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Prescribing regular drugs to prevent febrile convulsions risks more harm than benefit Prescribing regular drugs to prevent febrile convulsions risks more harm than benefit Discover Portal Discover Portal Prescribing regular drugs to prevent febrile convulsions risks more harm than benefit Published on 1 August 2017 doi: The benefits of giving anti-epileptic medication to children aged between six months and seven years who have had a convulsion while feverish, do not outweigh the harms. While (...) convulsions are fits that can occur when a young child (aged six months to six years) has a fever. Around 2 to 4% of children will have a febrile convulsion, with a third of those children going on to have another when feverish in the future. Most convulsions last under five minutes and the child may feel sleepy for a while afterwards. Simple febrile convulsions, by definition, are harmless and not a sign of serious brain disease, so can be managed with basic first aid such as putting the child
Topiramate for juvenile myoclonic epilepsy. Topiramate is a newer broad-spectrum antiepileptic drug (AED). Some studies have shown the benefits of topiramate in the treatment of juvenile myoclonic epilepsy (JME). However, there are no current systematic reviews to determine the efficacy and tolerability of topiramate in people with JME. This is an update of a Cochrane Review first published in 2015, and last updated in 2017.To evaluate the efficacy and tolerability of topiramate (...) in the treatment of JME.For the latest update, on 10 July 2018 we searched the Cochrane Register of Studies (CRS Web), which includes the Cochrane Epilepsy Group's Specialized Register and the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (Ovid 1946- ), and ClinicalTrials.gov. We also searched ongoing trials registers, reference lists and relevant conference proceedings, and contacted study authors and pharmaceutical companies.We included randomized controlled trials (RCTs) investigating
expression and cause. These advances have resulted in the new classification of epilepticseizures and epilepsies. A detailed clinical history and a reliable eyewitness account of a seizure are the cornerstones of the diagnosis. Ancillary investigations can help to determine cause and prognosis. Advances in brain imaging are helping to identify the structural and functional causes and consequences of the epilepsies. Comorbidities are increasingly recognised as important aetiological and prognostic (...) markers. Antiseizure medication might suppress seizures in up to two-thirds of all individuals but do not alter long-term prognosis. Epilepsy surgery is the most effective way to achieve long-term seizure freedom in selected individuals with drug-resistant focal epilepsy, but it is probably not used enough. With improved understanding of the gradual development of epilepsy, epigenetic determinants, and pharmacogenomics comes the hope for better, disease-modifying, or even curative, pharmacological
?tool=bestpractice.com The 2006 report by the International League Against Epilepsy Task Force on Classification and Terminology of Epilepsy and EpilepticSyndromes proposed a change in terminology and the omission of the words 'convulsion' and 'convulsive'. They suggested that the term 'febrile convulsions' be replaced by 'febrile seizures'. Fisher RS, Cross JH, French JA, et al. Operational classification of seizure types by the International League Against Epilepsy: position paper of the ILAE (...) Febrile seizure Febrile seizure - Symptoms, diagnosis and treatment | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search Febrile seizure Last reviewed: February 2019 Last updated: January 2019 Summary Febrile seizures are usually self-limiting; an increased risk of developing epilepsy is low except in a small number of cases. Most febrile seizures resolve spontaneously and quickly, and do not require acute or long-term anticonvulsant treatment. Definition
threshold, for example, antidepressants and antipsychotics. Serotonin syndrome has also been reported when tapentadol is used in combination with serotoninergic antidepressants. Published 9 January 2019 Last updated 9 January 2019 — From: Therapeutic area: , , , Contents Advice for healthcare professionals: as for all opioid medicines, tapentadol can induce seizures tapentadol should be prescribed with care in patients with a history of seizuredisorders or epilepsy tapentadol may increase seizure risk (...) include selective serotonin-reuptake inhibitors (SSRIs), serotonin norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants, and antipsychotics. Tapentadol should be used with care in patients with a history of seizuredisorders or epilepsy because of the increased risk of seizures. Strengthened warnings on seizure risk have been added to the Summary of Product Characteristics and Patient Information Leaflets. Reports of serotonin syndrome We are also aware of reports of serotonin
