Podcast
Questions and Answers
What databases were searched for randomized controlled trials?
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?
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?
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?
What type of observational studies were searched for?
Were studies reporting outcomes in children or adults considered?
Were studies reporting outcomes in children or adults considered?
What is the main research question addressed in this study?
What is the main research question addressed in this study?
What type of evidence is used to answer the research question?
What type of evidence is used to answer the research question?
What other factors are mentioned that might have influenced the results of the studies?
What other factors are mentioned that might have influenced the results of the studies?
What is the prevalence of myasthenia gravis (MG) estimated to be?
What is the prevalence of myasthenia gravis (MG) estimated to be?
Which treatment was identified as being uncertain in its benefit for the risk of progression to generalized MG?
Which treatment was identified as being uncertain in its benefit for the risk of progression to generalized MG?
What type of studies were reported to assess the effects of corticosteroids on progression to generalized MG?
What type of studies were reported to assess the effects of corticosteroids on progression to generalized MG?
What symptom did the review not find evidence for improvement through any treatments mentioned?
What symptom did the review not find evidence for improvement through any treatments mentioned?
What did the review suggest about the relationship between cholinesterase inhibitors and progression to generalized MG?
What did the review suggest about the relationship between cholinesterase inhibitors and progression to generalized MG?
The review identified how many observational studies regarding the effects of corticosteroids on progression to generalized MG?
The review identified how many observational studies regarding the effects of corticosteroids on progression to generalized MG?
Which agent was mentioned alongside corticosteroids as having uncertain benefits?
Which agent was mentioned alongside corticosteroids as having uncertain benefits?
What is the main purpose of immunosuppressive therapy mentioned in the context of MG?
What is the main purpose of immunosuppressive therapy mentioned in the context of MG?
What was the main objective of the systematic review conducted on ocular myasthenia?
What was the main objective of the systematic review conducted on ocular myasthenia?
Which databases were searched for articles related to ocular myasthenia treatment?
Which databases were searched for articles related to ocular myasthenia treatment?
What type of trial compared intranasal neostigmine with placebo for ocular symptoms?
What type of trial compared intranasal neostigmine with placebo for ocular symptoms?
What outcome measure was reported in the trial that compared corticotropin with placebo?
What outcome measure was reported in the trial that compared corticotropin with placebo?
What methodological issues affected the conclusions of the trial on intranasal neostigmine?
What methodological issues affected the conclusions of the trial on intranasal neostigmine?
What were the two main questions addressed in the evidence report?
What were the two main questions addressed in the evidence report?
What was a key limiting factor in the second clinical trial for corticotropin?
What was a key limiting factor in the second clinical trial for corticotropin?
Which of the following is NOT mentioned as a source of literature in the evidence review?
Which of the following is NOT mentioned as a source of literature in the evidence review?
What is the purpose of ensuring that the outcome measure is obtained in a blinded fashion?
What is the purpose of ensuring that the outcome measure is obtained in a blinded fashion?
Which of the following is NOT a requirement for outcome measures?
Which of the following is NOT a requirement for outcome measures?
What characterizes a Class II study according to the Quality Standards Subcommittee?
What characterizes a Class II study according to the Quality Standards Subcommittee?
What is included in practice parameters for neurology?
What is included in practice parameters for neurology?
What should be done to account for dropouts in a study?
What should be done to account for dropouts in a study?
Which of the following best describes a Class III study?
Which of the following best describes a Class III study?
Why is it important to present baseline characteristics in studies?
Why is it important to present baseline characteristics in studies?
What is the role of the Quality Standards Subcommittee (QSS)?
What is the role of the Quality Standards Subcommittee (QSS)?
What percentage of individuals presenting with purely ocular symptoms may progress to generalized disease within the first 1 to 2 years?
What percentage of individuals presenting with purely ocular symptoms may progress to generalized disease within the first 1 to 2 years?
What is one of the goals of treating ocular myasthenia?
What is one of the goals of treating ocular myasthenia?
What is a common treatment option that can be used to alleviate symptoms of ocular myasthenia?
What is a common treatment option that can be used to alleviate symptoms of ocular myasthenia?
Which of the following statements about immunosuppressive therapy for ocular myasthenia is accurate?
Which of the following statements about immunosuppressive therapy for ocular myasthenia is accurate?
Which adverse effect is associated with immunosuppressive drugs used in treating ocular myasthenia?
Which adverse effect is associated with immunosuppressive drugs used in treating ocular myasthenia?
What is a misconception about ocular myasthenia's severity?
What is a misconception about ocular myasthenia's severity?
What aspect of immunosuppressive therapy do its proponents argue?
What aspect of immunosuppressive therapy do its proponents argue?
