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class="bkr_bib"><h1 id="_NBK581141_"><span itemprop="name">Evidence review: Modifiable risk factors for a second seizure</span></h1><div class="subtitle">Epilepsies in children, young people and adults: diagnosis and management</div><p><b>Evidence review 2</b></p><p><i>NICE Guideline, No. 217</i></p><p class="contrib-group"><h4>Authors</h4><span itemprop="author">National Guideline Centre (UK)</span>.</p><div class="half_rhythm">London: <a href="https://www.nice.org.uk" ref="pagearea=meta&targetsite=external&targetcat=link&targettype=publisher"><span itemprop="publisher">National Institute for Health and Care Excellence (NICE)</span></a>; <span itemprop="datePublished">2022 Apr</span>.<div class="small">ISBN-13: <span itemprop="isbn">978-1-4731-4513-9</span></div></div><div><a href="/books/about/copyright/">Copyright</a> © NICE 2022.</div></div><div class="bkr_clear"></div></div><div id="niceng217er2.s1"><h2 id="_niceng217er2_s1_">1. Modifiable risk factors for a further seizure after a first seizure</h2><div id="niceng217er2.s1.1"><h3>1.1. Review question</h3><p>What are the modifiable risk factors for a further seizure after a first seizure, and what is the magnitude of risk of those factors?</p><div id="niceng217er2.s1.1.1"><h4>1.1.1. Introduction</h4><p>The likelihood of having a further seizure following a first seizure differs between individuals. Understanding and quantifying the magnitude or risk associated with different factors may help people to manage that risk and influence the impact on their lives as well as informing their shared decision to start long term antiseizure medication. This review area examines modifiable risk factors for a further seizure after a first seizure and what the magnitude of risk is for those factors.</p><p>Assessing modifiable risk factors for a second seizure is different from the prediction of a second seizure. Prediction is assessing if a tool can accurately predict a second seizure using all, or most of, the known risk factors for a second seizure. This will provide a risk score based on an individual’s risk factors. So, this identifies who is at risk of a second seizure. In comparison, analysing potential modifiable risk factors looks for individual modifiable risk factors which may have an impact on second seizures. This informs us which risk factors may be modified in people who are identified to be at risk of a second seizure.</p></div><div id="niceng217er2.s1.1.2"><h4>1.1.2. Summary of the protocol</h4><p>For full details see the review protocol in <a href="#niceng217er2.appa">Appendix A</a>.</p><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng217er2tab1"><a href="/books/NBK581141/table/niceng217er2.tab1/?report=objectonly" target="object" title="Table 1" class="img_link icnblk_img figpopup" rid-figpopup="figniceng217er2tab1" rid-ob="figobniceng217er2tab1"><img class="small-thumb" src="/books/NBK581141/table/niceng217er2.tab1/?report=thumb" src-large="/books/NBK581141/table/niceng217er2.tab1/?report=previmg" alt="Table 1. PICO characteristics of review question." /></a><div class="icnblk_cntnt"><h4 id="niceng217er2.tab1"><a href="/books/NBK581141/table/niceng217er2.tab1/?report=objectonly" target="object" rid-ob="figobniceng217er2tab1">Table 1</a></h4><p class="float-caption no_bottom_margin">PICO characteristics of review question. </p></div></div></div><div id="niceng217er2.s1.1.3"><h4>1.1.3. Methods and process</h4><p>This evidence review was developed using the methods and process described in <a href="https://www.nice.org.uk/process/pmg20/chapter/introduction-and-overview" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Developing NICE guidelines: the manual</a>. Methods specific to this review question are described in the review protocol in <a href="#niceng217er2.appa">appendix A</a> and the <a href="/books/NBK581141/bin/niceng217er2_bm1.pdf">methods</a> document.</p><p>Declarations of interest were recorded according to <a href="https://www.nice.org.uk/about/who-we-are/policies-and-procedures" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">NICE’s conflicts of interest policy</a>.</p></div><div id="niceng217er2.s1.1.4"><h4>1.1.4. Prognostic evidence: Included studies</h4><p>Six cohort studies were found investigating the modifiable risk factors for a second seizure after having a first seizure and were included in the review.<a class="bibr" href="#niceng217er2.ref2" rid="niceng217er2.ref2"><sup>2</sup></a><sup>,</sup>
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<a class="bibr" href="#niceng217er2.ref4" rid="niceng217er2.ref4"><sup>4</sup></a><sup>,</sup>
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<a class="bibr" href="#niceng217er2.ref5" rid="niceng217er2.ref5"><sup>5</sup></a><sup>,</sup>
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<a class="bibr" href="#niceng217er2.ref12" rid="niceng217er2.ref12"><sup>12</sup></a><sup>,</sup>
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<a class="bibr" href="#niceng217er2.ref31" rid="niceng217er2.ref31"><sup>31</sup></a><sup>,</sup>
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<a class="bibr" href="#niceng217er2.ref33" rid="niceng217er2.ref33"><sup>33</sup></a></p><p>Within the six studies included within the review, the risk factors considered were psychological factors, health conditions (e.g., diabetes and hypertension), infection or raised temperature and types of seizures. No evidence was found for the other risk factors considered:
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<ul><li class="half_rhythm"><div>Blood pressure</div></li><li class="half_rhythm"><div>Activity/exercise levels</div></li><li class="half_rhythm"><div>Alcohol/ recreational drugs</div></li><li class="half_rhythm"><div>Psychosocial factors</div></li><li class="half_rhythm"><div>Sleep deprivation</div></li><li class="half_rhythm"><div>AED use</div></li><li class="half_rhythm"><div>Other drugs that reduce seizure thresholds</div></li><li class="half_rhythm"><div>Tumours</div></li><li class="half_rhythm"><div>Drugs affecting sleep</div></li></ul></p><p>Of the included studies, two<a class="bibr" href="#niceng217er2.ref2" rid="niceng217er2.ref2"><sup>2</sup></a><sup>,</sup>
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<a class="bibr" href="#niceng217er2.ref4" rid="niceng217er2.ref4"><sup>4</sup></a> cohort studies investigated adult participants who were followed up from 1 – 5 years; one<a class="bibr" href="#niceng217er2.ref31" rid="niceng217er2.ref31"><sup>31</sup></a> study assessed adults, followed up for more than 5 years; and three<a class="bibr" href="#niceng217er2.ref5" rid="niceng217er2.ref5"><sup>5</sup></a><sup>,</sup>
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<a class="bibr" href="#niceng217er2.ref12" rid="niceng217er2.ref12"><sup>12</sup></a><sup>,</sup>
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<a class="bibr" href="#niceng217er2.ref33" rid="niceng217er2.ref33"><sup>33</sup></a> studies reviewed children (under 18) who were followed up for 1 – 5 years after their first seizure. No studies were found for other stratifications or those who had a mixed adult and child population.</p><p>Evidence from these studies is summarised in the clinical evidence summary below (<a class="figpopup" href="/books/NBK581141/table/niceng217er2.tab5/?report=objectonly" target="object" rid-figpopup="figniceng217er2tab5" rid-ob="figobniceng217er2tab5">Table 5</a>).</p><p>See also the study selection flow chart in <a href="#niceng217er2.appa">Appendix A</a>, study evidence tables in <a href="#niceng217er2.appd">Appendix D</a>, forest plots in <a href="#niceng217er2.appe">Appendix E</a> and GRADE tables in <a href="#niceng217er2.appf">Appendix F</a>.</p><div id="niceng217er2.s1.1.4.1"><h5>1.1.4.1. Excluded studies</h5><p>See the excluded studies list in <a href="#niceng217er2.appj">Appendix J</a>.</p></div></div><div id="niceng217er2.s1.1.5"><h4>1.1.5. Summary of studies included in the prognostic evidence</h4><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng217er2tab2"><a href="/books/NBK581141/table/niceng217er2.tab2/?report=objectonly" target="object" title="Table 2" class="img_link icnblk_img figpopup" rid-figpopup="figniceng217er2tab2" rid-ob="figobniceng217er2tab2"><img class="small-thumb" src="/books/NBK581141/table/niceng217er2.tab2/?report=thumb" src-large="/books/NBK581141/table/niceng217er2.tab2/?report=previmg" alt="Table 2. Summary of studies included in the evidence review – Adults >18 years (follow up 1 – 5 years)." /></a><div class="icnblk_cntnt"><h4 id="niceng217er2.tab2"><a href="/books/NBK581141/table/niceng217er2.tab2/?report=objectonly" target="object" rid-ob="figobniceng217er2tab2">Table 2</a></h4><p class="float-caption no_bottom_margin">Summary of studies included in the evidence review – Adults >18 years (follow up 1 – 5 years). </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng217er2tab3"><a href="/books/NBK581141/table/niceng217er2.tab3/?report=objectonly" target="object" title="Table 3" class="img_link icnblk_img figpopup" rid-figpopup="figniceng217er2tab3" rid-ob="figobniceng217er2tab3"><img class="small-thumb" src="/books/NBK581141/table/niceng217er2.tab3/?report=thumb" src-large="/books/NBK581141/table/niceng217er2.tab3/?report=previmg" alt="Table 3. Summary of studies included in the evidence review – Adults > 18 (follow up > 5 years)." /></a><div class="icnblk_cntnt"><h4 id="niceng217er2.tab3"><a href="/books/NBK581141/table/niceng217er2.tab3/?report=objectonly" target="object" rid-ob="figobniceng217er2tab3">Table 3</a></h4><p class="float-caption no_bottom_margin">Summary of studies included in the evidence review – Adults > 18 (follow up > 5 years). </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng217er2tab4"><a href="/books/NBK581141/table/niceng217er2.tab4/?report=objectonly" target="object" title="Table 4" class="img_link icnblk_img figpopup" rid-figpopup="figniceng217er2tab4" rid-ob="figobniceng217er2tab4"><img class="small-thumb" src="/books/NBK581141/table/niceng217er2.tab4/?report=thumb" src-large="/books/NBK581141/table/niceng217er2.tab4/?report=previmg" alt="Table 4. Summary of studies included in the evidence review – Children <18 years (follow up 1 – 5 years)." /></a><div class="icnblk_cntnt"><h4 id="niceng217er2.tab4"><a href="/books/NBK581141/table/niceng217er2.tab4/?report=objectonly" target="object" rid-ob="figobniceng217er2tab4">Table 4</a></h4><p class="float-caption no_bottom_margin">Summary of studies included in the evidence review – Children <18 years (follow up 1 – 5 years). </p></div></div><p>See <a href="#niceng217er2.appd">Appendix D</a> for full evidence tables.</p><div id="niceng217er2.s1.1.5.1"><h5>1.1.5.1. Summary of the prognostic evidence: Adults >18 years (follow up 1 – 5 years)</h5><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng217er2tab5"><a href="/books/NBK581141/table/niceng217er2.tab5/?report=objectonly" target="object" title="Table 5" class="img_link icnblk_img figpopup" rid-figpopup="figniceng217er2tab5" rid-ob="figobniceng217er2tab5"><img class="small-thumb" src="/books/NBK581141/table/niceng217er2.tab5/?report=thumb" src-large="/books/NBK581141/table/niceng217er2.tab5/?report=previmg" alt="Table 5. Clinical evidence summary: Lifetime generalized anxiety disorder." /></a><div class="icnblk_cntnt"><h4 id="niceng217er2.tab5"><a href="/books/NBK581141/table/niceng217er2.tab5/?report=objectonly" target="object" rid-ob="figobniceng217er2tab5">Table 5</a></h4><p class="float-caption no_bottom_margin">Clinical evidence summary: Lifetime generalized anxiety disorder. </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng217er2tab6"><a href="/books/NBK581141/table/niceng217er2.tab6/?report=objectonly" target="object" title="Table 6" class="img_link icnblk_img figpopup" rid-figpopup="figniceng217er2tab6" rid-ob="figobniceng217er2tab6"><img class="small-thumb" src="/books/NBK581141/table/niceng217er2.tab6/?report=thumb" src-large="/books/NBK581141/table/niceng217er2.tab6/?report=previmg" alt="Table 6. Clinical evidence summary: Lifetime mood disorder." /></a><div class="icnblk_cntnt"><h4 id="niceng217er2.tab6"><a href="/books/NBK581141/table/niceng217er2.tab6/?report=objectonly" target="object" rid-ob="figobniceng217er2tab6">Table 6</a></h4><p class="float-caption no_bottom_margin">Clinical evidence summary: Lifetime mood disorder. </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng217er2tab7"><a href="/books/NBK581141/table/niceng217er2.tab7/?report=objectonly" target="object" title="Table 7" class="img_link icnblk_img figpopup" rid-figpopup="figniceng217er2tab7" rid-ob="figobniceng217er2tab7"><img class="small-thumb" src="/books/NBK581141/table/niceng217er2.tab7/?report=thumb" src-large="/books/NBK581141/table/niceng217er2.tab7/?report=previmg" alt="Table 7. Clinical evidence summary: Psychiatric Disorders." /></a><div class="icnblk_cntnt"><h4 id="niceng217er2.tab7"><a href="/books/NBK581141/table/niceng217er2.tab7/?report=objectonly" target="object" rid-ob="figobniceng217er2tab7">Table 7</a></h4><p class="float-caption no_bottom_margin">Clinical evidence summary: Psychiatric Disorders. </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng217er2tab8"><a href="/books/NBK581141/table/niceng217er2.tab8/?report=objectonly" target="object" title="Table 8" class="img_link icnblk_img figpopup" rid-figpopup="figniceng217er2tab8" rid-ob="figobniceng217er2tab8"><img class="small-thumb" src="/books/NBK581141/table/niceng217er2.tab8/?report=thumb" src-large="/books/NBK581141/table/niceng217er2.tab8/?report=previmg" alt="Table 8. Clinical evidence summary: Sepsis." /></a><div class="icnblk_cntnt"><h4 id="niceng217er2.tab8"><a href="/books/NBK581141/table/niceng217er2.tab8/?report=objectonly" target="object" rid-ob="figobniceng217er2tab8">Table 8</a></h4><p class="float-caption no_bottom_margin">Clinical evidence summary: Sepsis. </p></div></div></div><div id="niceng217er2.s1.1.5.2"><h5>1.1.5.2. Summary of the prognostic evidence: Adults >18 years (follow up >5 years)</h5><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng217er2tab9"><a href="/books/NBK581141/table/niceng217er2.tab9/?report=objectonly" target="object" title="Table 9" class="img_link icnblk_img figpopup" rid-figpopup="figniceng217er2tab9" rid-ob="figobniceng217er2tab9"><img class="small-thumb" src="/books/NBK581141/table/niceng217er2.tab9/?report=thumb" src-large="/books/NBK581141/table/niceng217er2.tab9/?report=previmg" alt="Table 9. Clinical evidence summary: Partial seizures." /></a><div class="icnblk_cntnt"><h4 id="niceng217er2.tab9"><a href="/books/NBK581141/table/niceng217er2.tab9/?report=objectonly" target="object" rid-ob="figobniceng217er2tab9">Table 9</a></h4><p class="float-caption no_bottom_margin">Clinical evidence summary: Partial