Group (AWMSG) for restricted use in the treatment of patients with refractory epilepsy, who remain uncontrolled with, or are intolerant to, other adjunctive anti-epileptic medicines, within its licensed indication as adjunctive therapy in the treatment of partial-onset seizures (POS) with or without secondary generalisation in adult and adolescent patients from 16 years of age with epilepsy. • This submission covers a licence extension to include children aged = 4 to = 15 years. • Treatment choice (...) in two equally divided doses, once in the morning and once in the evening. Based on individual patient response and tolerability, the dose may be adjusted in the dose range of 50 mg/day to 200 mg/day 2-4 . Marketing authorisation date 14 January 2016 2-4 . 2.0 DECISION CONTEXT 2.1 Background Epilepsy is a chronic neurological disorder characterised by recurring, unprovoked seizures. The disorder affects over 600,000 (based on 2010 figures) people in the UK 5 . Partial-onset (focal) seizures (POS
Surgical outcomes for medically intractable epilepsy in low- and middle-income countries: a systematic review and meta-analysis OBJECTIVEThe aim of this study was to describe the current state of epilepsy surgery and establish estimates of seizure outcomes following surgery for medically intractable epilepsy (MIE) in low- and middle-income countries (LMICs).METHODSThe MEDLINE and Embase databases were searched without publication date restriction. This search was supplemented by a manual screen (...) of key epilepsy and neurosurgical journals (January 2005 to December 2016). Studies that reported outcomes for at least 10 patients of any age undergoing surgery for MIE in LMICs over a defined follow-up period were included. A meta-analysis with a random-effects model was performed in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement and MOOSE (Meta-analysis of Observational Studies in Epidemiology) guidelines. Pooled estimates of seizure
A Prediction Model to Determine Childhood Epilepsy After 1 or More Paroxysmal Events The clinical profile of children who had possible seizures is heterogeneous, and accuracy of diagnostic testing is limited. We aimed to develop and validate a prediction model that determines the risk of childhood epilepsy by combining available information at first consultation.We retrospectively collected data of 451 children who visited our outpatient department for diagnostic workup related to 1 or more (...) paroxysmal event(s). At least 1 year of follow-up was available for all children who were diagnosed with epilepsy or in whom diagnosis remained inconclusive. Clinical characteristics (sex, age of first seizure, event description, medical history) and EEG report were used as predictor variables for building a multivariate logistic regression model. Performance was validated in an external cohort (n = 187).Model discrimination was excellent, with an area under the receiver operating characteristic curve
of an epilepsysyndrome. Convulsive status epilepticus is a prolonged convulsiveseizure for 5 minutes or longer, or recurrent seizures one after the other without recovery in between. A cause of epilepsy is only identified in about one third of people with the disorder. Causes include structural, genetic, infectious, metabolic, and immune. In the UK, the prevalence of epilepsy is estimated to be 5–10 cases per 1000. It is more common in people with learning disabilities. Clinical features of epilepsy (...) to epilepsy include: Vasovagal syncope. Cardiac arrhythmias. Panic attacks with hyperventilation. Non-epilepticattackdisorders (psychogenic non-epilepticseizures, dissociative seizures, or pseudoseizures). Transient ischaemic attack. Migraine. Medication, alcohol, or drug intoxication. Sleep disorders. Movement disorders. Hypoglycaemia and metabolic disorders. Transient global amnesia. Delerium or dementia — altered awareness may be mistaken for seizure activity. In children, differential diagnoses
Treatment of epilepsy for people with Alzheimer's disease. Any type of seizure can be observed in Alzheimer's disease (AD). Antiepileptic drugs seem to prevent the recurrence of epilepticseizures in most people with AD. There are pharmacological and non-pharmacological treatments for epilepsy in people with AD. There are no current systematic reviews to evaluate the efficacy and tolerability of these treatments; this review aims to review those different modalities. This is an updated version (...) - ), ClinicalTrials.gov, and the WHO International Clinical Trials Registry Platform (ICTRP). In an effort to identify further published, unpublished and ongoing trials, we searched ongoing trials registers, reference lists and relevant conference proceedings, and contacted authors and pharmaceutical companies.We included randomized and quasi-randomized controlled trials investigating treatment for epilepsy in people with AD, with the outcomes of proportion of participants with seizure freedom or proportion
Nomograms to predict naming decline after temporal lobe surgery in adults with epilepsy To develop and externally validate models to predict the probability of postoperative naming decline in adults following temporal lobe epilepsy surgery using easily accessible preoperative clinical predictors.In this retrospective, prediction model development study, multivariable models were developed in a cohort of 719 patients who underwent temporal lobe epilepsy surgery at Cleveland Clinic and externally (...) validated in a cohort of 138 patients who underwent temporal lobe surgery at one of 3 epilepsy surgery centers in the United States (Columbia University Medical Center, Emory University School of Medicine, University of Washington School of Medicine).The development cohort was 54% female with an average age at surgery of 36 years (SD 12). Twenty-six percent of this cohort experienced clinically relevant postoperative naming decline. The model included 5 variables: side of surgery, age at epilepsy onset
Acetaminophen and Febrile Seizure Recurrences During the Same Fever Episode To confirm the safety of using acetaminophen for febrile seizures (FSs) and to assess its efficacy in preventing FS recurrence during the same fever episode.In this single-center, prospective, open, randomized controlled study, we included children and infants (age range: 6-60 months) with FSs who visited our hospital between May 1, 2015, and April 30, 2017. The effectiveness of acetaminophen was examined by comparing (...) the recurrence rates of patients in whom rectal acetaminophen (10 mg/kg) was administered every 6 hours until 24 hours after the first convulsion (if the fever remained >38.0°C) to the rates of patients in whom no antipyretics were administered. No placebo was administered to controls. The primary outcome measure was FS recurrence during the same fever episode.We evaluated 423 patients; of these, 219 were in the rectal acetaminophen group, and 204 were in the no antipyretics group. In the univariate analysis
) on its use in NHSScotland. The advice is summarised as follows: ADVICE: following an abbreviated submission brivaracetam (Briviact ® ) is accepted for restricted use within NHSScotland. Indication under review: Adjunctive therapy in the treatment of partial-onset seizures with or without secondary generalisation in children from 4 years to =15 years of age with epilepsy. SMC restriction: for use in patients with refractory epilepsy and treatment should be initiated by physicians who have appropriate (...) experience in the treatment of epilepsy. SMC has previously accepted brivaracetam for restricted use as adjunctive therapy in the treatment of partial-onset seizures with or without secondary generalisation in adult and adolescent patients from 16 years of age with epilepsy. Advice context: No part of this advice may be used without the whole of the advice being quoted in full. This advice represents the view of the Scottish Medicines Consortium and was arrived at after evaluation of the evidence
Ketogenic diets for drug-resistant epilepsy. Ketogenic diets (KDs), being high in fat and low in carbohydrates, have been suggested to reduce seizure frequency in people with epilepsy. At present, such diets are mainly recommended for children who continue to have seizures despite treatment with antiepileptic drugs (AEDs) (drug-resistant epilepsy). Recently, there has been interest in less restrictive KDs, including the modified Atkins diet (MAD), and the use of these diets has extended (...) studies; reasons for this being lack of observed efficacy and dietary tolerance.Only one study reported the use of KDs in adults with epilepsy; therefore further research would be of benefit.Other more palatable but related diets, such as the MAD, may have a similar effect on seizure control as the classical KD, but this assumption requires more investigation. For people who have medically intractable epilepsy or people who are not suitable for surgical intervention, KDs remain a valid option; however
