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stroke-linecap="round" style="fill:#FFF" d="m320,350a153,153 0 1,0-2,2l170,170m-91-117 110,110-26,26-110-110"></path></svg></a><a id="jr-fip-done" class="wsprkl btn" title="Dismiss find">✘</a></nav><nav id="jr-fip-info-p"><a id="jr-fip-prev" class="wsprkl btn" title="Jump to previuos match">◀</a><button id="jr-fip-matches">no matches yet</button><a id="jr-fip-next" class="wsprkl btn" title="Jump to next match">▶</a></nav></nav></div><div id="jr-epub-interstitial" class="hidden"></div><div id="jr-content"><article data-type="main"><div class="main-content lit-style"><div class="fm-sec bkr_bottom_sep"><div class="bkr_thumb"><a href="https://www.nice.org.uk" title="National Institute for Health and Care Excellence (NICE)" class="img_link icnblk_img" ref="pagearea=logo&targetsite=external&targetcat=link&targettype=publisher"><img class="source-thumb" src="/corehtml/pmc/pmcgifs/bookshelf/thumbs/th-niceng217er18-lrg.png" alt="Cover of Evidence review: Modifiable risk factors for epilepsy related mortality" /></a></div><div class="bkr_bib"><h1 id="_NBK586315_"><span itemprop="name">Evidence review: Modifiable risk factors for epilepsy related mortality</span></h1><div class="subtitle">Epilepsies in children, young people and adults: diagnosis and management</div><p><b>Evidence review 18</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="niceng217er18.s1"><h2 id="_niceng217er18_s1_">1. Modifiable risk factors for epilepsy-related mortality, including SUDEP, and the magnitude of risk of those factors</h2><div id="niceng217er18.s1.1"><h3>1.1. Review question</h3><p>What are the modifiable risk factors for epilepsy-related mortality, including SUDEP, and what is the magnitude of risk of the factors?</p><div id="niceng217er18.s1.1.1"><h4>1.1.1. Introduction</h4><p>Epilepsy is associated with a number of risks, including a risk of injury, including head injury, and mortality in the form of drowning and accidents. One significant cause of epilepsy-related mortality is Sudden Unexpected Death in Epilepsy (SUDEP). Overall, the rate of SUDEP is around 1 in 1000 people with epilepsy per year.</p><p>This review examines modifiable risk factors for epilepsy-related mortality, including SUDEP, to inform the approach to the management of seizures and the provision of information to people with epilepsy, their families and carers.</p></div><div id="niceng217er18.s1.1.2"><h4>1.1.2. Summary of the protocol</h4><p>For full details see the review protocol in <a href="#niceng217er18.appa">Appendix A</a>.</p><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng217er18tab1"><a href="/books/NBK586315/table/niceng217er18.tab1/?report=objectonly" target="object" title="Table 1" class="img_link icnblk_img figpopup" rid-figpopup="figniceng217er18tab1" rid-ob="figobniceng217er18tab1"><img class="small-thumb" src="/books/NBK586315/table/niceng217er18.tab1/?report=thumb" src-large="/books/NBK586315/table/niceng217er18.tab1/?report=previmg" alt="Table 1. PICO characteristics of review question." /></a><div class="icnblk_cntnt"><h4 id="niceng217er18.tab1"><a href="/books/NBK586315/table/niceng217er18.tab1/?report=objectonly" target="object" rid-ob="figobniceng217er18tab1">Table 1</a></h4><p class="float-caption no_bottom_margin">PICO characteristics of review question. </p></div></div></div><div id="niceng217er18.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="#niceng217er18.appa">appendix A</a> and the <a href="/books/NBK586315/bin/niceng217er18_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="niceng217er18.s1.1.4"><h4>1.1.4. Prognostic evidence</h4><div id="niceng217er18.s1.1.4.1"><h5>1.1.4.1. Included studies</h5><p>Four cohort<a class="bibr" href="#niceng217er18.ref7" rid="niceng217er18.ref7"><sup>7</sup></a><sup>,</sup>
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<a class="bibr" href="#niceng217er18.ref10" rid="niceng217er18.ref10"><sup>10</sup></a><sup>,</sup>
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<a class="bibr" href="#niceng217er18.ref22" rid="niceng217er18.ref22"><sup>22</sup></a><sup>,</sup>
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<a class="bibr" href="#niceng217er18.ref30" rid="niceng217er18.ref30"><sup>30</sup></a> studies and seven case-control<a class="bibr" href="#niceng217er18.ref15" rid="niceng217er18.ref15"><sup>15</sup></a><sup>,</sup>
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<a class="bibr" href="#niceng217er18.ref23" rid="niceng217er18.ref23"><sup>23</sup></a><sup>,</sup>
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<a class="bibr" href="#niceng217er18.ref26" rid="niceng217er18.ref26"><sup>26</sup></a><sup>,</sup>
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<a class="bibr" href="#niceng217er18.ref35" rid="niceng217er18.ref35"><sup>35</sup></a><sup>,</sup>
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<a class="bibr" href="#niceng217er18.ref36" rid="niceng217er18.ref36"><sup>36</sup></a><sup>,</sup>
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<a class="bibr" href="#niceng217er18.ref39" rid="niceng217er18.ref39"><sup>39</sup></a><sup>,</sup>
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<a class="bibr" href="#niceng217er18.ref40" rid="niceng217er18.ref40"><sup>40</sup></a> studies assessing the modifiable risk factors for epilepsy-related mortality (including SUDEP) were included within the review.</p><p>The following modifiable risk factors were investigated, but not limited to:
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<ul><li class="half_rhythm"><div>Sleeping unsupervised / living alone</div></li><li class="half_rhythm"><div>Prone sleeping position</div></li><li class="half_rhythm"><div>Uncontrolled/frequent Generalised Tonic Clonic Seizures (GTCS)</div></li><li class="half_rhythm"><div>Nocturnal GTCS</div></li><li class="half_rhythm"><div>Substance abuse/alcohol dependence</div></li><li class="half_rhythm"><div>Anti-seizure medication (ASM) polytherapy</div></li><li class="half_rhythm"><div>Other drug polytherapy</div></li><li class="half_rhythm"><div>Insufficient ASM therapy/any changes in prescription of drugs that could increase seizure rate</div></li><li class="half_rhythm"><div>Sleep deprivation / irregular sleep</div></li></ul></p><p>Within the eleven studies included within the review, the risk factors considered were: different seizure types; comorbidities; seizure frequency; anti-seizure medications; changes to medications; substance abuse/alcohol dependence and psychosocial factors (education, living conditions and supervision).</p><p>Of the studies included, one<a class="bibr" href="#niceng217er18.ref39" rid="niceng217er18.ref39"><sup>39</sup></a> study looked at adults followed up over one to five years; three<a class="bibr" href="#niceng217er18.ref10" rid="niceng217er18.ref10"><sup>10</sup></a><sup>,</sup>
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<a class="bibr" href="#niceng217er18.ref26" rid="niceng217er18.ref26"><sup>26</sup></a><sup>,</sup>
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<a class="bibr" href="#niceng217er18.ref30" rid="niceng217er18.ref30"><sup>30</sup></a> studies assessed adults who were followed up for longer than five years; one<a class="bibr" href="#niceng217er18.ref22" rid="niceng217er18.ref22"><sup>22</sup></a> study investigated children who were followed up for over five years; one<a class="bibr" href="#niceng217er18.ref7" rid="niceng217er18.ref7"><sup>7</sup></a> study which looked at a mixed population of children and adults followed up between one to five years and five<a class="bibr" href="#niceng217er18.ref15" rid="niceng217er18.ref15"><sup>15</sup></a><sup>,</sup>
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<a class="bibr" href="#niceng217er18.ref22" rid="niceng217er18.ref22"><sup>22</sup></a><sup>,</sup>
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<a class="bibr" href="#niceng217er18.ref35" rid="niceng217er18.ref35"><sup>35</sup></a><sup>,</sup>
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<a class="bibr" href="#niceng217er18.ref36" rid="niceng217er18.ref36"><sup>36</sup></a><sup>,</sup>
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<a class="bibr" href="#niceng217er18.ref40" rid="niceng217er18.ref40"><sup>40</sup></a> studies with a mixed population who followed up the participants for over five years.</p><p>See also the study selection flow chart in <a href="#niceng217er18.appa">Appendix A</a>, study evidence tables in <a href="#niceng217er18.appd">Appendix D</a>, forest plots in <a href="#niceng217er18.appe">Appendix E</a> and GRADE tables in <a href="#niceng217er18.appf">Appendix F</a>.</p></div><div id="niceng217er18.s1.1.4.2"><h5>1.1.4.2. Excluded studies</h5><p>See the excluded studies list in <a href="#niceng217er18.appj">Appendix J</a>.</p></div></div><div id="niceng217er18.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="figniceng217er18tab2"><a href="/books/NBK586315/table/niceng217er18.tab2/?report=objectonly" target="object" title="Table 2" class="img_link icnblk_img figpopup" rid-figpopup="figniceng217er18tab2" rid-ob="figobniceng217er18tab2"><img class="small-thumb" src="/books/NBK586315/table/niceng217er18.tab2/?report=thumb" src-large="/books/NBK586315/table/niceng217er18.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="niceng217er18.tab2"><a href="/books/NBK586315/table/niceng217er18.tab2/?report=objectonly" target="object" rid-ob="figobniceng217er18tab2">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="figniceng217er18tab3"><a href="/books/NBK586315/table/niceng217er18.tab3/?report=objectonly" target="object" title="Table 3" class="img_link icnblk_img figpopup" rid-figpopup="figniceng217er18tab3" rid-ob="figobniceng217er18tab3"><img class="small-thumb" src="/books/NBK586315/table/niceng217er18.tab3/?report=thumb" src-large="/books/NBK586315/table/niceng217er18.tab3/?report=previmg" alt="Table 3. Summary of studies included in the evidence review - Adults >18 years (follow up >5 years)." /></a><div class="icnblk_cntnt"><h4 id="niceng217er18.tab3"><a href="/books/NBK586315/table/niceng217er18.tab3/?report=objectonly" target="object" rid-ob="figobniceng217er18tab3">Table 3</a></h4><p class="float-caption no_bottom_margin">Summary of studies included in the evidence review - Adults >18 years (follow up >5 years). </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng217er18tab4"><a href="/books/NBK586315/table/niceng217er18.tab4/?report=objectonly" target="object" title="Table 4" class="img_link icnblk_img figpopup" rid-figpopup="figniceng217er18tab4" rid-ob="figobniceng217er18tab4"><img class="small-thumb" src="/books/NBK586315/table/niceng217er18.tab4/?report=thumb" src-large="/books/NBK586315/table/niceng217er18.tab4/?report=previmg" alt="Table 4. Summary of studies included in the evidence review – Children <18 years (follow up > 5 years)." /></a><div class="icnblk_cntnt"><h4 id="niceng217er18.tab4"><a href="/books/NBK586315/table/niceng217er18.tab4/?report=objectonly" target="object" rid-ob="figobniceng217er18tab4">Table 4</a></h4><p class="float-caption no_bottom_margin">Summary of studies included in the evidence review – Children <18 years (follow up > 5 years). </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng217er18tab5"><a href="/books/NBK586315/table/niceng217er18.tab5/?report=objectonly" target="object" title="Table 5" class="img_link icnblk_img figpopup" rid-figpopup="figniceng217er18tab5" rid-ob="figobniceng217er18tab5"><img class="small-thumb" src="/books/NBK586315/table/niceng217er18.tab5/?report=thumb" src-large="/books/NBK586315/table/niceng217er18.tab5/?report=previmg" alt="Table 5. Summary of studies included in the evidence review - mixed population of children <18 years and adults >18 years (follow up 1 - 5 years)." /></a><div class="icnblk_cntnt"><h4 id="niceng217er18.tab5"><a href="/books/NBK586315/table/niceng217er18.tab5/?report=objectonly" target="object" rid-ob="figobniceng217er18tab5">Table 5</a></h4><p class="float-caption no_bottom_margin">Summary of studies included in the evidence review - mixed population of children <18 years and adults >18 years (follow up 1 - 5 years). </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng217er18tab6"><a href="/books/NBK586315/table/niceng217er18.tab6/?report=objectonly" target="object" title="Table 6" class="img_link icnblk_img figpopup" rid-figpopup="figniceng217er18tab6" rid-ob="figobniceng217er18tab6"><img class="small-thumb" src="/books/NBK586315/table/niceng217er18.tab6/?report=thumb" src-large="/books/NBK586315/table/niceng217er18.tab6/?report=previmg" alt="Table 6. Summary of studies included in the evidence review - mixed population of children <18 years and adults >18 years (follow up >5 years)." /></a><div class="icnblk_cntnt"><h4 id="niceng217er18.tab6"><a href="/books/NBK586315/table/niceng217er18.tab6/?report=objectonly" target="object" rid-ob="figobniceng217er18tab6">Table 6</a></h4><p class="float-caption no_bottom_margin">Summary of studies included in the evidence review - mixed population of children <18 years and adults >18 years (follow up >5 years). </p></div></div></div><div id="niceng217er18.s1.1.6"><h4>1.1.6. Summary of the prognostic evidence – Adults >18 years (follow up 1 – 5 years)</h4><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng217er18tab7"><a href="/books/NBK586315/table/niceng217er18.tab7/?report=objectonly" target="object" title="Table 7" class="img_link icnblk_img figpopup" rid-figpopup="figniceng217er18tab7" rid-ob="figobniceng217er18tab7"><img class="small-thumb" src="/books/NBK586315/table/niceng217er18.tab7/?report=thumb" src-large="/books/NBK586315/table/niceng217er18.tab7/?report=previmg" alt="Table 7. Clinical evidence summary: one to five seizures per month." /></a><div class="icnblk_cntnt"><h4 id="niceng217er18.tab7"><a href="/books/NBK586315/table/niceng217er18.tab7/?report=objectonly" target="object" rid-ob="figobniceng217er18tab7">Table 7</a></h4><p class="float-caption no_bottom_margin">Clinical evidence summary: one to five seizures per month. </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng217er18tab8"><a href="/books/NBK586315/table/niceng217er18.tab8/?report=objectonly" target="object" title="Table 8" class="img_link icnblk_img figpopup" rid-figpopup="figniceng217er18tab8" rid-ob="figobniceng217er18tab8"><img class="small-thumb" src="/books/NBK586315/table/niceng217er18.tab8/?report=thumb" src-large="/books/NBK586315/table/niceng217er18.tab8/?report=previmg" alt="Table 8. Clinical evidence summary: Over five seizures per month." /></a><div class="icnblk_cntnt"><h4 id="niceng217er18.tab8"><a href="/books/NBK586315/table/niceng217er18.tab8/?report=objectonly" target="object" rid-ob="figobniceng217er18tab8">Table 8</a></h4><p class="float-caption no_bottom_margin">Clinical evidence summary: Over five seizures per month. </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng217er18tab9"><a href="/books/NBK586315/table/niceng217er18.tab9/?report=objectonly" target="object" title="Table 9" class="img_link icnblk_img figpopup" rid-figpopup="figniceng217er18tab9" rid-ob="figobniceng217er18tab9"><img class="small-thumb" src="/books/NBK586315/table/niceng217er18.tab9/?report=thumb" src-large="/books/NBK586315/table/niceng217er18.tab9/?report=previmg" alt="Table 9. Clinical evidence summary: One to three tonic-clonic seizures per year." /></a><div class="icnblk_cntnt"><h4 id="niceng217er18.tab9"><a href="/books/NBK586315/table/niceng217er18.tab9/?report=objectonly" target="object" rid-ob="figobniceng217er18tab9">Table 9</a></h4><p class="float-caption no_bottom_margin">Clinical evidence summary: One to three tonic-clonic seizures per year. </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng217er18tab10"><a href="/books/NBK586315/table/niceng217er18.tab10/?report=objectonly" target="object" title="Table 10" class="img_link icnblk_img figpopup" rid-figpopup="figniceng217er18tab10" rid-ob="figobniceng217er18tab10"><img class="small-thumb" src="/books/NBK586315/table/niceng217er18.tab10/?report=thumb" src-large="/books/NBK586315/table/niceng217er18.tab10/?report=previmg" alt="Table 10. Clinical evidence summary: Over three tonic-clonic seizures per year." /></a><div class="icnblk_cntnt"><h4 id="niceng217er18.tab10"><a href="/books/NBK586315/table/niceng217er18.tab10/?report=objectonly" target="object" rid-ob="figobniceng217er18tab10">Table 10</a></h4><p class="float-caption no_bottom_margin">Clinical evidence summary: Over three tonic-clonic seizures per year. </p></div></div></div><div id="niceng217er18.s1.1.7"><h4>1.1.7. Summary of the prognostic evidence – Adults >18 years (follow up > 5 years)</h4><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng217er18tab11"><a href="/books/NBK586315/table/niceng217er18.tab11/?report=objectonly" target="object" title="Table 11" class="img_link icnblk_img figpopup" rid-figpopup="figniceng217er18tab11" rid-ob="figobniceng217er18tab11"><img class="small-thumb" src="/books/NBK586315/table/niceng217er18.tab11/?report=thumb" src-large="/books/NBK586315/table/niceng217er18.tab11/?report=previmg" alt="Table 11. Clinical evidence summary: Seizure frequency." /></a><div class="icnblk_cntnt"><h4 id="niceng217er18.tab11"><a href="/books/NBK586315/table/niceng217er18.tab11/?report=objectonly" target="object" rid-ob="figobniceng217er18tab11">Table 11</a></h4><p class="float-caption no_bottom_margin">Clinical evidence summary: Seizure frequency. </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng217er18tab12"><a href="/books/NBK586315/table/niceng217er18.tab12/?report=objectonly" target="object" title="Table 12" class="img_link icnblk_img figpopup" rid-figpopup="figniceng217er18tab12" rid-ob="figobniceng217er18tab12"><img class="small-thumb" src="/books/NBK586315/table/niceng217er18.tab12/?report=thumb" src-large="/books/NBK586315/table/niceng217er18.tab12/?report=previmg" alt="Table 12. Clinical evidence summary: Number of anti-seizure medications." /></a><div class="icnblk_cntnt"><h4 id="niceng217er18.tab12"><a href="/books/NBK586315/table/niceng217er18.tab12/?report=objectonly" target="object" rid-ob="figobniceng217er18tab12">Table 12</a></h4><p class="float-caption no_bottom_margin">Clinical evidence summary: Number of anti-seizure medications. </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng217er18tab13"><a href="/books/NBK586315/table/niceng217er18.tab13/?report=objectonly" target="object" title="Table 13" class="img_link icnblk_img figpopup" rid-figpopup="figniceng217er18tab13" rid-ob="figobniceng217er18tab13"><img class="small-thumb" src="/books/NBK586315/table/niceng217er18.tab13/?report=thumb" src-large="/books/NBK586315/table/niceng217er18.tab13/?report=previmg" alt="Table 13. Clinical evidence summary: Adherence status: Nonadherence of medications." /></a><div class="icnblk_cntnt"><h4 id="niceng217er18.tab13"><a href="/books/NBK586315/table/niceng217er18.tab13/?report=objectonly" target="object" rid-ob="figobniceng217er18tab13">Table 13</a></h4><p class="float-caption no_bottom_margin">Clinical evidence summary: Adherence status: Nonadherence of medications. </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng217er18tab14"><a href="/books/NBK586315/table/niceng217er18.tab14/?report=objectonly" target="object" title="Table 14" class="img_link icnblk_img figpopup" rid-figpopup="figniceng217er18tab14" rid-ob="figobniceng217er18tab14"><img class="small-thumb" src="/books/NBK586315/table/niceng217er18.tab14/?report=thumb" src-large="/books/NBK586315/table/niceng217er18.tab14/?report=previmg" alt="Table 14. Clinical evidence summary: Adherence status: Untreated Epilepsy." /></a><div class="icnblk_cntnt"><h4 id="niceng217er18.tab14"><a href="/books/NBK586315/table/niceng217er18.tab14/?report=objectonly" target="object" rid-ob="figobniceng217er18tab14">Table 14</a></h4><p class="float-caption no_bottom_margin">Clinical evidence summary: Adherence status: Untreated Epilepsy. </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng217er18tab15"><a href="/books/NBK586315/table/niceng217er18.tab15/?report=objectonly" target="object" title="Table 15" class="img_link icnblk_img figpopup" rid-figpopup="figniceng217er18tab15" rid-ob="figobniceng217er18tab15"><img class="small-thumb" src="/books/NBK586315/table/niceng217er18.tab15/?report=thumb" src-large="/books/NBK586315/table/niceng217er18.tab15/?report=previmg" alt="Table 15. Clinical evidence summary: Polytherapy." /></a><div class="icnblk_cntnt"><h4 id="niceng217er18.tab15"><a href="/books/NBK586315/table/niceng217er18.tab15/?report=objectonly" target="object" rid-ob="figobniceng217er18tab15">Table 15</a></h4><p class="float-caption no_bottom_margin">Clinical evidence summary: Polytherapy. </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng217er18tab16"><a href="/books/NBK586315/table/niceng217er18.tab16/?report=objectonly" target="object" title="Table 16" class="img_link icnblk_img figpopup" rid-figpopup="figniceng217er18tab16" rid-ob="figobniceng217er18tab16"><img class="small-thumb" src="/books/NBK586315/table/niceng217er18.tab16/?report=thumb" src-large="/books/NBK586315/table/niceng217er18.tab16/?report=previmg" alt="Table 16. Clinical evidence summary: Alzheimer’s Disease." /></a><div class="icnblk_cntnt"><h4 id="niceng217er18.tab16"><a href="/books/NBK586315/table/niceng217er18.tab16/?report=objectonly" target="object" rid-ob="figobniceng217er18tab16">Table 16</a></h4><p class="float-caption no_bottom_margin">Clinical evidence summary: Alzheimer’s Disease. </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng217er18tab17"><a href="/books/NBK586315/table/niceng217er18.tab17/?report=objectonly" target="object" title="Table 17" class="img_link icnblk_img figpopup" rid-figpopup="figniceng217er18tab17" rid-ob="figobniceng217er18tab17"><img class="small-thumb" src="/books/NBK586315/table/niceng217er18.tab17/?report=thumb" src-large="/books/NBK586315/table/niceng217er18.tab17/?report=previmg" alt="Table 17. Clinical evidence summary: Brain tumour." /></a><div class="icnblk_cntnt"><h4 id="niceng217er18.tab17"><a href="/books/NBK586315/table/niceng217er18.tab17/?report=objectonly" target="object" rid-ob="figobniceng217er18tab17">Table 17</a></h4><p class="float-caption no_bottom_margin">Clinical evidence summary: Brain tumour. </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng217er18tab18"><a href="/books/NBK586315/table/niceng217er18.tab18/?report=objectonly" target="object" title="Table 18" class="img_link icnblk_img figpopup" rid-figpopup="figniceng217er18tab18" rid-ob="figobniceng217er18tab18"><img class="small-thumb" src="/books/NBK586315/table/niceng217er18.tab18/?report=thumb" src-large="/books/NBK586315/table/niceng217er18.tab18/?report=previmg" alt="Table 18. Clinical evidence summary: Meningitis." /></a><div class="icnblk_cntnt"><h4 id="niceng217er18.tab18"><a href="/books/NBK586315/table/niceng217er18.tab18/?report=objectonly" target="object" rid-ob="figobniceng217er18tab18">Table 18</a></h4><p class="float-caption no_bottom_margin">Clinical evidence summary: Meningitis. </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng217er18tab19"><a href="/books/NBK586315/table/niceng217er18.tab19/?report=objectonly" target="object" title="Table 19" class="img_link icnblk_img figpopup" rid-figpopup="figniceng217er18tab19" rid-ob="figobniceng217er18tab19"><img class="small-thumb" src="/books/NBK586315/table/niceng217er18.tab19/?report=thumb" src-large="/books/NBK586315/table/niceng217er18.tab19/?report=previmg" alt="Table 19. Clinical evidence summary: Stroke." /></a><div class="icnblk_cntnt"><h4 id="niceng217er18.tab19"><a href="/books/NBK586315/table/niceng217er18.tab19/?report=objectonly" target="object" rid-ob="figobniceng217er18tab19">Table 19</a></h4><p class="float-caption no_bottom_margin">Clinical evidence summary: Stroke. </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng217er18tab20"><a href="/books/NBK586315/table/niceng217er18.tab20/?report=objectonly" target="object" title="Table 20" class="img_link icnblk_img figpopup" rid-figpopup="figniceng217er18tab20" rid-ob="figobniceng217er18tab20"><img class="small-thumb" src="/books/NBK586315/table/niceng217er18.tab20/?report=thumb" src-large="/books/NBK586315/table/niceng217er18.tab20/?report=previmg" alt="Table 20. Clinical evidence summary: Charlson Comorbidity Index." /></a><div class="icnblk_cntnt"><h4 id="niceng217er18.tab20"><a href="/books/NBK586315/table/niceng217er18.tab20/?report=objectonly" target="object" rid-ob="figobniceng217er18tab20">Table 20</a></h4><p class="float-caption no_bottom_margin">Clinical evidence summary: Charlson Comorbidity Index. </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng217er18tab21"><a href="/books/NBK586315/table/niceng217er18.tab21/?report=objectonly" target="object" title="Table 21" class="img_link icnblk_img figpopup" rid-figpopup="figniceng217er18tab21" rid-ob="figobniceng217er18tab21"><img class="small-thumb" src="/books/NBK586315/table/niceng217er18.tab21/?report=thumb" src-large="/books/NBK586315/table/niceng217er18.tab21/?report=previmg" alt="Table 21. Clinical evidence summary: CNS infections." /></a><div class="icnblk_cntnt"><h4 id="niceng217er18.tab21"><a href="/books/NBK586315/table/niceng217er18.tab21/?report=objectonly" target="object" rid-ob="figobniceng217er18tab21">Table 21</a></h4><p class="float-caption no_bottom_margin">Clinical evidence summary: CNS infections. </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng217er18tab22"><a href="/books/NBK586315/table/niceng217er18.tab22/?report=objectonly" target="object" title="Table 22" class="img_link icnblk_img figpopup" rid-figpopup="figniceng217er18tab22" rid-ob="figobniceng217er18tab22"><img class="small-thumb" src="/books/NBK586315/table/niceng217er18.tab22/?report=thumb" src-large="/books/NBK586315/table/niceng217er18.tab22/?report=previmg" alt="Table 22. Clinical evidence summary: Metastatic Cancer." /></a><div class="icnblk_cntnt"><h4 id="niceng217er18.tab22"><a href="/books/NBK586315/table/niceng217er18.tab22/?report=objectonly" target="object" rid-ob="figobniceng217er18tab22">Table 22</a></h4><p class="float-caption no_bottom_margin">Clinical evidence summary: Metastatic Cancer. </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng217er18tab23"><a href="/books/NBK586315/table/niceng217er18.tab23/?report=objectonly" target="object" title="Table 23" class="img_link icnblk_img figpopup" rid-figpopup="figniceng217er18tab23" rid-ob="figobniceng217er18tab23"><img class="small-thumb" src="/books/NBK586315/table/niceng217er18.tab23/?report=thumb" src-large="/books/NBK586315/table/niceng217er18.tab23/?report=previmg" alt="Table 23. Clinical evidence summary: Solid Tumour (no metastasis)." /></a><div class="icnblk_cntnt"><h4 id="niceng217er18.tab23"><a href="/books/NBK586315/table/niceng217er18.tab23/?report=objectonly" target="object" rid-ob="figobniceng217er18tab23">Table 23</a></h4><p class="float-caption no_bottom_margin">Clinical evidence summary: Solid Tumour (no metastasis). </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng217er18tab24"><a href="/books/NBK586315/table/niceng217er18.tab24/?report=objectonly" target="object" title="Table 24" class="img_link icnblk_img figpopup" rid-figpopup="figniceng217er18tab24" rid-ob="figobniceng217er18tab24"><img class="small-thumb" src="/books/NBK586315/table/niceng217er18.tab24/?report=thumb" src-large="/books/NBK586315/table/niceng217er18.tab24/?report=previmg" alt="Table 