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European Child & Adolescent Psychiatry Jul 2020ADHD is a common neurodevelopmental disorder with onset of symptoms typically in early childhood. First signs of the disorder, including language delay, motor delay and...
ADHD is a common neurodevelopmental disorder with onset of symptoms typically in early childhood. First signs of the disorder, including language delay, motor delay and temperament characteristics, may be evident as early as infancy. The present review describes published evidence about early motor signs of either children with later symptoms of ADHD or a later diagnosis of the disorder. Nine published cohort studies were included after a systematic search of related terms in PubMed and PsycInfo databases. Study eligibility criteria included: (1) report on early motor function or any motor-related signs; (2) the presence of a participants' assessment by/at 12 months of age; (3) report of a later presence of ADHD symptoms. The limited number of reports included suggests an association between mild early neurological markers and later developmental coordination disorder and motor overflow movements. Unfortunately, due to their small sample sizes and focus on group reports rather than individuals, they have limited power to find strong associations. Early motor indicators of ADHD, if present, appear to be non-specific, and therefore not yet useful in clinical screening. Spontaneous motility seems to be a promising measure for early ADHD detection, although further studies with large cohorts are recommended to determine its clinical role in children at risk for ADHD.
Topics: Attention Deficit Disorder with Hyperactivity; Child; Child, Preschool; Female; Humans; Infant; Longitudinal Studies; Male
PubMed: 30798414
DOI: 10.1007/s00787-019-01298-5 -
Is Fluoxetine Good for Subacute Stroke? A Meta-Analysis Evidenced From Randomized Controlled Trials.Frontiers in Neurology 2021Fluoxetine is a drug commonly used to treat mental disorders, such as depression and obsessive-compulsive disorder, and some studies have shown that fluoxetine can...
Fluoxetine is a drug commonly used to treat mental disorders, such as depression and obsessive-compulsive disorder, and some studies have shown that fluoxetine can improve motor and function recovery after stroke. Therefore, we performed a meta-analysis to investigate the efficacy and safety of fluoxetine in the treatment of post-stroke neurological recovery. PubMed, Embase, and Cochrane Library were searched for randomized controlled trials (RCTs) that were performed to assess the efficacy and safety of fluoxetine for functional and motor recovery in subacute stroke patients up to October 2020. Review Manager 5.3 software was used to assess the data. The risk ratio (RR) and standardized mean difference (SMD) were analyzed and calculated with a fixed effects model. We pooled 6,788 patients from nine RCTs. The primary endpoint was modified Rankin Scale (mRS). Fluoxetine did not change the proportion of mRS ≤ 2 ( = 0.47). The secondary endpoints were Fugl-Meyer Motor Scale (FMMS), Barthel Index (BI), and National Institutes of Health Stroke Scale (NIHSS). Fluoxetine improved the FMMS ( < 0.00001) and BI( < 0.0001) and showed a tendency of improving NIHSS ( = 0.08). In addition, we found that fluoxetine reduced the rate of new-onset depression ( < 0.0001) and new antidepressants ( < 0.0001). In post-stroke treatment, fluoxetine did not improve participants' mRS and NIHSS but improved FMMS and BI. This difference could result from heterogeneities between the trials: different treatment duration, clinical scales sensitivity, patient age, delay of inclusion, and severity of the deficit.
PubMed: 33828519
DOI: 10.3389/fneur.2021.633781 -
Frontiers in Pharmacology 2022The effect of herbal medicine (HM) on amyotrophic lateral sclerosis (ALS) is controversial. Clinical trials investigating HMs continue; however, the use of HM is still...
