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Phase-specific strategies and interventions to enhance medication adherence across different phases in ADHD: a systematic review and meta-analysis. 提高多动症患者不同阶段服药依从性的特定策略和干预措施:系统综述和荟萃分析。
IF 3.4 2区 医学 Q1 Medicine Pub Date : 2024-07-01 Epub Date: 2024-06-11 DOI: 10.1080/14737175.2024.2360118
Muhammad Umair Khan, Syed Shahzad Hasan

Introduction: This systematic review and meta-analysis assessed the characteristics, types, and impact of interventions to improve adherence to attention-deficit hyperactivity disorder (ADHD) medications within the context of the three phases of adherence, namely, initiation, implementation, and discontinuation.

Methods: PubMed, Psychological Information Database, Embase, International Pharmaceutical Abstracts, and Google Scholar were systematically searched for relevant trials using appropriate search terms. Interventions were classified as educational, behavioural, affective, and multifaceted. Data was pooled using odds ratios and proportions.

Results: Seventeen studies were included in this review. In a pooled analysis of four RCTs, interventions did not significantly improve medication adherence (OR = 2.32; 95%-Confidence Interval=CI = 0.91-5.90; p = 0.08). In seven non-randomized trials, a pooled proportion of people who adhered to ADHD medication was considerably higher in the intervention group (85%, 95%CI = 78%-91%) than in the control group (47%, 95%CI = 33%-61%). Interventions varied in terms of study design, methods and their impact on different phases of adherence.

Conclusions: Despite some promising results, the lack of consideration of phase-specific adherence factors may limit the effectiveness and sustainability of interventions to improve adherence in clinical practice. Future interventions should be phase-specific, guided by factors which are pertinent to each phase. Meanwhile, clinicians should choose or tailor interventions based on individual needs and preferences.

导言:本系统性综述和荟萃分析评估了在坚持治疗的三个阶段(即开始、实施和停止)内,为改善对注意缺陷多动障碍(ADHD)药物的坚持治疗而采取的干预措施的特点、类型和影响:方法:使用适当的检索词对 PubMed、心理学信息数据库、Embase、《国际医药文摘》和 Google Scholar 中的相关试验进行了系统检索。干预分为教育性干预、行为干预、情感干预和多方面干预。使用几率比和比例对数据进行汇总:本综述共纳入 17 项研究。在对四项 RCT 进行的汇总分析中,干预措施并未显著改善服药依从性(OR = 2.32;95% 置信区间 =CI = 0.91-5.90;P = 0.08)。在七项非随机试验中,干预组坚持服用ADHD药物的总比例(85%,95%CI=78%-91%)大大高于对照组(47%,95%CI=33%-61%)。干预措施在研究设计、方法及其对不同阶段依从性的影响方面各不相同:尽管取得了一些令人鼓舞的结果,但缺乏对特定阶段依从性因素的考虑可能会限制临床实践中改善依从性干预措施的有效性和可持续性。未来的干预措施应针对具体阶段,以每个阶段的相关因素为指导。同时,临床医生应根据个人需求和偏好选择或定制干预措施。
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引用次数: 0
Risk factors and disease associations in people living with idiopathic intracranial hypertension. 特发性颅内高压患者的风险因素和疾病关联。
IF 4.3 2区 医学 Q1 Medicine Pub Date : 2024-07-01 Epub Date: 2024-05-27 DOI: 10.1080/14737175.2024.2359420
Olivia Potter, Vaishnavi Menon, Susan P Mollan

Introduction: Idiopathic intracranial hypertension is a neurological condition characterized by a raised intracranial pressure and papilledema, leading to chronic headaches and visual disturbances. By recognizing modifiable risk factors and deploying evidence-based interventions, healthcare providers have the potential to mitigate the burden of the disease and improve patient outcomes.