24. Clinical evidence summary: Depression." /></a><div class="icnblk_cntnt"><h4 id="niceng217er18.tab24"><a href="/books/NBK586315/table/niceng217er18.tab24/?report=objectonly" target="object" rid-ob="figobniceng217er18tab24">Table 24</a></h4><p class="float-caption no_bottom_margin">Clinical evidence summary: Depression. </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng217er18tab25"><a href="/books/NBK586315/table/niceng217er18.tab25/?report=objectonly" target="object" title="Table 25" class="img_link icnblk_img figpopup" rid-figpopup="figniceng217er18tab25" rid-ob="figobniceng217er18tab25"><img class="small-thumb" src="/books/NBK586315/table/niceng217er18.tab25/?report=thumb" src-large="/books/NBK586315/table/niceng217er18.tab25/?report=previmg" alt="Table 25. Clinical evidence summary: Diabetes (no complications)." /></a><div class="icnblk_cntnt"><h4 id="niceng217er18.tab25"><a href="/books/NBK586315/table/niceng217er18.tab25/?report=objectonly" target="object" rid-ob="figobniceng217er18tab25">Table 25</a></h4><p class="float-caption no_bottom_margin">Clinical evidence summary: Diabetes (no complications). </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng217er18tab26"><a href="/books/NBK586315/table/niceng217er18.tab26/?report=objectonly" target="object" title="Table 26" class="img_link icnblk_img figpopup" rid-figpopup="figniceng217er18tab26" rid-ob="figobniceng217er18tab26"><img class="small-thumb" src="/books/NBK586315/table/niceng217er18.tab26/?report=thumb" src-large="/books/NBK586315/table/niceng217er18.tab26/?report=previmg" alt="Table 26. Clinical evidence summary: Peripheral vascular disease." /></a><div class="icnblk_cntnt"><h4 id="niceng217er18.tab26"><a href="/books/NBK586315/table/niceng217er18.tab26/?report=objectonly" target="object" rid-ob="figobniceng217er18tab26">Table 26</a></h4><p class="float-caption no_bottom_margin">Clinical evidence summary: Peripheral vascular disease. </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng217er18tab27"><a href="/books/NBK586315/table/niceng217er18.tab27/?report=objectonly" target="object" title="Table 27" class="img_link icnblk_img figpopup" rid-figpopup="figniceng217er18tab27" rid-ob="figobniceng217er18tab27"><img class="small-thumb" src="/books/NBK586315/table/niceng217er18.tab27/?report=thumb" src-large="/books/NBK586315/table/niceng217er18.tab27/?report=previmg" alt="Table 27. Clinical evidence summary: Traumatic brain and head injury." /></a><div class="icnblk_cntnt"><h4 id="niceng217er18.tab27"><a href="/books/NBK586315/table/niceng217er18.tab27/?report=objectonly" target="object" rid-ob="figobniceng217er18tab27">Table 27</a></h4><p class="float-caption no_bottom_margin">Clinical evidence summary: Traumatic brain and head injury. </p></div></div></div><div id="niceng217er18.s1.1.8"><h4>1.1.8. Summary of the prognostic evidence – Children <18 years (follow up > 5 years)</h4><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng217er18tab28"><a href="/books/NBK586315/table/niceng217er18.tab28/?report=objectonly" target="object" title="Table 28" class="img_link icnblk_img figpopup" rid-figpopup="figniceng217er18tab28" rid-ob="figobniceng217er18tab28"><img class="small-thumb" src="/books/NBK586315/table/niceng217er18.tab28/?report=thumb" src-large="/books/NBK586315/table/niceng217er18.tab28/?report=previmg" alt="Table 28. Clinical evidence summary: Abnormal neurological examination." /></a><div class="icnblk_cntnt"><h4 id="niceng217er18.tab28"><a href="/books/NBK586315/table/niceng217er18.tab28/?report=objectonly" target="object" rid-ob="figobniceng217er18tab28">Table 28</a></h4><p class="float-caption no_bottom_margin">Clinical evidence summary: Abnormal neurological examination. </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng217er18tab29"><a href="/books/NBK586315/table/niceng217er18.tab29/?report=objectonly" target="object" title="Table 29" class="img_link icnblk_img figpopup" rid-figpopup="figniceng217er18tab29" rid-ob="figobniceng217er18tab29"><img class="small-thumb" src="/books/NBK586315/table/niceng217er18.tab29/?report=thumb" src-large="/books/NBK586315/table/niceng217er18.tab29/?report=previmg" alt="Table 29. Clinical evidence summary: Abnormal cognitive function." /></a><div class="icnblk_cntnt"><h4 id="niceng217er18.tab29"><a href="/books/NBK586315/table/niceng217er18.tab29/?report=objectonly" target="object" rid-ob="figobniceng217er18tab29">Table 29</a></h4><p class="float-caption no_bottom_margin">Clinical evidence summary: Abnormal cognitive function. </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng217er18tab30"><a href="/books/NBK586315/table/niceng217er18.tab30/?report=objectonly" target="object" title="Table 30" class="img_link icnblk_img figpopup" rid-figpopup="figniceng217er18tab30" rid-ob="figobniceng217er18tab30"><img class="small-thumb" src="/books/NBK586315/table/niceng217er18.tab30/?report=thumb" src-large="/books/NBK586315/table/niceng217er18.tab30/?report=previmg" alt="Table 30. Clinical evidence summary: Status Epilepticus (ever)." /></a><div class="icnblk_cntnt"><h4 id="niceng217er18.tab30"><a href="/books/NBK586315/table/niceng217er18.tab30/?report=objectonly" target="object" rid-ob="figobniceng217er18tab30">Table 30</a></h4><p class="float-caption no_bottom_margin">Clinical evidence summary: Status Epilepticus (ever). </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng217er18tab31"><a href="/books/NBK586315/table/niceng217er18.tab31/?report=objectonly" target="object" title="Table 31" class="img_link icnblk_img figpopup" rid-figpopup="figniceng217er18tab31" rid-ob="figobniceng217er18tab31"><img class="small-thumb" src="/books/NBK586315/table/niceng217er18.tab31/?report=thumb" src-large="/books/NBK586315/table/niceng217er18.tab31/?report=previmg" alt="Table 31. Clinical evidence summary: Metabolic / Structural Aetiology." /></a><div class="icnblk_cntnt"><h4 id="niceng217er18.tab31"><a href="/books/NBK586315/table/niceng217er18.tab31/?report=objectonly" target="object" rid-ob="figobniceng217er18tab31">Table 31</a></h4><p class="float-caption no_bottom_margin">Clinical evidence summary: Metabolic / Structural Aetiology. </p></div></div></div><div id="niceng217er18.s1.1.9"><h4>1.1.9. Summary of the prognostic evidence – Mixed population of children <18 years and adults >18 years (follow up 1 – 5 years)</h4><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng217er18tab32"><a href="/books/NBK586315/table/niceng217er18.tab32/?report=objectonly" target="object" title="Table 32" class="img_link icnblk_img figpopup" rid-figpopup="figniceng217er18tab32" rid-ob="figobniceng217er18tab32"><img class="small-thumb" src="/books/NBK586315/table/niceng217er18.tab32/?report=thumb" src-large="/books/NBK586315/table/niceng217er18.tab32/?report=previmg" alt="Table 32. Clinical evidence summary: Tumour aetiology." /></a><div class="icnblk_cntnt"><h4 id="niceng217er18.tab32"><a href="/books/NBK586315/table/niceng217er18.tab32/?report=objectonly" target="object" rid-ob="figobniceng217er18tab32">Table 32</a></h4><p class="float-caption no_bottom_margin">Clinical evidence summary: Tumour aetiology. </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng217er18tab33"><a href="/books/NBK586315/table/niceng217er18.tab33/?report=objectonly" target="object" title="Table 33" class="img_link icnblk_img figpopup" rid-figpopup="figniceng217er18tab33" rid-ob="figobniceng217er18tab33"><img class="small-thumb" src="/books/NBK586315/table/niceng217er18.tab33/?report=thumb" src-large="/books/NBK586315/table/niceng217er18.tab33/?report=previmg" alt="Table 33. Clinical evidence summary: Vascular lesion aetiology." /></a><div class="icnblk_cntnt"><h4 id="niceng217er18.tab33"><a href="/books/NBK586315/table/niceng217er18.tab33/?report=objectonly" target="object" rid-ob="figobniceng217er18tab33">Table 33</a></h4><p class="float-caption no_bottom_margin">Clinical evidence summary: Vascular lesion aetiology. </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng217er18tab34"><a href="/books/NBK586315/table/niceng217er18.tab34/?report=objectonly" target="object" title="Table 34" class="img_link icnblk_img figpopup" rid-figpopup="figniceng217er18tab34" rid-ob="figobniceng217er18tab34"><img class="small-thumb" src="/books/NBK586315/table/niceng217er18.tab34/?report=thumb" src-large="/books/NBK586315/table/niceng217er18.tab34/?report=previmg" alt="Table 34. Clinical evidence summary: Trauma aetiology." /></a><div class="icnblk_cntnt"><h4 id="niceng217er18.tab34"><a href="/books/NBK586315/table/niceng217er18.tab34/?report=objectonly" target="object" rid-ob="figobniceng217er18tab34">Table 34</a></h4><p class="float-caption no_bottom_margin">Clinical evidence summary: Trauma aetiology. </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng217er18tab35"><a href="/books/NBK586315/table/niceng217er18.tab35/?report=objectonly" target="object" title="Table 35" class="img_link icnblk_img figpopup" rid-figpopup="figniceng217er18tab35" rid-ob="figobniceng217er18tab35"><img class="small-thumb" src="/books/NBK586315/table/niceng217er18.tab35/?report=thumb" src-large="/books/NBK586315/table/niceng217er18.tab35/?report=previmg" alt="Table 35. Clinical evidence summary: Infection aetiology." /></a><div class="icnblk_cntnt"><h4 id="niceng217er18.tab35"><a href="/books/NBK586315/table/niceng217er18.tab35/?report=objectonly" target="object" rid-ob="figobniceng217er18tab35">Table 35</a></h4><p class="float-caption no_bottom_margin">Clinical evidence summary: Infection aetiology. </p></div></div></div><div id="niceng217er18.s1.1.10"><h4>1.1.10. Summary of the prognostic evidence – Mixed population of children <18 years and adults >18 years (follow up >5 years)</h4><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng217er18tab36"><a href="/books/NBK586315/table/niceng217er18.tab36/?report=objectonly" target="object" title="Table 36" class="img_link icnblk_img figpopup" rid-figpopup="figniceng217er18tab36" rid-ob="figobniceng217er18tab36"><img class="small-thumb" src="/books/NBK586315/table/niceng217er18.tab36/?report=thumb" src-large="/books/NBK586315/table/niceng217er18.tab36/?report=previmg" alt="Table 36. Clinical evidence summary: Seizure frequency - >10 seizures per year (at baseline)." /></a><div class="icnblk_cntnt"><h4 id="niceng217er18.tab36"><a href="/books/NBK586315/table/niceng217er18.tab36/?report=objectonly" target="object" rid-ob="figobniceng217er18tab36">Table 36</a></h4><p class="float-caption no_bottom_margin">Clinical evidence summary: Seizure frequency - >10 seizures per year (at baseline). </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng217er18tab37"><a href="/books/NBK586315/table/niceng217er18.tab37/?report=objectonly" target="object" title="Table 37" class="img_link icnblk_img figpopup" rid-figpopup="figniceng217er18tab37" rid-ob="figobniceng217er18tab37"><img class="small-thumb" src="/books/NBK586315/table/niceng217er18.tab37/?report=thumb" src-large="/books/NBK586315/table/niceng217er18.tab37/?report=previmg" alt="Table 37. Clinical evidence summary: Seizures prior to SUDEP." /></a><div class="icnblk_cntnt"><h4 id="niceng217er18.tab37"><a href="/books/NBK586315/table/niceng217er18.tab37/?report=objectonly" target="object" rid-ob="figobniceng217er18tab37">Table 37</a></h4><p class="float-caption no_bottom_margin">Clinical evidence summary: Seizures prior to SUDEP. </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng217er18tab38"><a href="/books/NBK586315/table/niceng217er18.tab38/?report=objectonly" target="object" title="Table 38" class="img_link icnblk_img figpopup" rid-figpopup="figniceng217er18tab38" rid-ob="figobniceng217er18tab38"><img class="small-thumb" src="/books/NBK586315/table/niceng217er18.tab38/?report=thumb" src-large="/books/NBK586315/table/niceng217er18.tab38/?report=previmg" alt="Table 38. Clinical evidence summary: Seizure frequency – (3 – 12 seizures past year)." /></a><div class="icnblk_cntnt"><h4 id="niceng217er18.tab38"><a href="/books/NBK586315/table/niceng217er18.tab38/?report=objectonly" target="object" rid-ob="figobniceng217er18tab38">Table 38</a></h4><p class="float-caption no_bottom_margin">Clinical evidence summary: Seizure frequency – (3 – 12 seizures past year). </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng217er18tab39"><a href="/books/NBK586315/table/niceng217er18.tab39/?report=objectonly" target="object" title="Table 39" class="img_link icnblk_img figpopup" rid-figpopup="figniceng217er18tab39" rid-ob="figobniceng217er18tab39"><img class="small-thumb" src="/books/NBK586315/table/niceng217er18.tab39/?report=thumb" src-large="/books/NBK586315/table/niceng217er18.tab39/?report=previmg" alt="Table 39. Clinical evidence summary: six to ten tonic-clonic seizures (previous 3 months)." /></a><div class="icnblk_cntnt"><h4 id="niceng217er18.tab39"><a href="/books/NBK586315/table/niceng217er18.tab39/?report=objectonly" target="object" rid-ob="figobniceng217er18tab39">Table 39</a></h4><p class="float-caption no_bottom_margin">Clinical evidence summary: six to ten tonic-clonic seizures (previous 3 months). </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng217er18tab40"><a href="/books/NBK586315/table/niceng217er18.tab40/?report=objectonly" target="object" title="Table 40" class="img_link icnblk_img figpopup" rid-figpopup="figniceng217er18tab40" rid-ob="figobniceng217er18tab40"><img class="small-thumb" src="/books/NBK586315/table/niceng217er18.tab40/?report=thumb" src-large="/books/NBK586315/table/niceng217er18.tab40/?report=previmg" alt="Table 40. Clinical evidence summary: eleven to twenty tonic-clonic seizures (previous 3 months)." /></a><div class="icnblk_cntnt"><h4 id="niceng217er18.tab40"><a href="/books/NBK586315/table/niceng217er18.tab40/?report=objectonly" target="object" rid-ob="figobniceng217er18tab40">Table 40</a></h4><p class="float-caption no_bottom_margin">Clinical evidence summary: eleven to twenty tonic-clonic seizures (previous 3 months). </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng217er18tab41"><a href="/books/NBK586315/table/niceng217er18.tab41/?report=objectonly" target="object" title="Table 41" class="img_link icnblk_img figpopup" rid-figpopup="figniceng217er18tab41" rid-ob="figobniceng217er18tab41"><img class="small-thumb" src="/books/NBK586315/table/niceng217er18.tab41/?report=thumb" src-large="/books/NBK586315/table/niceng217er18.tab41/?report=previmg" alt="Table 41. Clinical evidence summary: Twenty-one to fifty tonic-clonic seizures (previous 3 months)." /></a><div class="icnblk_cntnt"><h4 id="niceng217er18.tab41"><a href="/books/NBK586315/table/niceng217er18.tab41/?report=objectonly" target="object" rid-ob="figobniceng217er18tab41">Table 41</a></h4><p class="float-caption no_bottom_margin">Clinical evidence summary: Twenty-one to fifty tonic-clonic seizures (previous 3 months). </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng217er18tab42"><a href="/books/NBK586315/table/niceng217er18.tab42/?report=objectonly" target="object" title="Table 42" class="img_link icnblk_img figpopup" rid-figpopup="figniceng217er18tab42" rid-ob="figobniceng217er18tab42"><img class="small-thumb" src="/books/NBK586315/table/niceng217er18.tab42/?report=thumb" src-large="/books/NBK586315/table/niceng217er18.tab42/?report=previmg" alt="Table 42. Clinical evidence summary: Over fifty tonic-clonic seizures (previous 3 months)." /></a><div class="icnblk_cntnt"><h4 id="niceng217er18.tab42"><a href="/books/NBK586315/table/niceng217er18.tab42/?report=objectonly" target="object" rid-ob="figobniceng217er18tab42">Table 42</a></h4><p class="float-caption no_bottom_margin">Clinical evidence summary: Over fifty tonic-clonic seizures (previous 3 months). </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng217er18tab43"><a href="/books/NBK586315/table/niceng217er18.tab43/?report=objectonly" target="object" title="Table 43" class="img_link icnblk_img figpopup" rid-figpopup="figniceng217er18tab43" rid-ob="figobniceng217er18tab43"><img class="small-thumb" src="/books/NBK586315/table/niceng217er18.tab43/?report=thumb" src-large="/books/NBK586315/table/niceng217er18.tab43/?report=previmg" alt="Table 43. Clinical evidence summary: History of generalized tonic-clonic seizures." /></a><div class="icnblk_cntnt"><h4 id="niceng217er18.tab43"><a href="/books/NBK586315/table/niceng217er18.tab43/?report=objectonly" target="object" rid-ob="figobniceng217er18tab43">Table 43</a></h4><p class="float-caption no_bottom_margin">Clinical evidence summary: History of generalized tonic-clonic seizures. </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng217er18tab44"><a href="/books/NBK586315/table/niceng217er18.tab44/?report=objectonly" target="object" title="Table 44" class="img_link icnblk_img figpopup" rid-figpopup="figniceng217er18tab44" rid-ob="figobniceng217er18tab44"><img class="small-thumb" src="/books/NBK586315/table/niceng217er18.tab44/?report=thumb" src-large="/books/NBK586315/table/niceng217er18.tab44/?report=previmg" alt="Table 44. Clinical evidence summary: Focal seizures." /></a><div class="icnblk_cntnt"><h4 id="niceng217er18.tab44"><a href="/books/NBK586315/table/niceng217er18.tab44/?report=objectonly" target="object" rid-ob="figobniceng217er18tab44">Table 44</a></h4><p class="float-caption no_bottom_margin">Clinical evidence summary: Focal seizures. </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng217er18tab45"><a href="/books/NBK586315/table/niceng217er18.tab45/?report=objectonly" target="object" title="Table 45" class="img_link icnblk_img figpopup" rid-figpopup="figniceng217er18tab45" rid-ob="figobniceng217er18tab45"><img class="small-thumb" src="/books/NBK586315/table/niceng217er18.tab45/?report=thumb" src-large="/books/NBK586315/table/niceng217er18.tab45/?report=previmg" alt="Table 45. Clinical evidence summary: Focal and generalized seizures." /></a><div class="icnblk_cntnt"><h4 id="niceng217er18.tab45"><a href="/books/NBK586315/table/niceng217er18.tab45/?report=objectonly" target="object" rid-ob="figobniceng217er18tab45">Table 45</a></h4><p class="float-caption no_bottom_margin">Clinical evidence summary: Focal and generalized seizures. </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng217er18tab46"><a href="/books/NBK586315/table/niceng217er18.tab46/?report=objectonly" target="object" title="Table 46" class="img_link icnblk_img figpopup" rid-figpopup="figniceng217er18tab46" rid-ob="figobniceng217er18tab46"><img class="small-thumb" src="/books/NBK586315/table/niceng217er18.tab46/?report=thumb" src-large="/books/NBK586315/table/niceng217er18.tab46/?report=previmg" alt="Table 46. Clinical evidence summary: Undetermined seizures." /></a><div class="icnblk_cntnt"><h4 id="niceng217er18.tab46"><a href="/books/NBK586315/table/niceng217er18.tab46/?report=objectonly" target="object" rid-ob="figobniceng217er18tab46">Table 46</a></h4><p class="float-caption no_bottom_margin">Clinical evidence summary: Undetermined seizures. </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng217er18tab47"><a href="/books/NBK586315/table/niceng217er18.tab47/?report=objectonly" target="object" title="Table 47" class="img_link icnblk_img figpopup" rid-figpopup="figniceng217er18tab47" rid-ob="figobniceng217er18tab47"><img class="small-thumb" src="/books/NBK586315/table/niceng217er18.tab47/?report=thumb" src-large="/books/NBK586315/table/niceng217er18.tab47/?report=previmg" alt="Table 47. Clinical evidence summary: Substance abuse." /></a><div class="icnblk_cntnt"><h4 id="niceng217er18.tab47"><a href="/books/NBK586315/table/niceng217er18.tab47/?report=objectonly" target="object" rid-ob="figobniceng217er18tab47">Table 47</a></h4><p class="float-caption no_bottom_margin">Clinical evidence summary: Substance abuse. </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng217er18tab48"><a href="/books/NBK586315/table/niceng217er18.tab48/?report=objectonly" target="object" title="Table 48" class="img_link icnblk_img figpopup" rid-figpopup="figniceng217er18tab48" rid-ob="figobniceng217er18tab48"><img class="small-thumb" src="/books/NBK586315/table/niceng217er18.tab48/?report=thumb" src-large="/books/NBK586315/table/niceng217er18.tab48/?report=previmg" alt="Table 48. Clinical evidence summary: Alcohol dependence." /></a><div class="icnblk_cntnt"><h4 id="niceng217er18.tab48"><a href="/books/NBK586315/table/niceng217er18.tab48/?report=objectonly" target="object" rid-ob="figobniceng217er18tab48">Table 48</a></h4><p class="float-caption no_bottom_margin">Clinical evidence summary: Alcohol dependence. </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng217er18tab49"><a href="/books/NBK586315/table/niceng217er18.tab49/?report=objectonly" target="object" title="Table 49" class="img_link icnblk_img figpopup" rid-figpopup="figniceng217er18tab49" rid-ob="figobniceng217er18tab49"><img class="small-thumb" src="/books/NBK586315/table/niceng217er18.tab49/?report=thumb" src-large="/books/NBK586315/table/niceng217er18.tab49/?report=previmg" alt="Table 49. Clinical evidence summary: Alcoholism." /></a><div class="icnblk_cntnt"><h4 id="niceng217er18.tab49"><a href="/books/NBK586315/table/niceng217er18.tab49/?report=objectonly" target="object" rid-ob="figobniceng217er18tab49">Table 49</a></h4><p class="float-caption no_bottom_margin">Clinical evidence summary: Alcoholism. </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng217er18tab50"><a href="/books/NBK586315/table/niceng217er18.tab50/?report=objectonly" target="object" title="Table 50" class="img_link icnblk_img figpopup" rid-figpopup="figniceng217er18tab50" rid-ob="figobniceng217er18tab50"><img class="small-thumb" src="/books/NBK586315/table/niceng217er18.tab50/?report=thumb" src-large="/books/NBK586315/table/niceng217er18.tab50/?report=previmg" alt="Table 50. Clinical evidence summary: Local symptomatic seizures." /></a><div class="icnblk_cntnt"><h4 id="niceng217er18.tab50"><a href="/books/NBK586315/table/niceng217er18.tab50/?report=objectonly" target="object" rid-ob="figobniceng217er18tab50">Table 50</a></h4><p class="float-caption no_bottom_margin">Clinical evidence summary: Local symptomatic seizures. </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng217er18tab51"><a href="/books/NBK586315/table/niceng217er18.tab51/?report=objectonly" target="object" title="Table 51" class="img_link icnblk_img figpopup" rid-figpopup="figniceng217er18tab51" rid-ob="figobniceng217er18tab51"><img class="small-thumb" src="/books/NBK586315/table/niceng217er18.tab51/?report=thumb" src-large="/books/NBK586315/table/niceng217er18.tab51/?report=previmg" alt="Table 51. Clinical evidence summary: Local cryptogenic seizures." /></a><div class="icnblk_cntnt"><h4 id="niceng217er18.tab51"><a href="/books/NBK586315/table/niceng217er18.tab51/?report=objectonly" target="object" rid-ob="figobniceng217er18tab51">Table 51</a></h4><p class="float-caption no_bottom_margin">Clinical evidence summary: Local cryptogenic seizures. </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng217er18tab52"><a href="/books/NBK586315/table/niceng217er18.tab52/?report=objectonly" target="object" title="Table 52" class="img_link icnblk_img figpopup" rid-figpopup="figniceng217er18tab52" rid-ob="figobniceng217er18tab52"><img class="small-thumb" src="/books/NBK586315/table/niceng217er18.tab52/?report=thumb" src-large="/books/NBK586315/table/niceng217er18.tab52/?report=previmg" alt="Table 52. Clinical evidence summary: Undetermined seizures." /></a><div class="icnblk_cntnt"><h4 id="niceng217er18.tab52"><a href="/books/NBK586315/table/niceng217er18.tab52/?report=objectonly" target="object" rid-ob="figobniceng217er18tab52">Table 52</a></h4><p class="float-caption no_bottom_margin">Clinical evidence summary: Undetermined seizures. </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng217er18tab53"><a href="/books/NBK586315/table/niceng217er18.tab53/?report=objectonly" target="object" title="Table 53" class="img_link icnblk_img figpopup" rid-figpopup="figniceng217er18tab53" rid-ob="figobniceng217er18tab53"><img class="small-thumb" src="/books/NBK586315/table/niceng217er18.tab53/?report=thumb" src-large="/books/NBK586315/table/niceng217er18.tab53/?report=previmg" alt="Table 53. Clinical evidence summary: Anti-seizure medication therapy - monotherapy." /></a><div class="icnblk_cntnt"><h4 id="niceng217er18.tab53"><a href="/books/NBK586315/table/niceng217er18.tab53/?report=objectonly" target="object" rid-ob="figobniceng217er18tab53">Table 53</a></h4><p class="float-caption no_bottom_margin">Clinical evidence summary: Anti-seizure medication therapy - monotherapy. </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng217er18tab54"><a href="/books/NBK586315/table/niceng217er18.tab54/?report=objectonly" target="object" title="Table 54" class="img_link icnblk_img figpopup" rid-figpopup="figniceng217er18tab54" rid-ob="figobniceng217er18tab54"><img class="small-thumb" src="/books/NBK586315/table/niceng217er18.tab54/?report=thumb" src-large="/books/NBK586315/table/niceng217er18.tab54/?report=previmg" alt="Table 54. Clinical evidence summary: Anti-seizure medication therapy – Polytherapy (≥2 medications)." /></a><div class="icnblk_cntnt"><h4 id="niceng217er18.tab54"><a href="/books/NBK586315/table/niceng217er18.tab54/?report=objectonly" target="object" rid-ob="figobniceng217er18tab54">Table 54</a></h4><p class="float-caption no_bottom_margin">Clinical evidence summary: Anti-seizure medication therapy – Polytherapy (≥2 medications). </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng217er18tab55"><a href="/books/NBK586315/table/niceng217er18.tab55/?report=objectonly" target="object" title="Table 55" class="img_link icnblk_img figpopup" rid-figpopup="figniceng217er18tab55" rid-ob="figobniceng217er18tab55"><img class="small-thumb" src="/books/NBK586315/table/niceng217er18.tab55/?report=thumb" src-large="/books/NBK586315/table/niceng217er18.tab55/?report=previmg" alt="Table 55. Clinical evidence summary: Anti-seizure medication therapy – Two anti-seizure medications." /></a><div class="icnblk_cntnt"><h4 id="niceng217er18.tab55"><a href="/books/NBK586315/table/niceng217er18.tab55/?report=objectonly" target="object" rid-ob="figobniceng217er18tab55">Table 55</a></h4><p class="float-caption no_bottom_margin">Clinical evidence summary: Anti-seizure medication therapy – Two anti-seizure medications. </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng217er18tab56"><a href="/books/NBK586315/table/niceng217er18.tab56/?report=objectonly" target="object" title="Table 56" class="img_link icnblk_img figpopup" rid-figpopup="figniceng217er18tab56" rid-ob="figobniceng217er18tab56"><img class="small-thumb" src="/books/NBK586315/table/niceng217er18.tab56/?report=thumb" src-large="/books/NBK586315/table/niceng217er18.tab56/?report=previmg" alt="Table 56. Clinical evidence summary: Two antiseizure medications." /></a><div class="icnblk_cntnt"><h4 id="niceng217er18.tab56"><a href="/books/NBK586315/table/niceng217er18.tab56/?report=objectonly" target="object" rid-ob="figobniceng217er18tab56">Table 56</a></h4><p class="float-caption no_bottom_margin">Clinical evidence summary: Two antiseizure medications. </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng217er18tab57"><a href="/books/NBK586315/table/niceng217er18.tab57/?report=objectonly" target="object" title="Table 57" class="img_link icnblk_img figpopup" rid-figpopup="figniceng217er18tab57" rid-ob="figobniceng217er18tab57"><img