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Biomedical subjects

C E Counsell

Publications and source records attributed to C E Counsell.

18 recordsLinked to original sources
PubMed2005

Screening for undiagnosed parkinsonism in people aged 65 years and over in the community.

We screened a random sample of 2449 people aged 65 years and over for undiagnosed parkinsonism, using a postal screening questionnaire followed by clinical neurological assessment. Amongst the 1556 (63.5%) patients who responded, four patients with previously undiagnosed parkinsonism were identified, suggesting a prevalence of 257 per 100,000 (95% CI 70, 658) in this age-group. Although only small, the numbers were sufficient to significantly increase the incidence of parkinsonism in an incidence study. Two simple screening questions achieved a high sensitivity for newly diagnosed parkinsonism of 95%, but a low specificity of 28%.

Aged↗
PubMed2005

Monoamine oxidase B inhibitors for early Parkinson's disease.

BACKGROUND: It has been postulated that monoamine oxidase B (MAO-B) inhibitors alter disease progression in Parkinson's disease (PD). Clinical trials have produced conflicting results. OBJECTIVES: To assess the evidence from randomized controlled trials for the effectiveness and safety of long-term use of MAO-B inhibitors in early PD. SEARCH STRATEGY: We searched the following electronic databases: Cochrane Central Register of Controlled trials (CENTRAL) (The Cochrane Library Issue 2, 2004), MEDLINE (last searched 18th August 2004) and EMBASE (last searched 18th August 2004). We also handsearched neurology and movement disorders conference proceedings, checked reference lists of relevant studies and contacted other researchers. SELECTION CRITERIA: We sought to include all unconfounded randomized controlled trials that compared a MAO-B inhibitor with control, in the presence or absence of levodopa or dopamine agonists, in patients with early PD and where treatment and follow up lasted at least one year. DATA COLLECTION AND ANALYSIS: Two reviewers independently selected trials for inclusion, assessed the methodological quality, and extracted the data. A small amount of additional data was provided by the original authors. Random-effects models were used to analyse results, where appropriate. MAIN RESULTS: Ten trials were included (a total of 2422 patients), nine using selegiline, one using lazabemide. The methodological quality was reasonable although concealment of allocation was definitely adequate in only four trials. The mean follow up was for 5.8 years. MAO-B inhibitors were not associated with a significant increase in deaths (odds ratio (OR) 1.15; 95% confidence interval (CI) 0.92 to 1.44). They provided small benefits over control in impairment (weighted mean difference (WMD) for change in motor UPDRS score was 3.81 points less with MAO-B inhibitors; 95% CI 2.27 to 5.36) and disability (WMD for change in UPDRS ADL score was 1.50 less; 95% CI 0.48 to 2.53) at one year which, although statistically significant, were not clinically significant. There was a marked levodopa-sparing effect with MAO-B inhibitors which was associated with a significant reduction in motor fluctuations (OR 0.75; 95% CI 0.59 to 0.94) but not dyskinesia (OR 0.97; 95% CI 0.76 to 1.25). The reduction in motor fluctuations was, however, not robust in sensitivity analyses. Although adverse events were generally mild and infrequent, withdrawals due to side-effects were higher (OR 2.36; 95% CI 1.32 to 4.20) with MAO-B inhibitors. AUTHORS' CONCLUSIONS: MAO-B inhibitors do not appear to delay disease progression but may have a beneficial effect on motor fluctuations. There was no statistically significant effect on deaths although the confidence interval does not exclude a small increase with MAO-B inhibitors. At present we do not feel these drugs can be recommended for routine use in the treatment of early Parkinson's disease but further randomized controlled trials should be carried out to clarify, in particular, their effect on deaths and motor complications.

Antiparkinson Agents↗
PubMed2003

Reliability of the variables in a new set of models that predict outcome after stroke.

