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What is changing in chronic migraine treatment? An algorithm for onabotulinumtoxinA treatment by the Italian chronic migraine group

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EXPERT REVIEW OF NEUROTHERAPEUTICS 2020年第12期20卷 1275-1286页

作者： Sacco, Simona Russo, Antonio Geppetti, Pierangelo Grazzi, Licia Negro, Andrea Tassorelli, Cristina Tedeschi, Gioacchino Martelletti, Paolo Univ Aquila Dept Biotechnol & Appl Clin Sci Neurosci Sect I-67100 Laquila Italy Univ Campania Luigi Vanvitelli Headache Ctr Dept Med Surg Neurol Metab & Aging Sci Naples Italy Univ Florence Headache Ctr Careggi Univ Hosp Dept Hlth Sci Sect Clin Pharmacol Florence Italy IRCCS Fdn Neurol Inst C Besta Headache Ctr Neuroalgol Unit Milan Italy Sapienza Univ St Andrea Hosp Fac Med & Psychol Dept Clin & Mol Med Rome Italy IRCCS Mondino Fdn Headache Sci Ctr Pavia PV Italy Univ Pavia Dept Brain & Behav Sci Pavia PV Italy

Introduction OnabotulinumtoxinA (OBT-A) and monoclonal antibodies (mAbs) targeting the calcitonin gene-related peptide (CGRP) pathway are two of the few treatments that ameliorate chronic migraine (CM) in randomized controlled trials and real-life studies. Separate clinical practice guidelines have been developed for the management of CM with OBT-A or CGRP-targeting mAbs. Areas covered Considering the concomitant availability of OBT-A and CGRP-targeting mAbs as therapeutic treatment options, Italian migraine experts reviewed the evidence supporting the efficacy of OBT-A and CGRP-targeting mAbs in CM in order to rationalize the management of CM patients treated with OBT-A. Experts addressed everyday practice needs to shape the optimal pharmacological management by balancing adherence to regulatory indications, ethical considerations, and clinical expertise. Considering the remarkable challenge of improving the health and quality of life of patients with CM, even partial improvements may be clinically meaningful, particularly for those who are resistant or intolerant to oral migraine treatments. Expert opinion In this collaborative effort, we propose a treatment algorithm that integrates the relevant aspects of managing patients with CM to provide ready-to-use practical guidance regarding the appropriate use of OBT-A.

关键词： Chronic migraine onabotulinumtoxinA calcitonin gene-related peptide GCRP-targeting monoclonal antibodies migraine prophylaxis treatment algorithm

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Updating the recommendations for treatment of tardive syndromes: A systematic review of new evidence and practical treatment algorithm

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JOURNAL OF THE NEUROLOGICAL SCIENCES 2018年第0期389卷 67-75页

作者： Bhidayasiri, Roongroj Jitkritsadakul, Onanong Friedman, Joseph H. Fahn, Stanley Chulalongkorn Univ Chulalongkorn Ctr Excellence Parkinson Dis & Rela King Chulalongkorn Mem Hosp Dept MedFac MedThai Red Cross Soc Bangkok 10330 Thailand Juntendo Univ Dept Neurol Tokyo Japan Brown Univ Alpert Med Sch Dept Neurol Butler Hosp Providence RI 02912 USA Columbia Univ Dept Neurol Med Ctr New York NY USA

Background: Management of tardive syndromes (TS) is challenging, with only a few evidence-based therapeutic algorithms reported in the American Academy of Neurology (AAN) guideline in 2013. Objective: To update the evidence-based recommendations and provide a practical treatment algorithm for management of TS by addressing 5 questions: 1) Is withdrawal of dopamine receptor blocking agents (DRBAs) an effective TS treatment? 2) Does switching from typical to atypical DRBAs reduce TS symptoms? 3) What is the efficacy of pharmacologic agents in treating TS? 4) Do patients with TS benefit from chemodenervation with botulinum toxin? 5) Do patients with TS benefit from surgical therapy? Methods: Systematic reviews were conducted by searching PsycINFO, Ovid MEDLINE, PubMed, EMBASE, Web of Science and Cochrane for articles published between 2012 and 2017 to identify new evidence published after the 2013 AAN guidelines. Articles were classified according to an AAN 4-tiered evidence-rating scheme. To the extent possible, for each study we attempted to categorize results based on the description of the population enrolled (tardive dyskinesia [TD], tardive dystonia, tardive tremor, etc.). Recommendations were based on the evidence. Results and recommendations: New evidence was combined with the existing guideline evidence to inform our recommendations. Deutetrabenazine and valbenazine are established as effective treatments of TD (Level A) and must be recommended as treatment. Clonazepam and Ginkgo biloba probably improve TD (Level B) and should be considered as treatment. Amantadine and tetrabenazine might be considered as TD treatment (Level C). Pallidal deep brain stimulation possibly improves TD and might be considered as a treatment for intractable TD (Level C). There is insufficient evidence to support or refute TS treatment by withdrawing causative agents or switching from typical to atypical DRBA (Level U).

