Neurologische betrokkenheid bij Myotone Dystrofie type 1 – Psychostimulantia
Uitgangsvraag
Wat is de plaats van medicamenteuze behandeling van cognitieve problemen, hypersomnie en apathie bij myotone dystrofie type 1?
Aanbeveling
Start in de behandeling bij cognitieve problemen, slaperigheid, en/of apathie altijd met educatie en structuur, door een ergotherapeut en/of een revalidatiearts.
Sluit bij slaperigheid eerst andere oorzaken uit, zoals longfunctieproblematiek of slaapapneu.
Bespreek bij cognitieve problemen de resultaten van het neuropsychologisch onderzoek met patiënten en/of naasten/ouders indien dit is uitgevoerd en bied bij een gerichte hulpvraag eventueel cognitieve revalidatie aan.
Start in principe niet met psychostimulantia. Slechts bij specifieke patiënten kan men wel overwegen te starten met psychostimulantia. Indicaties hiervoor kunnen zijn:
- Behoefte aan sporadisch gebruik
- Behoefte aan continu gebruik, wanneer de patiënt zelf op zoek is naar een extra middel tegen overmatige slaap en een weekindeling onvoldoende helpt
Wanneer toch gestart wordt met psychostimulantia, kan dit:
- Ofwel met methylfenidaat. Monitor dan de verdraagzaamheid en de bijwerkingen.
- Ofwel met modafinil. Maak binnen een maand na starten een ECG vanwege het risico op geleidingsstoornissen. Controleer de bloeddruk en hartslag, en monitor op verdraagzaamheid en bijwerkingen (zie Farmacotherapeutisch Kompas). Staak in het geval van een aritmie. Houd bij vrouwen in de vruchtbare leeftijd rekening met mogelijke interactie met orale anticonceptie; ga bij hen over op een (aanvullende) andere vorm van anticonceptie.
Overwegingen
Balans tussen gewenste en ongewenste effecten
Psychostimulantia kunnen slaperigheid overdag verminderen, maar de bewijskracht is zeer laag. Dit komt door onnauwkeurigheid in het geschatte effect als gevolg van kleine studies met cross-over effect. Dit betekent dat we zeer onzeker zijn over het gevonden geschatte effect van psychostimulantia op slaperigheid. Voor apathie, sociale cognitie en executieve functie/concentratie werd geen kwantitatief gerapporteerd bewijs gevonden.
Psychostimulantia worden weinig voorgeschreven in de praktijk. Hun primaire doel is het verminderen van slaperigheid en toename van alertheid, wat andere functies zoals het uitvoeren van activiteiten en participatie in de maatschappij positief zou kunnen beïnvloeden. Uit de review van Annane (2024) blijkt dat psychostimulantia de kwaliteit van leven van mensen met Myotone Dystrofie type 1 dan ook positief kunnen beïnvloeden, hoewel met zeer lage bewijskracht.
Uit de internationale richtlijn Myotone Dystrofie (Myotonic Dystrophy Foundation, 2017), blijkt niet duidelijk wat de bewijskracht is voor psychostimulantia. Daarin wordt – naast het advies om bij slaapproblematiek uit te vragen wat de slaapgewoonten, medicatiegebruik en alcohol- en caffeïneconsumptie zijn – aangegeven dat psychostimulantia overwogen kunnen worden als gedacht wordt aan centrale hypersomnie.
Waarden en voorkeuren van patiënten (en eventueel hun naasten/verzorgers)
Voor de individuele patiënt is het belangrijk om het effect van psychostimulantia af te wegen tegen de bijwerkingen die kunnen optreden, zoals prikkelbaarheid en een opgejaagd gevoel. Bijwerkingen kunnen ook optreden op het gebied van stemming: pyschostimulantia kunnen leiden tot stemmingswisselingen.
Een groot deel van de patiënten ervaart zeer beperkte lijdensdruk door verminderd ziekte-inzicht (van der Velden, 2019; Timman, 2010; Bungener, 1998). Slechts enkele patiënten zoeken een oplossing voor toegenomen slaperigheid, bijvoorbeeld wanneer zij op het werk hier last van hebben. Medicatie is hiervoor sporadisch een oplossing; er valt ook al veel winst te halen met begeleiding middels bijvoorbeeld een weekschema met activiteiten, en hulp bij de verdeling van energie over de dag of week.
Naasten ondervinden vaker dan de patiënt lijdensdruk; zij ondervinden last door het verlies van initiatief en motivatie (apathie), en de verminderde sociaal-cognitieve functies (weinig empathie) van hun familie/relatie. De hulpvraag van naasten verdient aandacht, maar de oplossing ligt hiervoor vooral in ondersteuning, educatie, en soms psychotherapie.
Kostenaspecten
Psychostimulantia vormen extra kosten bovenop educatie en uitleg, wat standaard onderdelen van de behandeling zijn. Kosten liggen niet alleen in de medicatie zelf, maar ook voor de opvolging die ervoor nodig is: extra tussentijdse poliklinische controles met een hartfilmpje is noodzakelijk in verband met cardiovasculaire complicaties (ontstaan hypertensie, aritmieën).
Gelijkheid ((health) equity/equitable)
De interventie leidt niet tot een toename of afname van gezondheidsgelijkheid. Methylfenidaat en modafinil zijn goed beschikbaar.
Aanvaardbaarheid
Ethische aanvaardbaarheid
Ethisch speelt de afweging niet schaden (bijwerkingen van de psychostimulantia) versus autonomie/goed doen (winst in kwaliteit van leven door kunnen doen van dagelijkse activiteiten. Het zwaartepunt ligt bij niet schaden, gezien de beperkte effectiviteit van psychostimulantia. Deze kunnen incidenteel worden gegeven in specifieke situaties.
Duurzaamheid
Bij het voorschrijven van psychostimulantia spelen duurzaamheidsoverwegingen geen grote rol.
Haalbaarheid
Bij de behandeling van Myotone Dystrofie type 1 moet er voldoende aandacht zijn voor cognitieve problemen, en juiste diagnostiek moet hiervoor worden ingezet. De aanwezigheid van klachten betekent niet per se dat er sprake is van cognitieve stoornissen, maar ook andersom: de afwezigheid van klachten betekent niet altijd dat er geen stoornissen zijn, door mogelijk verminderd ziekte-inzicht.
Voor alle problematiek die er kan spelen bij Myotone Dystrofie, is het in ieder geval behulpzaam om structuur aan te bieden, eventueel onder begeleiding van een ergotherapeut. Een goede weekindeling met invulling van dagelijkse activiteiten en rustmomenten zorgt voor een goede verdeling van energie over de dag en dit komt cognitieve problemen en mentale belastbaarheid ten goede. Bij kinderen wordt deze structuur reeds aangeboden door middel van school, en begeleiding van een ergotherapeut heeft dan weinig meerwaarde.
Aandachtspunten bij cognitieve problemen bij Myotone Dystrofie type 1:
- Start met educatie (aan patiënt of aan ouders). Geef uitleg over de cognitieve problemen, oorzaken en invloed op het dagelijks leven, en indien er een neuropsychologisch onderzoek is gedaan aanvullen en onderbouwen met toelichting van de resultaten van dit onderzoek.
- Overweeg cognitieve revalidatie bij gemotiveerde patiënten (bijv. strategietraining of compensatietechnieken zoals goal managementtraining)
- Bij kinderen: Overweeg behandeling met methylfenidaat om concentratie en aandacht te verbeteren. Controleer voorafgaand en tijdens de behandeling de bloeddruk en controleer op ritmestoornissen door middel van een ECG.
Behandeling van slaperigheid bij Myotone Dystrofie type 1 is stapsgewijs:
- Sluit andere oorzaken van slaperigheid uit, zoals slaapapneu of nachtelijke hypoventilatie, en behandel deze indien aanwezig.
- Start met educatie (aan patiënt of aan ouders). Leg uit dat door betrokkenheid van het centrale zenuwstelsel bij Myotone Dystrofie type 1 vermoeidheid aanwezig kan zijn.
- Bied of adviseer conditietraining, waarmee de conditie wordt verbeterd en de negatieve spiraal van eventuele passiviteit en deconditionering (die elkaar versterken) kan worden doorbroken (zie hiervoor de submodule Neurologische complicaties - oefentherapie).
- Start alleen in individuele gevallen met medicatie (dit geldt voor zowel slaperigheid als apathie). De effectiviteit van psychostimulantia is niet overtuigend, en er is een risico op bijwerkingen. De motivatie van de patiënt is hierbij belangrijk: mensen moeten zelf medicatie willen, en komen hier alleen voor in aanmerking als blijkt dat een weekindeling onvoldoende helpt. Voor sporadisch gebruik (zo nodig) kan wel een psychostimulans worden voorgeschreven. Een specifiek aandachtspunt bij modafinil is de werking van orale anticonceptie. Deze kan door enzyminductie van CYP3A4/5 verminderd zijn. Geadviseerd wordt om tijdens gebruik van modafinil en tot twee maanden na het staken ervan over te gaan op een andere of gelijktijdige anticonceptieve methode.
De behandeling van apathie bij Myotone Dystrofie type 1 is stapsgewijs:
- Start met educatie (aan patiënt en/of naasten/ouders). Leg uit wat apathie is, waar het door komt en wat patiënten hier zelf aan kunnen doen. Het helpt om hiervoor structuur te bieden aan patiënten.
- Start alleen in individuele gevallen met medicatie. Hiervoor gelden dezelfde overwegingen en aandachtspunten als bij slaperigheid.
Voor naasten zijn begeleiding en educatie ook eerste keuze. Aanvullend kan soms Cognitieve Gedragstherapie (CGT) of Acceptance and Commitment Therapie (ACT) worden ingezet om met niet-helpende gedachten om te gaan.