OBJECTIVES: To provide valid predictions of outcome, the variables included in a prognostic model must be capable of reliable collection. The authors have recently reported a set of simple but rigorously developed models that predict outcome after stroke. The aim of this study was to establish the inter-rater reliability of the variables included in the models. METHODS: Inter-rater agreement was measured prospectively (between two clinicians; 92 patients) and retrospectively (between two auditors; 200 patients) and the validity of the data collected retrospectively was estimated by comparing them with data collected prospectively (195 patients). In the prospective study inter-rater agreement for urinary incontinence and for the variables of three other previously published models was also measured. The median difference (md) between ages and kappa statistics for other variables was calculated. RESULTS: For the model variables, prospective agreement ranged from good to excellent (age: md 0 years; living alone before the stroke kappa 0.84; pre-stroke functional independence kappa 0.67; normal verbal Glasgow Coma Scale score kappa 0.79; ability to lift both arms against gravity kappa 0.97; ability to walk unaided kappa 0.91) while retrospective agreement (age: md 0 years; kappa 0.55-0.92) and agreement between prospective and retrospective observers (age: md 0 years; kappa 0.49-0.78) was acceptable but less good. Prospective agreement was excellent for urinary incontinence (kappa 0.87) and variable for the other models (kappa 0.23-0.81) CONCLUSION: The variables included in these new simple models of outcome after stroke are capable of reliable collection, comparable to or better than that of the other predictive variables considered. When collected retrospectively, the model variables are likely to remain reliable and reasonably valid.

Aged↗
PubMed1998

Incidence studies of primary and secondary intracranial tumors: a systematic review of their methodology and results.

We reviewed the incidence studies of intracranial tumors to compare their methodology and identify whether there was evidence of true differences in incidence by time, place, age, or sex. Studies were identified from Medline (1966-95), bibliographies of relevant articles, and personal knowledge. For each study, various methodological details were recorded, along with the age-standardized incidence of all primary tumors and the crude and age/sex-specific incidences of different types of intracranial tumor. Methodological factors which significantly influenced the reported incidence were identified and the results of different studies were compared and combined in a meta-analysis if appropriate. Twenty studies (over 20,000 primary tumors) were included. Higher incidences of primary tumors were found in studies that: used many methods to identify cases (odds ratio [OR] 1.92); included a high percentage of asymptomatic patients (OR 2.03); did not require histologic confirmation of the diagnosis (OR 1.69). Studies from the 1980's reported higher incidences than in previous decades (OR 1.51), probably because of improved methodology. Comparable studies from the 1980's gave widely different incidence rates for all primary tumors (7.1-18.6 per 100,000 per year). In all studies, the incidence of neuroepithelial and meningeal tumors increased dramatically with age. Neuroepithelial tumors were 40% more common in men, whilst meningeal and cranial nerve tumors were about 80% and 40% more common in women, respectively. Further incidence studies are required to establish geographical and secular variations in the incidence of primary intracranial tumors but these must use comparable methodologies. Provisional guidelines for future studies are given.

Age Distribution↗
PubMed1997

A systematic review of the randomised trials of carotid patch angioplasty in carotid endarterectomy.

OBJECTIVES: To determine whether patch angioplasty is more effective than primary closure in carotid endarterectomy, and whether one type of patch is better than another. DESIGN: Systematic review of the randomised trials. MATERIALS: Trials were identified from the Cochrane Stroke Review Group database plus additional handsearching, electronic searching, and personal contact. METHODS: Two authors independently selected studies for inclusion and extracted details of trial quality and data on the following outcomes: any stroke; stroke ipsilateral to the operated artery; death; occlusion or restenosis, and other significant arterial complications. Meta-analysis of odds ratios (OR) was performed using the Peto method. RESULTS: Six trials (882 operations) compared routine patching with primary closure. Routine patching was associated with significant reductions in the risks of ipsilateral stroke during the perioperative period (OR 0.34, 95% CI 0.15-0.76) and during long-term follow-up (OR 0.38, 95% CI 0.16-0.88). Significant reductions in the odds of any stroke, stroke or death, acute arterial occlusion and long-term restenosis were also found. However, these results were based on very small numbers of outcome events and may be biased by losses to follow-up and publication bias. Three trials (326 operations) compared the use of polytetrafluoroethylene patches with venous patches. There were too few events (strokes, deaths, arterial complications) to determine whether there were significant differences between the patch materials. Fewer pseudoaneurysms occurred in those who received synthetic patches but the clinical consequence of this was unclear. CONCLUSIONS: Routine carotid patch angioplasty was associated with promising reductions in the risks of ipsilateral stroke and death, but the results should be interpreted cautiously because of the small number of outcome events, significant losses to follow-up, and poor trial methodology. Ideally, a large definitive trial should be performed. There is insufficient evidence to support the preferential use of one particular type of patch versus another.

