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A weakening, shrinking, and loss of muscle caused by disease or lack of use.

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Spinal muscular atrophy (SMA) is a severe neuromuscular disease with onset in childhood and adolescence that results in progressive muscle weakness. There are three main types of SMA. Drug treatment for SMA types II and III is discussed in a separate Cochrane review. The age of onset of SMA type I, also known as Werdnig‐Hoffmann disease, is before six months. Children with SMA type I will never be able to sit without support and usually die by the age of two years. It is one of the most important causes of death due to a genetic disease in childhood. There was only one small randomised trial in the original review, which assessed the efficacy of riluzole for 10 children with SMA type I. In this trial all three children in the placebo group died, but three of the seven children treated with riluzole were still alive at the ages of 30, 48 and 64 months. However, none of the children in the riluzole or placebo group developed the ability to roll, sit or stand. For several reasons the overall quality of the study was low, mainly because the study was too small to detect an effect and there were baseline differences that resulted in risk of bias. Evidence is insufficient to recommend riluzole for SMA type I. No further trials were identified for this 2011 update. No drug treatment has been shown to have significant efficacy for SMA type I.

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

Version: 2012

Spinal muscular atrophy (SMA) is a neuromuscular disorder that results in progressive muscle weakness with onset in childhood and adolescence. There are three main types of SMA. Drug treatment for SMA type I is discussed in a separate Cochrane review. This review is of drug treatment for SMA types II and III. Both of these reviews were first published in 2009 and are now updated. The age of onset of SMA type II is between six and 18 months. Children with SMA type II will never be able to walk without support; they survive beyond two years and may live into adolescence or longer. The age of onset of SMA III, also known as Kugelberg‐Welander disease, is after 18 months. Children with SMA type III develop the ability to walk at some time and their life expectancy is normal. From six randomised controlled trials, there is no evidence for a significant effect on the disease course when patients with SMA types II and III are treated with creatine (55 participants), phenylbutyrate (107 participants), gabapentin (84 participants), thyrotropin releasing hormone (9 participants), hydroxyurea (57 participants) or combination therapy with valproate and acetyl‐L‐carnitine (61 participants). The risk of bias of the included trials was systematically analysed and none of the studies were completely free of bias. Thus, there is still no known efficacious drug treatment for SMA types II and III.

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

Version: 2012

Neuralgic amyotrophy is a painful disorder of the peripheral nervous system that occurs in episodes. It affects the arms and shoulders, and leads to muscle wasting and weakness. There has been anecdotal evidence that corticosteroids can have a favourable effect on pain and recovery. No randomised clinical trial could be found in either the original 2009 review or when searches were updated in 2011 to validate the effects of this type of treatment, or any treatment. One randomised controlled trial comparing prednisolone to placebo is currently awaiting formal reporting.

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

Version: 2012

Diabetic amyotrophy, which is also known as diabetic lumbosacral radiculoplexus neuropathy, diabetic femoral neuropathy or Bruns‐Garland syndrome, is an uncommon disorder of the peripheral nerves (nerves outside the brain and spinal cord) that occurs in people with diabetes. The condition causes pain and weakness in the legs, mostly the muscles at the front of the thigh. Some researchers have found that blood vessels become inflamed and have suggested that this interrupts blood supply to the nerves. Medicines that target immune cells could be helpful.

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

Version: July 26, 2017

To systematically review and synthesize evidence evaluating the comparative effectiveness of treatments for menopausal symptoms, along with potential long-term benefits and harms of those treatments.

Comparative Effectiveness Reviews - Agency for Healthcare Research and Quality (US).

Version: March 2015

BACKGROUND: Neuromuscular electrical stimulation (NMES) therapy may be useful in early musculoskeletal rehabilitation during acute critical illness. The objective of this systematic review was to evaluate the effectiveness of NMES for preventing skeletal-muscle weakness and wasting in critically ill patients, in comparison with usual care.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2013

OBJECTIVES: To evaluate whether supported standing can affect lower limb muscle length, spasticity, bone mineral density or the function of adults with upper motor neurone disorders.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2012

Study Design Systematic review. Study Rationale Adult scoliosis is a common disorder that is associated with significantly higher pain, functional impairment, and effect on quality of life than those without scoliosis. Surgical spinal fusion has led to quantifiable improvement in patient's quality of life. However, for patients undergoing long lumbar fusion, the decision to stop the fusion at L5 or to extend to S1, particularly if the L5-S1 disc is healthy, remains controversial. Objective The aim of the study is to evaluate if fusion stopping at L5 increases the comparative rates of revision, correction loss, and/or poor functional outcomes compared with extension to the sacrum in adult scoliosis patients who require spinal fusion surgery. Materials and Methods A systematic review of the literature was performed using PubMed, the National Guideline Clearinghouse Database and bibliographies of key articles that evaluated adult scoliosis patients who required spinal fusion surgery and compared outcomes for fusions to the sacrum versus stopping at L5. Articles were included on the basis of predetermined criteria and were appraised using a predefined quality-rating scheme. Results From 111 citations, 26 articles underwent full-text review, and 3 retrospective cohort studies met all inclusion and exclusion criteria. Revision rates in subjects who underwent spinal fusion to L5 (20.8-23.5%) were lower in two studies compared with those with fusion extending to the sacrum (19.0-58.3%). Studies that assessed deformity correction used different measures, making comparison across studies difficult. No significant differences were found in patient-reported functional outcomes across two studies that used different measures. Conclusion The limited data available suggest that differences in revision rates did not consistently reach statistical significance across studies that compared spinal fusion to L5 versus extension to sacrum in adult scoliosis patients.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2013

