Evidence-Based Neurology (eBook)

Management of Neurological Disorders

Bart Demaerschalk, Dean Wingerchuk (Herausgeber)

eBook Download: PDF

2015 | 2. Auflage
John Wiley & Sons (Verlag)
978-1-119-06732-0 (ISBN)

Infos

From an expert editor team drawn from the Cochrane Neurological Network, Evidence-Based Neurology provides specialists and those in training with the skills and knowledge to apply evidence-based practice in the clinical setting.

• fills the gap between guidelines and primary studies as well as between primary and secondary scientific medical literature
• summarizes the most recent and important findings on treatments for neurological patients
• measures the benefit and, when applicable, the risk of harm inherent in specific neurological interventions
• now includes new non-clinical topics of interest to neurologists such as education and research

Bart M. Demaerschalk, MD, MSc, FRCP(C), Professor of Neurology, Department of Neurology, Mayo Clinic, College of Medicine, Phoenix, AZ, USA

Dean M. Wingerchuk, MD, MSc, FRCP(C), Professor of Neurology, Department of Neurology, Mayo Clinic College of Medicine, Scottsdale, AZ, USA

Inhalt

Cover???????????????????????? 1
Title Page?????????????????????????????????? 5
Copyright???????????????????????????????? 6
Contents?????????????????????????????? 7
Contributors?????????????????????????????????????? 9
Part 1 Evidence-based neurology: introduction???????????????????????????????????????????????????????????????????????????????????????????????????????? 13
Chapter 1 Evidence-based neurology in health education?????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????? 15
Introduction?????????????????????????????????????? 15
Objectives?????????????????????????????????? 15
Topic selection???????????????????????????????????????????? 16
Generating the clinical questions???????????????????????????????????????????????????????????????????????????????? 16
Preparing for the tutorial session?????????????????????????????????????????????????????????????????????????????????? 16
Tutorial?????????????????????????????? 16
Post-tutorial???????????????????????????????????????? 17
The critically appraised topic (CAT)?????????????????????????????????????????????????????????????????????????????????????? 17
Resources???????????????????????????????? 17
Faculty???????????????????????????? 17
Medical librarians and informatics experts?????????????????????????????????????????????????????????????????????????????????????????????????? 17
Time?????????????????????? 17
Space???????????????????????? 17
Educational resource material???????????????????????????????????????????????????????????????????????? 17
Informatics???????????????????????????????????? 18
The evidence to support an evidence-based health curriculum???????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????? 18
References?????????????????????????????????? 18
Chapter 2 Evidence-based medicine in health research?????????????????????????????????????????????????????????????????????????????????????????????????????????????????????? 21
Introduction?????????????????????????????????????? 21
Using evidence-based principles to develop and answer clinical research questions???????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????? 21
Sound research design with the end result in mind???????????????????????????????????????????????????????????????????????????????????????????????????????????????? 22
Therapeutic studies???????????????????????????????????????????????????? 22
Diagnostic studies?????????????????????????????????????????????????? 22
Resources for clinical investigators?????????????????????????????????????????????????????????????????????????????????????? 23
JAMA Evidence (jamaevidence.com)?????????????????????????????????????????????????????????????????????????????? 23
Center for Evidence-Based Medicine (cebm.net)???????????????????????????????????????????????????????????????????????????????????????????????????????? 23
EQUATOR Network (equator-network.org)???????????????????????????????????????????????????????????????????????????????????????? 23
Summary???????????????????????????? 23
References?????????????????????????????????? 24
Chapter 3 Evidence and ethics???????????????????????????????????????????????????????????????????????? 25
Introduction?????????????????????????????????????? 25
The current ethical framework in health care?????????????????????????????????????????????????????????????????????????????????????????????????????? 25
The ethical conduct of human subject research???????????????????????????????????????????????????????????????????????????????????????????????????????? 28
The role of empirical evidence in medical practice and ethics???????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????? 29
Neuroethics???????????????????????????????????? 30
References?????????????????????????????????? 31
Part 2 Evidence-based neurology in the hospital???????????????????????????????????????????????????????????????????????????????????????????????????????????? 33
Chapter 4 Thunderclap headache?????????????????????????????????????????????????????????????????????????? 35
Background?????????????????????????????????? 35
Case scenario???????????????????????????????????????? 35
Framing answerable clinical questions???????????????????????????????????????????????????????????????????????????????????????? 36
Critical review of the evidence???????????????????????????????????????????????????????????????????????????? 36
Risk of secondary TCH???????????????????????????????????????????????????????? 36
Differential diagnosis of TCH???????????????????????????????????????????????????????????????????????? 36
Lumbar puncture???????????????????????????????????????????? 39
Advanced noninvasive neuroimaging???????????????????????????????????????????????????????????????????????????????? 40
Invasive angiography?????????????????????????????????????????????????????? 41
Conclusions???????????????????????????????????? 41
