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Latest & greatest articles for epilepsy
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Stiripentol in severe myoclonic epilepsy in infancy: a randomised placebo-controlled syndrome-dedicated trial. STICLO study group. Stiripentol is an inhibitor of cytochrome P450 that showed antiepileptic efficacy in severe myoclonic epilepsy in infancy (SMEI) in association with clobazam and valproate in an open study. To confirm these results, 41 children with SMEI were included in a randomised, placebo-controlled, add-on trial.After a baseline period of 1 month, placebo (n=20) or stiripentol (...) . The results also provide good reason to focus studies on a specific epilepsysyndrome-a small sample of patients is sufficient to show the efficacy that might have been missed in a heterogeneous population.
2000LancetControlled trial quality: predicted high
costs. The pathways differed according to the patients' tolerance of AEDs and whether add-on drugs were used. The time horizon of the study was one year. An expert panel estimated the choice of drugs for first and second-line therapy for both partial and generalised epilepsy, as well as the treatment patterns, for each country. Outcomes assessed in the review The authors stated that the evidence shows that all drugs have similar effectiveness in terms of freedom from seizure. Thus, the input (...) appraisal of the use of AEDs in a naturalistic setting. Source of funding None stated. Bibliographic details Heaney D C, Shorvon S D, Sander J W, Boon P, Komarek V, Marusic P, Dravet C, Peerucca E, Majkowski J, Lopes Llima J, Arroyo S, Tomson T, Ried S, van Donselaar C, Eskazan E, Peeters P, Carita P, Tjong-a-Hung I, Myon E, Taieb C. Cost minimization analysis of antiepileptic drugs in newly diagnosed epilepsy in 12 European countries. Epilepsia 2000; 41(Supplement 5): S37-S44 PubMedID Other
Ketogenic diet for the treatment of refractory epilepsy in children: a systematic review of efficacy Ketogenic diet for the treatment of refractory epilepsy in children: a systematic review of efficacy Ketogenic diet for the treatment of refractory epilepsy in children: a systematic review of efficacy Lefevre F, Aronson N Authors' objectives To systematically review and synthesise the available evidence on the efficacy of the ketogenic diet, in reducing seizure frequency for children (...) in the study were all refractory to new anti-epileptic drugs (AEDs), and in general, had failed or were intolerant of treatments with multiple drug regimes. Outcomes assessed in the review The studies had to report relevant health outcomes after treatment. The main outcome measure evaluated was a reduction in seizure frequency. The optimal outcome was the complete elimination of seizures. A 50% or greater reduction in seizures was considered clinically significant. The studies also reported the percentage
Lorazepam for the prevention of recurrent seizures related to alcohol. Alcohol abuse is one of the most common causes of seizures in adults. In a randomized, double-blind study, we compared lorazepam with placebo for the prevention of recurrent seizures related to alcohol. Over a 21-month period, we studied consecutive patients with chronic alcohol abuse who were at least 21 years of age and who presented to the emergency departments of two hospitals in Boston after a witnessed, generalized (...) seizure. The patients were randomly assigned to receive either 2 mg of lorazepam in 2 ml of normal saline or 4 ml of normal saline intravenously and then observed for six hours. The primary end point was the occurrence of a second seizure during the observation period.Of the 229 patients who were initially evaluated, 186 met the entry criteria. In the lorazepam group, 3 of 100 patients (3 percent) had a second seizure, as compared with 21 of 86 patients (24 percent) in the placebo group (odds ratio
Buccal midazolam and rectal diazepam for treatment of prolonged seizures in childhood and adolescence: a randomised trial. Convulsive status epilepticus is the most common neurological medical emergency and has high morbidity and mortality. Early treatment before admission to hospital is best with an effective medication that can be administered safely. We aimed to find out whether there are differences in efficacy and adverse events between buccal administration of liquid midazolam and rectal (...) administration of liquid diazepam in the acute treatment of seizures.At a residential school with on-site medical facilities 42 young people with severe epilepsy were enrolled. Continuous seizures of more than 5 min duration were randomly treated with buccal midazolam or rectal diazepam. If the seizure did not stop within 10 min additional medication chosen by the attending physician was administered. We monitored oxygen saturation and blood pressure for 30 min after treatment. The main outcome measures were
