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Wu J, Zhou T, Guo Y, Tian Y, Lou Y, Feng J, li J. Video-based evaluation system for tic action in Tourette syndrome: modeling, detection, and evaluation. Health Inf Sci Syst 2023; 11:39. [PMID: 37649855 PMCID: PMC10462598 DOI: 10.1007/s13755-023-00240-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 08/12/2023] [Indexed: 09/01/2023] Open
Abstract
Behavioral ratings based on clinical observations are still the gold standard for screening, diagnosing, and assessing outcomes in Tourette syndrome. Detecting tic symptoms plays an important role in patient treatment and evaluation; accurate tic identification is the key to clinical diagnosis and evaluation. In this study, we proposed a tic action detection method using face video feature recognition for tic and control groups. Through facial ROI extraction, a 3D convolutional neural network was used to learn video feature representations, and multi-instance learning anomaly detection strategy was integrated to construct the tic action analysis and discrimination framework. We applied this tic recognition framework in our video dataset. The model evaluation results achieved average tic detection accuracy of 91.02%, precision of 77.07% and recall of 78.78%. And the tic score curve with postprocessing provided information of how the patient's twitches change over time. The detection results at the individual level indicated that our method can effectively detect tic actions in videos of Tourette patients without the need for fine labeling, which is significant for the long-term evaluation of patients with Tourette syndrome.
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Affiliation(s)
- Junya Wu
- Key Laboratory for Biomedical Engineering of Ministry of Education, Engineering Research Center of EMR and Intelligent Expert System, Ministry of Education, College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, 310027 China
| | - Tianshu Zhou
- Research Center for Healthcare Data Science, Zhejiang Laboratory, Hangzhou, 311100 China
| | - Yufan Guo
- Department of Pediatrics, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, 310009 China
| | - Yu Tian
- Key Laboratory for Biomedical Engineering of Ministry of Education, Engineering Research Center of EMR and Intelligent Expert System, Ministry of Education, College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, 310027 China
| | - Yuting Lou
- Department of Pediatrics, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, 310009 China
| | - Jianhua Feng
- Department of Pediatrics, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, 310009 China
| | - Jingsong li
- Key Laboratory for Biomedical Engineering of Ministry of Education, Engineering Research Center of EMR and Intelligent Expert System, Ministry of Education, College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, 310027 China
- Research Center for Healthcare Data Science, Zhejiang Laboratory, Hangzhou, 311100 China
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2
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Heijerman-Holtgrefe A, Huyser C, Verdellen C, van de Griendt J, Beljaars L, Kan KJ, Lindauer R, Cath D, Hoekstra P, Utens L. Effectiveness of 'Tackle Your Tics', a brief, intensive group-based exposure therapy programme for children with tic disorders: study protocol of a randomised controlled trial. BMJ Open 2022; 12:e058534. [PMID: 35768093 PMCID: PMC9240895 DOI: 10.1136/bmjopen-2021-058534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION This paper outlines the study protocol for the Dutch Tackle Your Tics study in youth with tic disorders. Tourette syndrome and chronic tic disorders are prevalent neurodevelopmental disorders, placing considerable burden on youth and their families. Behavioural treatment is the first-line, evidence-based intervention for tic disorders, but tic reduction and availability remain relatively low. Patient associations stress the need for more accessible high-quality treatments, also focusing on improving quality of life. Therefore, the brief, intensive group-based treatment Tackle Your Tics was developed. METHODS AND ANALYSIS Tackle Your Tics is a 4-day intensive and comprehensive group-based intervention for children and adolescents (9-17 years) with Tourette syndrome or a chronic tic disorder. The programme encompasses exposure and response prevention treatment and additional supporting components (coping strategies, relaxation exercises and parent support). To study the effectiveness of Tackle Your Tics and identify predictors/moderators at baseline, a single-blinded randomised controlled trial (n=104) is conducted, comparing Tackle Your Tics (n=52) with a waiting list condition lasting 3 months (n=52). Assessments are performed at similar time points for both groups: at baseline, after 4 weeks, and at 3 and 6 months of follow-up, on tic severity, quality of life and other psychosocial variables. ETHICS AND DISSEMINATION Ethics approval has been obtained from the medical ethical committee of the Amsterdam Medical Centre (METC nr NL66340.018.18, v3 June 2020). Findings will be presented on national and international conferences, peer-reviewed scientific journals, patient organisation meetings and public media. Patient representatives are fully integrated as part of the research team. If Tackle Your Tics proves to be effective, it can expand evidence-based treatment possibilities for children and adolescents with tic disorders. Identifying the psychosocial predictors/moderators for the effectiveness of this intervention can provide personalised treatment advice in the future. TRIAL REGISTRATION NUMBER NL8052.
