RoongrojBhidayasiri, Director and Associate Professor of Neurology, Chulalongkorn University, Department of Medicine, Bangkok, Thailandguidelines@aan.com
Stanley Fahn, New York, NY; Gary S. Gronseth, Kansas City, KS; Kelly L. Sullivan, Tampa, FL; Theresa A. Zesiewicz, Tampa, FL
Submitted September 04, 2013
We appreciate the authors’ comments and interest in our article. [1] We agree that various forms of tardive syndromes (TDS) can respond to medications or interventions differently and that well-designed randomized, controlled trials are needed, with specific TDS inclusion criteria/subtypes, to determine the most effective interventions for TDS symptoms. As the authors noted, 2 studies on vitamin B6 and piracetam were not included in our original analysis. [2,3] The first study, a double-blind, placebo-controlled trial on vitamin B6 treatment in 50 inpatients with schizophrenia/schizoaffective disorders, was rated Class III for no allocation concealment and a >20% (14/50) dropout rate.2 The second study, involving 40 patients with schizophrenic/schizoaffective disorders who received piracetam or placebo over 4 weeks, was rated Class III for the same reasons (9 dropouts). After applying the AAN’s classification scheme for rating therapeutic articles, [4] we found the data remain insufficient to support or refute use of vitamin B6 and piracetam as TDS treatments. Although the AAN endeavors to find all pertinent literature, as the AAN process manual prescribes,[4] we realize that no literature search is 100% effective, and we thank the authors for alerting us to these 2 studies. We corrected errors for an article cited in table e-1 and this table is updated online at: http://www.neurology.org/content/81/5/463/suppl/DC1. [5]
1. Bhidayasiri R, Fahn S, Weiner WJ, Gronseth GS, Sullivan KL, Zesiewicz TA. Evidence-based guideline: Treatment of tardive syndromes: Report of the Guideline Development Subcommittee of the American Academy of Neurology. Neurology;81:463-469.
2. Lerner V, Miodownik C, Kaptsan A, et al. Vitamin B6 treatment for tardive dyskinesia: a randomized, double-blind, placebo-controlled, crossover study. The J Clin Psychiatry 2007;68:1648-1654.
3. Libov I, Miodownik C, Bersudsky Y, Dwolatzky T, Lerner V. Efficacy of piracetam in the treatment of tardive dyskinesia in schizophrenic patients: a randomized, double-blind, placebo-controlled crossover study. J Clin Psychiatry 2007;68:1031-1037.
4. Gronseth GS, Woodroffe LM, Getchius TSD. Clinical practice guideline process manual. Minnesota, USA: The American Academy of Neurology, 2011.
5. Lerner V, Miodownik C, Kaptsan A, et al. Vitamin B6 in the treatment of tardive dyskinesia: a double-blind, placebo-controlled, crossover study. Am J Psychiatry 2001;158:1511-1514.
For disclosures, contact the editorial office at journal@neurology.org.
Editor's Note: A Correction will be published for this article.
We appreciate the authors’ comments and interest in our article. [1] We agree that various forms of tardive syndromes (TDS) can respond to medications or interventions differently and that well-designed randomized, controlled trials are needed, with specific TDS inclusion criteria/subtypes, to determine the most effective interventions for TDS symptoms. As the authors noted, 2 studies on vitamin B6 and piracetam were not included in our original analysis. [2,3] The first study, a double-blind, placebo-controlled trial on vitamin B6 treatment in 50 inpatients with schizophrenia/schizoaffective disorders, was rated Class III for no allocation concealment and a >20% (14/50) dropout rate.2 The second study, involving 40 patients with schizophrenic/schizoaffective disorders who received piracetam or placebo over 4 weeks, was rated Class III for the same reasons (9 dropouts). After applying the AAN’s classification scheme for rating therapeutic articles, [4] we found the data remain insufficient to support or refute use of vitamin B6 and piracetam as TDS treatments. Although the AAN endeavors to find all pertinent literature, as the AAN process manual prescribes,[4] we realize that no literature search is 100% effective, and we thank the authors for alerting us to these 2 studies. We corrected errors for an article cited in table e-1 and this table is updated online at: http://www.neurology.org/content/81/5/463/suppl/DC1. [5]
1. Bhidayasiri R, Fahn S, Weiner WJ, Gronseth GS, Sullivan KL, Zesiewicz TA. Evidence-based guideline: Treatment of tardive syndromes: Report of the Guideline Development Subcommittee of the American Academy of Neurology. Neurology;81:463-469.
2. Lerner V, Miodownik C, Kaptsan A, et al. Vitamin B6 treatment for tardive dyskinesia: a randomized, double-blind, placebo-controlled, crossover study. The J Clin Psychiatry 2007;68:1648-1654.
3. Libov I, Miodownik C, Bersudsky Y, Dwolatzky T, Lerner V. Efficacy of piracetam in the treatment of tardive dyskinesia in schizophrenic patients: a randomized, double-blind, placebo-controlled crossover study. J Clin Psychiatry 2007;68:1031-1037.
4. Gronseth GS, Woodroffe LM, Getchius TSD. Clinical practice guideline process manual. Minnesota, USA: The American Academy of Neurology, 2011.
5. Lerner V, Miodownik C, Kaptsan A, et al. Vitamin B6 in the treatment of tardive dyskinesia: a double-blind, placebo-controlled, crossover study. Am J Psychiatry 2001;158:1511-1514.
For disclosures, contact the editorial office at journal@neurology.org.
Editor's Note: A Correction will be published for this article.