OBJECTIVE: To analyze the outcomes enabled by the neuromuscular electric stimulation in critically ill patients in intensive care unit assisted.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2014

Motor neurone disease (MND) is a neurodegenerative condition that affects the brain and spinal cord. MND is characterised by the degeneration of primarily motor neurones, leading to muscle weakness.

NICE Guideline - National Clinical Guideline Centre (UK).

Version: February 2016

Falls represent an important source of preventable morbidity and mortality in older adults, the fastest growing segment of the U.S. population. We undertook a systematic review of falls interventions applicable to primary care populations to inform the U.S. Preventive Services Task Force’s (USPSTF’s) updated recommendation on preventing falls in older adults.

Evidence Syntheses - Agency for Healthcare Research and Quality (US).

Version: December 2010

In summary, a large number of women in the UK experience menopausal symptoms which, in many cases, can significantly affect their quality of life. It is probable that a minority of these women seek medical treatment and for those who do there is considerable variation in the help available, with many being told that the symptoms will get better with time. Since symptoms may often continue for 7 years or more, this advice is inappropriate and help should be offered where possible. Women need to know about the available options and their risks and benefits, and be empowered to become part of the decision-making process.

NICE Guideline - National Collaborating Centre for Women's and Children's Health (UK).

Version: November 12, 2015

Heavy menstrual bleeding (HMB) has an adverse effect on the quality of life of many women. It is not a problem associated with significant mortality. Many women seek help from their general practitioners and it is a common reason for referral into secondary care.

NICE Clinical Guidelines - National Collaborating Centre for Women's and Children's Health (UK).

Version: January 2007

Diabetes is a long-term condition that can have a major impact on the life of a child or young person, as well as their family or carers. In addition to insulin therapy, diabetes management should include education, support and access to psychological services, as detailed here and in this guideline. Preparations should also be made for the transition from paediatric to adult services, which have a somewhat different model of care and evidence base.

NICE Guideline - National Collaborating Centre for Women's and Children's Health (UK).

Version: August 2015

The study found limited evidence on the effectiveness of the various types of orthoses used within the NHS to manage patients with neuromuscular and central nervous system conditions, especially in relation to the outcomes that are important to patients.

Health Technology Assessment - NIHR Journals Library.

Version: July 2016

This guideline covers the physical, emotional, social and spiritual elements of end of life care, and focuses on improving the child or young person’s quality of life and supporting their family and carers. There are, for instance, recommendations on managing distressing symptoms and providing care and bereavement support after death. Recommendations have also been made about how services should be delivered. The guideline is aimed at all providers of paediatric end of life care, whatever their level of practise, and also for children and young people with life-limiting conditions and their parents or carers.

NICE Guideline - National Guideline Alliance (UK).

Version: December 2016

The study found that obesity [as measured using body mass index (BMI)] was found to persist from adolescence to adulthood and is associated with an increased risk of adult disease. However, increased BMI is not good at identifying which children (obese or healthy weight) will have obesity-related diseases in adulthood.

Health Technology Assessment - NIHR Journals Library.

Version: June 2015

Clinical guidelines have been defined as ‘systematically developed statements which assist clinicians and patients in making decisions about appropriate treatment for specific conditions’. This guideline has been developed with the aim of providing guidance on the care of children with bronchiolitis.

NICE Guideline - National Collaborating Centre for Women's and Children's Health (UK).

Version: June 2015

This guideline updates for primary prevention, the NICE technology appraisal, ‘Statins for the prevention of cardiovascular events’ (TA94, 2007) and reviews and updates the recommendations made in the NICE guideline Lipid Modification (CG67, 2008) for primary and secondary prevention of cardiovascular disease (CVD). The scope for this guideline was limited to the identification and assessment of CVD risk and to the assessment and modification of lipids in people at risk of CVD, or people with known CVD. The guideline development group wishes to make clear that lipid modification should take place as part of a programme of risk reduction which also include attention to the management of all other known CVD risk factors.

NICE Clinical Guidelines - National Clinical Guideline Centre (UK).

Version: July 2014

For many people faecal incontinence is the result of a complex interplay of contributing factors, many of which can co-exist. Some may be relatively simple to reverse.

NICE Clinical Guidelines - National Collaborating Centre for Acute Care (UK).

Version: 2007

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