social functioning. Early recognition of neurovascular disease is a prerequisite for the timely optimization of medical care and to connect patients to adaptive resources. While cognitive impairment has been well described in children, currently available data are limited in adults. As a result, guidance on the optimal cognitive screening strategies in adults is scarce. We conducted a systematic review to identify the different screening tools that have been evaluated in SCD. A meta-analysis was performed to estimate the prevalence of suspected cognitive impairment in this population. In this qualitative synthesis, we present 8 studies that evaluated 6 different screening tools. Patient characteristics that impacted on cognitive screening performance included age, education level, and a prior history of stroke. We report a pooled prevalence of 38% [14-62%] of suspected cognitive impairment. We discuss the relative benefits and limitations of the different screening tools to help clinicians select an adapted approach tailored to their specific patients' needs. Further studies are needed to establish and validate cognitive screening strategies in patients with diverse cultural and educational backgrounds.
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Affiliation(s)
- Maryline Couette
- Sickle Cell Referral Centre-UMGGR, University of Paris Est Créteil, Henri Mondor APHP, 94010, Créteil, France; CARMAS (Cardiovascular and Respiratory Manifestations of Acute Lung Injury and Sepsis), University of Paris Est Créteil, 94010, Créteil, France; IMRB, INSERM, University of Paris Est Créteil, 94010, Créteil, France
| | - Justine Roy
- Faculté de médecine, Université de Montréal, Montréal, QC, H3C 3J7, Canada
| | - Damien Oudin Doglioni
- Sickle Cell Referral Centre-UMGGR, University of Paris Est Créteil, Henri Mondor APHP, 94010, Créteil, France; Laboratoire Inter-Universitaire de Psychologie-Personnalité, Cognition, Changement Social (LIP/PC2S), Université Grenoble Alpes, 38058, Saint-Martin-d'Hères, France
| | - Olena Bereznyakova
- Axe Neurosciences et Carrefour de l'innovation, Centre de Recherche du CHUM (CRCHUM), Montréal, QC, H2X 0A9, Canada; Division of Neurology, Department of Medicine, Centre hospitalier de l'Université de Montréal (CHUM), Montréal, QC, H2X 0C1, Canada; Department of Neurosciences, Université de Montréal, Montréal, QC, H3C 3J7, Canada
| | - Christian Stapf
- Axe Neurosciences et Carrefour de l'innovation, Centre de Recherche du CHUM (CRCHUM), Montréal, QC, H2X 0A9, Canada; Division of Neurology, Department of Medicine, Centre hospitalier de l'Université de Montréal (CHUM), Montréal, QC, H2X 0C1, Canada; Department of Neurosciences, Université de Montréal, Montréal, QC, H3C 3J7, Canada
| | - Gregory Jacquin
- Axe Neurosciences et Carrefour de l'innovation, Centre de Recherche du CHUM (CRCHUM), Montréal, QC, H2X 0A9, Canada; Division of Neurology, Department of Medicine, Centre hospitalier de l'Université de Montréal (CHUM), Montréal, QC, H2X 0C1, Canada; Department of Neurosciences, Université de Montréal, Montréal, QC, H3C 3J7, Canada
| | - Valérie Fraïle
- Division of Psychology, Centre hospitalier de l'Université de Montréal (CHUM), Montréal, QC, H2X 0C1, Canada
| | - Philippe Desmarais
- Axe Neurosciences et Carrefour de l'innovation, Centre de Recherche du CHUM (CRCHUM), Montréal, QC, H2X 0A9, Canada; Department of Neurosciences, Université de Montréal, Montréal, QC, H3C 3J7, Canada; Division of Geriatrics, Department of Medicine, Centre hospitalier de l'Université de Montréal (CHUM), Montréal, QC, H2X 0C1, Canada
| | - Sara-Maude Desforges
- Faculté de médecine, Université de Montréal, Montréal, QC, H3C 3J7, Canada; Department of Medecine, Centre Hospitalier de l'Université de Montréal, Montréal, QC, H2X 0C1, Canada
| | - Lahoud Touma
- Division of Neurology, Department of Medicine, Centre hospitalier de l'Université de Montréal (CHUM), Montréal, QC, H2X 0C1, Canada; Department of Neurosciences, Université de Montréal, Montréal, QC, H3C 3J7, Canada
| | - Bénédicte Nauche
- Library, Centre Hospitalier de l'Université de Montréal, Montréal, QC, H2X 3E4, Canada
| | - Pablo Bartolucci
- Sickle Cell Referral Centre-UMGGR, University of Paris Est Créteil, Henri Mondor APHP, 94010, Créteil, France; IMRB, INSERM, University of Paris Est Créteil, 94010, Créteil, France; INSERM-U955, Equipe 2, Laboratoire d'Excellence, GRex, Institut Mondor, 94000, Créteil, France
| | - Kevin H M Kuo
- Division of Hematology, Department of Medicine, University of Toronto, Toronto, ON, M5S 1A1, Canada; Division of Medical Oncology and Hematology, Department of Medicine, University Health Network, Toronto, ON, M5G 2N2, Canada; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, M5T 3M7, Canada
