Seizure : the journal of the British Epilepsy Association
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Seizures are a common presentation to pre-hospital emergency services and they generate significant healthcare costs. This article summarises the United Kingdom (UK) Ambulance Service guidelines for the management of seizures and explores the extent to which these guidelines are evidence-based. ⋯ The evidence base for current pre-hospital guidelines for seizure emergencies is incomplete. A large proportion of patients are transported to hospital after a seizure but many of these may be suitable for home management. However, there is very little research into alternative care pathways or criteria that could be used to help paramedics avoid transport to hospital. More research is needed to improve care for people after a seizure and to improve the cost-effectiveness of the healthcare systems within which they are treated.
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Juvenile myoclonic epilepsy (JME) is a widely accepted epilepsy syndrome. Factors that are potentially predictive for seizure outcome in JME are not entirely clear yet. In the current study, we tried to identify factors that are potentially predictive for seizure outcome in patients with JME. ⋯ A correct diagnosis of JME does not guarantee an optimal response to therapy. Poorer drug adherence might result in more seizures; this should be highlighted for patients in every single visit. Longer follow-up gives the treating physician more time to adjust the drug(s) and formulate a plan that is appropriate for patients with difficult to treat seizures. We recommend valproate if seizure control is the main objective.
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Data about super-refractory status epilepticus (SRSE) are scarce. This study aimed to assess the clinical features and outcome of patients with SRSE. ⋯ We conclude that the typical patient susceptible to development of SRSE in West China is a young patient with encephalitis. Older age and multiple complications increase the risk of death. Most patients can survive with aggressive therapy, and their functional outcome improves over time.
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To assess the prevalence of clinically urgent intra-cranial pathology among children who had imaging for a first episode of non-febrile seizure with focal manifestations. ⋯ Four percent of children imaged with first time, afebrile focal seizures have findings important to initial management. Children younger than ≤ 18 months are at increased risk.