Guidelines and epilepsy practice: Antiseizure medication initiation following an unprovoked first seizure in adults.

Autor: Levi-Abayo S; Department of Clinical Biochemistry and Pharmacology, School of Pharmacy, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel., Ben-Shabat S; Department of Clinical Biochemistry and Pharmacology, School of Pharmacy, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel., Gandelman-Marton R; Neurology Department, Shamir-Assaf Harofeh Medical Center, Zerifin, Israel; Faculty of Medicine, Tel Aviv University, Israel. Electronic address: revitalgm@hotmail.com.
Jazyk: angličtina
Zdroj: Epilepsy research [Epilepsy Res] 2024 Feb; Vol. 200, pp. 107304. Date of Electronic Publication: 2024 Jan 15.
DOI: 10.1016/j.eplepsyres.2024.107304
Abstrakt: Objectives: Adherence rate to evidence-based clinical practice guidelines is relatively low and the impact of guidelines on clinical practice in epilepsy is variable. The 2015 practice guideline on the management of an unprovoked first seizure in adults specifies clinical variables associated with increased risk of seizure recurrence and the impact of immediate antiseizure medication (ASM) treatment on seizure outcome. We aimed to evaluate the impact of the evidence-based guideline for the management of an unprovoked first seizure in adults on clinical practice in our adult neurology department.
Methods: We retrospectively reviewed the computerized database of 169 adult patients admitted to the adult neurology department at Shamir-Assaf Harofeh Medical Center following a first unprovoked seizure between October 2011 and October 2018.
Results: ASMs were initiated in 86% of patients with a first unprovoked seizure pre- and in all patients admitted post- guideline publication. Monotherapy and use of old generation ASMs were more common in both groups and a combination of old- and new generation ASMs - among the pre-guideline group. The pre-guideline decision to initiate ASM treatment was significantly influenced only by epileptiform discharges in the electroencephalogram (EEG).
Discussion: This is the first study to evaluate the impact of the 2015 practice guideline on the initiation of ASM treatment after a first unprovoked seizure in adults. Further studies are needed to assess the global contribution of the guideline to clinical practice and its impact on patient outcomes.
Competing Interests: Declaration of Competing Interest The authors report no conflicts of interest.
(Copyright © 2024 Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
Externí odkaz: