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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 ...
NIHR Signal Talking therapy may relieve high levels of anxiety about health conditions
A specific talking therapy called ‘cognitive behavioural therapy for health anxiety’ may help people who are excessively worried about their health. Health anxiety reduced by a small, but meaningful amount, among the medical outpatients who were identified and treated. Delivered in one-hour sessions every two weeks, therapy lasted about four months. It was provided by junior therapists and trained nurses with no previous experience of the therapy. Benefits lasted for about five year...
NIHR Signal A range of anti-epilepsy drugs are effective as first-line treatment
Lamotrigine and levetiracetam are emerging as first-line treatments for epilepsy, which people may be more likely to keep taking than carbamazepine. Reducing the risk of adverse events and treatment withdrawal is important when selecting an anti-epilepsy drug as it usually will need to be taken long-term. This study reviewed evidence on anti-epilepsy drugs in adults and children. The drugs were compared directly or indirectly with each other. The main outcome of interest was time to withdrawal ...
NIHR Signal Steroid injections into the inner ear may be safe for treating Ménière’s disease
Injecting steroids into the space behind the ear drum may be a safer alternative to injections of gentamycin for treating Ménière’s disease. This disease is marked by severe attacks of dizziness and balance problems. This NIHR-funded trial randomised 60 people with Ménière’s disease who experienced severe attacks of vertigo and had not responded to standard treatment. They were randomly chosen to receive either the corticosteroid methylprednisolone or the...
NIHR Signal Fortified donor breast milk led to similar development for very-low-birthweight babies compared with formula milk
Providing very-low-birthweight babies with fortified human donor breast milk made no difference to their developmental neurological outcomes at 18 months compared with giving formula. This randomised controlled trial looked at 363 babies with birth weights of less than 1500g in neonatal intensive care units in Canada. When the mother’s own milk supply was limited, the babies were given either nutrient-enriched donor breast milk or formula developed for premature babies. There was no diffe...
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