Neurology
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Review
Detection of electrographic seizures with continuous EEG monitoring in critically ill patients.
To identify patients most likely to have seizures documented on continuous EEG (cEEG) monitoring and patients who require more prolonged cEEG to record the first seizure. ⋯ CEEG monitoring detected seizure activity in 19% of patients, and the seizures were almost always nonconvulsive. Coma, age <18 years, a history of epilepsy, and convulsive seizures prior to monitoring were risk factors for electrographic seizures. Comatose patients frequently required >24 hours of monitoring to detect the first electrographic seizure.
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Review Practice Guideline Comparative Study Guideline
Efficacy and tolerability of the new antiepileptic drugs II: treatment of refractory epilepsy: report of the Therapeutics and Technology Assessment Subcommittee and Quality Standards Subcommittee of the American Academy of Neurology and the American Epilepsy Society.
To assess the evidence demonstrating efficacy, tolerability, and safety of seven new antiepileptic drugs (AEDs) (gabapentin, lamotrigine, topiramate, tiagabine, oxcarbazepine, levetiracetam, and zonisamide) in the treatment of children and adults with refractory partial and generalized epilepsies. ⋯ The choice of AED depends upon seizure and/or syndrome type, patient age, concomitant medications, AED tolerability, safety, and efficacy. The results of this evidence-based assessment provide guidelines for the prescription of AEDs for patients with refractory epilepsy and identify those seizure types and syndromes where more evidence is necessary.
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Review Practice Guideline Comparative Study Guideline
Efficacy and tolerability of the new antiepileptic drugs I: treatment of new onset epilepsy: report of the Therapeutics and Technology Assessment Subcommittee and Quality Standards Subcommittee of the American Academy of Neurology and the American Epilepsy Society.
To assess the evidence demonstrating efficacy, tolerability, and safety of seven new antiepileptic drugs (AEDs) (gabapentin, lamotrigine, topiramate, tiagabine, oxcarbazepine, levetiracetam, and zonisamide-reviewed in the order in which these agents received approval by the US Food and Drug Administration) in the treatment of children and adults with newly diagnosed partial and generalized epilepsies. ⋯ The results of this evidence-based assessment provide guidelines for the prescription of AEDs for patients with newly diagnosed epilepsy and identify those seizure types and syndromes where more evidence is necessary.
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Central pain syndromes represent a form of neuropathic pain that is associated with lesions of the brain or the spinal cord after a stroke or other traumatic injury. Although spinal cord injury (SCI) pain and central post-stroke pain (CPSP) are both classified as central pain syndromes, they may have differing etiologies. The pathophysiology of SCI pain and CPSP has yet to be completely elucidated, but both spinal and supraspinal pathways may be involved. ⋯ Pharmacologic interventions that have demonstrated efficacy in central pain syndromes include iv lidocaine and opioids as well as the tricyclic antidepressant amitriptyline and the AEDs gabapentin and lamotrigine. Nonpharmacologic interventions have also demonstrated benefit in some patients who are refractory to pharmacologic treatments. Additional studies are needed to further evaluate the efficacy and safety of both pharmacologic and nonpharmacologic treatments for central pain syndromes.