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Strategies for improving adherence to antiepileptic drug treatment in people with epilepsy. Poor adherence to antiepileptic medication is associated with increased mortality, morbidity and healthcare costs. In this review, we focus on interventions designed and tested in randomised controlled trials and quasi-randomised controlled trials to assist people with adherence to antiepileptic medication. This is an updated version of the original Cochrane review published in the Cochrane Library (...) , Issue 1, 2010.To determine the effectiveness of interventions aimed at improving adherence to antiepileptic medication in adults and children with epilepsy.For the latest update, on 4 February 2016 we searched the Cochrane Epilepsy Group Specialized Register, the Cochrane Central Register of Controlled Trials (CENTRAL) via the Cochrane Register of Studies Online (CRSO), MEDLINE (Ovid 1946 to 4 February 2016), CINAHL Plus (EBSCOhost 1937 to 4 February 2016), PsycINFO (EBSCOhost 1887 to 4 February
editor for Epilepsy Currents . Dr. Tomson has served as the associate editor of Epilepsia ; is a member of the editorial boards of Epilepsy Research , EpilepticDisorders , and the European Journal of Clinical Pharmacology ; has received honoraria from Sun Pharmaceuticals, UCB, Eisai, and Bial; has served as a member of an expert panel for sudden unexpected death in epilepsy (SUDEP) adjudication in clinical trials of lamotrigine sponsored by GlaxoSmithKline; and has received research support from UCB (...) meeting of the French League Against Epilepsy; has received travel funding and honoraria from GlaxoSmithKline, Eisai, Janssen Cilag Pty Ltd, Cyberonics, Medtronic, and UCB Pharma (in order to participate on industry-funded advisory boards or symposia); has served as a journal editor for Epilepsia, Epilepsy Research, EpilepticDisorders , and Epilepsy Research and Treatment ; has served on speakers bureaus for Eisai, GlaxoSmithKline, and UCB Pharma for a symposium at the European and International
Epilepsy: What else might it be? Differential diagnosis | Diagnosis | Epilepsy | CKS | NICE Search CKS… Menu Differential diagnosis Epilepsy: What else might it be? Last revised in July 2019 What else might it be? Conditions which may present with similar features 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 include: Febrile convulsions. Breath-holding attacks. Night terrors. Stereotyped/ritulistic behaviour — especially in those with a learning disability. Basis for recommendation This information about differential diagnosis
Epilepsy: Scenario: Managing someone with suspected epilepsy Scenario: Suspected epilepsy | Management | Epilepsy | CKS | NICE Search CKS… Menu Scenario: Suspected epilepsyEpilepsy: Scenario: Managing someone with suspected epilepsy Last revised in July 2019 Scenario: Managing someone with suspected epilepsy From birth onwards. How should I manage someone with suspected epilepsy? Urgently refer all people suspected of having a first epilepticseizure to a specialist with training (...) in the Scottish Intercollegiate Guidelines Network (SIGN) guidelines Diagnosis and management of epilepsy in adults [ ]. The SIGN guideline for adults states that a significant proportion of epilepsy diagnoses made by non-specialists is incorrect, and epilepsy may be difficult to diagnose in the early stages [ ]. It is important that identification of the seizure type and epilepsysyndrome is attempted, and a distinction made between genetic generalised epilepsies and focal epilepsies as this can have
Epilepsy: Scenario: Managing an epilepticseizure Scenario: Managing an epilepticseizure | Management | Epilepsy | CKS | NICE Search CKS… Menu Scenario: Managing an epilepticseizureEpilepsy: Scenario: Managing an epilepticseizure Last revised in July 2019 Scenario: Managing an epilepticseizure From birth onwards. How do I manage a person having an epilepticseizure including status epilepticus? For people having a tonic-clonic seizure, note the time, and if it lasts less than 5 minutes (...) : Look for an epilepsy identity card or jewellery. Protect them from injury by: Cushioning their head, for example with a pillow. Removing glasses if they are wearing them. Removing harmful objects from nearby, or if this is not possible, moving the person away from immediate danger. Do not restrain them or put anything in their mouth. When the seizure stops, check their airway and place them in the recovery position. Observe them until they have recovered. Examine for, and manage, any injuries