The effect of herbal medicine (HM) on amyotrophic lateral sclerosis (ALS) is controversial. Clinical trials investigating HMs continue; however, the use of HM is still questioned. We aimed to systematically review the literature pertaining to the effects and safety of HM in ALS. Randomised controlled trials (RCTs) that investigated the efficacy of HMs in ALS patients compared to any types of controls were identified. Nine databases and six registers were searched from their inception dates to 25 March 2022. Per the PRISMA guidelines, trials were identified and extracted. The risk of bias was evaluated using the Cochrane's tool. Certainty of evidence was assessed as per the GRADE criteria. Forest plots were constructed to assess the effect size and corresponding 95% CIs using fixed-effect models, and random-effect models were employed when required. The primary outcome was the activity limitation measured by validated tools, such as the revised ALS Functional Rating Scale. Twenty studies ( = 1,218) were eligible. Of these, only five studies were double-blinded, and two were placebo-controlled. Fourteen HMs (fifty-one single botanicals) were involved; and were commonly used in nine, eight, and six trials, respectively. For delaying activity limitation, injection (MD, 2.84; 95% CI, 1.21 to 4.46; = 0.0006) and injection (SMD, 1.07; 0.69 to 1.45; < 0.00001) were significantly more efficacious than Riluzole, but the evidence was low quality. For ameliorating motor neuron loss, injection [right abductor pollicis brevis (APB): MD, 32.42; 7.91 to 56.93; = 0.01 and left APB: MD, 34.44; 12.85 to 56.03; = 0.002] was favoured, but the evidence was very low quality. Nine studies reported one hundred and twenty-three adverse events, twenty-six of which occurred in the treatment groups and ninety-seven in the control groups. Very low to low quality of evidence suggests that HMs seem to produce superior treatment responses for ALS without increased risk of adverse events. Additional studies with homogeneous participants, reduced methodological issues, and more efficient outcome measures are required to provide confirmatory evidence. https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42021277443.
PubMed: 36120351
DOI: 10.3389/fphar.2022.946548 -
Postepy W Kardiologii Interwencyjnej =... 2018Cardiac arrest (CA) due to cardiovascular disease is the leading cause of death in developed countries. It is estimated that over 350,000 people in Europe suffer from... (Review)
Review
Cardiac arrest (CA) due to cardiovascular disease is the leading cause of death in developed countries. It is estimated that over 350,000 people in Europe suffer from out-of-hospital cardiac arrest. According to the literature, the longer the episode of cardiac arrest, the greater the risk of cognitive impairment, especially short-term memory, as well as immediate and delayed recall. Other common dysfunctions include attention deficits and executive function disorders. The aim of this systematic review was to summarize current research on cognitive impairment in patients after sudden cardiac arrest. The electronic databases PubMed/MEDLINE, OVID, Web of Science, and EBSCO were searched using the following key words: 'sudden cardiac arrest', 'out-of-hospital cardiac arrest', 'cognitive function', 'cognitive impairment', 'functional outcome', 'cardiopulmonary resuscitation'. The most recent studies from the last 7 years (2011-2018) were included. Cognitive disorders occurred in a broad range of cases: from 13% to even 100%. In one study, cognitive deficits did not occur at all. Amongst the reviewed articles only two studies were carried out on a large group of patients. The remaining studies were conducted on a small group of respondents; therefore there was no possibility to generalize the results to the entire population. The areas in which the most cognitive impairment occurred were memory, executive functions and visual-motor skills. One of the conclusions derived from the reviewed literature is the importance of continuous training of cognitive functions, especially for people with cardiovascular risk.
PubMed: 30302097
DOI: 10.5114/aic.2018.78324 -
Health Technology Assessment... Jan 2016Tourette syndrome (TS) is a neurodevelopmental condition characterised by chronic motor and vocal tics affecting up to 1% of school-age children and young people and is... (Review)
Review
Clinical effectiveness and patient perspectives of different treatment strategies for tics in children and adolescents with Tourette syndrome: a systematic review and qualitative analysis.
BACKGROUND
Tourette syndrome (TS) is a neurodevelopmental condition characterised by chronic motor and vocal tics affecting up to 1% of school-age children and young people and is associated with significant distress and psychosocial impairment.
OBJECTIVE
To conduct a systematic review of the benefits and risks of pharmacological, behavioural and physical interventions for tics in children and young people with TS (part 1) and to explore the experience of treatment and services from the perspective of young people with TS and their parents (part 2).
DATA SOURCES
For the systematic reviews (parts 1 and 2), mainstream bibliographic databases, The Cochrane Library, education, social care and grey literature databases were searched using subject headings and text words for tic* and Tourette* from database inception to January 2013.
