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Guidelines for Treating First Seizure

Guidelines for Treating First Seizure

According to current estimates, about 150,000 American adults present with an unprovoked first seizure each year. Studies show that even one seizure can be a traumatic physical and psychological event for patients. They can have major consequences for patients, including loss of driving privileges, employment limitations, a higher risk for falls, and fears of having another seizure in public. Recurrent seizures can be even more serious and costly. Unprovoked first seizures are difficult to for clinicians to diagnose and treat. In 2007, practice guidelines were released to help clinicians evaluate an unprovoked first seizure in adults. In 2015, the American Academy of Neurology and the American Epilepsy Society issued evidence-based guidelines on prognosis and therapy for first seizures. This guideline, published in Neurology and available for free at www.neurology.org, clarifies when risk factors put individuals at greater risk for seizure recurrence. Prevention of seizure recurrence with antiepileptic drug (AED) therapy is also discussed. “Evidence-based approaches are needed to evaluate and manage adults after a first seizure,” says Allan Krumholz, MD, who was lead author of the guideline. “This guideline is a valuable tool because it could change approaches to treating first seizures, enabling clinicians to possibly improve outcomes and quality of life in patients.” Conveying Recurrence Risk The guidelines offer recommendations regarding the risk of seizure recurrence among patients who have an unprovoked first seizure. “Adults who have an unprovoked first seizure should be informed that their seizure recurrence risk is greatest early within the first 2 years,” Dr. Krumholz says. Studies show that recurrence risks vary between 21% and 45%, depending on a variety of factors (Figure). Several...

Immunotherapy for Autoimmune Epilepsy

A small observational study suggests that initiating immunotherapy early may improve seizure outcome in patients with medically intractable epilepsy for whom clinical and serological clues suggest an autoimmune basis. At an average of 17 months after these patients received immunotherapy, 81% reported improvements and 66% were seizure free. Abstract: Archives of Neurology, May...

Adding Surgery to Medication Benefits Temporal Lobe Epilepsy

When compared with antiepileptic drug (AED) therapy alone, using respective surgery plus AED therapy appears to result in a lower probability of seizures after 2 years follow-up in patients with newly intractable, disabling mesial temporal lobe epilepsy. Results from a small study indicated that 73% of patients who received AED therapy plus surgery were seizure free at 2 years, compared with a 0% rate for patients who received only AED therapy. Abstract: JAMA, March 7,...

Conference Highlights: Society of Critical Care Medicine 2011

The SCCM annual congress addressed important issues in the management of critically ill and injured patients, including CNS disorders in pediatric patients, early metabolic crisis after TBI, and inappropriate prescribing in the elderly after ICU discharge. » Characterizing Pediatric CNS Hospitalizations » Early Metabolic Crisis Common After TBI » The Elderly Receive Unnecessary Prescriptions After ICU Discharge Characterizing Pediatric CNS Hospitalizations The Particulars: Children with acute disorders of the central nervous system (CNS) are at risk of substantial morbidity and mortality. Previous research has found that 65% of deaths in children who die in the ICU were associated with acute CNS injuries. Among children who were previously healthy and later died, 96% of deaths have been associated with CNS injuries. Data Breakdown: A retrospective study sought to determine the volume and outcomes of hospitalized children with acute CNS disorders. After assessing 960,000 admissions for children aged 29 days to 19 years, non-traumatic disorders accounted for 79.7% of the admissions. The most common specific disorders were seizures (60.1%) and mild traumatic brain injury (19.2%). Children with acute CNS disorders received intensive care almost three times as often, were mechanically ventilated almost seven times as often, and died more than eight times as often as other hospitalized children. Take Home Pearls: Children with acute CNS disorders appear to be seen in hospital ICUs more often and have higher in-hospital mortality than children seen for other reasons. Early Metabolic Crisis Common After TBI [back to top] The Particulars: Previous research has suggested that metabolic crisis occurs frequently after traumatic brain injury (TBI). Little is known about the efficacy of standard resuscitation protocols for resolving these crises. Data...

Conference Highlight: Society of Critical Care Medicine

New research presented at the 40th annual congress of the Society of Critical Care Medicine from January 15-19, 2011 in San Diego addressed important issues in the management of critically ill and injured patients. The features below highlight just some of the studies that emerged from the congress. Characterizing Pediatric CNS Hospitalizations Early Metabolic Crisis Common After TBI The Elderly Receive Unnecessary Prescriptions After ICU Discharge  Characterizing Pediatric CNS Hospitalizations The Particulars: Children with acute disorders of the central nervous system (CNS) are at risk of substantial morbidity and mortality. Previous research has found that 65% of deaths in children who die in the ICU were associated with acute CNS injuries. Among children who were previously healthy and later died, 96% of deaths have been associated with CNS injuries. Data Breakdown: A retrospective study sought to determine the volume and outcomes of hospitalized children with acute CNS disorders. After assessing 960,000 admissions for children aged 29 days to 19 years, non-traumatic disorders accounted for 79.7% of the admissions. The most common specific disorders were seizures (60.1%) and mild traumatic brain injury (19.2%). Children with acute CNS disorders received intensive care almost three times as often, were mechanically ventilated almost seven times as often, and died more than eight times as often as other hospitalized children. Take Home Pearls: Children with acute CNS disorders appear to be seen in hospital ICUs more often and have higher in-hospital mortality than children seen for other reasons. Early Metabolic Crisis Common After TBI [back to top] The Particulars: Previous research has suggested that metabolic crisis occurs frequently after traumatic brain injury (TBI). Little...
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