Efficacy of CBD-enriched medical cannabis for treatment of refractory epilepsy in children and adolescents – An observational,longitudinal study

The objective of this observational study was to evaluate the efficacy of medical cannabis for the treatment of refractory epilepsy. Fifty-seven patients (age 1–20?years) with epilepsy of various etiologies were treated with Cannabis oil extract (CBD/THC ratio of 20:1) for at least 3?months (Median follow up time-18?months). Forty-Six Patients were included in the efficacy analysis. Average CBD dose was11.4?mg/kg/d. Twenty-six patients (56%) had ≤50% reduction in mean monthly seizure frequency. There was no statistically significant difference in response rate among various epilepsy etiologies, and cannabis strain used. Younger age at treatment onset (<10?years) and higher CBD dose (>11?mg/kg/d) were associated with better response to treatment. Adverse reactions were reported in 46% of patients and were the main reason for treatment cessation.Our results suggest that adding CBD-enriched cannabis extract to the treatment regimen of patients with refractory epilepsy may result in a significant reduction in seizure frequency according to parental reports. Randomized controlled trials are necessary to assess its true efficacy.     

Bilateral vestibulopathy patients’ perspectives on vestibular implant treatment: a qualitative study

Journal of Neurology - The aim of this study was to explore expectations of patients with bilateral vestibulopathy regarding vestibular implant treatment. This could advance the definition of...     

Effect of cabergoline added to levodopa treatment on sleep-wake cycle in idiopathic Parkinson’s disease: an open label 24-hour polysomnographic study

Summary. Few studies focused on the effects of cabergoline on sleep-wake cycle in PD. Twelve patients affected by PD treated with levodopa as monotherapy underwent two 24-hour ambulatory polysomnographic (A-PSG) sessions twice: in baseline condition (levodopa as monotherapy) and after addition of cabergoline. In each condition, a subjective evaluation of sleep quality and daytime sleepiness was obtained by means of Parkinson’s disease Sleep Scale (PDSS) and the Epworth Sleepiness Scale. The statistical analysis of sleep parameters revealed a significant increase of sleep efficiency and slow wave sleep under cabergoline. The PDSS total score showed a significant improvement of overall sleep quality after cabergoline. No significant changes in daytime sleepiness were observed. No patient referred and/or showed sleep attacks before and after addition of cabergoline. We hypothesize that the long-lasting effect of cabergoline may improve the objective quality of nocturnal sleep in PD patients complaining nocturnal motor disability without inducing daytime sleepiness.     

Intimate relationships and childbearing after adolescent depression: a population-based 15 year follow-up study

Purpose  

Adolescent depression is associated with a range of interpersonal adversities. We hypothesized that depressed adolescents are at subsequent increased risk of problems related to intimate relationships and childbearing in adulthood, and used longitudinal data to examine this.     

Gabapentin add-on treatment: how many patients become seizure-free?: An open-label multicenter study

The aim of the study was to find out the percentage of patients with localization-related epilepsy achieving complete seizure control with gabapentin (GBP) add-on therapy. Patients under anti-epileptic drug monotherapy during 8 weeks baseline (BSL) with 6 or more seizures were treated with GBP for 26 weeks up to 2400 mg/day. Patients obtaining complete seizure control of all seizures or any partial seizure type during the last 8 weeks were calculated. Seizure frequency was compared between BSL and last 8 weeks. In all, 110 patients were enrolled (92 completed, 18 discontinued): mean age of the completers: 37.6 years (range 16–72), median seizure frequency per 28 days at BSL: 6.8 (2.5–24.5), mean duration of epilepsy: 17.6 years (0.2–51.4), mean duration with GBP for completers: 182.8 days (144–187). Complete seizure control of all seizures was achieved in 8.7% of patients (simple partial seizures: 13.3%, complex partial seizures 24.3%, secondarily generalized seizures: 61.5%): 38% of the patients became seizure-free in at least 1 seizure-type; 40% experienced adverse events. Assessment for quality of life (QoL) and trough plasma levels of GBP did not correlate with the good effect of GBP.     

Computer-based treatment for anxiety and depression: is it feasible? Is it effective?

The rise of consumerism, escalating levels of technological change and increasing demand for better dissemination of psychological treatments signal a transformation in the treatment of mental health problems. Soon health care consumers will have a choice as to whether they wish to consult a clinician in his/her rooms in order to receive a diagnosis, treatment and support, or instead to receive these services electronically, or a combination of both. Some of the online services currently available include structured therapy programs, psychological treatment by email, real-time online counselling, professionally assisted chat rooms, self-help groups, health information and educational modules. This paper reviews the use of computer programs in mental health care and, in particular, for the treatment of anxiety and depression. Issues of feasibility, ethics, and effectiveness are discussed and the future of computer-based treatment programs in mental health is considered.     

Positive aspects of patients’ state: A measure for assessing outcome and predicting follow-up of treatment for depression

Abstract

Most psychotherapy outcome studies in the field of depression focus on changes in depressive symptoms and impairment of functioning. The present article reports on the General Life Functioning Scale (GLF), a measure of more positive aspects of a patient's experience, specifically the patient's sense of well-being and feeling that he or she can cope with problems that arise. The development of the GLF and psychometric data are presented, followed by outcome analyses and prediction of follow-up in the National Institute of Mental Health Treatment of Depression Collaborative Research Program. Although there were no significant outcome findings, the GLF at termination significantly predicted follow-up status, emphasizing the importance of considering the extent to which depressed patients make gains in positive aspects of experience.

