Caffeine as an adjuvant to ibuprofen in treating childhood headaches.

In adults, caffeine has been shown to enhance the effectiveness of most analgesics, including ibuprofen. This double-blind cross-over pilot study evaluated the effect of ibuprofen and caffeine compared with ibuprofen and placebo in 12 children with headaches. Patients completed diaries for both headaches. Outcome measures included a five-faces severity scale, a measure of clinical disability, and a scale of pain severity. Comparison of the cumulative response scores revealed a trend toward a greater response to ibuprofen-caffeine treatment of headaches (P = 0.14, P = 0.09, and P = 0.07 for the three measures, respectively). Further larger studies are needed to confirm this effect and to identify potential responders.

Impact of bisphosphonates on survival for patients with Duchenne muscular dystrophy.

OBJECTIVE: In this article we describe the association of bisphosphonate therapy on survival within a regional cohort of patients with Duchenne muscular dystrophy (DMD) who received steroid therapy and were managed in a single center. PATIENTS AND METHODS: The records of all patients with confirmed DMD who were born between 1963 and 2006 and who had received at least 1 year of steroid therapy were reviewed from birth until they reached the study end points (death, loss to follow-up, or the last follow-up was in 2009). A survival analysis was used to account for the variable follow-up duration within this cohort. RESULTS: Forty-four boys from this cohort with DMD were exposed to continuous steroid use. Bisphosphonate therapy was initiated for 16 patients (36%) between 1997 and 2007 at a median age of 12.5 years (range: 7-23 years). At the time of the last follow-up in 2009, 13 patients had died (30%) at a median age of 16 years (range: 14-27 years). Survival curves demonstrate that the prescription of bisphosphonates was associated with a significant improvement in survival rate (P = .005, log-rank test). Furthermore, a possible therapy-duration effect could be shown for bisphosphonate use (P = .007, log-rank test). CONCLUSIONS: The treatment of patients with DMD with steroids and bisphosphonates seems to be associated with significantly improved survival compared with treatment with steroids alone.

Impact of steroids on surgical experiences of patients with duchenne muscular dystrophy.

We studied surgical experiences within a regional cohort of patients with Duchenne muscular dystrophy, managed at a single center. Records of all patients with confirmed Duchenne muscular dystrophy who were born after 1962 were reviewed from birth until they reached study endpoints: scoliosis surgery, Achilles tendon lengthening, cataract surgery, loss to follow-up, or final follow-up point in 2009. A survival analysis was used to account for the variable follow-up duration within this cohort. By the end of the study period, 28/80 (35.0%) of boys with Duchenne muscular dystrophy had undergone spinal surgery, 22/80 (27.5%) had experienced Achilles tendon lengthening, and 6/80 (7.5%) had had cataracts removed. Moreover, 56.8% of this cohort received steroid therapy (prednisone or deflazacort; 95% confidence interval, 43.3-68.8%). Boys who had received steroid therapy were significantly less likely to undergo spinal surgery (P = 0.001), but were subsequently more likely to require cataract surgery (P = 0.005). Achilles tendon lengthening did not seem related to medication exposure. The treatment of patients with Duchenne muscular dystrophy with steroids significantly modified their surgical experience.

Duchenne muscular dystrophy: a 30-year population-based incidence study.

Duchenne muscular dystrophy (DMD) is among the most common lethal genetic diseases. It has been proposed that genetic counseling and prenatal diagnosis have begun to lower the incidence. We reviewed the records of all patients with confirmed DMD who were born between 1969 and 2008. Statistics Canada data on annual male births in Nova Scotia were obtained for each year.The overall incidence of 1 per 4700 male births remained stable during the 30-year period of the study. Similarly, the age at diagnosis did not change during that time.