Objective: To report long-term efficacy and safety results of the SANTE trial investigating deep brain stimulation of the anterior nucleus of the thalamus (ANT) for treatment of localization-related epilepsy. Methods: This long-term follow-up is a continuation of a previously reported trial of 5- vs 0-V ANT stimulation. Long-term follow-up began 13 months after device implantation with stimulation parameters adjusted at the investigators9 discretion. Seizure frequency was determined using daily seizure diaries. Results: The median percent seizure reduction from baseline at 1 year was 41%, and 69% at 5 years. The responder rate (≥50% reduction in seizure frequency) at 1 year was 43%, and 68% at 5 years. In the 5 years of follow-up, 16% of subjects were seizure-free for at least 6 months. There were no reported unanticipated adverse device effects or symptomatic intracranial hemorrhages. The Liverpool Seizure Severity Scale and 31-item Quality of Life in Epilepsy measure showed statistically significant improvement over baseline by 1 year and at 5 years ( p Conclusion: Long-term follow-up of ANT deep brain stimulation showed sustained efficacy and safety in a treatment-resistant population. Classification of evidence: This long-term follow-up provides Class IV evidence that for patients with drug-resistant partial epilepsy, anterior thalamic stimulation is associated with a 69% reduction in seizure frequency and a 34% serious device-related adverse event rate at 5 years.

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Long-term efficacy and safety of thalamic stimulation for drug-resistant partial epilepsy

Drop-out from addiction treatment: A systematic review of risk factors

This article reviews progress in adapting addiction treatment to respond more fully to the chronic nature of most patients' problems. After reviewing evidence that the natural history of addiction involves recurrent cycles of relapse and recovery, we discuss emerging approaches to recovery management, including techniques for improving the continuity of care, monitoring during periods of abstinence, and early reintervention; recent developments in the field related to self-management, mutual aid, and other recovery supports; and system-level interventions. We also address the importance of adjusting treatment funding and organizational structures to better meet the needs of individuals with a chronic disease.

Managing Addiction as a Chronic Condition

A single electrode room-temperature atmospheric pressure plasma plume generated between a high-voltage electrode and the surrounding room air is reported. The plasma plume has a peak current of about 360mA. This is highest current carried by a room-temperature plasma plume ever reported. The rotational and vibrational temperature of the plasma plume is about 300 and 2950K, respectively. Emission spectra show that excited species, such as O, OH, N2+, etc., are present in the plasma plume.

A single electrode room-temperature plasma jet device for biomedical applications

Although the literature indicates that there is an association of victimization with substance abuse, there has been limited research focused on understanding and synthesizing the factors that have...

Victimization and Substance Abuse among Women: Contributing Factors, Interventions, and Implications:

Reliability, validity and responsiveness of a revised scoring system for the Liverpool Seizure Severity Scale.

This study examines the role of family status and demographic characteristics in explaining the nearly 60% dropout rate for women in substance abuse treatment. Data from the administrative record files of the Illinois Office of Alcoholism and Substance Abuse (OASA) for the fiscal year 1996–97 were analyzed for women age 12 or older who completed intake for publicly funded substance abuse treatment and whose outpatient treatment records were closed at year-end. Multivariate logistic regression models found that the likelihood of not completing treatment was greatest for women who were African American, pregnant, had custody of minor children, or were younger than age 21. However, African American women who had children in foster care were more likely to complete treatment. Implications for treatment and research are discussed.

The impact of women's family status on completion of substance abuse treatment.

Although the substance abuse treatment community recognizes that physical and psychological problems are common among families with a substance-abusing member, third-party funding for comprehensive treatment of the families of substance abusers is limited. Failure to provide treatment for these collateral effects of substance abuse on the family is thought to reduce the efficacy of substance abuse treatment, increase the risk of relapse, and leave untreated secondary pathology among family members. This article presents a review of health care utilization and cost-offset studies of the collateral effects of substance abuse on the family to aid administrators and planners in documenting the economic advantages of comprehensive treatment for the families of substance abusers.

Substance abuse and family illness: Evidence from health care utilization and cost-offset research

Objective

Studies evaluating osteoarthritis treatment often use increased arthritis activity (“flare”) as a selection criterion, although no standardized assessments are available to quantify flare intensity and little is known about how this criterion affects treatment comparisons. This study evaluated the reliability of a flare assessment and how pretreatment flare intensity impacts conclusions on treatment efficacy.



Methods

Using data from a double-blind, randomized, controlled trial (n = 182), we compared 3 osteoarthritis treatments with placebo in patients who met 3 of 4 flare criteria. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) questionnaire was used to document levels of pain, stiffness, and physical functioning at baseline and at the final visit. Following factor analytic evaluation, the flare items were standardized and summed to create a flare intensity index, which was used to identify patient subgroups. Analysis of covariance was applied to compare change in WOMAC scale scores from baseline to final visit for assessment of treatment differences among the flare intensity subgroups.



Results

The flare indicators appeared unidimensional. Analyses were stratified by tertiles of flare intensity. Mean WOMAC scores improved in the patients receiving active treatment who were categorized into the 2 lowest flare intensity subgroups, but mean WOMAC scores improved in patients in all 4 treatment groups (active and placebo) in the most intense flare subgroup.



Conclusion

Patients with higher intensity flares may be more likely to report substantial improvement in functional status regardless of treatment. Failure to account for flare intensity in analyses of data from pain trials with flare-based designs may inflate the risk of Type I and Type II errors in the interpretation of study results.

Jane Scott-Lennox

Papers

Reliability, validity and responsiveness of a revised scoring system for the Liverpool Seizure Severity Scale.

The impact of women's family status on completion of substance abuse treatment.

Substance abuse and family illness: Evidence from health care utilization and cost-offset research

Stratification of flare intensity identifies placebo responders in a treatment efficacy trial of patients with osteoarthritis.

Ethnicity, church affiliation and beliefs about the causal agents of health: a comparative study employing a multivariate analysis of covariance1