Economic Evaluation of a Novel Treatment of Attention-Deficit/Hyperactivity Disorder in US Motor Vehicle Drivers.

Background: Attention-deficit/hyperactivity disorder (ADHD) affects approximately 4.4% of US adults. ADHD is associated with high-risk driving behavior and costly motor vehicle accidents. DYANAVEL XR (DXR) (Tris Pharma, Inc.) is a once-daily fast-acting amphetamine developed for ADHD treatment. A randomized controlled trial showed that DXR patients were 43% less likely to crash during a driving simulation than individuals taking placebo. Study outcomes suggest a DXR crash rate similar to that of a driver without ADHD, while patients treated with the current standard of care (SOC) have a 52% higher crash risk than non-ADHD drivers. Objective: The aim was to evaluate the economic benefits attributable to improved driving abilities and avoided crashes in DXR patients compared with patients treated with the SOC or those who are untreated. Methods: A cost-impact model estimated 1-year crash-related cost outcomes for DXR-treated patients compared with SOC-treated and untreated ADHD patients. SOC was assumed to consist of a combination of short-, intermediate-, and long-acting ADHD stimulant and non-stimulant medications. DXR crash risk was assumed equivalent to the non-ADHD population risk, as supported by trial data. Crash risk for untreated and SOC-treated ADHD patients were assumed to be 99% and 52% higher than the general US population, respectively. Model outcomes included the cost impact (medication- and crash-related costs) and the number of crashes, injuries, and fatalities avoided with DXR. Results: Treatment with DXR would avoid 0.82 crashes, 0.016 injuries, and 0.036 fatalities per year compared with untreated patients, and 0.036 crashes, 0.007 injuries, and 0.0001 fatalities per year compared with SOC-treated patients. Compared with a population of 25% SOC-treated patients and 75% untreated patients, DXR use would save an average of 4581 p e r p e r s o n p e r y e a r a c r o s s a l l a g e g r o u p s w h e n p r i c e d a t 80 per month, assuming all SOC-treated and untreated patients utilized DXR. When the value of quality-of-life improvement is considered, savings increase over 7-fold. Discussion: Outcomes suggest that DXR may be an economically beneficial treatment compared with SOC for ADHD patients. Conclusions: The economic model showed that DXR is cost-saving compared with no treatment and SOC by reducing the number of motor vehicle crashes in the ADHD population.

Motor Unit Number Index of the Upper Trapezius: A Meta-Analysis and Cross-sectional Study of Its Reliability.

Motor unit number index of the upper trapezius (MUNIX-Trapezius) is a candidate biomarker for bulbar lower motor neuron function; however, reliability data is incomplete. To assess MUNIX-Trapezius reliability in controls, we conducted a systematic review, a cross-sectional study (n = 20), and a meta-analysis. We demonstrated a high inter- and intra-rater intraclass correlation (0.86 and 0.94, respectively), indicating that MUNIX-Trapezius is reliable with between-study variability moderated by age and MUNIX technique. With further validation, this measure can serve as a disease monitoring and response biomarker of bulbar function in the therapeutic development for amyotrophic lateral sclerosis.

Physical Compatibility of Cefiderocol with Selected Intravenous Drugs During Simulated Y-site Administration.

The physical compatibility of cefiderocol for injection (prepared as a diluted 2% cefiderocol solution) with potential co-administration drug products is presented. The compatibility of cefiderocol with a selection of 91 intravenous drugs was tested at clinically relevant concentrations using the admixed volume ratio 1:1. Compatibility of the mixtures was determined by visual observations, turbidity, and particulate-matter measurements. The mixtures were examined immediately after mixing, and then at 1 hour and 4 hours thereafter at room temperature. When using 0.9% sodium chloride or 5% dextrose injection for diluents, solutions of dobutamine hydrochloride, esomeprazole sodium, methylprednisolone acetate, propofol, rocuronium bromide, amiodarone hydrochloride, famotidine, labetalol hydrochloride, mycophenolate mofetil, acyclovir sodium, amphotericin B, caspofungin acetate, doxycycline, posaconazole, diphenhydramine hydrochloride, and phenytoin sodium were found to cause visible cloudiness upon mixing with 2% cefiderocol in both diluents. Solutions of lorazepam, tobramycin sulfate, and vancomycin hydrochloride were determined incompatible by examining the mixtures with the aid of a Tyndall light. These 19 drugs were clearly incompatible with cefiderocol for injection by visual examination. In addition, solutions of iron sucrose and albumin were incompatible with 2% cefiderocol based on sub-visual tests for turbidity and/or particulate matter. Based on sub-visual data, the 0.9% sodium chloride admixture of aminophylline and 2% cefiderocol was incompatible, while inconclusive results were obtained for the 0.9% sodium chloride admixtures of 2% cefiderocol with amikacin sulfate. Similarly, the 5% dextrose admixtures of either ciprofloxacin or polymyxin B sulfate with 2% cefiderocol were incompatible, whereas data for phenylephrine hydrochloride morphine sulfate, or undiluted sodium bicarbonate were inconclusive. Overall, the 2% cefiderocol solution was physically compatible with 63 of 91 drugs challenged at 1:1 volume ratio in both 0.9% sodium chloride and 5% dextrose diluents for at least 4 hours at the concentrations tested in this study.

