Ocular Myasthenia Treatment Review
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What databases were searched for randomized controlled trials?

  • Cochrane Neuromuscular Disease Group Register, EMBASE
  • Medline, EMBASE
  • Cochrane Neuromuscular Disease Group Register, Medline
  • Cochrane Neuromuscular Disease Group Register, Medline, EMBASE (correct)

    • Which of the following was NOT a search term used in the databases?

  • patient age (correct)
  • series of terms describing specific therapies and specific types of clinical studies
  • myasthenia gravis
  • eye, ocular, and vision

    • What are the three criteria that studies had to meet to be included in the review?

  • randomized (or quasi-randomized) controlled trial or observational (cohort or case–control) study design, active treatment compared with placebo, no treatment, or some other treatment, results reported separately for patients with ocular myasthenia (Grade 1) as defined by the Myasthenia Gravis Foundation of America (correct)
  • randomized (or quasi-randomized) controlled trial or observational (cohort or case–control) study design, active treatment compared with placebo, no treatment, or some other treatment, results reported separately for patients with ocular myasthenia (Grade 1)
  • randomized (or quasi-randomized) controlled trial or observational (cohort or case–control) study design, active treatment compared with placebo, no treatment, or some other treatment, results reported separately for patients with ocular myasthenia as defined by the Myasthenia Gravis Foundation of America
  • randomized (or quasi-randomized) controlled trial or observational (cohort or case–control) study design, active treatment compared with placebo, no treatment, or some other treatment, results reported separately for patients with ocular myasthenia

    • What type of observational studies were searched for?

    <p>Cohort studies and Case– control studies (C)</p> Signup and view all the answers

    Were studies reporting outcomes in children or adults considered?

    <p>Both children and adults (C)</p> Signup and view all the answers

    What is the main research question addressed in this study?

    <p>All of the above (D)</p> Signup and view all the answers

    What type of evidence is used to answer the research question?

    <p>Randomized controlled trials (C)</p> Signup and view all the answers

    What other factors are mentioned that might have influenced the results of the studies?

    <p>All of the above (D)</p> Signup and view all the answers

    What is the prevalence of myasthenia gravis (MG) estimated to be?

    <p>5 to 15 per 100,000 (D)</p> Signup and view all the answers

    Which treatment was identified as being uncertain in its benefit for the risk of progression to generalized MG?

    <p>Corticosteroids (B)</p> Signup and view all the answers

    What type of studies were reported to assess the effects of corticosteroids on progression to generalized MG?

    <p>Observational studies (C)</p> Signup and view all the answers

    What symptom did the review not find evidence for improvement through any treatments mentioned?

    <p>Ocular symptoms (C)</p> Signup and view all the answers

    What did the review suggest about the relationship between cholinesterase inhibitors and progression to generalized MG?

    <p>Their effects are uncertain. (D)</p> Signup and view all the answers

    The review identified how many observational studies regarding the effects of corticosteroids on progression to generalized MG?

    <p>Five (C)</p> Signup and view all the answers

    Which agent was mentioned alongside corticosteroids as having uncertain benefits?

    <p>Azathioprine (B)</p> Signup and view all the answers

    What is the main purpose of immunosuppressive therapy mentioned in the context of MG?

    <p>To prevent progression to generalized MG (B)</p> Signup and view all the answers

    What was the main objective of the systematic review conducted on ocular myasthenia?

    <p>To provide evidence-based guidelines for medical treatment (D)</p> Signup and view all the answers

    Which databases were searched for articles related to ocular myasthenia treatment?

    <p>Medline, EMBASE, and Cochrane Neuromuscular Disease Group Register (D)</p> Signup and view all the answers

    What type of trial compared intranasal neostigmine with placebo for ocular symptoms?

    <p>Randomized controlled trial (D)</p> Signup and view all the answers

    What outcome measure was reported in the trial that compared corticotropin with placebo?

    <p>Quantification of the range of eye movements (A)</p> Signup and view all the answers

    What methodological issues affected the conclusions of the trial on intranasal neostigmine?

    <p>Methodologic limitations of the study (D)</p> Signup and view all the answers

    What were the two main questions addressed in the evidence report?

    <p>Are there effective treatments for ocular symptoms and risk reduction for progression to generalized MG? (D)</p> Signup and view all the answers

    What was a key limiting factor in the second clinical trial for corticotropin?

    <p>Results were not related to symptom improvement (D)</p> Signup and view all the answers

    Which of the following is NOT mentioned as a source of literature in the evidence review?

    <p>Research articles from university libraries (B)</p> Signup and view all the answers

    What is the purpose of ensuring that the outcome measure is obtained in a blinded fashion?

    <p>To minimize bias (A)</p> Signup and view all the answers

    Which of the following is NOT a requirement for outcome measures?

    <p>Adequate accounting for patient confidentiality (A)</p> Signup and view all the answers

    What characterizes a Class II study according to the Quality Standards Subcommittee?

    <p>RCT lacking one or more key criteria (C)</p> Signup and view all the answers

    What is included in practice parameters for neurology?

    <p>Specific recommendations based on evidence analysis (C)</p> Signup and view all the answers

    What should be done to account for dropouts in a study?

    <p>Adjust for differences statistically (B)</p> Signup and view all the answers

    Which of the following best describes a Class III study?

    <p>All other controlled trials not meeting Class II criteria (D)</p> Signup and view all the answers

    Why is it important to present baseline characteristics in studies?

    <p>To facilitate understanding of treatment groups' equivalence (A)</p> Signup and view all the answers

    What is the role of the Quality Standards Subcommittee (QSS)?