Phenobarbital compared with phenytoin for the treatment of neonatal seizures. Seizures occur in 1 to 2 percent of neonates admitted to an intensive care unit. The treatment is usually with either phenobarbital or phenytoin, but the efficacy of the two drugs has not been compared directly.From 1990 to 1995, we studied 59 neonates with seizures that were confirmed by electroencephalography. The neonates were randomly assigned to receive either phenobarbital or phenytoin intravenously, at doses (...) sufficient to achieve free plasma concentrations of 25 microg per milliliter for phenobarbital and 3 microg per milliliter for phenytoin. Neonates whose seizures were not controlled by the assigned drug were then treated with both drugs. Seizure control was assessed by electroencephalographic criteria.Seizures were controlled in 13 of the 30 neonates assigned to receive phenobarbital (43 percent) and 13 of the 29 neonates assigned to receive phenytoin (45 percent; P=1.00). When combined treatment
Safety and efficacy of vigabatrin and carbamazepine in newly diagnosed epilepsy: a multicentre randomised double-blind study. Vigabatrin European Monotherapy Study Group. Vigabatrin is a newly licensed drug for use in patients with epilepsy. We investigated whether this drug was comparable to standard first-line monotherapy in efficacy and incidence of adverse events.We enrolled 459 patients with newly diagnosed, previously untreated partial epilepticseizures from 44 European centres (...) . No significant difference was found for time to achieve 6 months of remission from seizures (p=0.058), but the most powerful outcome, time to first seizure after the first 6 weeks from randomisation, showed carbamazepine to be significantly more effective than vigabatrin (p=0.0001).Vigabatrin seems less effective but better tolerated than carbamazepine, which is the first-choice drug for the treatment of partial epilepsies. Vigabatrin cannot therefore be recommended as a first-line drug for monotherapy
1999LancetControlled trial quality: predicted high
are stated in 3 studies (3-51 years; 12 and younger and 13 to 20 years; and less than 18 and over 18 years of age). Outcomes assessed in the review The primary outcomes assessed were seizures and seizure frequency; use of anti-epileptic drugs; quality of life; and mortality. Secondary outcomes assessed were health assessment or psychosocial functioning, change in IQ and change in employment status. How were decisions on the relevance of primary studies made? The authors do not state how the papers were (...) % and 55%. Evidence on the use of anti-epileptic drugs after surgery is inconclusive. One study reported a statistically significant reduction in the average number of drugs used per patient, however, this was not replicated in two other studies The percentages of patients becoming seizure-free following hemispherectomies (Hs), multilobar resections (MR) and corpus collosum sections (CCSs) (reported in one multicentre retrospective case series) were 67.4%, 45.2% and 7.6% respectively. Quality of life
assessment on the reliability of the study and the conclusions drawn. Health technology Adjunctive therapy in epilepsy. Type of intervention Treatment. Economic study type Cost-effectiveness analysis. Study population Outpatient epileptic patients. Setting The practice setting was the community. The economic analysis was carried out at the Institute of Psychiatry, London, UK. Dates to which data relate Effectiveness and resource data appear to have been collected during 1998. It was unclear whether (...) a price year was used as it was not stated in the paper's methodology. Source of effectiveness data The evidence for the relative cost-effectiveness of lamotrigine versus topiramate for the treatment of epilepsy was derived from a single study. Link between effectiveness and cost data Prospective costing was undertaken on the effectiveness study samples. Study sample 81 patients with difficult to control seizures were selected for study inclusion. Eight were lost to follow-up after three interviews
on a per patient basis. The source of cost data was the study institution. The price year was not specified. The cost analysis did not cover the costs associated with hospital admissions due to conditions unrelated to epilepsy or epilepticseizures and admissions scheduled solely in the context of the pre-surgical evaluation. Statistical analysis of costs The paired student's t-test was used for statistical analysis. Indirect Costs Not included. Currency US dollars ($). Sensitivity analysis (...) with other studies. The degree to which the study sample was representative of the study population was not discussed. Implications of the study The main issue in further establishing the clinical efficacy of VNS is to determine whether there are specific types of epilepticseizures or epilepticsyndromes that respond better to VNS and how different stimulation parameters influence clinical response. More information on efficacy and safety in larger patient series is needed. Source of funding Supported