seizures. </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng217er2tab10"><a href="/books/NBK581141/table/niceng217er2.tab10/?report=objectonly" target="object" title="Table 10" class="img_link icnblk_img figpopup" rid-figpopup="figniceng217er2tab10" rid-ob="figobniceng217er2tab10"><img class="small-thumb" src="/books/NBK581141/table/niceng217er2.tab10/?report=thumb" src-large="/books/NBK581141/table/niceng217er2.tab10/?report=previmg" alt="Table 10. Clinical evidence summary: Status Epilepticus." /></a><div class="icnblk_cntnt"><h4 id="niceng217er2.tab10"><a href="/books/NBK581141/table/niceng217er2.tab10/?report=objectonly" target="object" rid-ob="figobniceng217er2tab10">Table 10</a></h4><p class="float-caption no_bottom_margin">Clinical evidence summary: Status Epilepticus. </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng217er2tab11"><a href="/books/NBK581141/table/niceng217er2.tab11/?report=objectonly" target="object" title="Table 11" class="img_link icnblk_img figpopup" rid-figpopup="figniceng217er2tab11" rid-ob="figobniceng217er2tab11"><img class="small-thumb" src="/books/NBK581141/table/niceng217er2.tab11/?report=thumb" src-large="/books/NBK581141/table/niceng217er2.tab11/?report=previmg" alt="Table 11. Clinical evidence summary: Diabetes Mellitus." /></a><div class="icnblk_cntnt"><h4 id="niceng217er2.tab11"><a href="/books/NBK581141/table/niceng217er2.tab11/?report=objectonly" target="object" rid-ob="figobniceng217er2tab11">Table 11</a></h4><p class="float-caption no_bottom_margin">Clinical evidence summary: Diabetes Mellitus. </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng217er2tab12"><a href="/books/NBK581141/table/niceng217er2.tab12/?report=objectonly" target="object" title="Table 12" class="img_link icnblk_img figpopup" rid-figpopup="figniceng217er2tab12" rid-ob="figobniceng217er2tab12"><img class="small-thumb" src="/books/NBK581141/table/niceng217er2.tab12/?report=thumb" src-large="/books/NBK581141/table/niceng217er2.tab12/?report=previmg" alt="Table 12. Clinical evidence summary: Hypertension." /></a><div class="icnblk_cntnt"><h4 id="niceng217er2.tab12"><a href="/books/NBK581141/table/niceng217er2.tab12/?report=objectonly" target="object" rid-ob="figobniceng217er2tab12">Table 12</a></h4><p class="float-caption no_bottom_margin">Clinical evidence summary: Hypertension. </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng217er2tab13"><a href="/books/NBK581141/table/niceng217er2.tab13/?report=objectonly" target="object" title="Table 13" class="img_link icnblk_img figpopup" rid-figpopup="figniceng217er2tab13" rid-ob="figobniceng217er2tab13"><img class="small-thumb" src="/books/NBK581141/table/niceng217er2.tab13/?report=thumb" src-large="/books/NBK581141/table/niceng217er2.tab13/?report=previmg" alt="Table 13. Clinical evidence summary: Atrial Fibrillation." /></a><div class="icnblk_cntnt"><h4 id="niceng217er2.tab13"><a href="/books/NBK581141/table/niceng217er2.tab13/?report=objectonly" target="object" rid-ob="figobniceng217er2tab13">Table 13</a></h4><p class="float-caption no_bottom_margin">Clinical evidence summary: Atrial Fibrillation. </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng217er2tab14"><a href="/books/NBK581141/table/niceng217er2.tab14/?report=objectonly" target="object" title="Table 14" class="img_link icnblk_img figpopup" rid-figpopup="figniceng217er2tab14" rid-ob="figobniceng217er2tab14"><img class="small-thumb" src="/books/NBK581141/table/niceng217er2.tab14/?report=thumb" src-large="/books/NBK581141/table/niceng217er2.tab14/?report=previmg" alt="Table 14. Clinical evidence summary: Functional disability – severe." /></a><div class="icnblk_cntnt"><h4 id="niceng217er2.tab14"><a href="/books/NBK581141/table/niceng217er2.tab14/?report=objectonly" target="object" rid-ob="figobniceng217er2tab14">Table 14</a></h4><p class="float-caption no_bottom_margin">Clinical evidence summary: Functional disability – severe. </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng217er2tab15"><a href="/books/NBK581141/table/niceng217er2.tab15/?report=objectonly" target="object" title="Table 15" class="img_link icnblk_img figpopup" rid-figpopup="figniceng217er2tab15" rid-ob="figobniceng217er2tab15"><img class="small-thumb" src="/books/NBK581141/table/niceng217er2.tab15/?report=thumb" src-large="/books/NBK581141/table/niceng217er2.tab15/?report=previmg" alt="Table 15. Clinical evidence summary: Functional disability – moderate." /></a><div class="icnblk_cntnt"><h4 id="niceng217er2.tab15"><a href="/books/NBK581141/table/niceng217er2.tab15/?report=objectonly" target="object" rid-ob="figobniceng217er2tab15">Table 15</a></h4><p class="float-caption no_bottom_margin">Clinical evidence summary: Functional disability – moderate. </p></div></div></div><div id="niceng217er2.s1.1.5.3"><h5>1.1.5.3. Summary of the prognostic evidence: Children <18 years (follow up 1-5 years)</h5><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng217er2tab16"><a href="/books/NBK581141/table/niceng217er2.tab16/?report=objectonly" target="object" title="Table 16" class="img_link icnblk_img figpopup" rid-figpopup="figniceng217er2tab16" rid-ob="figobniceng217er2tab16"><img class="small-thumb" src="/books/NBK581141/table/niceng217er2.tab16/?report=thumb" src-large="/books/NBK581141/table/niceng217er2.tab16/?report=previmg" alt="Table 16. Clinical evidence summary: Unprovoked Seizures." /></a><div class="icnblk_cntnt"><h4 id="niceng217er2.tab16"><a href="/books/NBK581141/table/niceng217er2.tab16/?report=objectonly" target="object" rid-ob="figobniceng217er2tab16">Table 16</a></h4><p class="float-caption no_bottom_margin">Clinical evidence summary: Unprovoked Seizures. </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng217er2tab17"><a href="/books/NBK581141/table/niceng217er2.tab17/?report=objectonly" target="object" title="Table 17" class="img_link icnblk_img figpopup" rid-figpopup="figniceng217er2tab17" rid-ob="figobniceng217er2tab17"><img class="small-thumb" src="/books/NBK581141/table/niceng217er2.tab17/?report=thumb" src-large="/books/NBK581141/table/niceng217er2.tab17/?report=previmg" alt="Table 17. Clinical evidence summary: Temperature ≥38 degrees." /></a><div class="icnblk_cntnt"><h4 id="niceng217er2.tab17"><a href="/books/NBK581141/table/niceng217er2.tab17/?report=objectonly" target="object" rid-ob="figobniceng217er2tab17">Table 17</a></h4><p class="float-caption no_bottom_margin">Clinical evidence summary: Temperature ≥38 degrees. </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng217er2tab18"><a href="/books/NBK581141/table/niceng217er2.tab18/?report=objectonly" target="object" title="Table 18" class="img_link icnblk_img figpopup" rid-figpopup="figniceng217er2tab18" rid-ob="figobniceng217er2tab18"><img class="small-thumb" src="/books/NBK581141/table/niceng217er2.tab18/?report=thumb" src-large="/books/NBK581141/table/niceng217er2.tab18/?report=previmg" alt="Table 18. Clinical evidence summary: Temperature (per F increase)." /></a><div class="icnblk_cntnt"><h4 id="niceng217er2.tab18"><a href="/books/NBK581141/table/niceng217er2.tab18/?report=objectonly" target="object" rid-ob="figobniceng217er2tab18">Table 18</a></h4><p class="float-caption no_bottom_margin">Clinical evidence summary: Temperature (per F increase). </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng217er2tab19"><a href="/books/NBK581141/table/niceng217er2.tab19/?report=objectonly" target="object" title="Table 19" class="img_link icnblk_img figpopup" rid-figpopup="figniceng217er2tab19" rid-ob="figobniceng217er2tab19"><img class="small-thumb" src="/books/NBK581141/table/niceng217er2.tab19/?report=thumb" src-large="/books/NBK581141/table/niceng217er2.tab19/?report=previmg" alt="Table 19. Clinical evidence summary: Temperature (per F increase)." /></a><div class="icnblk_cntnt"><h4 id="niceng217er2.tab19"><a href="/books/NBK581141/table/niceng217er2.tab19/?report=objectonly" target="object" rid-ob="figobniceng217er2tab19">Table 19</a></h4><p class="float-caption no_bottom_margin">Clinical evidence summary: Temperature (per F increase). </p></div></div><p>See <a href="#niceng217er2.appf">Appendix F</a> for full GRADE tables.</p></div></div><div id="niceng217er2.s1.1.6"><h4>1.1.6. Economic evidence</h4></div><div id="niceng217er2.s1.1.7"><h4>1.1.7. Included studies</h4><p>No health economic studies were included.</p></div><div id="niceng217er2.s1.1.8"><h4>1.1.8. Excluded studies</h4><p>No relevant health economic studies were excluded due to assessment of limited applicability or methodological limitations.</p><p>See also the health economic study selection flow chart in <a href="#niceng217er2.appg">Appendix G</a>.</p></div><div id="niceng217er2.s1.1.9"><h4>1.1.9. Economic model</h4><p>This area was not prioritised for a new cost-effectiveness analysis.</p></div><div id="niceng217er2.s1.1.10"><h4>1.1.10. Evidence statements</h4><div id="niceng217er2.s1.1.10.1"><h5>1.1.10.1. Clinical evidence statements</h5><ul><li class="half_rhythm"><div>None</div></li></ul></div><div id="niceng217er2.s1.1.10.2"><h5>1.1.10.2. Economic</h5><ul><li class="half_rhythm"><div>No relevant economic evaluations were identified.</div></li></ul></div></div><div id="niceng217er2.s1.1.11"><h4>1.1.11. The committee’s discussion and interpretation of the evidence</h4><div id="niceng217er2.s1.1.11.1"><h5>1.1.11.1. The outcomes that matter most</h5><p>The only outcome for this review question was a second seizure, as this review question was designed to evaluate the modifiable risk factors for second seizure in people who have had a first seizure.</p></div><div id="niceng217er2.s1.1.11.2"><h5>1.1.11.2. The quality of the evidence</h5><p>The evidence concerning the modifiable risk factors for second seizure was of low or very low quality. The main reasons were the risk of bias and indirectness. As all the studies were observational studies, they had to show adjustment was made for potential confounders, and one of the main reasons for downgrading was the failure of studies to adjust for at least two of the modifiable risk factors specified. Appropriate statistical adjustment for confounding variables should lead to the results that would be observed if the confounding variables are the same across the risk factor and no-risk factor groups, which should increase our confidence that the results are not confounded. Where the confidence interval of the odds, hazard or risk crosses the null line, this signifies that the result is consistent with the possibility of no effect from the risk factor in the population. The committee took note of these different elements in the quality assessment of the evidence in order to decide on recommendations.</p></div><div id="niceng217er2.s1.1.11.3"><h5>1.1.11.3. Benefits and harms</h5><p>The evidence showed that in adults who are followed up between one to five years, the presence of psychiatric disorders leads to almost three times the odds of a second seizure as no psychiatric disorders. In addition, people with sepsis have an odds of a second seizure that is almost five times greater than the odds in people who do not have sepsis. In adults followed up for over five years, vascular risk factors such as diabetes, hypertension and atrial fibrillation do not show significant effects in relation to a second seizure. However, the committee noted that vascular risk factors can predispose to late onset epilepsy. The committee, therefore, considered it good practice to assess these areas of a person’s health when they are assessed following a seizure.</p><p>The evidence showed that in children followed up for one to five years, unprovoked seizures result in 3.5 times the risk of a second seizure as no unprovoked seizures. One study showed that a temperature of over 38 degrees carries an odds of a second seizure that is double the odds observed with a temperature below 38 degrees. However, two studies also showed that a higher temperature can be a protective factor against premature mortality. They showed that people with higher temperatures have 0.3 to 0.8 times the risk of a second seizure, compared to lower temperatures.</p><p>No evidence was found in relation to other factors that the committee considered modifiable risk factors such as alcohol and recreational drug use and sleep deprivation. There are good pathophysiological reasons why these may cause seizures, and this is seen in clinical practice.</p><p>The committee agreed to emphasize that a comprehensive assessment of potential psychological, biological, and social risk factors should be carried out after a person’s first seizure and that these risks, and advice on how they may be modified, should be discussed with the person, their family, or carers.</p></div><div id="niceng217er2.s1.1.11.4"><h5>1.1.11.4. Cost effectiveness and resource use</h5><p>No economic evidence was identified for this review question.</p><p>The committee discussed the clinical evidence noting the low quality of the evidence presented for determining risk factors of a second seizure for both adults and a paediatric population. The committee noted that in adults, underlying psychiatric disorders and sepsis are non-modifiable risk factors that may increase a person’s risk of a second seizure. Therefore, the committee made a recommendation to assess the presence of these risk factors when presenting with an initial seizure.</p><p>The committee also discussed the clinical evidence presented for children, noting that children presenting with an initial afebrile seizure may be at increased risk of a second seizure.</p><p>The committee agreed that the recommendations made for adults are current best practice, but noted current practice varies. The committee estimated that only 25% of people presenting with an initial seizure are fully assessed for modifiable risk factors. In addition, the committee acknowledged that in current practice, biological risk factors are more likely to be reviewed than psychosocial risk factors.</p><p>The committee also acknowledged that in current practice, children presenting with an initial seizure will always be assessed to try and determine if they experienced an afebrile seizure. The committee noted that for those children presenting with an afebrile seizure, appropriate safety advice will be provided to the child’s parent or carer, and urgent referral advice will be provided, which can be used if a child experiences a second seizure.