class="small-thumb" src="/books/NBK586315/table/niceng217er18.tab57/?report=thumb" src-large="/books/NBK586315/table/niceng217er18.tab57/?report=previmg" alt="Table 57. Clinical evidence summary: Three antiseizure medications." /></a><div class="icnblk_cntnt"><h4 id="niceng217er18.tab57"><a href="/books/NBK586315/table/niceng217er18.tab57/?report=objectonly" target="object" rid-ob="figobniceng217er18tab57">Table 57</a></h4><p class="float-caption no_bottom_margin">Clinical evidence summary: Three antiseizure medications. </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng217er18tab58"><a href="/books/NBK586315/table/niceng217er18.tab58/?report=objectonly" target="object" title="Table 58" class="img_link icnblk_img figpopup" rid-figpopup="figniceng217er18tab58" rid-ob="figobniceng217er18tab58"><img class="small-thumb" src="/books/NBK586315/table/niceng217er18.tab58/?report=thumb" src-large="/books/NBK586315/table/niceng217er18.tab58/?report=previmg" alt="Table 58. Clinical evidence summary: Anti-seizure medication therapy – Polytherapy (> 3 anti-seizure medications)." /></a><div class="icnblk_cntnt"><h4 id="niceng217er18.tab58"><a href="/books/NBK586315/table/niceng217er18.tab58/?report=objectonly" target="object" rid-ob="figobniceng217er18tab58">Table 58</a></h4><p class="float-caption no_bottom_margin">Clinical evidence summary: Anti-seizure medication therapy – Polytherapy (> 3 anti-seizure medications). </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng217er18tab59"><a href="/books/NBK586315/table/niceng217er18.tab59/?report=objectonly" target="object" title="Table 59" class="img_link icnblk_img figpopup" rid-figpopup="figniceng217er18tab59" rid-ob="figobniceng217er18tab59"><img class="small-thumb" src="/books/NBK586315/table/niceng217er18.tab59/?report=thumb" src-large="/books/NBK586315/table/niceng217er18.tab59/?report=previmg" alt="Table 59. Clinical evidence summary: three to four anti-seizure medications." /></a><div class="icnblk_cntnt"><h4 id="niceng217er18.tab59"><a href="/books/NBK586315/table/niceng217er18.tab59/?report=objectonly" target="object" rid-ob="figobniceng217er18tab59">Table 59</a></h4><p class="float-caption no_bottom_margin">Clinical evidence summary: three to four anti-seizure medications. </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng217er18tab60"><a href="/books/NBK586315/table/niceng217er18.tab60/?report=objectonly" target="object" title="Table 60" class="img_link icnblk_img figpopup" rid-figpopup="figniceng217er18tab60" rid-ob="figobniceng217er18tab60"><img class="small-thumb" src="/books/NBK586315/table/niceng217er18.tab60/?report=thumb" src-large="/books/NBK586315/table/niceng217er18.tab60/?report=previmg" alt="Table 60. Clinical evidence summary: Over four anti-seizure medications." /></a><div class="icnblk_cntnt"><h4 id="niceng217er18.tab60"><a href="/books/NBK586315/table/niceng217er18.tab60/?report=objectonly" target="object" rid-ob="figobniceng217er18tab60">Table 60</a></h4><p class="float-caption no_bottom_margin">Clinical evidence summary: Over four anti-seizure medications. </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng217er18tab61"><a href="/books/NBK586315/table/niceng217er18.tab61/?report=objectonly" target="object" title="Table 61" class="img_link icnblk_img figpopup" rid-figpopup="figniceng217er18tab61" rid-ob="figobniceng217er18tab61"><img class="small-thumb" src="/books/NBK586315/table/niceng217er18.tab61/?report=thumb" src-large="/books/NBK586315/table/niceng217er18.tab61/?report=previmg" alt="Table 61. Clinical evidence summary: No anti-seizure medications." /></a><div class="icnblk_cntnt"><h4 id="niceng217er18.tab61"><a href="/books/NBK586315/table/niceng217er18.tab61/?report=objectonly" target="object" rid-ob="figobniceng217er18tab61">Table 61</a></h4><p class="float-caption no_bottom_margin">Clinical evidence summary: No anti-seizure medications. </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng217er18tab62"><a href="/books/NBK586315/table/niceng217er18.tab62/?report=objectonly" target="object" title="Table 62" class="img_link icnblk_img figpopup" rid-figpopup="figniceng217er18tab62" rid-ob="figobniceng217er18tab62"><img class="small-thumb" src="/books/NBK586315/table/niceng217er18.tab62/?report=thumb" src-large="/books/NBK586315/table/niceng217er18.tab62/?report=previmg" alt="Table 62. Clinical evidence summary: Monotherapy – Carbamazepine." /></a><div class="icnblk_cntnt"><h4 id="niceng217er18.tab62"><a href="/books/NBK586315/table/niceng217er18.tab62/?report=objectonly" target="object" rid-ob="figobniceng217er18tab62">Table 62</a></h4><p class="float-caption no_bottom_margin">Clinical evidence summary: Monotherapy – Carbamazepine. </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng217er18tab63"><a href="/books/NBK586315/table/niceng217er18.tab63/?report=objectonly" target="object" title="Table 63" class="img_link icnblk_img figpopup" rid-figpopup="figniceng217er18tab63" rid-ob="figobniceng217er18tab63"><img class="small-thumb" src="/books/NBK586315/table/niceng217er18.tab63/?report=thumb" src-large="/books/NBK586315/table/niceng217er18.tab63/?report=previmg" alt="Table 63. Clinical evidence summary: Monotherapy – Carbamazepine." /></a><div class="icnblk_cntnt"><h4 id="niceng217er18.tab63"><a href="/books/NBK586315/table/niceng217er18.tab63/?report=objectonly" target="object" rid-ob="figobniceng217er18tab63">Table 63</a></h4><p class="float-caption no_bottom_margin">Clinical evidence summary: Monotherapy – Carbamazepine. </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng217er18tab64"><a href="/books/NBK586315/table/niceng217er18.tab64/?report=objectonly" target="object" title="Table 64" class="img_link icnblk_img figpopup" rid-figpopup="figniceng217er18tab64" rid-ob="figobniceng217er18tab64"><img class="small-thumb" src="/books/NBK586315/table/niceng217er18.tab64/?report=thumb" src-large="/books/NBK586315/table/niceng217er18.tab64/?report=previmg" alt="Table 64. Clinical evidence summary: Monotherapy – Lamotrigine." /></a><div class="icnblk_cntnt"><h4 id="niceng217er18.tab64"><a href="/books/NBK586315/table/niceng217er18.tab64/?report=objectonly" target="object" rid-ob="figobniceng217er18tab64">Table 64</a></h4><p class="float-caption no_bottom_margin">Clinical evidence summary: Monotherapy – Lamotrigine. </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng217er18tab65"><a href="/books/NBK586315/table/niceng217er18.tab65/?report=objectonly" target="object" title="Table 65" class="img_link icnblk_img figpopup" rid-figpopup="figniceng217er18tab65" rid-ob="figobniceng217er18tab65"><img class="small-thumb" src="/books/NBK586315/table/niceng217er18.tab65/?report=thumb" src-large="/books/NBK586315/table/niceng217er18.tab65/?report=previmg" alt="Table 65. Clinical evidence summary: Monotherapy – Valproic Acid." /></a><div class="icnblk_cntnt"><h4 id="niceng217er18.tab65"><a href="/books/NBK586315/table/niceng217er18.tab65/?report=objectonly" target="object" rid-ob="figobniceng217er18tab65">Table 65</a></h4><p class="float-caption no_bottom_margin">Clinical evidence summary: Monotherapy – Valproic Acid. </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng217er18tab66"><a href="/books/NBK586315/table/niceng217er18.tab66/?report=objectonly" target="object" title="Table 66" class="img_link icnblk_img figpopup" rid-figpopup="figniceng217er18tab66" rid-ob="figobniceng217er18tab66"><img class="small-thumb" src="/books/NBK586315/table/niceng217er18.tab66/?report=thumb" src-large="/books/NBK586315/table/niceng217er18.tab66/?report=previmg" alt="Table 66. Clinical evidence summary: Monotherapy – Phenytoin." /></a><div class="icnblk_cntnt"><h4 id="niceng217er18.tab66"><a href="/books/NBK586315/table/niceng217er18.tab66/?report=objectonly" target="object" rid-ob="figobniceng217er18tab66">Table 66</a></h4><p class="float-caption no_bottom_margin">Clinical evidence summary: Monotherapy – Phenytoin. </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng217er18tab67"><a href="/books/NBK586315/table/niceng217er18.tab67/?report=objectonly" target="object" title="Table 67" class="img_link icnblk_img figpopup" rid-figpopup="figniceng217er18tab67" rid-ob="figobniceng217er18tab67"><img class="small-thumb" src="/books/NBK586315/table/niceng217er18.tab67/?report=thumb" src-large="/books/NBK586315/table/niceng217er18.tab67/?report=previmg" alt="Table 67. Clinical evidence summary: Monotherapy – Levetiracetam." /></a><div class="icnblk_cntnt"><h4 id="niceng217er18.tab67"><a href="/books/NBK586315/table/niceng217er18.tab67/?report=objectonly" target="object" rid-ob="figobniceng217er18tab67">Table 67</a></h4><p class="float-caption no_bottom_margin">Clinical evidence summary: Monotherapy – Levetiracetam. </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng217er18tab68"><a href="/books/NBK586315/table/niceng217er18.tab68/?report=objectonly" target="object" title="Table 68" class="img_link icnblk_img figpopup" rid-figpopup="figniceng217er18tab68" rid-ob="figobniceng217er18tab68"><img class="small-thumb" src="/books/NBK586315/table/niceng217er18.tab68/?report=thumb" src-large="/books/NBK586315/table/niceng217er18.tab68/?report=previmg" alt="Table 68. Clinical evidence summary: Monotherapy – Oxcarbazepine." /></a><div class="icnblk_cntnt"><h4 id="niceng217er18.tab68"><a href="/books/NBK586315/table/niceng217er18.tab68/?report=objectonly" target="object" rid-ob="figobniceng217er18tab68">Table 68</a></h4><p class="float-caption no_bottom_margin">Clinical evidence summary: Monotherapy – Oxcarbazepine. </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng217er18tab69"><a href="/books/NBK586315/table/niceng217er18.tab69/?report=objectonly" target="object" title="Table 69" class="img_link icnblk_img figpopup" rid-figpopup="figniceng217er18tab69" rid-ob="figobniceng217er18tab69"><img class="small-thumb" src="/books/NBK586315/table/niceng217er18.tab69/?report=thumb" src-large="/books/NBK586315/table/niceng217er18.tab69/?report=previmg" alt="Table 69. Clinical evidence summary: Monotherapy – Topiramate." /></a><div class="icnblk_cntnt"><h4 id="niceng217er18.tab69"><a href="/books/NBK586315/table/niceng217er18.tab69/?report=objectonly" target="object" rid-ob="figobniceng217er18tab69">Table 69</a></h4><p class="float-caption no_bottom_margin">Clinical evidence summary: Monotherapy – Topiramate. </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng217er18tab70"><a href="/books/NBK586315/table/niceng217er18.tab70/?report=objectonly" target="object" title="Table 70" class="img_link icnblk_img figpopup" rid-figpopup="figniceng217er18tab70" rid-ob="figobniceng217er18tab70"><img class="small-thumb" src="/books/NBK586315/table/niceng217er18.tab70/?report=thumb" src-large="/books/NBK586315/table/niceng217er18.tab70/?report=previmg" alt="Table 70. Clinical evidence summary: Monotherapy – Other anti-seizure medication." /></a><div class="icnblk_cntnt"><h4 id="niceng217er18.tab70"><a href="/books/NBK586315/table/niceng217er18.tab70/?report=objectonly" target="object" rid-ob="figobniceng217er18tab70">Table 70</a></h4><p class="float-caption no_bottom_margin">Clinical evidence summary: Monotherapy – Other anti-seizure medication. </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng217er18tab71"><a href="/books/NBK586315/table/niceng217er18.tab71/?report=objectonly" target="object" title="Table 71" class="img_link icnblk_img figpopup" rid-figpopup="figniceng217er18tab71" rid-ob="figobniceng217er18tab71"><img class="small-thumb" src="/books/NBK586315/table/niceng217er18.tab71/?report=thumb" src-large="/books/NBK586315/table/niceng217er18.tab71/?report=previmg" alt="Table 71. Clinical evidence summary: Nonadherence." /></a><div class="icnblk_cntnt"><h4 id="niceng217er18.tab71"><a href="/books/NBK586315/table/niceng217er18.tab71/?report=objectonly" target="object" rid-ob="figobniceng217er18tab71">Table 71</a></h4><p class="float-caption no_bottom_margin">Clinical evidence summary: Nonadherence. </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng217er18tab72"><a href="/books/NBK586315/table/niceng217er18.tab72/?report=objectonly" target="object" title="Table 72" class="img_link icnblk_img figpopup" rid-figpopup="figniceng217er18tab72" rid-ob="figobniceng217er18tab72"><img class="small-thumb" src="/books/NBK586315/table/niceng217er18.tab72/?report=thumb" src-large="/books/NBK586315/table/niceng217er18.tab72/?report=previmg" alt="Table 72. Clinical evidence summary: One to two changes in dose of antiseizure medication (per year)." /></a><div class="icnblk_cntnt"><h4 id="niceng217er18.tab72"><a href="/books/NBK586315/table/niceng217er18.tab72/?report=objectonly" target="object" rid-ob="figobniceng217er18tab72">Table 72</a></h4><p class="float-caption no_bottom_margin">Clinical evidence summary: One to two changes in dose of antiseizure medication (per year). </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng217er18tab73"><a href="/books/NBK586315/table/niceng217er18.tab73/?report=objectonly" target="object" title="Table 73" class="img_link icnblk_img figpopup" rid-figpopup="figniceng217er18tab73" rid-ob="figobniceng217er18tab73"><img class="small-thumb" src="/books/NBK586315/table/niceng217er18.tab73/?report=thumb" src-large="/books/NBK586315/table/niceng217er18.tab73/?report=previmg" alt="Table 73. Clinical evidence summary: Three to five changes in dose of antiseizure medication (per year)." /></a><div class="icnblk_cntnt"><h4 id="niceng217er18.tab73"><a href="/books/NBK586315/table/niceng217er18.tab73/?report=objectonly" target="object" rid-ob="figobniceng217er18tab73">Table 73</a></h4><p class="float-caption no_bottom_margin">Clinical evidence summary: Three to five changes in dose of antiseizure medication (per year). </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng217er18tab74"><a href="/books/NBK586315/table/niceng217er18.tab74/?report=objectonly" target="object" title="Table 74" class="img_link icnblk_img figpopup" rid-figpopup="figniceng217er18tab74" rid-ob="figobniceng217er18tab74"><img class="small-thumb" src="/books/NBK586315/table/niceng217er18.tab74/?report=thumb" src-large="/books/NBK586315/table/niceng217er18.tab74/?report=previmg" alt="Table 74. Clinical evidence summary: Antipsychotic medication." /></a><div class="icnblk_cntnt"><h4 id="niceng217er18.tab74"><a href="/books/NBK586315/table/niceng217er18.tab74/?report=objectonly" target="object" rid-ob="figobniceng217er18tab74">Table 74</a></h4><p class="float-caption no_bottom_margin">Clinical evidence summary: Antipsychotic medication. </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng217er18tab75"><a href="/books/NBK586315/table/niceng217er18.tab75/?report=objectonly" target="object" title="Table 75" class="img_link icnblk_img figpopup" rid-figpopup="figniceng217er18tab75" rid-ob="figobniceng217er18tab75"><img class="small-thumb" src="/books/NBK586315/table/niceng217er18.tab75/?report=thumb" src-large="/books/NBK586315/table/niceng217er18.tab75/?report=previmg" alt="Table 75. Clinical evidence summary: Anxiolytic medication." /></a><div class="icnblk_cntnt"><h4 id="niceng217er18.tab75"><a href="/books/NBK586315/table/niceng217er18.tab75/?report=objectonly" target="object" rid-ob="figobniceng217er18tab75">Table 75</a></h4><p class="float-caption no_bottom_margin">Clinical evidence summary: Anxiolytic medication. </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng217er18tab76"><a href="/books/NBK586315/table/niceng217er18.tab76/?report=objectonly" target="object" title="Table 76" class="img_link icnblk_img figpopup" rid-figpopup="figniceng217er18tab76" rid-ob="figobniceng217er18tab76"><img class="small-thumb" src="/books/NBK586315/table/niceng217er18.tab76/?report=thumb" src-large="/books/NBK586315/table/niceng217er18.tab76/?report=previmg" alt="Table 76. Clinical evidence summary: Asthma." /></a><div class="icnblk_cntnt"><h4 id="niceng217er18.tab76"><a href="/books/NBK586315/table/niceng217er18.tab76/?report=objectonly" target="object" rid-ob="figobniceng217er18tab76">Table 76</a></h4><p class="float-caption no_bottom_margin">Clinical evidence summary: Asthma. </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng217er18tab77"><a href="/books/NBK586315/table/niceng217er18.tab77/?report=objectonly" target="object" title="Table 77" class="img_link icnblk_img figpopup" rid-figpopup="figniceng217er18tab77" rid-ob="figobniceng217er18tab77"><img class="small-thumb" src="/books/NBK586315/table/niceng217er18.tab77/?report=thumb" src-large="/books/NBK586315/table/niceng217er18.tab77/?report=previmg" alt="Table 77. Clinical evidence summary: Sharing household but not sharing a bedroom." /></a><div class="icnblk_cntnt"><h4 id="niceng217er18.tab77"><a href="/books/NBK586315/table/niceng217er18.tab77/?report=objectonly" target="object" rid-ob="figobniceng217er18tab77">Table 77</a></h4><p class="float-caption no_bottom_margin">Clinical evidence summary: Sharing household but not sharing a bedroom. </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng217er18tab78"><a href="/books/NBK586315/table/niceng217er18.tab78/?report=objectonly" target="object" title="Table 78" class="img_link icnblk_img figpopup" rid-figpopup="figniceng217er18tab78" rid-ob="figobniceng217er18tab78"><img class="small-thumb" src="/books/NBK586315/table/niceng217er18.tab78/?report=thumb" src-large="/books/NBK586315/table/niceng217er18.tab78/?report=previmg" alt="Table 78. Clinical evidence summary: Living alone." /></a><div class="icnblk_cntnt"><h4 id="niceng217er18.tab78"><a href="/books/NBK586315/table/niceng217er18.tab78/?report=objectonly" target="object" rid-ob="figobniceng217er18tab78">Table 78</a></h4><p class="float-caption no_bottom_margin">Clinical evidence summary: Living alone. </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng217er18tab79"><a href="/books/NBK586315/table/niceng217er18.tab79/?report=objectonly" target="object" title="Table 79" class="img_link icnblk_img figpopup" rid-figpopup="figniceng217er18tab79" rid-ob="figobniceng217er18tab79"><img class="small-thumb" src="/books/NBK586315/table/niceng217er18.tab79/?report=thumb" src-large="/books/NBK586315/table/niceng217er18.tab79/?report=previmg" alt="Table 79. Clinical evidence summary: Secondary education." /></a><div class="icnblk_cntnt"><h4 id="niceng217er18.tab79"><a href="/books/NBK586315/table/niceng217er18.tab79/?report=objectonly" target="object" rid-ob="figobniceng217er18tab79">Table 79</a></h4><p class="float-caption no_bottom_margin">Clinical evidence summary: Secondary education. </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng217er18tab80"><a href="/books/NBK586315/table/niceng217er18.tab80/?report=objectonly" target="object" title="Table 80" class="img_link icnblk_img figpopup" rid-figpopup="figniceng217er18tab80" rid-ob="figobniceng217er18tab80"><img class="small-thumb" src="/books/NBK586315/table/niceng217er18.tab80/?report=thumb" src-large="/books/NBK586315/table/niceng217er18.tab80/?report=previmg" alt="Table 80. Clinical evidence summary: Primary education." /></a><div class="icnblk_cntnt"><h4 id="niceng217er18.tab80"><a href="/books/NBK586315/table/niceng217er18.tab80/?report=objectonly" target="object" rid-ob="figobniceng217er18tab80">Table 80</a></h4><p class="float-caption no_bottom_margin">Clinical evidence summary: Primary education. </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng217er18tab81"><a href="/books/NBK586315/table/niceng217er18.tab81/?report=objectonly" target="object" title="Table 81" class="img_link icnblk_img figpopup" rid-figpopup="figniceng217er18tab81" rid-ob="figobniceng217er18tab81"><img class="small-thumb" src="/books/NBK586315/table/niceng217er18.tab81/?report=thumb" src-large="/books/NBK586315/table/niceng217er18.tab81/?report=previmg" alt="Table 81. Clinical evidence summary: Same room supervision at night." /></a><div class="icnblk_cntnt"><h4 id="niceng217er18.tab81"><a href="/books/NBK586315/table/niceng217er18.tab81/?report=objectonly" target="object" rid-ob="figobniceng217er18tab81">Table 81</a></h4><p class="float-caption no_bottom_margin">Clinical evidence summary: Same room supervision at night. </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng217er18tab82"><a href="/books/NBK586315/table/niceng217er18.tab82/?report=objectonly" target="object" title="Table 82" class="img_link icnblk_img figpopup" rid-figpopup="figniceng217er18tab82" rid-ob="figobniceng217er18tab82"><img class="small-thumb" src="/books/NBK586315/table/niceng217er18.tab82/?report=thumb" src-large="/books/NBK586315/table/niceng217er18.tab82/?report=previmg" alt="Table 82. Clinical evidence summary: Special supervision at night (regular checks throughout the night or the use of a listening device)." /></a><div class="icnblk_cntnt"><h4 id="niceng217er18.tab82"><a href="/books/NBK586315/table/niceng217er18.tab82/?report=objectonly" target="object" rid-ob="figobniceng217er18tab82">Table 82</a></h4><p class="float-caption no_bottom_margin">Clinical evidence summary: Special supervision at night (regular checks throughout the night or the use of a listening device). </p></div></div><p>See <a href="#niceng217er18.appf">Appendix F</a> for full GRADE tables.</p></div><div id="niceng217er18.s1.1.11"><h4>1.1.11. Economic evidence</h4><div id="niceng217er18.s1.1.11.1"><h5>1.1.11.1. Included studies</h5><p>No health economic studies were included.</p></div><div id="niceng217er18.s1.1.11.2"><h5>1.1.11.2. Excluded studies</h5><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="#niceng217er18.appg">Appendix G</a>.</p></div></div><div id="niceng217er18.s1.1.12"><h4>1.1.12. Economic model</h4><p>This area was not prioritised for a new cost-effectiveness analysis.</p></div><div id="niceng217er18.s1.1.13"><h4>1.1.13. Evidence statements</h4><div id="niceng217er18.s1.1.13.1"><h5>1.1.13.1. Effectiveness</h5><ul><li class="half_rhythm"><div>None.</div></li></ul></div><div id="niceng217er18.s1.1.13.2"><h5>1.1.13.2. Economic</h5><ul><li class="half_rhythm"><div>No relevant economic evaluations were identified.</div></li></ul></div></div><div id="niceng217er18.s1.1.14"><h4>1.1.14. The committee’s discussion and interpretation of the evidence</h4><div id="niceng217er18.s1.1.14.1"><h5>1.1.14.1. The outcomes that matter most</h5><p>The two outcomes for this evidence review were death related to epilepsy or sudden unexpected death in Epilepsy (SUDEP). This was to ensure that the modifiable risk factors being assessed were in the context of the impact they would have on mortality and SUDEP. This was important as modifiable risk factors could be assessed in people who have been diagnosed with epilepsy, and the recommendations would potentially have the greatest impact for the person with epilepsy, their families, or carers, as well as the clinicians managing their epilepsy.</p></div><div id="niceng217er18.s1.1.14.2"><h5>1.1.14.2. The quality of the evidence</h5><p>The majority of results were of low or very low-quality evidence for all the stratifications for the outcomes of epilepsy-related mortality or SUDEP. The main reasons for this were: the risk of bias, indirectness for not adjusting for modifiable confounders and crossing of the null line. There were cohort studies and case-control studies included within this review. As all the studies were observational studies, they had to show adjustment was made for potential confounders. The evidence was downgraded if the study did not adjust for at least two of the four non-modifiable risk factors specified (age, gender, developmental/intellectual disability, and duration of epilepsy). Evidence of adjusting shows that the results are what they would be if all other variables were set to be the same across the risk factor and no risk factor group. In turn, this increases our confidence that the results are not confounded. Where the confidence interval of the odds, hazard or risk crossed one, or the null line, this signified that the result is consistent with no effect from the risk factor. This allowed the results to be divided into significant factors and non-significant factors. The committee took note of all these different elements in the quality assessment of the evidence to decide on recommendations.</p><p>There were several outcomes within some of the stratifications that were of moderate or high-quality evidence. Within the adults (follow up over 5 years) adherence, polytherapy, neurological conditions and Charlson Comorbidity Index; mixed population (follow up 1 - 5 years) tumour aetiology; and mixed population (follow up over 5 years) undetermined seizures, substance abuse, alcohol, dependence, polytherapy (2 or more anti-seizure medications or more than 3 anti-seizure medications, use of levetiracetam, non-adherence and living conditions were all of moderate to high quality and significant outcomes. The committee discussed all of the factors in relation to their quality and significance and decided those that were modifiable were important to consider for recommendations.</p></div><div id="niceng217er18.s1.1.14.3"><h5>1.1.14.3. Benefits and harms</h5><p>People with epilepsy are at increased risk (approximately 7 – 12% cumulative lifetime risk) of premature mortality and SUDEP so the identification of risk factors, particularly modifiable risk factors is of benefit to people with epilepsy and their families and carers. This can provide important information of their own risk but also what steps can be taken to manage the risk.</p><p>In adults who were followed up from one to five years there did not appear to be a significant difference in risk of death or SUDEP resulting from 1 – 5 seizures a month, >5 seizures a month, 1 – 3 tonic clonic seizures per year or > 3 tonic clonic seizures per year. However, for adults followed up over five years, being on more ASM’s led to an almost doubling of the odds of SUDEP compared to less ASMs; non-adherence of ASM’s led to an almost 3.5 times greater odds of death compared to being adherent to medications, and people with polytherapy (2 or more anti-seizure medications) had three-quarters the hazard of mortality as people not on polytherapy.</p><p>Comorbidities such as brain tumours, meningitis and stroke had almost two times the hazard of mortality compared to no neurological comorbidities. Although not modifiable risk factors, these conditions are important in a cumulative risk calculation.</p><p>Unexpectedly, the evidence showed that depression led to one-fifth of the risk of premature mortality compared to no depression, and having peripheral vascular disease led to approximately half the odds of mortality compared to the odds experienced without peripheral vascular disease. This is contrary to the understanding in current clinical practice that depression and peripheral vascular disease are modifiable risk factors that increase the risk of premature mortality. However, a higher score on the Charlson co-morbidity index, which is a measure of co-morbidities including cardiovascular disorders such as heart failure, stroke and peripheral heart disease as well as other chronic conditions, is associated with an increase in mortality. In children followed up for more than five years, having an abnormal neurological exam confers a hazard of mortality that is 12 times greater than the hazard experienced without an abnormal neurological exam and having abnormal cognitive function confers a hazard of mortality that is almost 4 times greater than the hazard experienced without abnormal cognitive function. Knowledge of the magnitude of these risk factors can contribute to the approach to epilepsy management.