REVIEW/RESEARCH METHODS
For part 1, randomised controlled trials and controlled before-and-after studies of pharmacological, behavioural or physical interventions in children or young people (aged < 18 years) with TS or chronic tic disorder were included. Mixed studies and studies in adults were considered as supporting evidence. Risk of bias associated with each study was evaluated using the Cochrane tool. When there was sufficient data, random-effects meta-analysis was used to synthesize the evidence and the quality of evidence for each outcome was assessed using the Grading of Recommendations Assessment, Development and Evaluation approach. For part 2, qualitative studies and survey literature conducted in populations of children/young people with TS or their carers or in health professionals with experience of treating TS were included in the qualitative review. Results were synthesized narratively. In addition, a national parent/carer survey was conducted via the Tourettes Action website. Participants included parents of children and young people with TS aged under 18 years. Participants (young people with TS aged 10-17 years) for the in-depth interviews were recruited via a national survey and specialist Tourettes clinics in the UK.
RESULTS
For part 1, 70 studies were included in the quantitative systematic review. The evidence suggested that for treating tics in children and young people with TS, antipsychotic drugs [standardised mean difference (SMD) -0.74, 95% confidence interval (CI) -1.08 to -0.41; n = 75] and noradrenergic agents [clonidine (Dixarit(®), Boehringer Ingelheim) and guanfacine: SMD -0.72, 95% CI -1.03 to -0.40; n = 164] are effective in the short term. There was little difference among antipsychotics in terms of benefits, but adverse effect profiles do differ. Habit reversal training (HRT)/comprehensive behavioural intervention for tics (CBIT) was also shown to be effective (SMD -0.64, 95% CI -0.99 to -0.29; n = 133). For part 2, 295 parents/carers of children and young people with TS contributed useable survey data. Forty young people with TS participated in in-depth interviews. Four studies were in the qualitative review. Key themes were difficulties in accessing specialist care and behavioural interventions, delay in diagnosis, importance of anxiety and emotional symptoms, lack of provision of information to schools and inadequate information regarding medication and adverse effects.
LIMITATIONS
The number and quality of clinical trials is low and this downgrades the strength of the evidence and conclusions.
CONCLUSIONS
Antipsychotics, noradrenergic agents and HRT/CBIT are effective in reducing tics in children and young people with TS. The balance of benefits and harms favours the most commonly used medications: risperidone (Risperdal(®), Janssen), clonidine and aripiprazole (Abilify(®), Otsuka). Larger and better-conducted trials addressing important clinical uncertainties are required. Further research is needed into widening access to behavioural interventions through use of technology including mobile applications ('apps') and video consultation.
STUDY REGISTRATION
This study is registered as PROSPERO CRD42012002059.
FUNDING
The National Institute for Health Research Health Technology Assessment programme.
Topics: Adolescent; Antipsychotic Agents; Behavior Therapy; Child; Complementary Therapies; Cost-Benefit Analysis; Humans; Parents; Tics; Tourette Syndrome
PubMed: 26786936
DOI: 10.3310/hta20040 -
Frontiers in Pediatrics 2022To systematically examine the effect of early motor interventions on motor and locomotor development in infants <1 year of age with motor developmental disability or at...
AIM
To systematically examine the effect of early motor interventions on motor and locomotor development in infants <1 year of age with motor developmental disability or at risk of motor delay.
METHODS
Pertinent literature from January 2000 to September 2021 was identified by searching the PubMed, Embase, Cochrane, Pedro and Web of Science databases. Selection criteria included interventions starting before 12 months corrected age. Methodological quality was assessed with AACPDM criteria, Mallen score and Cochrane risk of bias methodology. Evaluation procedure was performed using PRISMA protocol (PICO approach) and AMSTAR-2. This review was preregistered in PROSPERO (CRD42021286445).