Areas covered: It is well known that the condition occurs in predominantly pre-menopausal females who live with obesity particularly in the context of recent weight gain. This review discusses what risk factors may contribute to the metabolic underpinnings of cerebrospinal fluid dysregulation. There are a number of disease associations that are important to screen for as they can alter management.

Expert opinion: There is emerging evidence to suggest that idiopathic intracranial hypertension is a systemic metabolic disease and it is unknown what are all the risk factors are that precipitate the condition. Targeting certain hardwired risk factors is unachievable. However, as recent weight gain has been identified as a predominant risk factor for the development of the disease and relapse, modification of body weight should be the primary aim of management. Insightful research into the involvement of the neuroendocrine axis driving cerebrospinal fluid dysregulation now has the potential for the development of therapeutic targets.

简介特发性颅内高压是一种神经系统疾病,其特点是颅内压升高和乳头水肿,导致慢性头痛和视力障碍。通过识别可改变的风险因素并采取循证干预措施,医疗服务提供者有可能减轻该疾病的负担并改善患者的预后:众所周知,这种疾病主要发生在绝经前女性中,她们生活在肥胖的环境中,尤其是在近期体重增加的情况下。这篇综述讨论了哪些风险因素可能会导致脑脊液失调的代谢基础。专家认为,有一些疾病相关因素需要进行筛查,因为它们可能会改变治疗方法:有新证据表明,特发性颅内高压是一种全身性代谢疾病,而诱发这种疾病的风险因素尚不清楚。针对某些固有的危险因素是不可能实现的。然而,由于近期体重增加已被确定为该病发病和复发的主要风险因素,因此,控制体重应成为治疗的首要目标。目前,对神经内分泌轴参与脑脊液失调的深入研究有望开发出治疗靶点。
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引用次数: 0
Developments in the prediction of cognitive changes following deep brain stimulation in persons with Parkinson's disease. 帕金森病患者接受深部脑刺激后认知变化的预测进展。
IF 4.3 2区 医学 Q1 Medicine Pub Date : 2024-07-01 Epub Date: 2024-05-30 DOI: 10.1080/14737175.2024.2360121
Alexander I Tröster

Introduction: Deep brain stimulation (DBS) is an effective treatment for Parkinson's disease (PD) motor symptoms that improves function and quality of life in appropriately selected patients. Because mild to moderate cognitive declines can follow DBS and impact quality of life in a minority of patients, an important consideration involves the cognitive deficit and its prediction.

Areas covered: The author briefly summarizes cognitive outcomes from DBS and reviews in more detail the risks/predictors of post-DBS cognitive dysfunction by mainly focusing on work published between 2018 and 2024 and using comprehensive neuropsychological (NP) evaluations. Most publications concern bilateral subthalamic nucleus (STN) DBS. Comment is offered on challenges and potential avenues forward.

Expert opinion: STN DBS is relatively safe cognitively but declines occur especially in verbal fluency and executive function/working memory. Numerous predictors and risk factors for cognitive outcomes have been identified (age and pre-operative neuropsychological status appear the most robust) but precise risk estimates cannot yet be confidently offered. Future studies should employ study center consortia, follow uniform reporting criteria (to be developed), capitalize on advances in stimulation, biomarkers, and artificial intelligence, and address DBS in diverse groups. Advances offer an avenue to investigate the amelioration of cognitive deficits in PD using neuromodulation.

