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Miscellaneous

Second-generation antiepileptic medications in children: efficacy and cognitive effects

Pages 181-192 | Published online: 10 Jan 2014

References

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  • •The paper to read, with important observations including that the new drugs may not be adding much to our ability to make patients seizure free. Clearly, this approach will need to be constantly updated as even newer drugs are increasingly used. Also important is the finding that persons not responding to the first AEDs probably have something quite wrong with their brain and the chances of becoming seizure free with any drug are small. Indirectly supports the argument for early surgical intervention.
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  • ••A study performed about studies.Randomized-controlled trials of AEDs were reviewed to evaluate the methodologies used for assessing mood and quality of life. Concerns are expressed regarding the validity of the measures in the epilepsy population and failure to review previously defined methods, 52 different exams were used in 46 trials.
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  • •The investigators address an interesting problem that arises in many double-blind studies, can the patients and investigators really remain blinded? True placebo effects are well known to occur but certainly many drugs produce significant effects on seizures, mood, or just not feeling well. The investigators actually studied how accurate the guesses were.
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  • ••This study is not unique its use of normalpaid volunteers to assess the effects of a medication. The methodology of which tools are used in assessing the impact of the AEDs, however, rivals the best of any study. Many of the tasks have previously been demonstrated to be sensitive to these effects and a detailed description is provided.
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  • •Brief review of the data supporting introduction rates of both new and older AEDs.
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  • ••Start of the detailed mathematical analysesto allow comparison of all the AEDs and in conjunction with [59] all new approved medications are included. A list of the studies included is provided and this serves as the starting point for other investigators' approaches.
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  • •After-the-fact paper that explains [62] and [63]. The methodology is explained in detail and contrasted to OR determinations, the advantage of the number-to-treat for the clinician, but the concerns expressed by the statisticians. Includes an example using TPX.
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  • ••Review and insight into what is necessaryto move the development of new medications foreward.
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