Future research needs???????????????????????????????????????????????????????? 41
References?????????????????????????????????? 41
Chapter 5 Coma?????????????????????????????????????????? 45
Background?????????????????????????????????? 45
Framing clinical questions?????????????????????????????????????????????????????????????????? 45
General physical exam???????????????????????????????????????????????????????? 46
Neurologic exam???????????????????????????????????????????? 46
Ancillary testing???????????????????????????????????????????????? 47
Monitoring of a comatose patient?????????????????????????????????????????????????????????????????????????????? 47
Intracranial pressure (ICP) monitoring?????????????????????????????????????????????????????????????????????????????????????????? 47
Jugular bulb oximetry (SjvO2)???????????????????????????????????????????????????????????????????????? 48
Brain tissue oxygen tension (PbtO2) monitoring?????????????????????????????????????????????????????????????????????????????????????????????????????????? 49
Microdialysis???????????????????????????????????????? 49
Electroencephalography (EEG)?????????????????????????????????????????????????????????????????????? 49
Management?????????????????????????????????? 50
Osmotic therapy???????????????????????????????????????????? 50
Hypothermia???????????????????????????????????? 51
Pharmacologic agents in coma?????????????????????????????????????????????????????????????????????? 52
Clinical examination and scales???????????????????????????????????????????????????????????????????????????? 52
Comatose TBI patients???????????????????????????????????????????????????????? 52
Comatose postcardiac arrest patients?????????????????????????????????????????????????????????????????????????????????????? 52
Neuroimaging?????????????????????????????????????? 53
Traumatic brain injury?????????????????????????????????????????????????????????? 53
Anoxic-ischemic brain injury?????????????????????????????????????????????????????????????????????? 54
Electrophysiology???????????????????????????????????????????????? 55
EEG???????????????????? 55
Evoked potentials???????????????????????????????????????????????? 55
Biomarkers?????????????????????????????????? 56
Combining various parameters to predict outcome???????????????????????????????????????????????????????????????????????????????????????????????????????????? 56
Conclusion?????????????????????????????????? 56
References?????????????????????????????????? 56
Chapter 6 Acute ischemic stroke and transient ischemic attack???????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????? 65
Background?????????????????????????????????? 65
Mechanism and pathophysiology???????????????????????????????????????????????????????????????????????? 65
Epidemiology?????????????????????????????????????? 65
Clinical scenario???????????????????????????????????????????????? 65
Framing clinical questions and general approach to searching evidence???????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????? 66
Critical review of the evidence???????????????????????????????????????????????????????????????????????????? 66
Thrombolysis and clot retrieval???????????????????????????????????????????????????????????????????????????? 66
Organization of care?????????????????????????????????????????????????????? 67
Treatment of acute ischemic stroke?????????????????????????????????????????????????????????????????????????????????? 68
Management of complications???????????????????????????????????????????????????????????????????? 69
Brain edema???????????????????????????????????? 71
Epidemiology?????????????????????????????????????? 73
Diagnosis???????????????????????????????? 73
Evaluation?????????????????????????????????? 73
Clinical case example???????????????????????????????????????????????????????? 73
Framing clinical questions and general approach to searching evidence???????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????? 74
Treatment???????????????????????????????? 74
Noncardioembolic TIA?????????????????????????????????????????????????????? 74
Cardioembolic TIA???????????????????????????????????????????????? 74
Clinical case example???????????????????????????????????????????????????????? 75
References?????????????????????????????????? 75
Chapter 7 Spinal cord compression???????????????????????????????????????????????????????????????????????????????? 79
Introduction?????????????????????????????????????? 79
Spinal cord compression due to tumor - metastatic spinal cord compression???????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????? 79
Clinical questions: management of acute metastatic spinal cord compression?????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????? 79
Spinal cord compression due to infection - spondylodiscitis???????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????? 80
Clinical questions: management of spinal cord compression due to infection?????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????? 81
Spinal cord compression due to degenerative disease - cervical and thoracic spondylotic myelopathy?????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????? 81
Clinical questions: management of spinal cord compression due to degenerative disease???????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????? 82
Spinal cord compression due to trauma - traumatic spinal cord injury?????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????? 82
Clinical questions: management of spinal cord compression due to traumatic injury???????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????? 83
Summary???????????????????????????? 83
References?????????????????????????????????? 84
Chapter 8 Delirium?????????????????????????????????????????????????? 87
Introduction?????????????????????????????????????? 87
Methodology???????????????????????????????????? 88
Clinical questions and evidence???????????????????????????????????????????????????????????????????????????? 88
Clinical question (#1): What is the best approach to diagnose delirium????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????? 88
