Walton – Brivaracetam Add-On Therapy for Drug-Resistant Epilepsy

Author(s): Bresnahan R.; Panebianco M.; Marson A.G.

Source: Cochrane Database of Systematic Reviews; Mar 2019; vol. 2019 (no. 3)

Publication Date: Mar 2019

Publication Type(s): Review

Available  at Cochrane Database of Systematic Reviews –  from Cochrane Collaboration (Wiley)

Abstract:Background Epilepsy is one of the most common neurological disorders. It is estimated that up to 30% of patients with epilepsy continue to have epileptic seizures despite treatment with an antiepileptic drug. These patients are classified as drug-resistant and require treatment with a combination of multiple antiepileptic drugs. Brivaracetam is a third-generation antiepileptic drug that is a high-affinity ligand for synaptic vesicle protein 2A. This review investigates the use of brivaracetam as add-on therapy for epilepsy. Objectives To evaluate the efficacy and tolerability of brivaracetam when used as add-on treatment for people with drug-resistant epilepsy. Search methods We searched the following databases on 9 October 2018: the Cochrane Register of Studies (CRS Web), which includes the Cochrane Epilepsy Group Specialized Register and the Cochrane Central Register of Controlled Trials (CENTRAL); Medline (Ovid) 1946 to 8 October 2018; ClinicalTrials.gov; and the World Health Organization (WHO) International Clinical Trials Registry Platform ( ICTRP). Originally we also searched SCOPUS as a substitute for Embase, but this is no longer necessary, because randomised and quasi-randomised controlled trials in Embase are now included in CENTRAL. Selection criteria We sought randomised controlled trialswith parallel-group design, recruiting people of any agewith drug-resistant epilepsy.We accepted studies with any level of blinding (double-blind, single-blind, or unblind). Data collection and analysis In accordance with standard methodological procedures expected by the Cochrane Collaboration, two review authors independently assessed trials for inclusion before evaluating trial quality and extracting relevant data. The primary outcome to be assessed was 50% or greater reduction in seizure frequency. Secondary outcomes were: seizure freedom, treatment withdrawal for any reason, treatment withdrawal due to adverse events, the proportion of participants who experienced any adverse events, and drug interactions. We used an intention-to-treat (ITT) population for all primary analyses, and we presented results as risk ratios (RRs) with 95% confidence intervals (CIs).

Copyright © 2019 John Wiley and Sons Ltd. All rights reserved.

Database: EMBASE

Aintree – Incorporating Self-Reported Questions for Telemonitoring to Optimize Care of Patients with MND on Noninvasive Ventilation (MND OptNIVent)

Author(s): Ando H.; Ashcroft-Kelso H.; Halhead R.; Levene P.; Young C.A.; Chakrabarti B.; Angus R.M.; Cousins R.

Source: Amyotrophic Lateral Sclerosis and Frontotemporal Degeneration; 2019

Publication Date: 2019

Publication Type(s): Article

Abstract:Objective: Previous studies suggest a positive impact of telehealth in the care of people with motor neuron disease/amyotrophic lateral sclerosis (MND/ALS). This study reports the development of self-reported questions for telemonitoring, using a tablet-based device Careportal, in the care of patients with MND on noninvasive ventilation (NIV) and its initial impact. Method(s): The study consisted of a question development phase and an evaluation phase of the use of Careportal. The development phase employed a modified Delphi process. The evaluation phase involved a 24-week pilot study with 13 patients (median age = 66; median illness duration = 14 m), who were using NIV. The participants completed overnight oximetry and self-report questions via Careportal each week, generating interventions where required. Patient-ventilator interaction (PVI) data were monitored and the revised ALS functional rating scale (ALSFRS-R) was completed. Result(s): Telemonitoring encompassing the newly developed 26-item symptom questions showed good feasibility and validity. During the evaluation phase, 61 interventions were made for 10 patients, including seven patients who had routine clinic appointments during the trial to optimize care. ALSFRS-R showed significant illness deteriorations. Blood oxygen saturation (SpO2) levels were maintained, time ventilated and inspiratory pressures increased during the trial. Conclusion(s): The MND OptNIVent question set together with weekly ventilator and oximetry monitoring facilitated the maintenance of ventilation and SpO2 levels despite illness progression. The use of the question set, and devices, such as Careportal, facilitate care and may further enable a single point of contact for patients from which clinicians may offer proactive interventions to optimize care.