    <p>To develop clinically relevant strategies for neurology (A)</p> Signup and view all the answers

    What percentage of individuals presenting with purely ocular symptoms may progress to generalized disease within the first 1 to 2 years?

    <p>50% to 60% (A)</p> Signup and view all the answers

    What is one of the goals of treating ocular myasthenia?

    <p>Alleviating symptoms and preventing progression (A)</p> Signup and view all the answers

    What is a common treatment option that can be used to alleviate symptoms of ocular myasthenia?

    <p>Lid crutches or eye patching (C)</p> Signup and view all the answers

    Which of the following statements about immunosuppressive therapy for ocular myasthenia is accurate?

    <p>Its use is debated and lacks strong evidence. (D)</p> Signup and view all the answers

    Which adverse effect is associated with immunosuppressive drugs used in treating ocular myasthenia?

    <p>Significant adverse effects (C)</p> Signup and view all the answers

    What is a misconception about ocular myasthenia's severity?

    <p>It is not life-threatening for most patients. (D)</p> Signup and view all the answers

    What aspect of immunosuppressive therapy do its proponents argue?

    <p>It may help prevent the progression to generalized MG. (A)</p> Signup and view all the answers

    What is considered a sufficient follow-up measure in studies evaluating ocular myasthenia treatments?

    <p>Completeness of follow-up (B)</p> Signup and view all the answers

    What was the treatment modality used by Papapetropoulos in his study?

    <p>Corticosteroids (C)</p> Signup and view all the answers

    What was the mean age of participants in Kupersmith's cohort study?

    <p>50 years (B)</p> Signup and view all the answers

    Which author conducted a study on 34 participants using Azathioprine?

    <p>Mee (A)</p> Signup and view all the answers

    What was the exposure odds ratio (OR) reported by Sommer in his cohort study using Azathioprine?

    <p>0.27 (C)</p> Signup and view all the answers

    In the studies mentioned, which treatment had a gradual titration schedule?

    <p>Corticosteroids (A)</p> Signup and view all the answers

    What was the primary treatment used in the 2004 study by Monsul?

    <p>Corticosteroids (D)</p> Signup and view all the answers

    Which of the following studies had incomplete follow-up as per its design characteristics?

    <p>Kupersmith (2003) (C)</p> Signup and view all the answers

    What is the common treatment dosage referred to for corticosteroids in Mee's study?

    <p>25 mg QD (D)</p> Signup and view all the answers

    In the context of treatment outcomes, what was not done in any of the included studies?

    <p>Use of blinding (A)</p> Signup and view all the answers

    What was the male percentage in the participant group in Kupersmith's study?

    <p>57% (C)</p> Signup and view all the answers

    What aspect of follow-up was described as 'adequate' in Papapetropoulos's study?

    <p>Completeness of follow-up (A)</p> Signup and view all the answers

    Which study reported the highest exposure odds ratio (OR) value?

    <p>Papapetropoulos (2003) using corticosteroids (D)</p> Signup and view all the answers

    What was the main outcome reported for Mee's study employing Azathioprine?

    <p>OR of 0.04 (B)</p> Signup and view all the answers

    What was the duration of therapy for Kupersmith's corticosteroid treatment?

    <p>2 days to 1 week (D)</p> Signup and view all the answers

    Which treatment was never used in the provided studies?

    <p>Plasmapheresis (B)</p> Signup and view all the answers

    What type of study did Monsul conduct in 2004?

    <p>Cohort study (A)</p> Signup and view all the answers

    Study Notes

    Ocular Myasthenia Treatment Review

    • Objective: Provide evidence-based guidelines for treating ocular myasthenia.
    • Methods: Literature search (Medline, EMBASE, Cochrane) and expert consultations.
    • Evaluation criteria: Predefined criteria to evaluate the methodologic quality of articles.
    • Key Questions:
      • Efficacy of treatments for ocular myasthenia symptoms (diplopia, ptosis).
      • Treatment impact on progression to generalized myasthenia gravis (MG).

    Treatment Efficacy for Ocular Symptoms

    • Randomized Controlled Trials (RCTs):
      • One RCT compared intranasal neostigmine to placebo, but methodological limitations prevented definitive conclusions.
      • Another RCT compared corticotropin to placebo, but outcome data was in terms of eye movement range, hindering analysis of symptom improvement.
    • Limited Evidence: No high-quality evidence supports cholinesterase inhibitors, corticosteroids, or other immunosuppressants for improving ocular symptoms.

    Progression to Generalized MG

    • RCTs: No RCTs directly investigated the risk of generalized MG progression.
    • Observational Studies: Five observational studies examined the effects of corticosteroids on generalized MG progression, with two also looking at azathioprine's effect.
    • Uncertain Benefit: Observational data regarding the effect of corticosteroids and azathioprine on generalized MG progression is inconclusive.
    • Absence of High-Quality Evidence: No evidence-based recommendations are possible regarding the risk of progression from ocular to generalized MG.

    Recommendations

    • Further Research: High-quality, randomized, placebo-controlled studies are needed to evaluate the effectiveness of cholinesterase inhibitors, corticosteroids, and other immunosuppressants for ocular myasthenia and the risk of progression to generalized MG.
    • Clinical Considerations: Decisions regarding treatment should consider the patient's specific symptoms, potential benefits, and risks of each treatment option.

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    Related Documents

    Ocular Myasthenia Treatment Review 2007 PDF

    Description

    This quiz reviews evidence-based guidelines for treating ocular myasthenia, focusing on assessed efficacy of various treatments for symptoms like diplopia and ptosis. Key evaluations include randomized controlled trials and their methodological quality, which highlight the limitations in current treatment evidence.

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