</p><p>Within a mixed population of children and adults who were followed up for one to five years, the evidence showed having a tumour has a hazard of mortality that is 4.5 times greater than the hazard experienced without having a tumour.</p><p>In studies of a mixed population followed up for over five years, there were several significant risk factors that had an impact on the risk of premature mortality. For example, having over ten seizures per year has almost six times greater odds of SUDEP than the odds experienced with less than ten seizures per year, and having a history of generalized tonic clonic seizures has almost fourteen times greater odds of SUDEP than the odds experienced without a history of generalized tonic clonic seizures. In relation to medication and treatment of epilepsy, some results showed that three to five changes in dose of ASM per year has a risk of SUDEP that is nearly ten times greater than the risk experienced with no changes in ASM over a year and people on three ASM has an odds of SUDEP ten times greater than the odds experienced with monotherapy.</p><p>The committee agreed that these modifiable risk factors shown to have an impact on premature mortality or SUDEP could be grouped into a recommendation focused on treating seizures adequately with medication and adherence to medication. The committee agreed that focal to bilateral tonic-clonic seizures should be listed along with generalised tonic-clonic seizures as these more often cause convulsive seizures and are increasingly associated with drug-resistant epilepsy. In addition to this, social and lifestyle factors also showed an impact on premature mortality. For example, special supervision at night had about half of the odds of SUDEP compared to people with no supervision overnight and living alone has an odds of SUDEP that is five times greater than the odds when sharing a household and bedroom. The committee recognised the importance of these findings and included them as part of the recommendations to discuss whether night-time supervision might be helpful for some people who have seizures during sleep and are at higher risk of mortality. The committee discussed the challenges surrounding such an intervention and how it would not be feasible or appropriate in many circumstances but acknowledged parents or carers reported gaining some reassurance from the use of a night monitor in a child’s room.</p><p>The committee noted the importance of ongoing dialogue between the person with epilepsy, their families or carers, and their clinicians about the general management of their epilepsy, medications and seizures, which can help in tailoring treatment and enhance adherence to medications. A person’s risk of premature mortality or SUDEP can change at different stages in their life, which can be affected by how well their epilepsy is managed but also different environmental factors which indirectly affect their risks, such as stress and lifestyle choices. So, conversations around the risks of premature mortality need to be adapted according to risk factors which are relevant at the time of follow up.</p><p>The committee acknowledged it is important to note that the modifiable risk factors identified in the evidence are not the only risk factors that may have an impact on the risk of premature mortality and SUDEP. The committee agreed that the evidence base was limited with respect to many of the biologically plausible risk factors that had been included in the review protocol and were aware that absence of evidence did not equate to ‘evidence of absence’. They, therefore, suggested that discussions about modifiable risk factors between clinician and patient should not be limited to those mentioned in the recommendations and may include other risk factors such as sleep deprivation or sleeping position, and drug polytherapy.</p></div></div><div id="niceng217er18.s1.1.15"><h4>1.1.15. Cost effectiveness and resource use</h4><p>No health economic evidence was identified for this review question.</p><p>The committee discussed the clinical evidence presented and noted that people with epilepsy should be supported to understand their individual risk of mortality, including SUDEP, from the time of their epilepsy diagnosis and throughout the duration of their care. The committee acknowledged that the prospect of SUDEP could be extremely worrying for people with epilepsy causing increased anxiety and depression, worsening people’s quality of life. Therefore, support from health care professionals for people with epilepsy to understand their individualised risk is instrumental in improving patient’s quality of life. In addition, for those patients who are at greater risk of premature mortality, the committee discussed that healthcare workers should work with patients to reduce this risk. The committee noted that these recommendations are reflective of current practice and so are not expected to result in a substantial resource impact.</p><p>The committee also discussed the modifiable risk factors and co-morbidities associated with the risk of epilepsy-related mortality. It was noted that modifiable risk factors and co-morbidities should be discussed with people upon an initial diagnosis of a person’s epilepsy as well as throughout the duration of treatment. The committee acknowledged that in current practice, the degree to which modifiable risk factors are discussed with people varies. However, because the information provided on the modifiable risk factors of SUDEP is discussed at existing appointments people attend, this recommendation is not expected to result in a substantial resource impact.</p><p>Night-time supervision for people with epilepsy was also discussed. The committee noted that night-time supervision could be especially beneficial for people who have seizures during their sleep and have been assessed to be at high risk of epilepsy-related mortality as intercepting a person’s nocturnal seizure can be lifesaving. There are, however, significant implications associated with night-time monitoring. Night-time monitoring of people living in residential care should already be provided; however, the committee noted that, if possible, the level of supervision should be increased. This is because onset of a seizure when sleeping can start suddenly and unexpectedly, therefore without regular monitoring, there may be little benefit of monitoring at all. Overall, increasing the levels of monitoring of people residing in residential care should not result in a significant resource impact as there should already be night-time staff on shift able to conduct monitoring. The committee did, however, note that for places that do not currently provide regular monitoring, an additional member of staff may be required if the workload of night-staff is already high.</p><p>The committee acknowledged that night-time supervision for people with epilepsy not residing in care could be extremely challenging. Monitoring can be achieved through the use of baby monitors or other technologies which provide an alert to a parent, guardian, or partner when a person with epilepsy is experiencing a seizure. The purpose of the recommendation made by the committee is to inform people of the risks of night-time seizures and to make sure the correct approach to monitoring is adopted if appropriate. Advice on a person’s individualised risks of night-time seizures and the best way to monitor these can be provided by health care professionals. In general, the cost of monitoring devices is incurred by careers, guardians, or patients. Therefore, this recommendation is not expected to lead to a significant resource impact.</p><p>The committee also discussed that monitoring may not be possible for adults living alone or in other settings such as living in a house with friends. The committee noted that in these circumstances, the risks and the benefits should be assessed with the help of a healthcare professional for the appropriate course of action to be taken.</p></div><div id="niceng217er18.s1.1.16"><h4>1.1.16. Other factors the committee took into account</h4><p>The committee acknowledged the importance of the 2020 MBRRACE-UK report, which focuses on improving the lives of pregnant women and mothers. The report highlighted that 13% of women died from epilepsy and stroke during or up to six weeks after their pregnancy. In relation to the recommendations made as part of this review, the report urges for the risk related to night-time seizures, uncontrolled seizures, and ineffective treatment to be discussed with pregnant women to reduce the risk of premature mortality and SUDEP.</p></div><div id="niceng217er18.s1.1.17"><h4>1.1.17. Recommendations supported by this evidence review</h4><p>This evidence review supports recommendations 10.1.1 – 10.1.4 in the NICE guideline.</p></div></div></div><div id="niceng217er18.rl.r1"><h2 id="_niceng217er18_rl_r1_">References</h2><dl class="temp-labeled-list"><dl class="bkr_refwrap"><dt>1.</dt><dd><div class="bk_ref" id="niceng217er18.ref1">Alvarez
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T. Etiology, clinical course and outcome of infant epilepsy: Experience of a tertiary center in Thailand. Journal of Clinical Neuroscience. 2019; 59:119–123 [<a href="https://pubmed.ncbi.nlm.nih.gov/30415888" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 30415888</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>10.</dt><dd><div class="bk_ref" id="niceng217er18.ref10">Faught
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E, Duh
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MS, Weiner
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JR, Guerin
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MC. Nonadherence to antiepileptic drugs and increased mortality: findings from the RANSOM Study. Neurology. 2008; 71(20):1572–1578 [<a href="https://pubmed.ncbi.nlm.nih.gov/18565827" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 18565827</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>11.</dt><dd><div class="bk_ref" id="niceng217er18.ref11">Hesdorffer
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DC, Tomson
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T, Benn
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DC, Tomson
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CE, Lesko
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SM, Vezina
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RM, McCoy
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R, Corwin
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MJ, Mandell
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F et al. Infant sleep position and associated health outcomes. Archives of Pediatrics and Adolescent Medicine. 2003; 157(5):469–474 [<a href="https://pubmed.ncbi.nlm.nih.gov/12742883" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 12742883</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>14.</dt><dd><div class="bk_ref" id="niceng217er18.ref14">Lamberts
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RJ, Blom
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MT, Wassenaar
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M, Bardai
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A, Leijten
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GJ et al. Sudden cardiac arrest in people with epilepsy in the community: Circumstances and risk factors. Neurology. 2015; 85(3):212–218 [<a href="/pmc/articles/PMC4516291/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC4516291</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/26092917" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 26092917</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>15.</dt><dd><div class="bk_ref" id="niceng217er18.ref15">Langan
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Y, Nashef
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L, Sander
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JW. Case-control study of SUDEP. Neurology. 2005; 64(7):1131–1133 [<a href="https://pubmed.ncbi.nlm.nih.gov/15824334" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 15824334</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>16.</dt><dd><div class="bk_ref" id="niceng217er18.ref16">Li
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JM, Chen
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L, Zhou
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Y, Zhou
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D. Convulsive status epilepticus in adults and adolescents of southwest China: mortality, etiology, and predictors of death. Epilepsy & Behavior. 2009; 14(1):146–149 [<a href="https://pubmed.ncbi.nlm.nih.gov/18834956" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 18834956</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>17.</dt><dd><div class="bk_ref" id="niceng217er18.ref17">Logroscino
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G, Hesdorffer
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DC, Cascino
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WA. Status epilepticus without an underlying cause and risk of death: a population-based study. Archives of Neurology. 2008; 65(2):221–224 [<a href="https://pubmed.ncbi.nlm.nih.gov/18268191" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 18268191</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>18.</dt><dd><div class="bk_ref" id="niceng217er18.ref18">McCabe
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J, McLean
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B, Henley
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W, Harris
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C, Cheatle
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K, Ashby
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S et al. Sudden Unexpected Death in Epilepsy (SUDEP) and seizure safety: Modifiable and non-modifiable risk factors differences between primary and secondary care. Epilepsy & Behavior. 2021; 115:107637 [<a href="https://pubmed.ncbi.nlm.nih.gov/33317940" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 33317940</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>19.</dt><dd><div class="bk_ref" id="niceng217er18.ref19">McCarter
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AR, Timm
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PC, Shepard
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PW, Sandness
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DJ, Luu
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T, McCarter
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et al. Obstructive sleep apnea in refractory epilepsy: A pilot study investigating frequency, clinical features, and association with risk of sudden unexpected death in epilepsy. Epilepsia. 2018; 59(10):1973–1981 [<a href="/pmc/articles/PMC6855247/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC6855247</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/30246243" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 30246243</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>20.</dt><dd><div class="bk_ref" id="niceng217er18.ref20">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> [<a href="https://pubmed.ncbi.nlm.nih.gov/26677490" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 26677490</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>21.</dt><dd><div class="bk_ref" id="niceng217er18.ref21">Ngugi
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AK, Bottomley
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C, Fegan
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G, Chengo
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E, Odhiambo
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R, Bauni
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E et al. Premature mortality in active convulsive epilepsy in rural Kenya: causes and associated factors. Neurology. 2014; 82(7):582–589 [<a href="/pmc/articles/PMC3963418/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC3963418</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/24443454" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 24443454</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>22.</dt><dd><div class="bk_ref" id="niceng217er18.ref22">Nickels
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KC, Grossardt
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BR, Wirrell
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EC. Epilepsy-related mortality is low in children: a 30-year population-based study in Olmsted County, MN. Epilepsia. 2012; 53(12):2164–2171 [<a href="/pmc/articles/PMC3766953/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC3766953</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/22989286" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 22989286</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>23.</dt><dd><div class="bk_ref" id="niceng217er18.ref23">Nilsson
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L, Farahmand
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BY, Persson
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PG, Thiblin
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I, Tomson
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T. Risk factors for sudden unexpected death in epilepsy: a case-control study. Lancet. 1999; 353(9156):888–893 [<a href="https://pubmed.ncbi.nlm.nih.gov/10093982" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 10093982</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>24.</dt><dd><div class="bk_ref" id="niceng217er18.ref24">Novak
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JL, Miller
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PR, Markovic
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D, Meymandi
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SK, DeGiorgio
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CM. Risk assessment for sudden death in epilepsy: The SUDEP-7 Inventory. Frontiers in Neurology. 2015; 6:252 [<a href="/pmc/articles/PMC4673971/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC4673971</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/26696953" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 26696953</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>25.</dt><dd><div class="bk_ref" id="niceng217er18.ref25">Odom
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N, Bateman
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LM. Sudden unexpected death in epilepsy, periictal physiology, and the SUDEP-7 Inventory. Epilepsia. 2018; 59(10):e157–e160 [<a href="/pmc/articles/PMC6204287/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC6204287</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/30159901" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 30159901</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>26.</dt><dd><div class="bk_ref" id="niceng217er18.ref26">Ryu
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HU, Hong
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JP, Han
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SH, Choi
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EJ, Song
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JH, Lee
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SA et al. Seizure frequencies and number of anti-epileptic drugs as risk factors for sudden unexpected death in epilepsy. Journal of Korean Medical Science. 2015; 30(6):788–792 [<a href="/pmc/articles/PMC4444481/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC4444481</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/26028933" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 26028933</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>27.</dt><dd><div class="bk_ref" id="niceng217er18.ref27">Saetre
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E, Abdelnoor
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M. Incidence rate of sudden death in epilepsy: A systematic review and meta-analysis. Epilepsy & Behavior. 2018; 86:193–199 [<a href="https://pubmed.ncbi.nlm.nih.gov/30017838" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 30017838</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>28.</dt><dd><div class="bk_ref" id="niceng217er18.ref28">Saxena
|
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A, Jones
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L, Shankar
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R, McLean
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B, Newman
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CGJ, Hamandi
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K. Sudden unexpected death in epilepsy in children: A focused review of incidence and risk factors. Journal of Neurology, Neurosurgery and Psychiatry. 2018; 89(10):1064–1070 [<a href="https://pubmed.ncbi.nlm.nih.gov/29632029" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 29632029</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>29.</dt><dd><div class="bk_ref" id="niceng217er18.ref29">Shankar
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R, Henley
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W, Boland
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C, Laugharne
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R, McLean
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BN, Newman
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C et al. Decreasing the risk of sudden unexpected death in epilepsy: structured communication of risk factors for premature mortality in people with epilepsy. European Journal of Neurology. 2018; 25(9):1121–1127 [<a href="https://pubmed.ncbi.nlm.nih.gov/29611888" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 29611888</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>30.</dt><dd><div class="bk_ref" id="niceng217er18.ref30">Si
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Y, Xiao
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X, Xiang
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S, Liu
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J, Mo
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Q, Sun
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H. Risk assessment of in-hospital mortality of patients with epilepsy: A large cohort study. Epilepsy & Behavior. 2018; 84:44–48 [<a href="https://pubmed.ncbi.nlm.nih.gov/29753293" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 29753293</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>31.</dt><dd><div class="bk_ref" id="niceng217er18.ref31">Sillanpaa
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M, Shinnar
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S. SUDEP and other causes of mortality in childhood-onset epilepsy. Epilepsy & Behavior. 2013; 28(2):249–255 [<a href="https://pubmed.ncbi.nlm.nih.gov/23746924" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 23746924</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>32.</dt><dd><div class="bk_ref" id="niceng217er18.ref32">Singh
|
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K, Katz
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ES, Zarowski
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M, Loddenkemper
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T, Llewellyn
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N, Manganaro
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S et al. Cardiopulmonary complications during pediatric seizures: a prelude to understanding SUDEP. Epilepsia. 2013; 54(6):1083–1091 [<a href="/pmc/articles/PMC5304951/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC5304951</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/23731396" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 23731396</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>33.</dt><dd><div class="bk_ref" id="niceng217er18.ref33">Sveinsson
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O, Andersson
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T, Carlsson
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S, Tomson
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T. Circumstances of SUDEP: A nationwide population-based case series. Epilepsia. 2018; 59(5):1074–1082 [<a href="https://pubmed.ncbi.nlm.nih.gov/29663344" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 29663344</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>34.</dt><dd><div class="bk_ref" id="niceng217er18.ref34">Sveinsson
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O, Andersson
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T, Carlsson
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S, Tomson
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T. The incidence of SUDEP: A nationwide population-based cohort study. Neurology. 2017; 89(2):170–177 [<a href="https://pubmed.ncbi.nlm.nih.gov/28592455" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28592455</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>35.</dt><dd><div class="bk_ref" id="niceng217er18.ref35">Sveinsson
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O, Andersson
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T, Mattsson
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P, Carlsson
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S, Tomson
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T. Clinical risk factors in SUDEP: A nationwide population-based case-control study. Neurology. 2020; 94(4):e419–e429 [<a href="/pmc/articles/PMC7079690/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC7079690</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/31831600" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 31831600</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>36.</dt><dd><div class="bk_ref" id="niceng217er18.ref36">Sveinsson
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O, Andersson
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T, Mattsson
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P, Carlsson
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S, Tomson
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T. Pharmacological treatment and SUDEP risk: A nationwide population-based case-control study. Neurology. 2020; 95(18):e2509–e2518 [<a href="/pmc/articles/PMC7682832/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC7682832</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/32967928" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 32967928</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>37.</dt><dd><div class="bk_ref" id="niceng217er18.ref37">Tennis
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P, Cole
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TB, Annegers
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JF, Leestma
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JE, McNutt
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M, Rajput
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A. Cohort study of incidence of sudden unexplained death in persons with seizure disorder treated with antiepileptic drugs in Saskatchewan, Canada. Epilepsia. 1995; 36(1):29–36 [<a href="https://pubmed.ncbi.nlm.nih.gov/8001505" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 8001505</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>38.</dt><dd><div class="bk_ref" id="niceng217er18.ref38">Waddy
