Is adjunctive Cannabidiol effective in controlling seizures for adult patients with Lennox-Gastaut Syndrome? - A single centre long term follow up study.

Epileptic encephalopathies are a disabling and life-limiting cause of childhood-onset epilepsy. Lennox Gastaut syndrome (LGS) is a characteristic example. In spite of the development of multiple medical and surgical therapies, many patients with these conditions remain treatment refractory Cannabidiol was licenced by The National Institute for Health and Care Excellence (NICE) in December 2019 for the adjunctive treatment of seizures associated with Lennox Gastaut syndrome [TA 615].

Advancing bibliometric assessment of research productivity: an analysis of US Departments of Family Medicine.

INTRODUCTION Measurement of family medicine research productivity has lacked the replicable methodology needed to document progress. AIM In this study, we compared three methods: (1) faculty-to-publications; (2) publications-to-faculty; and (3) department-reported publications. METHODS In this cross-sectional analysis, publications in peer-reviewed, indexed journals for faculty in 13 US family medicine departments in 2015 were assessed.

Predicting seizures in pregnant women with epilepsy: Development and external validation of a prognostic model.

Background: Seizures are the main cause of maternal death in women with epilepsy, but there are no tools for predicting seizures in pregnancy. We set out to develop and validate a prognostic model, using information collected during the antenatal booking visit, to predict seizure risk at any time in pregnancy and until 6 weeks postpartum in women with epilepsy on antiepileptic drugs.

Methods And Findings: We used datasets of a prospective cohort study (EMPiRE) of 527 pregnant women with epilepsy on medication recruited from 50 hospitals in the UK (4 November 2011-17 August 2014).

The Scholarly Output of Faculty in Family Medicine Departments.

Background And Objectives: While prior efforts have assessed the scope of family medicine research, the methods have differed, and the efforts have not been routinely repeated. The purpose of this analysis was to quantify publications, journals, citations, and funding of US family medicine faculty and identify factors associated with these outcomes.

Methods: We identified faculty in US departments of family medicine through website searches and performed a cross-sectional study.

AntiEpileptic drug Monitoring in PREgnancy (EMPiRE): a double-blind randomised trial on effectiveness and acceptability of monitoring strategies.

Background: Pregnant women with epilepsy on antiepileptic drugs (AEDs) may experience a reduction in serum AED levels. This has the potential to worsen seizure control.

Objective: To determine if, in pregnant women with epilepsy on AEDs, additional therapeutic drug monitoring reduces seizure deterioration compared with clinical features monitoring after a reduction in serum AED levels.

Clinical outcomes of VNS therapy with AspireSR (including cardiac-based seizure detection) at a large complex epilepsy and surgery centre.

Purpose: To compare the efficacy of AspireSR to preceding VNS battery models for battery replacements, and to determine the efficacy of the AspireSR for new implants.

Methods: Data were collected retrospectively from patients with epilepsy who had VNS AspireSR implanted over a three-year period between June 2014 and June 2017 by a single surgeon. Cases were divided into two cohorts, those in whom the VNS was a new insertion, and those in whom the VNS battery was changed from a previous model to AspireSR.

No evidence of damage to the soft tissue or skeletal integrity of mesophotic corals exposed to a 3D marine seismic survey.

Scleractinian corals, primarily plate corals in families Agaricidae and Acroporidae, were monitored in situ before, during and after a 3D marine seismic survey. An initial four day seismic run, resulting in a maximum 24 h received sound exposure level (SEL) of 204 dB re 1 μPa·s and received 0-to-peak pressure (PK Pressure) of 226 dB re 1 μPa, had no detectable effect on soft tissues or skeletal integrity. Subsequently, a full marine seismic survey (Maxima 3D MSS), proceeded over two months and included seismic acquisition lines at 240 m spacing over the broader reef lagoon (South Scott Reef), generating maximum received SEL of 197 dB re 1 μPa·s and received PK Pressure of 220 dB re 1 μPa at the coral monitoring sites.