</p><p>The committee noted that if people are not appropriately assessed for risk of a second seizure, this could have a negative impact on a person’s quality of life in the long-term for those people who experience a second seizure. A first seizure may significantly impact a person’s life (for example, through social interactions or driving privileges), but the committee also noted experiencing a second seizure can result in a more severe negative impact on a person’s QoL compared to those people only experiencing one initial seizure. The committee also noted people who were appropriately assessed for risk of a second seizure are less likely to experience such a significant impact on their overall QoL if they experience a second seizure compared to those who were not assessed. This is because making people aware of the risks of second seizure enables them to understand these risks and manage the future impact seizures may have on their lives. Conversely, people who are not aware of these risks may be unaware they are at risk of a second seizure. In addition, people who experience a second seizure and have not been informed of these risks may feel annoyed they were not appropriately informed when they presented with an initial seizure. An epilepsy diagnosis can significantly impact a person’s daily living (for example, driving restrictions). Therefore, some people may perceive not being fully informed at the early stages of diagnosis pathway as ‘lost time’ in coming to terms with their diagnosis if they are later diagnosed with epilepsy.</p><p>The committee also acknowledged that not appropriately assessing a person’s risk factors when presenting with initial seizure may result in some people experiencing increased anxiety. For example, a person presenting with an initial seizure may be at low risk of a second seizure but if this is not appropriately assessed and conveyed to the person presenting with an initial seizure, they may seek information on the internet that does not necessarily apply to them.</p><p>Overall, the committee concluded there will likely be a change in clinical practice for how a large proportion of adults are managed after their first seizure resulting in additional costs for the NHS. However, the recommendations are not expected to lead to a substantial resource impact because the assessment of risk factors does not take long and can be discussed and assessed with the clinician when a person presents with an initial seizure. This will not constitute an additional visit with a health care professional but may require some additional time with a clinician assessing the person who has presented with an initial seizure. The additional costs incurred by the NHS observed in the form of additional staff time will likely be offset by the QoL gains observed from providing people with the appropriate information regarding their individualised risk of a second seizure.</p><p>There is not expected to be a substantial resource impact associated with the recommendation made for children as this recommendation reflects current practice.</p></div><div id="niceng217er2.s1.1.11.5"><h5>1.1.11.5. Other factors the committee took into account</h5><p>The committee agreed it was important to highlight that modifying risk factors to prevent second seizures is a multifactorial process. This is because the exact reason why some of these risk factors have a direct impact on seizure occurrence is not completely understood.</p><p>The committee discussed that after a person has had a seizure it is important to provide information to the person, and their families or carers on how to recognise a further seizure and to give advice on first aid and any measures they could take to reduce their risk of another seizure, as well as who they should contact if they experience a further seizure before their first appointment with the epilepsy service.</p></div></div><div id="niceng217er2.s1.1.12"><h4>1.1.12. Recommendations supported by this evidence review</h4><p>This evidence review supports recommendations 1.1.1 to 1.1.9 in the NICE guideline.</p></div></div></div><div id="niceng217er2.rl.r1"><h2 id="_niceng217er2_rl_r1_">References</h2><dl class="temp-labeled-list"><dl class="bkr_refwrap"><dt>1.</dt><dd><div class="bk_ref" id="niceng217er2.ref1">Arboix
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F, Schuster
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M. Alcohol use and alcohol-related seizures in patients with epilepsy. Frontiers in Neurology. 2018; 9:401 [<a href="/pmc/articles/PMC5996121/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC5996121</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/29922217" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 29922217</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>24.</dt><dd><div class="bk_ref" id="niceng217er2.ref24">Huang
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CC, Wang
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JJ. Risk factors for a first febrile convulsion in children: a population study in southern Taiwan. Epilepsia. 1999; 40(6):719–725 [<a href="https://pubmed.ncbi.nlm.nih.gov/10368069" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 10368069</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>25.</dt><dd><div class="bk_ref" id="niceng217er2.ref25">Hundozi
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Z, Shala
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S, Rrustemi
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et al. Hypertension on admission is associated with a lower risk of early seizures after stroke. Seizure. 2016; 36:40–43 [<a href="https://pubmed.ncbi.nlm.nih.gov/26895465" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 26895465</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>26.</dt><dd><div class="bk_ref" id="niceng217er2.ref26">Hwang
|
|
K, Joo
|
|
JD, Kim
|
|
YH, Han
|
|
JH, Oh
|
|
CW, Yun
|
|
CH
|
|
et al. Risk factors for preoperative and late postoperative seizures in primary supratentorial meningiomas. Clinical Neurology and Neurosurgery. 2019; 180:34–39 [<a href="https://pubmed.ncbi.nlm.nih.gov/30889470" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 30889470</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>27.</dt><dd><div class="bk_ref" id="niceng217er2.ref27">Hwang
|
|
SL, Lin
|
|
CL, Lee
|
|
KS, Lieu
|
|
AS, Kuo
|
|
TH, Chang
|
|
CZ
|
|
et al. Factors influencing seizures in adult patients with supratentorial astrocytic tumors. Acta Neurochirurgica. 2004; 146(6):589–594 [<a href="https://pubmed.ncbi.nlm.nih.gov/15168227" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 15168227</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>28.</dt><dd><div class="bk_ref" id="niceng217er2.ref28">Jeon
|
|
SM, Park
|
|
S, Kim
|
|
D, Kwon
|
|
JW. Risk of seizures associated with antipsychotic treatment in pediatrics with psychiatric disorders: a nested case-control study in Korea. European Child and Adolescent Psychiatry. 2021; 30(3):391–399 [<a href="https://pubmed.ncbi.nlm.nih.gov/32266577" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 32266577</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>29.</dt><dd><div class="bk_ref" id="niceng217er2.ref29">Johnson
|
|
EL, Krauss
|
|
GL, Lee
|
|
AK, Schneider
|
|
ALC, Dearborn
|
|
JL, Kucharska-Newton
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AM
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et al. Association between midlife risk factors and late-onset epilepsy: Results from the Atherosclerosis Risk in Communities Study. JAMA Neurology. 2018; 75(11):1375–1382 [<a href="/pmc/articles/PMC6248112/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC6248112</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/30039175" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 30039175</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>30.</dt><dd><div class="bk_ref" id="niceng217er2.ref30">Kantamalee
|
|
W, Katanyuwong
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|
K, Louthrenoo
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O. Clinical characteristics of febrile seizures and risk factors of its recurrence in chiang mai university hospital. Neurology Asia. 2017; 22(3):203–208</div></dd></dl><dl class="bkr_refwrap"><dt>31.</dt><dd><div class="bk_ref" id="niceng217er2.ref31">Kim
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HJ, Park
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KD, Choi
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KG, Lee
|
|
HW. Clinical predictors of seizure recurrence after the first post-ischemic stroke seizure. BMC Neurology. 2016; 16(1):212 [<a href="/pmc/articles/PMC5097386/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC5097386</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/27814760" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 27814760</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>32.</dt><dd><div class="bk_ref" id="niceng217er2.ref32">Kotsopoulos
|
|
I, de Krom
|
|
M, Kessels
|
|
F, Lodder
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J, Troost
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J, Twellaar
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et al. Incidence of epilepsy and predictive factors of epileptic and non-epileptic seizures. Seizure. 2005; 14(3):175–182 [<a href="https://pubmed.ncbi.nlm.nih.gov/15797352" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 15797352</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>33.</dt><dd><div class="bk_ref" id="niceng217er2.ref33">Kumar
|
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N, Midha
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T, Rao
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YK. Risk factors of recurrence of febrile seizures in children in a tertiary care hospital in kanpur: A one year follow up study. Annals of Indian Academy of Neurology. 2019; 22(1):31–36 [<a href="/pmc/articles/PMC6327698/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC6327698</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/30692757" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 30692757</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>34.</dt><dd><div class="bk_ref" id="niceng217er2.ref34">Kumari
|
|
PL, Nair
|
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MK, Nair
|
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SM, Kailas
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L, Geetha
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S. Iron deficiency as a risk factor for simple febrile seizures--a case control study. Indian Pediatrics. 2012; 49(1):17–19 [<a href="https://pubmed.ncbi.nlm.nih.gov/21719928" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 21719928</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>35.</dt><dd><div class="bk_ref" id="niceng217er2.ref35">Labovitz
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DL, Hauser
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WA, Sacco
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RL. Prevalence and predictors of early seizure and status epilepticus after first stroke. Neurology. 2001; 57(2):200–206 [<a href="https://pubmed.ncbi.nlm.nih.gov/11468303" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 11468303</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>36.</dt><dd><div class="bk_ref" id="niceng217er2.ref36">Li
|
|
X, Breteler
|
|
MM, de Bruyne
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MC, Meinardi
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H, Hauser
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WA, Hofman
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A. Vascular determinants of epilepsy: the Rotterdam Study. Epilepsia. 1997; 38(11):1216–1220 [<a href="https://pubmed.ncbi.nlm.nih.gov/9579923" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 9579923</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>37.</dt><dd><div class="bk_ref" id="niceng217er2.ref37">Mehta
|
|
A, Zusman
|
|
BE, Choxi
|
|
R, Shutter
|
|
LA, Yassin
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A, Antony
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A
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et al. Seizures after intracerebral hemorrhage: Incidence, risk factors, and impact on mortality and morbidity. World Neurosurgery. 2018; 112:e385–e392 [<a href="https://pubmed.ncbi.nlm.nih.gov/29355799" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 29355799</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>38.</dt><dd><div class="bk_ref" id="niceng217er2.ref38">Morais
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NM, Ranzan
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J, Riesgo
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RS. Predictors of epilepsy in children with cerebrovascular disease. Journal of Child Neurology. 2013; 28(11):1387–1391 [<a href="https://pubmed.ncbi.nlm.nih.gov/23143721" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 23143721</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>39.</dt><dd><div class="bk_ref" id="niceng217er2.ref39">Murray
|
|
BP, Carpenter
|
|
JE, Dunkley
|
|
CA, Moran
|
|
TP, Alfaifi
|
|
M, Alsukaiti
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|
WS
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et al. Seizures in tramadol overdoses reported in the ToxIC registry: predisposing factors and the role of naloxone. Clinical Toxicology: The Official Journal of the American Academy of Clinical Toxicology & European Association of Poisons Centres & Clinical Toxicologists. 2019; 57(8):692–696 [<a href="https://pubmed.ncbi.nlm.nih.gov/30676832" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 30676832</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>40.</dt><dd><div class="bk_ref" id="niceng217er2.ref40">National Institute for Health and Care Excellence. Developing NICE guidelines: the manual [updated October 2020]. London. National Institute for Health and Care Excellence, 2014. Available from: <a href="http://www.nice.org.uk/article/PMG20/chapter/1%20Introduction%20and%20overview" ref="pagearea=cite-ref&targetsite=external&targetcat=link&targettype=uri">http://www<wbr style="display:inline-block"></wbr>​.nice.org.uk<wbr style="display:inline-block"></wbr>​/article/PMG20/chapter<wbr style="display:inline-block"></wbr>​/1%20Introduction%20and%20overview</a></div></dd></dl><dl class="bkr_refwrap"><dt>41.</dt><dd><div class="bk_ref" id="niceng217er2.ref41">Parmontree
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|
P, Tunthanathip
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T, Doungngern
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T, Rojpitbulstit
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M, Kulviwat
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W, Ratanalert
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S. Predictive risk factors for early seizures in traumatic brain injury. Journal of Neurosciences in Rural Practice. 2019; 10(4):582–587 [<a href="/pmc/articles/PMC6906099/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC6906099</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/31831975" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 31831975</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>42.</dt><dd><div class="bk_ref" id="niceng217er2.ref42">Phabphal
