1.
The accuracy of aneurysm size in predicting rebleeding after subarachnoid hemorrhage: a meta-analysis
Yu Z, Zheng J, Guo R, Li M, Li H, Ma L, You C
Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology. 2020
Abstract
BACKGROUND Aneurysmal subarachnoid hemorrhage (SAH) is a severe cerebrovascular disease. Rebleeding is an independent predictor of unfavorable outcome after aneurysmal SAH. However, the accuracy of aneurysm size for predicting rebleeding after aneurysmal SAH is still unclear. Hence, we conducted this meta-analysis to evaluate the predictive accuracy of large aneurysm for rebleeding after SAH. METHODS We performed a literature search in PubMed and Embase. Original studies about aneurysm size and rebleeding after SAH were included. Two reviewers completed data extraction and quality assessment. Pooled sensitivity, specificity, and their 95% confidence intervals (CIs) of large aneurysm for predicting rebleeding were calculated and shown in a forest plot. The overall accuracy of large aneurysm for predicting rebleeding after SAH was shown using a summary receiver operating characteristic (SROC) curve. Publication bias were assessed using Deeks' funnel plot. RESULTS A total of ten studies with 3889 patients met eligibility criteria and were included in this meta-analysis. The pooled sensitivity and specificity of large aneurysm for predicting rebleeding were 0.39 (95% CI 0.25-0.56) and 0.75 (95% CI 0.67-0.82), respectively. The area under SROC curve was 0.67 (95% CI 0.62-0.71). Deeks' funnel plot did not show obvious publication bias among included studies in this meta-analysis. CONCLUSION The specificity of large aneurysm for predicting rebleeding after SAH is relatively high. However, its overall accuracy for predicting aneurysm rebleeding is not very satisfying. A comprehensive model should be developed to improve the accuracy of rebleeding prediction after SAH.
2.
High-dose intravenous immune globulin for stiff-person syndrome
Dalakas MC, Fujii M, Li M, Lutfi B, Kyhos J, McElroy B
New England Journal of Medicine. 2001;345((26):):1870-6.
Abstract
BACKGROUND Stiff-person syndrome is a disabling central nervous system disorder with no satisfactory treatment that is characterized by muscle rigidity, episodic muscle spasms, high titers of antibodies against glutamic acid decarboxylase (GAD65), and a frequent association with autoimmune disorders. Because stiff-person syndrome is most likely immune-mediated, we evaluated the efficacy of intravenous immune globulin. METHODS We assigned 16 patients who had stiff-person syndrome and anti-GAD65 antibodies, in random order, to receive intravenous immune globulin or placebo for three months, followed by a one-month washout period and then by three months of therapy with the alternative agent. Efficacy was judged by improvements in scores on the distribution-of-stiffness index and heightened-sensitivity scale from base line (month 1) to the second and third month of each treatment phase. Direct and carryover effects of treatment were compared in the two groups. RESULTS Among patients who received immune globulin first, stiffness scores decreased significantly (P=0.02) and heightened-sensitivity scores decreased substantially during immune globulin therapy but rebounded during placebo administration. In contrast, the scores in the group that received placebo first remained constant during placebo administration but dropped significantly during immune globulin therapy (P=0.01). When the data were analyzed for a direct and a first-order carryover effect, there was a significant difference in stiffness scores (P=0.01 and P<0.001, respectively) between the immune globulin and placebo groups, and immune globulin therapy had a significant direct treatment effect on sensitivity scores (P=0.03). Eleven patients who received immune globulin became able to walk more easily or without assistance, their frequency of falls decreased, and they were able to perform work-related or household tasks. The duration of the beneficial effects of immune globulin varied from six weeks to one year. Anti-GAD65 antibody titers declined after immune globulin therapy but not after placebo administration. CONCLUSIONS Intravenous immune globulin is a well-tolerated and effective, albeit costly, therapy for patients with stiff-person syndrome and anti-GAD65 antibodies.