Rationale van de aanbeveling: weging van argumenten voor en tegen de interventies
Psychostimulantia tonen met zeer lage bewijskracht een klein maar klinisch relevant effect op slaperigheid. Er is geen informatie is beschikbaar over executieve functie en sociale cognitie uit de literatuur. Gezien de relatief grote kans op bijwerkingen en toegenomen kosten, komt de werkgroep uit op een zwakke aanbeveling om psychostimulantia in principe niet structureel toe te passen – in slechts enkele individuele gevallen kan het gebruik overwogen worden.
Eindoordeel: Zwakke aanbeveling voor (conditioneel).
Onderbouwing
Although myotonic dystrophy type 1 is primarily a muscle disorder, complications can occur in many organ systems (e.g., gastrointestinal, pulmonary, cardiac, and ocular). The treatment for these complications is symptomatic: early detection and intervention are essential. Further management of myotonic dystrophy type 1 primarily focuses on rehabilitation.
Cognitive problems are common and sometimes associated with daytime sleepiness or general fatigue. These cognitive problems are primarily characterized by difficulties in executive functions (e.g., little initiative, low motivation), concentration and social cognition (e.g., empathy). The impact on quality of life is significant, as is the effect on close family members and caregivers. It remains unclear what role psychostimulants or other medications might play in the treatment of these cognitive problems.
Summary of Findings
Population: Patients with myotonic dystrophy type 1 and sleepiness/hypersomnia, fatigue and cognitive problems (e.g. concentration)
Intervention: Psychostimulants (methylphenidate, modafinil, dexamphetamine)
Comparator: Placebo, waiting list or no treatment
|
Outcome |
Study results and measurements |
Absolute effect estimates |
Certainty of the Evidence (Quality of evidence) |
Summary |
|
|
Psychostimulants |
Placebo |
||||
|
Sleepiness – Maintentance of Wakefulness Test (MWT) |
Mean Difference: 3.59 (95% CI -0.06 to 7.24)
Based on data from 72 participants in 3 studies Follow-up 3-4 weeks |
Mean improvement in MWT ranged from -0.38 to 5.7 minutes. (scale 19 to 40 minutes, higher is better) |
Very low Due risk of bias, due to inconsistency, due to serious imprecision1 |
The evidence is very uncertain about the effect of psychostimulants compared to placebo on sleepiness measured with the MWT in patients with myotonic dystrophy type 1.
(Orlikowski, 2009; Puymirat, 2012; Talbot, 2003) |
|
|
Sleepiness – Epworth Sleepiness Scale (ESS) |
Mean Difference: -2.55 (95% CI -4.0 to -1.1)
Based on data from 125 participants in 5 studies Follow-up 2-4 weeks |
Mean improvement in ESS ranged from -5 to 0 (scale 0 to 24, lower is better) |
Very low Due risk of bias, due to inconsistency, due to serious imprecision2 |
The evidence is very uncertain about the effect of psychostimulants compared to placebo on sleepiness measured with the ESS in patients with myotonic dystrophy type 1.
(MacDonald, 2002; Orlikowski, 2009; Puymirat, 2012; Talbot, 2003; Wintzen, 2007) |
|
|
Sleepiness – Multiple Sleep Latency Test (MSLT) |
Mean Difference: -1.82 (95% CI -5.57 to 1.93)
Based on data from 39 participants in 2 studies Follow-up 4 weeks |
Mean improvement in MSLT ranged from -3.68 to 0.15 minutes (scale 0 to 20, higher is better) |
Very low Due risk of bias, due to inconsistency, due to very serious imprecision3 |
The evidence is very uncertain about the effect of psychostimulants compared to placebo on sleepiness measured with the MSLT in patients with myotonic dystrophy type 1.
(Antonini, 1997; Orlikowski, 2009) |
|
|
Apathy |
Qualitatively assessed Based on data from 13 participants in 1 study Follow-up 2 weeks |
No difference regarding activity and actions was found (scale 0 to 5, higher is better) |
No GRADE (insufficient quantitative data available) |
No evidence was found regarding apathy in patients with myotonic dystrophy type 1. |
|
|
Executive function/ concentration |
Simulated driving performance Based on data from 20 participants in 1 study |
No difference in driving performance was found (standard deviation from centre of the road, lower is better) |
No GRADE (insufficient quantitative data available) |
Insufficient quantitative evidence was found regarding executive function in patients with myotonic dystrophy type 1. |
|
|
Social cognition |
|
|
No GRADE |
No evidence was found regarding social cognition in patients with myotonic dystrophy type 1. |
|
|
Side effects (from Annane, 2024) |
Proportion of participants with at least 1 adverse event: RR 1.70 (95% CI 0.75 to 3.85)
Based on data from 162 participants in 6 RCTs |
Number of participants with adverse events ranged from 34 fewer to 392 more |
Very Low GRADE Due risk of bias, due to inconsistency, due to very serious imprecision4 |
The evidence is very uncertain about the effect of psychostimulants compared to placebo on adverse events in patients with myotonic dystrophy type 1.
(Antonini, 1997; MacDonald, 2002; Orlikowski, 2009; Puymirat, 2012; Talbot, 2003; Wintzen, 2007) |
|
1. Risk of bias: serious (-1 level): no intention to treat analysis, no validation of found estimates possible in individual articles. Inconsistency: serious (-1 level): substantial heterogeneity among studies. Imprecision: very serious (-2 levels): wide confidence intervals, few patients, cross-over designs in all studies but one.
2. Risk of bias: serious (-1 level): some concerns in two studies that show largest effect, no intention to treat analysis. Inconsistency: serious (-1 level): substantial heterogeneity among studies. Imprecision: serious (-1 levels): wide confidence intervals, cross-over designs in all studies but one.
3. Risk of bias: serious (-1 level): one study stopped early, no intention to treat analysis. Inconsistency: serious (-1 level): substantial heterogeneity among studies. Imprecision: very serious (-2 levels): wide confidence intervals, few patients in only two studies.
4. Risk of bias: serious (-1 level): one study stopped early, no intention to treat analysis. Imprecision: very serious (-2 levels): wide confidence intervals, few patients in only two studies.
Description of studies
One study was included in the analysis of the literature. Important study characteristics and results are summarized in table 2. The assessment of the risk of bias is summarized in the risk of bias tables (under the tab ‘Evidence tabellen’).
The review by Annane (2024) assessed the effects of psychostimulants in myotonic dystrophy patients with hypersomnia. To this end, literature was systematically searched in 6 databases until January 5th, 2023. All randomized trials that evaluated any type of psychostimulant, versus placebo or no treatment, in patients with myotonic dystrophy and hypersomnia, were considered. Six trials with a total of 136 participants were included. Characteristics of the individual studies can be found in table 2.
Table 2. Characteristics of included studies
|
Study |
Participants |
Comparison |
Follow-up |
Outcomes |
Comments |
Risk of bias* |
|
Included in systematic review Annane, 2024 |
||||||
|
Antonini, 1997
Crossover RCT, Italy |
N at baseline: 11 Intervention: 6 | Control: 5
Sex (male): 55% Median age 39 years (range 21 to 61)
All with myotonic dystrophy and excessive daytime sleepiness. |
Intervention: Selegiline 20mg daily for 30 days
Control: Placebo |
4 weeks |
Sleep (MSLT) |
Trial was supported by a grant from Telethon-Italy
|
Low |
|
MacDonald, 2002
Crossover RCT, USA |
N at baseline: 40 Sex (male): 33% Mean age 41 years (SD ±12)
All with myotonic dystrophy and subjective complaints of daytime hypersomnolence. |
Intervention: 2 weeks treatment:
Control: Same as intervention, yet with placebo |
2 weeks |
Sleep (ESS)
Adverse events |
Supported in part by Draxis Health Inc
|
Low |
|
Orlikowski, 2009
Parallel group RCT, France |
N at baseline: 28 Sex (male): 54% Aged 18 to 69 years
All with genetically proven myotonic dystrophy type 1, and impairment of social or occupational functioning due to excessive sleepiness (ESS >10, MSLT £8). |
Intervention: Modafinil 300 mg daily for 1 month
Control: Placebo 300 mg daily for 1 month |
4 weeks |
Sleep (MWT, MSLT and ESS)
Adverse events |
Non-commercial funding received.
The study was interrupted prematurely for slow recruitment rate and drug expiration dates. |
Low |
|
Puymirat, 2012
Crossover RCT, Canada |
N at baseline: 24 Sex (male): 50% Mean age 46 years (SD ±13)
All with genetically confirmed myotonic dystrophy type 1 and excessive sleepiness (ESS >10) |
Intervention: Methylphenidate 20mg daily at breakfast for 3 weeks
Control: Placebo 300 mg daily for 1 month |
3 weeks |
Sleep (ESS and OSLER)
Adverse events |
Non-commercial funding received.
|
Some concerns (unclear risk of attrition bias) |
|
Talbot, 2003
Crossover RCT, UK |
N at baseline: 20 Sex (male): 65% Median age 43 years (range 18 to 65)
All with a diagnosis of myotonic dystrophy and ESS³ 10 |
Intervention: Modafinil daily at breakfast:
Control: Same as intervention, yet with placebo |
3 weeks |
Sleep (ESS and modified MWT)
Executive function (driving, activity)
|
Commercial funding received with unconditional charitable grant.
|
Low |
|
Wintzen, 2007
Crossover RCT, The Netherlands |
N at baseline: 13 Sex (male): 38% Mean age 43.5 years (SD ±13.9)
All with myotonic dystrophy |
Intervention: 2 weeks treatment:
Control: Same as intervention, yet with placebo |
2 weeks |
Sleep (ESS)
Apathy (interview for spontaneous activity)
|
Commercial funding received with unconditional charitable grant.
|
Some concerns (unclear randomization, allocation concealment) |
*Assessment from the Cochrane review by Annane (2024)
Results
1. Sleepiness
Maintenance of Wakefulness Test (MWT)
The MWT is a daytime sleep study that measures your ability to stay awake and alert during the day: during several 40-minute sessions, the patient is instructed to stay awake as long as possible. The sleep latency is measured: how long it takes to fall asleep. Three studies reported on this outcome (Orlikowski, 2009; Puymirat, 2012; Talbot, 2003). The latter used a modified version, and Puymirat (2012) used the Oxford Sleep Resistance Test (OSLER) which closely follows the MWT. The pooled mean difference was 3.59 minutes (95% CI -0.06 to 7.24) in favour of modafinil, this difference was not clinically relevant. See figure 1.