Clinical question (#2): Once delirium is diagnosed, what is the best pharmacologic intervention??????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????? 88
Clinical question (#3): What are other evidence-based interventions are recommended in treating delirium????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????? 89
Clinical question (#4): How does delirium affect outcome????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????? 89
Summary???????????????????????????? 90
Acknowledgments/Disclosures???????????????????????????????????????????????????????????????????? 90
References?????????????????????????????????? 90
Chapter 9 Status epilepticus?????????????????????????????????????????????????????????????????????? 93
Background?????????????????????????????????? 93
Framing clinical questions and search for evidence?????????????????????????????????????????????????????????????????????????????????????????????????????????????????? 93
Critical review of the evidence for each question???????????????????????????????????????????????????????????????????????????????????????????????????????????????? 94
Summary???????????????????????????? 97
Acknowledgements?????????????????????????????????????????????? 97
References?????????????????????????????????? 97
Chapter 10 Raised intracranial pressure???????????????????????????????????????????????????????????????????????????????????????????? 99
Introduction?????????????????????????????????????? 99
Methodology???????????????????????????????????? 99
Clinical question (#1): What is the best initial medical therapy in reducing intracranial pressure????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????? 100
Clinical question (#2): What is the role for corticosteroids in elevated ICP????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????? 101
Clinical question (#3): How effective is craniectomy on ICP??????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????? 102
Clinical question (#4): Is hypothermia effective in reducing ICP????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????? 102
Summary???????????????????????????? 103
Disclosures???????????????????????????????????? 103
Acknowledgments???????????????????????????????????????????? 103
References?????????????????????????????????? 103
Chapter 11 Traumatic brain injury???????????????????????????????????????????????????????????????????????????????? 105
Critical review of each question?????????????????????????????????????????????????????????????????????????????? 105
Traumatic acute subdural hematoma in adult brain-injured patients???????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????? 105
Conclusions???????????????????????????????????? 107
Anticonvulsive therapy in acute traumatic brain injury patients???????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????? 110
Antiepileptic: Prevents or reduces epileptic seizures???????????????????????????????????????????????????????????????????????????????????????????????????????????????????????? 110
Conclusion?????????????????????????????????? 113
Control of intracranial hypertension?????????????????????????????????????????????????????????????????????????????????????? 113
Background?????????????????????????????????? 113
References?????????????????????????????????? 115
Chapter 12 Myasthenia gravis?????????????????????????????????????????????????????????????????????? 119
Introduction?????????????????????????????????????? 119
Framing of clinical question and search strategy?????????????????????????????????????????????????????????????????????????????????????????????????????????????? 119
Clinical scenario???????????????????????????????????????????????? 120
Critical review of the evidence for each question???????????????????????????????????????????????????????????????????????????????????????????????????????????????? 120
Intravenous immunoglobulin (IVIg) versus plasma exchange in myasthenic crisis???????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????? 120
Clinical scenario???????????????????????????????????????????????? 121
Critical review of the evidence for each question???????????????????????????????????????????????????????????????????????????????????????????????????????????????? 121
Thymectomy in MG?????????????????????????????????????????????? 121
Mycophenolate mofetil in the treatment of MG?????????????????????????????????????????????????????????????????????????????????????????????????????? 122
IVIg in the treatment of chronic MG???????????????????????????????????????????????????????????????????????????????????? 122
Conclusions???????????????????????????????????? 123
References?????????????????????????????????? 123
Chapter 13 Acute visual loss?????????????????????????????????????????????????????????????????????? 125
Non-arteritic ischemic optic neuropathy???????????????????????????????????????????????????????????????????????????????????????????? 125
Background?????????????????????????????????? 125
Treatment???????????????????????????????? 125
Arteritic anterior ischemic optic neuropathy or giant cell arteritis?????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????? 125
Background?????????????????????????????????? 125
Treatment???????????????????????????????? 126
Retinal vascular occlusion syndromes?????????????????????????????????????????????????????????????????????????????????????? 126
Branch and central retinal artery occlusion???????????????????????????????????????????????????????????????????????????????????????????????????? 126
Terson's syndrome???????????????????????????????????????????????? 127
Background?????????????????????????????????? 127
Treatment???????????????????????????????? 127
Stroke?????????????????????????? 127
Treatment???????????????????????????????? 127
Optic nerve disorders???????????????????????????????????????????????????????? 128
Optic neuritis?????????????????????????????????????????? 128
Neuromyelitis optica?????????????????????????????????????????????????????? 128