[1.31] vs 2.18 [1.02], p = 0.94; n = 4 vs 3). The odds ratio for behavioural problems (phenobarbital vs phenytoin) was 0.51 (95% CI 0.16-1.59). There was no excess in parental reports of side-effects for phenobarbital. We found no difference in efficacy between the study drugs (adjusted hazard ratio for time to first seizure from randomisation 0.97 [0.28-3.30]).This evidence supports the acceptability of phenobarbital as a first-line drug for childhood epilepsy in rural settings in developing (...) Randomised controlled trial to assess acceptability of phenobarbital for childhood epilepsy in rural India. The use of phenobarbital for childhood epilepsy is controversial because of reported behavioural side-effects; however, whether this research can validly be extrapolated to developing countries is not clear. We undertook a randomised comparison of phenobarbital and phenytoin to assess the acceptability and efficacy of phenobarbital as monotherapy for childhood epilepsy in rural
1998LancetControlled trial quality: predicted high
), phenobarbital (15 mg per kilogram), and phenytoin (18 mg per kilogram). Patients were classified as having either overt generalized status epilepticus (defined as easily visible generalized convulsions) or subtle status epilepticus (indicated by coma and ictal discharges on the electroencephalogram, with or without subtle convulsive movements such as rhythmic muscle twitches or tonic eye deviation). Treatment was considered successful when all motor and electroencephalographic seizure activity ceased within (...) 20 minutes after the beginning of the drug infusion and there was no return of seizure activity during the next 40 minutes. Analyses were performed with data on only the 518 patients with verified generalized convulsive status epilepticus as well as with data on all 570 patients who were enrolled.Three hundred eighty-four patients had a verified diagnosis of overt generalized convulsive status epilepticus. In this group, lorazepam was successful in 64.9 percent of those assigned to receive
A comparison of rectal diazepam gel and placebo for acute repetitive seizures. Acute repetitive seizures are readily recognizable episodes involving increased seizure frequency. Urgent treatment is often required. Rectal diazepam gel is a promising therapy.We conducted a randomized, double-blind, parallel-group, placebo-controlled study of home-based treatment for acute repetitive seizures. Patients were randomly assigned to receive either rectal diazepam gel, at a dosage varying from 0.2 (...) to 0.5 mg per kilogram of body weight on the basis of age, or placebo. Children received one dose at the onset of acute repetitive seizures and a second dose four hours later. Adults received three doses -- one dose at onset, and two more doses 4 and 12 hours after onset. Treatment was administered by a care giver, such as a parent, who had received special training. The number of seizures after the first dose was counted for 12 hours in children and for 24 hours in adults.Of 125 study patients (64
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. Health technology Anti-epileptic drugs used in the treatment of partial or general tonic-clonic seizures. Type of intervention Treatment. Economic study type Cost-effectiveness analysis. Study population Patients, at least 13 years of age, with newly diagnosed cases of epilepsy. Patients had previously (...) ) respectively. This difference was significant in favour of LTG (hazard ratio 1.57, 95% CI: 1.07 - 2.31) Clinical conclusions LTG and CBZ have demonstrated similar rates of efficacy in the prevention of partial onset seizures and primary generalised tonic-clonic seizures in newly diagnosed epilepsy. LTG had better tolerability than CBZ and patients are therefore more likely to continue treatment than if they receive CBZ. Modelling A decision analysis model was used to estimate the total annual costs
and the choice of a second-line drug for patients in the withdrawal group. Implications of the study The authors concluded that, when considering the primary effects of the drugs and direct costs to the NHS, there appears to be little justification for using LTG as monotherapy during the first two years of treatment for newly diagnosed patients with epilepsy. The authors recommend that a similar type of analysis, incorporating seizure control, side effects and tolerability, should be considered as part (...) of all clinical trials of antiepileptic drugs in which efficacy of outcome is similar as a guide to assess optimal cost-effectiveness. Source of funding None stated. Bibliographic details Heaney D C, Shorvon S D, Sander J W. An economic appraisal of carbamazepine, lamotrigine, phenytoin and valproate as initial treatment in adults with newly diagnosed epilepsy. Epilepsia 1998; 39(Supplement 3): S19-S25 PubMedID Other publications of related interest Brodie MJ, Richens A, Yuen AWC. Double blind
