BreakThrough Digest Medical News |
| Brain haemorrhage patients offered better treatment Posted: 28 May 2013 09:00 PM PDT An international trial has provided surgeons with a formula which predicts when brain haemorrhage patients need surgery for the best outcome. Brain haemorrhage affects some 4 million patients a year worldwide and the trial, run from Newcastle University, will help to ensure the best treatment is given at the right time.
David Mendelow, Professor of Neurosurgery at Newcastle University and honorary consultant within the Newcastle Hospitals NHS Foundation Trust, who ran the trials, has devised a formula published today in The Lancet online which will allow surgeons to calculate when to intervene with surgery after an intracerebral haemorrhage. This occurs when the blood escapes from the blood vessels into the brain itself to produce a solid clot. Professor Mendelow said: “This study gives hope to patients at the time of their initial haemorrhagic stroke. Not only will some lives be saved, but we have shown that operating at the right time means that about one in five patients are able to regain their independence.” The results of the trial, known as STICH II (Surgical Trial in Lobar Intracerebral Haemorrhage) are published in The Lancet online and presented today at the European Stroke Conference in London. The randomised trial, co-ordinated and completed at the Newcastle University Neurosurgery Trials Unit involved 601 patients from 78 centres in 27 countries around the world. Prior to this trial, surgeons did not have the detailed information telling them which patients benefited the most from surgery. Now this research provides surgeons with a formula which can be applied to fine tune decision-making for all these patients. It uses the established Glasgow Coma Score (GCS) ? a neurological scale that aims to give a reliable, objective way of assessing and recording the conscious state of a person ? the age of the patient and the volume of the clot. It provides surgeons with a prognosis-based outcome; 10 x GCS ? Age (years) – 0.64 x Volume (ml) The cut-point was established as 27.672 – meaning that any patient scoring less than this figure should be operated upon to offer them the best prognosis. Professor Mendelow added: “Our work provides a definitive guide as to when surgery is needed and when it can avoided to ensure the best treatment for patients.” ### Reference: Early surgery versus initial conservative treatment in patients with spontaneous supratentorial lobar intracerebral haematomas (STICH II): a randomised trial. Professor A David Mendelow, Dr Barbara A Gregson, Dr Elise N Rowan, Professor Gordon D Murray, Dr Anil Gholkar, Mr Patrick M Mitchell, STICH II Investigators. The Lancet on-line 29th May 2013. http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(13)60986-1/fulltext Contact: Karen Bidewell |
| Avatar therapy helps silence voices in schizophrenia Posted: 28 May 2013 09:00 PM PDT An avatar system that enables people with schizophrenia to control the voice of their hallucinations is being developed by researchers at UCL with support from the Wellcome Trust. The computer-based system could provide quick and effective therapy that is far more successful than current pharmaceutical treatments, helping to reduce the frequency and severity of episodes of schizophrenia.
In an early pilot of this approach involving 16 patients and up to seven 30-minute sessions of therapy, almost all of the patients reported a reduction in the frequency and severity of the voices that they hear. Three of the patients stopped hearing voices completely after experiencing them for 16, 13 and 3.5 years. The avatar therapy does not address the patients’ delusions directly, but the study found that these do improve as an overall effect. The team has now received a £1.3 million Translation Award from the Wellcome Trust to refine the system and conduct a larger, randomised study to evaluate this novel approach to schizophrenia therapy. The study will be conducted at King’s College London Institute of Psychiatry. The first stage in the therapy is for the patient to create a computer-based avatar, by choosing the face and voice of the entity they believe is talking to them. The system then synchronises the avatar’s lips with its speech, enabling a therapist to speak to the patient through the avatar in real time. The therapist encourages the patient to oppose the voice and gradually teaches them to take control of their hallucinations. Julian Leff, Emeritus Professor of Mental Health Sciences at UCL, who developed the therapy and is leading the project, said: “Even though patients interact with the avatar as though it was a real person, because they have created it they know that it cannot harm them, as opposed to the voices, which often threaten to kill or harm them and their family. As a result the therapy helps patients gain the confidence and courage to confront the avatar, and their persecutor. “We record every therapy session on MP3 so that the patient essentially has a therapist in their pocket which they can listen to at any time when harassed by the voices. We’ve found that this helps them to recognise that the voices originate within their own mind and reinforces their control over the hallucinations.” The larger study will begin enrolling the first patients in early July. The team are currently training the therapists and research staff to deliver the avatar therapy and finalising the study set-up. The first results are expected towards the end of 2015. Professor Thomas Craig of King’s College London Institute of Psychiatry, who will lead the larger trial, said: “Auditory hallucinations are a very distressing experience that can be extremely difficult to treat successfully, blighting patients’ lives for many years. I am delighted to be leading the group that will carry out a rigorous randomised study of this intriguing new therapy with 142 people who have experienced distressing voices for many years. “The beauty of the therapy is its simplicity and brevity. Most other psychological therapies for these conditions are costly and take many months to deliver. If we show that this treatment is effective, we expect it could be widely available in the UK within just a couple of years as the basic technology is well developed and many mental health professionals already have the basic therapy skills that are needed to deliver it.” Schizophrenia affects around 1 in 100 people worldwide, the most common symptoms being delusions (false beliefs) and auditory hallucinations (hearing voices). The illness often has a devastating effect, making it impossible to work and to sustain social relationships. Even with the most effective anti-psychotic medication, around one in four people with schizophrenia continue to suffer from persecutory auditory hallucinations, severely impairing their ability to concentrate. Current guidelines from the National Institute for Health and Care Excellence (NICE) recommend that schizophrenia is treated using a combination of medication and talking therapies, such as cognitive behavioural therapy. However, fewer than one in ten patients with schizophrenia in the UK have access to this kind of psychological therapy. Ted Bianco, Director of Technology Transfer and Acting Director of the Wellcome Trust, said: “At a time when many companies have become wary about investing in drug discovery for mental health, we are delighted to be able to facilitate the evaluation of an alternative approach to treatment based on the fusion of a talking therapy with computer-assisted ‘training’. “In addition to the attraction that the intervention is not reliant on development of a new medication, the approach has the benefit of being directly testable in patients. Should the results of the trial prove encouraging, we expect there may be further applications of the basic strategy worth exploring in other areas of mental health.” The Wellcome Trust has funded this project through its translational funding programme, which helps turn early-stage innovations into new health products by supporting researchers to advance the innovation to the point where it becomes attractive for further development by the medical industry or healthcare agencies. Paul Jenkins, CEO of the charity Rethink Mental Illness said: “We welcome any research which could improve the lives of people living with psychosis. As our Schizophrenia Commission reported last year, people with the illness are currently being let down by the limited treatments available. While antipsychotic medication is crucial for many people, it comes with some very severe side-effects. Our members would be extremely interested in the development of any alternative treatments.” Contact: Jen Middleton |
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