with expert opinion that the diagnosis of epilepsy and epilepticseizures is largely clinical and depends on the history and examination [ ]. The recommendations on asking about aura and any potential triggers also reflect expert opinion in review articles [ ; ]. CKS recommends asking about residual symptoms after the attack based on examples given in review articles on generalised seizures [ ; ]. Classification of seizure type Expert opinion in the SIGN guideline Diagnosis and management of epilepsy (...) , or an to epilepsy. What happened before, during and after the attack (from the patient and an eyewitness). This should include: Any subjective symptoms at the start of the seizure (aura) — suggestive of focal epilepsy; these may provide information on where the seizure might arise. Any potential triggers , for example sleep deprivation, stress, light sensitivity, or alcohol use. Specific features of the seizure, for example : Short-lived (less than 1 minute), abrupt, generalised muscle stiffening (may cause
of the brain defined by any of the following: At least two unprovoked seizures occurring more than 24 hours apart. One unprovoked seizure and a probability of further seizures similar to the general recurrence risk after two unprovoked seizures, occurring over the next 10 years. Diagnosis 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 (...) EpilepsyEpilepsy | Topics A to Z | CKS | NICE Search CKS… Menu EpilepsyEpilepsy Last revised in July 2019 Epilepticseizure is a transient disturbance of consciousness, behaviour, emotion, motor function, or sensation, due to abnormal electrical activity Diagnosis Management Prescribing information Background information Epilepsy - Summary A seizure is the transient occurrence of signs or symptoms due to abnormal excessive or synchronous neuronal activity in the brain. Epilepsy is a disease
Febrile seizure: When should I suspect a febrile seizure? Diagnosis | Diagnosis | Febrile seizure | CKS | NICE Search CKS… Menu Diagnosis Febrile seizure: When should I suspect a febrile seizure? Last revised in November 2018 When should I suspect a febrile seizure? Suspect a diagnosis of febrile seizure if a child has a fever or febrile illness and a reported or witnessed seizure: Typical features of a simple febrile seizure include: The child is aged 6 months to 6 years. The seizure usually (...) lasts 2–3 minutes, and rarely lasts more than 10 minutes. The seizure is a generalized tonic-clonic type (muscle stiffening followed by rhythmical jerking or shaking of the limbs, which may be asymmetrical); twitching of the face; rolling back of the eyes; staring and loss of consciousness. There may be foaming at the mouth, difficulty breathing, pallor, or cyanosis. A brief post-ictal period of drowsiness, irritability, or confusion, with complete recovery within 1 hour. The child may have had
syndromes, such as: Dravet syndrome (severe myoclonic epilepsy of infancy) — a neurodevelopmental disorder characterized by prolonged intractable seizures initially triggered by fever. Typically over time seizures change to become myoclonic and later focal, with developmental delay associated. Genetic epilepsy with febrile seizures plus (GEFS+) — an autosomal dominant disorder where seizures continue beyond 6 years of age, and afebrile seizures may also occur. Other neurological conditions (...) on for more information. Hypoglycaemia or other metabolic disorders, such as a mitochondrial cytopathy — metabolic disorders may present with developmental delay, faltering growth, hepatosplenomegaly, and micro or macrocephaly. Drug use or withdrawal. See the CKS topic on for more information. Epilepsy — suspect if there is no compelling history of fever, the seizure was complex, there were post-ictal signs, or there is neurodevelopmental delay. See the CKS topic on for more information. Epilepsy
. [ ; ; ; ] Basis for recommendation The recommendations on acute management of febrile seizure are based on the Task Force Report of the International League Against Epilepsy (ILAE) Commission of Pediatrics Summary of recommendations for the management of infantile seizures [ ], a US research article on the emergency management of febrile status epilepticus [ ], and expert opinion in review articles on febrile seizure [ ; ; ; ; ; ; ]. The recommendation to monitor seizure duration is based on expert opinion (...) Febrile seizure: Scenario: Acute management of febrile seizure Scenario: Acute management of febrile seizure | Management | Febrile seizure | CKS | NICE Search CKS… Menu Scenario: Acute management of febrile seizure Febrile seizure: Scenario: Acute management of febrile seizure Last revised in November 2018 Scenario: Acute management of febrile seizure From age 6 months to 6 years. How should I manage a child having a febrile seizure? Most children will present to a healthcare professional
