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Rubia K, Johansson L, Carter B, Stringer D, Santosh P, Mehta MA, Conti AA, Bozhilova N, Eraydin IE, Cortese S. The efficacy of real versus sham external Trigeminal Nerve Stimulation (e TNS) in youth with Attention-Deficit/Hyperactivity Disorder (ADHD) over 4 weeks: a protocol for a multi-centre, double-blind, randomized, parallel-group, phase IIb study (ATTENS). BMC Psychiatry 2024; 24:326. [PMID: 38689273 PMCID: PMC11059677 DOI: 10.1186/s12888-024-05650-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 03/01/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND Attention Deficit/Hyperactivity Disorder (ADHD), if severe, is usually treated with stimulant or non-stimulant medication. However, users prefer non-drug treatments due to side effects. Alternative non-medication treatments have so far only shown modest effects. External trigeminal nerve stimulation (eTNS) is a minimal risk, non-invasive neuromodulation device, targeting the trigeminal system. It was approved for ADHD in 2019 by the USA Food and Drug administration (FDA) based on a small proof of concept randomised controlled trial (RCT) in 62 children with ADHD showing improvement of ADHD symptoms after 4 weeks of nightly real versus sham eTNS with minimal side effects. We present here the protocol of a larger confirmatory phase IIb study testing efficacy, longer-term persistency of effects and underlying mechanisms of action. METHODS A confirmatory, sham-controlled, double-blind, parallel-arm, multi-centre phase IIb RCT of 4 weeks of eTNS in 150 youth with ADHD, recruited in London, Portsmouth, and Southampton, UK. Youth with ADHD will be randomized to either real or sham eTNS, applied nightly for 4 weeks. Primary outcome is the change in the investigator-administered parent rated ADHD rating scale. Secondary outcomes are other clinical and cognitive measures, objective hyperactivity and pupillometry measures, side effects, and maintenance of effects over 6 months. The mechanisms of action will be tested in a subgroup of 56 participants using magnetic resonance imaging (MRI) before and after the 4-week treatment. DISCUSSION This multi-centre phase IIb RCT will confirm whether eTNS is effective in a larger age range of children and adolescents with ADHD, whether it improves cognition and other clinical measures, whether efficacy persists at 6 months and it will test underlying brain mechanisms. The results will establish whether eTNS is effective and safe as a novel non-pharmacological treatment for ADHD. TRIAL REGISTRATION ISRCTN82129325 on 02/08/2021, https://doi.org/10.1186/ISRCTN82129325 .
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Affiliation(s)
- Katya Rubia
- Department of Child & Adolescent Psychiatry/PO46 Institute of Psychiatry, Psychology & Neurosciences King's College London, De Crespigny Park, London, SE5 8AF, UK.
- Department of Child & Adolescent Psychiatry, Technical University, Dresden, Germany.
| | - Lena Johansson
- Department of Child & Adolescent Psychiatry/PO46 Institute of Psychiatry, Psychology & Neurosciences King's College London, De Crespigny Park, London, SE5 8AF, UK
| | - Ben Carter
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- King's Clinical Trial Unit, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Dominic Stringer
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- King's Clinical Trial Unit, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Paramala Santosh
- Department of Child & Adolescent Psychiatry/PO46 Institute of Psychiatry, Psychology & Neurosciences King's College London, De Crespigny Park, London, SE5 8AF, UK
- National and Specialist CAMHS, South London and Maudsley NHS Foundation Trust, London, UK
| | - Mitul A Mehta
- Department for Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Aldo Alberto Conti
- Department of Child & Adolescent Psychiatry/PO46 Institute of Psychiatry, Psychology & Neurosciences King's College London, De Crespigny Park, London, SE5 8AF, UK
| | - Natali Bozhilova
- Department of Child & Adolescent Psychiatry/PO46 Institute of Psychiatry, Psychology & Neurosciences King's College London, De Crespigny Park, London, SE5 8AF, UK
| | - Irem Ece Eraydin
- Centre for Innovation in Mental Health, School of Psychology, University of Southampton, Southampton, UK
| | - Samuele Cortese
- Centre for Innovation in Mental Health, School of Psychology, University of Southampton, Southampton, UK
- Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, Southampton, UK
- SOLENT NHS Trust, Southampton, UK