Background?????????????????????????????????? 128
Treatment???????????????????????????????? 128
Idiopathic intracranial hypertension?????????????????????????????????????????????????????????????????????????????????????? 128
Background?????????????????????????????????? 128
Treatment???????????????????????????????? 129
Non-physiologic vision loss???????????????????????????????????????????????????????????????????? 129
References?????????????????????????????????? 129
Chapter 14 Secondary prevention of stroke???????????????????????????????????????????????????????????????????????????????????????????????? 131
What can be done to prevent further strokes in stroke survivors??????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????? 131
Vascular risk factor modification for secondary stroke prevention???????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????? 131
Hypertension?????????????????????????????????????? 131
General statement???????????????????????????????????????????????? 131
Brief evidence summary?????????????????????????????????????????????????????????? 132
Dyslipidemia?????????????????????????????????????? 132
General statement???????????????????????????????????????????????? 132
Brief evidence summary?????????????????????????????????????????????????????????? 132
Diabetes?????????????????????????????? 132
General statement???????????????????????????????????????????????? 132
Brief evidence summary?????????????????????????????????????????????????????????? 133
Smoking cessation???????????????????????????????????????????????? 133
General statement???????????????????????????????????????????????? 133
Brief evidence summary?????????????????????????????????????????????????????????? 133
Antithrombotic agents in stroke survivors with atrial fibrillation?????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????? 133
General statement???????????????????????????????????????????????? 133
Brief evidence summary?????????????????????????????????????????????????????????? 133
Antiplatelet agents in stroke survivors without atrial fibrillation???????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????? 135
Antiplatelet agents other than aspirin?????????????????????????????????????????????????????????????????????????????????????????? 135
Combinations of antiplatelet agents (in the non-acute phase)?????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????? 136
Endarterectomy for symptomatic carotid disease?????????????????????????????????????????????????????????????????????????????????????????????????????????? 136
General statement???????????????????????????????????????????????? 136
Evidence summary?????????????????????????????????????????????? 136
Endovascular treatment (angioplasty and stenting) for carotid stenosis?????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????? 137
Obstructive sleep apnea management?????????????????????????????????????????????????????????????????????????????????? 137
General statement???????????????????????????????????????????????? 137
Evidence summary?????????????????????????????????????????????? 137
Lifestyle management (eating a balanced diet, limiting salt intake, moderating alcohol consumption, increasing physical activity, and optimizing weight)?????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????? 137
General statement???????????????????????????????????????????????? 137
Evidence summary?????????????????????????????????????????????? 138
Disclosure?????????????????????????????????? 138
References?????????????????????????????????? 138
Part 3 Evidence-based neurology in the clinic???????????????????????????????????????????????????????????????????????????????????????????????????????? 141
Chapter 15 Central nervous system infections?????????????????????????????????????????????????????????????????????????????????????????????????????? 143
Bacterial meningitis?????????????????????????????????????????????????????? 143
Timing of antibiotics???????????????????????????????????????????????????????? 143
Empiric antibiotic therapy?????????????????????????????????????????????????????????????????? 143
Corticosteroids???????????????????????????????????????????? 144
Supportive care???????????????????????????????????????????? 144
Prevention?????????????????????????????????? 145
CNS tuberculosis?????????????????????????????????????????????? 145
First-line therapies?????????????????????????????????????????????????????? 145
Drug resistance???????????????????????????????????????????? 146
HIV-infected patients???????????????????????????????????????????????????????? 146
Glucocorticosteroids?????????????????????????????????????????????????????? 146
Surgical interventions?????????????????????????????????????????????????????????? 146
Additional management considerations?????????????????????????????????????????????????????????????????????????????????????? 147
HSV encephalitis?????????????????????????????????????????????? 147
Acyclovir???????????????????????????????? 147
Duration of treatment???????????????????????????????????????????????????????? 147
Acyclovir resistance?????????????????????????????????????????????????????? 148
Oral antiviral therapy?????????????????????????????????????????????????????????? 148
Steroids?????????????????????????????? 148
Supportive treatments???????????????????????????????????????????????????????? 148
Cryptococcal meningitis???????????????????????????????????????????????????????????? 148
Antifungals in HIV-infected patients?????????????????????????????????????????????????????????????????????????????????????? 149
HIV-negative patients???????????????????????????????????????????????????????? 150
Increased intracranial pressure???????????????????????????????????????????????????????????????????????????? 150
References?????????????????????????????????? 150
Chapter 16 Evidence-based neuro-oncology?????????????????????????????????????????????????????????????????????????????????????????????? 155
Introduction?????????????????????????????????????? 155