immunization history. See the CKS topic on for more information. Neurodevelopmental history and any concerns. Whether the child attends daycare such as nursery (source of potential exposure to infection). Any family history of febrile seizures or epilepsy. Examine the child: Assess the level of consciousness, and check for any focal neurological deficit such as weakness of the hand, arm, or leg. Check the temperature after the seizure has ended. A temperature of more than 38°C is generally considered (...) significant. Assess fluid status and for signs of dehydration. See the CKS topic on for more information. Assess for other signs to identify the underlying cause of febrile illness, and manage appropriately. See the CKS topics on and for more information. Assess for stigmata of a neurocutaneous or metabolic disorder suggesting an for seizure. Be aware that investigations are not usually needed in primary care. Consider measuring blood glucose if a child cannot be roused or is having an acute seizure
the cause of the seizure, or for recurrent complex febrile seizure. If there is any focal neurological deficit, recent antibiotic use, or there is parental/carer anxiety or difficulty coping. Urgent hospital assessment should be considered if: There is unexplained fever and no apparent focus of infection. Referral to a paediatrician or paediatric neurologist should be arranged if: The child has neurodevelopmental delay and/or signs of a neurocutaneous syndrome or metabolic disorder. Parents/carers (...) the underlying cause of fever, where possible. Asking about fever onset, peak temperature, duration, and relationship to the seizure. Asking about the seizure and any post-ictal drowsiness. Asking about previous seizure episodes and any family history of febrile seizures or epilepsy. Assessing the child's temperature, consciousness level, any focal neurological deficit, fluid status, and signs of an alternative cause of seizure. Most children will present to a healthcare professional after the febrile
, Pfizer, SK Life Science, Sunovion, UCB, Upsher-Smith, and Vertex; has received grants from the noncommercial entities Epilepsy Research Foundation, Epilepsy Study Consortium, Epilepsy Therapy Project, and the National Institute of Neurological Disorders and Stroke of the NIH; serves on the editorial boards of Lancet Neurology , Neurology Today , and EpilepticDisorders ; is scientific officer for the Epilepsy Foundation of America, for which NYU receives salary support; and has received travel (...) Health & Science University, Portland; Department of Neurology (J.A.F.), New York University, New York; and Clinical Epilepsy Section (W.H.T.), National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD. David Gloss From the Department of Neurology (J.P.S.), University of Alabama at Birmingham; Department of Neurology (D.G.), Charleston Area Medical Center, WV; Department of Neurology (J.R.B., S.J.S.), Medical College of Wisconsin, Milwaukee; Children's National Medical Center (W.D.G
Cannabidiol (Epidioloex) - To treat rare, severe forms of epilepsy Drug Approval Package: Epidiolex (Cannabidiol) U.S. Department of Health and Human Services Search FDA Submit search Drug Approval Package: Epidiolex (Cannabidiol) Company: GW Research Ltd. Application Number: 210365 Orig 1 Approval Date: 07/27/2018 Persons with disabilities having problems accessing the PDF files below may call (301) 796-3634 for assistance. FDA Approval Letter and Labeling (PDF) (PDF) FDA Application Review
: newborn, baby, infant, preterm, premature; seizures, convulsion, fit, epilepsy, spasms, electroencephalogram, EEG, clonic, tonic, myoclonic, subtle, neurological, neurodevelopmental medication, drugs, antiepileptic drugs. Other keywords may have been used for specific aspects of the guideline. Queensland Clinical Guideline Supplement: Neonatal Seizures Refer to online version, destroy printed copies after use Page 6 of 13 2.6 Consultation Major consultative and development processes occurred between (...) Guideline supplement: Neonatal seizures Refer to online version, destroy printed copies after use Page 1 of 13 Maternity and Neonatal C linical G uideline Queensland Health Guideline Supplement: Neonatal seizures Queensland Clinical Guideline Supplement: Neonatal Seizures Refer to online version, destroy printed copies after use Page 2 of 13 Table of Contents List of Tables 2 Version Control Error! Bookmark not defined. 1 Introduction 3 1.1 Funding 3 1.2 Conflict of interest 3 1.3 Guideline