Copyright © 2019, © 2019 World Federation of Neurology on behalf of the Research Group on Motor Neuron Diseases.

Database: EMBASE


Aintree – Lifelong Congenital Urology: The Challenges for Patients and Surgeons

Author(s): Wood D.; De Win G.; Baird A.; Carmignani L.; Hoebeke P.; Holmdahl G.; Manzoni G.; Nijman R.J.M.; Taylor C.; Tekgul S.

Source: European Urology; 2019

Publication Date: 2019

Publication Type(s): Review

Abstract:Context: Patients born with complex congenital genitourinary anomalies (including bladder exstrophy, cloacal exstrophy, epispadias, neurogenic bladder, hypospadias and posterior urethral valves) often require major reconstructive surgery in childhood. These conditions, their treatment and sequelae require lifelong follow-up. This has created the need for adult urologists to provide care as these patients grow into adults. Objective(s): To evaluate current strategies for transition and provide a current position statement with examples of the challenges faced by patients and their health care teams as a result of these conditions and their treatment. Evidence Acquisition: Each of the authors was asked to provide a 500-word synthesis, based on current literature; to highlight the challenges faced in an area of their expertise. Evidence Synthesis: The authors assembled in March 2018 to form a consensus based on the data gathered. The aforementioned sections were reviewed and following the consensus discussion the paper was formulated and reviewed. Conclusion(s): Lifelong care of congenital problems is challenging and essential for many but not all. Expertise is needed to provide the best care for patients and make the best use of resources. Specialist centres appear to be the most effective and safe model. In the long term it would be ideal to establish an evidence base focused on the common long-term problems with these conditions to ensure excellent care with appropriate expertise. Patient Summary: Patients born with complex congenital anomalies of the genitourinary system require specialist care in childhood. Many will need lifelong care to manage their condition and the treatment of it. There is growing interest in this area of medicine and this consensus statement addresses the need for lifelong care in this group. The aim is to ensure that all patients that need care at any age are able to find what they need. Congenital urology is a fascinating field involving the lifelong care of patients with congenital anomalies. We provide a current position statement from which a network of interested practitioners will be able to build further.

Copyright © 2019 European Association of Urology

Database: EMBASE

Aintree – A Systematic Review and Meta-Analysis of the Prevalence of Small Fiber Pathology in Fibromyalgia: Implications for a New Paradigm in Fibromyalgia Etiopathogenesis

Author(s): Grayston R.; Czanner G.; Alam U.; Elhadd K.; Goebel A.; Frank B.; Uceyler N.; Malik R.A.

Source: Seminars in Arthritis and Rheumatism; Apr 2019; vol. 48 (no. 5); p. 933-940

Publication Date: Apr 2019

Publication Type(s): Article

Abstract:Objectives: Fibromyalgia is a condition which exhibits chronic widespread pain with neuropathic pain features and has a major impact on health-related quality of life. The pathophysiology remains unclear, however, there is increasing evidence for involvement of the peripheral nervous system with a high prevalence of small fiber pathology (SFP). The aim of this systematic literature review is to establish the prevalence of SFP in fibromyalgia. Method(s): An electronic literature search was performed using MEDLINE, EMBASE, PubMed, Web of Science, CINAHL and the Cochrane Library databases. Published full-text, English language articles that provide SFP prevalence data in studies of fibromyalgia of patients over 18years old were included. All articles were screened by two independent reviewers using a priori criteria. Methodological quality and risk of bias were evaluated using the critical appraisal tool by Munn et al. Overall and subgroup pooled prevalence were calculated by random-effects meta-analysis with 95% CI. Result(s): Database searches found 935 studies; 45 articles were screened of which 8 full text articles satisfied the inclusion criteria, providing data from 222 participants. The meta-analysis demonstrated the pooled prevalence of SFP in fibromyalgia is 49% (95% CI: 38-60%) with a moderate degree of heterogeneity, (I2= 68%). The prevalence estimate attained by a skin biopsy was 45% (95% CI: 32-59%, I2= 70%) and for corneal confocal microscopy it was 59% (95% CI: 40-78%, I2= 51%). Conclusion(s): There is a high prevalence of SFP in fibromyalgia. This study provides compelling evidence of a distinct phenotype involving SFP in fibromyalgia. Identifying SFP will aid in determining its relationship to pain and potentially facilitate the development of future interventions and pharmacotherapy.