简介:脑深部刺激(DBS)是治疗帕金森病(PD)运动症状的一种有效方法,可改善经适当选择的患者的功能和生活质量。由于少数患者在接受 DBS 治疗后可能会出现轻度至中度认知功能下降并影响生活质量,因此认知功能障碍及其预测是一个重要的考虑因素:作者简要总结了DBS的认知结果,并通过主要关注2018年至2024年间发表的、使用综合神经心理学(NP)评估的研究,更详细地回顾了DBS后认知功能障碍的风险/预测因素。大多数出版物涉及双侧丘脑下核(STN)DBS。专家意见:STN DBS 在认知方面相对安全,但会出现下降,尤其是在言语流畅性和执行功能/工作记忆方面。认知结果的许多预测因素和风险因素已被确定(年龄和术前神经心理状态似乎是最可靠的因素),但目前还不能有把握地提供精确的风险估计值。未来的研究应采用研究中心联盟,遵循统一的报告标准(有待制定),利用刺激、生物标志物和人工智能方面的进步,并针对不同群体进行 DBS 研究。研究进展为利用神经调控改善帕金森病认知障碍提供了一条途径。
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引用次数: 0
Identification and treatment of surgically-remediable causes of infantile epileptic spasms syndrome. 识别和治疗可通过手术修复的婴儿癫痫痉挛综合征病因。
IF 4.3 2区 医学 Q1 Medicine Pub Date : 2024-07-01 Epub Date: 2024-05-30 DOI: 10.1080/14737175.2024.2360117
Emma Macdonald-Laurs, Winston Dzau, Aaron E L Warren, Matthew Coleman, Cristina Mignone, Sarah E M Stephenson, Katherine B Howell

Introduction: Infantile epileptic spasms syndrome (IESS) is a common developmental and epileptic encephalopathy with poor long-term outcomes. A substantial proportion of patients with IESS have a potentially surgically remediable etiology. Despite this, epilepsy surgery is underutilized in this patient group. Some surgically remediable etiologies, such as focal cortical dysplasia and malformation of cortical development with oligodendroglial hyperplasia in epilepsy (MOGHE), are under-diagnosed in infants and young children. Even when a surgically remediable etiology is recognised, for example, tuberous sclerosis or focal encephalomalacia, epilepsy surgery may be delayed or not considered due to diffuse EEG changes, unclear surgical boundaries, or concerns about operating in this age group.

Areas covered: In this review, the authors discuss the common surgically remediable etiologies of IESS, their clinical and EEG features, and the imaging techniques that can aid in their diagnosis. They then describe the surgical approaches used in this patient group, and the beneficial impact that early epilepsy surgery can have on developing brain networks.

Expert opinion: Epilepsy surgery remains underutilized even when a potentially surgically remediable cause is recognized. Overcoming the barriers that result in under-recognition of surgical candidates and underutilization of epilepsy surgery in IESS will improve long-term seizure and developmental outcomes.

简介婴幼儿癫痫痉挛综合征(IESS)是一种常见的发育性癫痫性脑病,长期治疗效果不佳。相当一部分婴儿癫痫痉挛综合征患者的病因有可能通过手术得到治疗。尽管如此,癫痫手术在这一患者群体中的使用率却很低。一些可通过手术修复的病因,如局灶性皮质发育不良和癫痫性少突胶质增生性皮质发育畸形(MOGHE),在婴幼儿中诊断不足。即使认识到了可通过手术补救的病因,例如结节性硬化症或局灶性脑瘤,癫痫手术也可能因弥漫性脑电图改变、手术界限不清或担心在这一年龄组进行手术而被推迟或不予考虑:在这篇综述中,作者讨论了可通过手术治疗的常见 IESS 病因、其临床和脑电图特征以及有助于诊断的影像学技术。然后,他们介绍了用于这类患者的手术方法,以及早期癫痫手术对发育中的大脑网络的有益影响:癫痫手术仍然未得到充分利用,即使已发现潜在的可通过手术补救的病因。克服导致对手术候选者认识不足和对 IESS 癫痫手术利用不足的障碍,将改善癫痫发作和发育的长期预后。
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引用次数: 0
Current use of neurotoxins for alleviating symptoms of cervical dystonia 目前使用神经毒素缓解颈肌张力障碍症状的情况
IF 4.3 2区 医学 Q2 CLINICAL NEUROLOGY Pub Date : 2024-06-19 DOI: 10.1080/14737175.2024.2368638
Stephen Aradi, Robert A. Hauser
Cervical dystonia (CD) causes involuntary movements and postures of the head, neck, and shoulders, as well as nonmotor symptoms including pain, mood, and sleep dysfunction, and impacts quality of l...
颈肌张力障碍(CD)会导致头部、颈部和肩部的不自主运动和姿势,以及疼痛、情绪和睡眠功能障碍等非运动症状,并影响生活质量。
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引用次数: 0
Bipolar disorder staging and the impact it has on its management: an update. 躁郁症分期及其对治疗的影响:最新进展。
IF 4.3 2区 医学 Q1 Medicine Pub Date : 2024-06-01 Epub Date: 2024-05-16 DOI: 10.1080/14737175.2024.2355264
Bernardo Dell'Osso, Laura Cremaschi, Monica Macellaro, Rita Cafaro, Nicolaja Girone