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K, Geater
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A, Limapichat
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K, Sathirapanya
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P, Setthawatcharawanich
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S. Risk factors of recurrent seizure, co-morbidities, and mortality in new onset seizure in elderly. Seizure. 2013; 22(7):577–580 [<a href="https://pubmed.ncbi.nlm.nih.gov/23664806" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 23664806</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>43.</dt><dd><div class="bk_ref" id="niceng217er2.ref43">Pugh
|
|
MJ, Knoefel
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JE, Mortensen
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EM, Amuan
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ME, Berlowitz
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DR, Van Cott
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AC. New-onset epilepsy risk factors in older veterans. Journal of the American Geriatrics Society. 2009; 57(2):237–242 [<a href="https://pubmed.ncbi.nlm.nih.gov/19207140" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 19207140</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>44.</dt><dd><div class="bk_ref" id="niceng217er2.ref44">Rantala
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H, Uhari
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M. Risk factors for recurrences of febrile convulsions. Acta Neurologica Scandinavica. 1994; 90(3):207–210 [<a href="https://pubmed.ncbi.nlm.nih.gov/7847062" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 7847062</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>45.</dt><dd><div class="bk_ref" id="niceng217er2.ref45">Reith
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J, Jorgensen
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HS, Nakayama
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H, Raaschou
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HO, Olsen
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TS. Seizures in acute stroke: predictors and prognostic significance. The Copenhagen Stroke Study. Stroke. 1997; 28(8):1585–1589 [<a href="https://pubmed.ncbi.nlm.nih.gov/9259753" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 9259753</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>46.</dt><dd><div class="bk_ref" id="niceng217er2.ref46">Shinnar
|
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S, Berg
|
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AT, Moshe
|
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SL, O’Dell
|
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C, Alemany
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M, Newstein
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et al. The risk of seizure recurrence after a first unprovoked afebrile seizure in childhood: an extended follow-up. Pediatrics. 1996; 98(2 Pt 1):216–225 [<a href="https://pubmed.ncbi.nlm.nih.gov/8692621" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 8692621</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>47.</dt><dd><div class="bk_ref" id="niceng217er2.ref47">Sittichanbuncha
|
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Y, Chomrak
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C, Naksensin
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W, Sawanyawisuth
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K. Seizures at the emergency department in thailand and risk factors for recurrent seizures. Neurology Asia. 2015; 20(2):139–142</div></dd></dl><dl class="bkr_refwrap"><dt>48.</dt><dd><div class="bk_ref" id="niceng217er2.ref48">Skardelly
|
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M, Brendle
|
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E, Noell
|
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S, Behling
|
|
F, Wuttke
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TV, Schittenhelm
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J
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et al. Predictors of preoperative and early postoperative seizures in patients with intra-axial primary and metastatic brain tumors: A retrospective observational single center study. Annals of Neurology. 2015; 78(6):917–928 [<a href="https://pubmed.ncbi.nlm.nih.gov/26385488" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 26385488</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>49.</dt><dd><div class="bk_ref" id="niceng217er2.ref49">Skardelly
|
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M, Rother
|
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C, Noell
|
|
S, Behling
|
|
F, Wuttke
|
|
TV, Schittenhelm
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J
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et al. Risk factors of preoperative and early postoperative seizures in patients with meningioma: A retrospective single-center cohort study. World Neurosurgery. 2017; 97:538–546 [<a href="https://pubmed.ncbi.nlm.nih.gov/27777150" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 27777150</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>50.</dt><dd><div class="bk_ref" id="niceng217er2.ref50">Stimmel
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GL, Dopheide
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JA. Psychotropic drug-induced reductions in seizure threshold. Incidence and consequences. CNS Drugs. 1996; 5(1):37–50</div></dd></dl><dl class="bkr_refwrap"><dt>51.</dt><dd><div class="bk_ref" id="niceng217er2.ref51">Tosun
|
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A, Koturoglu
|
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G, Serdaroglu
|
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G, Polat
|
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M, Kurugol
|
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Z, Gokben
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S
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et al. Ratios of nine risk factors in children with recurrent febrile seizures. Pediatric Neurology. 2010; 43(3):177–182 [<a href="https://pubmed.ncbi.nlm.nih.gov/20691939" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 20691939</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>52.</dt><dd><div class="bk_ref" id="niceng217er2.ref52">Turon
|
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M, Abraira
|
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L, Cazorla
|
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S, Fonseca
|
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E, Quintana
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M, Toledo
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M
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et al. Vascular risk factors as independent predictors of neurocognitive impairments in patients with late-onset epilepsy who have small-vessel disease. Epilepsy & Behavior. 2020; 104(Pt B):106443 [<a href="https://pubmed.ncbi.nlm.nih.gov/31399342" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 31399342</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>53.</dt><dd><div class="bk_ref" id="niceng217er2.ref53">Vaaramo
|
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K, Puljula
|
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J, Tetri
|
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S, Juvela
|
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S, Hillbom
|
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M. Predictors of new-onset seizures: a 10-year follow-up of head trauma subjects with and without traumatic brain injury. Journal of Neurology, Neurosurgery and Psychiatry. 2014; 85(6):598–602 [<a href="https://pubmed.ncbi.nlm.nih.gov/23761917" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 23761917</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>54.</dt><dd><div class="bk_ref" id="niceng217er2.ref54">Wolpert
|
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F, Lareida
|
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A, Terziev
|
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R, Grossenbacher
|
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B, Neidert
|
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MC, Roth
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P
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et al. Risk factors for the development of epilepsy in patients with brain metastases. Neuro-Oncology. 2020; 22(5):718–728 [<a href="/pmc/articles/PMC7229256/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC7229256</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/31498867" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 31498867</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>55.</dt><dd><div class="bk_ref" id="niceng217er2.ref55">Wu
|
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CS, Liu
|
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HY, Tsai
|
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HJ, Liu
|
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SK. Seizure risk associated with antidepressant treatment among patients with depressive disorders: A population-based case-crossover study. Journal of Clinical Psychiatry. 2017; 78(9):e1226–e1232 [<a href="https://pubmed.ncbi.nlm.nih.gov/29068610" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 29068610</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>56.</dt><dd><div class="bk_ref" id="niceng217er2.ref56">Wu
|
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CS, Wang
|
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SC, Yeh
|
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IJ, Liu
|
|
SK. Comparative risk of seizure with use of first- and second-generation antipsychotics in patients with schizophrenia and mood disorders. Journal of Clinical Psychiatry. 2016; 77(5):e573–579 [<a href="https://pubmed.ncbi.nlm.nih.gov/27249081" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 27249081</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>57.</dt><dd><div class="bk_ref" id="niceng217er2.ref57">Xue
|
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H, Sveinsson
|
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O, Bartek
|
|
J, Jr., Forander
|
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P, Skyrman
|
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S, Kihlstrom
|
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L
|
|
et al. Long-term control and predictors of seizures in intracranial meningioma surgery: a population-based study. Acta Neurochirurgica. 2018; 160(3):589–596 [<a href="https://pubmed.ncbi.nlm.nih.gov/29327143" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 29327143</span></a>]</div></dd></dl></dl></div><div id="appendixesappgroup1"><h2 id="_appendixesappgroup1_">Appendices</h2><div id="niceng217er2.appa"><h3>Appendix A. Review protocols</h3><div id="niceng217er2.appa.s1"><h4>A.1. Review protocol for modifiable risk factors for second seizure</h4><p id="niceng217er2.appa.et1"><a href="/books/NBK581141/bin/niceng217er2-appa-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Download PDF</a><span class="small"> (225K)</span></p></div><div id="niceng217er2.appa.s2"><h4>A.2. Health economic review protocol</h4><p id="niceng217er2.appa.et2"><a href="/books/NBK581141/bin/niceng217er2-appa-et2.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Download PDF</a><span class="small"> (164K)</span></p></div></div><div id="niceng217er2.appb"><h3>Appendix B. Literature search strategies</h3><p>This literature search strategy was used for the following reviews:
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<ul><li class="half_rhythm"><div>What are the modifiable risk factors for a further seizure after a first seizure, and what is the magnitude of risk of those factors?</div></li><li class="half_rhythm"><div>What are the modifiable risk factors for epilepsy-related mortality, including SUDEP, and what is the magnitude of risk of the factors?</div></li></ul></p><p>The literature searches for this review are detailed below and complied with the methodology outlined in Developing NICE guidelines: the manual.<a class="bibr" href="#niceng217er2.ref40" rid="niceng217er2.ref40"><sup>40</sup></a></p><p>For more information, please see the <a href="/books/NBK581141/bin/niceng217er2_bm1.pdf">Methodology</a> review published as part of the accompanying documents for this guideline.</p><div id="niceng217er2.appb.s1"><h4>B.1. Clinical search literature search strategy</h4><p id="niceng217er2.appb.et1"><a href="/books/NBK581141/bin/niceng217er2-appb-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Download PDF</a><span class="small"> (183K)</span></p></div><div id="niceng217er2.appb.s2"><h4>B.2. Health Economics literature search strategy</h4><p id="niceng217er2.appb.et2"><a href="/books/NBK581141/bin/niceng217er2-appb-et2.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Download PDF</a><span class="small"> (145K)</span></p></div></div><div id="niceng217er2.appc"><h3>Appendix C. Prognostic evidence study selection</h3><p id="niceng217er2.appc.et1"><a href="/books/NBK581141/bin/niceng217er2-appc-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Figure 1. Flow chart of clinical study selection for the review of modifiable risk factors for second seizure</a><span class="small"> (PDF, 119K)</span></p></div><div id="niceng217er2.appd"><h3>Appendix D. Prognostic evidence</h3><p id="niceng217er2.appd.et1"><a href="/books/NBK581141/bin/niceng217er2-appd-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Download PDF</a><span class="small"> (231K)</span></p></div><div id="niceng217er2.appe"><h3>Appendix E. Forest plots</h3><div id="niceng217er2.appe.s1"><h4>E.1. Adults >18 years (follow up 1 – 5 years)</h4><p id="niceng217er2.appe.et1"><a href="/books/NBK581141/bin/niceng217er2-appe-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Download PDF</a><span class="small"> (171K)</span></p></div><div id="niceng217er2.appe.s2"><h4>E.2. Adults >18 years (follow up >5 years)</h4><p id="niceng217er2.appe.et2"><a href="/books/NBK581141/bin/niceng217er2-appe-et2.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Download PDF</a><span class="small"> (202K)</span></p></div><div id="niceng217er2.appe.s3"><h4>E.3. Children <18 years (follow up 1 – 5 years)</h4><p id="niceng217er2.appe.et3"><a href="/books/NBK581141/bin/niceng217er2-appe-et3.