Flowchart: Neonatal seizures, Abnormal movements in newborn babies Queensland Health State of Queensland (Queensland Health) 2017 http://creativecommons.org/licenses/by-nc-nd/3.0/au/deed.en Queensland Clinical Guidelines, Guidelines@health.qld.gov.au Queensland Clinical Guidelines www.health.qld.gov.au/qcg Abnormal movements in newborn babies Queensland Clinical Guideline: Neonatal seizures. Flowchart version: F17.23-3-V1-R22 Clinical • Clonic-recurrent muscle contraction • Tonic-sustained (...) muscle contraction • Myoclonic-brief active muscle contraction • Subtle-automatisms o Autonomic phenomena o Ocular-orbital phenomena o Orolingual phenomena o Hypomotor Seizure Activity Non-seizure activity Electrographical Abnormal movements in newborn baby • Jitteriness • Excessive startles • Benign neonatal sleep clonus • Tremors • Clonus Focal Seizure activity involves one area of brain affecting one side of body Multifocal Seizure activity involves more than one area of brain affecting several
Flowchart: Neonatal seizures, Investigations Queensland Health State of Queensland (Queensland Health) 2017 http://creativecommons.org/licenses/by-nc-nd/3.0/au/deed.en Queensland Clinical Guidelines, Guidelines@health.qld.gov.au Queensland Clinical Guidelines www.health.qld.gov.au/qcg Neonatal seizures: Investigations Queensland Clinical Guideline: Neonatal seizures. Flowchart version: F17.23-2-V1-R22 Guided by specific clinical features of baby or expert advice Pathology Blood • Lactate (...) • Commence continuous EEG monitoring if available • Record EEG if available Treat underlying cause(s) as indicated • Hypoglycaemia-Refer to QCG Newborn hypoglycaemia • Infection- Refer to QCG EOGBS • HIE-Refer to QCG HIE • Other Subsequent investigations as indicated Yes No Acute symptomatic seizure Subsequent investigations Pathology Blood • BGL • Urea and electrolytes Ca, Mg, Na • FBC • Blood culture CSF • Microscopy and bacterial culture • Glucose • Protein Urine • Culture Imaging • Cranial USS
Flowchart: Neonatal seizures, Assessment and management Queensland Health State of Queensland (Queensland Health) 2017 http://creativecommons.org/licenses/by-nc-nd/3.0/au/deed.en Queensland Clinical Guidelines, Guidelines@health.qld.gov.au Queensland Clinical Guidelines www.health.qld.gov.au/qcg Neonatal seizures: Assessment and management Queensland Clinical Guideline: Neonatal seizures Flowchart version: F17.23-1-V1-R22 Baby with suspected seizure activity Observe and monitor: • Seizure (...) activity • Temperature, heart rate, respiratory rate & effort, BP, O 2 saturation Treat cardiorespiratory compromise Assessment: • Review history (maternal, perinatal, family) • Physical examination • Neurological examination • Investigate for underlying cause as required o Refer to flowchart: Investigations Management: • Treat underlying cause o Refer to other QCG guidelines • Commence AEDs if seizures: o Duration > 3 minutes o More than 2 brief episodes o Detected on EEG • Initiate ongoing
approaches. Technology Description: Intravenous immunoglobulin (IVIG) is a purified blood product pooled from thousands of human blood donors. When provided in high doses, IVIG has an immunomodulatory effect, although its precise mechanism of action remains unclear. IVIG is increasingly being used as a therapeutic option for a variety of neurological autoimmune and inflammatory disorders, and has been proposed for the treatment of epilepsy. Controversy: Seizure recurrence following a single unprovoked (...) for treatment of intractable epilepsy in pediatric patients. Lansdale: HAYES, Inc. Healthcare Technology Brief Publication. 2017 Authors' conclusions Health Problem: Intractable epilepsy is diagnosed in 5% to 20% of pediatric patients with new-onset epilepsy. If uncontrolled, seizures in childhood may have a detrimental or even catastrophic impact on the developing brain. A connection has been made between inflammatory processes and neurological disease, including epilepsy, which may present new therapeutic