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SP, Ward
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JB, Becerra
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AZ, Powers
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T, Fwu
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CW, Williams
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KL et al. Epilepsy and antiseizure medications increase all-cause mortality in dialysis patients in the United States. Kidney International. 2019; 96(5):1176–1184 [<a href="https://pubmed.ncbi.nlm.nih.gov/31358345" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 31358345</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>39.</dt><dd><div class="bk_ref" id="niceng217er18.ref39">Walczak
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TS, Leppik
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IE, D’Amelio
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M, Rarick
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J, So
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E, Ahman
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P et al. Incidence and risk factors in sudden unexpected death in epilepsy: a prospective cohort study. Neurology. 2001; 56(4):519–525 [<a href="https://pubmed.ncbi.nlm.nih.gov/11222798" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 11222798</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>40.</dt><dd><div class="bk_ref" id="niceng217er18.ref40">Zhang
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WW, Si
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Y, Chen
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T, Chen
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D, Liu
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L, Deng
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Y et al. Risks of probable SUDEP among people with convulsive epilepsy in rural West China. Seizure. 2016; 39:19–23 [<a href="https://pubmed.ncbi.nlm.nih.gov/27235892" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 27235892</span></a>]</div></dd></dl><div id="niceng217er18.rl.r1.1"><h3>1.1.17.1. 1.1.14.2. Economic evidence – included studies</h3><ul class="simple-list"><p>[List references of studies included in the economic evidence review]</p></ul></div></dl></div><div id="appendixesappgroup1"><h2 id="_appendixesappgroup1_">Appendices</h2><div id="niceng217er18.appa"><h3>Appendix A. Review protocols</h3><div id="niceng217er18.appa.s1"><h4>A.1. Review protocol for [add key area, for example, unplanned hospital admission]</h4><p id="niceng217er18.appa.et1"><a href="/books/NBK586315/bin/niceng217er18-appa-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Download PDF</a><span class="small"> (249K)</span></p></div><div id="niceng217er18.appa.s2"><h4>A.2. Health economic review protocol</h4><p id="niceng217er18.appa.et2"><a href="/books/NBK586315/bin/niceng217er18-appa-et2.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Download PDF</a><span class="small"> (183K)</span></p></div></div><div id="niceng217er18.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="#niceng217er18.ref20" rid="niceng217er18.ref20"><sup>20</sup></a></p><p>For more information, please see the <a href="/books/NBK586315/bin/niceng217er18_bm1.pdf">Methodology</a> review published as part of the accompanying documents for this guideline.</p><div id="niceng217er18.appb.s1"><h4>B.1. Clinical search literature search strategy</h4><p id="niceng217er18.appb.et1"><a href="/books/NBK586315/bin/niceng217er18-appb-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Download PDF</a><span class="small"> (181K)</span></p></div><div id="niceng217er18.appb.s2"><h4>B.2. Health Economics literature search strategy</h4><p id="niceng217er18.appb.et2"><a href="/books/NBK586315/bin/niceng217er18-appb-et2.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Download PDF</a><span class="small"> (225K)</span></p></div></div><div id="niceng217er18.appc"><h3>Appendix C. Prognostic evidence study selection</h3><p id="niceng217er18.appc.et1"><a href="/books/NBK586315/bin/niceng217er18-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 epilepsy related mortality</a><span class="small"> (PDF, 126K)</span></p></div><div id="niceng217er18.appd"><h3>Appendix D. Prognostic evidence</h3><p id="niceng217er18.appd.et1"><a href="/books/NBK586315/bin/niceng217er18-appd-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Download PDF</a><span class="small"> (620K)</span></p></div><div id="niceng217er18.appe"><h3>Appendix E. Forest plots</h3><div id="niceng217er18.appe.s1"><h4>E.1. Adults >18 years (follow up 1 – 5 years)</h4><p id="niceng217er18.appe.et1"><a href="/books/NBK586315/bin/niceng217er18-appe-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Download PDF</a><span class="small"> (138K)</span></p></div><div id="niceng217er18.appe.s2"><h4>E.2. Adults >18 years (follow up >5 years)</h4><p id="niceng217er18.appe.et2"><a href="/books/NBK586315/bin/niceng217er18-appe-et2.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Download PDF</a><span class="small"> (178K)</span></p></div><div id="niceng217er18.appe.s3"><h4>E.3. Children <18 years (follow up >5 years)</h4><p id="niceng217er18.appe.et3"><a href="/books/NBK586315/bin/niceng217er18-appe-et3.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Download PDF</a><span class="small"> (132K)</span></p></div><div id="niceng217er18.appe.s4"><h4>E.4. Mixed population of children <18 years and adults >18 years (follow up 1 - 5 years)</h4><p id="niceng217er18.appe.et4"><a href="/books/NBK586315/bin/niceng217er18-appe-et4.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Download PDF</a><span class="small"> (130K)</span></p></div><div id="niceng217er18.appe.s5"><h4>E.5. Mixed population of children <18 years and adults >18 years (follow up > 5 years)</h4><p id="niceng217er18.appe.et5"><a href="/books/NBK586315/bin/niceng217er18-appe-et5.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Download PDF</a><span class="small"> (350K)</span></p></div></div><div id="niceng217er18.appf"><h3>Appendix F. GRADE tables</h3><div id="niceng217er18.appf.s1"><h4>F.1. Adults >18 years (follow up 1 – 5 years)</h4><p id="niceng217er18.appf.et1"><a href="/books/NBK586315/bin/niceng217er18-appf-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Download PDF</a><span class="small"> (187K)</span></p></div><div id="niceng217er18.appf.s2"><h4>F.2. Adults >18 years (follow up >5 years)</h4><p id="niceng217er18.appf.et2"><a href="/books/NBK586315/bin/niceng217er18-appf-et2.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Download PDF</a><span class="small"> (318K)</span></p></div><div id="niceng217er18.appf.s3"><h4>F.3. Children <18 years (follow up >5 years)</h4><p id="niceng217er18.appf.et3"><a href="/books/NBK586315/bin/niceng217er18-appf-et3.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Download PDF</a><span class="small"> (181K)</span></p></div><div id="niceng217er18.appf.s4"><h4>F.4. Mixed population of children <18 years and adults >18 years (follow up 1 - 5 years)</h4><p id="niceng217er18.appf.et4"><a href="/books/NBK586315/bin/niceng217er18-appf-et4.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Download PDF</a><span class="small"> (170K)</span></p></div><div id="niceng217er18.appf.s5"><h4>F.5. Mixed population of children <18 years and adults >18 years (follow up > 5 years)</h4><p id="niceng217er18.appf.et5"><a href="/books/NBK586315/bin/niceng217er18-appf-et5.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Download PDF</a><span class="small"> (644K)</span></p></div></div><div id="niceng217er18.appg"><h3>Appendix G. Economic evidence study selection</h3><p id="niceng217er18.appg.et1"><a href="/books/NBK586315/bin/niceng217er18-appg-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Download PDF</a><span class="small"> (177K)</span></p></div><div id="niceng217er18.apph"><h3>Appendix H. Economic evidence tables</h3><p>None.</p></div><div id="niceng217er18.appi"><h3>Appendix I. Health economic model</h3><p>No original economic modelling was undertaken for this review question.</p></div><div id="niceng217er18.appj"><h3>Appendix J. Excluded studies</h3><div id="niceng217er18.appj.s1"><h4>J.1. Clinical studies</h4><p id="niceng217er18.appj.et1"><a href="/books/NBK586315/bin/niceng217er18-appj-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Download PDF</a><span class="small"> (142K)</span></p></div><div id="niceng217er18.appj.s2"><h4>J.2. Health Economic studies</h4><p id="niceng217er18.appj.et2"><a href="/books/NBK586315/bin/niceng217er18-appj-et2.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Download PDF</a><span class="small"> (122K)</span></p></div></div></div></div><div class="fm-sec"><div><p>FINAL</p></div><div><p>Evidence reviews underpinning recommendations 10.1.1 – 10.1.4 and research recommendations 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: NBK586315</span><span class="label">PMID: <a href="https://pubmed.ncbi.nlm.nih.gov/36395298" title="PubMed record of this title" ref="pagearea=meta&targetsite=entrez&targetcat=link&targettype=pubmed">36395298</a></span></div></div><div class="small-screen-prev"></div><div class="small-screen-next"></div></article><article data-type="table-wrap" id="figobniceng217er18tab1"><div id="niceng217er18.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/NBK586315/table/niceng217er18.tab1/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng217er18.tab1_lrgtbl__"><table><tbody><tr><th id="hd_b_niceng217er18.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Population</th><td headers="hd_b_niceng217er18.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 diagnosis of epilepsy.</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_niceng217er18.tab1_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Prognostic variable(s) under consideration</th><td headers="hd_b_niceng217er18.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>Sleeping unsupervised/living alone</div></li><li class="half_rhythm"><div>Prone sleeping position</div></li><li class="half_rhythm"><div>Uncontrolled/frequent Generalised Tonic Clonic Seizures (GTCS)</div></li><li class="half_rhythm"><div>Nocturnal GTCS</div></li><li class="half_rhythm"><div>Substance abuse/alcohol dependence</div></li><li class="half_rhythm"><div>ASM polytherapy</div></li><li class="half_rhythm"><div>Other drug polytherapy</div></li><li class="half_rhythm"><div>Insufficient ASM therapy/any changes in prescription of drugs that could increase seizure rate</div></li><li class="half_rhythm"><div>Sleep deprivation/irregular sleep</div></li></ul>
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</td></tr><tr><th id="hd_b_niceng217er18.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Confounding factors</th><td headers="hd_b_niceng217er18.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No key confounders that have to be adjusted for have been identified, but the analysis report must demonstrate that it has tried to avoid bias arising from plausible potential confounders (the modifiable factors listed above plus other non-modifiable factors) by an appropriate method</td></tr><tr><th id="hd_b_niceng217er18.tab1_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Outcomes</th><td headers="hd_b_niceng217er18.tab1_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><ul><li class="half_rhythm"><div>Death, related to epilepsy</div></li><li class="half_rhythm"><div>SUDEP</div></li></ul>
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Follow up: any available but stratify according to: <1 yr., 1-5 yrs., >5 yrs.</td></tr><tr><th id="hd_b_niceng217er18.tab1_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study design</th><td headers="hd_b_niceng217er18.tab1_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">A longitudinal design, such as prospective/retrospective cohort studies. Case-control studies will be allowed, provided they meet criteria.</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobniceng217er18tab2"><div id="niceng217er18.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/NBK586315/table/niceng217er18.tab2/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng217er18.tab2_lrgtbl__"><table><thead><tr><th id="hd_h_niceng217er18.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study</th><th id="hd_h_niceng217er18.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Population</th><th id="hd_h_niceng217er18.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Analysis</th><th id="hd_h_niceng217er18.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Prognostic variable(s)</th><th id="hd_h_niceng217er18.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Confounders</th><th id="hd_h_niceng217er18.tab2_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Outcomes</th><th id="hd_h_niceng217er18.tab2_1_1_1_7" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Comments</th></tr></thead><tbody><tr><td headers="hd_h_niceng217er18.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Walczak 2001<a class="bibr" href="#niceng217er18.ref39" rid="niceng217er18.ref39"><sup>39</sup></a></td><td headers="hd_h_niceng217er18.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Cases = 20</p>
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<p>Controls = 80</p>
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<p>Participants were prospectively enrolled after evaluation at three upper mid-western epilepsy centres. A surveillance system was set up to identify deaths in this prevalence cohort.</p>
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</td><td headers="hd_h_niceng217er18.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Prospective case control study with multivariate analysis</td><td headers="hd_h_niceng217er18.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Number of seizures (number per month)</p>
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<p>Number of tonic-clonic seizures (per year)</p>
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</td><td headers="hd_h_niceng217er18.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Number of seizures (number per month)</p>
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<p>Number of tonic-clonic seizures (per year)</p>
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</td><td headers="hd_h_niceng217er18.tab2_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Risk of SUDEP</td><td headers="hd_h_niceng217er18.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="figobniceng217er18tab3"><div id="niceng217er18.tab3" class="table"><h3><span class="label">Table 3</span><span class="title">Summary of studies included in the evidence review - Adults >18 years (follow up >5 years)</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK586315/table/niceng217er18.tab3/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng217er18.tab3_lrgtbl__"><table><thead><tr><th id="hd_h_niceng217er18.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study</th><th id="hd_h_niceng217er18.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Population</th><th id="hd_h_niceng217er18.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Analysis</th><th id="hd_h_niceng217er18.tab3_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Prognostic variable(s)</th><th id="hd_h_niceng217er18.tab3_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Confounders</th><th id="hd_h_niceng217er18.tab3_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Outcomes</th><th id="hd_h_niceng217er18.tab3_1_1_1_7" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Comments</th></tr></thead><tbody><tr><td headers="hd_h_niceng217er18.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Faught 2008<a class="bibr" href="#niceng217er18.ref10" rid="niceng217er18.ref10"><sup>10</sup></a></td><td headers="hd_h_niceng217er18.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>N=33,658</p>
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<p>The study population was selected based on ≥18 years of age; ≥ one neurologist visit with a diagnosis of epilepsy or nonfebrile convulsions; ≥ two pharmacy dispensing’s for anti-seizure medications</p>
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</td><td headers="hd_h_niceng217er18.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Retrospective open cohort study design. Multivariate analysis with Cox regression models</td><td headers="hd_h_niceng217er18.tab3_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Adherence</p>
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<p>Use of ASM polytherapy</p>
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<p>Epilepsy related comorbidity</p>
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</td><td headers="hd_h_niceng217er18.tab3_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Adherence status</p>
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<p>Gender</p>
|
|
<p>Age</p>
|
|
<p>Race</p>
|
|
<p>Use of ASM polytherapy</p>
|
|
<p>Epilepsy related comorbidities</p>
|
|
</td><td headers="hd_h_niceng217er18.tab3_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Mortality</td><td headers="hd_h_niceng217er18.tab3_1_1_1_7" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td></tr><tr><td headers="hd_h_niceng217er18.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Ryu 2015<a class="bibr" href="#niceng217er18.ref26" rid="niceng217er18.ref26"><sup>26</sup></a></td><td headers="hd_h_niceng217er18.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>N=104</p>
|
|
<p>individuals who had died, had a diagnosis of epilepsy registered on the death certificate and were treated for epilepsy at the centre in the study period, and met the criteria for SUDEP</p>
|
|
</td><td headers="hd_h_niceng217er18.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Case control study with multivariate regression analysis</td><td headers="hd_h_niceng217er18.tab3_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Seizure frequency</p>
|
|
<p>Number of ASM’s</p>
|
|
</td><td headers="hd_h_niceng217er18.tab3_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Age at onset</p>
|
|
<p>Duration of disease</p>
|
|
<p>Aura</p>
|
|
<p>Family history of epilepsy</p>
|
|
<p>Psychiatric conditions</p>
|
|
<p>Epilepsy classification</p>
|
|
<p>Seizure frequency</p>
|
|
<p>Seizure related to lesion on MR imagine</p>
|
|
<p>Number of ASMs</p>
|
|
<p>Type of ASM</p>
|
|
</td><td headers="hd_h_niceng217er18.tab3_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Risk of SUDEP</td><td headers="hd_h_niceng217er18.tab3_1_1_1_7" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td></tr><tr><td headers="hd_h_niceng217er18.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Si 2018<a class="bibr" href="#niceng217er18.ref30" rid="niceng217er18.ref30"><sup>30</sup></a></td><td headers="hd_h_niceng217er18.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>N = 456</p>
|
|
<p>The number of patients included in the study were those with epilepsy who died and deceased patients without epilepsy as comparison.</p>
|
|
</td><td headers="hd_h_niceng217er18.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Prospective cohort study with logistic regression analysis</td><td headers="hd_h_niceng217er18.tab3_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>CNS infections</p>
|
|
<p>Metastatic cancer</p>
|
|
<p>Solid tumour without metastasis</p>
|
|
<p>Depression</p>
|
|
<p>Diabetes without complications</p>
|
|
<p>Peripheral vascular disease</p>
|
|
<p>Traumatic brain and head injuries</p>
|
|
</td><td headers="hd_h_niceng217er18.tab3_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Age</p>
|
|
<p>Gender</p>
|
|
<p>CNS infections</p>
|
|
<p>Metastatic cancer</p>
|
|
<p>Renal disease</p>
|
|
<p>Solid tumour without metastasis</p>
|
|
<p>Anoxic brain injury</p>
|
|
<p>Cardiac arrhythmias</p>
|
|
<p>Encephalopathy</p>
|
|
<p>Depression</p>
|
|
<p>Paraplegia, hemiplegia</p>
|
|
<p>Diabetes without complications</p>
|
|
<p>Peripheral vascular disease</p>
|
|
<p>Traumatic brain and head injuries</p>
|
|
</td><td headers="hd_h_niceng217er18.tab3_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Mortality</td><td headers="hd_h_niceng217er18.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="figobniceng217er18tab4"><div id="niceng217er18.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 > 5 years)</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK586315/table/niceng217er18.tab4/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng217er18.tab4_lrgtbl__"><table><thead><tr><th id="hd_h_niceng217er18.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study</th><th id="hd_h_niceng217er18.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Population</th><th id="hd_h_niceng217er18.tab4_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Analysis</th><th id="hd_h_niceng217er18.tab4_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Prognostic variable(s)</th><th id="hd_h_niceng217er18.tab4_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Confounders</th><th id="hd_h_niceng217er18.tab4_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Outcomes</th><th id="hd_h_niceng217er18.tab4_1_1_1_7" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Comments</th></tr></thead><tbody><tr><td headers="hd_h_niceng217er18.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Nickels 2012<a class="bibr" href="#niceng217er18.ref22" rid="niceng217er18.ref22"><sup>22</sup></a></td><td headers="hd_h_niceng217er18.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>n= 467</p>
|
|
<p>All children ages 1 month through 17 years diagnosed with new-onset epilepsy while resident in Olmsted County from 1980 to 2009 and had follow-up beyond the initial epilepsy diagnosis were included</p>
|
|
</td><td headers="hd_h_niceng217er18.tab4_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Cohort study with multivariate Cox regression models</td><td headers="hd_h_niceng217er18.tab4_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Abnormal neurological examination</p>
|
|
<p>Abnormal cognitive function</p>
|
|
<p>Status epilepticus, ever</p>
|
|
<p>Metabolic/ structural aetiology</p>
|
|
</td><td headers="hd_h_niceng217er18.tab4_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Neurologic examination cognitive function previous status epilepticus mode of onset, aetiology usage of ≥ 2 ASM’s seizure frequency intractable at last follow up</td><td headers="hd_h_niceng217er18.tab4_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Mortality</td><td headers="hd_h_niceng217er18.tab4_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="figobniceng217er18tab5"><div id="niceng217er18.tab5" class="table"><h3><span class="label">Table 5</span><span class="title">Summary of studies included in the evidence review - mixed population of children <18 years and adults >18 years (follow up 1 - 5 years)</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK586315/table/niceng217er18.tab5/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng217er18.tab5_lrgtbl__"><table><thead><tr><th id="hd_h_niceng217er18.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study</th><th id="hd_h_niceng217er18.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Population</th><th id="hd_h_niceng217er18.tab5_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Analysis</th><th id="hd_h_niceng217er18.tab5_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Prognostic variable(s)</th><th id="hd_h_niceng217er18.tab5_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Confounders</th><th id="hd_h_niceng217er18.tab5_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Outcomes</th><th id="hd_h_niceng217er18.tab5_1_1_1_7" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Comments</th></tr></thead><tbody><tr><td headers="hd_h_niceng217er18.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Chen 2005<a class="bibr" href="#niceng217er18.ref7" rid="niceng217er18.ref7"><sup>7</sup></a></td><td headers="hd_h_niceng217er18.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>n=263</p>
|
|
<p>Participants were prospectively recruited patients with epilepsy who were at least 17 years old and newly referred to the outpatient epilepsy clinics</p>
|
|
</td><td headers="hd_h_niceng217er18.tab5_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Prospective cohort study with Cox proportional hazards regression model</td><td headers="hd_h_niceng217er18.tab5_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Aetiology of seizure / epilepsy</td><td headers="hd_h_niceng217er18.tab5_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Age of onset</p>
|
|
<p>Frequency</p>
|
|
<p>Imaging</p>
|
|
<p>Type of seizure</p>
|
|
<p>Aetiology</p>
|
|
<p>Medication</p>
|
|
<p>Age</p>
|
|
<p>Gender</p>
|
|
</td><td headers="hd_h_niceng217er18.tab5_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Mortality</td><td headers="hd_h_niceng217er18.tab5_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="figobniceng217er18tab6"><div id="niceng217er18.tab6" class="table"><h3><span class="label">Table 6</span><span class="title">Summary of studies included in the evidence review - mixed population of children <18 years and adults >18 years (follow up >5 years)</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK586315/table/niceng217er18.tab6/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng217er18.tab6_lrgtbl__"><table><thead><tr><th id="hd_h_niceng217er18.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study</th><th id="hd_h_niceng217er18.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Population</th><th id="hd_h_niceng217er18.tab6_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Analysis</th><th id="hd_h_niceng217er18.tab6_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Prognostic variable(s)</th><th id="hd_h_niceng217er18.tab6_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Confounders</th><th id="hd_h_niceng217er18.tab6_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Outcomes</th><th id="hd_h_niceng217er18.tab6_1_1_1_7" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Comments</th></tr></thead><tbody><tr><td headers="hd_h_niceng217er18.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Langan 2005<a class="bibr" href="#niceng217er18.ref15" rid="niceng217er18.ref15"><sup>15</sup></a></td><td headers="hd_h_niceng217er18.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Cases = 151</p>
|
|
<p>Controls = 534</p>
|
|
<p>People with epilepsy who died suddenly between the ages of 16 and 50 years were identified by coroners and neurologists and by interviews with bereaved families</p>
|
|
</td><td headers="hd_h_niceng217er18.tab6_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Case control study with backward stepwise conditional logistic regression</td><td headers="hd_h_niceng217er18.tab6_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>History of generalized tonic clonic seizures</p>
|
|
<p>No of tonic clonic seizures in previous 3 months</p>
|
|
<p>Total number of anti-seizure medications</p>
|
|
<p>Carbamazepine usage</p>
|
|
<p>Supervision</p>
|
|
<p>Asthma</p>
|
|
</td><td headers="hd_h_niceng217er18.tab6_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>History of generalized tonic clonic seizures</p>
|
|
<p>No of tonic clonic seizures in previous 3 months</p>
|