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Download PDF</a><span class="small"> (155K)</span></p></div></div><div id="niceng217er2.appf"><h3>Appendix F. GRADE tables</h3><div id="niceng217er2.appf.s1"><h4>F.1. Adults >18 years (follow up 1 – 5 years)</h4><p id="niceng217er2.appf.et1"><a href="/books/NBK581141/bin/niceng217er2-appf-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Download PDF</a><span class="small"> (157K)</span></p></div><div id="niceng217er2.appf.s2"><h4>F.2. Adults >18 years (follow up >5 years)</h4><p id="niceng217er2.appf.et2"><a href="/books/NBK581141/bin/niceng217er2-appf-et2.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Download PDF</a><span class="small"> (181K)</span></p></div><div id="niceng217er2.appf.s3"><h4>F.3. Children <18 years (follow up 1 – 5 years)</h4><p id="niceng217er2.appf.et3"><a href="/books/NBK581141/bin/niceng217er2-appf-et3.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Download PDF</a><span class="small"> (160K)</span></p></div></div><div id="niceng217er2.appg"><h3>Appendix G. Economic evidence study selection</h3><p id="niceng217er2.appg.et1"><a href="/books/NBK581141/bin/niceng217er2-appg-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Download PDF</a><span class="small"> (131K)</span></p></div><div id="niceng217er2.apph"><h3>Appendix H. Economic evidence tables</h3><p>None.</p></div><div id="niceng217er2.appi"><h3>Appendix I. Health economic model</h3><p>No original economic modelling was undertaken for this review question.</p></div><div id="niceng217er2.appj"><h3>Appendix J. Excluded studies</h3><div id="niceng217er2.appj.s1"><h4>J.1. Clinical studies</h4><p id="niceng217er2.appj.et1"><a href="/books/NBK581141/bin/niceng217er2-appj-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Download PDF</a><span class="small"> (150K)</span></p></div><div id="niceng217er2.appj.s2"><h4>J.2. Health Economic studies</h4><p id="niceng217er2.appj.et2"><a href="/books/NBK581141/bin/niceng217er2-appj-et2.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Download PDF</a><span class="small"> (118K)</span></p></div></div></div></div><div class="fm-sec"><div><p>FINAL</p></div><div><p>Evidence review underpinning recommendations 1.1.1 – 1.1.9 in the NICE guideline</p><p>Developed by the National Guideline Centre</p></div><div><p><b>Disclaimer</b>: The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or service users. The recommendations in this guideline are not mandatory and the guideline does not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.</p><p>Local commissioners and/or providers have a responsibility to enable the guideline to be applied when individual health professionals and their patients or service users wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with compliance with those duties.</p><p>NICE guidelines cover health and care in England. Decisions on how they apply in other UK countries are made by ministers in the <a href="http://wales.gov.uk/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Welsh Government</a>, <a href="http://www.scotland.gov.uk/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Scottish Government</a>, and <a href="http://www.northernireland.gov.uk/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Northern Ireland Executive</a>. All NICE guidance is subject to regular review and may be updated or withdrawn.</p></div><div class="half_rhythm"><a href="/books/about/copyright/">Copyright</a> © NICE 2022.</div><div class="small"><span class="label">Bookshelf ID: NBK581141</span><span class="label">PMID: <a href="https://pubmed.ncbi.nlm.nih.gov/35700300" title="PubMed record of this title" ref="pagearea=meta&targetsite=entrez&targetcat=link&targettype=pubmed">35700300</a></span></div></div><div class="small-screen-prev"></div><div class="small-screen-next"></div></article><article data-type="table-wrap" id="figobniceng217er2tab1"><div id="niceng217er2.tab1" class="table"><h3><span class="label">Table 1</span><span class="title">PICO characteristics of review question</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK581141/table/niceng217er2.tab1/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng217er2.tab1_lrgtbl__"><table><tbody><tr><th id="hd_b_niceng217er2.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Population</th><td headers="hd_b_niceng217er2.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Inclusion: People with a history of a single seizure (as determined by a specialist).</p>
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<p>Exclusion: New-born babies with acute symptomatic seizures</p>
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</td></tr><tr><th id="hd_b_niceng217er2.tab1_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Risk factors under consideration</th><td headers="hd_b_niceng217er2.tab1_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<ul><li class="half_rhythm"><div>Vascular disease</div></li><li class="half_rhythm"><div>Blood pressure</div></li><li class="half_rhythm"><div>Activity/exercise levels</div></li><li class="half_rhythm"><div>Alcohol/ recreational drugs</div></li><li class="half_rhythm"><div>Psychological factors / stress</div></li><li class="half_rhythm"><div>Psychosocial factors</div></li><li class="half_rhythm"><div>Sleep deprivation</div></li><li class="half_rhythm"><div>AED use</div></li><li class="half_rhythm"><div>Other drugs that reduce seizure thresholds</div></li><li class="half_rhythm"><div>Tumours</div></li><li class="half_rhythm"><div>Drugs affecting sleep</div></li><li class="half_rhythm"><div>Systemic illness</div></li></ul></td></tr><tr><th id="hd_b_niceng217er2.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Confounding factors</th><td headers="hd_b_niceng217er2.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<ul><li class="half_rhythm"><div>No key confounders that have to be adjusted for have been identified</div></li></ul></td></tr><tr><th id="hd_b_niceng217er2.tab1_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Outcomes</th><td headers="hd_b_niceng217er2.tab1_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Second seizure (as determined by a specialist)</p>
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<p>Follow up: use all available but stratify: <6 months, 6-12 months, 1-5 years, >5 years</p>
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</td></tr><tr><th id="hd_b_niceng217er2.tab1_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study design</th><td headers="hd_b_niceng217er2.tab1_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<ul><li class="half_rhythm"><div>Prospective and retrospective cohort studies</div></li><li class="half_rhythm"><div>Case-control studies will be considered if demonstrated to avoid bias arising from plausible potential confounders by appropriate methods</div></li></ul></td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobniceng217er2tab2"><div id="niceng217er2.tab2" class="table"><h3><span class="label">Table 2</span><span class="title">Summary of studies included in the evidence review – Adults >18 years (follow up 1 – 5 years)</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK581141/table/niceng217er2.tab2/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng217er2.tab2_lrgtbl__"><table><thead><tr><th id="hd_h_niceng217er2.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Study</th><th id="hd_h_niceng217er2.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Population</th><th id="hd_h_niceng217er2.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Analysis</th><th id="hd_h_niceng217er2.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Prognostic variable(s)</th><th id="hd_h_niceng217er2.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Confounders</th><th id="hd_h_niceng217er2.tab2_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Outcomes</th><th id="hd_h_niceng217er2.tab2_1_1_1_7" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Comments</th></tr></thead><tbody><tr><td headers="hd_h_niceng217er2.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Assis 2019<a class="bibr" href="#niceng217er2.ref2" rid="niceng217er2.ref2"><sup>2</sup></a></td><td headers="hd_h_niceng217er2.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>N = 109</p>
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<p>Patients aged ≥60 years who were consecutively admitted to Hospital São Rafael, a general tertiary teaching hospital with 356 beds in Salvador, Brazil, between November 2015 and April 2018.</p>
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</td><td headers="hd_h_niceng217er2.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Prospective, observational, single-centre study with multivariate analysis of the risk factors for early seizure recurrence</td><td headers="hd_h_niceng217er2.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Sepsis</p>
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<p>Psychiatric Disorders</p>
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</td><td headers="hd_h_niceng217er2.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Comorbidities</p>
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<p>Neurological disorders</p>
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<p>Clinical disorders</p>
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</td><td headers="hd_h_niceng217er2.tab2_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Second Seizure</td><td headers="hd_h_niceng217er2.tab2_1_1_1_7" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>All factors significant within the univariate analysis were also used within the multivariate analysis but have not been clearly stated</p>
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<p>22 out of the 103 patients over the age of 60 had a previous diagnosis of epilepsy at the time of hospital admission.</p>
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</td></tr><tr><td headers="hd_h_niceng217er2.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Baldin 2017<a class="bibr" href="#niceng217er2.ref4" rid="niceng217er2.ref4"><sup>4</sup></a></td><td headers="hd_h_niceng217er2.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>N = 52</p>
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<p>Patients were found through emergency department records who had an unprovoked seizure (seizure or multiple seizures) within a 24-hour period without an identified proximate precipitant</p>
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</td><td headers="hd_h_niceng217er2.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Retrospective cohort study with multivariable Cox regression</td><td headers="hd_h_niceng217er2.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Lifetime generalized anxiety disorder</p>
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<p>Lifetime mood disorder</p>
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</td><td headers="hd_h_niceng217er2.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Age</p>
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<p>Gender</p>
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<p>Lifetime generalized anxiety disorder</p>
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<p>Lifetime mood disorder</p>
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</td><td headers="hd_h_niceng217er2.tab2_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Second Seizure</td><td headers="hd_h_niceng217er2.tab2_1_1_1_7" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobniceng217er2tab3"><div id="niceng217er2.tab3" class="table"><h3><span class="label">Table 3</span><span class="title">Summary of studies included in the evidence review – Adults > 18 (follow up > 5 years)</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK581141/table/niceng217er2.tab3/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng217er2.tab3_lrgtbl__"><table><thead><tr><th id="hd_h_niceng217er2.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Study</th><th id="hd_h_niceng217er2.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Population</th><th id="hd_h_niceng217er2.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Analysis</th><th id="hd_h_niceng217er2.tab3_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Prognostic variable(s)</th><th id="hd_h_niceng217er2.tab3_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Confounders</th><th id="hd_h_niceng217er2.tab3_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Outcomes</th><th id="hd_h_niceng217er2.tab3_1_1_1_7" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Comments</th></tr></thead><tbody><tr><td headers="hd_h_niceng217er2.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Kim 2016<a class="bibr" href="#niceng217er2.ref31" rid="niceng217er2.ref31"><sup>31</sup></a></td><td headers="hd_h_niceng217er2.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>N=124</p>
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<p>Patients admitted to Ewha Woman’s University Hospital between 2001 and 2012 due to cerebral infarction, 124 post-stroke seizure after ischemic stroke patients (PSSi) were included in this study.</p>
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</td><td headers="hd_h_niceng217er2.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Retrospective cohort study with multivariate logistic regression analysis</td><td headers="hd_h_niceng217er2.tab3_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Status Epilepticus</p>
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<p>Partial Seizure type</p>
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<p>Diabetes Mellitus</p>
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<p>Hypertension</p>
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<p>Atrial Fibrillation</p>
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<p>Functional disability</p>
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</td><td headers="hd_h_niceng217er2.tab3_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Age</p>
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<p>Male gender</p>
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<p>Diabetes Mellitus</p>
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<p>Hypertension</p>
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<p>Atrial Fibrillation</p>
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<p>Lesion size</p>
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<p>Cortical involvement</p>
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<p>Haemorrhagic transformation</p>
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<p>Functional disability</p>
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<p>Status Epilepticus</p>
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<p>Relevant EEG findings</p>
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<p>Partial Seizure type</p>