- Hassenfeld Children's Hospital at NYU Langone, New York University Child Center, New York City, NY, USA
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Soheili M, Shakerian M, Soleymani MR, Safapour P, Afshar M. A comparison between the lecture and self-study methods on female students' awareness and attitudes about text neck syndrome. J Educ Health Promot 2024; 13:15. [PMID: 38532914 PMCID: PMC10965018 DOI: 10.4103/jehp.jehp_1594_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 02/06/2023] [Indexed: 03/28/2024]
Abstract
BACKGROUND Text Neck Syndrome (TNS) is a common issue in the neck. The emergence of such issues makes it more pressing to offer ergonomic training to prevent their consequences. The present study aimed to compare training through the lecture and Self-Study methods awareness and attitudes about the TNS. MATERIALS AND METHODS The study was conducted on 94 female high-school students in 2021, and a quasi-experimental methodology was implemented. The participants were randomly divided into a lecture method and a self-study group. A researcher-made questionnaire was utilized for data collection to measure the participants' attitudes and awareness. The data were analyzed according to descriptive and inferential statistics. RESULT The findings showed that the mean post-test scores of the participants' awareness in the lecture method and self-study groups were 8.74 and 5.83, respectively, and a significant increase was observed in the post-test scores of the lecture method group. However, no significant difference was observed between the pre-test and post-test attitude scores of the two groups. CONCLUSION As training by the use of the lecture method in a webinar format has the characteristics of a traditional and online educational simultaneously, it offers an advantage that can be utilized in educational institutions as a complementary (or even an independent) method. Moreover, the experts in medical informational sciences need to accompany training groups as they are responsible to select and prepare credible content materials for audiences.
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Affiliation(s)
- Mahsa Soheili
- Department of Medical Library, Faculty of Management and Medical Information Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mahnaz Shakerian
- Department of Medical Library, Faculty of Management and Medical Information Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Reza Soleymani
- Department of Medical Library, Faculty of Management and Medical Information Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Parsa Safapour
- Department of Physiotherapy, School of Rehabilitation of Tehran University of Medical Sciences, Tehran, Iran
| | - Mina Afshar
- Department of Medical Library, Faculty of Management and Medical Information Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
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Moseley BD, Degiorgio CM. Refractory status epilepticus treated with trigeminal nerve stimulation. Epilepsy Res 2013; 108:600-3. [PMID: 24439211 DOI: 10.1016/j.eplepsyres.2013.12.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Revised: 11/09/2013] [Accepted: 12/05/2013] [Indexed: 11/25/2022]
Abstract
Refractory status epilepticus (RSE) is a neurologic emergency associated with significant morbidity and mortality. Alternative therapies are needed for patients who do not respond to more traditional therapies for RSE. We report on a patient with RSE treated with external trigeminal nerve stimulation (eTNS). On admission, the patient was experiencing consecutive focal dyscognitive seizures with secondary generalization without recovery in between. His seizures remained refractory to multiple therapies, including IV lorazepam, valproic acid, levetiracetam, phenobarbital, and midazolam. Although a burst suppression pattern was achieved with a continuous pentobarbital infusion, seizures returned following attempts to taper it. Given his beneficial response to eTNS during a previous clinical trial, eTNS was initiated. Four days after starting eTNS, the pentobarbital infusion was finally weaned, and his EEG revealed no further seizures. The patient's mental status improved and he was ultimately discharged with only moderately severe disability. Our case demonstrates that eTNS may have antiseizure effects in RSE. Given our patient's quick response, such benefit may have arisen from EEG-desynchronization. If confirmed in larger studies, eTNS could one day be considered along with other adjuvant treatments for RSE.