Critical care management of cerebral venous thrombosis.

PURPOSE OF REVIEW: Although recent trials of intervention for acute ischemic stroke have been positive, similar benefit in acute cerebral venous thrombosis (CVT) remains largely unclear. This review aims to summarize the existing evidence regarding the management of CVT, including anticoagulation and endovascular therapy. RECENT FINDINGS: The mainstay of treatment in CVT is systemic anticoagulation even in the setting of intracerebral hemorrhage. Nonrandomized studies and case series suggest that endovascular therapy in CVT is relatively safe, and can improve outcomes in the small subset of CVT patients with neurologic deterioration despite anticoagulation. SUMMARY: Despite a generally favorable prognosis, one in four patients with CVT develop neurological deterioration in the acute phase. Predisposing factors include a neurological deficit or seizures at onset, deep venous thrombosis, venous infarctions, or intracranial hemorrhage with mass effect and an underlying thrombophilia. More randomized trials are needed to compare the benefits of anticoagulation and endovascular therapy.

Dramatic Cataplexy Improvement Following Right Parietal Surgery.

This is the case of a 34-year-old woman with severe narcolepsy with cataplexy who experienced a dramatic reduction in cataplexy symptoms after resection of a right parietal astrocytoma. The patient underwent detailed neurological exam, neuropsychological testing, polysomnography and multiple sleep latency testing following surgery.

Fluorodeoxyglucose positron emission tomography in semantic dementia after 6 months of memantine: an open-label pilot study.

OBJECTIVES: To follow up on the increases we reported in normalized metabolic activity in salience network hubs from a 2-month open-label study of memantine in frontotemporal dementia (FTD). METHODS: We repeated fluorodeoxyglucose positron emission tomography (FDG-PET) after 6 months of drug use and subjected the data to Statistical Parametrical Mapping (SPM) analysis to reveal clusters of significant change from baseline. We also sought correlations between changes in behavioral disturbances on the Frontal Behavioral Inventory (FBI) and the PET signal. RESULTS: Recruitment of one progressive nonfluent aphasia and one behavioral variant FTD precluded statistical analysis for any FTD subtype other than semantic dementia (SD). The baseline-to-6-month interval showed increased normalized metabolic activity in the left orbitofrontal cortex (p < 0.002) for five participants with SD. The 2-6-month interval revealed a late increase in normalized metabolic activity in the left insula (p < 0.013), right insula (p < 0.009), and left anterior cingulate (p < 0.005). The right anterior cingulate showed both an initial increase and a delayed further increase (2-6 months, p < 0.016). FBI scores worsened by 43.3%. One participant with SD opted not to continue memantine beyond 2 months yet showed similar FDG-PET increases. CONCLUSIONS: Increases in normalized cortical metabolic activity in salience network hubs were sustained in SD over a 6-month period. Because one participant without medication also showed these changes, further investigation is recommended through a double-blind, placebo-controlled study with FDG-PET as an outcome measure.

When dementia is in the house: needs assessment survey for young caregivers.

OBJECTIVE: To learn more about the needs and experiences of young carers for patients of frontotemporal dementia (FTD) in order to create a relevant support website for young caregivers to dementia patients. METHODS: Two focus groups were held with a total of fourteen young carers aged 11-18. The data corpus was collected through a semi-structured interview facilitated by a medical journalist who had prior experience as a caregiver to a patient with FTD. The transcripts were narrowed to a dataset for descriptive analysis using a coding scheme to reveal the main themes of their responses. RESULTS: Seven overlapping theme areas were: emotional impact of living with a parent with FTD, caregiving, coping, symptoms, diagnosis, relationships, and support. Based on the participants' responses, a website was launched providing supportive information and counsel for young carers. CONCLUSION: Young carers saw the experience of caring for a parent with early-onset dementia as positive overall, but identified opportunities for professionals to assist them in overcoming stigma and the challenge of balancing childhood and adolescent development within this context.