Figure 1. Pooled mean difference of MWT (from Annane, 2024)
Epworth Sleepiness Scale (ESS)
The ESS is a questionnaire of 8 common scenarios in which respondents rate their likelihood of falling asleep. Scoring for each scenario goes from 0 to 3 (never doze off to high chance of dozing), totaling 0 to 24. Usually, a score higher than 10 indicates excessive daytime sleepiness. Five studies reported on this outcome (MacDonald, 2002; Orlikowski, 2009; Puymirat, 2012; Talbot, 2003; Wintzen, 2007). A pooled mean difference of -2.55 was found (95% CI -4.00 to -1.11) in favour of modafinil (or methylphenidate in the case of Puymirat, 2012), this difference is clinically relevant. See figure 2.
Figure 2. Pooled mean difference of ESS (from Annane, 2024)
Multiple Sleep Latency Test (MSLT)
The MSLT consists of 5 nap opportunities scheduled 2 hours apart throughout the day. The individual is asked to lie in the dark and fall asleep, whilst EEG (electro-encephalography), EOG (electro-oculography) and EMG (electromyography) are measured. The time it takes to fall asleep in each nap trail is recorded in minutes, where a sleep latency of <10 minutes indicates excessive sleepiness. Two studies reported on this outcome (Antonini, 1997; Orlikowski, 2009). The pooled mean difference was -1.82 (95% CI -5.57 to 1.93), which favours placebo. This difference is not clinically relevant. See figure 3.
Figure 3. Pooled mean difference of MSLT (from Annane, 2024)
2. Apathy
Wintzen (2007) reported the increase in spontaneous activity, assessed using a novel structured interview of both the participant and the partner or housemate, if present. The score ranges from 0 (no improvement) to 5 (substantial improvement). These interviews took place at home or by telephone. No quantitative outcome data was reported, only that “the structured interview regarding activity and actions did not show significant differences between modafinil and placebo (p = 0.2 for patients and p = 0.5 for partners/housemates)”.
3. Executive function/concentration
Talbot (2003) measured simulated driving performance: a steering simulator using computer-derived images of the moving edge of a road that winds pseudo-randomly, white on black as in night driving. The participant is to steer the vehicle accurately down the centre of the road using a standard computer games steering wheel. The ability to follow the road was expressed as the standard deviation about its centre. After treatment, for the modafinil group, this was 0.31; and for the placebo group 0.35 (p = 0.43).
4. Social Cognition
None of the included studies reported on the outcome measure social cognition.
5. Side effects
MacDonald (2002) reported 83 adverse events in 30 participants (65 on modafinil and 18 on placebo), mostly during the first week of treatment. Three participants withdrew due to adverse events: two in the modafinil group and one in the placebo group.
In Orlikowski (2009), eight participants (four in each arm) experienced at least one adverse event, yet no participants withdrew due to adverse events.
In Puymirat (2012), three participants discontinued methylphenidate due to treatment- emergent adverse events (one for diarrhoea; two for nervousness and irritability). Loss of appetite, nausea, and palpitations were the most common adverse events reported by more participants receiving methylphenidate than those receiving placebo.
A systematic review of the literature was performed to answer the following question(s):
What are the effects of psychostimulants or other medications on cognitive problems of myotonic dystrophy type 1, hypersomnia and apathy?
Table 1. PICO
|
Patients |
Patients with myotonic dystrophy type 1 and sleepiness/hypersomnia, fatigue and cognitive problems (concentration, executive dysfunction) |
|
Intervention |
Psychostimulants (methylphenidate, modafinil, dexamphetamine) |
|
Control |
Placebo, waiting list or no treatment |
|
Outcomes |
Sleepiness, apathy, executive function, concentration, social cognition, side effects (such as addictive effects) |
|
Other selection criteria |
Study design: systematic reviews, randomized controlled trials and comparative observational studies |
Relevant outcome measures
The guideline panel considered fatigue and sleepiness as critical outcome measures for decision making; and apathy, executive function, concentration, social cognition and side effects as important outcome measures for decision making.
The working group defined the outcome measures as follows:
- Sleepiness: measured with the maintenance of wakefulness test (MWT), Epworth Sleepiness Scale (ESS), or Multiple Sleep Latency Test (MSLT)
- Apathy: problems with motivation and initiation of action (measured with specific questionnaires, e.g. Apathy Evaluation Scale)
- Executive function and concentration: ability to plan and organize, and initiate actions (measured with several cognitive tests, response inhibition, cognitive flexibility, planning and problem-solving ability). These can be measured with the Stroop Colour Word Test, Trail making Test, Brixton, Wisconsin Card Sorting Test, among others.
- Social cognition: empathy and showing behavior fitting the social context (measured with tests for recognition of emotions, or Faux Pas Test for theory of mind).
- Side effects: addictive effects
For the Epworth Sleepiness Scale (ESS), a change of -2 was considered a minimally clinically important difference. For the questionnaires, a difference larger than the reliable change index (RCI) was considered clinically relevant (a difference larger than the possible measurement error. For the other outcomes, the guideline panel used a change of 20% (0.80 > RR > 1.25) as minimal clinically (patient) important difference.
Search and select (Methods)
A systematic literature search was performed by a medical information specialist using Embase.com, Ovid/Medline and Ovid/PsycInfo. All databases were searched from 2010 to December 17th, 2024, for systematic reviews, RCTs and observational studies. Systematic searches were completed using a combination of controlled vocabulary/subject headings (e.g., Emtree-terms, MeSH) wherever they were available and natural language keywords. The overall search strategy was derived from two primary search concepts: (1) myotonic dystrophy type 1 and (2) Psychostimulants. Duplicates were removed using EndNote software. After deduplication a total of 230 records were imported for title/abstract screening. Initially, three studies were selected based on title and abstract screening. After reading the full text, two studies were excluded (see the exclusion table under the tab ‘Evidence tabellen’), and one study was included.
- Annane D, Laberge L, Gallais B, Chevret S. Psychostimulants for hypersomnia (excessive daytime sleepiness) in myotonic dystrophy. Cochrane Database of Systematic Reviews 2024, Issue 11. Art. No.: CD003218. DOI: 10.1002/14651858.CD003218.pub3.
- Antonini G, Morino S, Fiorelli M, Fiorini M, Giubilei F. Selegiline in the treatment of hypersomnolence in myotonic dystrophy: a pilot study. Journal of the Neurological Sciences 1997;147(2):167-9. PMID: 9106123.
- Bungener C, Jouvent R, Delaporte C. Psychopathological and emotional deficits in myotonic dystrophy. J Neurol Neurosurg Psychiatry. 1998 Sep;65(3):353-6. doi: 10.1136/jnnp.65.3.353. PMID: 9728948; PMCID: PMC2170247.
- MacDonald JR, Hill JD, Tarnopolsky MA. Modafinil reduces excessive somnolence and enhances mood in patients with myotonic dystrophy. Neurology 2002;59(12):1876-80. PMID: 12499477.
- Orlikowski D, Chevret S, Quera Salva MA, Laforêt P, Lofaso F, Verschueren A, et al. Modafinil for the treatment of hypersomnia associated with myotonic dystrophy in adults: a multicenter, prospective, randomized, double-blind, placebo-controlled 4-week trial. Clinical Therapeutics 2009;31(8):1765-73. PMID: 19808135.
- Puymirat J, Bouchard JP, Mathieu J. Efficacy and tolerability of a 20-mg dose of methylphenidate for the treatment of daytime sleepiness in adult patients with myotonic dystrophy type 1: a 2-center, randomized, double-blind, placebo-controlled, 3-week crossover trial. Clinical Therapeutics 2012;34(5):1103-1111. PMID: 22578232.
- Talbot K, Stradling J, Crosby J, Hilton-Jones D. Reduction in excess daytime sleepiness by modafinil in patients with myotonic dystrophy. Neuromuscular Disorders 2003;13(5):357-64. PMID: 12798791.
- Timman R, Tibben A, Wintzen AR. Myotonic dystrophy: the burden for patients and their partners. J Rehabil Med. 2010 Oct;42(9):823-30. doi: 10.2340/16501977-0598. PMID: 20878042.
- van der Velden BG, Okkersen K, Kessels RP, Groenewoud J, van Engelen B, Knoop H, Raaphorst J. Affective symptoms and apathy in myotonic dystrophy type 1 a systematic review and meta-analysis. J Affect Disord. 2019 May 1;250:260-269. doi: 10.1016/j.jad.2019.03.036. Epub 2019 Mar 7. PMID: 30870776.
- Wintzen AR, Lammers GJ, van Dijk JG. Does modafinil enhance activity of patients with myotonic dystrophy?: a double-blind placebo-controlled crossover study. Journal of Neurology 2007;254(1):26-8. PMID: 17285226.
Risk of Bias tables
See risk of bias assessment in study by Annane (2024).