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Affiliation(s)
- Annet Heijerman-Holtgrefe
- Department of Child and Adolescent Psychiatry, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Levvel, Academic Center for Child and Adolescent Psychiatry and Specialized Youth Care, Amsterdam, The Netherlands
- Dutch Tourette Association, Haarlem, The Netherlands
| | - Chaim Huyser
- Levvel, Academic Center for Child and Adolescent Psychiatry and Specialized Youth Care, Amsterdam, The Netherlands
| | - Cara Verdellen
- PsyQ Nijmegen/Parnassia Group, Nijmegen, The Netherlands
- TicXperts, Heteren, The Netherlands
| | | | - Laura Beljaars
- Levvel, Academic Center for Child and Adolescent Psychiatry and Specialized Youth Care, Amsterdam, The Netherlands
- Dutch Tourette Association, Haarlem, The Netherlands
- Parnassia Group, The Hague, The Netherlands
| | - Kees-Jan Kan
- Research Institute of Child Development and Education, University of Amsterdam, Amsterdam, The Netherlands
| | - Ramón Lindauer
- Department of Child and Adolescent Psychiatry, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Levvel, Academic Center for Child and Adolescent Psychiatry and Specialized Youth Care, Amsterdam, The Netherlands
| | - Daniëlle Cath
- Department of Specialized Training, GGZ Drenthe, Assen, The Netherlands
- University Medical Center Groningen, Department of Psychiatry, University of Groningen, Groningen, The Netherlands
| | - Pieter Hoekstra
- University Medical Center Groningen, Department of Child and Adolescent Psychiatry, University of Groningen, Groningen, The Netherlands
| | - Lisbeth Utens
- Levvel, Academic Center for Child and Adolescent Psychiatry and Specialized Youth Care, Amsterdam, The Netherlands
- Research Institute of Child Development and Education, University of Amsterdam, Amsterdam, The Netherlands
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC - Sophia Children's Hospital, Rotterdam, the Netherlands
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Haas M, Jakubovski E, Kunert K, Fremer C, Buddensiek N, Häckl S, Lenz-Ziegenbein M, Musil R, Roessner V, Münchau A, Neuner I, Koch A, Müller-Vahl K. ONLINE-TICS: Internet-Delivered Behavioral Treatment for Patients with Chronic Tic Disorders. J Clin Med 2022; 11:jcm11010250. [PMID: 35011989 PMCID: PMC8745756 DOI: 10.3390/jcm11010250] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 12/24/2021] [Accepted: 12/28/2021] [Indexed: 02/04/2023] Open
Abstract
Comprehensive Behavioral Intervention for Tics (CBIT) is considered a first-line therapy for tics. However, availability of CBIT is extremely limited due to a lack of qualified therapists. This study is a multicenter (n = 5), randomized, controlled, observer-blind trial including 161 adult patients with chronic tic disorders (CTD) to provide data on efficacy and safety of an internet-delivered, completely therapist-independent CBIT intervention (iCBIT Minddistrict®) in the treatment of tics compared to placebo and face-to-face (f2f) CBIT. Using a linear mixed model with the change to baseline of Yale Global Tic Severity Scale-Total Tic Score (YGTSS-TTS) as a dependent variable, we found a clear trend towards significance for superiority of iCBIT (n = 67) over placebo (n = 70) (−1.28 (−2.58; 0.01); p = 0.053). In addition, the difference in tic reduction between iCBIT and placebo increased, resulting in a significant difference 3 (−2.25 (−3.75; −0.75), p = 0.003) and 6 months (−2.71 (−4.27; −1.16), p < 0.001) after the end of treatment. Key secondary analysis indicated non-inferiority of iCBIT in comparison to f2f CBIT (n = 24). No safety signals were detected. Although the primary endpoint was narrowly missed, it is strongly suggested that iCBIT is superior compared to placebo. Remarkably, treatment effects of iCBIT even increased over time.
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Affiliation(s)
- Martina Haas
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, 30625 Hannover, Germany; (M.H.); (E.J.); (K.K.); (C.F.); (N.B.); (M.L.-Z.)
| | - Ewgeni Jakubovski
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, 30625 Hannover, Germany; (M.H.); (E.J.); (K.K.); (C.F.); (N.B.); (M.L.-Z.)
| | - Katja Kunert
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, 30625 Hannover, Germany; (M.H.); (E.J.); (K.K.); (C.F.); (N.B.); (M.L.-Z.)
| | - Carolin Fremer
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, 30625 Hannover, Germany; (M.H.); (E.J.); (K.K.); (C.F.); (N.B.); (M.L.-Z.)
| | - Nadine Buddensiek
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, 30625 Hannover, Germany; (M.H.); (E.J.); (K.K.); (C.F.); (N.B.); (M.L.-Z.)
| | - Sebastian Häckl
- Institute for Biostatistics, Hannover Medical School Hannover, 30625 Hannover, Germany; (S.H.); (A.K.)
| | - Martina Lenz-Ziegenbein
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, 30625 Hannover, Germany; (M.H.); (E.J.); (K.K.); (C.F.); (N.B.); (M.L.-Z.)
| | - Richard Musil
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University Munich, 80539 Munich, Germany;
| | - Veit Roessner
- Department of Child and Adolescent Psychiatry and Psychotherapy, Technische Universität Dresden, 01307 Dresden, Germany;
| | - Alexander Münchau
- Institute of Systems Motor Science, University of Lübeck, 23562 Lübeck, Germany;
| | - Irene Neuner
- Department of Psychiatry, Psychotherapy, and Psychosomatics, School of Medicine, RWTH Aachen University, 52074 Aachen, Germany;
- Institute of Neuroscience and Medicine 4 (INM-4), Forschungszentrum Jülich, 52428 Jülich, Germany
- JARA-BRAIN—Translational Medicine, 52056 Aachen, Germany
| | - Armin Koch
- Institute for Biostatistics, Hannover Medical School Hannover, 30625 Hannover, Germany; (S.H.); (A.K.)
| | - Kirsten Müller-Vahl
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, 30625 Hannover, Germany; (M.H.); (E.J.); (K.K.); (C.F.); (N.B.); (M.L.-Z.)