Navigating payer heterogeneity in the United States: lessons for primary care.

With most providers accepting private and public funding, the US exemplifies hybridization, which results in both systemic benefits and harms. While this practice stimulates innovation, encourages practices to be efficient, and increases choice, it has also been linked to gaps in patient safety and overtreatment. We propose three lessons from the US for navigating a public and private system: hybridization allows for innovation; hybridization leads to administrative complexity; and if the costs of participation outweigh the benefits, practices may undergo dehybridization.

Epilepsy and Pregnancy: For healthy pregnancies and happy outcomes. Suggestions for service improvements from the Multispecialty UK Epilepsy Mortality Group.

Between 2009 and 2012 there were 26 epilepsy-related deaths in the UK of women who were pregnant or in the first post-partum year. The number of pregnancy-related deaths in women with epilepsy (WWE) has been increasing. Expert assessment suggests that most epilepsy-related deaths in pregnancy were preventable and attributable to poor seizure control.

Newer anti-epileptic drugs, vitamin status and neuropathy: A cross-sectional analysis.

Objective: Whether new antiepileptic drugs (AEDs) may result in neuropathy is unknown but possible given their effects on vitamin metabolism. This analysis aimed to determine frequency and correlates of neuropathy in subjects treated with new AEDs in relation to drug used, length of exposure and serum vitamin B12 and folate levels.

Methods: We performed a cross-sectional study of 52 consecutive epileptic subjects.

Development of a core outcome set for epilepsy in pregnancy (E-CORE): a national multi-stakeholder modified Delphi consensus study.

Objective: To develop a set of core outcomes for studies on pregnant women with epilepsy.

Design: Delphi consensus study.

Population: Healthcare professionals, and patient representatives with lived experience of epilepsy in the UK.

Type 1 diabetes mellitus and risk of incident epilepsy: a population-based, open-cohort study.

Aims/hypothesis: The aim of this research was to explore the relationship between incident epilepsy and type 1 diabetes in British participants.

Methods: Using The Health Improvement Network database, we conducted a retrospective, open-cohort study. Patients who were newly diagnosed with type 1 diabetes mellitus at the age of ≤40 years were identified and followed-up from 1 January 1990 to 15 September 2015.

Variation in the reporting of outcomes among pregnant women with epilepsy: a systematic review.

Studies on pregnant women with epilepsy should evaluate both neurological and pregnancy outcomes. We undertook a systematic review of the literature of studies on pregnant women with epilepsy to collate the outcomes reported, and the quality of outcomes report in these studies. We searched major electronic databases (from 1999 until January 2015).

Epilepsy in pregnancy and reproductive outcomes: a systematic review and meta-analysis.

Background: Antenatal care of women with epilepsy is varied. The association of epilepsy and antiepileptic drug exposure with pregnancy outcomes needs to be quantified to guide management. We did a systematic review and meta-analysis to investigate the association between epilepsy and reproductive outcomes, with or without exposure to antiepileptic drugs.

Early haemodynamic changes observed in patients with epilepsy, in a visual experiment and in simulations.

Objective: The objective of this study was to investigate whether previously reported early blood oxygen level dependent (BOLD) changes in epilepsy could occur as a result of the modelling techniques rather than physiological changes.

Methods: EEG-fMRI data were analysed from seven patients with focal epilepsy, six control subjects undergoing a visual experiment, in addition to simulations. In six separate analyses the event timing was shifted by either -9,-6,-3,+3,+6 or +9 s relative to the onset of the interictal epileptiform discharge (IED) or stimulus.

'The great imitator': Neurosyphilis and new-onset refractory status epilepticus (NORSE) syndrome.

New-onset refractory status epilepticus (NORSE) is a syndrome of new-onset drug resistant status epilepticus that often has a catastrophic outcome. A 30-year-old man of Somali origin presented with refractory status to a district general hospital. A clinical diagnosis of NORSE syndrome was made, and he was transferred to the regional epilepsy center for immunomodulatory treatment and consideration for cyclophosphamide treatment.