Table of excluded studies
|
Reference |
Reason for exclusion |
|
Puymirat J, Bouchard JP, Mathieu J. Efficacy and tolerability of a 20-mg dose of methylphenidate for the treatment of daytime sleepiness in adult patients with myotonic dystrophy type 1: a 2-center, randomized, double-blind, placebo-controlled, 3-week crossover trial. Clin Ther. 2012 May;34(5):1103-11. doi: 10.1016/j.clinthera.2012.03.060. PMID: 22578232. |
Included in the systematic review from Annane 2024. |
|
West SD, Lochmüller H, Hughes J, Atalaia A, Marini-Bettolo C, Baudouin SV, Anderson KN. Sleepiness and Sleep-related Breathing Disorders in Myotonic Dystrophy and Responses to Treatment: A Prospective Cohort Study. J Neuromuscul Dis. 2016 Nov 29;3(4):529-537. doi: 10.3233/JND-160191. PMID: 27911338. |
Comparison of responders to no responders (not according to PICO) and wrong outcome measure. |
Beoordelingsdatum en geldigheid
Publicatiedatum : 29-06-2026
Beoordeeld op geldigheid : 29-06-2026
Algemene gegevens
De ontwikkeling van deze richtlijnmodules werd ondersteund door het Kennisinstituut van de Federatie Medisch Specialisten (www.demedischspecialist.nl/kennisinstituut) en werd gefinancierd uit de Kwaliteitsgelden Medisch Specialisten (SKMS). De financier heeft geen enkele invloed gehad op de inhoud van de richtlijnmodule.
Samenstelling werkgroep
Voor het ontwikkelen van de richtlijnmodule is in 2023 een multidisciplinair cluster ingesteld. Dit cluster bestaat uit vertegenwoordigers van alle relevante organisaties die betrekking hebben op de zorg voor patiënten met myotone dystrofie.
Het cluster Myopathie bestaat uit meerdere richtlijnen, zie [hier] voor de actuele clusterindeling. De stuurgroep bewaakt het proces van modulair onderhoud binnen het cluster. De expertisegroepsleden worden indien nodig gevraagd om hun expertise in te zetten voor een specifieke richtlijnmodule. Het cluster Myopathie bestaat uit de volgende personen:
Clusterstuurgroep
- dr. K. (Karlien) Mul (voorzitter), neuroloog, Radboud UMC Nijmegen, namens de Nederlandse Vereniging voor Neurologie (NVN)
- M.I. (Meyke) Schouten, klinisch geneticus, Radboud UMC Nijmegen, namens de Vereniging Klinische Genetica Nederland (VKGN)
- Charlotte van Esch, namens Spierziekten Nederland
- Dr. E.H. Niks, kinderneuroloog, Leids Universitair Medisch Centrum, namens de NVN
Clusterexpertisegroep (meeschrijvende leden in deze cyclus)
- Dr. B.A.H. (Bettine) Vosse, longarts, Maastricht Universitair Medisch Centrum, namens de Nederlandse Vereniging Artsen Longziekten en Tuberculose (NVALT)
- Dr. C.G.W. (Charlotte) Seijger, longarts, Frisius MC, namens de NVALT
- Dr. A. (Arno) Roest, kindercardioloog, Leids Universitair Medisch Centrum, namens de Nederlandse Vereniging voor Kindergeneeskunde (NVK)
- Dr. F.M.A. (Frederik) van den Heuvel, cardioloog, Radboud UMC Nijmegen, namens de NVVC
- Dr. N.B.M. (Nicole) Voet, revalidatiearts, Klimmendaal, namens de Vereniging voor Revalidatieartsen (VRA)
- Drs. H.J.M. (Helma) Hijdra, kinderrevalidatiearts, Radboud UMC Nijmegen, namens de VRA
- Dr. A.A. (Annelien) Duits , klinisch neuropsycholoog, Radboud UMC Nijmegen en Maastricht UMC , namens het Nederlands Instituut van Psychologen (NIP)
- J.E. (Anne) Bruijnes, neuroloog, Maastricht Universitair Medisch Centrum, namens de NVN
- dr. J.T. (Jan) Groothuis, revalidatiearts, Radboud UMC Nijmegen, namens de VRA
- E.M. (Liesbeth) Winter, Leids Universitair Medisch Centrum, namens de Nederlandse Vereniging voor Internisten (NIV)
Met ondersteuning van
- Dr. M.M.J. van Rooijen, adviseur, Kennisinstituut van de Federatie Medisch Specialisten (tot 01-09-2025)
- Dr. M.L. Molag, adviseur, Kennisinstituut van de Federatie Medisch Specialisten
Belangenverklaringen
De Code ter voorkoming van oneigenlijke beïnvloeding door belangenverstrengeling is gevolgd. Alle clusterstuurgroepleden en actief betrokken expertisegroepsleden (fungerend als schrijver en/of meelezer bij tenminste één van de geprioriteerde richtlijnmodules) hebben schriftelijk verklaard of zij in de laatste drie jaar directe financiële belangen (betrekking bij een commercieel bedrijf, persoonlijke financiële belangen, onderzoeksfinanciering) of indirecte belangen (persoonlijke relaties, reputatiemanagement) hebben gehad. Gedurende de ontwikkeling of herziening van een richtlijnmodule worden wijzigingen in belangen aan de projectleider doorgegeven. De belangenverklaring wordt opnieuw bevestigd tijdens de commentaarfase. Een overzicht van de belangen van de clusterleden en betrokken expertisegroepsleden en het oordeel over het omgaan met eventuele belangen vindt u in onderstaande tabel. De ondertekende belangenverklaringen zijn op te vragen bij het secretariaat van het Kennisinstituut van de Federatie Medisch Specialisten.
|
Werkgroeplid |
Functie |
Nevenfuncties |
Gemelde belangen |
Ondernomen actie |
|
Mul (voorzitter) |
Neuroloog |
Geen |
Betaald adviseurschap Avidity Biosciences en Dyne Therapeutics mbt uitkomstmaten bespreken clinical trials FSHD |
Geen restricties |
|
Schouten |
Klinisch Geneticus |
Geen |
Geen |
Geen |
|
Van esch |
Medewerker kwaliteit van zorg Spierziekten Nederland |
Beleidsadviseur VSCA |
Geen |
Geen |
|
Vosse |
Longarts |
Geen |
Geen |
Geen |
|
Seijger |
Longarts |
Geen |
Geen |
Geen |
|
Roest |
Kindercardioloog |
Afdelingshoofd en METC |
Geen |
Geen |
|
van den Heuvel |
Cardioloog |
Geen |
Geen |
Geen |
|
Voet |
Revalidatiearts |
Geen |
Extern gefinancierd onderzoek: AFM Telethon;FSHD, trainingsstudie, app, internationaal
|
Geen |
|
Hijdra |
kinderrevalidatiearts |
Geen |
Geen |
Geen |
|
Duits |
Klinisch neuropsycholoog |
Geen |
Extern gefinancierd onderzoek: ParkinsonNL-Zelfmanagement Parkinson naasten-projectleider WKK (wetenschapscie KP en KNP)-Zelfmanagement Parkinson patienten-projectleider EHDN-Zelfmanagement Huntington naasten- Erasmus + (PI Maastricht)-Covid / online educatief platform-projectleider ZonMW-Leefstijl Parkinson-geen projectleider" |
Geen |
|
Bruijnes |
neuroloog |
Geen |
Extern gefinancierd onderzoek: Academisch Alliantie Fonds - Digitale zorg bij myotone dystrofie |
Geen |
|
Groothuis |
Revalidatiearts |
Medisch adviseur van diagnose werkgroep FSHD van Spierziekten Nederland, onbetaald. Bestuurslid Spierziekten Centrum Nederland, onbetaald. |
Extern gefinancierd onderzoek: "Prinses Beatrix Spierfonds Spieren voor Spieren, Voor Sara en Stofwisselkracht Duchenne Parents Project Fulcrum Therapeutics (medicatie FSHD)" |
Geen |
|
Winter |
Internist-endocrinoloog |
Presentaties voor Lily, Amgen/UCB waarvoor vergoeding |
Extern gefinancierd onderzoek: NWO (Dutch Organization for Scientific Research): Grant to organize and host an international consensus meeting on Chronic Nonbacterial Osteomyelitis (CNO) (Projectleider;Ja) Leiden University Fund: Grant to organize and host an international consensus meeting on Chronic Nonbacterial Osteomyelitis (CNO) (Projectleider; ja) Leiden University Medical Center (LUMC): Thema grant to finance a PhD (Projectleider; ja) Dioraphte: grant: ‘DEnosumab for the treatment of FIbrous Dysplasia/McCune- Albright Syndrome in adults (DeFiD): a randomized double-blind placebo controlled trial’ (€480,000)" |
Geen |
Inbreng patiëntenperspectief
De werkgroep besteedde aandacht aan het patiëntenperspectief door deelname aan het cluster myopathie waarin deze module werd ondergebracht. De richtlijnmodule werd ter commentaar voorgelegd aan Spierziekten Nederland en de Patiëntenfederatie. De door hen aangeleverde commentaren werden verwerkt.
Kwalitatieve raming van mogelijke financiële gevolgen in het kader van de Wkkgz
Bij de richtlijnmodule voerden de clusterleden conform de Wet kwaliteit, klachten en geschillen zorg (Wkkgz) een kwalitatieve raming uit om te beoordelen of de aanbevelingen mogelijk leiden tot substantiële financiële gevolgen. Bij het uitvoeren van deze beoordeling is de richtlijnmodule op verschillende domeinen getoetst (zie het stroomschema bij Werkwijze).
|
Module |
Uitkomst raming |
Toelichting |
|
Module Neurologische betrokkenheid bij MD1 - psychostimulantia |
geen financiële gevolgen |
Uit de toetsing volgt dat de aanbeveling(en) niet breed toepasbaar zijn (<5.000 patiënten) en daarom naar verwachting geen substantiële financiële gevolgen zal hebben voor de collectieve uitgaven. |
Werkwijze
Voor meer details over de gebruikte richtlijnmethodologie verwijzen wij u naar de Werkwijze. Relevante informatie voor de ontwikkeling/herziening van deze richtlijnmodule is hieronder weergegeven.
