Clin Med
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Epilepsy is common and has a variety of causes and associated pathologies. Increased understanding of the pathophysiology underlying the epilepsies and advances in classification, diagnostic imaging and drug treatments have led to a reduction in stigma and growing demand for services to be improved for patients. A number of important reports and guidelines have emerged in the UK in recent years, which are summarised here. Diagnosis, classification, management and models of care are discussed as well as the management of drug intractable seizures, status epilepticus, and approaches to special patient groups: women in the fertile years, the elderly and those with learning difficulties.
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The hormone melatonin is increasingly used for the treatment of certain sleep disorders, particularly those related to disturbed biological rhythms. This article summarises current knowledge of its mechanism of action and identifies situations where there is good evidence for its efficacy. The authors provide advice, based on their own experience and consistent published data, concerning the dose range of melatonin to be used and the critically important question of the timing of treatment. Anecdotal evidence for the use of melatonin needs to be replaced by data from well-controlled, preferably multi-centre, randomised clinical trials.
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Pulmonary embolism (PE) can be difficult to diagnose and manage. This paper examines recent national trends in admission rates and mortality for PE to help inform clinical practice. Admissions to NHS hospitals in England between 1 April 1996 and 31 March 2006 were studied. ⋯ Mortality decreased over time and was highest among the elderly. Pulmonary embolism is associated with a significant mortality although overall trends in mortality are improving in England. Age and comorbidities must be considered when developing guidelines and individual treatment plans.