Preventive treatment

预防性治疗
  • 文章类型: Journal Article
    背景:三叉神经痛(TN)是一种慢性神经性疼痛障碍,影响三叉神经的一个或多个分支。尽管全球流行率相对较低,TN是神经内科和急诊科的重要医疗保健问题,因为该病的诊断和治疗困难,对患者的生活质量有重大影响。由于所有这些原因,西班牙神经病学会的头痛研究小组已经就TN的管理达成了共识。
    方法:本文件由一组专门研究头痛的神经学家起草,他使用了国际头痛协会的术语。我们分析了已发表的关于TN诊断和治疗的科学证据,并建立了具有证据水平的实用建议。
    结论:TN的诊断基于临床标准。由三叉神经病变或疾病引起的疼痛分为TN和疼痛性三叉神经病变,根据国际头痛疾病分类,第三版。TN进一步细分为经典,次要,或者特发性,根据病因。临床诊断为TN的患者建议行脑部MRI检查,以排除次要原因。在检测神经血管压迫的MRI研究中,FIESTA,驱动器,建议使用orCISS序列。药物治疗是所有患者的初始选择。在选定的耐药疼痛或耐受性较差的病例中,应该考虑手术。
    BACKGROUND: Trigeminal neuralgia (TN) is a chronic neuropathic pain disorder affecting one or more branches of the trigeminal nerve. Despite its relatively low global prevalence, TN is an important healthcare problem both in neurology departments and in emergency departments due to the difficulty of diagnosing and treating the condition and its significant impact on patients\' quality of life. For all these reasons, the Spanish Society of Neurology\'s Headache Study Group has developed a consensus statement on the management of TN.
    METHODS: This document was drafted by a panel of neurologists specialising in headache, who used the terminology of the International Headache Society. We analysed the published scientific evidence on the diagnosis and treatment of TN and establish practical recommendations with levels of evidence.
    CONCLUSIONS: The diagnosis of TN is based on clinical criteria. Pain attributed to a lesion or disease of the trigeminal nerve is divided into TN and painful trigeminal neuropathy, according to the International Classification of Headache Disorders, third edition. TN is further subclassified into classical, secondary, or idiopathic, according to aetiology. Brain MRI is recommended in patients with clinical diagnosis of TN, in order to rule out secondary causes. In MRI studies to detect neurovascular compression, FIESTA, DRIVE, or CISS sequences are recommended. Pharmacological treatment is the initial choice in all patients. In selected cases with drug-resistant pain or poor tolerance, surgery should be considered.
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  • 文章类型: English Abstract
    This nationwide Austrian consensus statement summarizes the recommendations on the management of latent tuberculosis by treatment with biologic and targeted synthetic DMARDs. The essential questions with respect to screening and preventive treatment were discussed by experts from the disciplines of rheumatology, pneumology, infectious diseases, dermatology and gastroenterology, based on the available data, and then a joint consensus was formed by agreement. This involved a differentiated discussion on the various forms of treatment, and clear recommendations were formulated.
    UNASSIGNED: In diesem österreichweiten Consensus Statement sind die Empfehlungen zum Umgang mit latenter Tuberkulose bei Therapie mit biologischen und „targeted synthetic“ DMARDs zusammengefasst. Die wesentlichen Fragen bezüglich des Screenings und präventiver Therapie wurden von Expertinnen und Experten aus den Fachbereichen Rheumatologie, Pneumologie, Infektiologie, Dermatologie und Gastroenterologie auf Basis der vorhandenen Daten diskutiert und dann in einer Abstimmung zum gemeinsamen Konsens gebracht. Dabei wurde auch differenziert auf die unterschiedlichen Therapien eingegangen, und klare Empfehlungen wurden formuliert.
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  • 文章类型: Guideline
    因为研究治疗的临床试验结果会影响监管政策,处方模式,并在临床实践中使用,高质量的试验是偏头痛证据基础的重要组成部分.国际头痛协会自1991年以来发布了成人偏头痛临床试验指南。针对儿童和青少年偏头痛的多个问题,以及新的试验设计和药物进步的出现,生物制剂,设备,和行为干预,有必要针对儿童和青少年偏头痛临床试验的具体问题提供指导.
    这些准则的目的是提供一个当代的,标准化,和基于证据的设计方法,行为,并报告了儿童和青少年偏头痛预防性治疗的受控临床试验。
    这些指南的制定是基于国际头痛协会和监管机构先前发布的指南。这些建议是基于证据的,可用的地方。这一进程包括各委员会之间的协商,利益相关者(非专业人士和制药业)之间的圆桌讨论,并就最终草案与IHS成员进行公开磋商。
    提供了一系列针对儿童和青少年偏头痛临床试验中的主要问题的建议。建议得到基于证据的实践和经过验证的方法的支持,可用的地方。提供支持意见以澄清歧义。
    在设计和开展儿童和青少年偏头痛预防性治疗的临床试验时,应参考和使用这些指南。
    Because the results of clinical trials of investigational treatments influence regulatory policy, prescribing patterns, and use in clinical practice, high quality trials are an essential component of the evidence base for migraine. The International Headache Society has published guidelines for clinical trials in adults with migraine since 1991. With multiple issues specific to children and adolescents with migraine, as well as the emergence of novel trial designs and advances in pharmaceuticals, biologics, devices, and behavioural interventions, there is a need for guidance focusing on issues specific to the conduct of clinical trials in children and adolescents with migraine.
    The objective of these guidelines is to provide a contemporary, standardized, and evidence-based approach to the design, conduct, and reporting of well-controlled clinical trials of preventive treatment of migraine in children and adolescents.
    The development of these guidelines was based on guidelines previously published by the International Headache Society and regulatory bodies. The recommendations are evidence-based, where available. The process included consultations among various committees, roundtable discussions among stakeholders (lay people and the pharmaceutical industry), and open consultation with the IHS membership on the final draft.
    A series of recommendations addressing the major issues in clinical trials in children and adolescents with migraine is provided. Recommendations are supported by evidence-based practice and validated methodologies, where available. Supporting comments are provided to clarify ambiguities.
    These guidelines should be consulted and used in designing and conducting clinical trials of preventive treatments in children and adolescents with migraine.
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  • 文章类型: Journal Article
    Background Quality clinical trials form an essential part of the evidence base for the treatment of headache disorders. In 1991, the International Headache Society Clinical Trials Standing Committee developed and published the first edition of the Guidelines for Controlled Trials of Drugs in Migraine. In 2008, the Committee published the first specific guidelines on chronic migraine. Subsequent advances in drug, device, and biologicals development, as well as novel trial designs, have created a need for a revision of the chronic migraine guidelines. Objective The present update is intended to optimize the design of controlled trials of preventive treatment of chronic migraine in adults, and its recommendations do not apply to trials in children or adolescents.
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