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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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Management issues for women with epilepsy - Focus on pregnancy: Teratogenesis and perinatal outcomes DOI 10.1212/WNL.0b013e3181a6b312 2009;73;133-141 Published Online before print April 27, 2009 Neurology C. L. Harden, K. J. Meador, P. B. Pennell, et al. Neurology and American Epilepsy Society Assessment Subcommittee of the American Academy of Standards Subcommittee and Therapeutics and Technology Teratogenesis and perinatal outcomes: Report of the Quality Focus on pregnancy (an evidence-based (...) review): -- epilepsy Practice Parameter update: Management issues for women with This information is current as of April 27, 2009 http://www.neurology.org/content/73/2/133.full.html located on the World Wide Web at: The online version of this article, along with updated information and services, is 0028-3878. Online ISSN: 1526-632X. since 1951, it is now a weekly with 48 issues per year. Copyright . All rights reserved. Print ISSN: ® is the official journal of the American Academy of Neurology
A 24-year-old woman with intractable seizures: review of surgery for epilepsy. Epilepsy, a recurrent seizure disorder affecting 1% of the population, can be genetic in origin and thereby affect multiple members in a family, or it can be sporadic. Many sporadic seizures come from a specific "focus" in the cortex. Focal-onset seizures account for 60% of all cases of epilepsy. Among patients with partial seizures, 35% respond poorly to available medication and may benefit from neurosurgical (...) excisional surgery. In cases in which epilepsy is localized through different modes (electroencephalogram, magnetic resonance imaging, etc) to a specific area of the brain where there is an associated lesion, more than half of patients can expect a successful surgical outcome. In patients with consistent seizure-associated behavior but without a lesion, surgical treatment is less successful. Ms H, a young woman with a history of medically intractable partial epilepsy, does not have an anatomical lesion
Epilepsy surgery for pharmacoresistant temporal lobe epilepsy: a decision analysis. Patients with pharmacoresistant epilepsy have increased mortality compared with the general population, but patients with pharmacoresistant temporal lobe epilepsy who meet criteria for surgery and who become seizure-free after anterior temporal lobe resection have reduced excess mortality vs those with persistent seizures.To quantify the potential survival benefit of anterior temporal lobe resection for patients (...) with pharmacoresistant temporal lobe epilepsy vs continued medical management.Monte Carlo simulation model that incorporates possible surgical complications and seizure status, with 10,000 runs. The model was populated with health-related quality-of-life data obtained directly from patients and data from the medical literature. Insufficient data were available to assess gamma-knife radiosurgery or vagal nerve stimulation.Life expectancy and quality-adjusted life expectancy.Compared with medical management, anterior
Sudden unexpected death in epilepsy: current knowledge and future directions Although largely neglected in earlier literature, sudden unexpected death in epilepsy (SUDEP) is the most important epilepsy-related mode of death, and is the leading cause of death in people with chronic uncontrolled epilepsy. Research during the past two to three decades has shown that incidence varies substantially depending on the epilepsy population studied, ranging from 0.09 per 1000 patient-years in newly (...) diagnosed patients to 9 per 1000 patient-years in candidates for epilepsy surgery. Risk profiles have been delineated in case-control studies. These and other studies indicate that SUDEP mainly occurs in the context of a generalised tonic-clonic seizure. However, it remains unclear why a seizure becomes fatal in a person that might have had many similar seizures in the past. Here, we review SUDEP rates, risk factors, triggers, and proposed mechanisms, and critically assess potential preventive
Acupuncture for epilepsy. Seizures are poorly controlled in many people with epilepsy despite adequate current antiepileptic treatments. There is increasing interest in alternative therapies such as acupuncture; however, it remains unclear whether the existing evidence is rigorous enough to support the use of acupuncture. This is an update of a Cochrane review first published in 2006.To determine the effectiveness and safety of acupuncture in people with epilepsy.We searched the Cochrane (...) Epilepsy Group's Specialized Register (March 2008) and the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 1, 2008), MEDLINE, EMBASE, and other databases from inception to March 2008. Reference lists from relevant trials were reviewed. No language restrictions were imposed.Randomised controlled trials comparing acupuncture with placebo or sham treatment, antiepileptic drugs or no treatment; or comparing acupuncture plus other treatments with the same other
Interventions for psychotic symptoms concomitant with epilepsy. People suffering from epilepsy have an increased risk of suffering from psychotic symptoms. The psychotic syndromes associated with epilepsy have generally been classified as ictal, postictal and interictal psychosis. Anticonvulsant drugs have been reported to precipitate psychosis. Moreover, all antipsychotic drugs have the propensity to cause paroxysmal EEG abnormalities and induce seizures.To evaluate the benefits (...) of interventions used to treat clinically significant psychotic symptoms occurring in people with epilepsy with regard to global improvement, changes in mental state, hospitalization, behavior, quality of life, effect on the frequency of seizures and interaction with antiepileptic drugs.We searched the Trials Registers of the Cochrane Schizophrenia Group and the Cochrane Epilepsy Group (May 2008), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 2, 2008), MEDLINE (Ovid