Aged↗
PubMed1997

Local versus general anaesthesia in carotid endarterectomy: a systematic review of the evidence.

OBJECTIVE: To determine whether carotid endarterectomy under local anaesthesia is safer and as effective as under general anaesthesia. DESIGN: Systematic review of the randomised and non-randomised studies. MATERIALS: Studies were identified from the Cochrane Stroke Group's database plus additional handsearching and electronic searching. METHODS: Two authors independently selected studies for inclusion and extracted details of trial quality and data on death, any stroke, myocardial infarction and other operative complications. Meta-analysis was performed using the Peto method. RESULTS: There were 17 non-randomised studies (about 5970 patients) and only three randomised studies (143 patients). The non-randomised studies suggested that the use of local anaesthesia may be associated with clinically important reductions (approximately 50%) in the odds of stroke, stroke or death, myocardial infarction and pulmonary complications during the perioperative period, and with reductions in hospital stay. There were far too little data from the randomised trials to confirm or refute these findings: only one death and seven strokes were reported. CONCLUSIONS: Non-randomised studies suggest potentially important benefits from performing carotid endarterectomy under local anaesthesia. However, these studies were seriously flawed and can only be hypothesis generating. The results must be confirmed in large well-designed randomised trials before any recommendations on the use of local anaesthetic can be made.

Aged↗
PubMed1997

Limitations of using a cancer registry to identify incident primary intracranial tumours.

The completeness and accuracy of registration of primary intracranial tumours in the Scottish Cancer Registry was compared with a detailed incidence study performed over a two year period (1989-90). Of 228 patients with any primary intracranial tumour in the incidence study, 124 (54%) were identified as intracranial tumours in the cancer registry. The registry excluded benign tumours (although this was not consistent) and so the sensitivity of the registry varied with tumour type (84% for neuroepithelial tumours, 22% meningeal, 29% sellar, 0% cranial nerve). Of the 31 malignant tumours not found in the registry on our initial search, nine were found to have been included between 1989-90 but using different International Classification of Diseases-9th revision (ICD-9) codes or postcodes, and seven were found registered after 1990. Eleven per cent of cases (18/170) identified in the cancer registry were excluded from the incidence study: 11 had evidence of an intracranial tumour before 1989 whereas four definitely did not have an intracranial tumour. The cancer registry therefore significantly underestimated the incidence of all primary intracranial tumours, and of malignant intracranial tumours. Incidence studies must use additional methods to identify all primary tumours. Cancer registries should consider registering all primary intracranial tumours and may improve case ascertainment by screening neuroradiology data.

Brain Neoplasms↗
PubMed1996

Incidence of intracranial tumours in the Lothian region of Scotland, 1989-90.

OBJECTIVE: To determine the incidence of primary and secondary intracranial tumours in the Lothian region of south east Scotland. METHODS: A population based study was performed. Patients from Lothian with incident intracranial tumours diagnosed in 1989 and 1990 (by CT or histology) were identified retrospectively using multiple sources. Differences in incidence by tumour type, age, sex, and socioeconomic status were examined. RESULTS: Four hundred and forty two patients with incident intracranial tumours were identified (228 primary tumours and 214 secondary tumours). The crude yearly incidences of primary and secondary tumours were 15.3 and 14.3 per 100,000 respectively. The commonest primary tumours were neuroepithelial tumours (53.5%), meningeal tumours (19.5%), and sellar tumours (16.5%). About 50% of patients with secondary tumours had an underlying lung cancer. The incidence of primary and secondary tumours increased markedly with age. Meningeal tumours were more common in women, and neuroepithelial tumours were more common in those who lived in more affluent areas. CONCLUSIONS: The incidence rates of primary and secondary intracranial tumours in Lothian were more than twice those previously reported in the United Kingdom. Intracranial tumours are a significant cause of morbidity and mortality in the United Kingdom, and further research into their aetiology and treatment is urgently required.

