scholarly journals Pediatric unilateral spatial neglect: A systematic review

2021 ◽  
Vol 14 (3) ◽  
pp. 345-359
Author(s):  
Emerson Hart ◽  
Emily Grattan ◽  
Michelle Woodbury ◽  
Teri Lynn Herbert ◽  
Patty Coker-Bolt ◽  
...  
Keyword(s):  
Systematic Review ◽  
Treatment Options ◽  
Spatial Neglect ◽  
Pediatric Stroke ◽  
Stroke Survivors ◽  
Unilateral Spatial Neglect ◽  
Current Prevalence ◽  
Clinical Presentations ◽  
Assessment And Treatment ◽  
Poor Outcomes

PURPOSE: Unilateral spatial neglect (USN), an inability to attend to one side of space or one’s body, is commonly reported in adult stroke survivors and is associated with poor outcomes. USN has been reported in pediatric survivors of stroke, but its impact is unclear. The purpose of this systematic review was to summarize and evaluate the literature regarding USN in pediatric stroke survivors. METHODS: PRISMA guidelines, Scopus, CINAHL, PubMed, and other relevant databases were searched with terms including “children”, “stroke”, and “unilateral neglect”, with the ages of participants limited from to birth to 18 years. Data were extracted from studies on the clinical presentation of pediatric USN, the assessment of this condition, treatment options, or USN recovery. RESULTS: A total of 18 articles met inclusion criteria. There were no current prevalence data available. USN presents similarly in children compared to adults. Several different USN assessments were used, however, there were little data regarding treatment options. Furthermore, the data suggest that not all children fully recover. CONCLUSION: This systematic review reveals a lack of quality research to inform the assessment and treatment of children with USN. Although the literature spans decades, there remain no guidelines for standardized assessment or treatment. Similar to adults, paper-and-pencil testing may be less able to identify USN than functional assessments. It is likely that there are children who struggle with undetected USN-related deficits years after their injuries. With a rise of pediatric stroke survivors, there is a pressing need for clinicians to be educated about USN in children, clinical presentations, assessments, and treatments.

Neuroanatomical Abnormalities in Older Depressed Adults With Apathy: A Systematic Review

2019 ◽  
Vol 33 (5) ◽  
pp. 289-303 ◽  
Author(s):  
Monique A. Pimontel ◽  
Dora Kanellopoulos ◽  
Faith M. Gunning
Keyword(s):  
Systematic Review ◽  
Treatment Options ◽  
Late Life ◽  
Anterior Cingulate ◽  
Late Life Depression ◽  
Efficacious Treatment ◽  
Focal Brain Injury ◽  
Aging Populations ◽  
Future Treatments ◽  
Poor Outcomes

Objective: Apathy is a common phenomenon in late-life depression and is associated with poor outcomes. Apathy is often unrecognized in older depressed adults, and efficacious treatment options are lacking. This review provides a systematic review of the neuroanatomical abnormalities associated with apathy in late-life depression. In addition, the review summarizes the neuroimaging findings from studies of neurodegenerative and focal brain injury conditions that frequently present with apathy. The goal is to elucidate cerebral network abnormalities that give rise to apathy in older adults with mood disturbances and to inform future treatment targets. Method: Systematic literature review. Results: The few studies that have directly examined the neuroanatomical abnormalities of apathy in late-life depression suggest disturbances in the anterior cingulate cortex, insula, orbital and dorsal prefrontal cortex, striatum, and limbic structures (ie, amygdala, thalamus, and hippocampus). Studies examining the neuroanatomical correlates of apathy in other aging populations are consistent with the pattern observed in late-life depression. Conclusions: Apathy in late-life depression appears to be accompanied by neuroanatomical abnormalities in the salience and reward networks. These network findings are consistent with that observed in individuals presenting with apathy in other aging-related conditions. These findings may inform future treatments that target apathy.

scholarly journals Status Epilepticus: A Review, With Emphasis on Refractory Cases

2012 ◽  
Vol 39 (2) ◽  
pp. 157-169 ◽  
Author(s):  
Gary Hunter ◽  
G. Bryan Young
Keyword(s):  
Status Epilepticus ◽  
Treatment Options ◽  
Mortality Rates ◽  
Cognitive Outcomes ◽  
Diagnostic Methods ◽  
Significant Morbidity ◽  
Clinical Presentations ◽  
Recent Developments ◽  
Poor Outcomes

