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Epilepsy & Behavior : E&B Dec 2013We aimed to assess the quality of evidence on neuropsychological outcomes after epilepsy surgery (ES). Accordingly, we created an evidence-based neuropsychology (EBNP)... (Review)
Review
PURPOSE
We aimed to assess the quality of evidence on neuropsychological outcomes after epilepsy surgery (ES). Accordingly, we created an evidence-based neuropsychology (EBNP) checklist to assess neuropsychological outcomes and applied this tool to studies from a systematic review.
METHODS
The EBNP checklist was created using clinical expert input, scale development methodology for item generation and reduction and inter-rater reliability, and critical appraisal guidelines for studies about treatment. The checklist was applied to articles obtained through a systematic review of resective ES neuropsychological outcomes. The proportion of studies fulfilling the quality criteria and the total quality score were used to assess the quality of the evidence.
RESULTS
An initial 45-item checklist was applied to 147 articles, with excellent inter-rater agreement (kappa=0.80). The mean quality score was 23 (SD: 4, range: 12-33). There was substantial variability in the percentage of studies meeting the criteria for specific items (0-99%). The median proportion of papers fulfilling various quality criteria was 1.4% for items related to group comparisons, 37% for clinical applicability, 67% for patient description, 78% for outcome assessment, and 91% for interventions. Higher quality correlated with longitudinal design, reporting presurgical IQ, seizure frequency and antiepileptic drugs, and using validated measures of change in individual patients. The final EBNP checklist consisted of 19 items.
DISCUSSION
The EBNP checklist reliably identified quality strengths and threats to validity of neuropsychological outcome studies in ES. Studies would be most improved by the inclusion of random allocation to interventions or at minimum blinded outcome assessment, empirically based measures of reliable change and completeness of reporting of follow-up.
Topics: Cognition Disorders; Epilepsy; Evidence-Based Medicine; Humans; Postoperative Complications; Psychosurgery; Treatment Outcome
PubMed: 24126027
DOI: 10.1016/j.yebeh.2013.08.035 -
BMJ Clinical Evidence Jan 2012Obsessions or compulsions that cause personal distress or social dysfunction affect about 1% of adult men and 1.5% of adult women. About half of adults with obsessive... (Review)
Review
INTRODUCTION
Obsessions or compulsions that cause personal distress or social dysfunction affect about 1% of adult men and 1.5% of adult women. About half of adults with obsessive compulsive disorder (OCD) have an episodic course, whereas the other half have continuous problems. Prevalence in children and adolescents is 2.7%. The disorder persists in about 40% of children and adolescents at mean follow-up of 5.7 years.
METHODS AND OUTCOMES
We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of initial treatments for obsessive compulsive disorder in adults? What are the effects of initial treatments for obsessive compulsive disorder in children and adolescents? What are the effects of maintenance treatment for obsessive compulsive disorder in adults? What are the effects of maintenance treatment for obsessive compulsive disorder in children and adolescents? What are the effects of treatments for obsessive compulsive disorder in adults who have not responded to initial treatment with serotonin reuptake inhibitors (SRIs)? We searched: Medline, Embase, The Cochrane Library, and other important databases up to April 2011 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).
RESULTS
We found 43 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.
CONCLUSIONS
In this systematic review we present information relating to the effectiveness and safety of the following interventions: addition of antipsychotics to serotonin reuptake inhibitors, behavioural therapy alone or with serotonin reuptake inhibitors, cognitive therapy or cognitive behavioural therapy (CBT) (alone or with serotonin reuptake inhibitors), electroconvulsive therapy, optimum duration of maintenance treatment, psychosurgery, serotonin reuptake inhibitors (citalopram, clomipramine, fluoxetine, fluvoxamine, paroxetine, or sertraline), and transcranial magnetic stimulation.
Topics: Electroconvulsive Therapy; Emotions; Humans; Obsessive-Compulsive Disorder; Psychiatric Status Rating Scales; Psychosurgery; Treatment Outcome; United States Food and Drug Administration
PubMed: 22305974
DOI: No ID Found -
Acta Neurochirurgica Apr 2010Major depressive disorder is one of the most disabling and common diagnoses amongst psychiatric disorders, with a current worldwide prevalence of 5-10% of the general... (Review)
Review
INTRODUCTION
Major depressive disorder is one of the most disabling and common diagnoses amongst psychiatric disorders, with a current worldwide prevalence of 5-10% of the general population and up to 20-25% for the lifetime period.
HISTORICAL PERSPECTIVE
Nowadays, conventional treatment includes psychotherapy and pharmacotherapy; however, more than 60% of the treated patients respond unsatisfactorily, and almost one fifth becomes refractory to these therapies at long-term follow-up.
