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Latest & greatest articles for epilepsy
The Trip Database is a leading resource to help health professionals find trustworthy answers to their clinical questions. Users can access the latest research evidence and guidance to answer their clinical questions. We have a large collection of systematic reviews, clinical guidelines, regulatory guidance, clinical trials and many other forms of evidence. If you wanted the latest trusted evidence on epilepsy or other clinical topics then use Trip today.
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with active epilepsy have the potential to become seizure-free and go into long-term remission shortly after starting drug therapy with a single antiepileptic drug in monotherapy.Worldwide, carbamazepine and phenytoin are commonly-used broad spectrum antiepileptic drugs, suitable for most epilepticseizure types. Carbamazepine is a current first-line treatment for focal onset seizures in the USA and Europe. Phenytoin is no longer considered a first-line treatment, due to concerns over adverse events (...) Carbamazepine versus phenytoin monotherapy for epilepsy: an individual participant data review. This is an update of a Cochrane Review first published in 2002 and last updated in 2017. This review is one in a series of Cochrane Reviews investigating pair-wise monotherapy comparisons.Epilepsy is a common neurological condition in which abnormal electrical discharges from the brain cause recurrent unprovoked seizures. It is believed that with effective drug treatment, up to 70% of individuals
Pregabalin add-on for drug-resistant focal epilepsy. Epilepsy is a common neurological disease that affects approximately 1% of the UK population. Approximately one-third of these people continue to have seizures despite drug treatment. Pregabalin is one of the newer antiepileptic drugs which have been developed to improve outcomes.This is an updated version of the Cochrane Review published in Issue 3, 2014, and includes three new studies.To assess the efficacy and tolerability of pregabalin (...) , manufacturer of pregabalin, to identify published, unpublished, and ongoing trials.We included randomised controlled trials comparing pregabalin with placebo or an alternative antiepileptic drug as an add-on for people of any age with drug-resistant focal epilepsy. Double-blind and single-blind trials were eligible for inclusion. The primary outcome was 50% or greater reduction in seizure frequency; secondary outcomes were seizure freedom, treatment withdrawal for any reason, treatment withdrawal due
Self-management of Epilepsy: A Systematic Review. Although self-management is recommended for persons with epilepsy, its optimal strategies and effects are uncertain.To evaluate the components and efficacy of self-management interventions in the treatment of epilepsy in community-dwelling persons.English-language searches of MEDLINE, Cochrane Central Register of Controlled Trials, PsycINFO, and CINAHL in April 2018; the MEDLINE search was updated in March 2019.Randomized and nonrandomized (...) , and followed 2 general strategies: 1 based on education and the other on psychosocial therapy. Education-based approaches improved self-management behaviors (standardized mean difference, 0.52 [95% CI, 0.0 to 1.04]), and psychosocial therapy-based approaches improved quality of life (mean difference, 6.64 [CI, 2.51 to 10.77]). Overall, self-management interventions did not reduce seizure rates, but 1 educational intervention decreased a composite of seizures, emergency department visits
Rufinamide (Inovelon) - treatment of seizures associated with Lennox-Gastaut syndrome Final Appraisal Recommendation Advice No: 0919 – June 2019 Rufinamide (Inovelon ® ) 40 mg/ml oral suspension Limited submission by Eisai Ltd Additional note(s): ? AWMSG considered that rufinamide (Inovelon ® ) satisfied the AWMSG criteria for orphan status. ? This advice incorporates and replaces the existing AWMSG recommendation for rufinamide (Inovelon ® ) as an option for use as adjunctive therapy (...) in the treatment of seizures associated with Lennox-Gastaut syndrome in patients 4 years of age and older where other adjunctive treatments have proved sub-optimal or have not been tolerated (AWTTC reference number 1663, originally published October 2012). In reaching the above recommendation AWMSG has taken account of the appraisal documentation prepared by the AWMSG Secretariat (reference number 991), which includes the AWMSG Secretariat Assessment Report (ASAR), the Preliminary Appraisal Recommendation (PAR
patients who remain uncontrolled with, or are intolerant to, other anti-epileptic medicine combinations, within its licensed indication as adjunctive therapy in adults with partial-onset seizures, with or without secondary generalisation (AWTTC reference number 611, originally published November 2012). In reaching the above recommendation AWMSG has taken account of the appraisal documentation prepared by the AWMSG Secretariat (reference number 1214), which includes the AWMSG Secretariat Assessment (...) (Zebinix ® ) should be restricted to treatment of highly refractory patients who remain uncontrolled with, or are intolerant to, other anti-epileptic medicine combinations, within its licensed indication as adjunctive therapy in adults, adolescents and children aged above six years, with partial-onset seizures, with or without secondary generalisation. Eslicarbazepine acetate (Zebinix ® ) is not recommended for use within NHS Wales outside of this subpopulation. Page 2 of 2 Statement of use: No part
