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NIHR Signal Levetiracetam is a useful alternative to phenytoin in stopping prolonged epileptic seizures in children
Levetiracetam is as effective as phenytoin at stopping prolonged epileptic seizures in children. In this trial, levetiracetam stopped 70% of children convulsing compared with 64% for phenytoin within 35 to 45 minutes. Adverse events were similar. This combined with the fact levetiracetam may be easier to administer safely make it an important option. Most epileptic seizures stop by themselves within a few minutes, but sometimes they continue for much longer. If this happens emergency treatment ...
NIHR Signal When is it best to start the Parkinson’s drug, levodopa?
Earlier treatment with levodopa provides symptomatic relief to those with symptoms but does not appear to slow Parkinson’s disease from progressing. Therefore, timing is best determined by symptoms. The treatment of Parkinson’s disease is complex. Levodopa is the main drug used to reduce tremors and muscle stiffness. Whether it modifies the course of the disease or becomes less effective over time is debated, and it can have side effects, so patients and clinicians sometimes prefer ...
NIHR Signal Brain scan may predict long-term disabilities in babies with brain injury
Magnetic resonance spectroscopy, a type of scan which shows brain biochemistry, could help predict whether there will be long-term effects of brain injury (encephalopathy) in new-born babies. It is usually done alongside an MRI. Researchers scanned 82 babies being treated for brain injury, using MRI and also magnetic resonance spectroscopy. One biomarker tested at seven days after birth, thalamic N-acetylaspartate, correctly identified all babies who went on to have adverse developmental outcom...
NIHR Signal Early cooling provides no benefit following traumatic brain injury
Deliberate cooling (prophylactic hypothermia) in the early management of traumatic brain injury does not improve neurological outcomes at six months. Inducing hypothermia may also increase the risk of pneumonia. Hypothermia (33-35oC) is sometimes induced to try and limit brain damage in people with severe head injuries. However, evidence for its safety and effectiveness has been mixed. A 2015 trial (Eurotherm 3235) found that therapeutic hypothermia, for adults with raised intracranial pressur...
NIHR Signal No benefit from monitoring antiepileptic drug levels in pregnancy
Regular monitoring of antiepileptic drug levels in pregnant women with epilepsy does not improve seizure control compared with clinical features-based monitoring. This NIHR-funded study was conducted across 50 UK hospitals and is the largest randomised trial in pregnant women with epilepsy. Just over 260 pregnant women with unstable antiepileptic drug levels were assigned to ongoing monthly blood checks or clinical features monitoring. There were no differences in seizures or other pregnancy ou...
NIHR Signal Adrenaline can restart the heart but is no good for the brain
Treating cardiac arrests with adrenaline during resuscitation by paramedics slightly increases survival compared with placebo. Though adrenaline initially helped restore circulation in a third of cases, 3.2% of people survived to 30 days compared to 2.4% of people in the placebo group. Severe brain damage was nearly twice as likely in those who survived after adrenaline injections. Cardiac arrest occurs when the heart no longer pumps blood around the body, usually due to an irregular heart rhyt...
NIHR Signal Cannabis derivative may reduce seizures in some severe drug-resistant epilepsies, but adverse events increase
In people with some types of severe, drug-resistant epilepsy, adding cannabidiol to their treatment may reduce seizure frequency and improve quality of life compared with a placebo. The likelihood of being free from seizures for more than a year was still low, about 8%. However, an additional 12% of people had serious adverse effects with cannabidiol. These findings come from a systematic review, which included six trials in 555 patients. Most were children and adolescents with rare forms of ep...
NIHR Signal Early, intense rehabilitation helps recovery after serious traumatic head injury
Early, intensive rehabilitation aids recovery and improves outcomes for people with moderate to severe traumatic brain injury. A review of 11 studies found that starting rehabilitation early, while people were still in intensive care, or offering more intensive treatments helped patients with brain injury regain function compared with usual care. Early rehabilitation often included multisensory stimulation while the patient was still in a coma. The intensive multidisciplinary programmes mostly ...
NIHR Signal Lorazepam confirmed as first-line treatment for stopping prolonged seizures in children
Intravenous lorazepam is as effective as intravenous diazepam for stopping children’s tonic-clonic seizures in hospital. Lorazepam also results in fewer breathing problems than diazepam. Giving antiepileptic drugs intravenously generally stops seizures more quickly than giving the drugs buccally (in the cheek), intranasally (in the nose) or rectally. However, this effect can be cancelled out if administering the drug into the veins takes too long. Two of the 18 included trials were carrie...
NIHR Signal A commonly used treatment does not improve chronic low back pain
This trial found that destroying nerves that take pain signals to the brain using heat (radiofrequency denervation) did not improve pain, function or a sense of “recovery”. The treatment was used alongside exercise and was a variation of the technique commonly used in the UK. In this large study, it was compared to exercise alone. Low back pain is usually short-lived, but some people develop long-term back pain which can negatively impact their lives. NICE recommends exercise, pain ...
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