Zusammenfassung

Positive Aspekte des Patientenzustandes: Ein Maß zur Einschätzung des Behandlungserfolges und zur Vorhersage von Befindlichkeiten von depressiven Patienten zum Katamnesezeitpunkt

Die meisten Psychotherapie-Ergebnisstudien zu Depression sind auf Veränderung von depressiven Symptomen und die Beeinträchtigung von Funktionsweisen ausgerichtet. Die vorliegende Untersuchung berichtet über die General Life Functioning Skala (GLF), einem Maß zu positiven Aspekten der Erfahrung eines Patienten, insbesondere dem Gefühl des Wohlergehens und dem Gefühl, aufkommende Probleme bewältigen zu können. Es wird über die Konstruktion der GLF berichtet und es werden psychometrische Daten dazu vorgelegt, gefolgt durch Ergebnisanalysen und Vorhersagen des Zustandes von Patienten zum Anamnesezeitpunkt im ‘National Institute of Mental Health Treatment of Depression Collaborative Research Program’. Obwohl es keine signifikanten Ergebnisdaten gab, sagte die zu Ende der Behandlungen erhobene GLF den Zustand zum Anamnesezeitpunkt signifikant vorher. Auf diese Art konnte die Wichtigkeit der Berücksichtigung des Ausmaßes, in dem depressive Patienten über das Ende der Behandlung hinaus weitere positive Erfahrungsgewinne verbuchen können, deutlich herausgestellt werden.

Résumé

Les aspects positifs de l’état du patient?: une mesure pour évaluer le résultat et prédire la catamnèse dans le traitement de la dépression

La plupart des études d'efficacité dans le domaine de la dépression focalisent sur les changements des symptômes dépressifs et l'handicap fonctionnel. Cet article parle de l'Echelle de Fonctionnement Général dans la Vie (GLF), une mesure d'aspects plus primitifs de l'expérience du patient, en particulier le sens de bien-être du patient et le sentiment qu'il arrive à gérer les problèmes qui surviennent. Nous présentons le développement et des données psychométriques de la GLF, ensuite des analyses d'efficacité et la prédiction de la catamnèse dans le Programme de Recherche en Collaboration de l'Institut National de Santé Mentale sur le Traitement de la Dépression. Malgré l'absence de résultats significatifs concernant l'efficacité, la GLF a prédit de façon significative à la fin du traitement l’état à la catamnèse, ce qui souligne l'importance de considérer la mesure dans laquelle des patients dépressifs font des progrès dans des aspects positifs de leur expérience.

Resumen

Aspectos positivos del estado de los pacientes: una medida para estimar el resultado y predecir el seguimiento en el tratamiento de la depresión

La mayoría de los estudios de resultado en psicoterapia de la depresión se centran en los cambios de los síntomas depresivos y de las dificultades de funcionamiento de estas personas. Este artículo informa sobre la Escala general del funcionamiento vital (GLF), una medida de los aspectos positivos de la experiencia del paciente, específicamente de su sensación de bienestar y del sentimiento de poder afrontar los problemas que le surgen. Se presenta el desarrollo de la GLF y los datos psicométricos, junto con análisis del resultado y la predicción del seguimiento en el Programa Colaborativo de Investigación de tratamiento de la depresión del Instituto Nacional de Salud Mental (Nacional Institute of Mental Health Treatment of Depression Collaborative Research Program. Si bien no se encontraron resultados significativos, la GLF aplicada al terminar predijo significativamente el estatuto del seguimiento, enfatizando la importancia de considerar el grado en que los pacientes depresivos mejoran en los aspectos positivos de su experiencia.

Resumo

Aspectos positivos do estado do paciente: Uma medida para avaliação dos resultados e predição do follow-up para o tratamento da depressão

A maioria dos estudos de resultados terapêuticos na área da depressão foca-se nas mudanças dos sintomas depressivos e do comprometimento do funcionamento. O presente artigo descreve a Escala de Funcionamento Geral de Vida (General Life Functioning Scale, GLF), uma medida dos aspectos mais positivos da experiência do paciente, especificamente o sentido de bem-estar do paciente e o sentimento de que pode lidar com os problemas que surjam. É apresentado o desenvolvimento da GLF, bem como os dados psicométricos, seguidos pelas análises de resultados e predição do seguimento (follow up) no Programa Colaborativo de Investigação do Tratamento da Depressão do National Institute of Mental Health (NIMH Treatment of Depression Collaborative Research Program). Apesar de não existirem resultados finais significativos, a GLF, no final da terapia, predisse significativamente o estado no seguimento (follow up), enfatizando a importância de considerar até que ponto os pacientes depressivos obtém ganhos nos aspectos positivos da experiência.

Sommario

Aspetti positivi dello stato dei pazienti: una misura per valutare i risultati e per aggiornare la predizione del trattamento per la depressione

La maggior parte degli studi di esito in psicoterapia nel campo della depressione si focalizzano sui cambiamenti dei sintomi depressivi e nelle disfunzioni del funzionamento. Il presente articolo presenta una relazione sulla scala di funzionamento di vita generale (GLF), una misura degli aspetti positivi dell'esperienza del paziente, specificamente sul senso di benessere del paziente e dei sentimenti che lui o lei possono fronteggiare con i problemi che si presentano.

Sono presentati gli sviluppi della GLF ed i dati psicometrici, seguiti dalle analisi di esito e dalle previsioni di follow-up del National Institute of Mental Health Treatment of Depression Collaborative Research Program. Sebbene non ci fossero risultati significativi di esito, la GLF ha predetto significativamente la condizione di follow-up, enfatizzando l'importanza di considerare il grado/il punto al quale i pazienti depressi dimostrano di acquistare esperienza negli aspetti positivi.

Abstract

     

Multimodality treatment of cerebral AVMs in children: a single-centre 20 years experience

Purpose  

The purpose of this study was to review our experience with a multimodality treatment approach in the management of cerebral arteriovenous malformation (AVM) in children.