Download Intramuscular high dose of thiamine treatment improves working

Critical Appraisal Topics Outline
Title:
Intramuscular high dose of thiamine treatment improves working memory
function of alcohol-dependent people
Clinical bottom line:
Administering intramuscular high dose of thiamine, more than 200mg daily for a consecutive
period of time, will significantly improve the working memory and cognitive function of
alcohol-dependent people.
Citation/s:
Alcohol Clin Exp Res. 2001 Jan;25(1):112-6
Thiamin treatment and working memory function of alcohol-dependent people:
preliminary findings
Lead author's name and fax: Ambrose ML, Bowden SC, Whelan G.
Clinical Scenario & PICO Question:
情境重點簡述：（與 PICO 有關的為主）
P: 58 y/o man, chronic alcoholism with suspected chronic pancreatitis, delirium for 2 more
months, ataxia(+), reduced consciousness(-), eye movement abnormalities(-)
I/E: thiamine
C: placebo
O: cognitive function and improved neurological signs
Type of Question: therapy
Search Terms & Strategy:
Database: Pubmed
Key words & Search strategy:
#4 Select 5 document(s) 00:29:35 5
#3 Search #1 OR #2 23:51:10 21
#2 Search (thiamine AND (korsakoff OR alcohol OR alcoholism )) AND systematic[sb]
23:50:22 14
#1 Search (thiamine AND (korsakoff OR alcohol OR alcoholism )) AND (randomized
controlled trial[Publication Type] OR (randomized[Title/Abstract] AND
controlled[Title/Abstract] AND trial[Title/Abstract])) 23:49:48 8
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The Study: Level of Evidence: Ib
Individual randomized control study, double-blind
169 participants were recruited and underwent a 4–5 day withdrawal regime with
conservative management and any medications for sedation. Before group assignment and
commencement of treatment, each subject was given a medical and neurological
examination, including the Mini-Mental State Examination (MMSE). 43 of the initial sample
did not complete treatment and assessment, and the final treatment groups differed in age
and average daily ethanol consumption. Therefore, data from 19 participants were
removed to equate treatment group means on the background variables of age, education,
and drinking history without regard to treatment outcome data. Finally, 107 patients entered
the study.
Participants were assigned randomly in equal numbers to one of five treatment groups
that received 5, 20, 50, 100, or 200 mg of intramuscular thiamin (as thiamin hydrochloride),
once per day. All participants were blind to treatment dose and conformed to a DSM-IV
diagnosis of alcohol dependence. On the third day of admission, all subjects were
assessed individually on delayed alternation (DA) by a psychologist blind to treatment
condition.
The Evidence:
1.
A significant difference between dosage groups in the number of trials taken to reach
criterion [F(4,102) = 2.50, p = 0.047, f = 0.31]. A planned comparison between the 200
mg group and the mean of the other dosage groups was significant [t(104) =2.18, p =
0.031, d = 0.22]
Comments:
1. The relatively small size of each treatment group, the high rate of non-completion, and
the short duration of thiamin treatment, the results should be regarded as preliminary.
2. The pattern of results does not appear to reflect a simple stepwise dose-response
relationship.
3. The heterogeneity of the treatment population in each sub-group is apparent that larger
sample will facilitate good group-match under strict randomization.
4. The result of this study should generalize to other samples of alcohol-dependent people,
due to broad subject selection criteria.
5. Our patient, who is alcohol-dependent without clinical triad of WKS, is compatible with
the sample in this study. There is no problem in lowering down the level of evidence
when applying the result of the study.
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References:
1.
Sechi G, Serra A. Lancet Neurol. 2007 May;6 (5):442-55. Wernicke's encephalopathy: new clinical settings and
recent advances in diagnosis and management.
2.
Day E, Bentham P, Callaghan R, Kuruvilla T, George S. Cochrane Database Syst Rev. 2004;(1):CD004033.
Thiamine for Wernicke-Korsakoff Syndrome in people at risk from alcohol abuse. (LoE: 1a)
3.
Jackson R, Teece S. Emerg Med J. 2004 Jul;21(4):501-2. Best evidence topic report. Oral or intravenous thiamine
in the emergency department.
4.
Kopelman MD. Br J Psychiatry. 1995 Feb;166 (2):154-73. The Korsakoff syndrome.
Kill or Update By:
Killed when 6/18/2009
科部會議名稱：「精神科 EBM style 期刊閱讀」
舉行日期時間： 12/18/2008, 1400-1500）
報告者：姓名：R1 陳濬廷
Code:
指導臨床教師：A 陳俊志
840975987
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139302
Email: [email protected]