Introduction: The longitudinal course of bipolar disorder (BD) is associated with an active process of neuroprogression, characterized by structural brain alterations and progressive functional impairment. In the last decades, a growing need of a standardized staging model for BD arose, with the aim of a more appropriate definition of stage-specific clinical manifestations and the identification of more customized therapeutic tools.

Areas covered: The authors review the literature on clinical aspects, neurobiological correlates and treatment issues related to BD progression. Thereafter, they address the definition, constructs, and evolution of the staging concept, focusing on the clinical applications of BD staging models available in literature.

Expert opinion: Although several staging models for BD have been proposed to date, their application in clinical practice is still relatively scant. This may have a detrimental impact on the clinical and therapeutic management of BD, in terms of early and proper diagnosis as well as tailored treatment interventions according to the different stages of illness. Future research efforts should tend to the integration of recent insights on neuroimaging and epigenetic markers, toward a standardized and multidimensional staging model.

简介双相情感障碍(BD)的纵向病程与活跃的神经进展过程有关,其特点是大脑结构改变和进行性功能损害。在过去的几十年中,人们越来越需要为双相情感障碍建立一个标准化的分期模型,以便更恰当地定义特定阶段的临床表现,并确定更加个性化的治疗工具:作者回顾了有关 BD 进展的临床方面、神经生物学相关性和治疗问题的文献。之后,他们讨论了分期概念的定义、构建和演变,重点关注文献中现有 BD 分期模型的临床应用:专家观点:尽管迄今为止已提出了多个 BD 分期模型,但其在临床实践中的应用仍相对较少。这可能会对 BD 的临床和治疗管理产生不利影响,包括早期和正确诊断,以及根据疾病的不同阶段进行有针对性的治疗干预。未来的研究工作应倾向于整合神经影像学和表观遗传学标志物的最新研究成果,以建立一个标准化的多维分期模型。
{"title":"Bipolar disorder staging and the impact it has on its management: an update.","authors":"Bernardo Dell'Osso, Laura Cremaschi, Monica Macellaro, Rita Cafaro, Nicolaja Girone","doi":"10.1080/14737175.2024.2355264","DOIUrl":"10.1080/14737175.2024.2355264","url":null,"abstract":"<p><strong>Introduction: </strong>The longitudinal course of bipolar disorder (BD) is associated with an active process of neuroprogression, characterized by structural brain alterations and progressive functional impairment. In the last decades, a growing need of a standardized staging model for BD arose, with the aim of a more appropriate definition of stage-specific clinical manifestations and the identification of more customized therapeutic tools.</p><p><strong>Areas covered: </strong>The authors review the literature on clinical aspects, neurobiological correlates and treatment issues related to BD progression. Thereafter, they address the definition, constructs, and evolution of the staging concept, focusing on the clinical applications of BD staging models available in literature.</p><p><strong>Expert opinion: </strong>Although several staging models for BD have been proposed to date, their application in clinical practice is still relatively scant. This may have a detrimental impact on the clinical and therapeutic management of BD, in terms of early and proper diagnosis as well as tailored treatment interventions according to the different stages of illness. Future research efforts should tend to the integration of recent insights on neuroimaging and epigenetic markers, toward a standardized and multidimensional staging model.</p>","PeriodicalId":12190,"journal":{"name":"Expert Review of Neurotherapeutics","volume":null,"pages":null},"PeriodicalIF":4.3,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140956967","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Tackling internet gaming disorder: what are the challenges in its treatment? 应对网络游戏障碍:治疗网络游戏障碍面临哪些挑战?
IF 4.3 2区 医学 Q1 Medicine Pub Date : 2024-06-01 Epub Date: 2024-05-09 DOI: 10.1080/14737175.2024.2349819
Kristyn Zajac, Meredith K Ginley, Lourah M Kelly, Jessica N Flori, Rory A Pfund
{"title":"Tackling internet gaming disorder: what are the challenges in its treatment?","authors":"Kristyn Zajac, Meredith K Ginley, Lourah M Kelly, Jessica N Flori, Rory A Pfund","doi":"10.1080/14737175.2024.2349819","DOIUrl":"10.1080/14737175.2024.2349819","url":null,"abstract":"","PeriodicalId":12190,"journal":{"name":"Expert Review of Neurotherapeutics","volume":null,"pages":null},"PeriodicalIF":4.3,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11152157/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140891697","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Profiling tofersen as a treatment of superoxide dismutase 1 amyotrophic lateral sclerosis. 分析托非森治疗超氧化物歧化酶 1 肌萎缩性脊髓侧索硬化症的效果。
IF 4.3 2区 医学 Q1 Medicine Pub Date : 2024-06-01 Epub Date: 2024-05-17 DOI: 10.1080/14737175.2024.2355983
Miguel Oliveira Santos, Mamede de Carvalho