| | - Stéphanie Forté
- Faculté de médecine, Université de Montréal, Montréal, QC, H3C 3J7, Canada; Department of Medicine, Division of Hematology and Medical Oncology, Centre Hospitalier de l'Université de Montréal, Montréal, QC, H2X 3E4, Canada; Carrefour de l'innovation, Centre de Recherche du CHUM (CRCHUM), Montréal, H2X 0A9, QC, Canada.
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Bedrouni M, Touma L, Sauvé C, Botez S, Soulières D, Forté S. Numb Chin Syndrome in Sickle Cell Disease: A Systematic Review and Recommendations for Investigation and Management. Diagnostics (Basel) 2022; 12:diagnostics12122933. [PMID: 36552940 PMCID: PMC9776680 DOI: 10.3390/diagnostics12122933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 11/15/2022] [Accepted: 11/21/2022] [Indexed: 11/25/2022] Open
Abstract
Numb chin syndrome (NCS) is a rare sensory neuropathy resulting from inferior alveolar or mental nerve injury. It manifests as hypoesthesia, paraesthesia, or, rarely, as pain in the chin and lower lip. Several case reports suggest that sickle cell disease (SCD) could be a cause of NCS. However, information about NCS is scarce in this population. Our objectives were to synthesize all the available literature relevant to NCS in SCD and to propose recommendations for diagnosis and management based on the best available evidence. A systematic review was performed on several databases to identify all relevant publications on NCS in adults and children with SCD. We identified 73 publications; fourteen reports met the inclusion/exclusion criteria. These described 33 unique patients. Most episodes of NCS occurred in the context of typical veno-occlusive crises that involved the mandibular area. Radiological signs of bone infarction were found on some imaging, but not all. Neuropathy management was mostly directed toward the underlying cause. Overall, these observations suggest that vaso-occlusion and bone infarction could be important pathophysiological mechanisms of NCS. However, depending on the individual context, we recommend a careful evaluation to rule out differential causes, including infections, local tumors, metastatic disease, and stroke.
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Affiliation(s)
- Mahdi Bedrouni
- Department of Physiology, McGill University, Montréal, QC H3A 0G4, Canada
| | - Lahoud Touma
- Department of Neurosciences, Université de Montréal, Montréal, QC H3T 1J4, Canada
| | - Caroline Sauvé
- Library, Centre Hospitalier de l’Université de Montréal, Montréal, QC H2X 3E4, Canada
| | - Stephan Botez
- Department of Neurosciences, Université de Montréal, Montréal, QC H3T 1J4, Canada
| | - Denis Soulières
- Departement of Medicine, Division of Hematology and Medical Oncology, Centre Hospitalier de l’Université de Montréal, Montréal, QC H2X 3E4, Canada
- Department of Medicine, Université de Montréal, Montreal, QC H3T 1J4, Canada
| | - Stéphanie Forté
- Departement of Medicine, Division of Hematology and Medical Oncology, Centre Hospitalier de l’Université de Montréal, Montréal, QC H2X 3E4, Canada
- Department of Medicine, Université de Montréal, Montreal, QC H3T 1J4, Canada
- Correspondence:
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4
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Nehme A, Ducroux C, Panzini MA, Bard C, Bereznyakova O, Boisseau W, Deschaintre Y, Diestro JDB, Guilbert F, Jacquin G, Maallah MT, Nelson K, Padilha IG, Poppe AY, Rioux B, Roy D, Touma L, Weill A, Gioia LC, Létourneau-Guillon L. Non-contrast CT markers of intracerebral hematoma expansion: a reliability study. Eur Radiol 2022; 32:6126-6135. [PMID: 35348859 DOI: 10.1007/s00330-022-08710-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 02/21/2022] [Accepted: 03/01/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVES We evaluated whether clinicians agree in the detection of non-contrast CT markers of intracerebral hemorrhage (ICH) expansion. METHODS From our local dataset, we randomly sampled 60 patients diagnosed with spontaneous ICH. Fifteen physicians and trainees (Stroke Neurology, Interventional and Diagnostic Neuroradiology) were trained to identify six density (Barras density, black hole, blend, hypodensity, fluid level, swirl) and three shape (Barras shape, island, satellite) expansion markers, using standardized definitions. Thirteen raters performed a second assessment. Inter- and intra-rater agreement were measured using Gwet's AC1, with a coefficient > 0.60 indicating substantial to almost perfect agreement. RESULTS Almost perfect inter-rater agreement was observed for the swirl (0.85, 95% CI: 0.78-0.90) and fluid level (0.84, 95% CI: 0.76-0.90) markers, while the hypodensity (0.67, 