Drowning in people with epilepsy: how great is the risk? People with epilepsy are known to be at increased risk of death by drowning but there are few data available regarding the size of the risk. We aimed to quantify the risk using meta-analysis.A literature search identified 51 cohorts of people with epilepsy in whom the number of deaths by drowning in people with epilepsy and the number of person-years at risk could be estimated. Population data were taken from the WHO Statistical (...) Information Service or from the UK Office for National Statistics where available. Standardized mortality ratios (SMRs) with 95% CIs were calculated for each cohort, for groups of cohorts, and for the total population. Additionally, an SMR for drowning in people with epilepsy in England and Wales (1999-2000) was calculated using National Registries.Eighty-eight drowning deaths were observed compared with 4.70 expected, giving an SMR of 18.7 (95% CI 15.0 to 23.1). Compared with community-based incident
Psychological treatments for epilepsy. Psychological interventions such as relaxation therapy, cognitive behaviour therapy, bio-feedback and educational interventions have been used alone or in combination in the treatment of epilepsy, to reduce the seizure frequency and improve the quality of life.To assess whether the treatment of epilepsy with psychological methods is effective in reducing seizure frequency and/or leads to a better quality of life.We searched the Cochrane Epilepsy Group's (...) for inclusion and extracted data. Primary analyses were by intention to treat. Outcomes included reduction in seizure frequency and quality of life.We found three small trials (50 participants) of relaxation therapy. They were of poor methodological quality and a meta-analysis was therefore not undertaken. No study found a significant effect of relaxation therapy on seizure frequency. Two trials found cognitive behavioural therapy (CBT) to be effective in reducing depression, among people with epilepsy
Preconception counselling for women with epilepsy to reduce adverse pregnancy outcome. The provision of preconception counselling to women with epilepsy (WWE) has become established as recommended practice and includes a review of drug treatment and the provision of information and advice on both seizure and treatment-related risks to both mother and child. In this review we assess the evidence regarding the effectiveness of preconception counselling for WWE.To determine the effectiveness (...) of preconception counselling for WWE, measured by a reduction in adverse pregnancy outcome in both mother and child; increased knowledge of preconception issues in WWE and increasing intention to plan pregnancy.We searched the Epilepsy Group's Specialized Register (30/01/2008), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2007, Issue 4), and electronic databases: MEDLINE (OVID) (1950-February 2008); SCOPUS (1966-March 2008); CINAHL (1982-March 2008); PsyclNFO (1806-March
Outcomes of epilepsy surgery in adults and children Surgery is widely accepted as an effective therapy for selected individuals with medically refractory epilepsy. Numerous studies in the past 20 years have reported seizure freedom for at least 1 year in 53-84% of patients after anteromesial temporal lobe resections for mesial temporal lobe sclerosis, in 66-100% of patients with dual pathology, in 36-76% of patients with localised neocortical epilepsy, and in 43-79% of patients after (...) hemispherectomies. Reported rates for non-resective surgery have been less impressive in terms of seizure freedom; however, the benefit is more apparent when reported in terms of significant seizure reductions. In this Review, we consider the outcomes of surgery in adults and children with epilepsy and review studies of neurological and cognitive sequelae, psychiatric and behavioural outcomes, and overall health-related quality of life.
Clobazam as an add-on in the management of refractory epilepsy. Epilepsy effects approximately 1% of the population, with up to 30% of patients continuing to have seizures despite antiepileptic drug treatment.To assess the efficacy and tolerability of clobazam when used as an add-on therapy for patients with refractory partial onset or generalised onset seizures.We searched the following on 22nd March 2007: (a) The Cochrane Epilepsy Group Specialised Register; (b) The Cochrane Central Register
Levetiracetam for the treatment of idiopathic generalized epilepsy with myoclonic seizures Currently, there are no published randomized controlled trials evaluating the efficacy and safety of adjunctive antiepileptic therapy in idiopathic generalized epilepsy with myoclonic seizures.This randomized, double-blind, placebo-controlled multicenter trial assessed the efficacy and tolerability of adjunctive treatment with levetiracetam 3,000 mg/day in adolescents (>or=12 years) and adults (epilepsy, who experienced myoclonic seizures on >or=8 days during a prospective 8-week baseline period, despite antiepileptic monotherapy. The 8-week baseline period was followed by 4-week up-titration, 12-week evaluation, and 6-week down-titration/conversion periods.Of 122 patients randomized, 120 (levetiracetam, n = 60; placebo, n = 60) were evaluable. Diagnoses were either juvenile myoclonic epilepsy (93.4%) or juvenile absence epilepsy (6.6%). A reduction