- Correspondence:
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Lin L, Lan Y, Zhu H, Yu L, Wu S, Wan W, Shu Y, Xiang H, Hou T, Zhang H, Ma Y, Su W, Li M. Effects of Chemogenetic Inhibition of D1 or D2 Receptor-Containing Neurons of the Substantia Nigra and Striatum in Mice With Tourette Syndrome. Front Mol Neurosci 2021; 14:779436. [PMID: 34955745 PMCID: PMC8696039 DOI: 10.3389/fnmol.2021.779436] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 11/09/2021] [Indexed: 01/02/2023] Open
Abstract
As tourette syndrome (TS) is a common neurobehavioral disorder, the primary symptoms of which include behavioral stereotypies. Dysfunction of the substantia nigra-striatum network could be the main pathogenesis of TS, which is closely associated with dopamine (DA) and its receptors. TS is often resistant to conventional treatments. Therefore, it is necessary to investigate the neurobiological mechanisms underlying its pathogenesis. In this study, we investigated whether chemogenetic activation or inhibition of dopaminergic D1 receptor (D1R)- or D2 receptor (D2R)-containing neurons in the substantia nigra pars compacta (SNpc) or dorsal striatum (dSTR) affected the stereotyped behavior and motor functions of TS mice. Intraperitoneal injection of 3,3'-iminodipropionitrile (IDPN) was used to induce TS in mice. Stereotyped behavior test and open-field, rotarod, and grip strength tests were performed to evaluate stereotyped behavior and motor functions, respectively. Immunofluorescence labeling was used to detect the co-labeling of virus fluorescence and D1R or D2R. We found that chemogenetic inhibition of D1R- or D2R-containing neurons in the SNpc and dSTR alleviated behavioral stereotypies and motor functions in TS mice. Chemogenetic activation of D1R-containing neurons in the dSTR aggravated behavioral stereotypies and motor functions in vehicle-treated mice, but neither was aggravated in TS mice. In conclusion, chemogenetic inhibition of D1R- or D2R-containing neurons in the SNpc and dSTR alleviated behavioral stereotypies of TS, providing a new treatment target for TS. Moreover, the activation of D1R-containing neurons in the dSTR may contribute to the pathogenesis of TS, which can be chosen as a more precise target for treatment.
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Affiliation(s)
- Lixue Lin
- Department of Neurobiology, School of Basic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Department of Rehabilitation, Wuhan No.1 Hospital, Wuhan, China
| | - Yuye Lan
- Department of Neurobiology, School of Basic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - He Zhu
- Institute of Clinical Medicine, Zhanjiang Central People's Hospital, Zhanjiang, China
| | - Lingling Yu
- Institute of Integrated Traditional Chinese and Western Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shuang Wu
- Department of Neurobiology, School of Basic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wangyixuan Wan
- Department of Neurobiology, School of Basic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yang Shu
- Department of Central Laboratory, Affiliated Hospital of Jiangsu University, Zhenjiang, China
| | - Hongchun Xiang
- Department of Acupuncture and Moxibustion, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Tengfei Hou
- Department of Neurobiology, School of Basic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hong Zhang
- Department of Neurobiology, School of Basic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yan Ma
- Department of Rehabilitation, Wuhan No.1 Hospital, Wuhan, China
| | - Wen Su
- Department of Pediatrics, Wuhan No.1 Hospital, Wuhan, China
| | - Man Li
- Department of Neurobiology, School of Basic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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5
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Cen SS, Yu J, Wang Q, Deeb W, Wang KL, Shukla AW, Malaty I, Ramirez-Zamora A, Zhang JG, Hu W, Meng FG. Multidisciplinary Telemedicine Care for Tourette Syndrome: Minireview. Front Neurol 2021; 11:573576. [PMID: 33391146 PMCID: PMC7775481 DOI: 10.3389/fneur.2020.573576] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 11/16/2020] [Indexed: 11/24/2022] Open
Abstract
Tourette syndrome (TS) is a childhood-onset, chronic neuropsychiatric disorder characterized by multiple motor and vocal tics. TS poses a considerable burden on both patients and health care providers, leading to a major detriment of educational success, occupation, and interpersonal relationships. A multidisciplinary, specialist-driven management approach is required due to the complexity of TS. However, access to such specialty care is often dramatically limited by the patients' locations and the specialists' geographic clustering in large urban centers. Telemedicine uses electronic information and communication technology to provide and support health care when distance separates participants. Therefore, we conducted this mini-review to describe the latest information on telemedicine in the assessment and management of TS and discuss the potential contributions to care for TS patients with a multidisciplinary approach. We believe that telemedicine could be a revolutionary method in improving medical access to patients with TS.
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Affiliation(s)
- Shan-Shan Cen
- Program in Movement Disorders and Neurorestoration, Department of Neurology, Fixel Institution for Neurological Diseases, University of Florida, Gainesville, FL, United States.,Department of Neurology, Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Jun Yu
- Program in Movement Disorders and Neurorestoration, Department of Neurology, Fixel Institution for Neurological Diseases, University of Florida, Gainesville, FL, United States
| | - Qiao Wang
- Department of Functional Neurosurgery, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Wissam Deeb
- Program in Movement Disorders and Neurorestoration, Department of Neurology, Fixel Institution for Neurological Diseases, University of Florida, Gainesville, FL, United States.,Department of Neurology, University of Massachusetts, Worcester, MA, United States
| | - Kai-Liang Wang
- Department of Functional Neurosurgery, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Aparna Wagle Shukla
- Program in Movement Disorders and Neurorestoration, Department of Neurology, Fixel Institution for Neurological Diseases, University of Florida, Gainesville, FL, United States
| | - Irene Malaty
- Program in Movement Disorders and Neurorestoration, Department of Neurology, Fixel Institution for Neurological Diseases, University of Florida, Gainesville, FL, United States
| | - Adolfo Ramirez-Zamora
- Program in Movement Disorders and Neurorestoration, Department of Neurology, Fixel Institution for Neurological Diseases, University of Florida, Gainesville, FL, United States
| | - Jian-Guo Zhang
- Department of Functional Neurosurgery, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Wei Hu
- Program in Movement Disorders and Neurorestoration, Department of Neurology, Fixel Institution for Neurological Diseases, University of Florida, Gainesville, FL, United States
| | - Fan-Gang Meng
- Department of Functional Neurosurgery, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Chinese Institute for Brain Research, Beijing, China