95% CI: 0.56-0.76) and blend (0.62, 95% CI: 0.51-0.71) markers showed substantial agreement. Inter-rater agreement was otherwise moderate, and comparable between density and shape markers. Inter-rater agreement was lower for the three markers that require the rater to identify one specific axial slice (Barras density, Barras shape, island: 0.46, 95% CI: 0.40-0.52 versus others: 0.60, 95% CI: 0.56-0.63). Inter-observer agreement did not differ when stratified for raters' experience, hematoma location, volume, or anticoagulation status. Intra-rater agreement was substantial to almost perfect for all but the black hole marker. CONCLUSION In a large sample of raters with different backgrounds and expertise levels, only four of nine non-contrast CT markers of ICH expansion showed substantial to almost perfect inter-rater agreement. KEY POINTS • In a sample of 15 raters and 60 patients, only four of nine non-contrast CT markers of ICH expansion showed substantial to almost perfect inter-rater agreement (Gwet's AC1> 0.60). • Intra-rater agreement was substantial to almost perfect for eight of nine hematoma expansion markers. • Only the blend, fluid level, and swirl markers achieved substantial to almost perfect agreement across all three measures of reliability (inter-rater agreement, intra-rater agreement, agreement with the results of a reference reading).
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Affiliation(s)
- Ahmad Nehme
- Neurovascular Health Program, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada.
| | - Célina Ducroux
- Neurovascular Health Program, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada
| | - Marie-Andrée Panzini
- Neurovascular Health Program, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada
| | - Céline Bard
- Département de Radiologie, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada
| | - Olena Bereznyakova
- Neurovascular Health Program, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada
- Axe Neurosciences, Centre de Recherche du CHUM (CRCHUM), Montréal, Québec, Canada
- Département de Neurosciences, Université de Montréal, Montréal, Québec, Canada
| | - William Boisseau
- Département de Radiologie, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada
| | - Yan Deschaintre
- Neurovascular Health Program, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada
- Axe Neurosciences, Centre de Recherche du CHUM (CRCHUM), Montréal, Québec, Canada
- Département de Neurosciences, Université de Montréal, Montréal, Québec, Canada
| | | | - François Guilbert
- Département de Radiologie, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada
| | - Grégory Jacquin
- Neurovascular Health Program, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada
- Axe Neurosciences, Centre de Recherche du CHUM (CRCHUM), Montréal, Québec, Canada
- Département de Neurosciences, Université de Montréal, Montréal, Québec, Canada
| | - Mohamed Taoubane Maallah
- Département de Radiologie, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada
| | - Kristoff Nelson
- Département de Radiologie, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada
| | - Igor Gomes Padilha
- Département de Radiologie, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada
| | - Alexandre Y Poppe
- Neurovascular Health Program, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada
- Axe Neurosciences, Centre de Recherche du CHUM (CRCHUM), Montréal, Québec, Canada
- Département de Neurosciences, Université de Montréal, Montréal, Québec, Canada
| | - Bastien Rioux
- Neurovascular Health Program, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada
| | - Daniel Roy
- Département de Radiologie, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada
| | - Lahoud Touma
- Neurovascular Health Program, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada
| | - Alain Weill
- Département de Radiologie, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada
| | - Laura C Gioia
- Neurovascular Health Program, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada
- Axe Neurosciences, Centre de Recherche du CHUM (CRCHUM), Montréal, Québec, Canada
- Département de Neurosciences, Université de Montréal, Montréal, Québec, Canada
| | - Laurent Létourneau-Guillon
- Département de Radiologie, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada
- Imaging and Engineering Axis, Centre de Recherche du CHUM (CRCHUM), Montréal, Québec, Canada
