Effect of dystonia and botulinum toxin treatment on health-related quality of life.

In view of the steadily rising demand for treatment of dystonia with botulinum toxin (BT), a relatively expensive neurologic paralytic agent, an exploratory study was undertaken to assess the extent to which dystonia and BT treatment affect the quality of people's lives. One hundred thirty adults with a current diagnosis of dystonia completed two generic measures of health-related quality of life (HRQoL) at regular intervals over a minimum of 6 months. One hundred two participants were receiving regular injections of BT; 28 were not taking BT. The HRQoL instruments used were the EuroQol and the Short Form 36 health survey questionnaire (SF-36). Compared with general population samples, study participants reported greater impairment on all EuroQol and SF-36 dimensions and gave a lower rating to their own health status. Participants with nonfocal dystonia had significantly more problems with usual activities than participants with focal dystonia, and a higher number had problems with mobility and self-care. The groups reported similar levels of pain and emotional well-being. Small improvements in HRQoL were seen after the administration of BT, although few of these were statistically significant. The study results offer further psychometric evidence for the discriminant and construct validity of both the EuroQol and the SF-36.

Measuring patient benefit from botulinum toxin in the treatment of dystonia. Feasibility of cost-utility analysis.

The dystonias are a group of movement disorders arising from CNS dysfunction and characterised by involuntary and prolonged spasms of muscle contraction. Recently there has been increasing demand for treatment with botulinum toxin (BT), a relatively expensive neurological paralytic agent. As there has been no systematic assessment of patient benefit from BT, this study was undertaken to develop and test a methodology for assessing the cost utility of BT therapy for patients with dystonias. A generic health status instrument, the EuroQOL, was completed at regular intervals over at least 6 months by 130 patients with a current diagnosis of dystonia. A general population tariff was used to calculate quality-adjusted life-year (QALY) gains from BT treatment, and relevant cost data were obtained from patients and medical records. The cost-per-QALY estimates ranged considerably, depending on the type of dystonia, the duration of BT treatment, type of health-related quality-of-life (HR-QOL) tariff used and baseline characteristics of participants. The study findings reflect the general clinical impression of BT: that it can benefit patients with dystonia, but the benefit may be small compared with many treatments for other diseases. The nature of the disease and its cyclical treatment caused practical difficulties in recruiting participants, administering questionnaires and in estimating QALY gains.

Racial differences in the prevalence of small-for-dates infants among college-educated women.

We used Illinois vital records and U.S. Census data to quantify the association of race and small-for-dates rates among women with 16 or more years of education. The small-for-dates rate for African-Americans was 2.8%, compared with 1.2% for whites [odds ratio (OR) = 2.5; 95% confidence interval (CI) = 1.8-3.4]. Adjustment for measures of socioeconomic status did not reduce the racial disparity (OR = 2.9; 95% CI = 1.4-4.5). We conclude that unidentified variables occurring with greater prevalence among African-Americans increase the risk of small-for-dates infants among college-educated African-American mothers.

Beclomethasone dipropionate aerosol compared with dry powder in the treatment of asthma.

In a double-blind trial, beclomethasone dipropionate inhaled as a dry powder in doses of 200 micrograms three times a day was compared with the conventional aerosol of 100 micrograms three times a day, each for a period of 4 weeks. Neither the dry powder nor the aerosol showed any significant advantage over each other in terms of ventilatory function. Plasma cortisol levels were unaltered with the two medications in spite of the doubled dose of the corticosteroid powder. Choice of one or the other method of administration of medication depended on patient preference and the ease with which he could familiarize himself with either technique.

Beclomethasone dipropionate in asthma: a comparison of two methods of administration.

Beclomethasone dipropionate inhaled as a dry powder in doses of 200 microgram four times a day was compared with the usual dose of 100 microgram four times a day from a pressurized aerosol in 65 patients with asthma who used pressurized aerosols correctly. Each treatment was given for an eight-week period. The dry powder did not show any clinically significant advantage over the aerosol in terms of ventilatory function as measured by FEV1 and the daily peak flow measurements during both treatments did not differ. The incidence of oral candidiasis was low and no other side-effects were encountered. It was concluded that beclomethasone dipropionate in dry powder form was as effective as aerosol in the treatment of asthma.

Comparison of labetalol and propranolol in hypertension.

1 Labetalol has been compared with propranolol in a double-blind, double-dummy study of 24 patients with mild or moderate essential hypertension. 2 Two patients were unable to tolerate propranolol and five labetalol, because of symptom side effects; this difference was not significant (P greater than 0.1). 3 On a self-administered questionnaire, labetalol was associated with a greater number of side effects per patient than propranolol, but no individual side effect was significantly more common with either drug. 4 There was no difference in the number of spontaneously reported side effects between the two drugs. 5 Both drugs impaired pulmonary function, but propranolol caused a greater reduction than labetalol after 8 weeks of treatment. 6 We conclude that labetalol and propranolol are similarly effective and acceptable to the patient.

Intranasal beclomethasone dipropionate in seasonal rhinitis in general practice.

Thirty-five patients with seasonal allergic rhinitis were treated in a double-blind comparative trial in and East London Group Practice with either beclomethasone dipropionate (50 micrograms in each nostril four times a day) or a placebo aerosol preparation identical in appearance. There was a statistically significant difference in favour of intranasal beclomethasone dipropionate (P less than 0-05).

Double-blind cross-over trial comparing intranasal beclomethasone dipropionate and placebo in perennial rhinitis.

Twenty-five patients with perennial rhinitis completed a double-blind cross-over trial of intranasal beclomethasone dipropionate 200 mug daily and placebo. Of these patients 19 preferred the active drug and two preferred placebo. There were significant reductions in symptom scores for nasal obstruction and rhinorrhoea and in the use of decongestant nasal drops when using the active drug. No changes in morning plasma cortisol levels occurred during the three-week treatment period.

Recovery of adrenal function after substitution of beclomethasone dipropionate for oral corticosteroids.

Of 16 steroid-dependent asthmatic patients oral treatment has been discontinued in six and reduced in four after the introduction of beclomethasone dipropionate. Substitution of inhaled beclomethasone for oral steroids was unsuccessful in the remaining six patients. Serial adrenal function studies in the patients whose oral treatment was discontinued showed progressive recovery, and five out of six had a normal response to tetracosactrin stimulation after two months.

Comparison of beclomethasone dipropionate aerosol and prednisolone in reversible airways obstruction.

This paper describes a double-bond crossover trial of prednisolone and beclomethasone dipropionate aerosol in 38 steroid-dependent patients with reversible diffuse airways obstruction. Altogether there was no difference in the patient's preference of the two treatment groups or in the number of times they used their bronchodilator aerosol, or in the forced expiratory volume in one second, vital capacity, or peak expiratory flow rate in the two treatment groups. The plasma cortisol levels when the patients were on the aerosol were much higher than when they were on prednisolone. The use of inhaled aerosol steroids seems to be preferable as it eliminates the usual complications of oral steroid therapy.