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Jakubovski E, Pisarenko A, Fremer C, Haas M, May M, Schumacher C, Schindler C, Häckl S, Aguirre Davila L, Koch A, Brunnauer A, Cimpianu CL, Lutz B, Bindila L, Müller-Vahl K. The CANNA-TICS Study Protocol: A Randomized Multi-Center Double-Blind Placebo Controlled Trial to Demonstrate the Efficacy and Safety of Nabiximols in the Treatment of Adults With Chronic Tic Disorders. Front Psychiatry 2020; 11:575826. [PMID: 33324255 PMCID: PMC7725747 DOI: 10.3389/fpsyt.2020.575826] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 11/02/2020] [Indexed: 01/13/2023] Open
Abstract
Background: Gilles de la Tourette syndrome (TS) is a chronic neuropsychiatric disorder characterized by motor and vocal tics. First-line treatments for tics are antipsychotics and tic-specific behavioral therapies. However, due to a lack of trained therapists and adverse events of antipsychotic medication many patients seek alternative treatment options including cannabis. Based on the favorable results obtained from case studies on different cannabis-based medicines as well as two small randomized controlled trials using delta-9-tetrahydrocannabinol (THC), we hypothesize that the cannabis extract nabiximols can be regarded as a promising new and safe treatment strategy in TS. Objective: To test in a double blind randomized clinical trial, whether treatment with the cannabis extract nabiximols is superior to placebo in patients with chronic tic disorders. Patients and Methods: This is a multicenter, randomized, double-blind, placebo controlled, parallel-group, phase IIIb trial, which aims to enroll 96 adult patients with chronic tic disorders (TS or chronic motor tic disorder) across 6 centers throughout Germany. Patients will be randomized with a 2:1 ratio into a nabiximols and a placebo arm. The primary efficacy endpoint is defined as tic reduction of at least 30% (compared to baseline) according to the Total Tic Score of the Yale Global Tic Severity Scale (YGTSS-TTS) after 13 weeks of treatment. In addition, several secondary endpoints will be assessed including changes in different psychiatric comorbidities, quality of life, driving ability, and safety assessments. Discussion: This will be the first large, controlled study investigating efficacy and safety of a cannabis-based medicine in patients with TS. Based on available data using different cannabis-based medicines, we expect not only a reduction of tics, but also an improvement of psychiatric comorbidities. If the cannabis extract nabiximols is proven to be safe and effective, it will be a valuable alternative treatment option. The results of this study will be of high health-economic relevance, because a substantial number of patients uses cannabis (illegally) as self-medication. Conclusion: The CANNA-TICS trial will clarify whether nabiximols is efficacious and safe in the treatment of patients with chronic tic disorders. Clinical Trial Registration: This trial is registered at clinicaltrialsregister.eu (Eudra-CT 2016-000564-42) and clinicaltrials.gov (NCT03087201).
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Affiliation(s)
- Ewgeni Jakubovski
- Clinic of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Anna Pisarenko
- Clinic of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Carolin Fremer
- Clinic of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Martina Haas
- Clinic of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Marcus May
- Clinical Research Center Core Facility, Hannover Medical School, Hannover, Germany
| | - Carsten Schumacher
- Clinical Research Center Core Facility, Hannover Medical School, Hannover, Germany
| | - Christoph Schindler
- Clinical Research Center Core Facility, Hannover Medical School, Hannover, Germany.,Center for Pharmacology and Toxicology, Hannover Medical School, Hannover, Germany
| | - Sebastian Häckl
- Hannover Medical School, Institute for Biostatistics, Hannover, Germany
| | - Lukas Aguirre Davila
- Hannover Medical School, Institute for Biostatistics, Hannover, Germany.,Section Biostatistics, Paul-Ehrlich-Institute, Langen, Germany
| | - Armin Koch
- Hannover Medical School, Institute for Biostatistics, Hannover, Germany
| | - Alexander Brunnauer
- Department of Neuropsychology, Kbo-Inn-Salzach-Klinikum, Psychiatric Hospital, Wasserburg am Inn, Germany.,Department of Psychiatry and Psychotherapy, Ludwig-Maximilians University Munich, Munich, Germany
| | - Camelia Lucia Cimpianu
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians University Munich, Munich, Germany
| | - Beat Lutz
- Institute of Physiological Chemistry, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Laura Bindila
- Institute of Physiological Chemistry, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Kirsten Müller-Vahl
- Clinic of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
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7
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Milosev LM, Psathakis N, Szejko N, Jakubovski E, Müller-Vahl KR. Treatment of Gilles de la Tourette Syndrome with Cannabis-Based Medicine: Results from a Retrospective Analysis and Online Survey. Cannabis Cannabinoid Res 2019; 4:265-274. [PMID: 31872061 DOI: 10.1089/can.2018.0050] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction: Gilles de la Tourette syndrome (GTS) is a neuropsychiatric disorder that is characterized by motor and vocal tics and psychiatric comorbidities, including attention deficit/hyperactivity disorder (ADHD) and obsessive-compulsive behavior/disorder (OCB/OCD). From anecdotal reports and preliminary controlled studies, it is suggested that cannabis-based medicine (CBM) may improve tics and comorbidities in adults with GTS. This study was designed to further investigate efficacy and safety of CBM in GTS and specifically compare effects of different CBM. Materials and Methods: First, we performed a retrospective data analysis including all those adult patients seen at our clinic, who had used CBM for the treatment of GTS at some time. All these patients were asked to complete an online survey (second study part) to receive more detailed data about treatment with CBM. Results: From medical records, we identified 98 patients who had used CBM (most often street cannabis followed by nabiximols, dronabinol, medicinal cannabis) for the treatment of GTS: Of the 38 patients who were able to judge, 66% preferred treatment with medicinal cannabis, 18% dronabinol, 11% nabiximols, and 5% street cannabis. Altogether, CBM resulted in a subjective improvement of tics (of about 60% in 85% of treated cases), comorbidities (55% of treated cases, most often OCB/OCD, ADHD, and sleeping disorders), and quality of life (93%). The effects of CBM appear to persist in the long term. Adverse events occurred in half of the patients, but they were rated as tolerable. Dosages of all CBM varied markedly. Patients assessed cannabis (with a preference for tetrahydrocannabinol [THC]-rich strains) as more effective and better tolerated compared with nabiximols and dronabinol. These data were confirmed by results obtained from the online survey (n=40). Conclusion: From our results, it is further supported that CBM might be effective and safe in the treatment of tics and comorbidities at least in a subgroup of adult patients with GTS. In our sample, patients favored THC-rich cannabis over dronabinol and nabiximols, which might be related to the entourage effect of cannabis. However, several limitations of the study have to be taken into considerations such as the open uncontrolled design and the retrospective data analysis.