关键词： Tardive dyskinesia Tardive syndromes Evidence-based guideline treatment algorithm

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A standardized stepwise drug treatment algorithm for depression reduces direct treatment costs in depressed inpatients - Results from the German algorithm Project (GAP3)

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JOURNAL OF AFFECTIVE DISORDERS 2018年第0期228卷 173-177页

作者： Ricken, Roland Wiethoff, Katja Reinhold, Thomas Stamm, Thomas J. Baghai, Thomas C. Fisher, Robert Seemueller, Florian Brieger, Peter Cordes, Joachim Laux, Gerd Hauth, Iris Moeller, Hans-Juergen Heinz, Andreas Bauer, Michael Adli, Mazda Charite Univ Med Berlin Dept Psychiat & Psychotherapy Campus Charite Mitte Charitepl 1 D-10117 Berlin Germany Charite Univ Med Berlin Inst Social Med Epidemiol & Hlth Econ Campus Charite Mitte Berlin Germany Univ Regensburg Dept Psychiat & Psychotherapy Regensburg Germany East London NHS Fdn Trust City & Hackney Ctr Mental Hlth Donald Winnicott Ctr London England Kbo Lech Mangfall Klin Garmisch Partenkirchen Garmisch Partenkirchen Germany Kbo Isar Amper Klinikum Munich Germany Heinrich Heine Univ Dusseldorf Dept Psychiat & Psychotherapy Dusseldorf Germany Inst Psychol Med Haag Germany Alexianer St Joseph Krankenhaus Berlin Weissensee Dept Psychiat & Psychotherapy Berlin Germany Ludwig Maximilians Univ Munchen Dept Psychiat & Psychotherapy Munich Germany Tech Univ Dresden Univ Hosp Carl Gustav Carus Dresden Dept Psychiat & Psychotherapy Dresden Germany Fliedner Klin Berlin Ctr Psychiat Psychotherapy & Psychosomat Med Berlin Germany Brandenburg Med Sch Theodor Fontane Dept Psychiat & Psychotherapy Neuruppin Germany

Background: In a previous single center study we found that a standardized drug treatment algorithm (ALGO) was more cost effective than treatment as usual (TAU) for inpatients with major depression. This report aimed to determine whether this promising initial finding could be replicated in a multicenter study. Methods: treatment costs were calculated for two time periods: the study period (from enrolment to exit from study) and time in hospital (from enrolment to hospital discharge) based on daily hospital charges. Cost per remitted patient during the study period was considered as primary outcome. Results: 266 patients received ALGO and 84 received TAU. For the study period, ALGO costs were significantly lower than TAU (ALGO: 7 848 +/- 6 065 (sic);TAU: 10 033 +/- 7 696 (sic);p= 0.04). For time in hospital, costs were not different (ALGO: 14 734 +/- 8 329 (sic);TAU: 14 244 +/- 8 419 (sic);p = 0.617). Remission rates did not differ for the study period (ALGO: 57.9%, TAU: 50.0%;p= 0.201). Remission rates were greater in ALGO (83.3%) than TAU (66.2%) for time in hospital (p = 0.002). Cost per remission was lower in ALGO (13 554 +/- 10 476 (sic)) than TAU (20 066 +/- 15 391 (sic)) for the study period (p< 0.001) and for time in hospital (ALGO: 17 582 +/- 9 939 (sic);TAU: 21 516 +/- 12 718 (sic);p = 0.036). Limitations: Indirect costs were not assessed. Different dropout rates in TAU and ALGO complicated interpretation. Conclusions: treatment algorithms enhance the cost effectiveness of the care of depressed inpatients, which replicates our prior results in an independent sample.