Does in utero exposure of antiepileptic drugs lead to failure to reach full cognitive potential?

A clinical scenario of a young female on 800 mg of sodium valproate (VPA) who has recently failed lamotrigine (LTG) and levetiracetam (LEV) and who is currently planning a pregnancy is presented. Currently available data pertaining to the longer-term development of children exposed to antiepileptic drugs (AEDs) are reviewed along with considerations around the methodology and interpretation of such research. There is an accumulation of data highlighting significant risks associated with prenatal exposed to VPA, with the level of risk being mediated by dose.

The management of Convulsive Refractory Status Epilepticus in adults in the UK: No consistency in practice and little access to continuous EEG monitoring.

Purpose: Convulsive Status Epilepticus (CSE) is a common neurological emergency with patients presenting with prolonged epileptic activity. Sub-optimal management is coupled with high morbidity and mortality. Continuous electroencephalogram (EEG) monitoring is considered essential by the National Institute for Health and Care Excellence (NICE) in the management of Convulsive Refractory Status Epilepticus (CRSE).

Specialist management of routine dental procedures in adults with refractory epilepsy.

Little published information exists about the management of dental treatment procedures for people with epilepsy who, despite their medication, continue to have seizures. This paper draws on relevant literature in neurology and anaesthetics to provide a multi-speciality consensus on methods of assessment and adjunctive treatment options in order to manage the risk of a clinically significant seizure occurring during a procedure. It aims to enhance current guidelines and practice in the provision of specialist care for this diverse group.

Effects of monitoring strategies on seizures in pregnant women on lamotrigine: a meta-analysis.

Objectives: Pregnant women with epilepsy have a significantly increased risk of mortality and morbidity compared to non-pregnant women. At least one in 250 pregnancies is exposed to anti-epileptic drugs (AED). Seizure deterioration occurs in up to a third of pregnant women.

Ictal consciousness in epilepsy and nonepileptic attack disorder.

Exploration of subjective experiences during seizures may enhance knowledge of the differing natures of epilepsy and nonepileptic attack disorder (NEAD). We performed a quantitative evaluation of both the general level of awareness and the specific contents of consciousness during seizures using the Ictal Consciousness Inventory (ICI). Ninety-five adult outpatients attending general neuropsychiatry and epilepsy clinics with established diagnoses of either epilepsy (n = 66) or NEAD (n = 29) completed one ICI for each witnessed seizure recalled.

Behavioral and cognitive effects of anti-epileptic drugs.

Anti-epileptic drugs (AEDs) have a variety of mechanisms of action which are reflected through different anticonvulsant activities and behavioral effects. Two categories of AEDs are considered based on psychotropic profile. The first group is characterized by potentiation of gamma-aminobutyric acid (GABA) inhibitory neurotransmission, and comprises of agents such as vigabatrin, tiagabine, and gabapentin.

The neural correlates of altered consciousness during epileptic seizures.

Epileptic seizures are characterized by a multifaceted spectrum of alterations in the general level of awareness and/or the subjective contents of consciousness. Complete loss of consciousness occurs when epileptic activity involves both cortical and subcortical structures, as in generalized seizures. On the other hand, simple partial seizures can spare both the level and contents of consciousness.

Understanding routine antiepileptic drug decisions: a qualitative analysis of patients' accounts of hospital consultations.

Objective: We sought to understand how antiepileptic drug (AED) decisions, similar to those that occur in observational studies on AEDs, were made between doctors and patients in the hospital clinic. We could find no previous research that focused specifically on understanding AED decision making in epilepsy.

Methods: In-depth interviews were conducted with patients who carried a secure diagnosis of epilepsy and who had recently attended a follow-up appointment with a consultant with a special interest in epilepsy.