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Affiliation(s)
- Leonie M Milosev
- Clinic of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Nikolas Psathakis
- Clinic of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Natalia Szejko
- Department of Neurology, Medical University of Warsaw, Warszawa, Poland.,Department of Bioethics, Medical University of Warsaw, Warszawa, Poland
| | - Ewgeni Jakubovski
- Clinic of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Kirsten R Müller-Vahl
- Clinic of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
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Dang TTH, Rowell D, Liddle J, Coyne T, Silburn P, Connelly LB. Economic evaluation of deep-brain stimulation for Tourette's syndrome: an initial exploration. J Neurol 2019; 266:2997-3008. [PMID: 31485722 DOI: 10.1007/s00415-019-09521-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 08/26/2019] [Accepted: 08/28/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Deep-brain stimulation (DBS) can be effective in controlling medically intractable symptoms of Tourette's syndrome (TS). There is no evidence to date, though, of the potential cost-effectiveness of DBS for this indication. OBJECTIVE To provide the first estimates of the likely cost-effectiveness of DBS in the treatment of severe TS. METHODS We conducted a cost-utility analysis using clinical data from 17 Australian patients receiving DBS. Direct medical costs for DBS using non-rechargeable and rechargeable batteries and for the alternative best medical treatment (BMT), and health utilities for BMT were sourced from the literature. Incremental cost-effectiveness ratios (ICERs) were estimated using a Markov models with a 10-year time horizon and 5% discount rate. RESULTS DBS increased quality-adjusted life year (QALY) gained from 2.76 to 4.60 over a 10-year time horizon. The ICER for DBS with non-rechargeable (rechargeable) batteries, compared to BMT, was A$33,838 (A$15,859) per QALY. The ICER estimates are sensitive to DBS costs and selected time horizon. CONCLUSIONS Our study indicates that DBS may be a cost-effective treatment for severe TS, based on the very limited clinical data available and under particular assumptions. While the limited availability of data presents a challenge, we also conduct sensitivity analyses to test the robustness of the results to the assumptions used in the analysis. We nevertheless recommend the implementation of randomised controlled trials that collect a comprehensive range of costs and the use of a widely accepted health-related quality of life instrument to enable more definitive statements about the cost-effectiveness of DBS for TS.
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Affiliation(s)
- Tho T H Dang
- Asia-Pacific Centre for Neuromodulation, Queensland Brain Institute, The University of Queensland, Brisbane, Australia. .,Centre for the Business and Economics of Health, The University of Queensland, Brisbane, Australia.
| | - David Rowell
- Centre for the Business and Economics of Health, The University of Queensland, Brisbane, Australia
| | - Jacki Liddle
- School of Information Technology and Electrical Engineering, The University of Queensland, Brisbane, Australia
| | - Terry Coyne
- Asia-Pacific Centre for Neuromodulation, Queensland Brain Institute, The University of Queensland, Brisbane, Australia
| | - Peter Silburn
- Asia-Pacific Centre for Neuromodulation, Queensland Brain Institute, The University of Queensland, Brisbane, Australia
| | - Luke B Connelly
- Asia-Pacific Centre for Neuromodulation, Queensland Brain Institute, The University of Queensland, Brisbane, Australia.,Centre for the Business and Economics of Health, The University of Queensland, Brisbane, Australia.,Dipartimento di Sociologia e Diritto dell'Economia, The University of Bologna, Bologna, Italy
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Robertson MM, Eapen V. The Psychosocial Aspects of the Gilles de la Tourette Syndrome: Empirical Evidence from the Literature. Curr Behav Neurosci Rep 2017. [DOI: 10.1007/s40473-017-0107-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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10
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Deeb W, Giordano JJ, Rossi PJ, Mogilner AY, Gunduz A, Judy JW, Klassen BT, Butson CR, Van Horne C, Deny D, Dougherty DD, Rowell D, Gerhardt GA, Smith GS, Ponce FA, Walker HC, Bronte-Stewart HM, Mayberg HS, Chizeck HJ, Langevin JP, Volkmann J, Ostrem JL, Shute JB, Jimenez-Shahed J, Foote KD, Wagle Shukla A, Rossi MA, Oh M, Pourfar M, Rosenberg PB, Silburn PA, de Hemptine C, Starr PA, Denison T, Akbar U, Grill WM, Okun MS. Proceedings of the Fourth Annual Deep Brain Stimulation Think Tank: A Review of Emerging Issues and Technologies. Front Integr Neurosci 2016; 10:38. [PMID: 27920671 PMCID: PMC5119052 DOI: 10.3389/fnint.2016.00038] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 11/01/2016] [Indexed: 02/02/2023] Open
Abstract
This paper provides an overview of current progress in the technological advances and the use of deep brain stimulation (DBS) to treat neurological and neuropsychiatric disorders, as presented by participants of the Fourth Annual DBS Think Tank, which was convened in March 2016 in conjunction with the Center for Movement Disorders and Neurorestoration at the University of Florida, Gainesveille FL, USA. The Think Tank discussions first focused on policy and advocacy in DBS research and clinical practice, formation of registries, and issues involving the use of DBS in the treatment of Tourette Syndrome. Next, advances in the use of neuroimaging and electrochemical markers to enhance DBS specificity were addressed. Updates on ongoing use and developments of DBS for the treatment of Parkinson's disease, essential tremor, Alzheimer's disease, depression, post-traumatic stress disorder, obesity, addiction were presented, and progress toward innovation(s) in closed-loop applications were discussed. Each section of these proceedings provides updates and highlights of new information as presented at this year's international Think Tank, with a view toward current and near future advancement of the field.
