events and ongoing trials

Here you will find a listing of events, ongoing trials and meeting overviews

Teaching Evidence-Based Neurology in Europe: Cochrane Systematic Reviews in Practice

Four workshops to be held within two years, June 2005 – December 2006, in the UK, SPAIN, PORTUGAL and ITALY. European Union funding covers travel, accommodation and registration fees for 70 young neurologists to attend each workshop. (See grant application, deadline 30 April 2005).

Epilepsy, Thursday/Friday 30 June – 1 July 2005, London, UK
 Workshop Materials
Multiple Sclerosis, Friday/Saturday 16-17 December 2005, Madrid, SPAIN
  Workshop Materials
Parkinson’s Disease, Friday/Saturday 5-6 May 2006, Lisbon, PORTUGAL
  Workshop Materials
Stroke, Friday/Saturday 1-2 December 2006, Perugia, ITALY

Participants are encouraged to attend all four workshops, but, space permitting, anyone can attend individual workshops by completing a registration form. The aim of the workshop series is to train neurologists to use systematic reviews of the effectiveness of treatments in their clinical practice. Primary emphasis is placed on teaching participants to identify relevant clinical questions and to critically evaluate results of the related scientific literature. (See program details)

For more information: [email protected]

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Evidence-Based Multiple Sclerosis—Systematic Reviews from The Cochrane Library

Workshop presented by the Cochrane Neurological Network during the XLVI National Congress of Italy’s Hospital Neurological Scienzes association (Scienze Neurologiche Ospedaliere—SNO), 24-27 May 2006, San Benedetto del Tronto, Italy

Thursday 25 May 2006
15:30-17:30
San Benedetto del Tronto, Italy

Coordinators:   Giuliani and Di Battista

30 min              The Nature and Limits of Evidence-Based Medicine
15 min            The epidemiologist’s point of view, A. Liberati
15 min            The clinical neurologist’s point of view, G. Giuliani

From The Cochrane Library

15 min              Disease-modifying therapies of MS, G. Filippini
15 min              Relapsing clinical therapies of MS, L. Durelli
15 min              Symptomatic therapies in MS, E. Pucci
15 min              Rehabilitative therapies in MS, A. Solari
 30 min              Open discussion on the treatment themes, L. Candelise, Director, Cochrane Neurological Network

For more information: [email protected]

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XIV Cochrane Colloquium

The XIV Cochrane Colloquium will be an opportunity to celebrate what has been achieved already by the Cochrane Collaboration and also a chance to assess how the Collaboration can continue to grow and evolve to meet its aims.

23-26 October 2006
Dublin, Ireland

For more information: www.colloquium.info

Randomized Controlled Clinical Trial for Patients with Ischemic Stroke

“Local versus Systemic Thrombolysis for Acute Stroke”
To determine the efficacy of rt-PA administered in two comparative ways, within 3 hours of the onset of symptoms

Coordinator: Alfonso Ciccone

Primary aims of the trial are to assess whether local intra-arterial (LIA) recombinant tissue plasminogen activator rt-PA, as compared to intravenous (IV) rt-PA, increases survival, free of disability, at 3 months. Secondary aims are to assess whether LIA rt-PA improves the 7-day neurological deficit, as compared to IV rt-PA, and whether LIA rt-PA is safe compared to IV rt-PA based on the following events reported within 7 days: symptomatic intracranial hemorrhages, fatal and non-fatal stroke, death from any cause, neurological deterioration.

Azienda Ospedaliera
Niguarda Ca’ Granda di Milano
Dipartimento di Scienze Neurologiche

Click here for more information or to get involved with the trial.

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CRASH-2: A large randomised placebo controlled trial among trauma patients with, or at risk of, significant haemorrhage, of the effects of antifibrinolytic treatment on death and transfusion requirement

Clinical co-ordinator: Ian Roberts

For people at ages 5 to 45 years, trauma is second only to HIV/AIDS as a cause of death. Each year worldwide about 3 million people die as a result of trauma, many after reaching the hospital. CRASH-2 aims to determine the effect of the early administration of the antifibrinolytic agent tranexamic acid (TXA) on death and transfusion requirement in adult trauma patients with ongoing significant haemorrhage, or who are considered to be at risk of significant haemorrhage.

Enquiries to: CRASH Trials Co-ordinating Centre, LSHTM, Keppel Street, London WC1E 7HT
tel +44(0)20 7299 4684, fax +44(0)20 7299 46, email [email protected]

For further information and to register your interest: [email protected]

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Randomized Controlled Trial of Standard and New Antiepileptic Drugs (SANAD)

SANAD compares the effectiveness and cost effectiveness of standard and new antiepileptic drugs in patients with epilepsy.

Where carbamazepine is the standard first-line treatment, patients are randomized to carbamazepine, gabapentin, lamotrigine, oxcarbazepine or topiramate.

