Neurology
Epilepsy, Newly Diagnosed Patients
February 2001
Clinical Focus*
- What elements (expertise, services, and tests) may be needed to make the first diagnosis and initiate and monitor optimal treatment? What is the cumulative contribution (in order of increasing invasiveness and cost) of each of the following tests (electroencephalogram—standard, ambulatory, video, invasive; computed tomography; magnetic resonance imaging; lumbar puncture; blood tests), and what is the cumulative contribution (in order of increasing invasiveness and cost) to the accurate diagnosis of patients undergoing a first diagnosis? What is the positive and negative predictive value of each test alone? In what instances do additional tests add little useful information? Is there evidence to show that not applying particular tests will lead to incorrect diagnosis, negative health, or negative psychosocial outcomes? Are these tests useful for all patients undergoing first diagnosis or for only particular subpopulations? Which components of the patient's history are necessary to accurately diagnose the first seizure?
- What criteria should be used to guide decisions about the timing and selection of treatments for patients undergoing first diagnosis?
- Which interventions are necessary to adequately monitor patients on their first epileptic drug regimen or to ensure that the first diagnosis was correct? For what period of time should this monitoring occur? Should such monitoring be routine or prompted by particular symptoms/events?
- What aspects of clinical/pharmacologic expertise have been demonstrated to result in optimal patient outcomes (maximum reduction of seizure frequency with minimal side effects)?
- What is necessary for patients at the time of first diagnosis in terms of social services, counseling (regarding, for example, employment or driving), or assistance and information from the Epilepsy Foundation? Is there evidence demonstrating that counseling improves patient followup, compliance, or quality of life?
*Addressed in the summary or evidence report.
Management of Newly Diagnosed Patients with Epilepsy: A Systematic Review of the Literature
Summary (Publication No. 01-E037, February 2001)
Evidence Report (Publication No. 01-E038, February 2001)
(File Download)
EPC: MetaWorks, Inc.
Topic Nominator: Centers for Disease Control and Prevention
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