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Touma L, Dansereau B, Chan AY, Jetté N, Kwon CS, Braun KPJ, Friedman D, Jehi L, Rolston JD, Vadera S, Wong-Kisiel LC, Englot DJ, Keezer MR. Neurostimulation in People with Drug-Resistant Epilepsy: Systematic Review and Meta-Analysis from the ILAE Surgical Therapies Commission. Epilepsia 2022; 63:1314-1329. [PMID: 35352349 DOI: 10.1111/epi.17243] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 03/25/2022] [Accepted: 03/28/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Summarize the current evidence on efficacy and tolerability of vagus nerve stimulation (VNS), responsive neurostimulation (RNS), and deep brain stimulation (DBS) through a systematic review and meta-analysis. METHODS We followed the PRISMA reporting standards and searched Ovid Medline, Ovid Embase, and the Cochrane Central Register of Controlled Trials. We included published randomized controlled trials (RCT) and their corresponding open-label extension studies, as well as prospective case series, with ≥ 20 participants (excluding studies limited to children). Our primary outcome was the mean (or median when unavailable) percentage decrease in frequency, as compared to baseline, of all epileptic seizures at last follow-up. Secondary outcomes included proportion of treatment responders and proportion with seizure freedom. RESULTS We identified 30 eligible studies, six of which were RCTs. At long-term follow-up (mean 1.3 years), five observational studies for VNS reported a pooled mean percentage decrease in seizure frequency of 34.7% (95% CI: -5.1, 74.5). In the open-label extension studies for RNS, the median seizure reduction was 53%, 66%, and 75% at two, five, and nine years of follow-up, respectively. For DBS, the median reduction was 56%, 65%, and 75% at two, five, and seven years, respectively. The proportion of individuals with seizure freedom at last follow-up increased significantly over time for DBS and RNS while a positive trend was observed for VNS. Quality of life was improved in all modalities. The most common complications included hoarseness, cough and throat pain for VNS and implant site pain, headache, and dysesthesia for DBS and RNS. SIGNIFICANCE Neurostimulation modalities are an effective treatment option for drug resistant epilepsy, with improving outcomes over time and few major complications. Seizure reduction rates among the three therapies were similar during the initial blinded phase. Recent long-term follow-up studies are encouraging for RNS and DBS but are lacking for VNS.
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Affiliation(s)
- Lahoud Touma
- Research Centre of the Centre hospitalier de l'Université de Montréal (CRCHUM), Montréal, QC, Canada.,Department of Neurosciences, Université de Montréal, Montréal, QC, Canada
| | - Bénédicte Dansereau
- Research Centre of the Centre hospitalier de l'Université de Montréal (CRCHUM), Montréal, QC, Canada.,Department of Neurosciences, Université de Montréal, Montréal, QC, Canada
| | - Alvin Y Chan
- Department of Neurological Surgery, School of Medicine, University of California, Irvine, Orange, CA, USA
| | - Nathalie Jetté
- Department of Neurosurgery and Neurology, Icahn School of Medicine at Mount Sinai, NY, USA
| | - Churl-Su Kwon
- Department of Neurosurgery and Neurology, Icahn School of Medicine at Mount Sinai, NY, USA
| | - Kees P J Braun
- Department of Child Neurology, University Medical Center Utrecht, member of ERN EpiCARE, Utrecht, Netherlands
| | - Daniel Friedman
- Department of Neurology, New York University Langone Health, NY, USA
| | - Lara Jehi
- Department of Neurology, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - John D Rolston
- Department of Neurosurgery, University of Utah, Salt Lake City, UT, USA
| | - Sumeet Vadera
- Department of Neurological Surgery, School of Medicine, University of California, Irvine, Orange, CA, USA
| | | | - Dario J Englot
- Departments of Neurological Surgery, Neurology, Radiological, Electrical Engineering, and Biomedical Engineering, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Mark R Keezer
- Research Centre of the Centre hospitalier de l'Université de Montréal (CRCHUM), Montréal, QC, Canada.,Department of Neurosciences, Université de Montréal, Montréal, QC, Canada.,Honorary Researcher, Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, The Netherlands.,School of Public Health, Université de Montréal, Montréal, QC, Canada
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Abstract
The spectrum of demyelinating diseases affecting the central nervous system is broad. Although many have a chronic course, neuroinflammatory conditions often present with acute to subacute onset symptoms requiring hospitalization when severe. This article reviews the acute phase assessment and management of these disorders, with a particular focus on multiple sclerosis, neuromyelitis optica spectrum disorder, myelin oligodendrocyte glycoprotein antibody disorder, and several atypical demyelinating diseases.