Epilepsy duration and seizure outcome in epilepsy surgery: A systematic review and meta-analysis To conduct a systematic review and meta-analysis on the effect of earlier or later resective epilepsy surgery on seizure outcome.We searched the electronic databases PubMed, EMBASE, and Cochrane Library for studies investigating the association of epilepsy duration and seizure freedom after resective surgery. Two reviewers independently screened citations for eligibility and assessed relevant (...) studies for risk of bias. We combined data in meta-analyses using a random effects model. We assessed the certainty of evidence according to Grading of Recommendations Assessment, Development and Evaluation (GRADE).Twenty-five studies were included, 12 of which had data suitable for meta-analyses. Comparing seizure outcome if epilepsy surgery was performed before vs after 2, 5, 10, and 20 years of epilepsy duration, and comparing epilepsy duration <5 years to >10 years, we found significant effects
Surgery for epilepsy. This is an updated version of the original Cochrane review, published in 2015.Focal epilepsies are caused by a malfunction of nerve cells localised in one part of one cerebral hemisphere. In studies, estimates of the number of individuals with focal epilepsy who do not become seizure-free despite optimal drug therapy vary between at least 20% and up to 70%. If the epileptogenic zone can be located, surgical resection offers the chance of a cure with a corresponding (...) increase in quality of life.The primary objective is to assess the overall outcome of epilepsy surgery according to evidence from randomised controlled trials.Secondary objectives are to assess the overall outcome of epilepsy surgery according to non-randomised evidence, and to identify the factors that correlate with remission of seizures postoperatively.For the latest update, we searched the following databases on 11 March 2019: Cochrane Register of Studies (CRS Web), which includes the Cochrane
Topiramate versus carbamazepine monotherapy for epilepsy: an individual participant data review. This is an updated version of the original Cochrane Review published in Issue 12, 2016. This review is one in a series of Cochrane Reviews investigating pair-wise monotherapy comparisons.Epilepsy is a common neurological condition in which abnormal electrical discharges from the brain cause recurrent unprovoked seizures. It is believed that with effective drug treatment, up to 70% of individuals (...) with active epilepsy have the potential to become seizure-free and go into long-term remission shortly after starting drug therapy, the majority of which may be able to achieve remission with a single antiepileptic drug (AED).The correct choice of first-line AED for individuals with newly diagnosed seizures is of great importance and should be based on the highest-quality evidence available regarding the potential benefits and harms of various treatments for an individual.Topiramate and carbamazepine
Antiepileptic Drugs to Prevent Seizures After Spontaneous Intracerebral Hemorrhage Background and Purpose- We sought to evaluate the available literature to determine whether primary seizure prevention with antiepileptic drugs reduces the risk of poor outcomes and clinically relevant seizures among adult patients with spontaneous intracerebral hemorrhage. Methods- Meta-analysis of observational studies and randomized controlled trials evaluating the use of any antiepileptic drug for primary (...) seizure prevention among adult (≥18 years) patients with spontaneous intracerebral hemorrhage. The primary end point was poor clinical outcome at the longest recorded follow-up, defined as either a high (>3) modified Rankin Scale score or all-cause mortality during follow-up if the modified Rankin Scale score was not recorded. Early and late seizures were secondary outcomes. A random mixed effects model was used to estimate the pooled odds ratio of outcomes and associated 95% CI. Results- We
Levetiracetam versus phenytoin for second-line treatment of paediatric convulsive status epilepticus (EcLiPSE): a multicentre, open-label, randomised trial. Phenytoin is the recommended second-line intravenous anticonvulsant for treatment of paediatric convulsive status epilepticus in the UK; however, some evidence suggests that levetiracetam could be an effective and safer alternative. This trial compared the efficacy and safety of phenytoin and levetiracetam for second-line management (...) of paediatric convulsive status epilepticus.This open-label, randomised clinical trial was undertaken at 30 UK emergency departments at secondary and tertiary care centres. Participants aged 6 months to under 18 years, with convulsive status epilepticus requiring second-line treatment, were randomly assigned (1:1) using a computer-generated randomisation schedule to receive levetiracetam (40 mg/kg over 5 min) or phenytoin (20 mg/kg over at least 20 min), stratified by centre. The primary outcome was time