Epidemiology, prognostic factors and molecular markers?????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????? 155
Trial outcome criteria and defining response to therapy???????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????? 155
Best pre-operative medical management???????????????????????????????????????????????????????????????????????????????????????? 155
Steroids?????????????????????????????? 155
Seizures?????????????????????????????? 156
Best surgical treatment in primary brain tumours?????????????????????????????????????????????????????????????????????????????????????????????????????????????? 157
Introduction?????????????????????????????????????? 157
Biopsy versus resection for high-grade glioma???????????????????????????????????????????????????????????????????????????????????????????????????????? 157
Intra-operative imaging to maximise extent of resection???????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????? 157
Techniques to make surgery safer?????????????????????????????????????????????????????????????????????????????? 157
Best oncological treatment in primary brain tumours???????????????????????????????????????????????????????????????????????????????????????????????????????????????????? 158
Local chemotherapy?????????????????????????????????????????????????? 158
Systemic chemotherapy???????????????????????????????????????????????????????? 158
Best treatment of brain metastasis????????????????????????????????????????????????????????????????????????????????????? 159
Introduction?????????????????????????????????????? 159
Role of surgical resection?????????????????????????????????????????????????????????????????? 159
Role of SRS???????????????????????????????????? 159
Role of non-focal therapy (WBRT) after focal therapy (SRS or surgery)???????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????? 160
Surgery versus SRS (+/- WBRT)???????????????????????????????????????????????????????????????????????? 160
Summary???????????????????????????? 160
References?????????????????????????????????? 161
Chapter 17 Epilepsy???????????????????????????????????????????????????? 165
Background?????????????????????????????????? 165
Definition?????????????????????????????????? 165
Incidence/prevalence?????????????????????????????????????????????????????? 165
Aetiology/risk factors?????????????????????????????????????????????????????????? 165
Classification?????????????????????????????????????????? 165
Prognosis???????????????????????????????? 165
Interventions???????????????????????????????????????? 165
Aims of the intervention?????????????????????????????????????????????????????????????? 166
Outcomes investigated???????????????????????????????????????????????????????? 166
Methodology???????????????????????????????????? 166
AED Treatment After First Seizure???????????????????????????????????????????????????????????????????????????????? 166
Summary???????????????????????????? 167
AED monotherapy for partial epilepsy?????????????????????????????????????????????????????????????????????????????????????? 167
carbamazepine monotherapy for partial epilepsy?????????????????????????????????????????????????????????????????????????????????????????????????????????? 167
Phenobarbitone Monotherapy for Partial Epilepsy???????????????????????????????????????????????????????????????????????????????????????????????????????????? 169
Phenytoin monotherapy for partial epilepsy?????????????????????????????????????????????????????????????????????????????????????????????????? 170
Sodium valproate monotherapy for partial epilepsy???????????????????????????????????????????????????????????????????????????????????????????????????????????????? 170
Lamotrigine monotherapy for partial epilepsy?????????????????????????????????????????????????????????????????????????????????????????????????????? 170
Topiramate monotherapy for partial epilepsy???????????????????????????????????????????????????????????????????????????????????????????????????? 171
Levetiracetam monotherapy for partial epilepsy?????????????????????????????????????????????????????????????????????????????????????????????????????????? 171
Gabapentin monotherapy for partial epilepsy???????????????????????????????????????????????????????????????????????????????????????????????????? 171
Oxcarbazepine monotherapy for partial epilepsy?????????????????????????????????????????????????????????????????????????????????????????????????????????? 172
Addition of second-line AEDs?????????????????????????????????????????????????????????????????????? 172
172???????????????????? 1
Head-to-head comparisons of newer AEDs (add-on treatment)???????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????? 175
Indirect comparisons of antiepileptic drugs???????????????????????????????????????????????????????????????????????????????????????????????????? 176
Summary???????????????????????????? 176
AED withdrawal for people in remission?????????????????????????????????????????????????????????????????????????????????????????? 176
Withdrawal versus continued treatment???????????????????????????????????????????????????????????????????????????????????????? 176
Early versus late discontinuation???????????????????????????????????????????????????????????????????????????????? 177
Rapid versus slow withdrawal of AED???????????????????????????????????????????????????????????????????????????????????? 177
Summary???????????????????????????? 177
Surgery???????????????????????????? 178
Temporal lobectomy?????????????????????????????????????????????????? 178
Amygdalohippocampectomy???????????????????????????????????????????????????????????? 178
Summary???????????????????????????? 178
Vagus nerve stimulation for drug-resistant epilepsy???????????????????????????????????????????????????????????????????????????????????????????????????????????????????? 178
Summary???????????????????????????? 179
Generalised epilepsy?????????????????????????????????????????????????????? 179
Carbamazepine for generalised epilepsy?????????????????????????????????????????????????????????????????????????????????????????? 180