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</td><td headers="hd_h_niceng217er2.tab3_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Second Seizure</td><td headers="hd_h_niceng217er2.tab3_1_1_1_7" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobniceng217er2tab4"><div id="niceng217er2.tab4" class="table"><h3><span class="label">Table 4</span><span class="title">Summary of studies included in the evidence review – Children <18 years (follow up 1 – 5 years)</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK581141/table/niceng217er2.tab4/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng217er2.tab4_lrgtbl__"><table><thead><tr><th id="hd_h_niceng217er2.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Study</th><th id="hd_h_niceng217er2.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Population</th><th id="hd_h_niceng217er2.tab4_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Analysis</th><th id="hd_h_niceng217er2.tab4_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Prognostic variable(s)</th><th id="hd_h_niceng217er2.tab4_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Confounders</th><th id="hd_h_niceng217er2.tab4_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Outcomes</th><th id="hd_h_niceng217er2.tab4_1_1_1_7" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Comments</th></tr></thead><tbody><tr><td headers="hd_h_niceng217er2.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Berg 1998<a class="bibr" href="#niceng217er2.ref5" rid="niceng217er2.ref5"><sup>5</sup></a></td><td headers="hd_h_niceng217er2.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>N=428</p>
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<p>Only children with a first febrile seizure, a temperature of ≥101F, no evidence of intracranial infection, and no history of unprovoked seizures were eligible</p>
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</td><td headers="hd_h_niceng217er2.tab4_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Prospective cohort study with Cox regression model</td><td headers="hd_h_niceng217er2.tab4_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Temperature</p>
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<p>Unprovoked seizures</p>
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</td><td headers="hd_h_niceng217er2.tab4_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Age</p>
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<p>Family history</p>
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<p>Duration of fever</p>
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<p>Temperature</p>
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<p>Unprovoked seizure</p>
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</td><td headers="hd_h_niceng217er2.tab4_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Second seizure</td><td headers="hd_h_niceng217er2.tab4_1_1_1_7" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td></tr><tr><td headers="hd_h_niceng217er2.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Cheung 2015<a class="bibr" href="#niceng217er2.ref12" rid="niceng217er2.ref12"><sup>12</sup></a></td><td headers="hd_h_niceng217er2.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>N=650</p>
|
|
<p>All children aged below 6 years presented with seizure attended A&E who required admissions to paediatric ward were included.</p>
|
|
</td><td headers="hd_h_niceng217er2.tab4_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Retrospective cohort analysis with binomial logistic regression</td><td headers="hd_h_niceng217er2.tab4_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Temperature in A&E (≥38oC)</td><td headers="hd_h_niceng217er2.tab4_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Pre-hospital seizure duration between 5-15 minutes</p>
|
|
<p>Pre-hospital seizure duration more than 15 minutes</p>
|
|
<p>History of prematurity</p>
|
|
<p>History of epilepsy</p>
|
|
<p>Fever in A&E (≥38oC)</p>
|
|
<p>Paracetamol taken within 4 hours on A&E arrival</p>
|
|
<p>History of brain insult</p>
|
|
</td><td headers="hd_h_niceng217er2.tab4_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Second Seizure</td><td headers="hd_h_niceng217er2.tab4_1_1_1_7" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td></tr><tr><td headers="hd_h_niceng217er2.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Kumar 2019<a class="bibr" href="#niceng217er2.ref33" rid="niceng217er2.ref33"><sup>33</sup></a></td><td headers="hd_h_niceng217er2.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>N=528</p>
|
|
<p>Children between 6 months and 5 years, presenting with seizure accompanied by fever, that is, a core body temperature (rectal temperature) of 100.4°F or 38°C, without central nervous system infection</p>
|
|
</td><td headers="hd_h_niceng217er2.tab4_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Prospective cohort study with multiple logistic regression</td><td headers="hd_h_niceng217er2.tab4_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Temperature (during seizure) per °F</td><td headers="hd_h_niceng217er2.tab4_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Gender</p>
|
|
<p>Age at first seizure</p>
|
|
<p>Temperature</p>
|
|
<p>Duration of fever</p>
|
|
<p>Family history of febrile seizures</p>
|
|
<p>Family history of epilepsy</p>
|
|
</td><td headers="hd_h_niceng217er2.tab4_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Second Seizure</td><td headers="hd_h_niceng217er2.tab4_1_1_1_7" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">The outcome was compared to those without recurrent febrile seizures</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobniceng217er2tab5"><div id="niceng217er2.tab5" class="table"><h3><span class="label">Table 5</span><span class="title">Clinical evidence summary: Lifetime generalized anxiety disorder</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK581141/table/niceng217er2.tab5/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng217er2.tab5_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng217er2.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Outcomes</th><th id="hd_h_niceng217er2.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">
|
|
<p>No of Participants</p>
|
|
<p>(studies)</p>
|
|
<p>Follow up</p>
|
|
</th><th id="hd_h_niceng217er2.tab5_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">
|
|
<p>Quality of the evidence</p>
|
|
<p>(GRADE)</p>
|
|
</th><th id="hd_h_niceng217er2.tab5_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">
|
|
<p>Relative effect</p>
|
|
<p>(95% CI)</p>
|
|
</th></tr></thead><tbody><tr><td headers="hd_h_niceng217er2.tab5_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">Second Seizure</td><td headers="hd_h_niceng217er2.tab5_1_1_1_2 hd_h_niceng217er2.tab5_1_1_1_3 hd_h_niceng217er2.tab5_1_1_1_4" colspan="3" rowspan="1" style="text-align:left;vertical-align:top;">No lifetime generalized anxiety disorder as reference</td></tr><tr><td headers="hd_h_niceng217er2.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>52</p>
|
|
<p>(1 study)</p>
|
|
<p>1-5 years</p>
|
|
</td><td headers="hd_h_niceng217er2.tab5_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>⊕⊝⊝⊝</p>
|
|
<p>VERY LOW<sup>1</sup><sup>,</sup><sup>2</sup><sup>,</sup><sup>3</sup><sup>,</sup><sup>4</sup></p>
|
|
<p>due to risk of bias, indirectness, imprecision</p>
|
|
</td><td headers="hd_h_niceng217er2.tab5_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>HR 2.48</p>
|
|
<p>(0.8 to 7.69)</p>
|
|
</td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt>1</dt><dd><div id="niceng217er2.tab5_1"><p class="no_margin">Downgraded by 1 increment if the majority of the evidence was at high risk of bias, and downgraded by 2 increments if the majority of the evidence was at very high risk of bias</p></div></dd></dl><dl class="bkr_refwrap"><dt>2</dt><dd><div id="niceng217er2.tab5_2"><p class="no_margin">Downgraded for indirectness as analysis did not adjust for at least two of the modifiable confounders</p></div></dd></dl><dl class="bkr_refwrap"><dt>3</dt><dd><div id="niceng217er2.tab5_3"><p class="no_margin">Downgraded by 1 increment if the confidence interval crossed the null line</p></div></dd></dl><dl class="bkr_refwrap"><dt>4</dt><dd><div id="niceng217er2.tab5_4"><p class="no_margin">Adjusted for age, gender, lifetime generalized anxiety disorder and lifetime mood disorder</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng217er2tab6"><div id="niceng217er2.tab6" class="table"><h3><span class="label">Table 6</span><span class="title">Clinical evidence summary: Lifetime mood disorder</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK581141/table/niceng217er2.tab6/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng217er2.tab6_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng217er2.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Outcomes</th><th id="hd_h_niceng217er2.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">
|
|
<p>No of Participants</p>
|
|
<p>(studies)</p>
|
|
<p>Follow up</p>
|
|
</th><th id="hd_h_niceng217er2.tab6_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">
|
|
<p>Quality of the evidence</p>
|
|
<p>(GRADE)</p>
|
|
</th><th id="hd_h_niceng217er2.tab6_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">
|
|
<p>Relative effect</p>
|
|
<p>(95% CI)</p>
|
|
</th></tr></thead><tbody><tr><td headers="hd_h_niceng217er2.tab6_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">Second Seizure</td><td headers="hd_h_niceng217er2.tab6_1_1_1_2 hd_h_niceng217er2.tab6_1_1_1_3 hd_h_niceng217er2.tab6_1_1_1_4" colspan="3" rowspan="1" style="text-align:left;vertical-align:top;">No lifetime mood disorder as reference</td></tr><tr><td headers="hd_h_niceng217er2.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>52</p>
|
|
<p>(1 study)</p>
|
|
<p>1-5 years</p>
|
|
</td><td headers="hd_h_niceng217er2.tab6_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>⊕⊝⊝⊝</p>
|
|
<p>VERY LOW<sup>1</sup><sup>,</sup><sup>2</sup><sup>,</sup><sup>3</sup><sup>,</sup><sup>4</sup></p>
|
|
<p>due to risk of bias, indirectness, imprecision</p>
|
|
</td><td headers="hd_h_niceng217er2.tab6_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>HR 1.90</p>
|
|
<p>(0.8 to 4.51)</p>
|
|
</td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt>1</dt><dd><div id="niceng217er2.tab6_1"><p class="no_margin">Downgraded by 1 increment if the majority of the evidence was at high risk of bias, and downgraded by 2 increments if the majority of the evidence was at very high risk of bias</p></div></dd></dl><dl class="bkr_refwrap"><dt>2</dt><dd><div id="niceng217er2.tab6_2"><p class="no_margin">Downgraded for indirectness as analysis did not adjust for at least two of the modifiable confounders</p></div></dd></dl><dl class="bkr_refwrap"><dt>3</dt><dd><div id="niceng217er2.tab6_3"><p class="no_margin">Downgraded by 1 increment if the confidence interval crossed the null line</p></div></dd></dl><dl class="bkr_refwrap"><dt>4</dt><dd><div id="niceng217er2.tab6_4"><p class="no_margin">Adjusted for age, gender, lifetime generalized anxiety disorder and lifetime mood disorder</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng217er2tab7"><div id="niceng217er2.tab7" class="table"><h3><span class="label">Table 7</span><span class="title">Clinical evidence summary: Psychiatric Disorders</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK581141/table/niceng217er2.tab7/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng217er2.tab7_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng217er2.tab7_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Outcomes</th><th id="hd_h_niceng217er2.tab7_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">
|
|
<p>No of Participants</p>
|
|
<p>(studies)</p>
|
|
<p>Follow up</p>
|
|
</th><th id="hd_h_niceng217er2.tab7_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">
|
|
<p>Quality of the evidence</p>
|
|
<p>(GRADE)</p>
|
|
</th><th id="hd_h_niceng217er2.tab7_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">
|
|
<p>Relative effect</p>
|
|
<p>(95% CI)</p>
|
|
</th></tr></thead><tbody><tr><td headers="hd_h_niceng217er2.tab7_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">Second Seizure</td><td headers="hd_h_niceng217er2.tab7_1_1_1_2 hd_h_niceng217er2.tab7_1_1_1_3 hd_h_niceng217er2.tab7_1_1_1_4" colspan="3" rowspan="1" style="text-align:left;vertical-align:top;">No psychiatric disorders as reference</td></tr><tr><td headers="hd_h_niceng217er2.tab7_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>109</p>
|
|
<p>(1 study)</p>
|
|
<p>1-5 years</p>
|
|
</td><td headers="hd_h_niceng217er2.tab7_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>⊕⊕⊝⊝</p>
|
|
<p>LOW<sup>1</sup><sup>,</sup><sup>2</sup></p>
|
|
<p>due to risk of bias</p>
|
|
</td><td headers="hd_h_niceng217er2.tab7_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>OR 2.88</p>
|
|
<p>(1.07 to 7.75)</p>
|
|
</td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt>1</dt><dd><div id="niceng217er2.tab7_1"><p class="no_margin">Downgraded by 1 increment if the majority of the evidence was at high risk of bias, and downgraded by 2 increments if the majority of the evidence was at very high risk of bias</p></div></dd></dl><dl class="bkr_refwrap"><dt>2</dt><dd><div id="niceng217er2.tab7_2"><p class="no_margin">Adjusted for multiple comorbidities, neurological disorders and clinical disorders</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng217er2tab8"><div id="niceng217er2.tab8" class="table"><h3><span class="label">Table 8</span><span class="title">Clinical evidence summary: Sepsis</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK581141/table/niceng217er2.tab8/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng217er2.tab8_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng217er2.tab8_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Outcomes</th><th id="hd_h_niceng217er2.tab8_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">
|
|
<p>No of Participants</p>
|
|
<p>(studies)</p>
|
|
<p>Follow up</p>
|
|
</th><th id="hd_h_niceng217er2.tab8_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">
|
|
<p>Quality of the evidence</p>
|
|
<p>(GRADE)</p>
|
|
</th><th id="hd_h_niceng217er2.tab8_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">
|
|
<p>Relative effect</p>
|
|
<p>(95% CI)</p>
|
|
</th></tr></thead><tbody><tr><td headers="hd_h_niceng217er2.tab8_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">Second Seizure</td><td headers="hd_h_niceng217er2.tab8_1_1_1_2 hd_h_niceng217er2.tab8_1_1_1_3 hd_h_niceng217er2.tab8_1_1_1_4" colspan="3" rowspan="1" style="text-align:left;vertical-align:top;">No sepsis as reference</td></tr><tr><td headers="hd_h_niceng217er2.tab8_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>109</p>
|
|
<p>(1 study)</p>
|
|
<p>1-5 years</p>
|
|
</td><td headers="hd_h_niceng217er2.tab8_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>⊕⊕⊝⊝</p>
|
|
<p>LOW<sup>1</sup><sup>,</sup><sup>2</sup></p>
|
|
<p>due to risk of bias</p>
|
|