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Affiliation(s)
- Lahoud Touma
- Department of Neurosciences, Unviersity of Montreal, Centre Hospitalier de l'Université de Montréal
| | - Alexandra Muccilli
- Department of Medicine, Division of Neurology, St. Michael's Hospital, University of Toronto, Toronto, Canada.
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Kalaycioglu I, Rioux B, Neves BJ, Nehme A, Touma L, Dansereau B, Veilleux-Carpentier A, Keezer MR. The reliability of risk of bias tools for nonrandomized studies. Ann Epidemiol 2021. [DOI: 10.1016/j.annepidem.2021.05.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Giavasi C, Keezer MR, Sander JW, Neves Briard J, Touma L. Generic versus branded antiepileptic drug monotherapy for epilepsy. Hippokratia 2021. [DOI: 10.1002/14651858.cd011839.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Christina Giavasi
- Department of Clinical and Experimental Epilepsy; National Hospital for Neurology & Neurosurgery and UCL Institute of Neurology; London UK
| | - Mark R Keezer
- Neurosciences & Social and Preventative Medicine; Centre de Recherche du Centre Hospitalier de l'Université de Montréal; Montreal Canada
| | - Josemir W Sander
- Department of Clinical and Experimental Epilepsy; UCL Queen Square Institute of Neurology; London UK
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Rioux B, Touma L, Nehme A, Gore G, Keezer MR, Gioia LC. Frequency and predictors of occult cancer in ischemic stroke: A systematic review and meta-analysis. Int J Stroke 2020; 16:12-19. [PMID: 33197367 DOI: 10.1177/1747493020971104] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND The optimal approach for cancer screening after an ischemic stroke remains unclear. AIMS We sought to summarize the existing evidence regarding the frequency and predictors of cancer after an ischemic stroke. SUMMARY OF REVIEW We searched seven databases from January 1980 to September 2019 for articles reporting malignant tumors and myeloproliferative neoplasms diagnosed after an ischemic stroke (PROSPERO protocol: CRD42019132455). We screened 15,400 records and included 51 articles. The pooled cumulative incidence of cancer within one year after an ischemic stroke was 13.6 per thousand (95% confidence interval [CI], 5.6-24.8), higher in studies focusing on cryptogenic stroke (62.0 per thousand; 95% CI, 13.6-139.3 vs 9.6 per thousand; 95% CI, 4.0-17.3; p = 0.02) and those reporting cancer screening (39.2 per thousand; 95% CI, 16.4-70.6 vs 7.2 per thousand; 95% CI, 2.5-14.1; p = 0.003). Incidence of cancer after stroke was generally higher compared to people without stroke. Most cases were diagnosed within the first few months after stroke. Several predictors of cancer were identified, namely older age, smoking, and involvement of multiple vascular territories as well as elevated C-reactive protein and d-dimers. CONCLUSIONS The frequency of incident cancer after an ischemic stroke is low, but higher in cryptogenic stroke and after cancer screening. Several predictors may increase the yield of cancer screening after an ischemic stroke. The pooled incidence of post-stroke cancer is likely underestimated, and larger studies with systematic assessment of cancer after stroke are needed to produce more precise and valid estimates.