2019LancetControlled trial quality: predicted high
Zealand Clinical Trials Registry, number ACTRN12615000129583.Between March 19, 2015, and Nov 29, 2017, 639 children presented to participating emergency departments with convulsive status epilepticus; 127 were missed, and 278 did not meet eligibility criteria. The parents of one child declined to give consent, leaving 233 children (114 assigned to phenytoin and 119 assigned to levetiracetam) in the intention-to-treat population. Clinical cessation of seizure activity 5 min after completion of infusion (...) Levetiracetam versus phenytoin for second-line treatment of convulsive status epilepticus in children (ConSEPT): an open-label, multicentre, randomised controlled trial. Phenytoin is the current standard of care for second-line treatment of paediatric convulsive status epilepticus after failure of first-line benzodiazepines, but is only effective in 60% of cases and is associated with considerable adverse effects. A newer anticonvulsant, levetiracetam, can be given more quickly, is potentially
2019LancetControlled trial quality: predicted high
Rufinamide (Inovelon) - as adjunctive therapy in the treatment of seizures associated with Lennox-Gastaut syndrome Published 08 April 2019 1 www.scottishmedicines.org.uk Product update SMC2146 rufinamide 40mg/mL oral suspension and 100mg, 200mg, 400mg tablets (Inovelon®) Eisai Limited 8 March 2019 The Scottish Medicines Consortium (SMC) has completed its assessment of the above product and advises NHS Boards and Area Drug and Therapeutic Committees (ADTCs) on its use in NHSScotland. The advice (...) is summarised as follows: ADVICE: following an abbreviated submission rufinamide (Inovelon®) is accepted for restricted use within NHSScotland. Indication under review: as adjunctive therapy in the treatment of seizures associated with Lennox-Gastaut syndrome in patients 1 years to =4 years. SMC restriction: restricted to use in patients who have failed treatment with or are intolerant of other antiepileptic drugs. Rufinamide (Inovelon®) has previously been accepted for restricted use in adults and children
Brivaracetam add-on therapy for drug-resistant epilepsy. Epilepsy is one of the most common neurological disorders. It is estimated that up to 30% of patients with epilepsy continue to have epilepticseizures despite treatment with an antiepileptic drug. These patients are classified as drug-resistant and require treatment with a combination of multiple antiepileptic drugs. Brivaracetam is a third-generation antiepileptic drug that is a high-affinity ligand for synaptic vesicle protein 2A (...) ), was not significantly different following treatment with brivaracetam compared to placebo. However, participants receiving brivaracetam did appear to be significantly more likely to withdraw from treatment specifically because of adverse events compared with those receiving placebo (RR 1.54, 95% CI 1.02 to 2.33; 6 studies; low-quality evidence).Brivaracetam, when used as add-on therapy for patients with drug-resistant epilepsy, is effective in reducing seizure frequency and can aid patients in achieving seizure
Ethosuximide, sodium valproate or lamotrigine for absence seizures in children and adolescents. This is an updated version of the Cochrane Review previously published in 2017.Absence seizures (AS) are brief epilepticseizures which present in childhood and adolescence. Depending on clinical features and electroencephalogram (EEG) findings they are divided into typical, atypical absences, and absences with special features. Typical absences are characterised by sudden loss of awareness (...) and an EEG typically shows generalised spike wave discharges at three cycles per second. Ethosuximide, valproate and lamotrigine are currently used to treat absence seizures. This review aims to determine the best choice of antiepileptic drug for children and adolescents with AS.To review the evidence for the effects of ethosuximide, valproate and lamotrigine as treatments for children and adolescents with absence seizures (AS), when compared with placebo or each other.For the latest update we searched
in NHS Scotland. The advice is summarised as follows: ADVICE: following an abbreviated submission eslicarbazepine acetate (Zebinix ® ) is accepted for restricted use within NHSScotland. Indication under review: as adjunctive therapy in adolescents and children aged above 6 years with partial-onset seizures with or without secondary generalisation. SMC restriction: patients with highly refractory epilepsy who have been heavily pre-treated and remain uncontrolled with existing anti-epileptic drugs. SMC (...) Eslicarbazepine acetate (Zebinix) - as adjunctive therapy in adolescents and children aged above 6 years with partial-onset seizures Published 11 February 2019 Product Update: eslicarbazepine acetate 200mg and 800mg tablets and oral suspension 50mg/mL (Zebinix ® ) SMC2087 Eisai Ltd 10 August 2018 (Issued 11 January 2019) The Scottish Medicines Consortium (SMC) has completed its assessment of the above product and advises NHS Boards and Area Drug and Therapeutic Committees (ADTCs) on its use