Status epilepticus is among the most dramatic of clinical presentations encountered by emergency room physicians, neurologists, neurosurgeons and intensivists. While progress in its management has been aided significantly with an increasing number of effective treatment options, improved diagnostic methods and more effective monitoring, poor outcomes and diagnostic failures are still frequently encountered. Refractory cases still carry significant morbidity and mortality rates, including poor cognitive outcomes. This review discusses basic pathophysiology and management of status epilepticus, neuroimaging findings, the role of continuous electroencephalogram monitoring and nonconvulsive status epilepticusas well as recent developments in treatment options for refractory cases.

scholarly journals Is Unilateral Spatial Neglect Associated With Motor Recovery of the Affected Upper Extremity Poststroke? A Systematic Review

2019 ◽  
Vol 33 (3) ◽  
pp. 179-187 ◽  
Author(s):  
Noa Doron ◽  
Debbie Rand
Keyword(s):  
Systematic Review ◽  
Functional Outcome ◽  
Upper Extremity ◽  
Spatial Neglect ◽  
Inclusion Criteria ◽  
Poor Functional Outcome ◽  
Unilateral Spatial Neglect ◽  
Multiple Domains ◽  
Sensorimotor Recovery ◽  
The Relationship

Background and Purpose. Individuals with stroke often present symptoms of multiple domains, such as weakness of the affected upper extremity (UE) and unilateral spatial neglect (USN), which are both associated with poor functional outcome. The aims of this systematic review were to search and review studies that investigated (1) the relationship between USN and affected UE sensorimotor recovery poststroke and (2) the effectiveness of sensorimotor interventions to improve the affected UE in patients with USN. Methods. An electronic search of databases (MEDLINE, EMBASE, CINAHL and Cochrane CENTRAL) was conducted using a combination of the following terms: stroke, USN, and affected UE. Studies meeting the inclusion criteria were rated using a modified version of the Quality Index, and relevant data were extracted. Results. A total of 850 studies were identified, and 14 were included; 13 studies assessed correlations between USN and the affected UE capacity/recovery, and 1 study assessed an intervention to improve the UE of individuals with USN. An association between presence of USN and UE capacity/recovery was found in most studies and USN did not interfere with recovery of the affected UE in the single experimental study. Conclusions. USN is associated with poor UE motor capacity and less UE recovery poststroke. Therefore, these impairments should be considered when planning rehabilitation and discharge. Because USN is a well-researched phenomenon, the lack of studies and insufficient evidence related to UE interventions in individuals with USN was unexpected. These interventions should be developed and researched to improve UE and overall functional outcome poststroke.

The effect of theta-burst stimulation on unilateral spatial neglect following stroke: a systematic review

2018 ◽  
Vol 33 (2) ◽  
pp. 183-194 ◽  
Author(s):  
Andreea Cotoi ◽  
Magdalena Mirkowski ◽  
Jerome Iruthayarajah ◽  
Rachel Anderson ◽  
Robert Teasell
Keyword(s):  
Systematic Review ◽  
Adverse Events ◽  
Spatial Neglect ◽  
Inclusion Criteria ◽  
Theta Burst Stimulation ◽  
Stimulation Protocol ◽  
Burst Stimulation ◽  
Unilateral Spatial Neglect ◽  
Treatment Characteristics ◽  
Theta Burst

Objective: To evaluate the effectiveness of theta-burst stimulation for the treatment of stroke-induced unilateral spatial neglect. Data sources: A systematic literature search was conducted from the inception of each database to 30 June 2018 using CINAHL, EMBASE, PubMed, PsycINFO, and Scopus. Review methods: Articles were included if theta-burst stimulation was used to treat neglect following a stroke. The additional a priori inclusion criteria were as follows: (1) ⩾3 adult (⩾18 years) participants, (2) ⩾50% stroke population, and (3) peer-reviewed journal articles published in English. Extracted data included study and treatment characteristics, results, and adverse events. Results: Nine studies met the inclusion criteria, generating a total of 148 participants. Eight studies evaluated a continuous stimulation protocol and one study investigated an intermittent stimulation protocol. Overall, both protocols significantly improved neglect severity when compared against placebo or active controls ( P < 0.05). Adding smooth pursuit training to theta-burst stimulation did not improve neglect relative to when the stimulation was delivered alone ( P > 0.05). There was inconsistent reporting of neglect terminology, outcome measures, and adverse events. The treatment characteristics were heterogeneous among the trials. Conclusion: This systematic review found that theta-burst stimulation seems to improve post-stroke unilateral spatial neglect, but because the evidence is limited to a few small studies with varied and inconsistent protocols and use of terminology, no firm conclusion on effectiveness can be drawn.