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Affiliation(s)
- Brian D Moseley
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
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Ness KK, Jones KE, Smith WA, Spunt SL, Wilson CL, Armstrong GT, Srivastava DK, Robison LL, Hudson MM, Gurney JG. Chemotherapy-related neuropathic symptoms and functional impairment in adult survivors of extracranial solid tumors of childhood: results from the St. Jude Lifetime Cohort Study. Arch Phys Med Rehabil 2013; 94:1451-7. [PMID: 23537607 PMCID: PMC3929944 DOI: 10.1016/j.apmr.2013.03.009] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2012] [Revised: 03/15/2013] [Accepted: 03/17/2013] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To ascertain prevalence of peripheral sensory and motor neuropathy, and to evaluate impairments in relation to function. DESIGN St. Jude Lifetime Cohort Study, a clinical follow-up study designed to evaluate adverse late effects in adult survivors of childhood cancer. SETTING A children's research hospital. PARTICIPANTS Eligibility required treatment for an extracranial solid malignancy between 1962 and 2002, age ≥ 18 years, ≥ 10 years postdiagnosis, and no history of cranial radiation. Survivors (N=531) were included in the evaluation with a median age of 32 years and a median time from diagnosis of 25 years. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Primary exposure measures were cumulative doses of vinca-alkaloid and platinum-based chemotherapies. Survivors with scores ≥ 1 on the sensory subscale of the Modified Total Neuropathy Score were classified with prevalent sensory impairment. Those with sex-specific z scores of ≤-1.3 for dorsiflexion strength were classified with prevalent motor impairment. Participants completed the 6-minute walk test (endurance), the Timed Up & Go test (mobility), and the Sensory Organization Test (balance). RESULTS The prevalence of sensory and motor impairment was 20% and 17.5%, respectively. Vinca-alkaloid exposure was associated with an increased risk of motor impairment (adjusted odds ratio [OR]=1.66; 95% confidence interval [CI], 1.04-2.64) without evidence for a dose response. Platinum exposure was associated with increased risk of sensory impairment (adjusted OR=1.62; 95% CI, .97-2.72) without evidence of a dose response. Sensory impairment was associated with poor endurance (OR=1.99; 95% CI, .99-4.0) and mobility (OR=1.65; 95% CI, .96-2.83). CONCLUSIONS Vincristine and cisplatin exposure may increase risk for long-term motor and sensory impairment, respectively. Survivors with sensory impairment are at increased risk for functional performance limitations.
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Affiliation(s)
- Kirsten K Ness
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA.
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Florian V, Caroline F, Francis C, Camille S, Fabielle A. Leptin modulates enteric neurotransmission in the rat proximal colon: an in vitro study. ACTA ACUST UNITED AC 2013; 185:73-8. [PMID: 23816465 DOI: 10.1016/j.regpep.2013.06.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2012] [Revised: 03/21/2013] [Accepted: 06/20/2013] [Indexed: 12/13/2022]
Abstract
Leptin has been shown to modulate gastrointestinal functions including nutrient absorption, growth, and inflammation and to display complex effects on gut motility. Leptin receptors have also been identified within the enteric nervous system (ENS), which plays a crucial role in digestive functions. Although leptin has recently been shown to activate neurons in the ENS, the precise mechanisms involved are so far unknown. Therefore, the aim of the present study was to determine the effects of leptin on rat proximal colon smooth muscle and enteric neuron activities. The effects of exogenous leptin on tone and on responses to transmural nerve stimulation (TNS) of isolated circular smooth muscle of proximal colon in rats were investigated using an organ bath technique. The effects of a physiological concentration (0.1 μM) of leptin were also studied on tone and TNS-induced relaxation in the presence of atropine, hexamethonium, L-N(G)-nitroarginine methyl ester (L-NAME) and capsazepine. Leptin caused a slight but significant decrease in tone, TNS-induced relaxation and contraction in a concentration-dependent manner in colonic preparations. Cholinergic antagonists abolished the effects of 0.1 μM leptin on TNS-induced relaxation. This concentration of leptin had no further effect on relaxation in the presence of L-NAME. In the presence of capsazepine, leptin had no further effect either on tone or relaxation compared to the drug alone. In conclusion, leptin modulates the activity of enteric inhibitory and excitatory neurons in proximal colon. These effects may be mediated through nitrergic neurons. Intrinsic primary afferent neurons may be involved.
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Affiliation(s)
- Voinot Florian
- Université de Strasbourg, Institut Pluridisciplinaire Hubert Curien, 23 rue Becquerel, 67087 Strasbourg, France; CNRS, UMR7178, 67037 Strasbourg, France
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