Introduction: Amyotrophic lateral sclerosis (ALS) is a rapidly progressive motor neuron disorder with a fatal outcome 3-5 years after disease onset due to respiratory complications. Superoxide dismutase 1 (SOD1) mutations are found in about 2% of all patients. Tofersen is a novel oligonucleotide antisense drug specifically developed to treat SOD1-ALS patients.

Areas covered: Our review covers and discusses tofersen pharmacological properties and its phase I/II and III clinical trials results. Other available drugs and their limitations are also addressed.

Expert opinion: VALOR study failed to meet the primary endpoint (change in the revised Amyotrophic Lateral Sclerosis Functional Rating Scale score from baseline to week 28, tofersen arm vs. placebo), but a significant reduction in plasma neurofilament light chain (NfL) levels was observed in tofersen arm (60% vs. 20%). PrefALS study has proposed plasma NfL has a potential biomarker for presymptomatic treatment, since it increases 6-12 months before phenoconversion. There is probably a delay between plasma NfL reduction and the clinical benefit. ATLAS study will allow more insights regarding tofersen clinical efficacy in disease progression rate, survival, and even disease onset delay in presymptomatic SOD1 carriers.

简介肌萎缩性脊髓侧索硬化症(ALS)是一种进展迅速的运动神经元疾病,发病后 3-5 年会因呼吸系统并发症而死亡。所有患者中约有 2% 发现超氧化物歧化酶 1 (SOD1) 突变。Tofersen 是一种新型寡核苷酸反义药物,专门用于治疗 SOD1-ALS 患者:我们的综述涵盖并讨论了 Tofersen 的药理特性及其 I/II 期和 III 期临床试验结果。同时还讨论了其他可用药物及其局限性:VALOR研究未能达到主要终点(修订后的肌萎缩侧索硬化症功能评定量表评分从基线到第28周的变化,托非森组与安慰剂组相比),但观察到托非森组血浆神经丝轻链(NfL)水平显著下降(60%对20%)。PrefALS 研究提出,血浆 NfL 是无症状治疗的潜在生物标志物,因为它在表型转换前 6-12 个月就会增加。血浆 NfL 降低与临床获益之间可能存在延迟。ATLAS 研究将有助于深入了解托非森在无症状 SOD1 携带者的疾病进展率、生存率甚至发病延迟方面的临床疗效。
{"title":"Profiling tofersen as a treatment of superoxide dismutase 1 amyotrophic lateral sclerosis.","authors":"Miguel Oliveira Santos, Mamede de Carvalho","doi":"10.1080/14737175.2024.2355983","DOIUrl":"10.1080/14737175.2024.2355983","url":null,"abstract":"<p><strong>Introduction: </strong>Amyotrophic lateral sclerosis (ALS) is a rapidly progressive motor neuron disorder with a fatal outcome 3-5 years after disease onset due to respiratory complications. Superoxide dismutase 1 (SOD1) mutations are found in about 2% of all patients. Tofersen is a novel oligonucleotide antisense drug specifically developed to treat SOD1-ALS patients.</p><p><strong>Areas covered: </strong>Our review covers and discusses tofersen pharmacological properties and its phase I/II and III clinical trials results. Other available drugs and their limitations are also addressed.