scholarly journals Translating Biomarkers of Cholangiocarcinoma for Theranosis: A Systematic Review

Cancers ◽  
2020 ◽  
Vol 12 (10) ◽  
pp. 2817
Author(s):  
Imeshi Wijetunga ◽  
Laura E. McVeigh ◽  
Antonia Charalambous ◽  
Agne Antanaviciute ◽  
Ian M. Carr ◽  
...  
Keyword(s):  
Systematic Review ◽  
Selection Criteria ◽  
Tumor Targeting ◽  
Treatment Options ◽  
Target Selection ◽  
High Sensitivity ◽  
T Score ◽  
Novel Treatment ◽  
Poor Outcomes ◽  
Therapy And Diagnosis

Cholangiocarcinoma (CCA) is a rare disease with poor outcomes and limited research efforts into novel treatment options. A systematic review of CCA biomarkers was undertaken to identify promising biomarkers that may be used for theranosis (therapy and diagnosis). MEDLINE/EMBASE databases (1996–2019) were systematically searched using two strategies to identify biomarker studies of CCA. The PANTHER Go-Slim classification system and STRING network version 11.0 were used to interrogate the identified biomarkers. The TArget Selection Criteria for Theranosis (TASC-T) score was used to rank identified proteins as potential targetable biomarkers for theranosis. The following proteins scored the highest, CA9, CLDN18, TNC, MMP9, and EGFR, and they were evaluated in detail. None of these biomarkers had high sensitivity or specificity for CCA but have potential for theranosis. This review is unique in that it describes the process of selecting suitable markers for theranosis, which is also applicable to other diseases. This has highlighted existing validated markers of CCA that can be used for active tumor targeting for the future development of targeted theranostic delivery systems. It also emphasizes the relevance of bioinformatics in aiding the search for validated biomarkers that could be repurposed for theranosis.

scholarly journals Systematic Review and network meta-analysis of the efficacy of existing treatments for patients with recurrent glioblastoma (rGBM)

2021 ◽  
Author(s):  
Anna Schritz ◽  
Nassera Aouali ◽  
Aurélie Fischer ◽  
Coralie Dessenne ◽  
Roisin Adams ◽  
...  
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Treatment Options ◽  
Treatment Strategies ◽  
Progression Free Survival ◽  
Recurrent Glioblastoma ◽  
Comprehensive Overview ◽  
Free Survival ◽  
Treatment Regimens ◽  
Poor Outcomes

Abstract Background Despite advances in the treatment of cancers over the last years, treatment options for patients with recurrent glioblastoma (rGBM) remain limited with poor outcomes. Many regimens have been investigated in clinical trials; however, there is a lack of knowledge on comparative effectiveness. The aim of this systematic review is to provide an overview of existing treatment strategies and to estimate the relative efficacy of these regimens in terms of progression free survival (PFS) and overall survival (OS). Methods We conducted a systematic review to identify randomized controlled trials (RCTs) investigating any treatment regimen in adult patients suffering from rGBM. Connected studies reporting at least one of our primary outcomes were included in a Bayesian network meta-analysis (NMA) estimating relative treatment effects. Results Forty RCTs fulfilled our inclusion criteria evaluating the efficacy of thirty-eight drugs as mono- or combination therapy. Median OS ranged from 2.9 to 18.3 months; median PFS ranged from 0.7 to 6 months. We performed an NMA including 24 treatments that were connected within a large evidence network. Our NMA indicated improvement in PFS with most bevacizumab (BV) based regimens compared to other regimens. We did not find any differences in OS between treatments. Conclusion This systematic review provides a comprehensive overview of existing treatment options for rGBM. The NMA provides relative effects for many of these treatment regimens, which have not been directly compared in RCTs. Overall, outcomes for patients with rGBM remain poor across all treatment options, highlighting the need for innovative treatment options.

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