|
<p>Total number of anti-seizure medications</p>
|
|
<p>Carbamazepine usage</p>
|
|
<p>Supervision</p>
|
|
<p>Asthma</p>
|
|
</td><td headers="hd_h_niceng217er18.tab6_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Risk of SUDEP</td><td headers="hd_h_niceng217er18.tab6_1_1_1_7" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Supervision at night was defined as the presence in the bedroom of an individual of normal intelligence and at least 10 years old or the use of special precautions. Special precautions involved regular checks throughout the night or the use of a listening device.</td></tr><tr><td headers="hd_h_niceng217er18.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Nilsson 1999<a class="bibr" href="#niceng217er18.ref23" rid="niceng217er18.ref23"><sup>23</sup></a></td><td headers="hd_h_niceng217er18.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Cases = 57</p>
|
|
<p>Controls = 171</p>
|
|
<p>Cases were individuals who had died with a diagnosis of epilepsy registered on the death certificate and who after review of medical and necropsy records were found to meet SUDEP criteria.</p>
|
|
</td><td headers="hd_h_niceng217er18.tab6_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Nested case control study with multivariate analysis</td><td headers="hd_h_niceng217er18.tab6_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Seizure frequency during last year</p>
|
|
<p>Epilepsy type</p>
|
|
<p>Number of ASM</p>
|
|
<p>Changes in dose of ASM per year</p>
|
|
<p>Anxiolytic medication</p>
|
|
<p>Antipsychotic medication</p>
|
|
</td><td headers="hd_h_niceng217er18.tab6_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Seizure frequency during last year</p>
|
|
<p>Epilepsy type</p>
|
|
<p>Number of ASM</p>
|
|
<p>Changes in dose of ASM per year</p>
|
|
</td><td headers="hd_h_niceng217er18.tab6_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Risk of SUDEP</td><td headers="hd_h_niceng217er18.tab6_1_1_1_7" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td></tr><tr><td headers="hd_h_niceng217er18.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Sveinsson 2020<a class="bibr" href="#niceng217er18.ref36" rid="niceng217er18.ref36"><sup>36</sup></a></p>
|
|
<p>
|
|
<i>(Sveinsson a)</i>
|
|
</p>
|
|
</td><td headers="hd_h_niceng217er18.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Cases n = 255</p>
|
|
<p>Controls n=1148</p>
|
|
<p>All deaths with epilepsy written on the death certificate (n = 1,276), were eligible SUDEP cases.</p>
|
|
</td><td headers="hd_h_niceng217er18.tab6_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Case control study with conditional logistic regression and individual modelling</td><td headers="hd_h_niceng217er18.tab6_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>ASM therapy</p>
|
|
<p>Monotherapy</p>
|
|
<p>Nonadherence</p>
|
|
</td><td headers="hd_h_niceng217er18.tab6_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>ASM therapy</p>
|
|
<p>Medication</p>
|
|
<p>Time since last dispensed ASM Nonadherence</p>
|
|
</td><td headers="hd_h_niceng217er18.tab6_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Risk of SUDEP</td><td headers="hd_h_niceng217er18.tab6_1_1_1_7" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Model 3 from analysis used within review: adjusted for the same variables as model 2 together with history of GTCS, GTCS frequency in the last year and nocturnal GTCS last year</td></tr><tr><td headers="hd_h_niceng217er18.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Sveinsson 2020<a class="bibr" href="#niceng217er18.ref35" rid="niceng217er18.ref35"><sup>35</sup></a></p>
|
|
<p>
|
|
<i>(Sveinsson b)</i>
|
|
</p>
|
|
</td><td headers="hd_h_niceng217er18.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Cases n = 255</p>
|
|
<p>Controls n=1148</p>
|
|
<p>All deaths with epilepsy written on the death certificate (n = 1,276), were eligible SUDEP cases.</p>
|
|
</td><td headers="hd_h_niceng217er18.tab6_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Case control study with conditional logistic regression and individual modelling</td><td headers="hd_h_niceng217er18.tab6_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Type of Epilepsy</p>
|
|
<p>Living conditions</p>
|
|
<p>Highest education</p>
|
|
<p>Alcohol dependence</p>
|
|
<p>Substance abuse</p>
|
|
</td><td headers="hd_h_niceng217er18.tab6_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Age</p>
|
|
<p>Sex</p>
|
|
<p>Generalized tonic-clonic seizures frequency and nocturnal generalized tonic-clonic seizures last year of observation</p>
|
|
<p>Living conditions</p>
|
|
<p>Antiepileptic drugs</p>
|
|
</td><td headers="hd_h_niceng217er18.tab6_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Risk of SUDEP</td><td headers="hd_h_niceng217er18.tab6_1_1_1_7" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Model 3 from analysis used within review: Adjusted for age, sex, generalized tonic-clonic seizure frequency and nocturnal generalized tonic-clonic seizures last year, living conditions and epileptic drugs.</td></tr><tr><td headers="hd_h_niceng217er18.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Zhang 2016<a class="bibr" href="#niceng217er18.ref40" rid="niceng217er18.ref40"><sup>40</sup></a></td><td headers="hd_h_niceng217er18.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Probable SUDEP n = 35</p>
|
|
<p>Control n = 105</p>
|
|
<p>Patients with convulsive epilepsy</p>
|
|
</td><td headers="hd_h_niceng217er18.tab6_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Case control study with multivariate logistic regression analysis</td><td headers="hd_h_niceng217er18.tab6_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Seizure frequency</p>
|
|
<p>Seizure free prior (prior to SUDEP)</p>
|
|
</td><td headers="hd_h_niceng217er18.tab6_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Onset age</p>
|
|
<p>Seizure frequency at baseline (n/year) Seizure free prior to probable SUDEP (1 month)</p>
|
|
</td><td headers="hd_h_niceng217er18.tab6_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Risk of probable SUDEP</td><td headers="hd_h_niceng217er18.tab6_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="figobniceng217er18tab7"><div id="niceng217er18.tab7" class="table"><h3><span class="label">Table 7</span><span class="title">Clinical evidence summary: one to five seizures per month</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK586315/table/niceng217er18.tab7/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng217er18.tab7_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng217er18.tab7_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Outcomes</th><th id="hd_h_niceng217er18.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_niceng217er18.tab7_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Quality of the evidence (GRADE)</th><th id="hd_h_niceng217er18.tab7_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Relative effect (95% CI)</th></tr></thead><tbody><tr><td headers="hd_h_niceng217er18.tab7_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">SUDEP - Male</td><td headers="hd_h_niceng217er18.tab7_1_1_1_2 hd_h_niceng217er18.tab7_1_1_1_3 hd_h_niceng217er18.tab7_1_1_1_4" colspan="3" rowspan="1" style="text-align:left;vertical-align:top;">No seizures as reference</td></tr><tr><td headers="hd_h_niceng217er18.tab7_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>20</p>
|
|
<p>(1 study)</p>
|
|
<p>1 - 5 years</p>
|
|
</td><td headers="hd_h_niceng217er18.tab7_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_niceng217er18.tab7_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>OR 3.40</p>
|
|
<p>(0.5 to 23.12)</p>
|
|
</td></tr><tr><td headers="hd_h_niceng217er18.tab7_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">SUDEP - Female</td><td headers="hd_h_niceng217er18.tab7_1_1_1_2 hd_h_niceng217er18.tab7_1_1_1_3 hd_h_niceng217er18.tab7_1_1_1_4" colspan="3" rowspan="1" style="text-align:left;vertical-align:top;">No seizures as reference</td></tr><tr><td headers="hd_h_niceng217er18.tab7_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>20</p>
|
|
<p>(1 study)</p>
|
|
<p>1 - 5 years</p>
|
|
</td><td headers="hd_h_niceng217er18.tab7_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_niceng217er18.tab7_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>OR 5.70</p>
|
|
<p>(0.6 to 54.15)</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="niceng217er18.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="niceng217er18.tab7_2"><p class="no_margin">Downgraded for indirectness as analysis did not adjust for at least two of the non-modifiable confounders</p></div></dd></dl><dl class="bkr_refwrap"><dt>3</dt><dd><div id="niceng217er18.tab7_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="niceng217er18.tab7_4"><p class="no_margin">Outcomes adjusted for number of seizures (per month) and number of tonic clonic seizures (per year)</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng217er18tab8"><div id="niceng217er18.tab8" class="table"><h3><span class="label">Table 8</span><span class="title">Clinical evidence summary: Over five seizures per month</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK586315/table/niceng217er18.tab8/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng217er18.tab8_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng217er18.tab8_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Outcomes</th><th id="hd_h_niceng217er18.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_niceng217er18.tab8_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Quality of the evidence (GRADE)</th><th id="hd_h_niceng217er18.tab8_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Relative effect (95% CI)</th></tr></thead><tbody><tr><td headers="hd_h_niceng217er18.tab8_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">SUDEP - Male</td><td headers="hd_h_niceng217er18.tab8_1_1_1_2 hd_h_niceng217er18.tab8_1_1_1_3 hd_h_niceng217er18.tab8_1_1_1_4" colspan="3" rowspan="1" style="text-align:left;vertical-align:top;">No seizures as reference</td></tr><tr><td headers="hd_h_niceng217er18.tab8_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>20</p>
|
|
<p>(1 study)</p>
|
|
<p>1 - 5 years</p>
|
|
</td><td headers="hd_h_niceng217er18.tab8_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_niceng217er18.tab8_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>OR 1.0</p>
|
|
<p>(0.1 to 10)</p>
|
|
</td></tr><tr><td headers="hd_h_niceng217er18.tab8_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">SUDEP – Female</td><td headers="hd_h_niceng217er18.tab8_1_1_1_2 hd_h_niceng217er18.tab8_1_1_1_3 hd_h_niceng217er18.tab8_1_1_1_4" colspan="3" rowspan="1" style="text-align:left;vertical-align:top;">No seizures as reference</td></tr><tr><td headers="hd_h_niceng217er18.tab8_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>20</p>
|
|
<p>(1 study)</p>
|
|
<p>1 - 5 years</p>
|
|
</td><td headers="hd_h_niceng217er18.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><sup>,</sup><sup>3</sup><sup>,</sup><sup>4</sup></p>
|
|
<p>due to risk of bias, indirectness</p>
|
|
</td><td headers="hd_h_niceng217er18.tab8_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>OR 7.40</p>
|
|
<p>(1.3 to 42.12)</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="niceng217er18.tab8_1"><p class="no_margin">Downgraded by 1 increment if the majority of the evidence was at moderate risk of bias, and downgraded by 2 increments if the majority of the evidence was at high risk of bias</p></div></dd></dl><dl class="bkr_refwrap"><dt>2</dt><dd><div id="niceng217er18.tab8_2"><p class="no_margin">Downgraded for indirectness as analysis did not adjust for at least two of the non-modifiable confounders</p></div></dd></dl><dl class="bkr_refwrap"><dt>3</dt><dd><div id="niceng217er18.tab8_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="niceng217er18.tab8_4"><p class="no_margin">Outcomes adjusted for number of seizures (per month) and number of tonic clonic seizures (per year)</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng217er18tab9"><div id="niceng217er18.tab9" class="table"><h3><span class="label">Table 9</span><span class="title">Clinical evidence summary: One to three tonic-clonic seizures per year</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK586315/table/niceng217er18.tab9/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng217er18.tab9_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng217er18.tab9_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Outcomes</th><th id="hd_h_niceng217er18.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_niceng217er18.tab9_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Quality of the evidence (GRADE)</th><th id="hd_h_niceng217er18.tab9_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Relative effect (95% CI)</th></tr></thead><tbody><tr><td headers="hd_h_niceng217er18.tab9_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">SUDEP - Male</td><td headers="hd_h_niceng217er18.tab9_1_1_1_2 hd_h_niceng217er18.tab9_1_1_1_3 hd_h_niceng217er18.tab9_1_1_1_4" colspan="3" rowspan="1" style="text-align:left;vertical-align:top;">No tonic – clonic seizures as reference</td></tr><tr><td headers="hd_h_niceng217er18.tab9_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>20</p>
|
|
<p>(1 study)</p>
|
|
<p>1 - 5 years</p>
|
|
</td><td headers="hd_h_niceng217er18.tab9_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, imprecision</p>
|
|
</td><td headers="hd_h_niceng217er18.tab9_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>OR 4.30</p>
|
|
<p>(0.5 to 36.98)</p>
|
|
</td></tr><tr><td headers="hd_h_niceng217er18.tab9_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">SUDEP - Female</td><td headers="hd_h_niceng217er18.tab9_1_1_1_2 hd_h_niceng217er18.tab9_1_1_1_3 hd_h_niceng217er18.tab9_1_1_1_4" colspan="3" rowspan="1" style="text-align:left;vertical-align:top;">No tonic – clonic seizures as reference</td></tr><tr><td headers="hd_h_niceng217er18.tab9_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>20</p>
|
|
<p>(1 study)</p>
|
|
<p>1 - 5 years</p>
|
|
</td><td headers="hd_h_niceng217er18.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 risk of bias, indirectness</p>
|
|
</td><td headers="hd_h_niceng217er18.tab9_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>OR 11.20</p>
|
|
<p>(1.6 to 78.39)</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="niceng217er18.tab9_1"><p class="no_margin">Downgraded by 1 increment if the majority of the evidence was at moderate risk of bias, and downgraded by 2 increments if the majority of the evidence was at high risk of bias</p></div></dd></dl><dl class="bkr_refwrap"><dt>2</dt><dd><div id="niceng217er18.tab9_2"><p class="no_margin">Downgraded for indirectness as analysis did not adjust for at least two of the non-modifiable confounders</p></div></dd></dl><dl class="bkr_refwrap"><dt>3</dt><dd><div id="niceng217er18.tab9_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="niceng217er18.tab9_4"><p class="no_margin">Outcomes adjusted for number of seizures (per month) and number of tonic clonic seizures (per year)</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng217er18tab10"><div id="niceng217er18.tab10" class="table"><h3><span class="label">Table 10</span><span class="title">Clinical evidence summary: Over three tonic-clonic seizures per year</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK586315/table/niceng217er18.tab10/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng217er18.tab10_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng217er18.tab10_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Outcomes</th><th id="hd_h_niceng217er18.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_niceng217er18.tab10_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Quality of the evidence (GRADE)</th><th id="hd_h_niceng217er18.tab10_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Relative effect (95% CI)</th></tr></thead><tbody><tr><td headers="hd_h_niceng217er18.tab10_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">SUDEP – Male</td><td headers="hd_h_niceng217er18.tab10_1_1_1_2 hd_h_niceng217er18.tab10_1_1_1_3 hd_h_niceng217er18.tab10_1_1_1_4" colspan="3" rowspan="1" style="text-align:left;vertical-align:top;">No tonic – clonic seizures as reference</td></tr><tr><td headers="hd_h_niceng217er18.tab10_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>20</p>
|
|
<p>(1 study)</p>
|
|
<p>1 - 5 years</p>
|
|
</td><td headers="hd_h_niceng217er18.tab10_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, imprecision</p>
|
|
</td><td headers="hd_h_niceng217er18.tab10_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>OR 3.30</p>
|
|
<p>(0.5 to 21.78)</p>
|
|
</td></tr><tr><td headers="hd_h_niceng217er18.tab10_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">SUDEP - Female</td><td headers="hd_h_niceng217er18.tab10_1_1_1_2 hd_h_niceng217er18.tab10_1_1_1_3 hd_h_niceng217er18.tab10_1_1_1_4" colspan="3" rowspan="1" style="text-align:left;vertical-align:top;">No tonic – clonic seizures as reference</td></tr><tr><td headers="hd_h_niceng217er18.tab10_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>20</p>
|
|
<p>(1 study)</p>
|
|
<p>1 - 5 years</p>
|
|
</td><td headers="hd_h_niceng217er18.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 risk of bias, indirectness</p>
|
|
</td><td headers="hd_h_niceng217er18.tab10_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>OR 28.00</p>
|
|
<p>(3.8 to 206.31)</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="niceng217er18.tab10_1"><p class="no_margin">Downgraded by 1 increment if the majority of the evidence was at moderate risk of bias, and downgraded by 2 increments if the majority of the evidence was at high risk of bias</p></div></dd></dl><dl class="bkr_refwrap"><dt>2</dt><dd><div id="niceng217er18.tab10_2"><p class="no_margin">Downgraded for indirectness as analysis did not adjust for at least two of the non-modifiable confounders</p></div></dd></dl><dl class="bkr_refwrap"><dt>3</dt><dd><div id="niceng217er18.tab10_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="niceng217er18.tab10_4"><p class="no_margin">Outcomes adjusted for number of seizures (per month) and number of tonic clonic seizures (per year)</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng217er18tab11"><div id="niceng217er18.tab11" class="table"><h3><span class="label">Table 11</span><span class="title">Clinical evidence summary: Seizure frequency</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK586315/table/niceng217er18.tab11/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng217er18.tab11_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng217er18.tab11_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Outcomes</th><th id="hd_h_niceng217er18.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_niceng217er18.tab11_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Quality of the evidence (GRADE)</th><th id="hd_h_niceng217er18.tab11_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Relative effect (95% CI)</th></tr></thead><tbody><tr><td headers="hd_h_niceng217er18.tab11_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">SUDEP</td><td headers="hd_h_niceng217er18.tab11_1_1_1_2 hd_h_niceng217er18.tab11_1_1_1_3 hd_h_niceng217er18.tab11_1_1_1_4" colspan="3" rowspan="1" style="text-align:left;vertical-align:top;">One or less than one seizure compared to over one seizure per month</td></tr><tr><td headers="hd_h_niceng217er18.tab11_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>104</p>
|
|
<p>(1 study)</p>
|
|
<p>>5 years</p>
|
|
</td><td headers="hd_h_niceng217er18.tab11_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_niceng217er18.tab11_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>OR 2.50</p>
|
|
<p>(0.9 to 6.95)</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="niceng217er18.tab11_1"><p class="no_margin">Downgraded by 1 increment if the majority of the evidence was at moderate risk of bias, and downgraded by 2 increments if the majority of the evidence was at high risk of bias</p></div></dd></dl><dl class="bkr_refwrap"><dt>2</dt><dd><div id="niceng217er18.tab11_2"><p class="no_margin">Downgraded for indirectness as analysis did not adjust for at least two of the non-modifiable confounders</p></div></dd></dl><dl class="bkr_refwrap"><dt>3</dt><dd><div id="niceng217er18.tab11_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="niceng217er18.tab11_4"><p class="no_margin">Outcomes adjusted for Age at onset, Duration of disease, Aura, Family history of epilepsy, Psychiatric conditions, Epilepsy classification, Seizure frequency, Seizure related to lesion on MR imaging, Number of ASMs, Type of ASM</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng217er18tab12"><div id="niceng217er18.tab12" class="table"><h3><span class="label">Table 12</span><span class="title">Clinical evidence summary: Number of anti-seizure medications</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK586315/table/niceng217er18.tab12/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng217er18.tab12_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng217er18.tab12_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Outcomes</th><th id="hd_h_niceng217er18.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_niceng217er18.tab12_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Quality of the evidence (GRADE)</th><th id="hd_h_niceng217er18.tab12_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Relative effect (95% CI)</th></tr></thead><tbody><tr><td headers="hd_h_niceng217er18.tab12_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">SUDEP</td><td headers="hd_h_niceng217er18.tab12_1_1_1_2 hd_h_niceng217er18.tab12_1_1_1_3 hd_h_niceng217er18.tab12_1_1_1_4" colspan="3" rowspan="1" style="text-align:left;vertical-align:top;">Less ASM’s compared to more ASM’s</td></tr><tr><td headers="hd_h_niceng217er18.tab12_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>104</p>
|
|
<p>(1 study)</p>
|
|
<p>>5 years</p>
|
|
</td><td headers="hd_h_niceng217er18.tab12_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_niceng217er18.tab12_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>OR 1.80</p>
|
|
<p>(1.1 to 2.95)</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="niceng217er18.tab12_1"><p class="no_margin">Downgraded by 1 increment if the majority of the evidence was at moderate risk of bias, and downgraded by 2 increments if the majority of the evidence was at high risk of bias</p></div></dd></dl><dl class="bkr_refwrap"><dt>2</dt><dd><div id="niceng217er18.tab12_2"><p class="no_margin">Downgraded for indirectness as analysis did not adjust for at least two of the non-modifiable confounders</p></div></dd></dl><dl class="bkr_refwrap"><dt>3</dt><dd><div id="niceng217er18.tab12_3"><p class="no_margin">Outcomes adjusted for Age at onset, Duration of disease, Aura, Family history of epilepsy, Psychiatric conditions, Epilepsy classification, Seizure frequency, Seizure related to lesion on MR imaging, Number of ASMs, Type of ASM</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng217er18tab13"><div id="niceng217er18.tab13" class="table"><h3><span class="label">Table 13</span><span class="title">Clinical evidence summary: Adherence status: Nonadherence of medications</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK586315/table/niceng217er18.tab13/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng217er18.tab13_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng217er18.tab13_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Outcomes</th><th id="hd_h_niceng217er18.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_niceng217er18.tab13_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Quality of the evidence (GRADE)</th><th id="hd_h_niceng217er18.tab13_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Relative effect (95% CI)</th></tr></thead><tbody><tr><td headers="hd_h_niceng217er18.tab13_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">Mortality</td><td headers="hd_h_niceng217er18.tab13_1_1_1_2 hd_h_niceng217er18.tab13_1_1_1_3 hd_h_niceng217er18.tab13_1_1_1_4" colspan="3" rowspan="1" style="text-align:left;vertical-align:top;">Adherence to medication as reference</td></tr><tr><td headers="hd_h_niceng217er18.tab13_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>33,658</p>
|
|
<p>(1 study)</p>
|
|
<p>>5 years</p>
|
|
</td><td headers="hd_h_niceng217er18.tab13_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>⊕⊕⊕⊝</p>
|
|
<p>MODERATE<sup>1</sup><sup>,</sup><sup>2</sup></p>
|
|
<p>due to risk of bias</p>
|
|
</td><td headers="hd_h_niceng217er18.tab13_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>HR 3.32</p>
|
|
<p>(3.11 to 3.54)</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="niceng217er18.tab13_1"><p class="no_margin">Downgraded by 1 increment if the majority of the evidence was at moderate risk of bias, and downgraded by 2 increments if the majority of the evidence was at high risk of bias</p></div></dd></dl><dl class="bkr_refwrap"><dt>2</dt><dd><div id="niceng217er18.tab13_2"><p class="no_margin">Outcomes adjusted for adherence status, gender, age, race, use of ASM polytherapy, epilepsy related comorbidities</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng217er18tab14"><div id="niceng217er18.tab14" class="table"><h3><span class="label">Table 14</span><span class="title">Clinical evidence summary: Adherence status: Untreated Epilepsy</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK586315/table/niceng217er18.tab14/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng217er18.tab14_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng217er18.tab14_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Outcomes</th><th id="hd_h_niceng217er18.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_niceng217er18.tab14_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Quality of the evidence (GRADE)</th><th id="hd_h_niceng217er18.tab14_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Relative effect (95% CI)</th></tr></thead><tbody><tr><td headers="hd_h_niceng217er18.tab14_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">Mortality</td><td headers="hd_h_niceng217er18.tab14_1_1_1_2 hd_h_niceng217er18.tab14_1_1_1_3 hd_h_niceng217er18.tab14_1_1_1_4" colspan="3" rowspan="1" style="text-align:left;vertical-align:top;">Adherence to medication as reference</td></tr><tr><td headers="hd_h_niceng217er18.tab14_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>33,658</p>
|
|
<p>(1 study)</p>
|
|
<p>>5 years</p>
|
|
</td><td headers="hd_h_niceng217er18.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 risk of bias, imprecision</p>
|
|
</td><td headers="hd_h_niceng217er18.tab14_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>HR 0.92</p>
|
|