180???????????????????? 1
Phenobarbital for generalised epilepsy?????????????????????????????????????????????????????????????????????????????????????????? 180
Phenytoin for generalised epilepsy?????????????????????????????????????????????????????????????????????????????????? 180
Sodium valproate for generalised epilepsy???????????????????????????????????????????????????????????????????????????????????????????????? 181
Lamotrigine for generalised epilepsy?????????????????????????????????????????????????????????????????????????????????????? 181
Topiramate for generalised epilepsy???????????????????????????????????????????????????????????????????????????????????? 181
Levetiracetam for generalised epilepsy?????????????????????????????????????????????????????????????????????????????????????????? 181
Gabapentin for generalised epilepsy???????????????????????????????????????????????????????????????????????????????????? 181
Conclusion?????????????????????????????????? 181
Additional treatments???????????????????????????????????????????????????????? 181
Lamotrigine add-on versus adding placebo?????????????????????????????????????????????????????????????????????????????????????????????? 181
Levetiracetam add-on versus placebo???????????????????????????????????????????????????????????????????????????????????? 182
Summary???????????????????????????? 182
Abbreviations???????????????????????????????????????? 182
References?????????????????????????????????? 182
Chapter 18 Cognitive disorders: mild cognitive impairment and Alzheimer's disease???????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????? 185
Introduction?????????????????????????????????????? 185
Framing the clinical questions?????????????????????????????????????????????????????????????????????????? 186
Search strategy???????????????????????????????????????????? 186
Clinical questions?????????????????????????????????????????????????? 186
Treatment of mild cognitive impairment?????????????????????????????????????????????????????????????????????????????????????????? 186
Treatment of mild to moderate Alzheimer's disease???????????????????????????????????????????????????????????????????????????????????????????????????????????????? 188
Treatment of moderate to severe Alzheimer's disease???????????????????????????????????????????????????????????????????????????????????????????????????????????????????? 190
Treatment of agitated behavior in Alzheimer's disease???????????????????????????????????????????????????????????????????????????????????????????????????????????????????????? 192
Conclusion?????????????????????????????????? 200
References?????????????????????????????????? 200
Chapter 19 Evidence-based treatment of Parkinson's disease?????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????? 203
Background?????????????????????????????????? 203
Clinical questions?????????????????????????????????????????????????? 203
Search strategy???????????????????????????????????????????? 203
Critical review of the evidence???????????????????????????????????????????????????????????????????????????? 203
Early Parkinson's disease???????????????????????????????????????????????????????????????? 203
Conclusion?????????????????????????????????? 207
PD patients with levodopa-induced motor complications???????????????????????????????????????????????????????????????????????????????????????????????????????????????????????? 207
Conclusion?????????????????????????????????? 212
Deep brain stimulation?????????????????????????????????????????????????????????? 212
Conclusion?????????????????????????????????? 216
References?????????????????????????????????? 216
Chapter 20 Therapies for multiple sclerosis???????????????????????????????????????????????????????????????????????????????????????????????????? 221
Introduction?????????????????????????????????????? 221
Methods???????????????????????????? 221
Clinically isolated syndrome?????????????????????????????????????????????????????????????????????? 222
Clinical scenario???????????????????????????????????????????????? 222
Interferon-beta and glatiramer acetate for relapsing-remitting multiple sclerosis???????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????? 222
Clinical scenario???????????????????????????????????????????????? 222
Natalizumab and fingolimod?????????????????????????????????????????????????????????????????? 225
Clinical scenario???????????????????????????????????????????????? 225
The newest oral therapies: Teriflunomide and dimethyl fumarate?????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????? 226
Clinical scenario???????????????????????????????????????????????? 226
Secondary progressive MS?????????????????????????????????????????????????????????????? 227
Clinical scenario???????????????????????????????????????????????? 227
Primary progressive MS?????????????????????????????????????????????????????????? 228
Clinical scenario???????????????????????????????????????????????? 228
Dalfampridine???????????????????????????????????????? 228
Clinical scenario???????????????????????????????????????????????? 228
Conclusions???????????????????????????????????? 229
References?????????????????????????????????? 229
Chapter 21 Amyotrophic lateral sclerosis?????????????????????????????????????????????????????????????????????????????????????????????? 231
Background?????????????????????????????????? 231
Framing answerable clinical questions???????????????????????????????????????????????????????????????????????????????????????? 231
General approach to the search for evidence???????????????????????????????????????????????????????????????????????????????????????????????????? 233
Critical review of the evidence for each question???????????????????????????????????????????????????????????????????????????????????????????????????????????????? 233
Pharmacological treatment???????????????????????????????????????????????????????????????? 233
Assessment of respiratory function?????????????????????????????????????????????????????????????????????????????????? 236