</p><p><strong>Expert opinion: </strong>VALOR study failed to meet the primary endpoint (change in the revised Amyotrophic Lateral Sclerosis Functional Rating Scale score from baseline to week 28, tofersen arm vs. placebo), but a significant reduction in plasma neurofilament light chain (NfL) levels was observed in tofersen arm (60% vs. 20%). PrefALS study has proposed plasma NfL has a potential biomarker for presymptomatic treatment, since it increases 6-12 months before phenoconversion. There is probably a delay between plasma NfL reduction and the clinical benefit. ATLAS study will allow more insights regarding tofersen clinical efficacy in disease progression rate, survival, and even disease onset delay in presymptomatic SOD1 carriers.</p>","PeriodicalId":12190,"journal":{"name":"Expert Review of Neurotherapeutics","volume":null,"pages":null},"PeriodicalIF":4.3,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140956968","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The donepezil transdermal system for the treatment of patients with mild, moderate, or severe Alzheimer's disease: a critical review. 用于治疗轻度、中度或重度阿尔茨海默病患者的多奈哌齐透皮系统:评论性综述。
IF 4.3 2区 医学 Q1 Medicine Pub Date : 2024-06-01 Epub Date: 2024-05-24 DOI: 10.1080/14737175.2024.2355981
Austin Buck, Kayvon Rezaei, Aman Quazi, Gary Goldmeier, Bret Silverglate, George T Grossberg

Introduction: Cholinesterase inhibitors, along with memantine, are the mainstay of symptomatic treatment for AD (Alzheimer's disease); however, these medications are typically administered orally, which can be difficult for people with AD and their caregivers.

Areas covered: In this drug profile and narrative review, the authors trace the development of the new FDA-approved transdermal donepezil. The authors discuss the studies showing its bioequivalence with the oral formulation, including two double-blinded placebo controlled non-inferiority trials. The authors also compare the patch to the only other transdermal cholinesterase inhibitor on the market, rivastigmine, and highlight the potential advantages and disadvantages between these two treatments.

Expert opinion: While the patch is bio-equivalent, it is rather large and may not be affordable for some patients. In addition, there is no high dose (e.g. 23 mg) equivalent. Nevertheless, transdermal donepezil will be useful for people with AD and their caregivers, given its effectiveness and potential convenience.

