by Physicians Weekly | Jul 22, 2014
The first part of new evidence-based guidelines, published in the September 2014 issue of Neurosurgery, sought to identify which signs, symptoms, and neurologic and cognitive deficits have the highest and most consistent prevalence in samples of individuals sustaining a potentially concussive event. The researchers, composed of a team led by Nancy Carney, PhD, Oregon Health & Science University, Portland, and Jamshid Ghajar, MD, Brain Trauma Foundation, New York, New York, sifted through over 5,000 studies and systematically narrowed the stack down to 26 that met their strict criteria. According to the results, the four indicators of concussion, observed in alert individuals (defined as a Glasgow Coma Scale Score, 13 to 15) after a force to the head are the following: 1. Observed and documented disorientation or confusion immediately after the event 2. Impaired balance within 1 day after injury 3. Slower reaction time within 2 days after injury 4. Impaired verbal learning and memory within 2 days after injury The main symptoms experienced by subjects with potential concussive events were headache (93%), blurred vision (75%), dizziness (64%), and nausea (61%). Other key findings from the review include: * Decrements in cognitive function decreased from 58% on day 1 to 8% on day 7, indicating that in the majority of cases, cognitive deficits resolve within 1 week. * Tests of reaction time, memory, and attention/processing speed/working memory most consistently showed deficits in cognitive function within the first week of injury. * Individuals with a history of previous concussions had lower scores on tests from baseline to 5 days after injury, compared to those without previous concussions. The research team hopes...
by Physicians Weekly | Jan 25, 2013
About 38% of people who suffer from migraine could benefit from preventive treatments, but less than one-third currently uses them. Some analyses have shown that migraine attacks can be reduced by more than half with preventive therapies. In 2000, the American Academy of Neurology (AAN) published guidelines for migraine prevention. In the April 24, 2012 issue of Neurology, the AAN and the American Headache Society issued updated guidelines to account for new evidence. One set of guidelines was developed specifically for prescription products, while another was created for OTC drugs and complementary therapies. In each guideline, the safety and efficacy of pharmacologic therapies for migraine prevention was addressed. The reviews addressed the strength of evidence backing a given drug’s superiority relative to placebo. Prescription Drugs for Migraine Among prescription medications, several β-blockers (metoprolol, propranolol, and timolol) and seizure drugs (divalproex sodium, sodium valproate, and topiramate) established “proven efficacy” for migraine prevention based on clinical research. One selective serotonin receptor agonist (frovatriptan) was also proven effective. It’s recommended that clinicians consider offering these medications to migraineurs to reduce the frequency and severity of attacks. Topiramate was elevated to a Level A recommendation (indicating “proven efficacy”) on the strength of five randomized trials. Other drugs that had previously been used for migraine prevention were downgraded from higher recommendations in 2000 because the current evidence failed to clearly support their efficacy. OTCs & Complimentary Therapies for Migraine Petasites, also known as butterbur, were shown to be effective in preventing migraine. Several NSAIDs were found to be “probably effective,” including fenoprofen, ibuprofen, ketoprofen, naproxen and naproxen sodium,...
