Evidence-based guideline: Management of an unprovoked first seizure in adults

Krumholz, Allan; Wiebe, Samuel; Gronseth, Gary S.; Gloss, David; Sánchez, Ana M.; Kabir, Arif Md. Rashedul; Liferidge, Aisha T.; Martello, Justin; Kanner, Andrés M.; Shinnar, Shlomo; Hopp, Jennifer L.; French, Jacqueline A.

doi:10.1212/wnl.0000000000001487

Cited by 253 publications

(127 citation statements)

References 33 publications

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“…In line with the new-onset seizure guideline, the risk of seizure recurrence in a patient with an epileptogenic lesion is 26% (10% in MRInegative patients) at 1 year and 48% at 5 years, indicating an at least 2-fold increase in risk of having subsequent seizures in patients with lesions (21). Thus, the presence of an abnormality may not only have a negative effect on the outcome, but may also affect the treatment selection (e.g., earlier surgical evaluation instead of continued pharmacotherapy) because patients with certain types of lesions (e.g., medial temporal lobe epilepsy) are substantially less likely to achieve seizure control with antiepileptic drugs (AEDs) (22).…”

Section: Brain Imaging In Epilepsy Now and In The Future Jerzy Szaflmentioning

confidence: 72%

Epilepsy Treatment: A Futurist View

Privitera

2017

Epilepsy Curr

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Advances in epilepsy treatment are occurring at a rapid pace, and it is challenging for us to keep up with the latest in our field. As we struggle to keep up with the literature and concentrate on our own research and clinical work, we often fail to exercise our imagination and envision what our field will be like in future decades. This was the assignment to the speakers for the Presidential Symposium at the 2016 American Epilepsy Society Annual Meeting. I challenged the experts to step outside the frame of their usual daily work to imagine what epilepsy treatment would and should look like for the next generation of epilepsy specialists and their patients. As you will read in the following sections, the speakers truly stepped up to the challenge to look into the crystal ball. The following are summaries of each lecture that describe the current state, existing cutting edge ideas, and some surprising predictions for the future. I am grateful for the tremendous effort these experts put into this challenge and hope they stimulate your imagination so you will work to bring these advances to our patients.

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Section: Brain Imaging In Epilepsy Now and In The Future Jerzy Szaflmentioning

confidence: 72%

Epilepsy Treatment: A Futurist View

Privitera

2017

Epilepsy Curr

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“…Risk factors for seizure recurrence are not well established for cats and dogs. A number of relative risk factors have been identified in epileptic people, including a diagnosis of current or previously defined cerebral lesions or trauma, presence of interictal EEG epileptic discharges (up to 90% recurrence rate) and a history of marked postictal adverse effects 13, 14. Evidence‐based guidelines from several international groups are well established for people based on risk‐benefit ratio and predictability factors of drug effect 15, 16, 17.…”

Section: When Should Treatment Be Started?mentioning

confidence: 99%

“…Overwhelming evidence exists in people that there is no benefit to starting treatment after a single unprovoked event 14. The earlier AED treatment is started; however, the better the potential outcome may be for seizure control 21, 22, 23.…”

Section: When Should Treatment Be Started?mentioning

confidence: 99%

2015 ACVIM Small Animal Consensus Statement on Seizure Management in Dogs

Podell

Volk

Berendt

et al. 2016

Veterinary Internal Medicne

131

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This report represents a scientific and working clinical consensus statement on seizure management in dogs based on current literature and clinical expertise. The goal was to establish guidelines for a predetermined, concise, and logical sequential approach to chronic seizure management starting with seizure identification and diagnosis (not included in this report), reviewing decision‐making, treatment strategies, focusing on issues related to chronic antiepileptic drug treatment response and monitoring, and guidelines to enhance patient response and quality of life. Ultimately, we hope to provide a foundation for ongoing and future clinical epilepsy research in veterinary medicine.