</td><td headers="hd_h_niceng217er2.tab8_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>OR 4.52</p>
|
|
<p>(1.42 to 14.39)</p>
|
|
</td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt>1</dt><dd><div id="niceng217er2.tab8_1"><p class="no_margin">Downgraded by 1 increment if the majority of the evidence was at high risk of bias, and downgraded by 2 increments if the majority of the evidence was at very high risk of bias</p></div></dd></dl><dl class="bkr_refwrap"><dt>2</dt><dd><div id="niceng217er2.tab8_2"><p class="no_margin">Adjusted for multiple comorbidities, neurological disorders and clinical disorders</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng217er2tab9"><div id="niceng217er2.tab9" class="table"><h3><span class="label">Table 9</span><span class="title">Clinical evidence summary: Partial seizures</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK581141/table/niceng217er2.tab9/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng217er2.tab9_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng217er2.tab9_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Outcomes</th><th id="hd_h_niceng217er2.tab9_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">
|
|
<p>No of Participants</p>
|
|
<p>(studies)</p>
|
|
<p>Follow up</p>
|
|
</th><th id="hd_h_niceng217er2.tab9_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">
|
|
<p>Quality of the evidence</p>
|
|
<p>(GRADE)</p>
|
|
</th><th id="hd_h_niceng217er2.tab9_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">
|
|
<p>Relative effect</p>
|
|
<p>(95% CI)</p>
|
|
</th></tr></thead><tbody><tr><td headers="hd_h_niceng217er2.tab9_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">Second Seizure</td><td headers="hd_h_niceng217er2.tab9_1_1_1_2 hd_h_niceng217er2.tab9_1_1_1_3 hd_h_niceng217er2.tab9_1_1_1_4" colspan="3" rowspan="1" style="text-align:left;vertical-align:top;">No partial seizures as reference</td></tr><tr><td headers="hd_h_niceng217er2.tab9_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>124</p>
|
|
<p>(1 study)</p>
|
|
<p>>5 years</p>
|
|
</td><td headers="hd_h_niceng217er2.tab9_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>⊕⊕⊝⊝</p>
|
|
<p>LOW<sup>1</sup><sup>,</sup><sup>2</sup><sup>,</sup><sup>3</sup></p>
|
|
<p>due to indirectness, imprecision</p>
|
|
</td><td headers="hd_h_niceng217er2.tab9_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>OR 4.62</p>
|
|
<p>(0.55 to 39.08)</p>
|
|
</td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt>1</dt><dd><div id="niceng217er2.tab9_1"><p class="no_margin">Downgraded for indirectness as analysis did not adjust for at least two of the modifiable confounders</p></div></dd></dl><dl class="bkr_refwrap"><dt>2</dt><dd><div id="niceng217er2.tab9_2"><p class="no_margin">Downgraded by 1 increment if the confidence interval crossed the null line</p></div></dd></dl><dl class="bkr_refwrap"><dt>3</dt><dd><div id="niceng217er2.tab9_3"><p class="no_margin">Adjusted for age, male gender, diabetes mellitus, hypertension, atrial fibrillation, lesion size, cortical involvement, haemorrhagic transformation, functional disability, status epilepticus, relevant EEG findings, partial seizure type</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng217er2tab10"><div id="niceng217er2.tab10" class="table"><h3><span class="label">Table 10</span><span class="title">Clinical evidence summary: Status Epilepticus</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK581141/table/niceng217er2.tab10/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng217er2.tab10_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng217er2.tab10_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Outcomes</th><th id="hd_h_niceng217er2.tab10_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">
|
|
<p>No of Participants</p>
|
|
<p>(studies)</p>
|
|
<p>Follow up</p>
|
|
</th><th id="hd_h_niceng217er2.tab10_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">
|
|
<p>Quality of the evidence</p>
|
|
<p>(GRADE)</p>
|
|
</th><th id="hd_h_niceng217er2.tab10_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">
|
|
<p>Relative effect</p>
|
|
<p>(95% CI)</p>
|
|
</th></tr></thead><tbody><tr><td headers="hd_h_niceng217er2.tab10_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">Second Seizure</td><td headers="hd_h_niceng217er2.tab10_1_1_1_2 hd_h_niceng217er2.tab10_1_1_1_3 hd_h_niceng217er2.tab10_1_1_1_4" colspan="3" rowspan="1" style="text-align:left;vertical-align:top;">No status epilepticus as reference</td></tr><tr><td headers="hd_h_niceng217er2.tab10_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>124</p>
|
|
<p>(1 study)</p>
|
|
<p>>5 years</p>
|
|
</td><td headers="hd_h_niceng217er2.tab10_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>⊕⊕⊝⊝</p>
|
|
<p>LOW<sup>1</sup><sup>,</sup><sup>2</sup><sup>,</sup><sup>3</sup></p>
|
|
<p>due to indirectness, imprecision</p>
|
|
</td><td headers="hd_h_niceng217er2.tab10_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>OR 1.08</p>
|
|
<p>(0.15 to 7.68)</p>
|
|
</td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt>1</dt><dd><div id="niceng217er2.tab10_1"><p class="no_margin">Downgraded for indirectness as analysis did not adjust for at least two of the modifiable confounders</p></div></dd></dl><dl class="bkr_refwrap"><dt>2</dt><dd><div id="niceng217er2.tab10_2"><p class="no_margin">Downgraded by 1 increment if the confidence interval crossed the null line</p></div></dd></dl><dl class="bkr_refwrap"><dt>3</dt><dd><div id="niceng217er2.tab10_3"><p class="no_margin">Adjusted for age, male gender, diabetes mellitus, hypertension, atrial fibrillation, lesion size, cortical involvement, haemorrhagic transformation, functional disability, status epilepticus, relevant EEG findings, partial seizure type</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng217er2tab11"><div id="niceng217er2.tab11" class="table"><h3><span class="label">Table 11</span><span class="title">Clinical evidence summary: Diabetes Mellitus</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK581141/table/niceng217er2.tab11/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng217er2.tab11_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng217er2.tab11_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Outcomes</th><th id="hd_h_niceng217er2.tab11_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">
|
|
<p>No of Participants</p>
|
|
<p>(studies)</p>
|
|
<p>Follow up</p>
|
|
</th><th id="hd_h_niceng217er2.tab11_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">
|
|
<p>Quality of the evidence</p>
|
|
<p>(GRADE)</p>
|
|
</th><th id="hd_h_niceng217er2.tab11_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">
|
|
<p>Relative effect</p>
|
|
<p>(95% CI)</p>
|
|
</th></tr></thead><tbody><tr><td headers="hd_h_niceng217er2.tab11_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">Second Seizure</td><td headers="hd_h_niceng217er2.tab11_1_1_1_2 hd_h_niceng217er2.tab11_1_1_1_3 hd_h_niceng217er2.tab11_1_1_1_4" colspan="3" rowspan="1" style="text-align:left;vertical-align:top;">No diabetes mellitus as reference</td></tr><tr><td headers="hd_h_niceng217er2.tab11_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>116,608</p>
|
|
<p>(1 study)</p>
|
|
<p>>5 years</p>
|
|
</td><td headers="hd_h_niceng217er2.tab11_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>⊕⊕⊝⊝</p>
|
|
<p>LOW<sup>1</sup><sup>,</sup><sup>2</sup><sup>,</sup><sup>3</sup></p>
|
|
<p>due to indirectness, imprecision</p>
|
|
</td><td headers="hd_h_niceng217er2.tab11_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>OR 0.35</p>
|
|
<p>(0.04 to 3.15)</p>
|
|
</td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt>1</dt><dd><div id="niceng217er2.tab11_1"><p class="no_margin">Downgraded for indirectness as analysis did not adjust for at least two of the modifiable confounders</p></div></dd></dl><dl class="bkr_refwrap"><dt>2</dt><dd><div id="niceng217er2.tab11_2"><p class="no_margin">Downgraded by 1 increment if the confidence interval crossed the null line</p></div></dd></dl><dl class="bkr_refwrap"><dt>3</dt><dd><div id="niceng217er2.tab11_3"><p class="no_margin">Adjusted for age, male gender, diabetes mellitus, hypertension, atrial fibrillation, lesion size, cortical involvement, haemorrhagic transformation, functional disability, status epilepticus, relevant EEG findings, partial seizure type</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng217er2tab12"><div id="niceng217er2.tab12" class="table"><h3><span class="label">Table 12</span><span class="title">Clinical evidence summary: Hypertension</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK581141/table/niceng217er2.tab12/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng217er2.tab12_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng217er2.tab12_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Outcomes</th><th id="hd_h_niceng217er2.tab12_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">
|
|
<p>No of Participants</p>
|
|
<p>(studies)</p>
|
|
<p>Follow up</p>
|
|
</th><th id="hd_h_niceng217er2.tab12_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">
|
|
<p>Quality of the evidence</p>
|
|
<p>(GRADE)</p>
|
|
</th><th id="hd_h_niceng217er2.tab12_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">
|
|
<p>Relative effect</p>
|
|
<p>(95% CI)</p>
|
|
</th></tr></thead><tbody><tr><td headers="hd_h_niceng217er2.tab12_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">Second Seizure</td><td headers="hd_h_niceng217er2.tab12_1_1_1_2 hd_h_niceng217er2.tab12_1_1_1_3 hd_h_niceng217er2.tab12_1_1_1_4" colspan="3" rowspan="1" style="text-align:left;vertical-align:top;">No hypertension as reference</td></tr><tr><td headers="hd_h_niceng217er2.tab12_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>124</p>
|
|
<p>(1 study)</p>
|
|
<p>>5 years</p>
|
|
</td><td headers="hd_h_niceng217er2.tab12_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>⊕⊕⊝⊝</p>
|
|
<p>LOW<sup>1</sup><sup>,</sup><sup>2</sup><sup>,</sup><sup>3</sup></p>
|
|
<p>due to indirectness, imprecision</p>
|
|
</td><td headers="hd_h_niceng217er2.tab12_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>OR 0.35</p>
|
|
<p>(0.04 to 3.2)</p>
|
|
</td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt>1</dt><dd><div id="niceng217er2.tab12_1"><p class="no_margin">Downgraded for indirectness as analysis did not adjust for at least two of the modifiable confounders</p></div></dd></dl><dl class="bkr_refwrap"><dt>2</dt><dd><div id="niceng217er2.tab12_2"><p class="no_margin">Downgraded by 1 increment if the confidence interval crossed the null line</p></div></dd></dl><dl class="bkr_refwrap"><dt>3</dt><dd><div id="niceng217er2.tab12_3"><p class="no_margin">Adjusted for age, male gender, diabetes mellitus, hypertension, atrial fibrillation, lesion size, cortical involvement, haemorrhagic transformation, functional disability, status epilepticus, relevant EEG findings, partial seizure type</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng217er2tab13"><div id="niceng217er2.tab13" class="table"><h3><span class="label">Table 13</span><span class="title">Clinical evidence summary: Atrial Fibrillation</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK581141/table/niceng217er2.tab13/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng217er2.tab13_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng217er2.tab13_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Outcomes</th><th id="hd_h_niceng217er2.tab13_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">
|
|
<p>No of Participants</p>
|
|
<p>(studies)</p>
|
|
<p>Follow up</p>
|
|
</th><th id="hd_h_niceng217er2.tab13_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">
|
|
<p>Quality of the evidence</p>
|
|
<p>(GRADE)</p>
|
|
</th><th id="hd_h_niceng217er2.tab13_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">
|
|
<p>Relative effect</p>
|
|
<p>(95% CI)</p>
|
|
</th></tr></thead><tbody><tr><td headers="hd_h_niceng217er2.tab13_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">Second Seizure</td><td headers="hd_h_niceng217er2.tab13_1_1_1_2 hd_h_niceng217er2.tab13_1_1_1_3 hd_h_niceng217er2.tab13_1_1_1_4" colspan="3" rowspan="1" style="text-align:left;vertical-align:top;">No atrial fibrillation as reference</td></tr><tr><td headers="hd_h_niceng217er2.tab13_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>124</p>
|
|
<p>(1 study)</p>
|
|
<p>>5 years</p>
|
|
</td><td headers="hd_h_niceng217er2.tab13_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>⊕⊕⊝⊝</p>
|
|
<p>LOW<sup>1</sup><sup>,</sup><sup>2</sup><sup>,</sup><sup>3</sup></p>
|
|
<p>due to indirectness, imprecision</p>
|
|
</td><td headers="hd_h_niceng217er2.tab13_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>OR 10.45</p>
|
|
<p>(0.61 to 179.37)</p>
|
|
</td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt>1</dt><dd><div id="niceng217er2.tab13_1"><p class="no_margin">Downgraded for indirectness as analysis did not adjust for at least two of the modifiable confounders</p></div></dd></dl><dl class="bkr_refwrap"><dt>2</dt><dd><div id="niceng217er2.tab13_2"><p class="no_margin">Downgraded by 1 increment if the confidence interval crossed the null line</p></div></dd></dl><dl class="bkr_refwrap"><dt>3</dt><dd><div id="niceng217er2.tab13_3"><p class="no_margin">Adjusted for age, male gender, diabetes mellitus, hypertension, atrial fibrillation, lesion size, cortical involvement, haemorrhagic transformation, functional disability, status epilepticus, relevant EEG findings, partial seizure type</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng217er2tab14"><div id="niceng217er2.tab14" class="table"><h3><span class="label">Table 14</span><span class="title">Clinical evidence summary: Functional disability – severe</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK581141/table/niceng217er2.tab14/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng217er2.tab14_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng217er2.tab14_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Outcomes</th><th id="hd_h_niceng217er2.tab14_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">
|
|
<p>No of Participants</p>
|
|
<p>(studies)</p>
|
|
<p>Follow up</p>
|
|
</th><th id="hd_h_niceng217er2.tab14_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">
|
|
<p>Quality of the evidence</p>
|
|
<p>(GRADE)</p>
|
|
</th><th id="hd_h_niceng217er2.tab14_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">
|
|
<p>Relative effect</p>
|
|
<p>(95% CI)</p>
|
|
</th></tr></thead><tbody><tr><td headers="hd_h_niceng217er2.tab14_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">Second Seizure</td><td headers="hd_h_niceng217er2.tab14_1_1_1_2 hd_h_niceng217er2.tab14_1_1_1_3 hd_h_niceng217er2.tab14_1_1_1_4" colspan="3" rowspan="1" style="text-align:left;vertical-align:top;">No functional disability as reference</td></tr><tr><td headers="hd_h_niceng217er2.tab14_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>124</p>