RESULTS
Ten articles met the inclusion criteria; seven had moderate to strong methodological quality. The interventions included treadmill training ( = 3), crawling training ( = 1), "tummy time" ( = 1), physical therapy with neonatal developmental program ( = 1) or Bobath approach ( = 1), treadmill training combined with active leg movements ( = 2) or Bobath physiotherapy ( = 1). The three key characteristics of effective interventions that emerged from the review were: (1) the infants' disability or risk of delay was well-defined; (2) the protocol was standardized and easy to replicate; (3) infants were required to make active movements.
CONCLUSION
There is an urgent need for additional high-quality studies on the effects of early motor interventions on the gross motor and locomotor development of infants with a range of disabilities or risks for delay. Suggestions for future research are outlined.
PubMed: 35573941
DOI: 10.3389/fped.2022.877345 -
Neuroscience and Biobehavioral Reviews Jun 2022When used during pregnancy, benzodiazepines (BZDs) and related z-drugs could pass readily through the placenta and the foetal blood-brain barrier, where they can bind to... (Review)
Review
When used during pregnancy, benzodiazepines (BZDs) and related z-drugs could pass readily through the placenta and the foetal blood-brain barrier, where they can bind to γ-amino butyric acid (GABA) receptors in the developing foetal brain. Yet, data on long-term safety of prenatal BZD and z-drug use and its impact on offspring neurodevelopment are inconclusive. In this systematic review, we qualitatively synthetize the existing evidence on maternal exposure to various BZDs and z-drugs during pregnancy and offspring cognitive, emotional, behavioural, and motor skills developmental outcomes. Nineteen studies were included. We used harvest plots to visualize the directions of reported associations. Despite several associations between distinct types of BZDs and z-drugs and an increased risk of outcomes within different neurodevelopmental domains were observed, a remarkable scarcity of overall research on the topic and considerable discrepancies in methodology, particularly towards controlling for confounding by indication, precluded drawing conclusions with a reasonable degree of certainty. We outline various research strategies to mitigate methodological limitations and provide directions for future empirical studies on the topic.
Topics: Benzodiazepines; Female; Humans; Hypnotics and Sedatives; Pregnancy; Prenatal Exposure Delayed Effects
PubMed: 35367514
DOI: 10.1016/j.neubiorev.2022.104647 -
Journal of Neurology May 2019Patients who suffer a transient ischemic attack (TIA) have a high short-term risk of developing ischemic stroke, notably within the first 48 h. Timely diagnosis and...
BACKGROUND
Patients who suffer a transient ischemic attack (TIA) have a high short-term risk of developing ischemic stroke, notably within the first 48 h. Timely diagnosis and urgent preventive treatment substantially reduce this risk. We conducted a systemic review to quantify patient delay in patients with (suspected) TIA, and assess determinants related to such delay.
METHODS
A systematic review using MEDLINE and EMBASE databases up to March 2017 to identify studies reporting the time from onset of TIA symptoms to seeking medical help.
RESULTS
We identified nine studies providing data on patient delay, published between 2006 and 2016, with 7/9 studies originating from the United Kingdom (UK). In total 1103 time-defined TIA patients (no remaining symptoms > 24 h), and 896 patients with a minor stroke (i.e., mild remaining symptoms > 24 h) were included (49.1% men, mean age 72.2 years). Patient's delay of more than 24 h was reported in 33.1-44.4% of TIA patients, with comparable proportions for minor stroke patients. Delays were on average shorter in patients interviewed at the emergency department than among patients seen at TIA outpatient clinics. Univariably associated with a shorter delay were (1) a longer duration of symptoms, (2) motor symptoms, (3) a higher ABCD2 score, and (4) correct patient's recognition as possible ischemic cerebrovascular event.
CONCLUSIONS
More than a third of patients experiencing a TIA delays medical attention for more than a day, thus critically extending the initiation of stroke preventive treatment. There still seems to be insufficient awareness among lay people that symptoms suggestive of TIA should be considered as an emergency. Additional data and multivariable analyses are needed to define main determinants of patient delay.
