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No strong evidence about the effects of sensory stimulation for a brain‐injured person in a coma

About half of people in a coma (deep unconsciousness) because of traumatic brain injury will wake within a year of the accident. Speeding recovery to allow people to wake sooner is a priority for them and their family. One type of treatment uses sensory stimulation to try to keep the person's brain working normally. Sensory stimulation methods vary greatly, from one or two hourly sessions of a day, through to shorter sessions every hour for 12 to 14 hours a day. The review found there is no strong evidence to determine whether sensory stimulation benefits people in comas.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2008

Intracranial electrical stimulation to treat drug‐resistant epilepsy

Despite many antiepileptic drugs being available, about 30% of epilepsy patients are not seizure‐free. Electrical stimulation through intracranially implanted electrodes has been proposed as an alternative treatment for these patients. This review aimed to evaluate its efficacy, safety and tolerability. Various brain structures have been targeted with scheduled (that is seizure‐independent) stimulation, including the anterior thalamic nucleus (1 trial, 109 participants), the centromedian thalamic nucleus (2 trials, 20 participants), the cerebellar cortex (3 trials, 22 participants) and the hippocampus (3 trials, 15 participants). In addition, one trial (191 participants) studied responsive stimulation (that is only upon seizure detection) of the seizure onset zone. There is evidence for moderate (15% to 30%) seizure frequency reduction after short‐term (one to three months) anterior thalamic nucleus stimulation in (multi)focal epilepsy, hippocampal stimulation in temporal lobe epilepsy, and responsive seizure onset zone stimulation in (multi)focal epilepsy. However, there is no evidence for significant impact on seizure freedom, the proportion of patients with a greater than 50% seizure frequency reduction, or quality of life. Adverse effects of anterior thalamic stimulation include self‐reported depression and subjective memory impairment, and possibly anxiety and confusional state. Responsive seizure onset zone stimulation was well tolerated with few side effects but the sudden unexplained death in epilepsy (SUDEP) rate was slightly elevated in the (for this purpose) small trial and should be closely monitored in further studies. There is insufficient evidence to make firm conclusive statements on the efficacy or side effects of hippocampal, centromedian thalamic and cerebellar cortical stimulation. Intracranial implantation of the electrodes was relatively safe without permanent symptomatic sequelae in the patients included in the trials. More larger and well‐designed trials on intracranial electrical stimulation treatments are needed to validate and optimize its efficacy and safety and to compare this treatment to currently available treatments (for example antiepileptic drugs).

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Fact sheet: Tinnitus

After a loud concert, sports event or using a very noisy machine like a chainsaw, people often hear ringing in their ears – even after the outside noise has stopped. This ringing usually goes away after a short while, though. It is called tinnitus, and everyone experiences it from time to time. But 1 or 2 out of every 10 people will hear this kind of noise constantly for a while. Or they have episodes that just come and go, for no obvious reason. The tinnitus could go on for months or even years, but it is usually only mild and a bit annoying.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: April 11, 2013

Botulinum toxin type B for cervical dystonia or involuntary positioning of the head

Cervical dystonia is the most common form of focal dystonia and is characterized by involuntary posturing of the head. It is frequently associated with neck pain and may lead to physical disability and social withdrawal. Botulinum toxin type A (BtA) has become the first line therapy but some patients become resistant to this drug. Another serotype of Botulum toxin, type B (BtB) has been developed. Three randomized controlled studies of a single intramuscular injection of BtB (up to a dose of 10,000 Units) showed improvements in the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) total score, which includes measures of disability, severity and pain, and patient assessed measures four weeks after injection and lasting about 16 weeks, even in patients resistant to BtA. Adverse events associated with how the drug works included difficulty in swallowing (dysphagia) and dry mouth.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Acupuncture for fibromyalgia

This summary of a Cochrane review presents what we know from research about the effect of acupuncture on fibromyalgia.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Pain (PDQ®): Patient Version

Expert-reviewed information summary about pain as a complication of cancer or its treatment. Approaches to the management and treatment of cancer-associated pain are discussed.

PDQ Cancer Information Summaries [Internet] - National Cancer Institute (US).

Version: April 10, 2014

Unusual Cancers of Childhood (PDQ®): Patient Version

Expert-reviewed information summary about the treatment of unusual cancers of childhood such as cancers of the head and neck, chest, abdomen, reproductive system, skin, and others.

PDQ Cancer Information Summaries [Internet] - National Cancer Institute (US).

Version: February 10, 2015

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