NONPHARMACOLOGICAL TECHNIQUES
Growing social incapacity and economic burdens make the medical community strive for better therapies, with fewer complications. Various nonpharmacological techniques like electroconvulsive therapy, vagus nerve stimulation, transcranial magnetic stimulation, lesion surgery, and deep brain stimulation have been developed for this purpose.
DISCUSSION
We reviewed the literature from the beginning of the twentieth century until July 2009 and described the early clinical effects and main reported complications of these methods.
Topics: Animals; Brain Mapping; Chronic Disease; Deep Brain Stimulation; Depressive Disorder, Major; Dominance, Cerebral; Electroconvulsive Therapy; Emotions; Humans; Outcome and Process Assessment, Health Care; Postoperative Complications; Prefrontal Cortex; Psychosurgery; Recurrence; Retreatment; Solitary Nucleus; Transcranial Magnetic Stimulation; Vagus Nerve; Vagus Nerve Stimulation
PubMed: 20101419
DOI: 10.1007/s00701-009-0589-6 -
Revista de NeurologiaPsychosurgery and the neurochemical treatment of pain (NTP) are therapeutic options restricted to patients who show resistance to medical treatments. Surgical techniques... (Review)
Review
INTRODUCTION
Psychosurgery and the neurochemical treatment of pain (NTP) are therapeutic options restricted to patients who show resistance to medical treatments. Surgical techniques have been perfected over the last few decades.
AIMS
Our aim was to conduct a systematic review of the studies dealing with psychosurgery and NTP reported in the literature, based on the standards of quality used in evidence-based medicine.
DEVELOPMENT
Following screening and selection, nine of the 178 papers found (MEDLINE, 1990-2002) were selected for the study: three referring to the treatment of neuropathic pain and six about the treatment of obsessive-compulsive disorder (OCD). The objectives were the therapeutic results in all cases, the study of the anatomical-functional bases in three of them and the description of side effects in five. After adapting the standards of quality used in evidence-based medicine (there are no standards for papers about surgery), one was classified in group B, six in group C and two as C-D. The three papers about the treatment of pain reported a significant improvement in the pain scales in 40-77% of patients. As regards the treatment of OCD, results showed an overall improvement of the scales in 20.4-70% of the patients with an improvement above 50%. The side effects are also described.
CONCLUSIONS
Data published support the indication of psychosurgery and NTP for selected patients with neuropathic pain and OCD. The methodological limitations of the papers prevent us from drawing conclusions about the other diseases for which these techniques have been indicated.
Topics: Diagnosis, Differential; Evidence-Based Medicine; Humans; MEDLINE; Obsessive-Compulsive Disorder; Pain Management; Psychosurgery
PubMed: 15175979
DOI: No ID Found -
Epilepsia Oct 2001The literature regarding seizure outcome and prognostic factors for outcome after temporal lobectomy is often contradictory. This is problematic, as these data are the... (Meta-Analysis)
Meta-Analysis
PURPOSE
The literature regarding seizure outcome and prognostic factors for outcome after temporal lobectomy is often contradictory. This is problematic, as these data are the basis on which surgical decisions and counseling are founded. We sought to clarify inconsistencies in the literature by critically examining the methods and findings of recent research.
METHODS
A systematic review of the 126 articles concerning temporal lobectomy outcome published from 1991 was conducted.
RESULTS
Major methodologic issues in the literature were heterogeneous definitions of seizure outcome, a predominance of cross-sectional analyses (83% of studies), and relatively short follow-up in many studies. The range of seizure freedom was wide (33-93%; median, 70%); there was a tendency for better outcome in more recent studies. Of 63 factors analyzed, good outcome appeared to be associated with several factors including preoperative hippocampal sclerosis, anterior temporal localization of interictal epileptiform activity, absence of preoperative generalized seizures, and absence of seizures in the first postoperative week. A number of factors had no association with outcome (e.g., age at onset, preoperative seizure frequency, and extent of lateral resection).
CONCLUSIONS
Apparently conflicting results in the literature may be explained by the methodologic issues identified here (e.g., sample size, selection criteria and method of analysis). To obtain a better understanding of patterns of long-term outcome, increased emphasis on longitudinal analytic methods is required. The systematic review of possible risk factors for seizure recurrence provides a basis for planning further research.
Topics: Electroencephalography; Epilepsy, Temporal Lobe; Humans; Postoperative Complications; Psychosurgery; Recurrence; Temporal Lobe; Treatment Outcome
PubMed: 11737164
DOI: 10.1046/j.1528-1157.2001.02001.x