Zoekverantwoording
Algemene informatie
|
Cluster/richtlijn: Cluster Myopathie & Spierdystrofie |
|
|
Uitgangsvraag/modules: UV5 Hoe worden neurologische complicaties voorkomen en behandeld? |
|
|
Database(s): Embase.com, Ovid/Medline, Ovid/PsycInfo |
Datum: 4 november 2024 en 17 december 20204 |
|
Periode: vanaf 2010 |
Talen: geen restrictie |
|
Literatuurspecialist: Alies Oost |
Rayyan: https://new.rayyan.ai/reviews/1214818/screening |
|
BMI-zoekblokken: voor verschillende opdrachten wordt (deels) gebruik gemaakt van de zoekblokken van BMI-Online https://blocks.bmi-online.nl/ |
|
|
Toelichting: Voor deze vraag is gezocht op de elementen:
De sleutelartikelen worden niet gevonden met deze search. Het sleutelartikel van Annane wordt niet gevonden omdat het te oud is (2006). De andere twee (van Leddy en Okkersen) bevatten geen termen voor psychostimulantia. Na overleg met de adviseur is besloten dat deze als achtergrondartikelen kunnnen worden beschouwd. Op 17 december 2024 is een update van de search van 4 november gedaan. |
|
|
Te gebruiken voor richtlijntekst: A systematic literature search was performed by a medical information specialist using the following bibliographic databases: Embase.com, Ovid/Medline and Ovid/PsycInfo. The databases were searched from 2010 to December 17, 2024 for systematic reviews, RCTs and observational studies. Systematic searches were completed using a combination of controlled vocabulary/subject headings (e.g., Emtree-terms, MeSH) wherever they were available and natural language keywords. The overall search strategy was derived from two primary search concepts: (1) myotonic dystrophy; (2) psychostimulantia. Duplicates were removed using EndNote software. After deduplication a total of 230 records were imported for title/abstract screening. |
|
Zoekopbrengst - 4 november 2024
|
|
EMBASE |
OVID/MEDLINE |
OVID/PSYCINFO |
Ontdubbeld |
|
SR |
38 |
5 |
0 |
37 |
|
RCT |
60 |
7 |
2 |
64 |
|
Observationele studies |
128 |
6 |
0 |
128 |
|
Totaal |
226 |
18 |
2 |
229* |
*in Rayyan
Zoekopbrengst - 17 december 2024
|
|
EMBASE |
OVID/MEDLINE |
OVID/PSYCINFO |
Ontdubbeld (ook t.o.v. de opbrengst van 04-11-2024) |
|
SR |
39 |
7 |
0 |
1 |
|
RCT |
60 |
8 |
2 |
0 |
|
Observationele studies |
128 |
6 |
0 |
0 |
|
Totaal |
227 |
21 |
2 |
1* |
*in Rayyan
Zoekstrategie - 4 november 2024
Embase.com
|
No. |
Query |
Results |
|
#1 |
'myotonic dystrophy'/exp OR (((dystroph* OR atroph*) NEAR/3 myoton*):ti,ab,kw) OR ((('type 1' OR 'type one' OR 'type i') NEAR/3 (dystroph* OR myoton*)):ti,ab,kw) OR steinert*:ti,ab,kw OR 'muscular* dystroph*':ti,ab,kw OR 'myoton* myopath*':ti,ab,kw |
52049 |
|
#2 |
'psychotropic agent'/exp OR 'central stimulant agent'/exp OR psychostimula*:ti,ab,kw OR psychoactive:ti,ab,kw OR psychopharmac*:ti,ab,kw OR ((('central nervous' OR cns) NEAR/3 stimula*):ti,ab,kw) OR 'methylphenidate'/exp OR 'methylphenidate':ti,ab,kw OR 'ritalin':ti,ab,kw OR 'modafinil'/exp OR 'modafinil':ti,ab,kw OR 'provigil':ti,ab,kw OR 'dexamphetamine'/exp OR 'dexamphetamin*':ti,ab,kw OR 'dexamfetamin*':ti,ab,kw OR dextroamphetamin*:ti,ab,kw OR 'dextro amphetamin*':ti,ab,kw OR dexedrin*:ti,ab,kw OR dexadrin*:ti,ab,kw OR dexamed:ti,ab,kw OR procentra:ti,ab,kw OR zenzedi:ti,ab,kw OR 'lisdexamfetamine'/exp OR 'lisdexamfetamin*':ti,ab,kw OR 'lisdexamphetamin*':ti,ab,kw OR 'vyvanse':ti,ab,kw |
1478608 |
|
#3 |
#1 AND #2 NOT ('conference abstract'/it OR 'editorial'/it OR 'letter'/it OR 'note'/it) NOT (('animal'/exp OR 'animal experiment'/exp OR 'animal model'/exp OR 'nonhuman'/exp) NOT 'human'/exp) |
770 |
|
#4 |
#3 AND [2010-2025]/py |
451 |
|
#5 |
'meta analysis'/exp OR 'meta analysis (topic)'/exp OR metaanaly*:ti,ab OR 'meta analy*':ti,ab OR metanaly*:ti,ab OR 'systematic review'/de OR 'cochrane database of systematic reviews'/jt OR prisma:ti,ab OR prospero:ti,ab OR (((systemati* OR scoping OR umbrella OR 'structured literature') NEAR/3 (review* OR overview*)):ti,ab) OR ((systemic* NEAR/1 review*):ti,ab) OR (((systemati* OR literature OR database* OR 'data base*') NEAR/10 search*):ti,ab) OR (((structured OR comprehensive* OR systemic*) NEAR/3 search*):ti,ab) OR (((literature NEAR/3 review*):ti,ab) AND (search*:ti,ab OR database*:ti,ab OR 'data base*':ti,ab)) OR (('data extraction':ti,ab OR 'data source*':ti,ab) AND 'study selection':ti,ab) OR ('search strategy':ti,ab AND 'selection criteria':ti,ab) OR ('data source*':ti,ab AND 'data synthesis':ti,ab) OR medline:ab OR pubmed:ab OR embase:ab OR cochrane:ab OR (((critical OR rapid) NEAR/2 (review* OR overview* OR synthes*)):ti) OR ((((critical* OR rapid*) NEAR/3 (review* OR overview* OR synthes*)):ab) AND (search*:ab OR database*:ab OR 'data base*':ab)) OR metasynthes*:ti,ab OR 'meta synthes*':ti,ab |
1075326 |
|
#6 |
'clinical trial'/exp OR 'randomization'/exp OR 'single blind procedure'/exp OR 'double blind procedure'/exp OR 'crossover procedure'/exp OR 'placebo'/exp OR 'prospective study'/exp OR rct:ab,ti OR random*:ab,ti OR 'single blind':ab,ti OR 'randomised controlled trial':ab,ti OR 'randomized controlled trial'/exp OR placebo*:ab,ti |
4136728 |
|
#7 |
'major clinical study'/de OR 'clinical study'/de OR 'case control study'/de OR 'family study'/de OR 'longitudinal study'/de OR 'retrospective study'/de OR 'prospective study'/de OR 'comparative study'/de OR 'cohort analysis'/de OR ((cohort NEAR/1 (study OR studies)):ab,ti) OR (('case control' NEAR/1 (study OR studies)):ab,ti) OR (('follow up' NEAR/1 (study OR studies)):ab,ti) OR (observational NEAR/1 (study OR studies)) OR ((epidemiologic NEAR/1 (study OR studies)):ab,ti) OR (('cross sectional' NEAR/1 (study OR studies)):ab,ti) |
8477803 |
|
#8 |
'case control study'/de OR 'comparative study'/exp OR 'control group'/de OR 'controlled study'/de OR 'controlled clinical trial'/de OR 'crossover procedure'/de OR 'double blind procedure'/de OR 'phase 2 clinical trial'/de OR 'phase 3 clinical trial'/de OR 'phase 4 clinical trial'/de OR 'pretest posttest design'/de OR 'pretest posttest control group design'/de OR 'quasi experimental study'/de OR 'single blind procedure'/de OR 'triple blind procedure'/de OR (((control OR controlled) NEAR/6 trial):ti,ab,kw) OR (((control OR controlled) NEAR/6 (study OR studies)):ti,ab,kw) OR (((control OR controlled) NEAR/1 active):ti,ab,kw) OR 'open label*':ti,ab,kw OR (((double OR two OR three OR multi OR trial) NEAR/1 (arm OR arms)):ti,ab,kw) OR ((allocat* NEAR/10 (arm OR arms)):ti,ab,kw) OR placebo*:ti,ab,kw OR 'sham-control*':ti,ab,kw OR (((single OR double OR triple OR assessor) NEAR/1 (blind* OR masked)):ti,ab,kw) OR nonrandom*:ti,ab,kw OR 'non-random*':ti,ab,kw OR 'quasi-experiment*':ti,ab,kw OR crossover:ti,ab,kw OR 'cross over':ti,ab,kw OR 'parallel group*':ti,ab,kw OR 'factorial trial':ti,ab,kw OR ((phase NEAR/5 (study OR trial)):ti,ab,kw) OR ((case* NEAR/6 (matched OR control*)):ti,ab,kw) OR ((match* NEAR/6 (pair OR pairs OR cohort* OR control* OR group* OR healthy OR age OR sex OR gender OR patient* OR subject* OR participant*)):ti,ab,kw) OR ((propensity NEAR/6 (scor* OR match*)):ti,ab,kw) OR versus:ti OR vs:ti OR compar*:ti OR ((compar* NEAR/1 study):ti,ab,kw) OR (('major clinical study'/de OR 'clinical study'/de OR 'cohort analysis'/de OR 'observational study'/de OR 'cross-sectional study'/de OR 'multicenter study'/de OR 'correlational study'/de OR 'follow up'/de OR cohort*:ti,ab,kw OR 'follow up':ti,ab,kw OR followup:ti,ab,kw OR longitudinal*:ti,ab,kw OR prospective*:ti,ab,kw OR retrospective*:ti,ab,kw OR observational*:ti,ab,kw OR 'cross sectional*':ti,ab,kw OR cross?ectional*:ti,ab,kw OR multicent*:ti,ab,kw OR 'multi-cent*':ti,ab,kw OR consecutive*:ti,ab,kw) AND (group:ti,ab,kw OR groups:ti,ab,kw OR subgroup*:ti,ab,kw OR versus:ti,ab,kw OR vs:ti,ab,kw OR compar*:ti,ab,kw OR 'odds ratio*':ab OR 'relative odds':ab OR 'risk ratio*':ab OR 'relative risk*':ab OR 'rate ratio':ab OR aor:ab OR arr:ab OR rrr:ab OR ((('or' OR 'rr') NEAR/6 ci):ab))) |