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Affiliation(s)
- Bastien Rioux
- Department of Neurosciences, 5622University of Montreal, Montreal, Canada.,Centre hospitalier de l'Université de Montréal, Montreal, Canada
| | - Lahoud Touma
- Department of Neurosciences, 5622University of Montreal, Montreal, Canada.,Centre hospitalier de l'Université de Montréal, Montreal, Canada
| | - Ahmad Nehme
- Department of Neurosciences, 5622University of Montreal, Montreal, Canada.,Centre hospitalier de l'Université de Montréal, Montreal, Canada
| | - Genevieve Gore
- Schulich Library of Physical Sciences, Life Sciences, and Engineering, 5620McGill University, Montreal, Canada
| | - Mark R Keezer
- Department of Neurosciences, 5622University of Montreal, Montreal, Canada.,Centre hospitalier de l'Université de Montréal, Montreal, Canada.,Department of Social and Preventive Medicine, School of Public Health, 5622University of Montreal, Montreal, Canada
| | - Laura C Gioia
- Department of Neurosciences, 5622University of Montreal, Montreal, Canada.,Centre hospitalier de l'Université de Montréal, Montreal, Canada
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Toffa DH, Touma L, El Meskine T, Bouthillier A, Nguyen DK. Learnings from 30 years of reported efficacy and safety of vagus nerve stimulation (VNS) for epilepsy treatment: A critical review. Seizure 2020; 83:104-123. [PMID: 33120323 DOI: 10.1016/j.seizure.2020.09.027] [Citation(s) in RCA: 95] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 09/23/2020] [Accepted: 09/25/2020] [Indexed: 12/11/2022] Open
Abstract
Three decades after its introduction as an adjuvant therapeutic option in the management of selective drug-resistant epilepsy cases (DRE), vagus nerve stimulation (VNS) retains growing interest. An implantable device was first approved for epilepsy in Europe in 1994 and in the United States (US) in 1997. Subsequent modifications improved the safety and the efficacy of the system. The most recent application of vagal neurostimulation is represented by transcutaneous devices that are claimed to have strong therapeutic potential. In this review, we sought to analyze the most meaningful available data describing the indications, safety and efficacy of the different approaches of VNS in clinical practice. Therefore, we identified studies reporting VNS efficacy and/or safety in epilepsy and its comorbidities from January 1990 to February 2020 from various databases including PubMed, Scopus, Cochrane, US government databases and VNS manufacturer published resources. In general, VNS efficacy becomes optimal around the sixth month of treatment and a 50-100 % seizure frequency reduction is achieved in approximately 45-65 % of the patients. However, some clinically relevant differences have been reported with specific factors such as epilepsy etiology or type, patient age as well as the delay of VNS therapy onset. VNS efficacy on seizure frequency has been demonstrated in both children and adults, in lesional and non-lesional cases, in focal and generalized epilepsies, on both seizures and epilepsy comorbidities. Regarding the latter, VNS can lead to an improvement of about 25-35 % in depression scores, 35 % in anxiety scores and 25 % in mood assessment scores. If non-invasive devices are undeniably safer, their efficacy is limited due to the scarcity of large cohort studies and the disparity of methodological approaches (study design and stimulation parameters). Overall, we believe that there is a progress margin for improving the safety of implantable devices and, above all, the effectiveness of the various VNS approaches.
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Affiliation(s)
- Dènahin Hinnoutondji Toffa
- Department of Neurology, CHUM, University of Montreal, Montreal, Canada; CHUM Research Center, University of Montreal, Montreal, Canada.