NIPPV???????????????????????? 237
Invasive assisted ventilation???????????????????????????????????????????????????????????????????????? 238
Cough assist devices (insufflation/exsufflation)?????????????????????????????????????????????????????????????????????????????????????????????????????????????? 238
Feeding gastrostomy???????????????????????????????????????????????????? 239
Symptom control???????????????????????????????????????????? 241
Multidisciplinary care?????????????????????????????????????????????????????????? 242
Conclusions???????????????????????????????????? 242
References?????????????????????????????????? 242
Chapter 22 Peripheral nerve disorders???????????????????????????????????????????????????????????????????????????????????????? 247
Introduction?????????????????????????????????????? 247
Treatment for CIDP?????????????????????????????????????????????????? 247
Treatment for Guillain-Barre syndrome???????????????????????????????????????????????????????????????????????????????????????? 248
Treatment for multifocal motor neuropathy???????????????????????????????????????????????????????????????????????????????????????????????? 249
Treatment for diabetic polyneuropathy???????????????????????????????????????????????????????????????????????????????????????? 251
References?????????????????????????????????? 252
Chapter 23 Critical illness neuromyopathy???????????????????????????????????????????????????????????????????????????????????????????????? 255
Background?????????????????????????????????? 255
Clinical features and diagnosis???????????????????????????????????????????????????????????????????????????? 255
Framing of clinical question and search strategy?????????????????????????????????????????????????????????????????????????????????????????????????????????????? 256
Clinical scenario???????????????????????????????????????????????? 256
Critical review of the evidence for each question???????????????????????????????????????????????????????????????????????????????????????????????????????????????? 256
Intensive insulin therapy in CINM???????????????????????????????????????????????????????????????????????????????? 256
Physical and occupational therapy in critical illness neuromyopathy???????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????? 257
Electrical muscle stimulation in CINM???????????????????????????????????????????????????????????????????????????????????????? 258
Conclusions???????????????????????????????????? 258
References?????????????????????????????????? 258
Chapter 24 Muscle disorders???????????????????????????????????????????????????????????????????? 261
Introduction?????????????????????????????????????? 261
Critical review of the evidence for each disorder???????????????????????????????????????????????????????????????????????????????????????????????????????????????? 261
Duchenne muscular dystrophy???????????????????????????????????????????????????????????????????? 261
Limb-girdle muscular dystrophies?????????????????????????????????????????????????????????????????????????????? 262
Myasthenia gravis???????????????????????????????????????????????? 262
Polymyositis?????????????????????????????????????? 264
Facioscapulohumeral muscular dystrophy?????????????????????????????????????????????????????????????????????????????????????????? 265
References?????????????????????????????????? 266
Chapter 25 Sleep disorders?????????????????????????????????????????????????????????????????? 269
Background?????????????????????????????????? 269
Framing clinical questions?????????????????????????????????????????????????????????????????? 269
Critical review of evidence???????????????????????????????????????????????????????????????????? 269
Sleep-disordered breathing and stroke???????????????????????????????????????????????????????????????????????????????????????? 269
Narcolepsy with and without cataplexy???????????????????????????????????????????????????????????????????????????????????????? 270
Idiopathic hypersomnia with and without long sleep time???????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????? 274
REM-Behavior Disorder in Parkinson's disease?????????????????????????????????????????????????????????????????????????????????????????????????????? 275
Insomnia in Parkinson's disease???????????????????????????????????????????????????????????????????????????? 276
Conclusion?????????????????????????????????? 276
References?????????????????????????????????? 277
Chapter 26 Acute migraine attacks???????????????????????????????????????????????????????????????????????????????? 279
Background?????????????????????????????????? 279
Case scenario???????????????????????????????????????? 279
Framing answerable clinical questions???????????????????????????????????????????????????????????????????????????????????????? 279
Critical review of the evidence???????????????????????????????????????????????????????????????????????????? 280
1. Diagnosis?????????????????????????????????????? 280
2. CT scan?????????????????????????????????? 280
3. Nonspecific acute treatments???????????????????????????????????????????????????????????????????????????? 281
4. Specific acute treatments?????????????????????????????????????????????????????????????????????? 281
5. Prophylaxis?????????????????????????????????????????? 283
6. Prognosis?????????????????????????????????????? 288
Conclusion?????????????????????????????????? 288
Future research needs???????????????????????????????????????????????????????? 288
References?????????????????????????????????? 288
Chapter 27 Therapy of vestibular disorders, nystagmus and cerebellar ataxia?????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????? 291
Introduction?????????????????????????????????????? 291
Principles of the pharmacotherapy of vertigo, dizziness, ocular motor disorders, and nystagmus?????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????? 291
Peripheral vestibular disorders???????????????????????????????????????????????????????????????????????????? 291