15512994 |
|
#9 |
#4 AND #5 - SR |
38 |
|
#10 |
#4 AND #6 NOT #9 - RCT |
60 |
|
#11 |
#4 AND (#7 OR #8) NOT (#9 OR #10) - observationeel |
128 |
|
#12 |
#9 OR #10 OR #11 |
226 |
Ovid/Medline
|
# |
Searches |
Results |
|
1 |
exp Myotonic Dystrophy/ or ((dystroph* or atroph*) adj3 myoton*).ti,ab,kf. or ((type 1 or type one or type i) adj3 (dystroph* or myoton*)).ti,ab,kf. or steinert*.ti,ab,kf. or muscular* dystroph*.ti,ab,kf. or myoton* myopath*.ti,ab,kf. |
36298 |
|
2 |
exp Psychotropic Drugs/ or exp Central Nervous System Stimulants/ or psychostimula*.ti,ab,kf. or psychoactive.ti,ab,kf. or psychopharmac*.ti,ab,kf. or (('central nervous' or cns) adj3 stimula*).ti,ab,kf. or exp Methylphenidate/ or 'methylphenidate'.ti,ab,kf. or 'ritalin'.ti,ab,kf. or exp Modafinil/ or 'modafinil'.ti,ab,kf. or 'provigil'.ti,ab,kf. or exp Dextroamphetamine/ or 'dexamphetamin*'.ti,ab,kf. or 'dexamfetamin*'.ti,ab,kf. or dextroamphetamin*.ti,ab,kf. or 'dextro amphetamin*'.ti,ab,kf. or dexedrin*.ti,ab,kf. or dexadrin*.ti,ab,kf. or dexamed.ti,ab,kf. or procentra.ti,ab,kf. or zenzedi.ti,ab,kf. or exp Lisdexamfetamine Dimesylate/ or 'lisdexamfetamin*'.ti,ab,kf. or 'lisdexamphetamin*'.ti,ab,kf. or 'vyvanse'.ti,ab,kf. |
512667 |
|
3 |
(1 and 2) not (comment/ or editorial/ or letter/) not ((exp animals/ or exp models, animal/) not humans/) |
137 |
|
4 |
limit 3 to yr="2010 -Current" |
39 |
|
5 |
meta-analysis/ or meta-analysis as topic/ or (metaanaly* or meta-analy* or metanaly*).ti,ab,kf. or systematic review/ or cochrane.jw. or (prisma or prospero).ti,ab,kf. or ((systemati* or scoping or umbrella or "structured literature") adj3 (review* or overview*)).ti,ab,kf. or (systemic* adj1 review*).ti,ab,kf. or ((systemati* or literature or database* or data-base*) adj10 search*).ti,ab,kf. or ((structured or comprehensive* or systemic*) adj3 search*).ti,ab,kf. or ((literature adj3 review*) and (search* or database* or data-base*)).ti,ab,kf. or (("data extraction" or "data source*") and "study selection").ti,ab,kf. or ("search strategy" and "selection criteria").ti,ab,kf. or ("data source*" and "data synthesis").ti,ab,kf. or (medline or pubmed or embase or cochrane).ab. or ((critical or rapid) adj2 (review* or overview* or synthes*)).ti. or (((critical* or rapid*) adj3 (review* or overview* or synthes*)) and (search* or database* or data-base*)).ab. or (metasynthes* or meta-synthes*).ti,ab,kf. |
786636 |
|
6 |
exp clinical trial/ or randomized controlled trial/ or exp clinical trials as topic/ or randomized controlled trials as topic/ or Random Allocation/ or Double-Blind Method/ or Single-Blind Method/ or (clinical trial, phase i or clinical trial, phase ii or clinical trial, phase iii or clinical trial, phase iv or controlled clinical trial or randomized controlled trial or multicenter study or clinical trial).pt. or random*.ti,ab. or (clinic* adj trial*).tw. or ((singl* or doubl* or treb* or tripl*) adj (blind$3 or mask$3)).tw. or Placebos/ or placebo*.tw. |
2799343 |
|
7 |
Epidemiologic studies/ or case control studies/ or exp cohort studies/ or Controlled Before-After Studies/ or Case control.tw. or cohort.tw. or Cohort analy$.tw. or (Follow up adj (study or studies)).tw. or (observational adj (study or studies)).tw. or Longitudinal.tw. or Retrospective*.tw. or prospective*.tw. or consecutive*.tw. or Cross sectional.tw. or Cross-sectional studies/ or historically controlled study/ or interrupted time series analysis/ [Onder exp cohort studies vallen ook longitudinale, prospectieve en retrospectieve studies] |
4870750 |
|
8 |
Case-control Studies/ or clinical trial, phase ii/ or clinical trial, phase iii/ or clinical trial, phase iv/ or comparative study/ or control groups/ or controlled before-after studies/ or controlled clinical trial/ or double-blind method/ or historically controlled study/ or matched-pair analysis/ or single-blind method/ or (((control or controlled) adj6 (study or studies or trial)) or (compar* adj (study or studies)) or ((control or controlled) adj1 active) or "open label*" or ((double or two or three or multi or trial) adj (arm or arms)) or (allocat* adj10 (arm or arms)) or placebo* or "sham-control*" or ((single or double or triple or assessor) adj1 (blind* or masked)) or nonrandom* or "non-random*" or "quasi-experiment*" or "parallel group*" or "factorial trial" or "pretest posttest" or (phase adj5 (study or trial)) or (case* adj6 (matched or control*)) or (match* adj6 (pair or pairs or cohort* or control* or group* or healthy or age or sex or gender or patient* or subject* or participant*)) or (propensity adj6 (scor* or match*))).ti,ab,kf. or (confounding adj6 adjust*).ti,ab. or (versus or vs or compar*).ti. or ((exp cohort studies/ or epidemiologic studies/ or multicenter study/ or observational study/ or seroepidemiologic studies/ or (cohort* or 'follow up' or followup or longitudinal* or prospective* or retrospective* or observational* or multicent* or 'multi-cent*' or consecutive*).ti,ab,kf.) and ((group or groups or subgroup* or versus or vs or compar*).ti,ab,kf. or ('odds ratio*' or 'relative odds' or 'risk ratio*' or 'relative risk*' or aor or arr or rrr).ab. or (("OR" or "RR") adj6 CI).ab.)) |
5824694 |
|
9 |
4 and 5 - SR |
5 |
|
10 |
(4 and 6) not 9 - RCT |
7 |
|
11 |
(4 and (7 or 8)) not (9 or 10) - observationeel |
6 |
|
12 |
9 or 10 or 11 |
18 |
Ovid/PsycInfo
|
# |
Searches |
Results |
|
1 |
exp Muscular Dystrophy/ or exp Myotonia/ or ((dystroph* or atroph*) adj3 myoton*).ti,ab,id. or ((type 1 or type one or type i) adj3 (dystroph* or myoton*)).ti,ab,id. or steinert*.ti,ab,id. or muscular* dystroph*.ti,ab,id. or myoton* myopath*.ti,ab,id. |
2317 |
|
2 |
exp Psychotropic Drugs/ or exp CNS Stimulating Drugs/ or psychostimula*.ti,ab,id. or psychoactive.ti,ab,id. or psychopharmac*.ti,ab,id. or (('central nervous' or cns) adj3 stimula*).ti,ab,id. or exp Methylphenidate/ or 'methylphenidate'.ti,ab,id. or 'ritalin'.ti,ab,id. or 'modafinil'.ti,ab,id. or 'provigil'.ti,ab,id. or exp Dextroamphetamine/ or 'dexamphetamin*'.ti,ab,id. or 'dexamfetamin*'.ti,ab,id. or dextroamphetamin*.ti,ab,id. or 'dextro amphetamin*'.ti,ab,id. or dexedrin*.ti,ab,id. or dexadrin*.ti,ab,id. or dexamed.ti,ab,id. or procentra.ti,ab,id. or zenzedi.ti,ab,id. or 'lisdexamfetamin*'.ti,ab,id. or 'lisdexamphetamin*'.ti,ab,id. or 'vyvanse'.ti,ab,id. |
140325 |
|
3 |
1 and 2 |
21 |
|
4 |
limit 3 to yr="2010 -Current" |
8 |
|
5 |
((literature review or systematic review or meta analysis).md. or "literature review"/ or meta analysis/ or (((meta adj2 analy*) or metaanaly* or (synthes* adj2 (literature* or research* or studies or data)) or (pooled and analys*) or ((data adj1 pool*) and studies) or medline or medlars or embase or cinahl or scisearch or psychlit or psyclit or cinhal or cancerlit or cochrane or bids or pubmed or ovid or ((hand or manual or database* or computer*) adj1 search*) or (electronic adj1 (database* or data base or data bases))).ti,ab,id. or (review* or overview).ti. or (bibliograph* or relevant journals or ((review* or overview*) adj9 (systematic* or methodologic* or quantitativ* or research* or literature* or studies or trial* or effective*))).ab.)) not (((retrospective* or record* or case* or patient*) adj1 review*) or ((patient* or review*) adj1 chart*)).ti,ab,id. |