<p>(0.84 to 1.01)</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="niceng217er18.tab14_1"><p class="no_margin">Downgraded by 1 increment if the majority of the evidence was at moderate risk of bias, and downgraded by 2 increments if the majority of the evidence was at high risk of bias</p></div></dd></dl><dl class="bkr_refwrap"><dt>2</dt><dd><div id="niceng217er18.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="niceng217er18.tab14_3"><p class="no_margin">Outcomes adjusted for adherence status, gender, age, race, use of ASM polytherapy, epilepsy related comorbidities</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng217er18tab15"><div id="niceng217er18.tab15" class="table"><h3><span class="label">Table 15</span><span class="title">Clinical evidence summary: Polytherapy</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK586315/table/niceng217er18.tab15/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng217er18.tab15_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng217er18.tab15_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Outcomes</th><th id="hd_h_niceng217er18.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_niceng217er18.tab15_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Quality of the evidence (GRADE)</th><th id="hd_h_niceng217er18.tab15_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Relative effect (95% CI)</th></tr></thead><tbody><tr><td headers="hd_h_niceng217er18.tab15_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">Mortality</td><td headers="hd_h_niceng217er18.tab15_1_1_1_2 hd_h_niceng217er18.tab15_1_1_1_3 hd_h_niceng217er18.tab15_1_1_1_4" colspan="3" rowspan="1" style="text-align:left;vertical-align:top;">No ASM polytherapy compared to ASM polytherapy</td></tr><tr><td headers="hd_h_niceng217er18.tab15_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>33,658</p>
|
|
<p>(1 study)</p>
|
|
<p>>5 years</p>
|
|
</td><td headers="hd_h_niceng217er18.tab15_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>⊕⊕⊕⊝</p>
|
|
<p>MODERATE<sup>1</sup><sup>,</sup><sup>2</sup></p>
|
|
<p>due to risk of bias</p>
|
|
</td><td headers="hd_h_niceng217er18.tab15_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>HR 0.75</p>
|
|
<p>(0.69 to 0.82)</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="niceng217er18.tab15_1"><p class="no_margin">Downgraded by 1 increment if the majority of the evidence was at moderate risk of bias, and downgraded by 2 increments if the majority of the evidence was at high risk of bias</p></div></dd></dl><dl class="bkr_refwrap"><dt>2</dt><dd><div id="niceng217er18.tab15_2"><p class="no_margin">Outcomes adjusted for adherence status, gender, age, race, use of ASM polytherapy, epilepsy related comorbidities</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng217er18tab16"><div id="niceng217er18.tab16" class="table"><h3><span class="label">Table 16</span><span class="title">Clinical evidence summary: Alzheimer’s Disease</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK586315/table/niceng217er18.tab16/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng217er18.tab16_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng217er18.tab16_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Outcomes</th><th id="hd_h_niceng217er18.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_niceng217er18.tab16_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Quality of the evidence (GRADE)</th><th id="hd_h_niceng217er18.tab16_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Relative effect (95% CI)</th></tr></thead><tbody><tr><td headers="hd_h_niceng217er18.tab16_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">Mortality</td><td headers="hd_h_niceng217er18.tab16_1_1_1_2 hd_h_niceng217er18.tab16_1_1_1_3 hd_h_niceng217er18.tab16_1_1_1_4" colspan="3" rowspan="1" style="text-align:left;vertical-align:top;">No Neurological condition as reference</td></tr><tr><td headers="hd_h_niceng217er18.tab16_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>33,658</p>
|
|
<p>(1 study)</p>
|
|
<p>>5 years</p>
|
|
</td><td headers="hd_h_niceng217er18.tab16_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>⊕⊕⊕⊝</p>
|
|
<p>MODERATE<sup>1</sup><sup>,</sup><sup>2</sup></p>
|
|
<p>due to risk of bias</p>
|
|
</td><td headers="hd_h_niceng217er18.tab16_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>HR 1.7</p>
|
|
<p>(1.54 to 1.88)</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="niceng217er18.tab16_1"><p class="no_margin">Downgraded by 1 increment if the majority of the evidence was at moderate risk of bias, and downgraded by 2 increments if the majority of the evidence was at high risk of bias</p></div></dd></dl><dl class="bkr_refwrap"><dt>2</dt><dd><div id="niceng217er18.tab16_2"><p class="no_margin">Outcomes adjusted for adherence status, gender, age, race, use of ASM polytherapy, epilepsy related comorbidities</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng217er18tab17"><div id="niceng217er18.tab17" class="table"><h3><span class="label">Table 17</span><span class="title">Clinical evidence summary: Brain tumour</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK586315/table/niceng217er18.tab17/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng217er18.tab17_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng217er18.tab17_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Outcomes</th><th id="hd_h_niceng217er18.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_niceng217er18.tab17_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Quality of the evidence (GRADE)</th><th id="hd_h_niceng217er18.tab17_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Relative effect (95% CI)</th></tr></thead><tbody><tr><td headers="hd_h_niceng217er18.tab17_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">Mortality</td><td headers="hd_h_niceng217er18.tab17_1_1_1_2 hd_h_niceng217er18.tab17_1_1_1_3 hd_h_niceng217er18.tab17_1_1_1_4" colspan="3" rowspan="1" style="text-align:left;vertical-align:top;">No Neurological condition as reference</td></tr><tr><td headers="hd_h_niceng217er18.tab17_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>33,658</p>
|
|
<p>(1 study)</p>
|
|
<p>>5 years</p>
|
|
</td><td headers="hd_h_niceng217er18.tab17_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>⊕⊕⊕⊝</p>
|
|
<p>MODERATE<sup>1</sup><sup>,</sup><sup>2</sup></p>
|
|
<p>due to risk of bias</p>
|
|
</td><td headers="hd_h_niceng217er18.tab17_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>HR 1.58</p>
|
|
<p>(1.39 to 1.8)</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="niceng217er18.tab17_1"><p class="no_margin">Downgraded by 1 increment if the majority of the evidence was at moderate risk of bias, and downgraded by 2 increments if the majority of the evidence was at high risk of bias</p></div></dd></dl><dl class="bkr_refwrap"><dt>2</dt><dd><div id="niceng217er18.tab17_2"><p class="no_margin">Outcomes adjusted for adherence status, gender, age, race, use of ASM polytherapy, epilepsy related comorbidities</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng217er18tab18"><div id="niceng217er18.tab18" class="table"><h3><span class="label">Table 18</span><span class="title">Clinical evidence summary: Meningitis</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK586315/table/niceng217er18.tab18/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng217er18.tab18_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng217er18.tab18_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Outcomes</th><th id="hd_h_niceng217er18.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_niceng217er18.tab18_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Quality of the evidence (GRADE)</th><th id="hd_h_niceng217er18.tab18_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Relative effect (95% CI)</th></tr></thead><tbody><tr><td headers="hd_h_niceng217er18.tab18_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">Mortality</td><td headers="hd_h_niceng217er18.tab18_1_1_1_2 hd_h_niceng217er18.tab18_1_1_1_3 hd_h_niceng217er18.tab18_1_1_1_4" colspan="3" rowspan="1" style="text-align:left;vertical-align:top;">No Neurological condition as reference</td></tr><tr><td headers="hd_h_niceng217er18.tab18_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>33,658</p>
|
|
<p>(1 study)</p>
|
|
<p>>5 years</p>
|
|
</td><td headers="hd_h_niceng217er18.tab18_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>⊕⊕⊕⊝</p>
|
|
<p>MODERATE<sup>1</sup><sup>,</sup><sup>2</sup></p>
|
|
<p>due to risk of bias</p>
|
|
</td><td headers="hd_h_niceng217er18.tab18_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>HR 1.34</p>
|
|
<p>(1.08 to 1.66)</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="niceng217er18.tab18_1"><p class="no_margin">Downgraded by 1 increment if the majority of the evidence was at moderate risk of bias, and downgraded by 2 increments if the majority of the evidence was at high risk of bias</p></div></dd></dl><dl class="bkr_refwrap"><dt>2</dt><dd><div id="niceng217er18.tab18_2"><p class="no_margin">Outcomes adjusted for adherence status, gender, age, race, use of ASM polytherapy, epilepsy related comorbidities</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng217er18tab19"><div id="niceng217er18.tab19" class="table"><h3><span class="label">Table 19</span><span class="title">Clinical evidence summary: Stroke</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK586315/table/niceng217er18.tab19/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng217er18.tab19_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng217er18.tab19_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Outcomes</th><th id="hd_h_niceng217er18.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_niceng217er18.tab19_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Quality of the evidence (GRADE)</th><th id="hd_h_niceng217er18.tab19_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Relative effect (95% CI)</th></tr></thead><tbody><tr><td headers="hd_h_niceng217er18.tab19_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">Mortality</td><td headers="hd_h_niceng217er18.tab19_1_1_1_2 hd_h_niceng217er18.tab19_1_1_1_3 hd_h_niceng217er18.tab19_1_1_1_4" colspan="3" rowspan="1" style="text-align:left;vertical-align:top;">No Neurological condition as reference</td></tr><tr><td headers="hd_h_niceng217er18.tab19_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>33,658</p>
|
|
<p>(1 study)</p>
|
|
<p>>5 years</p>
|
|
</td><td headers="hd_h_niceng217er18.tab19_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>⊕⊕⊕⊝</p>
|
|
<p>MODERATE<sup>1</sup><sup>,</sup><sup>2</sup></p>
|
|
<p>due to risk of bias</p>
|
|
</td><td headers="hd_h_niceng217er18.tab19_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>HR 1.3</p>
|
|
<p>(1.22 to 1.39)</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="niceng217er18.tab19_1"><p class="no_margin">Downgraded by 1 increment if the majority of the evidence was at moderate risk of bias, and downgraded by 2 increments if the majority of the evidence was at high risk of bias</p></div></dd></dl><dl class="bkr_refwrap"><dt>2</dt><dd><div id="niceng217er18.tab19_2"><p class="no_margin">Outcomes adjusted for adherence status, gender, age, race, use of ASM polytherapy, epilepsy related comorbidities</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng217er18tab20"><div id="niceng217er18.tab20" class="table"><h3><span class="label">Table 20</span><span class="title">Clinical evidence summary: Charlson Comorbidity Index</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK586315/table/niceng217er18.tab20/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng217er18.tab20_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng217er18.tab20_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Outcomes</th><th id="hd_h_niceng217er18.tab20_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_niceng217er18.tab20_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Quality of the evidence (GRADE)</th><th id="hd_h_niceng217er18.tab20_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Relative effect (95% CI)</th></tr></thead><tbody><tr><td headers="hd_h_niceng217er18.tab20_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">Mortality</td><td headers="hd_h_niceng217er18.tab20_1_1_1_2 hd_h_niceng217er18.tab20_1_1_1_3 hd_h_niceng217er18.tab20_1_1_1_4" colspan="3" rowspan="1" style="text-align:left;vertical-align:top;">Lower CCI compared to higher CCI</td></tr><tr><td headers="hd_h_niceng217er18.tab20_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>33,658</p>
|
|
<p>(1 study)</p>
|
|
<p>>5 years</p>
|
|
</td><td headers="hd_h_niceng217er18.tab20_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>⊕⊕⊕⊝</p>
|
|
<p>MODERATE<sup>1</sup><sup>,</sup><sup>2</sup></p>
|
|
<p>due to risk of bias</p>
|
|
</td><td headers="hd_h_niceng217er18.tab20_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>HR 1.19</p>
|
|
<p>(1.18 to 1.2)</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="niceng217er18.tab20_1"><p class="no_margin">Downgraded by 1 increment if the majority of the evidence was at moderate risk of bias, and downgraded by 2 increments if the majority of the evidence was at high risk of bias</p></div></dd></dl><dl class="bkr_refwrap"><dt>2</dt><dd><div id="niceng217er18.tab20_2"><p class="no_margin">Outcomes adjusted for adherence status, gender, age, race, use of ASM polytherapy, epilepsy related comorbidities</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng217er18tab21"><div id="niceng217er18.tab21" class="table"><h3><span class="label">Table 21</span><span class="title">Clinical evidence summary: CNS infections</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK586315/table/niceng217er18.tab21/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng217er18.tab21_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng217er18.tab21_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Outcomes</th><th id="hd_h_niceng217er18.tab21_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_niceng217er18.tab21_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Quality of the evidence (GRADE)</th><th id="hd_h_niceng217er18.tab21_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Relative effect (95% CI)</th></tr></thead><tbody><tr><td headers="hd_h_niceng217er18.tab21_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">Mortality</td><td headers="hd_h_niceng217er18.tab21_1_1_1_2 hd_h_niceng217er18.tab21_1_1_1_3 hd_h_niceng217er18.tab21_1_1_1_4" colspan="3" rowspan="1" style="text-align:left;vertical-align:top;">No CNS infection as reference</td></tr><tr><td headers="hd_h_niceng217er18.tab21_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>456</p>
|
|
<p>(1 study)</p>
|
|
<p>1 - 5 years</p>
|
|
</td><td headers="hd_h_niceng217er18.tab21_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_niceng217er18.tab21_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>OR 6.10</p>
|
|
<p>(4.1 to 9.08)</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="niceng217er18.tab21_1"><p class="no_margin">Downgraded by 1 increment if the majority of the evidence was at moderate risk of bias, and downgraded by 2 increments if the majority of the evidence was at high risk of bias</p></div></dd></dl><dl class="bkr_refwrap"><dt>2</dt><dd><div id="niceng217er18.tab21_2"><p class="no_margin">Downgraded for indirectness as analysis did not adjust for at least two of the non-modifiable confounders</p></div></dd></dl><dl class="bkr_refwrap"><dt>3</dt><dd><div id="niceng217er18.tab21_3"><p class="no_margin">Outcomes adjusted for age, gender, CNS infections, metastatic cancer, renal disease, solid tumours without metastasis, anoxic brain injury, cardiac arrhythmias, encephalopathy, depression, paraplegia, diabetes without complications, peripheral vascular disease, traumatic brain and head injuries</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng217er18tab22"><div id="niceng217er18.tab22" class="table"><h3><span class="label">Table 22</span><span class="title">Clinical evidence summary: Metastatic Cancer</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK586315/table/niceng217er18.tab22/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng217er18.tab22_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng217er18.tab22_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Outcomes</th><th id="hd_h_niceng217er18.tab22_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_niceng217er18.tab22_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Quality of the evidence (GRADE)</th><th id="hd_h_niceng217er18.tab22_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Relative effect (95% CI)</th></tr></thead><tbody><tr><td headers="hd_h_niceng217er18.tab22_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">Mortality</td><td headers="hd_h_niceng217er18.tab22_1_1_1_2 hd_h_niceng217er18.tab22_1_1_1_3 hd_h_niceng217er18.tab22_1_1_1_4" colspan="3" rowspan="1" style="text-align:left;vertical-align:top;">No metastatic cancer as reference</td></tr><tr><td headers="hd_h_niceng217er18.tab22_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>456</p>
|
|
<p>(1 study)</p>
|
|
<p>1 - 5 years</p>
|
|
</td><td headers="hd_h_niceng217er18.tab22_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_niceng217er18.tab22_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>OR 3.70</p>
|
|
<p>(2.2 to 6.22)</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="niceng217er18.tab22_1"><p class="no_margin">Downgraded by 1 increment if the majority of the evidence was at moderate risk of bias, and downgraded by 2 increments if the majority of the evidence was at high risk of bias</p></div></dd></dl><dl class="bkr_refwrap"><dt>2</dt><dd><div id="niceng217er18.tab22_2"><p class="no_margin">Downgraded for indirectness as analysis did not adjust for at least two of the non-modifiable confounders</p></div></dd></dl><dl class="bkr_refwrap"><dt>3</dt><dd><div id="niceng217er18.tab22_3"><p class="no_margin">Outcomes adjusted for age, gender, CNS infections, metastatic cancer, renal disease, solid tumours without metastasis, anoxic brain injury, cardiac arrhythmias, encephalopathy, depression, paraplegia, diabetes without complications, peripheral vascular disease, traumatic brain and head injuries</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng217er18tab23"><div id="niceng217er18.tab23" class="table"><h3><span class="label">Table 23</span><span class="title">Clinical evidence summary: Solid Tumour (no metastasis)</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK586315/table/niceng217er18.tab23/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng217er18.tab23_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng217er18.tab23_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Outcomes</th><th id="hd_h_niceng217er18.tab23_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_niceng217er18.tab23_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Quality of the evidence (GRADE)</th><th id="hd_h_niceng217er18.tab23_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Relative effect (95% CI)</th></tr></thead><tbody><tr><td headers="hd_h_niceng217er18.tab23_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">Mortality</td><td headers="hd_h_niceng217er18.tab23_1_1_1_2 hd_h_niceng217er18.tab23_1_1_1_3 hd_h_niceng217er18.tab23_1_1_1_4" colspan="3" rowspan="1" style="text-align:left;vertical-align:top;">No solid tumour as reference</td></tr><tr><td headers="hd_h_niceng217er18.tab23_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>456</p>
|
|
<p>(1 study)</p>
|
|
<p>1 - 5 years</p>
|
|
</td><td headers="hd_h_niceng217er18.tab23_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_niceng217er18.tab23_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>OR 2.0</p>
|
|
<p>(1.1 to 3.64)</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="niceng217er18.tab23_1"><p class="no_margin">Downgraded by 1 increment if the majority of the evidence was at moderate risk of bias, and downgraded by 2 increments if the majority of the evidence was at high risk of bias</p></div></dd></dl><dl class="bkr_refwrap"><dt>2</dt><dd><div id="niceng217er18.tab23_2"><p class="no_margin">Downgraded for indirectness as analysis did not adjust for at least two of the non-modifiable confounders</p></div></dd></dl><dl class="bkr_refwrap"><dt>3</dt><dd><div id="niceng217er18.tab23_3"><p class="no_margin">Outcomes adjusted for age, gender, CNS infections, metastatic cancer, renal disease, solid tumours without metastasis, anoxic brain injury, cardiac arrhythmias, encephalopathy, depression, paraplegia, diabetes without complications, peripheral vascular disease, traumatic brain and head injuries</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng217er18tab24"><div id="niceng217er18.tab24" class="table"><h3><span class="label">Table 24</span><span class="title">Clinical evidence summary: Depression</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK586315/table/niceng217er18.tab24/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng217er18.tab24_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng217er18.tab24_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Outcomes</th><th id="hd_h_niceng217er18.tab24_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_niceng217er18.tab24_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Quality of the evidence (GRADE)</th><th id="hd_h_niceng217er18.tab24_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Relative effect (95% CI)</th></tr></thead><tbody><tr><td headers="hd_h_niceng217er18.tab24_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">Mortality</td><td headers="hd_h_niceng217er18.tab24_1_1_1_2 hd_h_niceng217er18.tab24_1_1_1_3 hd_h_niceng217er18.tab24_1_1_1_4" colspan="3" rowspan="1" style="text-align:left;vertical-align:top;">No depression as reference</td></tr><tr><td headers="hd_h_niceng217er18.tab24_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>456</p>
|
|
<p>(1 study)</p>
|
|
<p>1 - 5 years</p>
|
|
</td><td headers="hd_h_niceng217er18.tab24_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_niceng217er18.tab24_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">OR 0.20 (0.1 to 0.4)</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="niceng217er18.tab24_1"><p class="no_margin">Downgraded by 1 increment if the majority of the evidence was at moderate risk of bias, and downgraded by 2 increments if the majority of the evidence was at high risk of bias</p></div></dd></dl><dl class="bkr_refwrap"><dt>2</dt><dd><div id="niceng217er18.tab24_2"><p class="no_margin">Downgraded for indirectness as analysis did not adjust for at least two of the non-modifiable confounders</p></div></dd></dl><dl class="bkr_refwrap"><dt>3</dt><dd><div id="niceng217er18.tab24_3"><p class="no_margin">Outcomes adjusted for age, gender, CNS infections, metastatic cancer, renal disease, solid tumours without metastasis, anoxic brain injury, cardiac arrhythmias, encephalopathy, depression, paraplegia, diabetes without complications, peripheral vascular disease, traumatic brain and head injuries</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng217er18tab25"><div id="niceng217er18.tab25" class="table"><h3><span class="label">Table 25</span><span class="title">Clinical evidence summary: Diabetes (no complications)</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK586315/table/niceng217er18.tab25/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng217er18.tab25_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng217er18.tab25_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Outcomes</th><th id="hd_h_niceng217er18.tab25_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_niceng217er18.tab25_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Quality of the evidence (GRADE)</th><th id="hd_h_niceng217er18.tab25_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Relative effect (95% CI)</th></tr></thead><tbody><tr><td headers="hd_h_niceng217er18.tab25_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">Mortality</td><td headers="hd_h_niceng217er18.tab25_1_1_1_2 hd_h_niceng217er18.tab25_1_1_1_3 hd_h_niceng217er18.tab25_1_1_1_4" colspan="3" rowspan="1" style="text-align:left;vertical-align:top;">No diabetes as reference</td></tr><tr><td headers="hd_h_niceng217er18.tab25_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>456</p>
|
|
<p>(1 study)</p>
|
|
<p>1 - 5 years</p>
|
|
</td><td headers="hd_h_niceng217er18.tab25_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_niceng217er18.tab25_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>OR 1.40</p>
|
|
<p>(1 to 1.96)</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="niceng217er18.tab25_1"><p class="no_margin">Downgraded by 1 increment if the majority of the evidence was at moderate risk of bias, and downgraded by 2 increments if the majority of the evidence was at high risk of bias</p></div></dd></dl><dl class="bkr_refwrap"><dt>2</dt><dd><div id="niceng217er18.tab25_2"><p class="no_margin">Downgraded for indirectness as analysis did not adjust for at least two of the non-modifiable confounders</p></div></dd></dl><dl class="bkr_refwrap"><dt>3</dt><dd><div id="niceng217er18.tab25_3"><p class="no_margin">Outcomes adjusted for age, gender, CNS infections, metastatic cancer, renal disease, solid tumours without metastasis, anoxic brain injury, cardiac arrhythmias, encephalopathy, depression, paraplegia, diabetes without complications, peripheral vascular disease, traumatic brain and head injuries</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng217er18tab26"><div id="niceng217er18.tab26" class="table"><h3><span class="label">Table 26</span><span class="title">Clinical evidence summary: Peripheral vascular disease</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK586315/table/niceng217er18.tab26/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng217er18.tab26_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng217er18.tab26_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Outcomes</th><th id="hd_h_niceng217er18.tab26_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_niceng217er18.tab26_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Quality of the evidence (GRADE)</th><th id="hd_h_niceng217er18.tab26_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Relative effect (95% CI)</th></tr></thead><tbody><tr><td headers="hd_h_niceng217er18.tab26_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">Mortality</td><td headers="hd_h_niceng217er18.tab26_1_1_1_2 hd_h_niceng217er18.tab26_1_1_1_3 hd_h_niceng217er18.tab26_1_1_1_4" colspan="3" rowspan="1" style="text-align:left;vertical-align:top;">No peripheral vascular disease as reference</td></tr><tr><td headers="hd_h_niceng217er18.tab26_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>456</p>
|
|
<p>(1 study)</p>
|
|
<p>1 - 5 years</p>
|
|
</td><td headers="hd_h_niceng217er18.tab26_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_niceng217er18.tab26_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>OR 0.50</p>
|
|