by a detailed critical assessment on the reliability of the study and the conclusions drawn. Health technology Anti-epileptic drugs (AEDs) for patients with refractory epilepsy. Type of intervention Treatment. Economic study type Cost-effectiveness analysis Study population Patients over the age of 16 with refractory epilepsy. Setting Hospital. The economic analysis was conducted in Research Triangle Park, North Carolina, USA. Dates to which data relate Data on effectiveness and resource use were collected (...) , estimating cost-effectiveness of lamotrigine for patients in different stages of refractory epilepsy at the end of year 1, year 2 and years 3 - 10. It was assumed that patients would discontinue use of lamotrigine at the end of the first year if the improvement in seizure free days had been less than 25%. Outcomes assessed in the review The outcomes assessed were the reduction in frequency of seizures and seizure free days from additional use of lamotrigine. Study designs and other criteria for inclusion
of the efficacy and safety of lamotrigine in patients with partial seizures. Neurology 1993;43:2284-2291. Indexing Status Subject indexing assigned by NLM MeSH Adjuvants, Pharmaceutic /economics /therapeutic use; Adult; Anticonvulsants /economics /therapeutic use; Cost of Illness; Cost-Benefit Analysis; Epilepsy /drug therapy /economics; Female; Humans; Male; Prospective Studies; Quality-Adjusted Life Years; Retrospective Studies; Triazines /economics /therapeutic use AccessionNumber 21998000468 Date (...) Adjunctive lamotrigine therapy in patients with refractory seizures: a lifetime cost-utility analysis Adjunctive lamotrigine therapy in patients with refractory seizures: a lifetime cost-utility analysis Adjunctive lamotrigine therapy in patients with refractory seizures: a lifetime cost-utility analysis Messori A, Trippoli S, Becagli P, Cincotta M, Labbate M G, Zaccara G Record Status This is a critical abstract of an economic evaluation that meets the criteria for inclusion on NHS EED. Each
% reduction in seizure frequency (studies were only included in this analysis if a minimum of 12 months' surgical follow-up was reported). Participants included in the review To be included in the meta-analysis, the patients had to have had a localisation-related epilepticsyndrome, and at least an interictal EEG-documented epileptiform abnormality. The patients were categorised as: medically refractory, medically responsive, or if not explicitly stated, not refractory; adults or paediatrics (aged less (...) SPECT brain imaging in epilepsy: a meta-analysis SPECT brain imaging in epilepsy: a meta-analysis SPECT brain imaging in epilepsy: a meta-analysis Devous M D, Thisted R A, Morgan G F, Leroy R F, Rowe C C Authors' objectives To derive the sensitivity and specificity of interictal, postictal or ictal regional cerebral blood flow patterns single-photon enhanced computed tomography (SPECT) brain imaging for the identification of seizure focus in medically refractory patients. Searching Two
Functional diagnostic imaging in epilepsy Functional diagnostic imaging in epilepsy Functional diagnostic imaging in epilepsy Corabian P, Hailey D Record Status This is a bibliographic record of a published health technology assessment from a member of INAHTA. No evaluation of the quality of this assessment has been made for the HTA database. Citation Corabian P, Hailey D. Functional diagnostic imaging in epilepsy. Edmonton: Alberta Heritage Foundation for Medical Research (AHFMR). AHFMR HTA (...) Report 10. 1998 Authors' objectives To assess the role of high cost functional diagnostic imaging in routine management of refractory epilepsy. The technologies considered were positron emission tomography (PET), magnetic resonance spectroscopy (MRS), functional magnetic resonance imaging (fMRI) and magnetoencephalography (MEG) when used with MRI as magnetic source imaging (MSI). Authors' conclusions Of the functional diagnostic imaging methods considered, only PET has a potential place in routine
to reduce frequency of partial-onset seizures, refractory to anti-epileptic medication, in adolescents and adults who are not suitable candidates for epilepsy surgery or who have failed to improve following surgery. The technology provides an alternative approach to treatment of individuals for whom other management options are poor. Results from small observational studies suggest that the therapeutic effect of VNS appears to be better and is achieved more rapidly in children than in adults. Final (...) Vagus nerve stimulation for refractory epilepsy Vagus nerve stimulation for refractory epilepsy Vagus nerve stimulation for refractory epilepsy Alberta Heritage Foundation for Medical Research Record Status This is a bibliographic record of a published health technology assessment from a member of INAHTA. No evaluation of the quality of this assessment has been made for the HTA database. Citation Alberta Heritage Foundation for Medical Research. Vagus nerve stimulation for refractory epilepsy