504471 |
|
6 |
exp clinical trial/ or randomized controlled trial/ or randomized controlled trials as topic/ or Random Allocation/ or Double-Blind Method/ or Single-Blind Method/ or (clinical trial, phase i or clinical trial, phase ii or clinical trial, phase iii or clinical trial, phase iv or controlled clinical trial or randomized controlled trial or multicenter study or clinical trial).pt. or random*.ti,ab. or (clinic* adj trial*).tw. or ((singl* or doubl* or treb* or tripl*) adj (blind$3 or mask$3)).tw. or Placebos/ or placebo*.tw. |
309252 |
|
7 |
Epidemiologic studies/ or case control studies/ or exp Cohort Analysis/ or Controlled Before-After Studies/ or Case control.tw. or cohort*.tw. or Cohort analy$.tw. or (Follow up adj (study or studies)).tw. or (observational adj (study or studies)).tw. or Longitudinal.tw. or Retrospective*.tw. or prospective*.tw. or consecutive*.tw. or Cross sectional.tw. or Cross-sectional studies/ or historically controlled study/ or interrupted time series analysis/ |
498459 |
|
8 |
4 and 5 - SR |
0 |
|
9 |
(4 and 6) not 8 - RCT |
2 |
|
10 |
(4 and 7) not (8 or 9) - observationeel |
0 |
Zoekstrategie - 17 december 2024
Embase.com
|
No. |
Query |
Results |
|
#1 |
'myotonic dystrophy'/exp OR (((dystroph* OR atroph*) NEAR/3 myoton*):ti,ab,kw) OR ((('type 1' OR 'type one' OR 'type i') NEAR/3 (dystroph* OR myoton*)):ti,ab,kw) OR steinert*:ti,ab,kw OR 'muscular* dystroph*':ti,ab,kw OR 'myoton* myopath*':ti,ab,kw |
52270 |
|
#2 |
'psychotropic agent'/exp OR 'central stimulant agent'/exp OR psychostimula*:ti,ab,kw OR psychoactive:ti,ab,kw OR psychopharmac*:ti,ab,kw OR ((('central nervous' OR cns) NEAR/3 stimula*):ti,ab,kw) OR 'methylphenidate'/exp OR 'methylphenidate':ti,ab,kw OR 'ritalin':ti,ab,kw OR 'modafinil'/exp OR 'modafinil':ti,ab,kw OR 'provigil':ti,ab,kw OR 'dexamphetamine'/exp OR 'dexamphetamin*':ti,ab,kw OR 'dexamfetamin*':ti,ab,kw OR dextroamphetamin*:ti,ab,kw OR 'dextro amphetamin*':ti,ab,kw OR dexedrin*:ti,ab,kw OR dexadrin*:ti,ab,kw OR dexamed:ti,ab,kw OR procentra:ti,ab,kw OR zenzedi:ti,ab,kw OR 'lisdexamfetamine'/exp OR 'lisdexamfetamin*':ti,ab,kw OR 'lisdexamphetamin*':ti,ab,kw OR 'vyvanse':ti,ab,kw |
1485557 |
|
#3 |
#1 AND #2 NOT ('conference abstract'/it OR 'editorial'/it OR 'letter'/it OR 'note'/it) NOT (('animal'/exp OR 'animal experiment'/exp OR 'animal model'/exp OR 'nonhuman'/exp) NOT 'human'/exp) |
773 |
|
#4 |
#3 AND [2010-2025]/py |
454 |
|
#5 |
'meta analysis'/exp OR 'meta analysis (topic)'/exp OR metaanaly*:ti,ab OR 'meta analy*':ti,ab OR metanaly*:ti,ab OR 'systematic review'/de OR 'cochrane database of systematic reviews'/jt OR prisma:ti,ab OR prospero:ti,ab OR (((systemati* OR scoping OR umbrella OR 'structured literature') NEAR/3 (review* OR overview*)):ti,ab) OR ((systemic* NEAR/1 review*):ti,ab) OR (((systemati* OR literature OR database* OR 'data base*') NEAR/10 search*):ti,ab) OR (((structured OR comprehensive* OR systemic*) NEAR/3 search*):ti,ab) OR (((literature NEAR/3 review*):ti,ab) AND (search*:ti,ab OR database*:ti,ab OR 'data base*':ti,ab)) OR (('data extraction':ti,ab OR 'data source*':ti,ab) AND 'study selection':ti,ab) OR ('search strategy':ti,ab AND 'selection criteria':ti,ab) OR ('data source*':ti,ab AND 'data synthesis':ti,ab) OR medline:ab OR pubmed:ab OR embase:ab OR cochrane:ab OR (((critical OR rapid) NEAR/2 (review* OR overview* OR synthes*)):ti) OR ((((critical* OR rapid*) NEAR/3 (review* OR overview* OR synthes*)):ab) AND (search*:ab OR database*:ab OR 'data base*':ab)) OR metasynthes*:ti,ab OR 'meta synthes*':ti,ab |
1087015 |
|
#6 |
'clinical trial'/exp OR 'randomization'/exp OR 'single blind procedure'/exp OR 'double blind procedure'/exp OR 'crossover procedure'/exp OR 'placebo'/exp OR 'prospective study'/exp OR rct:ab,ti OR random*:ab,ti OR 'single blind':ab,ti OR 'randomised controlled trial':ab,ti OR 'randomized controlled trial'/exp OR placebo*:ab,ti |
4170368 |
|
#7 |
'major clinical study'/de OR 'clinical study'/de OR 'case control study'/de OR 'family study'/de OR 'longitudinal study'/de OR 'retrospective study'/de OR 'prospective study'/de OR 'comparative study'/de OR 'cohort analysis'/de OR ((cohort NEAR/1 (study OR studies)):ab,ti) OR (('case control' NEAR/1 (study OR studies)):ab,ti) OR (('follow up' NEAR/1 (study OR studies)):ab,ti) OR (observational NEAR/1 (study OR studies)) OR ((epidemiologic NEAR/1 (study OR studies)):ab,ti) OR (('cross sectional' NEAR/1 (study OR studies)):ab,ti) |
8556513 |
|
#8 |
'case control study'/de OR 'comparative study'/exp OR 'control group'/de OR 'controlled study'/de OR 'controlled clinical trial'/de OR 'crossover procedure'/de OR 'double blind procedure'/de OR 'phase 2 clinical trial'/de OR 'phase 3 clinical trial'/de OR 'phase 4 clinical trial'/de OR 'pretest posttest design'/de OR 'pretest posttest control group design'/de OR 'quasi experimental study'/de OR 'single blind procedure'/de OR 'triple blind procedure'/de OR (((control OR controlled) NEAR/6 trial):ti,ab,kw) OR (((control OR controlled) NEAR/6 (study OR studies)):ti,ab,kw) OR (((control OR controlled) NEAR/1 active):ti,ab,kw) OR 'open label*':ti,ab,kw OR (((double OR two OR three OR multi OR trial) NEAR/1 (arm OR arms)):ti,ab,kw) OR ((allocat* NEAR/10 (arm OR arms)):ti,ab,kw) OR placebo*:ti,ab,kw OR 'sham-control*':ti,ab,kw OR (((single OR double OR triple OR assessor) NEAR/1 (blind* OR masked)):ti,ab,kw) OR nonrandom*:ti,ab,kw OR 'non-random*':ti,ab,kw OR 'quasi-experiment*':ti,ab,kw OR crossover:ti,ab,kw OR 'cross over':ti,ab,kw OR 'parallel group*':ti,ab,kw OR 'factorial trial':ti,ab,kw OR ((phase NEAR/5 (study OR trial)):ti,ab,kw) OR ((case* NEAR/6 (matched OR control*)):ti,ab,kw) OR ((match* NEAR/6 (pair OR pairs OR cohort* OR control* OR group* OR healthy OR age OR sex OR gender OR patient* OR subject* OR participant*)):ti,ab,kw) OR ((propensity NEAR/6 (scor* OR match*)):ti,ab,kw) OR versus:ti OR vs:ti OR compar*:ti OR ((compar* NEAR/1 study):ti,ab,kw) OR (('major clinical study'/de OR 'clinical study'/de OR 'cohort analysis'/de OR 'observational study'/de OR 'cross-sectional study'/de OR 'multicenter study'/de OR 'correlational study'/de OR 'follow up'/de OR cohort*:ti,ab,kw OR 'follow up':ti,ab,kw OR followup:ti,ab,kw OR longitudinal*:ti,ab,kw OR prospective*:ti,ab,kw OR retrospective*:ti,ab,kw OR observational*:ti,ab,kw OR 'cross sectional*':ti,ab,kw OR cross?ectional*:ti,ab,kw OR multicent*:ti,ab,kw OR 'multi-cent*':ti,ab,kw OR consecutive*:ti,ab,kw) AND (group:ti,ab,kw OR groups:ti,ab,kw OR subgroup*:ti,ab,kw OR versus:ti,ab,kw OR vs:ti,ab,kw OR compar*:ti,ab,kw OR 'odds ratio*':ab OR 'relative odds':ab OR 'risk ratio*':ab OR 'relative risk*':ab OR 'rate ratio':ab OR aor:ab OR arr:ab OR rrr:ab OR ((('or' OR 'rr') NEAR/6 ci):ab))) |
15648220 |
|
#9 |
#4 AND #5 |
39 |
|
#10 |
#4 AND #6 NOT #9 |
60 |
|
#11 |
#4 AND (#7 OR #8) NOT (#9 OR #10) |
128 |
|
#12 |
#9 OR #10 OR #11 |
227 |
Ovid/Medline
|
# |
Searches |
Results |
|
1 |
exp Myotonic Dystrophy/ or ((dystroph* or atroph*) adj3 myoton*).ti,ab,kf. or ((type 1 or type one or type i) adj3 (dystroph* or myoton*)).ti,ab,kf. or steinert*.ti,ab,kf. or muscular* dystroph*.ti,ab,kf. or myoton* myopath*.ti,ab,kf. |
36466 |
|
2 |
