Article

The specialist nurse role in the treatment of refractory epilepsy.

University College London Hospitals NHS Trust, National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, UK.
Seizure (impact factor: 1.8). 08/2004; 13(5):303-7. DOI:10.1016/j.seizure.2003.08.001 pp.303-7
Source: PubMed

ABSTRACT The main aim of epilepsy treatment is rapid and complete control of seizures without antiepileptic drug (AED) side effects. This outcome is achieved in 60-70% of newly diagnosed patients. In refractory epilepsy, new AEDs render some additional patients seizure free but make treatment more complex. The choice of AEDs, their differing pharmacokinetics, efficacy, tolerability and potential interactions are multiplied. Up to of 75% of patients develop AED side effects, most AEDs can cause paradoxical reactions, and when AED doses are changed seizures may worsen. Despite the increased complexity of epilepsy treatment and the biomedical and psychosocial consequences of uncontrolled seizures, many patients have difficulty accessing specialist services. A service that involves the epilepsy nurse specialist (ENS) giving patients and General Practitioners (GPs) free access to treatment advice has recently been established to improve care. Over a 2-week period 60 treatment-related telephone or outpatient consultations were provided out of a total of 124 contacts. Changes to the AED regimen were implemented in 44/60, and the GP was notified by letter in 31/44. The audit results are presented and epilepsy treatment including AED efficacy, tolerability, interactions and side effects are discussed.

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    Article: Anxiety in patients with epilepsy: systematic review and suggestions for clinical management.
    Stefan Beyenburg, Alex J Mitchell, Dieter Schmidt, Christian E Elger, Markus Reuber
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    ABSTRACT: Up to 50 or 60% of patients with chronic epilepsy have various mood disorders including depression and anxiety. Whereas the relationship between epilepsy and depression has received much attention, less is known about anxiety disorders. It is now recognized that anxiety can have a profound influence on the quality of life of patients with epilepsy. The relationship between anxiety disorders and epilepsy is complex. It is necessary to distinguish between different manifestations of anxiety disorder: ictal, postictal, and interictal anxiety. Preexisting vulnerability factors, neurobiological factors, iatrogenic influences (antiepileptic drugs, epilepsy surgery), and psychosocial factors are all likely to play a role, but with considerable individual differences. Despite the high prevalence of anxiety disorders in patients with epilepsy, there are no systematic treatment studies or evidence-based guidelines for best treatment practice. Nevertheless, a practical approach based on the temporal relationship between anxiety and epileptic seizures allows clinicians to consider appropriate treatment strategies to reduce the psychiatric comorbidity in patients with epilepsy.
    Epilepsy & Behavior 10/2005; 7(2):161-71. · 2.34 Impact Factor
Data provided are for informational purposes only. Although carefully collected, accuracy cannot be guaranteed. The impact factor represents a rough estimation of the journal's impact factor and does not reflect the actual current impact factor. Publisher conditions are provided by RoMEO. Differing provisions from the publisher's actual policy or licence agreement may be applicable.

Keywords

2-week period 60 treatment-related telephone
 
additional patients seizure free
 
AED doses
 
AED efficacy
 
AED regimen
 
AED side effects
 
antiepileptic drug
 
audit results
 
complete control
 
differing pharmacokinetics
 
epilepsy nurse specialist
 
epilepsy treatment
 
General Practitioners
 
increased complexity
 
main aim
 
outpatient consultations
 
potential interactions
 
refractory epilepsy
 
treatment advice
 
uncontrolled seizures
 

Patricia G Hosking