Topics: Databases, Bibliographic; Humans; Ischemic Attack, Transient; Stroke; Time Factors; Time-to-Treatment
PubMed: 30027321
DOI: 10.1007/s00415-018-8977-6 -
Developmental Medicine and Child... Feb 2021To determine how the severity of antenatally diagnosed germinal matrix-intraventricular hemorrhage (GMH-IVH) relates to morbidity and mortality, and to explore potential... (Meta-Analysis)
Meta-Analysis
AIM
To determine how the severity of antenatally diagnosed germinal matrix-intraventricular hemorrhage (GMH-IVH) relates to morbidity and mortality, and to explore potential risk factors.
METHOD
We conducted a systematic review and individual patient data meta-analysis of antenatally diagnosed fetal GMH-IVH. The primary outcomes were mortality and morbidity. Potential associations with clinical factors during pregnancy were explored. Analysis employed Fisher's exact test and logistic regression.
RESULTS
We included 240 cases from 80 studies. Presence of venous infarction was associated with mortality (odds ratio [OR] 4.3, 95% confidence interval [CI] 1.4-13.25), motor impairment (OR 103.2, 95% CI 8.6-1238), epilepsy (OR 6.46, 95% CI 2.64-16.06), and developmental delay (OR 8.55, 95% CI 2.12-48.79). Shunt placement was associated with gestational age at GMH-IVH diagnosis and in utero progression. Many cases had uncomplicated pregnancies but possible co-occurring conditions included twin gestation, small for gestational age, and congenital anomalies.
INTERPRETATION
Severity of fetal GMH-IVH, specifically venous infarction, is associated with overall mortality and morbidity. Risk factors for fetal GMH-IVH are poorly understood and controlled studies are required.
WHAT THIS PAPER ADDS
Preterm germinal matrix-intraventricular hemorrhage (GMH-IVH) grading can be applied to fetuses. Many fetal germinal matrix hemorrhages occur in otherwise typical pregnancies. Half of fetuses with post-hemorrhagic ventricular dilatation receive a shunt after delivery. Fetuses with grade I or II GMH-IVH have few sequelae. Fetuses with periventricular hemorrhagic infarction have a high burden of motor impairment.
Topics: Cerebral Infarction; Cerebral Intraventricular Hemorrhage; Female; Fetal Diseases; Humans; Infant, Newborn; Male; Pregnancy; Prenatal Diagnosis
PubMed: 33094492
DOI: 10.1111/dmcn.14713 -
Canadian Journal of Rural Medicine :... 2022Indigenous Peoples are much more likely than non-Indigenous Peoples to be seriously injured or die in motor vehicle collisions (MVCs). This study updates and extends a... (Meta-Analysis)
Meta-Analysis
INTRODUCTION
Indigenous Peoples are much more likely than non-Indigenous Peoples to be seriously injured or die in motor vehicle collisions (MVCs). This study updates and extends a previous systematic review, suggesting that future research ought to incorporate social-environmental factors.
METHODS
We conducted a systematic review and meta-analysis of the published and grey literature on MVCs involving Indigenous Peoples in Canada between 2010 and 2020. We focussed on personal (e.g. driving an old vehicle) and community social-environmental-economic factors (e.g. prevalent low socioeconomic status).
RESULTS
Eleven comparative cohorts that resulted in 23 at minimum, age-standardised, mortality or morbidity rate outcomes were included in our meta-analysis. Indigenous Peoples were twice as likely as non-Indigenous Peoples to be seriously injured (rate ratio [RRpooled] = 2.18) and more than 3 times as likely to die (RR = 3.40) in MVCs. Such great risks to Indigenous Peoples do not seem to have diminished over the past generation. Furthermore, such risks were greater on-reserves and in smaller, rural and remote, places.
CONCLUSION
Such places may lack community resources, including fewer transportation and healthcare infrastructural investments, resulting in poorer road conditions in Indigenous communities and longer delays to trauma care. This seems to add further evidence of geo-structural violence (geographical and institutional violence) perpetrated against Indigenous Peoples in yet more structures (i.e. institutions) of Canadian society. Canada's system of highways and roadways and its remote health-care system represent legitimate policy targets in aiming to solve this public health problem.
Topics: Canada; Humans; Indigenous Peoples; Motor Vehicles
PubMed: 35343182
DOI: 10.4103/cjrm.cjrm_42_21