| | - Lahoud Touma
- Department of Neurology, CHUM, University of Montreal, Montreal, Canada
| | | | - Alain Bouthillier
- Department of Neurosurgery, CHUM, University of Montreal, Montreal, Canada
| | - Dang Khoa Nguyen
- Department of Neurology, CHUM, University of Montreal, Montreal, Canada; CHUM Research Center, University of Montreal, Montreal, Canada
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Affiliation(s)
- Lahoud Touma
- Division of Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital/McGill University, Montreal, Quebec, Canada2Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Kristian B. Filion
- Division of Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital/McGill University, Montreal, Quebec, Canada2Faculty of Medicine, McGill University, Montreal, Quebec, Canada3Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada4Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Mark J. Eisenberg
- Division of Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital/McGill University, Montreal, Quebec, Canada2Faculty of Medicine, McGill University, Montreal, Quebec, Canada3Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada5Division of Cardiology, Jewish General Hospital/McGill University, Montreal, Quebec, Canada
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Touma L, Filion KB, Sterling LH, Atallah R, Windle SB, Eisenberg MJ. Stent Retrievers for the Treatment of Acute Ischemic Stroke: A Systematic Review and Meta-analysis of Randomized Clinical Trials. JAMA Neurol 2016; 73:275-81. [PMID: 26810499 DOI: 10.1001/jamaneurol.2015.4441] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Stent retrievers are a promising alternative for the treatment of acute ischemic stroke (AIS). Several recently completed clinical trials have examined the use of stent retrievers with intravenous recombinant tissue plasminogen activator (rtPA) compared with rtPA alone. OBJECTIVE To conduct a systematic review and meta-analysis of randomized clinical trials to quantify the benefits and risks of using stent retrievers in addition to rtPA for the treatment of AIS. DATA SOURCES The MEDLINE, EMBASE, and Cochrane Library of Clinical Trials databases were searched from inception to July 2015 for the keywords stent*, retriev*, Solitaire, Trevo, Revive, and stroke. Trial registries were also searched. A total of 326 publications were identified and 213 potentially relevant records were screened. STUDY SELECTION Randomized clinical trials that examined stent retrievers with rtPA vs rtPA alone were included in the meta-analysis. DATA EXTRACTION AND SYNTHESIS Two independent reviewers extracted study data and performed quality assessment using the Cochrane Risk of Bias Tool. DerSimonian and Laird random-effects models were used to estimate relative risks (RRs), risk differences (RDs), and numbers needed to treat. MAIN OUTCOMES AND MEASURES The primary outcome was the proportion of patients achieving functional independence (defined as a score of 0-2 on the modified Rankin Scale, with 0 indicating no disability and 6 indicating death) at 90 days. Risks of all-cause mortality, intracranial hemorrhage, and parenchymal hematoma at 90 days were also assessed. RESULTS Five randomized clinical trials met our inclusion criteria (n = 1287 patients). Patients randomized to stent-retriever therapy with rtPA had significantly improved rates of functional independence at 90 days compared with those randomized to rtPA alone (RR, 1.72; 95% CI, 1.48-1.99; RD, 0.19; 95% CI, 0.13-0.25). When data were pooled across trials, the effect of stent-retriever therapy on all-cause mortality at 90 days was inconclusive (RR, 0.82; 95% CI, 0.60-1.11; RD, -0.04; 95% CI, -0.08 to 0.1). There were similarly no detectable differences in the risks of intracranial hemorrhage (RR, 1.15; 95% CI, 0.67-1.97; RD, 0.00; 95% CI, -0.02 to 0.03) or parenchymal hematoma (RR, 1.18; 95% CI, 0.71-1.94; RD, 0.01; 95% CI, -0.01 to 0.04), although the 95% CIs were wide. Fixed-effects sensitivity analyses produced similar results for all outcomes. CONCLUSIONS AND RELEVANCE The use of stent retrievers in conjunction with rtPA vs rtPA alone is associated with significant improvement of functional independence 90 days after AIS.