Adolescent↗
PubMed1994

Coeliac disease and autoimmune thyroid disease.

A well defined cohort of coeliac patients was studied prospectively to assess the prevalence of coexisting thyroid disease and positive thyroid autoantibodies. Comparison with epidemiological data on the prevalence of coeliac disease in a neighbouring area suggested that few adult coeliac patients had been missed. Overall, 14% of the coeliac patients had thyroid disease: 10.3% were hypothyroid and 3.7% hyperthyroid, both significantly more than expected. There were significantly more coeliac disease patients with thyroid autoantibodies than expected--11% had thyroglobulin antibodies and 15% had thyroid microsomal antibodies. This association is clinically important. Three patients are described in whom the coexistence of coeliac disease and hypothyroidism led to diagnostic difficulties and delay of treatment.

Adult↗
PubMed1994

Focal necrotising herpes simplex encephalitis: a report of two cases with good clinical and neuropsychological outcomes.

Two patients with atypical focal necrotising herpes simplex encephalitis are described. They presented with relatively mild clinical disease but despite treatment with acyclovir (10 mg/kg/day for three days in case 1 and 10 days in case 2) they developed dramatic, progressive changes (shown on brain CT) that mimicked space occupying lesions of the temporal lobes. Both patients therefore had a diagnostic and therapeutic temporal lesionectomy followed by further 10 day courses of acyclovir. They subsequently went on to make good clinical and neuropsychological recoveries.

Adolescent↗
PubMed1991

Prosthetic valve endocarditis.

Prosthetic valve endocarditis occurs in 2-4% of patients with prosthetic valves and carries a mortality of around 50%. A low index of suspicion should enable early diagnosis. The empirical use of antibiotics in patients with a prosthetic valve who develop an unexplained fever is inappropriate. Careful liaison between cardiologist, microbiologist and cardiac surgeon is essential for optimal management.

Diagnosis, Differential↗
PubMedDate not supplied

The miracle of DICE therapy for acute stroke: fact or fictional product of subgroup analysis?

OBJECTIVE: To determine whether inappropriate subgroup analysis together with chance could change the conclusion of a systematic review of several randomised trials of an ineffective treatment. DESIGN: 44 randomised controlled trials of DICE therapy for stroke were performed (simulated by rolling different coloured dice; two trials per investigator). Each roll of the dice yielded the outcome (death or survival) for that "patient." Publication bias was also simulated. The results were combined in a systematic review. SETTING: Edinburgh. MAIN OUTCOME MEASURE: Mortality. RESULTS: The "hypothesis generating" trial suggested that DICE therapy provided complete protection against death from acute stroke. However, analysis of all the trials suggested a reduction of only 11% (SD 11) in the odds of death. A predefined subgroup analysis by colour of dice suggested that red dice therapy increased the odds by 9% (22). If the analysis excluded red dice trials and those of poor methodological quality the odds decreased by 22% (13, 2P = 0.09). Analysis of "published" trials showed a decrease of 23% (13, 2P = 0.07) while analysis of only those in which the trialist had become familiar with the intervention showed a decrease of 39% (17, 2P = 0.02). CONCLUSION: The early benefits of DICE therapy were not confirmed by subsequent trials. A plausible (but inappropriate) subset analysis of the effects of treatment led to the qualitatively different conclusion that DICE therapy reduced mortality, whereas in truth it was ineffective. Chance influences the outcome of clinical trials and systematic reviews of trials much more than many investigators realise, and its effects may lead to incorrect conclusions about the benefits of treatment.

Bias↗