Abstract:
BACKGROUND:Cervical dystonia is characterized by involuntary posturing of the head and frequently is associated with neck pain. Disability and social withdrawal are common. In recent years, Botulinum toxin Type A (BtA) has become the first line therapy. However its true efficacy, in particular the potential effect size, is still unclear. OBJECTIVES:To determine whether botulinum toxin (BtA) is an effective and safe treatment for cervical dystonia. SEARCH STRATEGY:We searched the Cochrane Movement Disorders Group trials register (June 2003), the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 3, 2003, MEDLINE (1977 to June 2003), EMBASE (1977 to June 2003) and reference lists of articles. We also contacted drug manufacturers and researchers in the field. SELECTION CRITERIA:Randomised studies comparing BtA with placebo in adults with cervical dystonia. DATA COLLECTION AND ANALYSIS:Two reviewers independently assessed trial quality and extracted data. Study authors were contacted for additional information. Adverse effects information was collected from the trials. MAIN RESULTS:We found thirteen high quality eligible studies. They were short term (6 to 16 weeks). Eight trials, enrolling 361 patients, used the BtA formulation Botox(r) and five, enrolling 319 patients, used the BtA formulation Dysport. The dose and technique of administration varied significantly between studies.Meta-analysis showed statistically and clinically significant improvements on objective rating scales: (Peto OR 4.31; 95% confidence interval (CI) 2.68 to 6.94) and subjective rating scales (Peto OR 6.58; 95% CI 4.55 to 9.54); and for pain relief in subjective scales (Peto OR 11.92; 95% CI 6.32 to 22.5). However, for many of the outcomes, we could use data from only a few studies. Only adverse events clearly associated with the mechanism of action of BtA were more frequent in the treatment group. These included neck weakness, dysphagia, dry mouth/sore throat and voice changes/hoarseness. Sub-group and sensitivity analyses showed a clear dose-response relationship for subjective and objective benefit and for frequency and severity of adverse events. Indirect comparisons between trials that used Dysport against placebo and trials that used Botox against placebo showed no significant differences between Dysport and Botox in terms of benefits or adverse events. AUTHORS' CONCLUSIONS:A single injection cycle of BtA is effective and safe for treating cervical dystonia. Enriched trials (using patients previously treated with BtA), suggest that further injection cycles continue to work for most patients.
journal_name
Cochrane Database Syst Revjournal_title
The Cochrane database of systematic reviewsauthors
Costa J,Espírito-Santo C,Borges A,Ferreira JJ,Coelho M,Moore P,Sampaio Cdoi
10.1002/14651858.CD003633.pub2keywords:
subject
Has Abstractpub_date
2005-01-25 00:00:00pages
CD003633issue
1issn
1469-493Xpub_type
杂志文章,meta分析,评审abstract:BACKGROUND:Eczema is a chronic skin disease characterised by dry skin, intense itching, inflammatory skin lesions, and a considerable impact on quality of life. Moisturisation is an integral part of treatment, but it is unclear if moisturisers are effective. OBJECTIVES:To assess the effects of moisturisers for eczema....
journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,meta分析,评审
doi:10.1002/14651858.CD012119.pub2
更新日期:2017-02-06 00:00:00
abstract:BACKGROUND:Given the substantial period of time adults spend in their workplaces each day, these provide an opportune setting for interventions addressing modifiable behavioural risk factors for chronic disease. Previous reviews of trials of workplace-based interventions suggest they can be effective in modifying a ran...
journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,meta分析
doi:10.1002/14651858.CD012439.pub2
更新日期:2018-11-14 00:00:00
abstract:BACKGROUND:One to eight per cent of women suffer third-degree perineal tear (anal sphincter injury) and fourth-degree perineal tear (rectal mucosa injury) during vaginal birth, and these tears are more common after forceps delivery (28%) and midline episiotomies. Third- and fourth-degree tears can become contaminated w...
journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,评审
doi:10.1002/14651858.CD005125.pub4
更新日期:2014-10-07 00:00:00
abstract:BACKGROUND:Reduced uterine blood flow from maternal hypotension may contribute to fetal heart rate changes which are common following regional analgesia (epidural or spinal or combined spinal-epidural (CSE)) during labour. Intravenous fluid preloading may help to reduce maternal hypotension but using lower doses of loc...
journal_title:The Cochrane database of systematic reviews
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doi:10.1002/14651858.CD000175.pub2
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abstract:BACKGROUND:Nausea and vomiting is a common and distressing presenting complaint in emergency departments (ED). The aetiology of nausea and vomiting in EDs is diverse and drugs are commonly prescribed. There is currently no consensus as to the optimum drug treatment of nausea and vomiting in the adult ED setting. OBJEC...
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doi:10.1002/14651858.CD010106.pub2
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doi:10.1002/14651858.CD002986.pub2
更新日期:2012-09-12 00:00:00
abstract:BACKGROUND:Sepsis is a common and frequently fatal condition. Human recombinant activated protein C (APC) has been used to reduce the high rate of death by severe sepsis or septic shock. This is an update of a Cochrane review (originally published in 2007 and updated in 2008). OBJECTIVES:We assessed the clinical effec...
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doi:10.1002/14651858.CD004388.pub4
更新日期:2011-04-13 00:00:00
abstract:BACKGROUND:Miscarriage is a common complication of pregnancy that can be caused by a wide range of factors. Poor dietary intake of vitamins has been associated with an increased risk of miscarriage, therefore supplementing women with vitamins either prior to or in early pregnancy may help prevent miscarriage. OBJECTIV...
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doi:10.1002/14651858.CD004073.pub4
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更新日期:2014-04-22 00:00:00
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journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,评审
doi:10.1002/14651858.CD001710
更新日期:2001-01-01 00:00:00
abstract:BACKGROUND:Peripheral arterial disease (PAD) is frequently treated by either an infrainguinal autologous (using the patient's own veins) or synthetic graft bypass. The rate of occlusion of the graft after one year is between 12% and 60%. To prevent occlusion, patients are treated with an antiplatelet or antithrombotic ...
journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,meta分析,评审
doi:10.1002/14651858.CD000536.pub2
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abstract:BACKGROUND:Episiotomy is done to prevent severe perineal tears, but its routine use has been questioned. The relative effects of midline compared with midlateral episiotomy are unclear. OBJECTIVES:The objective of this review was to assess the effects of restrictive use of episiotomy compared with routine episiotomy d...
journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,评审
doi:10.1002/14651858.CD000081
更新日期:2000-01-01 00:00:00
abstract:BACKGROUND:Excision of the transformation zone of the cervix is the most commonly used approach to treat cervical precancerous lesions (cervical intraepithelial neoplasia (CIN)) to reduce the risk of developing cervical cancer. As the excision of the transformation zone leaves a raw area on the cervix, there is a risk ...
journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,meta分析,评审
doi:10.1002/14651858.CD009957.pub2
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pub_type: 杂志文章,评审
doi:10.1002/14651858.CD005025.pub2
更新日期:2006-01-25 00:00:00
abstract:BACKGROUND:Pulmonary arteriovenous malformations are abnormal direct connections between the pulmonary artery and pulmonary vein which result in a right-to-left shunt. They are associated with substantial morbidity and mortality mainly from the effects of paradoxical emboli. Potential complications include stroke, cere...
journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,评审
doi:10.1002/14651858.CD008017.pub2
更新日期:2010-05-12 00:00:00
abstract:BACKGROUND:The health benefits of physical activity and exercise are well documented and these effects could help people with schizophrenia. OBJECTIVES:To determine the mental health effects of exercise/physical activity programmes for people with schizophrenia or schizophrenia-like illnesses. SEARCH STRATEGY:We sear...
journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,meta分析,评审
doi:10.1002/14651858.CD004412.pub2
更新日期:2010-05-12 00:00:00
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journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,评审
doi:10.1002/14651858.CD001921
更新日期:2001-01-01 00:00:00
abstract:BACKGROUND:Nasal continuous positive airway pressure (NCPAP) is used to support preterm infants recently extubated, those experiencing significant apnoea of prematurity and those with respiratory distress soon after birth as an alternative to intubation and ventilation. This review will focus exclusively on identifying...
journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,meta分析,评审
doi:10.1002/14651858.CD002977
更新日期:2002-01-01 00:00:00
abstract:BACKGROUND:Respiratory syncytial virus (RSV) bronchiolitis and pneumonia hospitalize hundreds of thousands of infants every year. Treatment is largely supportive therapy, (for example, oxygen, fluids and occasionally mechanical ventilation). Ribavirin, an antiviral agent, is licensed for severe RSV infection, although ...
journal_title:The Cochrane database of systematic reviews
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doi:10.1002/14651858.CD004883.pub2
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pub_type: 杂志文章,评审
doi:10.1002/14651858.CD001005
更新日期:2002-01-01 00:00:00
abstract:BACKGROUND:Orbital lymphangiomas are a subset of localized vascular and lymphatic malformations, which most commonly occur in the head and neck region. Orbital lymphangiomas typically present in the first decade of life with signs of ptosis, proptosis, restriction of ocular motility, compressive optic neuropathy, and d...
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pub_type: 杂志文章,meta分析,评审
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更新日期:2014-01-24 00:00:00
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abstract:BACKGROUND:Many people with cancer experience moderate to severe pain that requires treatment with strong opioids, such as oxycodone and morphine. Strong opioids are, however, not effective for pain in all people, neither are they well-tolerated by all people. The aim of this review was to assess whether oxycodone is a...
journal_title:The Cochrane database of systematic reviews
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更新日期:2017-08-22 00:00:00
abstract:BACKGROUND:Failure of implantation and conception may result from an inability of the blastocyst to escape from its outer coat, known as the zona pellucida. Artificial disruption of this coat is known as assisted hatching (AH) and has been proposed as a method for improving the success of assisted conception. OBJECTIV...
journal_title:The Cochrane database of systematic reviews
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更新日期:2009-04-15 00:00:00
abstract:BACKGROUND:Obstructive sleep apnoea is the periodic reduction (hypopnoea) or cessation (apnoea) of breathing due to narrowing or occlusion of the upper airway during sleep. The main symptom is daytime sleepiness and it has been suggested it is linked to premature death, hypertension, ischaemic heart disease, stroke and...
journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,meta分析,评审
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更新日期:2006-07-19 00:00:00
abstract:BACKGROUND:Cystic fibrosis is a life-limiting inherited condition which affects one in 2500 newborns in the UK and 70,000 children and adults worldwide. The condition is multifaceted and affects many systems in the body. The respiratory system is particularly affected due to a build up of thickened secretions and a pre...
journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,meta分析,评审
doi:10.1002/14651858.CD012102.pub2
更新日期:2017-12-19 00:00:00
abstract:BACKGROUND:Multifocal motor neuropathy (MMN) is characterised by progressive, predominantly distal, asymmetrical limb weakness and usually multiple partial motor nerve conduction blocks. Intravenous immunoglobulin (IVIg) is beneficial but the role of immunosuppressive agents is uncertain. This is an update of a review ...
journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,评审
doi:10.1002/14651858.CD003217.pub5
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abstract:BACKGROUND:Pulmonary arteriovenous malformations are abnormal direct connections between the pulmonary artery and pulmonary vein which result in a right-to-left shunt. They are associated with substantial morbidity and mortality mainly from the effects of paradoxical emboli. Potential complications include stroke, cere...
journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,评审
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更新日期:2015-01-29 00:00:00
abstract:BACKGROUND:Acute respiratory infections (ARIs) last for less than 30 days and are the most common acute diseases affecting people. Exercise has been shown to improve health generally, but it is uncertain whether exercise may be effective in reducing the occurrence, severity, and duration of ARIs. This is an update of o...
journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,meta分析
doi:10.1002/14651858.CD010596.pub3
更新日期:2020-04-04 00:00:00