% of febrile seizures in children are classified as "complex" and require specific treatment by an emergency medical service as well as hospitalisation in order to investigate the cause. A complex seizure presents at least one of the following features: duration of more than 15 minutes; recurrence within 24 hours; partial seizure , i.e. with convulsions affecting only part of the body, without loss of consciousness; neurological disorder following the seizure. Situations in which there is a risk (...) -choice treatments FEATURED REVIEW Febrile seizures occur in around 3% of children. What are the essential points for healthcare professionals to keep in mind? And what are the warning signs to look out for? Full review (4 pages) available for download by subscribers. A simple febrile seizure is defined as an episode of generalised seizures lasting less than 15 minutes and occurring only once in 24 hours in a child during a febrile episode, without intracranial infection, metabolic disorders
Antiepileptic drugs as prophylaxis for de novo brain tumour-related epilepsy after craniotomy: a systematic review and meta-analysis of harm and benefits To investigate potential harm and benefits of antiepileptic drugs (AED) given prophylactically to prevent de novo brain tumour-related epilepsy after craniotomy.Randomised controlled trials (RCT) and retrospective studies published before 27 November 2018 were included. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (...) guidelines were applied. Eligible patients were diagnosed with a brain tumour, were seizure naïve and underwent craniotomy. The random effects model was used for quantitative synthesis. The analysis was adjusted for the confounding effect of including patients with a history of seizure prior to study inclusion.A total of 454 patients received prophylactic AED whereas 333 were allocated to placebo or no treatment. Two RCTs and four retrospective studies were identified. The OR was 1.09 (95% CI 0.7 to 1.8
and also describes the current options regarding the routes and preparations used when it is difficult to secure intravenous access quickly. Share your views on the research. Why was this study needed? About one in 240 children (aged 16 years and under) have a diagnosis of epilepsy in the UK. Tonic-clonic seizures are the type of epilepticseizure that are most easily recognisable. They have two phases: loss of consciousness with the muscles stiffening; followed by jerking of the limbs. Most tonic (...) -clonic seizures last for less than five minutes. If they last longer, it is likely that they won’t stop spontaneously. If they don’t stop, they can lead to serious complications or death. Around 1,000 people die each year from epilepsy in the UK. There is a range of anti-epileptic drugs available to stop the seizures. This Cochrane review was last updated in 2008. Since then, a number of new randomised controlled trials have been published. This update aimed to evaluate this new evidence, looking
when selecting an anti-epilepsy drug as it usually will need to be taken long-term. This study reviewed evidence on anti-epilepsy drugs in adults and children. The drugs were compared directly or indirectly with each other. The main outcome of interest was time to withdrawal from treatment, which indicates effectiveness and tolerability. The findings support NICE recommendations to use carbamazepine or lamotrigine as first-line therapies for epilepsy with partial seizures, with levetiracetam (...) as an alternative. Sodium valproate or lamotrigine are recommended for people with generalised tonic-clonic seizures, and levetiracetam is an alternative option. Share your views on the research. Why was this study needed? Epilepsy is common, affecting around one in every hundred people in the UK. People with epilepsy experience seizures due to abnormal electrical activity in the brain. Some types of epilepsy occur in one part of the brain (partial seizures) while others are more widespread (generalised
an alternative. There has been widespread interest from the public and the media in the medical use of cannabis and its active components (called cannabinoids). The medicinal grade cannabinoid studied in the main trials of this review do not have hallucinogenic effects. Laboratory and animal studies have suggested that cannabinoids might reduce epilepticseizures, and they have shown promise in some studies in people with severe epilepsy. However, there has been concern about the quality of these studies (...) samples with rare and severe epilepsysyndromes; RCTs examining other syndromes and cannabinoids are needed. PROSPERO REGISTRATION NUMBER: CRD42017055412. Drug-resistant epilepsy. Where adequate trials of two tolerated and appropriately chosen single drug or combination antiepileptic drug regimens have failed to stop seizures completely. Seizure freedom. Defined in the review as having no seizures of any type for either 12 months or three times the longest seizure-free interval before the trial