. The dossier was sent to IQWiG on 30 November 2017. Research question The aim of the present report was to assess the added benefit of perampanel as adjunctive therapy for primary generalized tonic-clonic seizures in adults and adolescents aged 12 years and older with idiopathic generalized epilepsy in comparison with the appropriate comparator therapy (ACT). The ACT specified by the G-BA is shown in Table 2. Table 2: Research question of the benefit assessment of perampanel Research question Subindication (...) ACT a 1 Adjunctive therapy for primary generalized tonic- clonic seizures in adults and adolescents aged 12 years and older with idiopathic generalized epilepsy an individual antiepileptic adjunctive therapy, if medically indicated and if no pharmacoresistance/intolerance and contraindications are known yet, with one of the following drugs: lamotrigine, levetiracetam, valproic acid b , topiramate, clobazam Treatment is to be chosen by the doctor depending on the basic and prior therapy/therapies
, Shinnar S, Gloss D, et al. Evidence-based guideline: treatment of convulsive status epilepticus in children and adults: report of the Guideline Committee of the American Epilepsy Society. Epilepsy Curr. 2016;16:48-61. 10. ShorvonS.Clinicaltrialsinacute repetitive seizures and status epilepticus. EpilepticDisord. 2012;14:138-147. 11. Morimoto K, Fahnestock M, Racine RJ. Kindling and status epilepticus models of epilepsy:rewiring the brain.ProgNeurobiol. 2004;73:1-60. 12. MeierkordH,BoonP,EngelsenB (...) midazolam and intravenous diazepam sedation for procedures and seizures. Indian J Pediatr. 2006;73:975-978. 4. Arya R, Gulati S, Kabra M, et al. Intranasal versus intravenous lorazepam for control of acute seizures in children: a randomized open-label study. Epilepsia. 2011;52:788-793. 5. Thakker A, Shanbag P. A randomized controlled trial of intranasal-midazolam versus intravenous-diazepam for acute childhood seizures. J Neurol. 2013;260:470-474. ofstatusepilepticus,ageofpatients, number of patients
Subpial transection surgery for epilepsy. Nearly 30% of patients with epilepsy continue to have seizures despite using several antiepileptic drugs (AEDs). Such patients are regarded as having refractory, or uncontrolled, epilepsy. While there is no universally accepted definition of uncontrolled, or medically refractory, epilepsy, for the purposes of this review we will consider seizures as drug resistant if they have failed to respond to a minimum of two AEDs. Specialists consider that early (...) surgical intervention may prevent seizures at a younger age, which in turn may improve the intellectual and social status of children. Many types of surgery are available for treating refractory epilepsy; one such procedure is known as subpial transection.To assess the effects of subpial transection for focal-onset seizures and generalised tonic-clonic seizures in children and adults.For the latest update we searched the following databases on 7 August 2018: the Cochrane Register of Studies (CRS Web
Gabapentin add-on treatment for drug-resistant focal epilepsy. This is an updated version of the Cochrane Review previously published in 2013.Most people with epilepsy have a good prognosis and their seizures are well controlled by a single antiepileptic drug, but up to 30% develop drug-resistant epilepsy, especially those with focal seizures. In this review, we summarised the evidence from randomised controlled trials (RCTs) of gabapentin, when used as an add-on treatment for drug-resistant (...) Clinical Trials Registry Platform (ICTRP, 20 March 2018). We imposed no language restrictions.Randomised, placebo-controlled, double-blind, add-on trials of gabapentin in people with drug-resistant focal epilepsy. We also included trials using an active drug control group or comparing different doses of gabapentin.For this update, two review authors independently selected trials for inclusion and extracted the relevant data. We assessed the following outcomes: seizure frequency, seizure freedom
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 phenobarbitone are commonly used broad-spectrum antiepileptic drugs, suitable for most epilepticseizure types. Carbamazepine is a current first-line treatment for focal onset seizures, and is used in the USA and Europe. Phenobarbitone is no longer considered a first-line treatment because of concerns (...) Carbamazepine versus phenobarbitone monotherapy for epilepsy: an individual participant data review. This is an updated version of the Cochrane Review previously published in 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
Oxcarbazepine versus phenytoin monotherapy for epilepsy: an individual participant data review. This is an updated version of the Cochrane Review previously published in 2013. 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 with a single antiepileptic drug in monotherapy.Worldwide, phenytoin is a commonly used antiepileptic drug. It is important to know how newer drugs, such as oxcarbazepine, compare with commonly used standard treatments.To review the time to treatment failure, remission and first seizure with oxcarbazepine compared to phenytoin, when used as monotherapy in people with focal onset