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Affiliation(s)
- Wissam Deeb
- Department of Neurology, Center for Movement Disorders and Neurorestoration, University of Florida Gainesville, FL, USA
| | - James J Giordano
- Department of Neurology, and Neuroethics Studies Program, Pellegrino Center for Clinical Bioethics, Georgetown University Medical Center Washington, DC, USA
| | - Peter J Rossi
- Department of Neurology, Center for Movement Disorders and Neurorestoration, University of Florida Gainesville, FL, USA
| | - Alon Y Mogilner
- Department of Neurosurgery, Center for Neuromodulation, New York University Langone Medical Center New York, NY, USA
| | - Aysegul Gunduz
- Department of Neurology, Center for Movement Disorders and Neurorestoration, University of FloridaGainesville, FL, USA; J. Crayton Pruitt Family Department of Biomedical Engineering, University of FloridaGainesville, FL, USA
| | - Jack W Judy
- Department of Neurology, Center for Movement Disorders and Neurorestoration, University of FloridaGainesville, FL, USA; J. Crayton Pruitt Family Department of Biomedical Engineering, University of FloridaGainesville, FL, USA
| | | | - Christopher R Butson
- Department of Bioengineering, Scientific Computing and Imaging Institute, University of Utah Salt Lake City, UT, USA
| | - Craig Van Horne
- Department of Neurosurgery, University of Kentucky Chandler Medical Center Lexington, KY, USA
| | - Damiaan Deny
- Department of Psychiatry, Academic Medical Center, University of Amsterdam Amsterdam, Netherlands
| | - Darin D Dougherty
- Department of Psychiatry, Massachusetts General Hospital Boston, MA, USA
| | - David Rowell
- Asia Pacific Centre for Neuromodulation, Queensland Brain Institute, The University of Queensland Brisbane, QLD, Australia
| | - Greg A Gerhardt
- Department of Anatomy and Neurobiology, University of Kentucky Chandler Medical Center Lexington, KY, USA
| | - Gwenn S Smith
- Departments of Psychiatry and Behavioral Sciences and Radiology and Radiological Sciences, Johns Hopkins University School of Medicine Baltimore, MD, USA
| | - Francisco A Ponce
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center Phoenix Arizona, AZ, USA
| | - Harrison C Walker
- Department of Neurology and Department of Biomedical Engineering, University of Alabama at Birmingham Birmingham, AL, USA
| | - Helen M Bronte-Stewart
- Departments of Neurology and Neurological Sciences and Neurosurgery, Stanford University Stanford, CA, USA
| | - Helen S Mayberg
- Department of Psychiatry, Emory University School of Medicine Atlanta, GA, USA
| | - Howard J Chizeck
- Electrical Engineering Department, University of WashingtonSeattle, WA, USA; NSF Engineering Research Center for Sensorimotor Neural EngineeringSeattle, WA, USA
| | - Jean-Philippe Langevin
- Department of Neurosurgery, VA Greater Los Angeles Healthcare System Los Angeles, CA, USA
| | - Jens Volkmann
- Department of Neurology, University Clinic of Würzburg Würzburg, Germany
| | - Jill L Ostrem
- Department of Neurology, University of California San Francisco San Francisco, CA, USA
| | - Jonathan B Shute
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida Gainesville, FL, USA
| | | | - Kelly D Foote
- Department of Neurology, Center for Movement Disorders and Neurorestoration, University of FloridaGainesville, FL, USA; Department of Neurological Sciences, University of FloridaGainesville, FL, USA
| | - Aparna Wagle Shukla
- Department of Neurology, Center for Movement Disorders and Neurorestoration, University of Florida Gainesville, FL, USA
| | - Marvin A Rossi
- Departments of Neurological Sciences, Diagnostic Radiology, and Nuclear Medicine, Rush University Medical Center Chicago, IL, USA
| | - Michael Oh
- Division of Functional Neurosurgery, Department of Neurosurgery, Allegheny General Hospital Pittsburgh, PA, USA
| | - Michael Pourfar
- Department of Neurology, New York University Langone Medical Center New York, NY, USA
| | - Paul B Rosenberg
- Psychiatry and Behavioral Sciences, Johns Hopkins Bayview Medical Center, Johns Hopkins School of Medicine Baltimore, MD, USA
| | - Peter A Silburn
- Asia Pacific Centre for Neuromodulation, Queensland Brain Institute, The University of Queensland Brisbane, QLD, Australia
| | - Coralie de Hemptine
- Graduate Program in Neuroscience, Department of Neurological Surgery, Kavli Institute for Fundamental Neuroscience, University of California, San Francisco San Francisco, CA, USA
| | - Philip A Starr
- Graduate Program in Neuroscience, Department of Neurological Surgery, Kavli Institute for Fundamental Neuroscience, University of California, San Francisco San Francisco, CA, USA
| | | | - Umer Akbar
- Movement Disorders Program, Department of Neurology, Alpert Medical School, Rhode Island Hospital, Brown University Providence, RI, USA
| | - Warren M Grill
- Department of Biomedical Engineering, Duke University Durham, NC, USA
| | - Michael S Okun
- Department of Neurology, Center for Movement Disorders and Neurorestoration, University of Florida Gainesville, FL, USA
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Jakubovski E, Reichert C, Karch A, Buddensiek N, Breuer D, Müller-Vahl K. The ONLINE-TICS Study Protocol: A Randomized Observer-Blind Clinical Trial to Demonstrate the Efficacy and Safety of Internet-Delivered Behavioral Treatment for Adults with Chronic Tic Disorders. Front Psychiatry 2016; 7:119. [PMID: 27445874 PMCID: PMC4928510 DOI: 10.3389/fpsyt.2016.00119] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 06/20/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND In recent years, behavioral therapy with comprehensive behavioral intervention for tics (CBIT) has been recognized as an effective and safe treatment in patients with Gilles de la Tourette syndrome. In Germany, however, dissemination of CBIT is restricted due to a considerable lack of well-trained therapists. The aim of this study is to overcome this deficiency by creating a new and sophisticated Internet-delivered CBIT (iCBIT) program. With this study, we want to demonstrate that iCBIT is superior to Internet-delivered psychoeducation and comparable to face-to-face CBIT. METHOD AND ANALYSIS This is a multicenter, prospective, randomized, controlled, observer-blind clinical trial, which will be conducted at five sites in Germany (ONLINE-TICS). Over the course of 2 years, 160 adult patients with chronic tic disorders will be assigned to one of three treatment arms: iCBIT (n = 72), online psychoeducation (n = 72), or face-to-face CBIT (n = 16). All treatments will consist of eighty therapy sessions over a period of 10 weeks and will follow the well-established CBIT manual by Woods and colleagues. The primary outcome measure will be the change in Yale Global Tic Severity Scale (YGTSS) at 1-week posttreatment. Secondary outcome measures include YGTSS change at 3 and 6 months, video- and self-ratings of tics as well as scales for psychiatric comorbidities assessed at each visit. The primary analysis will compare iCBIT to online psychoeducation using a mixed linear model with the YGTSS change as dependent variable. Secondary analyses will look at the comparison between iCBIT and face-to-face CBIT in a non-inferiority analysis. DISCUSSION If iCBIT proves to be effective, it would be a considerable contribution to close the wide gap in treatment providers for tic disorders not only in Germany but also in several other countries, since this Internet-delivered therapy does not require the supervision of a therapist. In addition, iCBIT would be a cost-effective and readily available treatment alternative that guarantees high quality standard of CBIT. ETHICS AND DISSEMINATION All institutional review boards approve the protocol. All participants will provide informed consent. There are no conflicts of interest. After study completion, the results will be published. STUDY REGISTRATION ClinicalTrials.gov Identifier: NCT02413216.