Gestational age, birth weight, intrauterine growth, and the risk of epilepsy The authors evaluated the association between gestational age, birth weight, intrauterine growth, and epilepsy in a population-based cohort of 1.4 million singletons born in Denmark (1979-2002). A total of 14,334 inpatients (1979-2002) and outpatients (1995-2002) with epilepsy were registered in the Danish National Hospital Register. Children who were potentially growth restricted were identified through two methods: 1 (...) ) sex-, birth-order-, and gestational-age-specific z score of birth weight; and 2) deviation from the expected birth weight estimated based on the birth weight of an older sibling. The incidence rates of epilepsy increased consistently with decreasing gestational age and birth weight. The incidence rate ratios of epilepsy in the first year of life were more than fivefold among children born at 22-32 weeks compared with 39-41 weeks and among children whose birth weight was <2,000 g compared
Care delivery and self-management strategies for adults with epilepsy. Epilepsy care has been criticised for its lack of impact. Various service models and strategies have been developed in response to perceived inadequacies in care provision.To compare the effectiveness of any specialised or dedicated intervention for the care of adults with epilepsy to the effectiveness of usual care.We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 2, 2006 (...) reported on five trials of specialist epilepsy nurses. Of the 13 trials, at least three (four reports) have methodological weaknesses, and some of the results from other analyses within studies need to be interpreted with caution because of limiting factors in the studies. Consequently, there is currently limited evidence for the effectiveness of interventions to improve the health and life quality of people with epilepsy. It was not possible to combine study results in a meta-analysis because
WITHDRAWN: Specialist epilepsy nurses for treating epilepsy. Epilepsy is a common serious neurological condition with a 0.5% prevalence. As a result of the perceived deficiencies and suggestions to improve the quality of care offered to people with epilepsy, two models of service provision have been suggested by researchers: specialist epilepsy out-patient clinics (as opposed to the management of patients in general neurology clinics or general medical clinics) and nurse-based liaison services (...) between primary (GP) and secondary/tertiary (hospital-based) care.To overview the evidence from controlled trials investigating the effectiveness of specialist epilepsy nurses compared to routine care.We searched the Cochrane Central Register of Controlled Trials (TheCochraneLibrary Issue 4, 2004), MEDLINE (October 2004), GEARS, EMBASE, ECRI, Effectiveness Healthcare Bulletin, Effectiveness Matters, Bandolier, Evidence Based Purchasing, National Research Register and PsycINFO databases.Randomized
WITHDRAWN: Epilepsy clinics versus general neurology or medical clinics. Epilepsy is the most common serious neurological condition after stroke, with a 0.5% prevalence, and a two to three per cent life time risk of being given a diagnosis of epilepsy in the developed world.As a result of perceived deficiencies of the quality of care offered to people with epilepsy, two models of service provision have been suggested by researchers: specialist epilepsy out-patient clinics (as opposed (...) to the management of people in general neurology clinics or general medical clinics) and nurse-based liaison services between primary (GP) and secondary/tertiary (hospital-based) care.The aim of this review was to assess the evidence from controlled trials investigating the effectiveness of specialist epilepsy clinics compared to routine care. A second similar review investigating the effectiveness of specialist epilepsy nurses has also been published.We searched the Cochrane Central Register of Controlled
Stiripentol (Diacomit®) for use in conjunction with clobazam and valproate in patients with severe myoclonic epilepsy in infancy Stiripentol (Diacomit®) for use in conjunction with clobazam and valproate in patients with severe myoclonic epilepsy in infancy Stiripentol (Diacomit®) for use in conjunction with clobazam and valproate in patients with severe myoclonic epilepsy in infancy All Wales Medicines Strategy Group (AWMSG) Record Status This is a bibliographic record of a published health (...) technology assessment. No evaluation of the quality of this assessment has been made for the HTA database. Citation All Wales Medicines Strategy Group (AWMSG). Stiripentol (Diacomit®) for use in conjunction with clobazam and valproate in patients with severe myoclonic epilepsy in infancy. Penarth: All Wales Therapeutics and Toxicology Centre (AWTTC), secretariat of the All Wales Medicines Strategy Group (AWMSG). AWMSG Secretariat Assessment Report Advice No. 1608. 2008 Authors' conclusions Stiripentol
The cost-effective use of 18F-FDG PET in the presurgical evaluation of medically refractory focal epilepsy The cost-effective use of 18F-FDG PET in the presurgical evaluation of medically refractory focal epilepsy The cost-effective use of 18F-FDG PET in the presurgical evaluation of medically refractory focal epilepsy O'Brien T J, Miles K, Ware R, Cook M J, Binns D S, Hicks R J Record Status This is a critical abstract of an economic evaluation that meets the criteria for inclusion on NHS EED (...) . Each abstract contains a brief summary of the methods, the results and conclusions followed by a detailed critical assessment on the reliability of the study and the conclusions drawn. CRD summary The authors evaluated the therapeutic and health impacts of various strategies which involved fluorine-18 (18F)- fluorodeoxyglucose (FDG) positron emission tomography (PET) in the pre-surgical evaluation for medically refractory focal epilepsy. They concluded that 18 F-FDG PET provided important
A systematic review on MEG and its use in the presurgical evaluation of localization-related epilepsy Untitled Document The CRD Databases will not be available from 08:00 BST on Friday 4th October until 08:00 BST on Monday 7th October for essential maintenance. We apologise for any inconvenience.