简介:胆碱酯酶抑制剂和美金刚是AD(阿尔茨海默病)对症治疗的主要药物;然而,这些药物通常都是口服给药,这对AD患者及其护理人员来说可能很困难:在这篇药物简介和叙述性综述中,作者追溯了经 FDA 批准的新透皮多奈哌齐的发展历程。作者讨论了显示其与口服制剂生物等效性的研究,包括两项双盲安慰剂对照非劣效性试验。作者还将该贴剂与市场上唯一一种透皮胆碱酯酶抑制剂利伐斯的明进行了比较,并强调了这两种治疗方法之间潜在的优缺点:专家意见:虽然这种贴片具有生物等效性,但其体积较大,一些患者可能负担不起。此外,也没有高剂量(如 23 毫克)的同等药物。尽管如此,鉴于其有效性和潜在的便利性,透皮多奈哌齐对注意力缺失症患者及其护理人员还是很有用的。
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引用次数: 0
The management of sleep disturbances in children with attention-deficit/hyperactivity disorder (ADHD): an update of the literature. 对注意力缺陷/多动症(ADHD)儿童睡眠障碍的管理:最新文献。
IF 4.3 2区 医学 Q1 Medicine Pub Date : 2024-06-01 Epub Date: 2024-05-13 DOI: 10.1080/14737175.2024.2353692
Samuele Cortese, Guilherme Fusetto Veronesi, Alessandra Gabellone, Anna Margari, Lucia Marzulli, Emilia Matera, Maria Giuseppina Petruzelli, Francesco Maria Piarulli, Fabio Tarantino, Alessio Bellato, Valeria Parlatini, Ebba Du Rietz, Henrik Larsson, Samantha Hornsey, Cathy Hill, Lucia Margari

Introduction: Sleep disorders represent an important comorbidity in individuals with ADHD. While the links between ADHD and sleep disturbances have been extensively investigated, research on the management of sleep disorders in individuals with ADHD is relatively limited, albeit expanding.

Areas covered: The authors searched PubMed, Medline, PsycInfo, Embase+Embase Classic, Web of Sciences databases, and clinicaltrials.gov up to 4 January 2024, for randomized controlled trials (RCTs) of any intervention for sleep disorders associated with ADHD. They retained 16 RCTs (eight on pharmacological and eight on non-pharmacological interventions), supporting behavioral intervention and melatonin, and nine ongoing RCTs registered on clinicaltrials.gov.

Expert opinion: The pool of RCTs testing interventions for sleep disorders in individuals with ADHD is expanding. However, to inform clinical guidelines, there is a need for additional research in several areas, including 1) RCTs based on a precise phenotyping of sleep disorders; 2) pragmatic RCTs recruiting neurodevelopmental populations representative of those seen in clinical services; 3) trials testing alternative interventions (e.g. suvorexant or light therapy) or ways to deliver them (e.g. online); 4) sequential and longer-term RCTs; 5) studies testing the impact of sleep interventions on outcomes other than sleep; 6) and implementation of advanced evidence synthesis and precision medicine approaches.

简介睡眠障碍是多动症患者的一个重要合并症。虽然对多动症与睡眠障碍之间的联系进行了广泛的研究,但有关多动症患者睡眠障碍管理的研究相对有限,尽管研究范围在不断扩大:作者检索了PubMed、Medline、PsycInfo、Embase+Embase Classic、Web of Sciences数据库和clinicaltrials.gov(截至2024年1月4日),以寻找针对与ADHD相关的睡眠障碍的任何干预措施的随机对照试验(RCT)。他们保留了 16 项支持行为干预和褪黑素的 RCT(8 项关于药物干预,8 项关于非药物干预),以及 9 项在 clinicaltrials.gov.expert opinion 上注册的正在进行的 RCT:测试多动症患者睡眠障碍干预措施的 RCT 研究正在不断增加。然而,为了给临床指南提供信息,还需要在多个领域开展更多研究,包括:1)基于睡眠障碍精确表型的研究性试验;2)招募具有临床服务代表性的神经发育人群参与的务实性研究性试验;3)测试替代性干预措施的试验(如舒眠宁(suvorexant)或眠尔通(眠尔通))。4)连续和长期的 RCT;5)测试睡眠干预对睡眠以外的其他结果的影响的研究;6)实施先进的证据综合和精准医学方法。
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引用次数: 0
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Expert Review of Neurotherapeutics
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