关键词： Cost effectiveness analysis Health economy Depression treatment algorithm

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Interdisciplinary treatment algorithm for facial high-flow arteriovenous malformations, and review of the literature

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JOURNAL OF CRANIO-MAXILLOFACIAL SURGERY 2018年第5期46卷 765-772页

作者： Kansy, Katinka Bodem, Jens Engel, Michael Freudlsperger, Christian Moehlenbruch, Markus A. Herweh, Christian Bendszus, Martin Hoffmann, Juergen Kargus, Steffen Heidelberg Univ Hosp Dept Oral & Maxillofacial Surg Neuenheimer Feld 400 D-69120 Heidelberg Germany Heidelberg Univ Hosp Dept Neuroradiol Heidelberg Germany

Introduction: High-flow arteriovenous malformations (HF-AVMs) are congenital vascular malformations. Typical localizations include the face, oral cavity, and extremities. Due to the high recurrence rate of AVM after incomplete resection or embolization, a combination of both therapeutic modalities has become the preferred choice of treatment. Therefore, we have developed an interdisciplinary therapeutic treatment algorithm for facial HF-AVM and performed a systematic review of the literature. Patients and methods: In a retrospective analysis, all patients who were treated using the interdisciplinary therapeutic treatment algorithm for facial HF-AVM between 10/2010 and 09/2014 were included in the study. Small HF-AVMs (n = 2) without prior therapy and with clearly detectable arterial blood supply were treated by surgical monotherapy. Larger, previously unsuccessfully treated HF-AVMs and lesions with complex arterial blood supply were treated using a combined therapy (n = 6). Combined therapy consisted of a preoperative embolization and a subsequent surgical resection 1-2 days later. If an extensive surgical reconstruction became necessary due to the size of the malformation, or the risk of recurrence was high due to the complex vascular anatomical situation, a second postoperative angiogram was performed to safely exclude a residual nidus, using a 'second look' prior to definitive wound closure (n = 3). HF-AVMs that did not allow for curative therapeutic intervention due to their size and localization were treated by interventional monotherapy (n = 1). Patients with suspicion of a primarily hormone-dependent growth during pregnancy were closely followed up clinically, following a 'wait and see' strategy (n = 1). In addition, a systematic literature review was performed to analyze treatment outcomes and current standards. Results: 13 patients with a mean age of 39 years were included in the analysis. Patients were followed up for a mean of 26.8 months (range 12-60 mon

关键词： Arteriovenous malformation treatment algorithm Facial AVM HF-AVM Vascular malformation

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Kidney and Thyroid Cancer-Specific treatment algorithm for Spinal Metastases: A Validation Study

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WORLD NEUROSURGERY 2019年 122卷 E1305-E1311页

作者： Kato, Satoshi Murakami, Hideki Demura, Satoru Yoshioka, Katsuhito Yokogawa, Noriaki Yonezawa, Noritaka Shimizu, Takaki Oku, Norihiro Kitagawa, Ryo Tsuchiya, Hiroyuki Kanazawa Univ Grad Sch Med Sci Dept Orthopaed Surg Kanazawa Ishikawa Japan

BACKGROUND: Spinal metastases (SMs) from kidney and thyroid cancers have several common features suggesting that excisional surgery for isolated and removable SMs can improve survival. We propose a simple treatment algorithm for SMs from these cancers. Our study aimed to evaluate the efficacy of the algorithm. METHODS: We performed a retrospective analysis of the data of 69 consecutive patients (48 with kidney and 21 with thyroid cancers) who underwent excisional surgery for SMs between 1995 and 2014. The patients were retrospectively classified into an indicated group for excisional SM surgery and a nonindicated group according to our algorithm, and the Tokuhashi and Tomita scoring systems. Patients in the indicated group were expected to survive >= 2 years postoperatively, whereas those in the nonindicated group were not. The positive predictive value and negative predictive value (NPV) were calculated using the predicted versus actual survival times of the patients. Survival was defined as the time from the first excisional surgery for the spinal lesion to death or the last follow-up of >= 2 years. RESULTS: For patients with kidney cancer, the 2- and 5-year survival rates were 85.4% and 60.4%, respectively. For patients with thyroid cancer, the 2- and 5-year survival rates were 100% and 83.8%, respectively. Our algorithm had a compatible high positive predictive value (95.5%) and NPV (100%), whereas the Tokuhashi and Tomita scoring systems had low NPVs of 15.8% and 13.3%, respectively. CONCLUSIONS: Our treatment algorithm of SMs from kidney and thyroid cancers is useful for determining an adequate treatment including excisional surgery.