Where valproate is the standard first-line treatment, patients are randomized to valproate, lamotrigine or topiramate.
Outcomes include time to treatment failure, time to 12-month remission, time to first seizure, quality of life and cost effectiveness.

Recruitment started in 1999 and was completed in August 2005. A total of 2443 patients were recruited. Final follow-up data was collected through October 2005. Results will be published in 2006.

For further information: www.liv.ac.uk/neuroscience/sanad

Evidence-based Neurology: a hot topic at the 18th World Congress of Neurology

By Bo Wu, MD, PhD, and Ming Liu, MD, Department of Neurology, West China Hospital Sichuan University, Chengdu 610041, China

At the 18th World Congress of Neurology, held 5-11 November 2005 in Sydney, Australia, Evidence-based Neurology was a hot topic, attracting the attention of many participants. Prof Charles Warlow from the United Kingdom and Prof Louis Caplan from the United States had an exciting debate about whether “Evidence-based medicine is the gold standard,” on the evening of 7 November 2005. Prof Charles Warlow argued in favor of EBM as a gold standard, and Prof Louis Caplan argued against it. Prof John Norris chaired the session. Their interesting debate and impressive presentation skills made this session very exciting, and the interaction between the presenters and the audience was quite good. They all agreed that using scientific evidence as much as possible to guide clinical practice is very important, and neurologists and other clinical doctors should improve their skills, not only with respect to clinical judgment, but also with respect to evidence-based clinical practice.

There was a session on Evidence-based Neurology organized by the Cochrane Neurological Network on 8 November 2005. Prof Livia Candelise from Italy and Prof Ming Liu from China co-chaired the morning session. Five well known neurologists and researchers gave their lectures at this session. Prof Peter Sandercock from the University of Edinburgh gave two lectures on, “What can the Cochrane Library tell us about Neurological Practice now and in the future, and what can it not tell us?” and “Control of ICP after acute brain injury”. He indicated that the Cochrane Library had a significant impact both on current practice and future practice. Prof Richard Hughes made a speech on, “Treatment of diseases of the peripheral nervous system.” He assessed the evidence on treatment of the peripheral nervous system, and he pointed out more reviews are needed on common and important topics such as diabetic neuropathy, painful neuropathy and leprosy. Prof Graeme Hankey from the Royal Perth Hospital gave a presentation on, “The rehabilitation of Stroke patients.” He commented on the evidence for the rehabilitation of stroke patients. Prof Ettore Beghi from Italy delivered a speech on, “Surgery for Epilepsy: Assessing evidence from published studies.” Prof Charles Warlow gave a lecture on, “What to do when the RCTs are not there.” These lectures covered all the hot topics in the field of Neurology. During the Cochrane Neurological Network session, participants from all over the world had warm discussions with these experts.

On the afternoon of 8 November 2005, there were free communications on Evidence-Based Neurology. Prof Peter Sandercock and Prof Veronika Skvortsova from Russia co-chaired the session. A Philippine neurologist made a speech on, “Effect of steroids in Tuberculous Meningitis-a meta-analysis.” An Italian neurologist gave a presentation on, “Recombinant interferon beta or glatiramer acetate for delaying conversion of the first demyelinating event to multiple sclerosis: a Cochrane review.” A neurologist from Australia delivered a speech on, “Shared Care in Stroke Survivors-Translation of Research into Service.” A neurologist from the United Kingdom gave a lecture on, “Requiring consent biases the results of neurological disease registers: evidence of ‘consent bias’ from the Scottish Intracranial Vascular Malformation Study (SIVMS).” Chinese neurologists presented, “Tirilazad for aneurismal subarachnoid hemorrhage” and “Evidence of traditional Chinese patent medicine for ischemic stroke: a systematic review.”

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WORKSHOP RECAP – Treatment of neurological diseases-an evidence-based approach

On September 18, 2005 the Cochrane Neurological Network presented a focused workshop during the 9th Congress of the European Federation of Neurological Societies (EFNS) in Athens, Greece. The EFNS conference had 4500 registered participants, mostly neurologists from all over the world. The Neurological Network workshop, entitled Treatment of neurological diseases–an evidence-based approach, focused on invasive interventions in the treatment of neurological disorders and attracted considerable interest. The workshop was organised and run by Graziella Filippini (Milan, Italy), and assisted by Daniel Bereczki (Debrecen, Hungary). About 150 conference participants attended the workshop, mostly neurologists from European countries and from other continents as well.