What is considered a sufficient follow-up measure in studies evaluating ocular myasthenia treatments?
What is considered a sufficient follow-up measure in studies evaluating ocular myasthenia treatments?
What was the treatment modality used by Papapetropoulos in his study?
What was the treatment modality used by Papapetropoulos in his study?
What was the mean age of participants in Kupersmith's cohort study?
What was the mean age of participants in Kupersmith's cohort study?
Which author conducted a study on 34 participants using Azathioprine?
Which author conducted a study on 34 participants using Azathioprine?
What was the exposure odds ratio (OR) reported by Sommer in his cohort study using Azathioprine?
What was the exposure odds ratio (OR) reported by Sommer in his cohort study using Azathioprine?
In the studies mentioned, which treatment had a gradual titration schedule?
In the studies mentioned, which treatment had a gradual titration schedule?
What was the primary treatment used in the 2004 study by Monsul?
What was the primary treatment used in the 2004 study by Monsul?
Which of the following studies had incomplete follow-up as per its design characteristics?
Which of the following studies had incomplete follow-up as per its design characteristics?
What is the common treatment dosage referred to for corticosteroids in Mee's study?
What is the common treatment dosage referred to for corticosteroids in Mee's study?
In the context of treatment outcomes, what was not done in any of the included studies?
In the context of treatment outcomes, what was not done in any of the included studies?
What was the male percentage in the participant group in Kupersmith's study?
What was the male percentage in the participant group in Kupersmith's study?
What aspect of follow-up was described as 'adequate' in Papapetropoulos's study?
What aspect of follow-up was described as 'adequate' in Papapetropoulos's study?
Which study reported the highest exposure odds ratio (OR) value?
Which study reported the highest exposure odds ratio (OR) value?
What was the main outcome reported for Mee's study employing Azathioprine?
What was the main outcome reported for Mee's study employing Azathioprine?
What was the duration of therapy for Kupersmith's corticosteroid treatment?
What was the duration of therapy for Kupersmith's corticosteroid treatment?
Which treatment was never used in the provided studies?
Which treatment was never used in the provided studies?
What type of study did Monsul conduct in 2004?
What type of study did Monsul conduct in 2004?
Flashcards
Ocular Myasthenia
Ocular Myasthenia
A neuromuscular disorder affecting eye muscles causing weakness.
Systematic Review
Systematic Review
A comprehensive analysis of all relevant literature on a topic.
Evidence-based Guidelines
Evidence-based Guidelines
Recommendations based on systematic reviews and clinical evidence.
Randomized Controlled Trial
Randomized Controlled Trial
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Intranasal Neostigmine
Intranasal Neostigmine
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Corticotropin
Corticotropin
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Methodologic Limitations
Methodologic Limitations
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Risk of Progression
Risk of Progression
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Myasthenia Gravis (MG)
Myasthenia Gravis (MG)
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Prevalence of MG
Prevalence of MG
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Ocular symptoms in MG
Ocular symptoms in MG
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Corticosteroids
Corticosteroids
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Azathioprine
Azathioprine
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Generalized MG
Generalized MG
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Observational studies
Observational studies
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Evidence-based recommendations
Evidence-based recommendations
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Cochrane Neuromuscular Disease Group
Cochrane Neuromuscular Disease Group
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Randomized Controlled Trial (RCT)
Randomized Controlled Trial (RCT)
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Myasthenia Gravis
Myasthenia Gravis
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Cholinesterase Inhibitors
Cholinesterase Inhibitors
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Cohort Study
Cohort Study
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Placebo
Placebo
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Evidence-Based Medicine
Evidence-Based Medicine
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Progression to Generalized MG
Progression to Generalized MG
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Immunosuppressive Therapy
Immunosuppressive Therapy
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Symptoms of Ocular Myasthenia
Symptoms of Ocular Myasthenia
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Lid Crutches
Lid Crutches
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Eye Patching
Eye Patching
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Debate on Treatment
Debate on Treatment
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Adverse Effects of Therapy
Adverse Effects of Therapy
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Primary Outcome
Primary Outcome
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Exclusion Criteria
Exclusion Criteria
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Inclusion Criteria
Inclusion Criteria
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Dropouts
Dropouts
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Cross-overs
Cross-overs
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Baseline Characteristics
Baseline Characteristics
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Masked Outcome Assessment
Masked Outcome Assessment
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Practice Parameters
Practice Parameters
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Case-control study
Case-control study
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Odds Ratio (OR)
Odds Ratio (OR)
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Efficacy
Efficacy
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Patient compliance
Patient compliance
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Follow-up completeness
Follow-up completeness
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Blinding
Blinding
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Treatment schedule
Treatment schedule
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Titration
Titration
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Mean age
Mean age
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Treatment modality
Treatment modality
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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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