关键词： Kidney cancer Spinal metastases Thyroid cancer treatment algorithm Validation study

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Combined lateral condyle mass and olecranon fractures: A proposed treatment algorithm and surgical technique

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JOURNAL OF ORTHOPAEDIC SURGERY 2019年第2期27卷 2309499019837146-2309499019837146页

作者： Lame, Kai Yet Mahadev, Arjandas KK Womens & Childrens Hosp KKH Dept Orthopaed Surg Singapore Singapore

Combined lateral condyle mass and olecranon fractures are infrequently seen. These cases are easily missed, and only 12 previous cases are detailed in the English medical literature. The decision for surgical fixation usually depends on the amount of displacement of the individual fractures. However, the optimal surgical approach or technique for open reduction and internal fixation has not been agreed upon. We present three original case reports and analyse them together with all other known cases in the English literature. We discuss how to avoid missing these combined fractures and propose a treatment algorithm based on the different permutations of the fracture displacement. Our detailed surgical approach (using a posterior 'olecranon osteotomy' approach) is also described.

关键词： combined fractures lateral condyle humerus fractures olecranon fracture treatment algorithm

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Comparing the treatment algorithm and Complications for Patients Undergoing an Anterior Cervical Discectomy and Fusion at a Physician-Owned Specialty Hospital and a University-Owned Tertiary Care Hospital

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AMERICAN JOURNAL OF MEDICAL QUALITY 2017年第2期32卷 208-214页

作者： Schroeder, Gregory D. Kurd, Mark F. Kepler, Christopher K. Radcliff, Kris E. Rihn, Jeffery A. Anderson, D. Greg Hilibrand, Alan S. Vaccaro, Alexander R. Thomas Jefferson Univ Rothman Inst Philadelphia PA USA

The purpose of this case-control study is to compare the treatment algorithm and complication rate for patients who undergo an anterior cervical discectomy and fusion at a physician-owned specialty hospital to those who undergo surgery at a university-owned tertiary care hospital. Two controls were identified for 77 patients, and no differences in demographic data were identified. The median time between the onset of symptoms and surgery was shorter for patients who had surgery at the tertiary care center than for patients who had surgery at the specialty hospital (26.7 weeks vs 32.7 weeks, P = .0004). Furthermore, a higher percentage of patients who had surgery at the specialty hospital attempted nonoperative treatments than patients who underwent surgery at the tertiary care hospital.

关键词： physician-owned hospital specialty hospital treatment algorithm ACDF

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Recurrent posterior knee laxity: diagnosis, technical aspects and treatment algorithm

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KNEE SURGERY SPORTS TRAUMATOLOGY ARTHROSCOPY 2017年第10期25卷 3046-3052页

作者： Rousseau, Romain Makridis, Konstantinos G. Pasquier, Gilles Miletic, Bruno Djian, Patrick Pierre & Marie Curie Univ Hop Pitie Salpetriere 47 Blvd Hop F-75013 Paris France Cabinet Goethe 23 Ave Niel F-75017 Paris France Univ Lille CHRU Lille Clin Chirurg Orthoped Hop Roger Salengro Rue Emile Laine F-59037 Lille France Hop Privw La Louviere 69 Rue Louviere F-59000 Lille France

Aim of this study was to determine the characteristics, clinical and radiological diagnostic methods of PCL isolated and combined knee injuries. One hundred and twelve patients with a recurrent posterior knee laxity were surgically treated. Clinical examination, MRI, Telos (TM) stress dynamic X-rays, KT-1000 measurements and the IKDC questionnaire were used to diagnose and evaluate these injuries. Median follow-up was 4.5 years (2-11 years). Thirty-two patients (28.6 %) had an isolated posterior laxity, 53 (47.3 %) a posterior posterolateral laxity, 21 (18.7 %) a posterior posteromedial laxity and six (5.4 %) patients had a complex posterior and mediolateral laxity. Road traffic accidents and sports injuries were the main causes of trauma. The mean preoperative value of posterior tibial translation was 13.5 mm (SD 1.4) and the mean postoperative value was 4.4 mm (SD 1.7) as measured with the Telos device. In the cases with a concomitant ACL rupture, the mean preoperative value of anterior tibial translation was 6.5 mm (SD 1.3) and the mean postoperative value was 1.7 mm (SD 0.8). The mean pre- and postoperative IKDC scores were 74.5 (SD 4.2) and 87.9 (SD 3.1), respectively. Meniscal and/or cartilage injuries were found in 80 patients (71.4 %). Recurrent posterior knee laxity can be restored with the one-stage PCL reconstruction using a quadriceps graft and reconstruction of the posteromedial-posterolateral lesions using the LaPrade techniques. The benefits of this study include enabling surgeons to accurately manage these injuries from a clinical perspective, and treating them with a specific surgical algorithm. III.