The first speaker of the meeting, Graziella Filippini, gave an overview of the activities of the Cochrane Neurological Network. Then Martin Brown (London, UK) summarised the available evidence on endovascular treatments for stroke prevention. The conclusions were based mostly on two Cochrane reviews by Dr. Brown and his co-workers (Coward LJ, Featherstone RL, Brown MM: Percutaneous transluminal angioplasty and stenting for carotid artery stenosis. The Cochrane Database of Systematic Reviews 2004, Issue 1. and Coward LJ, Featherstone RL, Brown MM: Percutaneous transluminal angioplasty and stenting for vertebral artery stenosis. The Cochrane Database of Systematic Reviews 2005, Issue 2.) In the next lecture, based on a systematic literature review, Ettore Beghi (Milan, Italy) identified factors associated with better outcome after surgery for epileptic patients, which included, among others, febrile seizures, mesial temporal sclerosis and brain tumors. Finally, Cristina Sampaio (Lisbon, Portugal) discussed the effects of deep brain stimulation in Parkinson’s disease based on the current state of a Cochrane review in preparation (Motto C, Tamma F, Candelise L. Deep brain stimulation of subthalamic nucleus for Parkinson’s disease. Protocol. The Cochrane Database of Systematic Reviews 2003, Issue 2.)

Meeting outcome: Comparing endovascular treatment with carotid endarterectomy, similar early risks and long-term benefits were found. It was concluded that current evidence does not support a widespread change in clinical practice away from recommending carotid endarterectomy, and the results of currently ongoing RCTs are awaited. There is currently insufficient evidence to assess the effects of percutaneous transluminal angioplasty for vertebral artery stenosis. For epilepsy surgery, better standards for the assessment of surgical outcome should be applied in observational studies. Regarding deep brain stimulation in Parkinson’s disease, further controlled trials and data on long-term efficacy and safety are needed.

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WORKSHOP RECAP – Carpal Tunnel Syndrome

On October 26, 2002, in Corciano, a charming medievil village near Perugia, Italy, the Cochrane Neurological Network organised its second multidisciplinarian workshop to discuss Cochrane systematic reviews on the treatment of Carpal Tunnel Syndrome (CTS). A variety of experts participated in the presentation, including neurologists and orthopedic hand surgeons of different backgrounds. Organisers included MG Celani, AT Cantisani and E Righetti. The chairpersons were Rodrigo Salinas, author of two of the reviews presented during the meeting, and CNN Advisory Board director Livia Candelise. Attendees included CNN members, rheumatologists, doctors specializing in on-the-job injuries, neurosurgeons, neurologists, neurophysiopathologists, internists, orthopedists, physiotherapists and trainees of the above-mentioned specialisations. During the meeting, one clinical neurologist, one neurophysiologist, and one orthopedist described to the group their routine treatment of the disease, presented a review, and then lead a discussion.

The two reviews and one protocol presented included: the review, “Local corticosteroid injection for carpal tunnel syndrome” (S Marshall et al, Issue 4, 2002 of the Cochrane Library), which evaluates the efficacy of steroid injection in patients who have been affected by typical CTS symptoms; the protocol, “Non-surgical treatment (other than steroid injection) for carpal tunnel syndrome” (D O’Connor et al, CL Issue 3, 2001), which considers various conservative treatments other than steroid injection; and the review, “Surgical versus non-surgical treatment for carpal tunnel syndrome” (RJ Verdugo et al, CL Issue 2, 2002), which compares the efficacy of surgical to non-surgical interventions in the treatment of CTS.

Meeting outcome: It was determined that it is necessary to favor controlled clinical studies correcting for the drawbacks highlighted in previous studies. Such corrections should include specific diagnostic criteria; a large sample size; suitable follow up; subgroup division by age, sex, and clinically and instrumentally determined severity of the disease; duration of the disease; and degree of stressful activity.

For more information about the CTS workshop held 26 October in Corciano, please contact:

Cochrane Neurological Network
Tel.:+39 0255033831 or +39 0250320434
Fax:+39 0250320430
Email: [email protected]

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WORKSHOP RECAP – “Evidence Based Treatments for Multiple Sclerosis”

In May 2002, the Cochrane Multiple Sclerosis Group held its first international workshop on “Evidence Based Treatments for Multiple Sclerosis.”

The workshop focused on the following three topics: outcome, study quality, and heterogeneity.

Forty-seven world-wide participants attended the meeting, which included representatives of four national MS Societies from Australia, Greece, Italy, and the UK.

During the workshop, the group decided on three new initiatives involving the development of links among the MS National Societies and the MS Cochrane Review Group. The objective was to improve the dissemination of results of the systematic reviews and to link new consumers to the Group.

The review group editors will prepare a document dealing with the outcomes to be used in systematic reviews. The document will take into consideration the preferences expressed by reviewers and consumers on the topic.

Additionally, a new working group will be established to develop systematic reviews on rehabilitation for MS. Already four proposed review titles have been submitted for editorial approval.

For more information about the Cochrane Multiple Sclerosis Group workshop, “Evidence Based Treatments for Multiple Sclerosis,” held 16-18 May in Milan, Italy, please contact:

Liliana Coco
Tel: +39 022394201
Fax: +39 0270638217
E-mail: [email protected]