|
|
<p>(1 study)</p>
|
|
<p>>5 years</p>
|
|
</td><td headers="hd_h_niceng217er2.tab14_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>⊕⊕⊝⊝</p>
|
|
<p>LOW<sup>1</sup><sup>,</sup><sup>2</sup><sup>,</sup><sup>3</sup></p>
|
|
<p>due to indirectness, imprecision</p>
|
|
</td><td headers="hd_h_niceng217er2.tab14_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>OR 3.52</p>
|
|
<p>(0.35 to 35.44)</p>
|
|
</td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt>1</dt><dd><div id="niceng217er2.tab14_1"><p class="no_margin">Downgraded for indirectness as analysis did not adjust for at least two of the modifiable confounders</p></div></dd></dl><dl class="bkr_refwrap"><dt>2</dt><dd><div id="niceng217er2.tab14_2"><p class="no_margin">Downgraded by 1 increment if the confidence interval crossed the null line</p></div></dd></dl><dl class="bkr_refwrap"><dt>3</dt><dd><div id="niceng217er2.tab14_3"><p class="no_margin">Adjusted for age, male gender, diabetes mellitus, hypertension, atrial fibrillation, lesion size, cortical involvement, haemorrhagic transformation, functional disability, status epilepticus, relevant EEG findings, partial seizure type</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng217er2tab15"><div id="niceng217er2.tab15" class="table"><h3><span class="label">Table 15</span><span class="title">Clinical evidence summary: Functional disability – moderate</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK581141/table/niceng217er2.tab15/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng217er2.tab15_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng217er2.tab15_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Outcomes</th><th id="hd_h_niceng217er2.tab15_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">
|
|
<p>No of Participants</p>
|
|
<p>(studies)</p>
|
|
<p>Follow up</p>
|
|
</th><th id="hd_h_niceng217er2.tab15_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">
|
|
<p>Quality of the evidence</p>
|
|
<p>(GRADE)</p>
|
|
</th><th id="hd_h_niceng217er2.tab15_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">
|
|
<p>Relative effect</p>
|
|
<p>(95% CI)</p>
|
|
</th></tr></thead><tbody><tr><td headers="hd_h_niceng217er2.tab15_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">Second Seizure</td><td headers="hd_h_niceng217er2.tab15_1_1_1_2 hd_h_niceng217er2.tab15_1_1_1_3 hd_h_niceng217er2.tab15_1_1_1_4" colspan="3" rowspan="1" style="text-align:left;vertical-align:top;">No functional disability as reference</td></tr><tr><td headers="hd_h_niceng217er2.tab15_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>124</p>
|
|
<p>(1 study)</p>
|
|
<p>>5 years</p>
|
|
</td><td headers="hd_h_niceng217er2.tab15_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>⊕⊕⊝⊝</p>
|
|
<p>LOW<sup>1</sup><sup>,</sup><sup>2</sup><sup>,</sup><sup>3</sup></p>
|
|
<p>due to indirectness, imprecision</p>
|
|
</td><td headers="hd_h_niceng217er2.tab15_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>OR 0.39</p>
|
|
<p>(0.01 to 9.93)</p>
|
|
</td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt>1</dt><dd><div id="niceng217er2.tab15_1"><p class="no_margin">Downgraded for indirectness as analysis did not adjust for at least two of the modifiable confounders</p></div></dd></dl><dl class="bkr_refwrap"><dt>2</dt><dd><div id="niceng217er2.tab15_2"><p class="no_margin">Downgraded by 1 increment if the confidence interval crossed the null line</p></div></dd></dl><dl class="bkr_refwrap"><dt>3</dt><dd><div id="niceng217er2.tab15_3"><p class="no_margin">Adjusted for age, male gender, diabetes mellitus, hypertension, atrial fibrillation, lesion size, cortical involvement, haemorrhagic transformation, functional disability, status epilepticus, relevant EEG findings, partial seizure type</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng217er2tab16"><div id="niceng217er2.tab16" class="table"><h3><span class="label">Table 16</span><span class="title">Clinical evidence summary: Unprovoked Seizures</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK581141/table/niceng217er2.tab16/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng217er2.tab16_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng217er2.tab16_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Outcomes</th><th id="hd_h_niceng217er2.tab16_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">
|
|
<p>No of Participants</p>
|
|
<p>(studies)</p>
|
|
<p>Follow up</p>
|
|
</th><th id="hd_h_niceng217er2.tab16_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">
|
|
<p>Quality of the evidence</p>
|
|
<p>(GRADE)</p>
|
|
</th><th id="hd_h_niceng217er2.tab16_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">
|
|
<p>Relative effect</p>
|
|
<p>(95% CI)</p>
|
|
</th></tr></thead><tbody><tr><td headers="hd_h_niceng217er2.tab16_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">Second Seizure</td><td headers="hd_h_niceng217er2.tab16_1_1_1_2 hd_h_niceng217er2.tab16_1_1_1_3 hd_h_niceng217er2.tab16_1_1_1_4" colspan="3" rowspan="1" style="text-align:left;vertical-align:top;">No unprovoked seizures as reference</td></tr><tr><td headers="hd_h_niceng217er2.tab16_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>428</p>
|
|
<p>(1 study)</p>
|
|
<p>1 - 5 years</p>
|
|
</td><td headers="hd_h_niceng217er2.tab16_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>⊕⊝⊝⊝</p>
|
|
<p>VERY LOW<sup>1</sup><sup>,</sup><sup>2</sup><sup>,</sup><sup>3</sup></p>
|
|
<p>due to risk of bias, indirectness</p>
|
|
</td><td headers="hd_h_niceng217er2.tab16_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>RR 3.47</p>
|
|
<p>(1.61 to 7.48)</p>
|
|
</td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt>1</dt><dd><div id="niceng217er2.tab16_1"><p class="no_margin">Downgraded by 1 increment if the majority of the evidence was at high risk of bias, and downgraded by 2 increments if the majority of the evidence was at very high risk of bias</p></div></dd></dl><dl class="bkr_refwrap"><dt>2</dt><dd><div id="niceng217er2.tab16_2"><p class="no_margin">Downgraded for indirectness as analysis did not adjust for at least two of the modifiable confounders</p></div></dd></dl><dl class="bkr_refwrap"><dt>3</dt><dd><div id="niceng217er2.tab16_3"><p class="no_margin">Adjusted for age, family history of epilepsy, duration of fever, temperature, unprovoked seizure</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng217er2tab17"><div id="niceng217er2.tab17" class="table"><h3><span class="label">Table 17</span><span class="title">Clinical evidence summary: Temperature ≥38 degrees</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK581141/table/niceng217er2.tab17/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng217er2.tab17_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng217er2.tab17_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Outcomes</th><th id="hd_h_niceng217er2.tab17_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">
|
|
<p>No of Participants</p>
|
|
<p>(studies)</p>
|
|
<p>Follow up</p>
|
|
</th><th id="hd_h_niceng217er2.tab17_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">
|
|
<p>Quality of the evidence</p>
|
|
<p>(GRADE)</p>
|
|
</th><th id="hd_h_niceng217er2.tab17_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">
|
|
<p>Relative effect</p>
|
|
<p>(95% CI)</p>
|
|
</th></tr></thead><tbody><tr><td headers="hd_h_niceng217er2.tab17_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">Second Seizure</td><td headers="hd_h_niceng217er2.tab17_1_1_1_2 hd_h_niceng217er2.tab17_1_1_1_3 hd_h_niceng217er2.tab17_1_1_1_4" colspan="3" rowspan="1" style="text-align:left;vertical-align:top;">Temperature <38 degrees as reference</td></tr><tr><td headers="hd_h_niceng217er2.tab17_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>650</p>
|
|
<p>(1 study)</p>
|
|
<p>1 - 5 years</p>
|
|
</td><td headers="hd_h_niceng217er2.tab17_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
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<p>⊕⊕⊝⊝</p>
|
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<p>LOW<sup>1</sup><sup>,</sup><sup>2</sup><sup>,</sup><sup>3</sup></p>
|
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<p>due to risk of bias, indirectness</p>
|
|
</td><td headers="hd_h_niceng217er2.tab17_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>OR 2.07</p>
|
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<p>(1.07 to 4.01)</p>
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|
</td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt>1</dt><dd><div id="niceng217er2.tab17_1"><p class="no_margin">Downgraded by 1 increment if the majority of the evidence was at high risk of bias, and downgraded by 2 increments if the majority of the evidence was at very high risk of bias</p></div></dd></dl><dl class="bkr_refwrap"><dt>2</dt><dd><div id="niceng217er2.tab17_2"><p class="no_margin">Downgraded for indirectness as analysis did not adjust for at least two of the modifiable confounders</p></div></dd></dl><dl class="bkr_refwrap"><dt>3</dt><dd><div id="niceng217er2.tab17_3"><p class="no_margin">Adjusted for pre-hospital seizure duration between 5 – 15 minutes and more than 15 minutes, history of prematurity, history of epilepsy, fever in A&E(≥38°C), paracetamol taken within 4 hours on A&E arrival, history of brain insult</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng217er2tab18"><div id="niceng217er2.tab18" class="table"><h3><span class="label">Table 18</span><span class="title">Clinical evidence summary: Temperature (per F increase)</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK581141/table/niceng217er2.tab18/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng217er2.tab18_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng217er2.tab18_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Outcomes</th><th id="hd_h_niceng217er2.tab18_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">
|
|
<p>No of Participants</p>
|
|
<p>(studies)</p>
|
|
<p>Follow up</p>
|
|
</th><th id="hd_h_niceng217er2.tab18_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">
|
|
<p>Quality of the evidence</p>
|
|
<p>(GRADE)</p>
|
|
</th><th id="hd_h_niceng217er2.tab18_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">
|
|
<p>Relative effect</p>
|
|
<p>(95% CI)</p>
|
|
</th></tr></thead><tbody><tr><td headers="hd_h_niceng217er2.tab18_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">Second Seizure</td><td headers="hd_h_niceng217er2.tab18_1_1_1_2 hd_h_niceng217er2.tab18_1_1_1_3 hd_h_niceng217er2.tab18_1_1_1_4" colspan="3" rowspan="1" style="text-align:left;vertical-align:top;">Higher temperature compared to lower temperature increase</td></tr><tr><td headers="hd_h_niceng217er2.tab18_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>650</p>
|
|
<p>(1 study)</p>
|
|
<p>1 - 5 years</p>
|
|
</td><td headers="hd_h_niceng217er2.tab18_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>⊕⊝⊝⊝</p>
|
|
<p>VERY LOW<sup>1</sup><sup>,</sup><sup>2</sup><sup>,</sup><sup>3</sup></p>
|
|
<p>due to risk of bias, indirectness</p>
|
|
</td><td headers="hd_h_niceng217er2.tab18_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>RR 0.79</p>
|
|
<p>(0.68 to 0.92)</p>
|
|
</td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt>1</dt><dd><div id="niceng217er2.tab18_1"><p class="no_margin">Downgraded by 1 increment if the majority of the evidence was at high risk of bias, and downgraded by 2 increments if the majority of the evidence was at very high risk of bias</p></div></dd></dl><dl class="bkr_refwrap"><dt>2</dt><dd><div id="niceng217er2.tab18_2"><p class="no_margin">Downgraded for indirectness as analysis did not adjust for at least two of the modifiable confounders</p></div></dd></dl><dl class="bkr_refwrap"><dt>3</dt><dd><div id="niceng217er2.tab18_3"><p class="no_margin">Adjusted for age, family history of epilepsy, duration of fever, temperature, unprovoked seizure</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng217er2tab19"><div id="niceng217er2.tab19" class="table"><h3><span class="label">Table 19</span><span class="title">Clinical evidence summary: Temperature (per F increase)</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK581141/table/niceng217er2.tab19/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng217er2.tab19_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng217er2.tab19_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Outcomes</th><th id="hd_h_niceng217er2.tab19_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">
|
|
<p>No of Participants</p>
|
|
<p>(studies)</p>
|
|
<p>Follow up</p>
|
|
</th><th id="hd_h_niceng217er2.tab19_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">
|
|
<p>Quality of the evidence</p>
|
|
<p>(GRADE)</p>
|
|
</th><th id="hd_h_niceng217er2.tab19_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">
|
|
<p>Relative effect</p>
|
|
<p>(95% CI)</p>
|
|
</th></tr></thead><tbody><tr><td headers="hd_h_niceng217er2.tab19_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">Second Seizure</td><td headers="hd_h_niceng217er2.tab19_1_1_1_2 hd_h_niceng217er2.tab19_1_1_1_3 hd_h_niceng217er2.tab19_1_1_1_4" colspan="3" rowspan="1" style="text-align:left;vertical-align:top;">Higher temperature compared to lower temperature increase</td></tr><tr><td headers="hd_h_niceng217er2.tab19_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>528</p>
|
|
<p>(1 study)</p>
|
|
<p>1 - 5 years</p>
|
|
</td><td headers="hd_h_niceng217er2.tab19_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>⊕⊕⊝⊝</p>
|
|
<p>LOW<sup>1</sup><sup>,</sup><sup>2</sup><sup>,</sup><sup>3</sup></p>
|
|
<p>due to risk of bias, indirectness</p>
|
|
</td><td headers="hd_h_niceng217er2.tab19_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>OR 0.34</p>
|
|
<p>(0.15 to 0.77)</p>
|
|
</td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt>1</dt><dd><div id="niceng217er2.tab19_1"><p class="no_margin">Downgraded by 1 increment if the majority of the evidence was at high risk of bias, and downgraded by 2 increments if the majority of the evidence was at very high risk of bias</p></div></dd></dl><dl class="bkr_refwrap"><dt>2</dt><dd><div id="niceng217er2.tab19_2"><p class="no_margin">Downgraded for indirectness as analysis did not adjust for at least two of the modifiable confounders</p></div></dd></dl><dl class="bkr_refwrap"><dt>3</dt><dd><div id="niceng217er2.tab19_3"><p class="no_margin">Adjusted for age at first seizure, gender, temperature, duration of fever, family history of febrile seizures, family history of epilepsy</p></div></dd></dl></dl></div></div></div></article></div><div id="jr-scripts"><script src="/corehtml/pmc/jatsreader/ptpmc_3.22/js/libs.min.js"> </script><script src="/corehtml/pmc/jatsreader/ptpmc_3.22/js/jr.min.js"> </script></div></div>
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