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Affiliation(s)
- Ewgeni Jakubovski
- Department of Psychiatry, Socialpsychiatry and Psychotherapy, Hannover Medical School , Hannover , Germany
| | - Cornelia Reichert
- Department of Psychiatry, Socialpsychiatry and Psychotherapy, Hannover Medical School , Hannover , Germany
| | - Annika Karch
- Institute for Biostatistics, Hannover Medical School , Hannover , Germany
| | - Nadine Buddensiek
- Department of Psychiatry, Socialpsychiatry and Psychotherapy, Hannover Medical School , Hannover , Germany
| | - Daniel Breuer
- Clinical Trial Center, Hannover Medical School , Hannover , Germany
| | - Kirsten Müller-Vahl
- Department of Psychiatry, Socialpsychiatry and Psychotherapy, Hannover Medical School , Hannover , Germany
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12
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Robertson MM. A personal 35 year perspective on Gilles de la Tourette syndrome: assessment, investigations, and management. Lancet Psychiatry 2015; 2:88-104. [PMID: 26359615 DOI: 10.1016/s2215-0366(14)00133-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Accepted: 10/09/2014] [Indexed: 01/17/2023]
Abstract
After having examined the definition, clinical phenomenology, comorbidity, psychopathology, and phenotypes in the first paper of this Series, here I discuss the assessment, including neuropsychology, and the effects of Gilles de la Tourette syndrome with studies showing that the quality of life of patients with Tourette's syndrome is reduced and that there is a substantial burden on the family. In this paper, I review my local and collaborative studies investigating causal factors (including genetic vulnerability, prenatal and perinatal difficulties, and neuro-immunological factors). I also present my studies on neuro-imaging, electro-encephalograms, and other special investigations, which are helpful in their own right or to exclude other conditions. Finally, I also review our studies on treatment including medications, transcranial magnetic stimulation, biofeedback, target-specific botulinum toxin injections, biofeedback and, in severe refractory adults, psychosurgery and deep brain stimulation. This Review summarises and highlights selected main findings from my clinic (initially The National Hospital for Neurology and Neurosurgery Queen Square and University College London, UK, and, subsequently, at St George's Hospital, London, UK), and several collaborations since 1980. As in Part 1 of this Series, I address the main controversies in the fields and the research of other groups, and I make suggestions for future research.
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Affiliation(s)
- Mary M Robertson
- Department of Neurology, Tourette Clinic, Atkinson Morley Wing, St Georges Hospital, London University College London, London; Division of Psychiatry, Faculty of Brain Sciences, University College London, London, UK; Department of Psychiatry, University of Cape Town, South Africa.
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13
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Strzelczyk A, Haag A, Reese JP, Nickolay T, Oertel WH, Dodel R, Knake S, Rosenow F, Hamer HM. Trends in resource utilization and prescription of anticonvulsants for patients with active epilepsy in Germany. Epilepsy Behav 2013; 27:433-8. [PMID: 23591262 DOI: 10.1016/j.yebeh.2013.03.007] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2013] [Revised: 03/09/2013] [Accepted: 03/11/2013] [Indexed: 10/27/2022]
Abstract
This study evaluated trends in the resource use of patients with active epilepsy over a 5-year period at an outpatient clinic of a German epilepsy center. Two cross-sectional cohorts of consecutive adults with active epilepsy were evaluated over a 3-month period in 2003 and 2008. Data on socioeconomic status, course of epilepsy, as well as direct and indirect costs were recorded using validated patient questionnaires. We enrolled 101 patients in 2003 and 151 patients in 2008. In both cohorts, 76% of the patients suffered from focal epilepsy, and the majority was on antiepileptic drug (AED) polytherapy (mean AED number: 1.7 (2003), 1.8 (2008)). We calculated epilepsy-specific costs of € 2955 in 2003 and € 3532 in 2008 per 3 months per patient. Direct medical costs were mainly due to anticonvulsants in 2003 (59.4% of total direct costs, 34.0% in 2008) and to hospitalization in 2008 (46.9% of total direct costs, 27.7% in 2003). The proportion of enzyme-inducing anticonvulsants and 'old' AEDs decreased between 2003 and 2008. Indirect costs of € 1689 and € 1847 were mainly due to early retirement (48.4%; 46.0% of total indirect costs in 2003; 2008), unemployment (26.1%; 24.2%), and days off due to seizures (25.5%; 29.8%). This study showed a shift in distribution of direct cost components with increased hospital costs as well as a cost-neutral increase in the prescription of 'newer' AEDs. The amount and distribution of indirect cost components remained unchanged.