Copyright © 2018 The Authors

Database: EMBASE

Aintree – Use of a Modified Delphi Approach to Develop Research Priorities in HPB Surgery across the United Kingdom

Author(s): Knight S.R.; Harrison E.M.; Pathak S.; Christie A.; Jones L.; Rees J.; Davies H.; Wilson M.S.J.; Vaughan-Shaw P.; Roberts K.; Toogood G.; Taylor M.A.

Source: HPB; 2019

Publication Date: 2019

Publication Type(s): Article

Available  at HPB –  from Europe PubMed Central – Open Access

Abstract:Background: Research prioritisation can help identify clinically relevant questions and encourage high-quality, patient-centred research. Delphi methodology aims to develop consensus opinion within a group of experts, with recent Delphi projects helping to define the research agenda and funding within several medical and surgical specialties. Method(s): All members of the Association of Upper Gastrointestinal Surgeons (AUGIS) were asked to submit clinical research questions using an online survey (Phase 1). Two consecutive rounds of Delphi prioritisation by multidisciplinary HPB healthcare professionals (Phase 2) were undertaken to establish a final list of the most highly prioritised research questions. A multidisciplinary steering committee analysed the results of each phase. Result(s): Ninety-three HPB-focussed questions were identified in Phase 1, with thirty-seven questions of sufficient priority to enter a further prioritisation round. A final group of 11 questions considered highest priority were identified. The most highly ranked research questions related to treatment pathways, operative strategies and the impact of HPB procedures on quality of life, particularly for malignant disease. Conclusion(s): Expert consensus has identified research priorities within the UK HPB surgical community over the coming years. Funding applications, to establish well-designed, high quality collaborative research are now required to address these questions.

Copyright © 2019 International Hepato-Pancreato-Biliary Association Inc.

Database: EMBASE

Walton – Outcome Measurement and Reporting in Childhood Epilepsy Treated with Ketogenic Diet Therapy: A Scoping Review Protocol.

Authors: Carroll J, Martin-McGill K, Cross H, Hickson M, Collinson A.

Source: JBI Database System Rev Implement Rep. 2019 Mar 14.

doi: 10.11124/JBISRIR-2017-003924. [Epub ahead of print]

PMID: 30889074 [PubMed – as supplied by publisher]

Aintree – Recommendations for Determining HPV Status in Patients with Oropharyngeal Cancers under TNM8 Guidelines: A Two-Tier Approach

Authors: Craig SG, Anderson LA, Schache AG, Moran M, Graham L, Currie K, Rooney K, Robinson M, Upile NS, Brooker R, Mesri M, Bingham V, McQuaid S, Jones T, McCance DJ, Salto-Tellez M, McDade SS, James JA.

Source: Br J Cancer. 2019 Mar 20. doi: 10.1038/s41416-019-0414-9.

[Epub ahead of print]

PMID: 30890775 [PubMed – as supplied by publisher]

Walton – Missed Opportunities for Diagnosing Brain Tumours in Primary Care: A Qualitative Study of Patient Experiences

Authors: Walter FM, Penfold C, Joannides A, Saji S, Johnson M, Watts C, Brodbelt A, Jenkinson MD, Price SJ, Hamilton W, Scott SE.

Source: Br J Gen Pract. 2019 Mar 11. pii: bjgp19X701861.

doi: 10.3399/bjgp19X701861. [Epub ahead of print]

PMID: 30858332 [PubMed – as supplied by publisher]


Walton – Understanding the Core Principles of a ‘Modified Ketogenic Diet’: A UK and Ireland Perspective.

Authors: Martin-McGill KJ, Lambert B, Whiteley VJ, Wood S, Neal EG, Simpson ZR, Schoeler NE; Ketogenic Dietitians Research Network (KDRN).

Source: J Hum Nutr Diet. 2019 Mar 11. doi: 10.1111/jhn.12637. [Epub ahead of print]

PMID: 30859652 [PubMed – as supplied by publisher]