exp Psychotropic Drugs/ or exp Central Nervous System Stimulants/ or psychostimula*.ti,ab,kf. or psychoactive.ti,ab,kf. or psychopharmac*.ti,ab,kf. or (('central nervous' or cns) adj3 stimula*).ti,ab,kf. or exp Methylphenidate/ or 'methylphenidate'.ti,ab,kf. or 'ritalin'.ti,ab,kf. or exp Modafinil/ or 'modafinil'.ti,ab,kf. or 'provigil'.ti,ab,kf. or exp Dextroamphetamine/ or 'dexamphetamin*'.ti,ab,kf. or 'dexamfetamin*'.ti,ab,kf. or dextroamphetamin*.ti,ab,kf. or 'dextro amphetamin*'.ti,ab,kf. or dexedrin*.ti,ab,kf. or dexadrin*.ti,ab,kf. or dexamed.ti,ab,kf. or procentra.ti,ab,kf. or zenzedi.ti,ab,kf. or exp Lisdexamfetamine Dimesylate/ or 'lisdexamfetamin*'.ti,ab,kf. or 'lisdexamphetamin*'.ti,ab,kf. or 'vyvanse'.ti,ab,kf. |
513996 |
|
3 |
(1 and 2) not (comment/ or editorial/ or letter/) not ((exp animals/ or exp models, animal/) not humans/) |
141 |
|
4 |
limit 3 to yr="2010 -Current" |
43 |
|
5 |
meta-analysis/ or meta-analysis as topic/ or (metaanaly* or meta-analy* or metanaly*).ti,ab,kf. or systematic review/ or cochrane.jw. or (prisma or prospero).ti,ab,kf. or ((systemati* or scoping or umbrella or "structured literature") adj3 (review* or overview*)).ti,ab,kf. or (systemic* adj1 review*).ti,ab,kf. or ((systemati* or literature or database* or data-base*) adj10 search*).ti,ab,kf. or ((structured or comprehensive* or systemic*) adj3 search*).ti,ab,kf. or ((literature adj3 review*) and (search* or database* or data-base*)).ti,ab,kf. or (("data extraction" or "data source*") and "study selection").ti,ab,kf. or ("search strategy" and "selection criteria").ti,ab,kf. or ("data source*" and "data synthesis").ti,ab,kf. or (medline or pubmed or embase or cochrane).ab. or ((critical or rapid) adj2 (review* or overview* or synthes*)).ti. or (((critical* or rapid*) adj3 (review* or overview* or synthes*)) and (search* or database* or data-base*)).ab. or (metasynthes* or meta-synthes*).ti,ab,kf. |
796993 |
|
6 |
exp clinical trial/ or randomized controlled trial/ or exp clinical trials as topic/ or randomized controlled trials as topic/ or Random Allocation/ or Double-Blind Method/ or Single-Blind Method/ or (clinical trial, phase i or clinical trial, phase ii or clinical trial, phase iii or clinical trial, phase iv or controlled clinical trial or randomized controlled trial or multicenter study or clinical trial).pt. or random*.ti,ab. or (clinic* adj trial*).tw. or ((singl* or doubl* or treb* or tripl*) adj (blind$3 or mask$3)).tw. or Placebos/ or placebo*.tw. |
2819936 |
|
7 |
Epidemiologic studies/ or case control studies/ or exp cohort studies/ or Controlled Before-After Studies/ or Case control.tw. or cohort.tw. or Cohort analy$.tw. or (Follow up adj (study or studies)).tw. or (observational adj (study or studies)).tw. or Longitudinal.tw. or Retrospective*.tw. or prospective*.tw. or consecutive*.tw. or Cross sectional.tw. or Cross-sectional studies/ or historically controlled study/ or interrupted time series analysis/ [Onder exp cohort studies vallen ook longitudinale, prospectieve en retrospectieve studies] |
4909927 |
|
8 |
Case-control Studies/ or clinical trial, phase ii/ or clinical trial, phase iii/ or clinical trial, phase iv/ or comparative study/ or control groups/ or controlled before-after studies/ or controlled clinical trial/ or double-blind method/ or historically controlled study/ or matched-pair analysis/ or single-blind method/ or (((control or controlled) adj6 (study or studies or trial)) or (compar* adj (study or studies)) or ((control or controlled) adj1 active) or "open label*" or ((double or two or three or multi or trial) adj (arm or arms)) or (allocat* adj10 (arm or arms)) or placebo* or "sham-control*" or ((single or double or triple or assessor) adj1 (blind* or masked)) or nonrandom* or "non-random*" or "quasi-experiment*" or "parallel group*" or "factorial trial" or "pretest posttest" or (phase adj5 (study or trial)) or (case* adj6 (matched or control*)) or (match* adj6 (pair or pairs or cohort* or control* or group* or healthy or age or sex or gender or patient* or subject* or participant*)) or (propensity adj6 (scor* or match*))).ti,ab,kf. or (confounding adj6 adjust*).ti,ab. or (versus or vs or compar*).ti. or ((exp cohort studies/ or epidemiologic studies/ or multicenter study/ or observational study/ or seroepidemiologic studies/ or (cohort* or 'follow up' or followup or longitudinal* or prospective* or retrospective* or observational* or multicent* or 'multi-cent*' or consecutive*).ti,ab,kf.) and ((group or groups or subgroup* or versus or vs or compar*).ti,ab,kf. or ('odds ratio*' or 'relative odds' or 'risk ratio*' or 'relative risk*' or aor or arr or rrr).ab. or (("OR" or "RR") adj6 CI).ab.)) |
5861053 |
|
9 |
4 and 5 |
7 |
|
10 |
(4 and 6) not 9 |
8 |
|
11 |
(4 and (7 or 8)) not (9 or 10) |
6 |
|
12 |
9 or 10 or 11 |
21 |
Ovid/PsycInfo
|
# |
Searches |
Results |
|
1 |
exp Muscular Dystrophy/ or exp Myotonia/ or ((dystroph* or atroph*) adj3 myoton*).ti,ab,id. or ((type 1 or type one or type i) adj3 (dystroph* or myoton*)).ti,ab,id. or steinert*.ti,ab,id. or muscular* dystroph*.ti,ab,id. or myoton* myopath*.ti,ab,id. |
2321 |
|
2 |
exp Psychotropic Drugs/ or exp CNS Stimulating Drugs/ or psychostimula*.ti,ab,id. or psychoactive.ti,ab,id. or psychopharmac*.ti,ab,id. or (('central nervous' or cns) adj3 stimula*).ti,ab,id. or exp Methylphenidate/ or 'methylphenidate'.ti,ab,id. or 'ritalin'.ti,ab,id. or 'modafinil'.ti,ab,id. or 'provigil'.ti,ab,id. or exp Dextroamphetamine/ or 'dexamphetamin*'.ti,ab,id. or 'dexamfetamin*'.ti,ab,id. or dextroamphetamin*.ti,ab,id. or 'dextro amphetamin*'.ti,ab,id. or dexedrin*.ti,ab,id. or dexadrin*.ti,ab,id. or dexamed.ti,ab,id. or procentra.ti,ab,id. or zenzedi.ti,ab,id. or 'lisdexamfetamin*'.ti,ab,id. or 'lisdexamphetamin*'.ti,ab,id. or 'vyvanse'.ti,ab,id. |
140863 |
|
3 |
1 and 2 |
21 |
|
4 |
limit 3 to yr="2010 -Current" |
8 |
|
5 |
((literature review or systematic review or meta analysis).md. or "literature review"/ or meta analysis/ or (((meta adj2 analy*) or metaanaly* or (synthes* adj2 (literature* or research* or studies or data)) or (pooled and analys*) or ((data adj1 pool*) and studies) or medline or medlars or embase or cinahl or scisearch or psychlit or psyclit or cinhal or cancerlit or cochrane or bids or pubmed or ovid or ((hand or manual or database* or computer*) adj1 search*) or (electronic adj1 (database* or data base or data bases))).ti,ab,id. or (review* or overview).ti. or (bibliograph* or relevant journals or ((review* or overview*) adj9 (systematic* or methodologic* or quantitativ* or research* or literature* or studies or trial* or effective*))).ab.)) not (((retrospective* or record* or case* or patient*) adj1 review*) or ((patient* or review*) adj1 chart*)).ti,ab,id. |
507545 |
|
6 |
exp clinical trial/ or randomized controlled trial/ or randomized controlled trials as topic/ or Random Allocation/ or Double-Blind Method/ or Single-Blind Method/ or (clinical trial, phase i or clinical trial, phase ii or clinical trial, phase iii or clinical trial, phase iv or controlled clinical trial or randomized controlled trial or multicenter study or clinical trial).pt. or random*.ti,ab. or (clinic* adj trial*).tw. or ((singl* or doubl* or treb* or tripl*) adj (blind$3 or mask$3)).tw. or Placebos/ or placebo*.tw. |
311270 |
|
7 |
Epidemiologic studies/ or case control studies/ or exp Cohort Analysis/ or Controlled Before-After Studies/ or Case control.tw. or cohort*.tw. or Cohort analy$.tw. or (Follow up adj (study or studies)).tw. or (observational adj (study or studies)).tw. or Longitudinal.tw. or Retrospective*.tw. or prospective*.tw. or consecutive*.tw. or Cross sectional.tw. or Cross-sectional studies/ or historically controlled study/ or interrupted time series analysis/ |
503012 |
|
8 |
4 and 5 |
0 |
|
9 |
(4 and 6) not 8 |
2 |
|
10 |
(4 and 7) not (8 or 9) |
0 |