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“…Since the standard neurologic evaluation for first-time seizures includes performance of an electroencephalogram (EEG) as an outpatient, patients must undergo an EEG after ED discharge. 5,6 Research has demonstrated the importance of performing early EEGs among first-time seizure patients for timely identification of epilepsy, as rapid diagnosis and immediate initiation of antiepileptic drug (AED) therapy after an epileptic seizure significantly reduces seizure risk in the short term by about 35%. 5,7 However, the barriers to appropriate outpatient follow-up and the important patient and family centered outcomes related to first time seizures in adults are poorly understood.…”

mentioning

confidence: 99%

“…5,6 Research has demonstrated the importance of performing early EEGs among first-time seizure patients for timely identification of epilepsy, as rapid diagnosis and immediate initiation of antiepileptic drug (AED) therapy after an epileptic seizure significantly reduces seizure risk in the short term by about 35%. 5,7 However, the barriers to appropriate outpatient follow-up and the important patient and family centered outcomes related to first time seizures in adults are poorly understood.In this paper, we utilize the concept of patient-centered outcomes to consider the patients' and families' experiences when deriving treatment options for first-time seizure patients. …”

mentioning

confidence: 99%

Patient-centered outcomes: a qualitative exploration of patient experience with electroencephalograms in the Emergency Department

Davis

Beverly

Hernandez‐Nino

et al. 2017

Qual Res Med Healthc

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Seizures are fear-inducing experiences for those having them and for their friends and family members. [1][2][3] Seizures comprise an estimated 1%-2% of all Emergency Department (ED) visits per year. 4 Despite that fact that patient-centered outcomes and shared decision-making models are widely promoted in healthcare today, no research has attempted to understand the ED experience from the point of view of first-time seizure patients and their families, including their experiences of the setting and pace of the typical components of a first-time seizure evaluation, diagnosis and treatment.The current ED practice standard for uncomplicated first time generalized seizures in adults evaluates patients for toxic, metabolic, structural, cardiogenic and systemic causes.5 If no abnormalities are identified, patients are instructed to refrain from at-risk activity (e.g. driving, swimming) and told to arrange follow-up with a neurologist. Since the standard neurologic evaluation for first-time seizures includes performance of an electroencephalogram (EEG) as an outpatient, patients must undergo an EEG after ED discharge. 5,6 Research has demonstrated the importance of performing early EEGs among first-time seizure patients for timely identification of epilepsy, as rapid diagnosis and immediate initiation of antiepileptic drug (AED) therapy after an epileptic seizure significantly reduces seizure risk in the short term by about 35%. 5,7 However, the barriers to appropriate outpatient follow-up and the important patient and family centered outcomes related to first time seizures in adults are poorly understood.In this paper, we utilize the concept of patient-centered outcomes to consider the patients' and families' experiences when deriving treatment options for first-time seizure patients. EEGs in the Emergency DepartmentThere has been virtually no research on Emergency Patient-centered outcomes: a qualitative exploration of patient experience with electroencephalograms in the Emergency Department ABSTRACTThe primary objective of this qualitative project was to understand the experience of patients who had first-time seizures and who did, and did not, have electroencephalograms (EEGs) performed in the Emergency Department (ED) as part of their initial evaluation, so as to refine the diagnostic and therapeutic approach to these patients and transform the standard of care for first-time seizures by focusing on outcomes as defined by patient experiences and expectations. In this paper, we show that, regardless of the diagnostic and therapeutic approach patients are given in the ED, patients and caregivers trust that health care providers will perform the standard of care consistent with the current medical practice for first-time seizures. However, performing EEGs in the ED and initiating appropriate anticonvulsant therapy for those patients who are at high risk for future seizures addresses patient needs by offering patients a sense of security and control over their medical condition and expediting appropriate follow up c...

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Evidence-based guideline: Management of an unprovoked first seizure in adults

Cited by 253 publications

References 33 publications

Epilepsy Treatment: A Futurist View

Epilepsy Treatment: A Futurist View

2015 ACVIM Small Animal Consensus Statement on Seizure Management in Dogs

Patient-centered outcomes: a qualitative exploration of patient experience with electroencephalograms in the Emergency Department

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