关键词： Recurrent posterior knee laxity PCL injury PCL reconstruction Diagnosis treatment algorithm

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Classification of ulnar triangular fibrocartilage complex tears. A treatment algorithm for Palmer type IB tears

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JOURNAL OF HAND SURGERY-EUROPEAN VOLUME 2017年第4期42卷 405-414页

作者： Atzei, A. Luchetti, R. Garagnani, L. Policlin San Giorgio Fenice Hand Surg Pordenone Italy Hand Surg Unit Casa Cura Giovanni 23 Treviso Italy Rimini Hand Surg & Rehabil Ctr Rimini Italy Guys & St Thomas NHS Fdn Trust Dept Orthopaed London England

The classical definition of Palmer Type IB' triangular fibrocartilage complex tear, includes a spectrum of clinical conditions. This review highlights the clinical and arthroscopic criteria that enable us to categorize five classes on a treatment-oriented classification system of triangular fibrocartilage complex peripheral tears. Class 1 lesions represent isolated tears of the distal triangular fibrocartilage complex without distal radio-ulnar joint instability and are amenable to arthroscopic suture. Class 2 tears include rupture of both the distal triangular fibrocartilage complex and proximal attachments of the triangular fibrocartilage complex to the fovea. Class 3 tears constitute isolated ruptures of the proximal attachment of the triangular fibrocartilage complex to the fovea;they are not visible at radio-carpal arthroscopy. Both Class 2 and Class 3 tears are diagnosed with a positive hook test and are typically associated with distal radio-ulnar joint instability. If required, treatment is through reattachment of the distal radio-ulnar ligament insertions to the fovea. Class 4 lesions are irreparable tears due to the size of the defect or to poor tissue quality and, if required, treatment is through distal radio-ulnar ligament reconstruction with tendon graft. Class 5 tears are associated with distal radio-ulnar joint arthritis and can only be treated with salvage procedures. This subdivision of type IB triangular fibrocartilage complex tear provides more insights in the pathomechanics and treatment strategies. Level of evidence: II

关键词： Triangular fibrocartilage complex triangular fibrocartilage distal radio-ulnar joint instability treatment algorithm arthroscopy distal radio-ulnar joint wrist

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Encouraging treatment algorithm for computer-assisted navigated total knee arthroplasty (TKA)

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JOURNAL OF ORTHOPAEDICS 2017年第3期14卷 377-383页

作者： Cip, J. Widemschek, M. Bach, C. Ruckenstuhl, P. Benesch, T. Studer, K. Martin, A. Med Univ Graz Acad Teaching Hosp Feldkirch Dept Orthoped Surg Carinagasse 47 A-6800 Feldkirch Austria Med Univ Graz Dept Orthoped & Trauma Auenbruggerpl 5 A-8036 Graz Austria Univ Vienna Vienna Austria Childrens Hosp St Gallen Dept Pediat Orthoped Surg Claudiusstr 6 CH-9006 St Gallen Switzerland Acad Teaching Hosp Bregenz Dept Traumatol Carl Pedenz Str 2 A-6900 Bregenz Austria

Objective: Navigated computer-assisted total knee arthroplasty (TKA) shows inconclusive mid-to long-term outcome results and is limited by increased costs, surgery-time and an additional learning curve. We introduced a treatment algorithm preserving computer-assisted TKA for patients with adipositasper-magna, posttraumatic leg-deformities, osteosynthetic material in-situ or reduced preoperative X-ray quality. Methods: 237 primary unilateral TKA were allocated based on the treatment concept described above. A retrospective pre- and postoperative radiological analysis was performed. Results: 222 TKA (93.7%) were within 3 degrees varus/valgus of mechanical-lower-limb axis (mean absolute deviation: 1.8 degrees +/- 1.3 degrees). Conclusion: This algorithm showed an excellent postoperative implantation-accuracy based on an accurate preoperative surgery-planning. (C) 2017 Prof. PK Surendran Memorial Education Foundation. Published by Elsevier, a division of RELX India, Pvt. Ltd. All rights reserved.

关键词： TKA Navigation treatment algorithm Radiological analysis Computer-assisted TKA

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