Acute unilateral vestibulopathy???????????????????????????????????????????????????????????????????????????? 291
Causal therapy?????????????????????????????????????????? 292
Improvement of central vestibular compensation?????????????????????????????????????????????????????????????????????????????????????????????????????????? 292
Meniere's disease???????????????????????????????????????????????? 292
Transtympanic administration of gentamicin?????????????????????????????????????????????????????????????????????????????????????????????????? 293
Transtympanic administration of glucocorticoids???????????????????????????????????????????????????????????????????????????????????????????????????????????? 293
Comparison between gentamicin and glucocorticoids???????????????????????????????????????????????????????????????????????????????????????????????????????????????? 293
Betahistine???????????????????????????????????? 293
Vestibular paroxysmia???????????????????????????????????????????????????????? 293
Central vestibular, ocular motor, and cerebellar disorders?????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????? 294
Acquired pendular nystagmus (APN) and oculopalatal tremor???????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????? 298
Periodic alternating nystagmus (PAN)?????????????????????????????????????????????????????????????????????????????????????? 298
Infantile nystagmus???????????????????????????????????????????????????? 299
Perspectives?????????????????????????????????????? 299
Acknowledgements?????????????????????????????????????????????? 299
References?????????????????????????????????? 299
Chapter 28 Neuro-ophthalmology?????????????????????????????????????????????????????????????????????????? 303
Introduction?????????????????????????????????????? 303
Optic neuritis?????????????????????????????????????????? 303
Arteritic anterior ischemic optic neuropathy?????????????????????????????????????????????????????????????????????????????????????????????????????? 305
Non-arteritic anterior ischemic optic neuropathy?????????????????????????????????????????????????????????????????????????????????????????????????????????????? 308
Acknowledgement???????????????????????????????????????????? 310
References?????????????????????????????????? 311
Chapter 29 Therapeutic connection in neurorehabilitation: theory, evidence and practice???????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????? 315
Background?????????????????????????????????? 315
Defining therapeutic connection???????????????????????????????????????????????????????????????????????????? 316
Framing clinical questions?????????????????????????????????????????????????????????????????? 316
Approach to searching the evidence?????????????????????????????????????????????????????????????????????????????????? 317
1. What does the evidence say about the association between therapeutic connection and outcome in neurorehabilitation??????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????? 317
2. What is the theoretical basis for research exploring therapeutic connection in neurorehabilitation??????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????? 324
3. How important is the therapeutic connection with family for outcome in neurorehabilitation??????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????? 326
How do the cognitive, neurobehavioural and communication sequelae commonly inherent in brain injury impact on the development of a therapeutic connection??????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????? 327
Chapter summary???????????????????????????????????????????? 327
Conclusion?????????????????????????????????? 328
References?????????????????????????????????? 328
Part 4 Telemedicine feature???????????????????????????????????????????????????????????????????? 331
Chapter 30 Evidence-based teleneurology practice?????????????????????????????????????????????????????????????????????????????????????????????????????????????? 333
Introduction to the chapter???????????????????????????????????????????????????????????????????? 333
Methodology???????????????????????????????????? 333
Clinical Questions?????????????????????????????????????????????????? 333
Question 1: Is teleneurology feasible and safe????????????????????????????????????????????????????????????????????????????????????????????????????????????? 333
Question 2: Is teleneurology "cost-effective"??????????????????????????????????????????????????????????????????????????????????????????????????????????? 334
Question 3: How does teleneurology exam compare to the complete neurological bedside exam??????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????? 334
Question 4: Can teleneurology affect patient outcomes??????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????? 334
Chapter summary???????????????????????????????????????????? 334
Acknowledgements?????????????????????????????????????????????? 334
Disclosures???????????????????????????????????? 334
References?????????????????????????????????? 335
Index???????????????????????? 337
EULA?????????????????????? 348

Produkt-Details

• Erscheint lt. Verlag: 8.9.2015
• Reihe/Serie: Evidence-Based Medicine
• Reihe/Serie: Evidence-Based Medicine
• Mitarbeit: Berater: Livia Candelise
• Sprache: englisch
• Themenwelt: Medizin / Pharmazie ► Medizinische Fachgebiete ► Neurologie
• Schlagworte: Cochrane Neurological NetworkEvidence-Based NeurologyClinical Evidence-based medicineNeurologyMethodologyNeurologistsBart DemaerschalkDean WingerchukLivia CandeliseEvidenceEthicsThunderclap headacheCritical Illness NeuromyopathyAcute Visual lossMyasthenia GravisTraumatic Brain InjuryRaised Intracranial PressureStatus EpilepticusDeliriumSpinal Cord CompressionAcute Ischemic StrokeTransient Ischemic AttackComaNeurorehabilitationNeuro-OphthalmologyVestibular disordersnystagmusHeadache DisordersSleep DisordersM • Medical Science • Medizin • Neurologie • Neurology
• ISBN-10: 1-119-06732-4 / 1119067324
• ISBN-13: 978-1-119-06732-0 / 9781119067320