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Affiliation(s)
- Lahoud Touma
- Division of Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital/McGill University, Montreal, Quebec, Canada2Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Kristian B Filion
- Division of Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital/McGill University, Montreal, Quebec, Canada2Faculty of Medicine, McGill University, Montreal, Quebec, Canada3Department of Epidemiology, Biostatistics, and Occupational Healt
| | - Lee H Sterling
- Division of Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital/McGill University, Montreal, Quebec, Canada2Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Renée Atallah
- Division of Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital/McGill University, Montreal, Quebec, Canada
| | - Sarah B Windle
- Division of Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital/McGill University, Montreal, Quebec, Canada
| | - Mark J Eisenberg
- Division of Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital/McGill University, Montreal, Quebec, Canada2Faculty of Medicine, McGill University, Montreal, Quebec, Canada3Department of Epidemiology, Biostatistics, and Occupational Healt
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Sterling LH, Windle SB, Filion KB, Touma L, Eisenberg MJ. Varenicline and Adverse Cardiovascular Events: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. J Am Heart Assoc 2016; 5:JAHA.115.002849. [PMID: 26903004 PMCID: PMC4802486 DOI: 10.1161/jaha.115.002849] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Background Varenicline is an efficacious smoking‐cessation drug. However, previous meta‐analyses provide conflicting results regarding its cardiovascular safety. The publication of several new randomized controlled trials (RCTs) provides an opportunity to reassess this potential adverse drug reaction. Methods and Results We searched MEDLINE, EMBASE, and the Cochrane Library for RCTs that compare varenicline with placebo for smoking cessation. RCTs reporting cardiovascular serious adverse events and/or all‐cause mortality during the treatment period or within 30 days of treatment discontinuation were eligible for inclusion. Relative risks (RRs) with 95% CIs were generated by using DerSimonian–Laird random‐effects models. Thirty‐eight RCTs met our inclusion criteria (N=12 706). Events were rare in both varenicline (57/7213) and placebo (43/5493) arms. No difference was observed for cardiovascular serious adverse events when comparing varenicline with placebo (RR 1.03, 95% CI 0.72–1.49). Similar findings were obtained when examining cardiovascular (RR 1.04, 95% CI 0.57–1.89) and noncardiovascular patients (RR 1.03, 95% CI 0.64–1.64). Deaths were rare in both varenicline (11/7213) and placebo (9/5493) arms. Although 95% CIs were wide, pooling of all‐cause mortality found no difference between groups (RR 0.88, 95% CI 0.50–1.52), including when stratified by participants with (RR 1.24, 95% CI 0.40–3.83) and without (RR 0.77, 95% CI 0.40–1.48) cardiovascular disease. Conclusions We found no evidence that varenicline increases the rate of cardiovascular serious adverse events. Results were similar among those with and without cardiovascular disease. Given varenicline's efficacy as a smoking cessation drug and the long‐term cardiovascular benefits of cessation, it should continue to be prescribed for smoking cessation.
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Affiliation(s)
- Lee H Sterling
- Division of Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital/McGill University, Montreal, Quebec, Canada Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Sarah B Windle
- Division of Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital/McGill University, Montreal, Quebec, Canada
| | - Kristian B Filion
- Division of Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital/McGill University, Montreal, Quebec, Canada Faculty of Medicine, McGill University, Montreal, Quebec, Canada Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Lahoud Touma
- Division of Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital/McGill University, Montreal, Quebec, Canada Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Mark J Eisenberg
- Division of Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital/McGill University, Montreal, Quebec, Canada Division of Cardiology, Jewish General Hospital/McGill University, Montreal, Quebec, Canada Faculty of Medicine, McGill University, Montreal, Quebec, Canada Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
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Abstract
Tortuous anatomy of the cervicoencephalic vessels can cause failure in 4 to 6% of interventional procedures by slippage of the material back in the aorta, kinking or difficulty to move forward a balloon. stent or microcatheter. We report on an old patient with high vascular tortuosity, referred for embolization of a ruptured aneurysm of the left inferior cerebellar artery. Access wasn't possible until we used a "triple axial system" with a long 7F sheath, positioned in the left subclavian artery and strongly supported by a super stiff guidewire with its distal end floating freely in the vascular lumen. Inside the sheath and parallel to the guidewire, we pushed a 4F catheter till the mid-vertebral artery. The microcatheter-microguide system tracked through it, towards the aneurysm, with the backward tendency being neutralized by the increased stiffness. Our technique presents the advantage of a strong back-up support, without increased risks such as vasospasm, clotting or dissection, since the guidewire serving as a stiff rail, lies exteriorly to the navigated vessel. Efficiency of this elegant and relatively low risk solution has yet to be proved in larger series.
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Affiliation(s)
- S Slaba
- Service d'lmagerie Médicale, Hôtel-Dieu de France, Beyrouth, Liban.
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Abstract
We report the case of a patient presenting severe buttock claudication with normal neurologic and osteoarticular exams. He underwent a guidewire recanalization of his occluded superior gluteal artery followed by a percutaneous angioplasty with stenting, resulting in total relief of symptoms. This observation represents the first publication describing the use of a stent with recanalization of the gluteal artery. The technique seems promising for buttock pathology.
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Affiliation(s)
- S Slaba
- Service d'Imagerie Médicale, Hôtel-Dieu de France, rue Alfred Naccache, Beyrouth, Liban.
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