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Affiliation(s)
- Adam Strzelczyk
- Department of Neurology and Epilepsy Center Hessen, Philipps-University, Marburg, Germany.
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Robinson LR, Bitsko RH, Schieve LA, Visser SN. Tourette syndrome, parenting aggravation, and the contribution of co-occurring conditions among a nationally representative sample. Disabil Health J 2012; 6:26-35. [PMID: 23260608 DOI: 10.1016/j.dhjo.2012.10.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2012] [Revised: 09/24/2012] [Accepted: 10/23/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND Previous research suggests that parents of a child with Tourette Syndrome (TS) have lower self-concepts, higher caregiver burden, and more difficulties with home activities. However, the contributions of TS and mental, emotional, or behavioral (MEB) conditions to family functioning are difficult to identify from previous research due to relatively small TS sample sizes and high rates of co-occurring conditions within samples of children with TS. OBJECTIVE The current study hypothesized that families of children with TS would report significantly more family functioning difficulties (more parenting aggravation, more difficulty with coping with the child's care, less parent-child communication, and less consistent family routines). Specifically, co-occurring conditions would contribute substantially to reported parenting aggravation. METHOD Parent-reported data from the 2007 National Survey of Children's Health were analyzed, including whether the child had been diagnosed with TS or an MEB. Weighted analyses were restricted to US children 6-17 years of age (n = 64,034) and adjusted for child age, sex, race and ethnicity. RESULTS Parents of children with TS were more likely to fall into the high parenting aggravation index category compared with parents of children without TS (aPR = 3.8, 95% CI: 2.2-6.6). Controlling for the co-occurring MEB conditions attenuated the relations between TS and parenting aggravation; however, a significant effect for TS remained in some cases. CONCLUSION Parents of children with TS may face significant challenges in raising their children, leading to increased parenting aggravation; these challenges appear to be primarily associated with the presence of co-occurring MEB conditions.
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Affiliation(s)
- Lara R Robinson
- Child Development Studies Team, Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA.
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Strzelczyk A, Nickolay T, Bauer S, Haag A, Knake S, Oertel WH, Reif PS, Rosenow F, Reese JP, Dodel R, Hamer HM. Evaluation of health-care utilization among adult patients with epilepsy in Germany. Epilepsy Behav 2012; 23:451-7. [PMID: 22381385 DOI: 10.1016/j.yebeh.2012.01.021] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2011] [Accepted: 01/09/2012] [Indexed: 10/28/2022]
Abstract
This study evaluated the resource use of patients with epilepsy in the German district of Marburg-Biedenkopf. A cross-sectional cohort of consecutive adults with epilepsy, irrespective of seizure severity, duration of illness and epilepsy syndrome, was investigated in all health-care sectors. Costs of inpatient and outpatient treatment were derived from billing data of participating hospitals and office-based physicians. Data on socioeconomic status, course of epilepsy and further direct and indirect costs were recorded using patient questionnaires. We enrolled 366 patients from the district of Marburg-Biedenkopf and calculated annual epilepsy-specific costs of €7738 per patient. Direct costs contributed 31.1% (€2406) and indirect costs 68.9% (€5332) of the total costs. Direct medical costs were mainly due to hospitalization (33.2% of total direct costs) and anticonvulsants (26.7%). Costs of admissions were due to status epilepticus (24.4%), video-EEG monitoring (14.8%), newly diagnosed patients (14.4%) and seizure-related injuries (8.8%). Indirect costs were mainly due to early retirement (38.0%), unemployment (35.9%) and days off due to seizures (26.2%). The mean costs of epilepsy found in our study were lower than those found in studies conducted at European epilepsy centers due to the inclusion of patients in all health-care sectors.
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Affiliation(s)
- Adam Strzelczyk
- Department of Neurology and Epilepsy Center Hessen, Philipps-University, Marburg, Germany.
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Zhang W, Bansback N, Boonen A, Severens JL, Anis AH. Development of a composite questionnaire, the valuation of lost productivity, to value productivity losses: application in rheumatoid arthritis. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2012; 15:46-54. [PMID: 22264971 DOI: 10.1016/j.jval.2011.07.009] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2011] [Revised: 07/15/2011] [Accepted: 07/20/2011] [Indexed: 05/06/2023]
Abstract
OBJECTIVE Existing productivity questionnaires do not capture sufficient information to enable the proper valuation of an individual's productivity loss to a society. The purpose of this article is to develop a questionnaire that captures the time lost from work due to a health problem and job and workplace characteristics so that the value of productivity loss to society can be calculated. METHODS First, a questionnaire battery was developed by selecting items from existing productivity questionnaires. Next, items with similar content were identified and duplications were eliminated. Third, the draft questionnaire's feasibility was pretested in a focus group (n = 15). Finally, after appropriate refinements, its applicability was tested in 140 employed patients with rheumatoid arthritis recruited from a cohort in the United Kingdom. Multipliers relating the wage to marginal productivity were also derived using the questionnaire. RESULTS The final questionnaire includes items on employment status; absenteeism; presenteeism; unpaid work; and job characteristics, which includes questions on team dynamics, availability of substitutes and their substitutability, time sensitivity, and compensation mechanisms. The importance of incorporating these questions demonstrated that when one employee was absent, or present at work but unable to work at full capacity, the consequent output loss could exceed the output of the employee alone. Multipliers were shown to be greater than one and represented the excess output loss. CONCLUSIONS The new questionnaire enabled the job and workplace characteristics to be captured so that the actual productivity loss at the societal level attributable to absenteeism and presenteeism could be valued.
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Affiliation(s)
- Wei Zhang
- Centre for Health Evaluation & Outcome Sciences, St. Paul's Hospital, Vancouver, BC, Canada
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