<p>(0.3 to 0.83)</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="niceng217er18.tab26_1"><p class="no_margin">Downgraded by 1 increment if the majority of the evidence was at moderate risk of bias, and downgraded by 2 increments if the majority of the evidence was at high risk of bias</p></div></dd></dl><dl class="bkr_refwrap"><dt>2</dt><dd><div id="niceng217er18.tab26_2"><p class="no_margin">Downgraded for indirectness as analysis did not adjust for at least two of the non-modifiable confounders</p></div></dd></dl><dl class="bkr_refwrap"><dt>3</dt><dd><div id="niceng217er18.tab26_3"><p class="no_margin">Outcomes adjusted for age, gender, CNS infections, metastatic cancer, renal disease, solid tumours without metastasis, anoxic brain injury, cardiac arrhythmias, encephalopathy, depression, paraplegia, diabetes without complications, peripheral vascular disease, traumatic brain and head injuries</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng217er18tab27"><div id="niceng217er18.tab27" class="table"><h3><span class="label">Table 27</span><span class="title">Clinical evidence summary: Traumatic brain and head injury</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK586315/table/niceng217er18.tab27/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng217er18.tab27_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng217er18.tab27_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Outcomes</th><th id="hd_h_niceng217er18.tab27_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_niceng217er18.tab27_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Quality of the evidence (GRADE)</th><th id="hd_h_niceng217er18.tab27_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Relative effect (95% CI)</th></tr></thead><tbody><tr><td headers="hd_h_niceng217er18.tab27_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">Mortality</td><td headers="hd_h_niceng217er18.tab27_1_1_1_2 hd_h_niceng217er18.tab27_1_1_1_3 hd_h_niceng217er18.tab27_1_1_1_4" colspan="3" rowspan="1" style="text-align:left;vertical-align:top;">No traumatic brain and head injury as reference</td></tr><tr><td headers="hd_h_niceng217er18.tab27_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>456</p>
|
|
<p>(1 study)</p>
|
|
<p>1 - 5 years</p>
|
|
</td><td headers="hd_h_niceng217er18.tab27_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_niceng217er18.tab27_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>OR 5.10</p>
|
|
<p>(2.8 to 9.29)</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="niceng217er18.tab27_1"><p class="no_margin">Downgraded by 1 increment if the majority of the evidence was at moderate risk of bias, and downgraded by 2 increments if the majority of the evidence was at high risk of bias</p></div></dd></dl><dl class="bkr_refwrap"><dt>2</dt><dd><div id="niceng217er18.tab27_2"><p class="no_margin">Downgraded for indirectness as analysis did not adjust for at least two of the non-modifiable confounders</p></div></dd></dl><dl class="bkr_refwrap"><dt>3</dt><dd><div id="niceng217er18.tab27_3"><p class="no_margin">Outcomes adjusted for age, gender, CNS infections, metastatic cancer, renal disease, solid tumours without metastasis, anoxic brain injury, cardiac arrhythmias, encephalopathy, depression, paraplegia, diabetes without complications, peripheral vascular disease, traumatic brain and head injuries</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng217er18tab28"><div id="niceng217er18.tab28" class="table"><h3><span class="label">Table 28</span><span class="title">Clinical evidence summary: Abnormal neurological examination</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK586315/table/niceng217er18.tab28/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng217er18.tab28_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng217er18.tab28_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Outcomes</th><th id="hd_h_niceng217er18.tab28_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_niceng217er18.tab28_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Quality of the evidence (GRADE)</th><th id="hd_h_niceng217er18.tab28_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Relative effect (95% CI)</th></tr></thead><tbody><tr><td headers="hd_h_niceng217er18.tab28_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">Mortality</td><td headers="hd_h_niceng217er18.tab28_1_1_1_2 hd_h_niceng217er18.tab28_1_1_1_3 hd_h_niceng217er18.tab28_1_1_1_4" colspan="3" rowspan="1" style="text-align:left;vertical-align:top;">Normal neurological examination as reference</td></tr><tr><td headers="hd_h_niceng217er18.tab28_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>467</p>
|
|
<p>(1 study)</p>
|
|
<p>>5 years</p>
|
|
</td><td headers="hd_h_niceng217er18.tab28_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_niceng217er18.tab28_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>HR 12.80</p>
|
|
<p>(1.4 to 116.96)</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="niceng217er18.tab28_1"><p class="no_margin">Downgraded for indirectness as analysis did not adjust for at least two of the non-modifiable confounders</p></div></dd></dl><dl class="bkr_refwrap"><dt>2</dt><dd><div id="niceng217er18.tab28_2"><p class="no_margin">Downgraded by 1 increment if the majority of the evidence was at moderate risk of bias, and downgraded by 2 increments if the majority of the evidence was at high risk of bias</p></div></dd></dl><dl class="bkr_refwrap"><dt>3</dt><dd><div id="niceng217er18.tab28_3"><p class="no_margin">Adjusted for neurologic examination, cognitive function, previous status epilepticus, mode of onset, aetiology, usage of ≥ 2 ASM’s, seizure frequency, intractable at last follow up</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng217er18tab29"><div id="niceng217er18.tab29" class="table"><h3><span class="label">Table 29</span><span class="title">Clinical evidence summary: Abnormal cognitive function</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK586315/table/niceng217er18.tab29/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng217er18.tab29_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng217er18.tab29_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Outcomes</th><th id="hd_h_niceng217er18.tab29_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_niceng217er18.tab29_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Quality of the evidence (GRADE)</th><th id="hd_h_niceng217er18.tab29_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Relative effect (95% CI)</th></tr></thead><tbody><tr><td headers="hd_h_niceng217er18.tab29_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">Mortality</td><td headers="hd_h_niceng217er18.tab29_1_1_1_2 hd_h_niceng217er18.tab29_1_1_1_3 hd_h_niceng217er18.tab29_1_1_1_4" colspan="3" rowspan="1" style="text-align:left;vertical-align:top;">Normal cognitive function as reference</td></tr><tr><td headers="hd_h_niceng217er18.tab29_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>467</p>
|
|
<p>(1 study)</p>
|
|
<p>>5 years</p>
|
|
</td><td headers="hd_h_niceng217er18.tab29_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_niceng217er18.tab29_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>HR 3.78</p>
|
|
<p>(0.42 to 34.02)</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="niceng217er18.tab29_1"><p class="no_margin">Downgraded for indirectness as analysis did not adjust for at least two of the non-modifiable confounders</p></div></dd></dl><dl class="bkr_refwrap"><dt>2</dt><dd><div id="niceng217er18.tab29_2"><p class="no_margin">Downgraded by 1 increment if the majority of the evidence was at moderate risk of bias, and downgraded by 2 increments if the majority of the evidence was at high risk of bias</p></div></dd></dl><dl class="bkr_refwrap"><dt>3</dt><dd><div id="niceng217er18.tab29_3"><p class="no_margin">Adjusted for neurologic examination, cognitive function, previous status epilepticus, mode of onset, aetiology, usage of ≥ 2 ASM’s, seizure frequency, intractable at last follow up</p></div></dd></dl><dl class="bkr_refwrap"><dt>4</dt><dd><div id="niceng217er18.tab29_4"><p class="no_margin">Unclear which factors were adjusted for in the multivariate analysis</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng217er18tab30"><div id="niceng217er18.tab30" class="table"><h3><span class="label">Table 30</span><span class="title">Clinical evidence summary: Status Epilepticus (ever)</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK586315/table/niceng217er18.tab30/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng217er18.tab30_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng217er18.tab30_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Outcomes</th><th id="hd_h_niceng217er18.tab30_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_niceng217er18.tab30_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Quality of the evidence (GRADE)</th><th id="hd_h_niceng217er18.tab30_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Relative effect (95% CI)</th></tr></thead><tbody><tr><td headers="hd_h_niceng217er18.tab30_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">Mortality</td><td headers="hd_h_niceng217er18.tab30_1_1_1_2 hd_h_niceng217er18.tab30_1_1_1_3 hd_h_niceng217er18.tab30_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_niceng217er18.tab30_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>467</p>
|
|
<p>(1 study)</p>
|
|
<p>>5 years</p>
|
|
</td><td headers="hd_h_niceng217er18.tab30_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_niceng217er18.tab30_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>HR 1.34</p>
|
|
<p>(0.48 to 3.74)</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="niceng217er18.tab30_1"><p class="no_margin">Downgraded for indirectness as analysis did not adjust for at least two of the non-modifiable confounders</p></div></dd></dl><dl class="bkr_refwrap"><dt>2</dt><dd><div id="niceng217er18.tab30_2"><p class="no_margin">Downgraded by 1 increment if the majority of the evidence was at moderate risk of bias, and downgraded by 2 increments if the majority of the evidence was at high risk of bias</p></div></dd></dl><dl class="bkr_refwrap"><dt>3</dt><dd><div id="niceng217er18.tab30_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="niceng217er18.tab30_4"><p class="no_margin">Adjusted for neurologic examination, cognitive function, previous status epilepticus, mode of onset, aetiology, usage of ≥ 2 ASM’s, seizure frequency, intractable at last follow up</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng217er18tab31"><div id="niceng217er18.tab31" class="table"><h3><span class="label">Table 31</span><span class="title">Clinical evidence summary: Metabolic / Structural Aetiology</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK586315/table/niceng217er18.tab31/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng217er18.tab31_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng217er18.tab31_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Outcomes</th><th id="hd_h_niceng217er18.tab31_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_niceng217er18.tab31_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Quality of the evidence (GRADE)</th><th id="hd_h_niceng217er18.tab31_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Relative effect (95% CI)</th></tr></thead><tbody><tr><td headers="hd_h_niceng217er18.tab31_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">Mortality</td><td headers="hd_h_niceng217er18.tab31_1_1_1_2 hd_h_niceng217er18.tab31_1_1_1_3 hd_h_niceng217er18.tab31_1_1_1_4" colspan="3" rowspan="1" style="text-align:left;vertical-align:top;">No metabolic / structural aetiology as reference</td></tr><tr><td headers="hd_h_niceng217er18.tab31_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>467</p>
|
|
<p>(1 study)</p>
|
|
<p>>5 years</p>
|
|
</td><td headers="hd_h_niceng217er18.tab31_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_niceng217er18.tab31_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>HR 2.62</p>
|
|
<p>(0.69 to 9.95)</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="niceng217er18.tab31_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="niceng217er18.tab31_2"><p class="no_margin">Downgraded for indirectness as analysis did not adjust for at least two of the non-modifiable confounders</p></div></dd></dl><dl class="bkr_refwrap"><dt>3</dt><dd><div id="niceng217er18.tab31_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="niceng217er18.tab31_4"><p class="no_margin">Adjusted for neurologic examination, cognitive function, previous status epilepticus, mode of onset, aetiology, usage of ≥ 2 ASM’s, seizure frequency, intractable at last follow up</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng217er18tab32"><div id="niceng217er18.tab32" class="table"><h3><span class="label">Table 32</span><span class="title">Clinical evidence summary: Tumour aetiology</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK586315/table/niceng217er18.tab32/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng217er18.tab32_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng217er18.tab32_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Outcomes</th><th id="hd_h_niceng217er18.tab32_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_niceng217er18.tab32_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Quality of the evidence (GRADE)</th><th id="hd_h_niceng217er18.tab32_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Relative effect (95% CI)</th></tr></thead><tbody><tr><td headers="hd_h_niceng217er18.tab32_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">Mortality</td><td headers="hd_h_niceng217er18.tab32_1_1_1_2 hd_h_niceng217er18.tab32_1_1_1_3 hd_h_niceng217er18.tab32_1_1_1_4" colspan="3" rowspan="1" style="text-align:left;vertical-align:top;">Cryptogenic aetiology as reference</td></tr><tr><td headers="hd_h_niceng217er18.tab32_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>263</p>
|
|
<p>(1 study)</p>
|
|
<p>1 - 5 years</p>
|
|
</td><td headers="hd_h_niceng217er18.tab32_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>⊕⊕⊕⊝</p>
|
|
<p>MODERATE<sup>1</sup></p>
|
|
<p>due to risk of bias</p>
|
|
</td><td headers="hd_h_niceng217er18.tab32_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>HR 4.67</p>
|
|
<p>(1.76 to 12.39)</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="niceng217er18.tab32_1"><p class="no_margin">Downgraded by 1 increment if the majority of the evidence was at moderate risk of bias, and downgraded by 2 increments if the majority of the evidence was at high risk of bias</p></div></dd></dl><dl class="bkr_refwrap"><dt>2</dt><dd><div id="niceng217er18.tab32_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="niceng217er18.tab32_3"><p class="no_margin">Adjusted for age of onset, frequency, imaging, type of seizure, aetiology, medication, age, gender</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng217er18tab33"><div id="niceng217er18.tab33" class="table"><h3><span class="label">Table 33</span><span class="title">Clinical evidence summary: Vascular lesion aetiology</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK586315/table/niceng217er18.tab33/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng217er18.tab33_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng217er18.tab33_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Outcomes</th><th id="hd_h_niceng217er18.tab33_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_niceng217er18.tab33_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Quality of the evidence (GRADE)</th><th id="hd_h_niceng217er18.tab33_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Relative effect (95% CI)</th></tr></thead><tbody><tr><td headers="hd_h_niceng217er18.tab33_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">Mortality</td><td headers="hd_h_niceng217er18.tab33_1_1_1_2 hd_h_niceng217er18.tab33_1_1_1_3 hd_h_niceng217er18.tab33_1_1_1_4" colspan="3" rowspan="1" style="text-align:left;vertical-align:top;">Cryptogenic aetiology as reference</td></tr><tr><td headers="hd_h_niceng217er18.tab33_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>263</p>
|
|
<p>(1 study)</p>
|
|
<p>1 - 5 years</p>
|
|
</td><td headers="hd_h_niceng217er18.tab33_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, imprecision</p>
|
|
</td><td headers="hd_h_niceng217er18.tab33_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>HR 1.37</p>
|
|
<p>(0.46 to 4.08)</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="niceng217er18.tab33_1"><p class="no_margin">Downgraded by 1 increment if the majority of the evidence was at moderate risk of bias, and downgraded by 2 increments if the majority of the evidence was at high risk of bias</p></div></dd></dl><dl class="bkr_refwrap"><dt>2</dt><dd><div id="niceng217er18.tab33_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="niceng217er18.tab33_3"><p class="no_margin">Adjusted for age of onset, frequency, imaging, type of seizure, aetiology, medication, age, gender</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng217er18tab34"><div id="niceng217er18.tab34" class="table"><h3><span class="label">Table 34</span><span class="title">Clinical evidence summary: Trauma aetiology</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK586315/table/niceng217er18.tab34/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng217er18.tab34_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng217er18.tab34_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Outcomes</th><th id="hd_h_niceng217er18.tab34_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_niceng217er18.tab34_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Quality of the evidence (GRADE)</th><th id="hd_h_niceng217er18.tab34_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Relative effect (95% CI)</th></tr></thead><tbody><tr><td headers="hd_h_niceng217er18.tab34_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">Mortality</td><td headers="hd_h_niceng217er18.tab34_1_1_1_2 hd_h_niceng217er18.tab34_1_1_1_3 hd_h_niceng217er18.tab34_1_1_1_4" colspan="3" rowspan="1" style="text-align:left;vertical-align:top;">Cryptogenic aetiology as reference</td></tr><tr><td headers="hd_h_niceng217er18.tab34_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>263</p>
|
|
<p>(1 study)</p>
|
|
<p>1 - 5 years</p>
|
|
</td><td headers="hd_h_niceng217er18.tab34_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, imprecision</p>
|
|
</td><td headers="hd_h_niceng217er18.tab34_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>HR 0.81</p>
|
|
<p>(0.22 to 2.98)</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="niceng217er18.tab34_1"><p class="no_margin">Downgraded by 1 increment if the majority of the evidence was at moderate risk of bias, and downgraded by 2 increments if the majority of the evidence was at high risk of bias</p></div></dd></dl><dl class="bkr_refwrap"><dt>2</dt><dd><div id="niceng217er18.tab34_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="niceng217er18.tab34_3"><p class="no_margin">Adjusted for age of onset, frequency, imaging, type of seizure, aetiology, medication, age, gender</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng217er18tab35"><div id="niceng217er18.tab35" class="table"><h3><span class="label">Table 35</span><span class="title">Clinical evidence summary: Infection aetiology</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK586315/table/niceng217er18.tab35/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng217er18.tab35_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng217er18.tab35_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Outcomes</th><th id="hd_h_niceng217er18.tab35_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_niceng217er18.tab35_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Quality of the evidence (GRADE)</th><th id="hd_h_niceng217er18.tab35_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Relative effect (95% CI)</th></tr></thead><tbody><tr><td headers="hd_h_niceng217er18.tab35_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">Mortality</td><td headers="hd_h_niceng217er18.tab35_1_1_1_2 hd_h_niceng217er18.tab35_1_1_1_3 hd_h_niceng217er18.tab35_1_1_1_4" colspan="3" rowspan="1" style="text-align:left;vertical-align:top;">Cryptogenic aetiology as reference</td></tr><tr><td headers="hd_h_niceng217er18.tab35_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>263</p>
|
|
<p>(1 study)</p>
|
|
<p>1 - 5 years</p>
|
|
</td><td headers="hd_h_niceng217er18.tab35_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, imprecision</p>
|
|
</td><td headers="hd_h_niceng217er18.tab35_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>HR 1.18</p>
|
|
<p>(0.15 to 9.28)</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="niceng217er18.tab35_1"><p class="no_margin">Downgraded by 1 increment if the majority of the evidence was at moderate risk of bias, and downgraded by 2 increments if the majority of the evidence was at high risk of bias</p></div></dd></dl><dl class="bkr_refwrap"><dt>2</dt><dd><div id="niceng217er18.tab35_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="niceng217er18.tab35_3"><p class="no_margin">Adjusted for age of onset, frequency, imaging, type of seizure, aetiology, medication, age, gender</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng217er18tab36"><div id="niceng217er18.tab36" class="table"><h3><span class="label">Table 36</span><span class="title">Clinical evidence summary: Seizure frequency - >10 seizures per year (at baseline)</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK586315/table/niceng217er18.tab36/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng217er18.tab36_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng217er18.tab36_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Outcomes</th><th id="hd_h_niceng217er18.tab36_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_niceng217er18.tab36_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Quality of the evidence (GRADE)</th><th id="hd_h_niceng217er18.tab36_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Relative effect (95% CI)</th></tr></thead><tbody><tr><td headers="hd_h_niceng217er18.tab36_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">probable SUDEP</td><td headers="hd_h_niceng217er18.tab36_1_1_1_2 hd_h_niceng217er18.tab36_1_1_1_3 hd_h_niceng217er18.tab36_1_1_1_4" colspan="3" rowspan="1" style="text-align:left;vertical-align:top;">≤Ten seizures per year as reference</td></tr><tr><td headers="hd_h_niceng217er18.tab36_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>35</p>
|
|
<p>(1 study)</p>
|
|
<p>>5 years</p>
|
|
</td><td headers="hd_h_niceng217er18.tab36_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, imprecision</p>
|
|
</td><td headers="hd_h_niceng217er18.tab36_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>OR 5.90</p>
|
|
<p>(2.2 to 15.82)</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="niceng217er18.tab36_1"><p class="no_margin">Downgraded by 1 increment if the majority of the evidence was at moderate risk of bias, and downgraded by 2 increments if the majority of the evidence was at high risk of bias</p></div></dd></dl><dl class="bkr_refwrap"><dt>2</dt><dd><div id="niceng217er18.tab36_2"><p class="no_margin">Downgraded for indirectness as analysis did not adjust for at least two of the non-modifiable confounders</p></div></dd></dl><dl class="bkr_refwrap"><dt>3</dt><dd><div id="niceng217er18.tab36_3"><p class="no_margin">Adjusted for age at onset, duration of epilepsy, type of epilepsy, causes of epilepsy, living conditions, highest education</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng217er18tab37"><div id="niceng217er18.tab37" class="table"><h3><span class="label">Table 37</span><span class="title">Clinical evidence summary: Seizures prior to SUDEP</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK586315/table/niceng217er18.tab37/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng217er18.tab37_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng217er18.tab37_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Outcomes</th><th id="hd_h_niceng217er18.tab37_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_niceng217er18.tab37_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Quality of the evidence (GRADE)</th><th id="hd_h_niceng217er18.tab37_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Relative effect (95% CI)</th></tr></thead><tbody><tr><td headers="hd_h_niceng217er18.tab37_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">probable SUDEP</td><td headers="hd_h_niceng217er18.tab37_1_1_1_2 hd_h_niceng217er18.tab37_1_1_1_3 hd_h_niceng217er18.tab37_1_1_1_4" colspan="3" rowspan="1" style="text-align:left;vertical-align:top;">Seizure free prior to SUDEP as reference</td></tr><tr><td headers="hd_h_niceng217er18.tab37_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>35</p>
|
|
<p>(1 study)</p>
|
|
<p>>5 years</p>
|
|
</td><td headers="hd_h_niceng217er18.tab37_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_niceng217er18.tab37_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>OR 9.50</p>
|
|
<p>(3 to 30.08)</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="niceng217er18.tab37_1"><p class="no_margin">Downgraded by 1 increment if the majority of the evidence was at moderate risk of bias, and downgraded by 2 increments if the majority of the evidence was at high risk of bias</p></div></dd></dl><dl class="bkr_refwrap"><dt>2</dt><dd><div id="niceng217er18.tab37_2"><p class="no_margin">Downgraded for indirectness as analysis did not adjust for at least two of the non-modifiable confounders</p></div></dd></dl><dl class="bkr_refwrap"><dt>3</dt><dd><div id="niceng217er18.tab37_3"><p class="no_margin">Adjusted for age at onset, duration of epilepsy, type of epilepsy, causes of epilepsy, living conditions, highest education</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng217er18tab38"><div id="niceng217er18.tab38" class="table"><h3><span class="label">Table 38</span><span class="title">Clinical evidence summary: Seizure frequency – (3 – 12 seizures past year)</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK586315/table/niceng217er18.tab38/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng217er18.tab38_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng217er18.tab38_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Outcomes</th><th id="hd_h_niceng217er18.tab38_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_niceng217er18.tab38_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Quality of the evidence (GRADE)</th><th id="hd_h_niceng217er18.tab38_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Relative effect (95% CI)</th></tr></thead><tbody><tr><td headers="hd_h_niceng217er18.tab38_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">SUDEP</td><td headers="hd_h_niceng217er18.tab38_1_1_1_2 hd_h_niceng217er18.tab38_1_1_1_3 hd_h_niceng217er18.tab38_1_1_1_4" colspan="3" rowspan="1" style="text-align:left;vertical-align:top;">0 – 2 seizures as reference</td></tr><tr><td headers="hd_h_niceng217er18.tab38_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>57</p>
|
|
<p>(1 study)</p>
|
|
<p>>5 years</p>
|
|
</td><td headers="hd_h_niceng217er18.tab38_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_niceng217er18.tab38_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>RR 4.47</p>
|
|
<p>(1.33 to 15.02)</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="niceng217er18.tab38_1"><p class="no_margin">Downgraded by 1 increment if the majority of the evidence was at moderate risk of bias, and downgraded by 2 increments if the majority of the evidence was at high risk of bias</p></div></dd></dl><dl class="bkr_refwrap"><dt>2</dt><dd><div id="niceng217er18.tab38_2"><p class="no_margin">Downgraded for indirectness as analysis did not adjust for at least two of the non-modifiable confounders</p></div></dd></dl><dl class="bkr_refwrap"><dt>3</dt><dd><div id="niceng217er18.tab38_3"><p class="no_margin">Adjusted for seizure frequency during last year, age in years at epilepsy onset, epilepsy type, number of ASM, changes in dose of ASM per year.</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng217er18tab39"><div id="niceng217er18.tab39" class="table"><h3><span class="label">Table 39</span><span class="title">Clinical evidence summary: six to ten tonic-clonic seizures (previous 3 months)</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK586315/table/niceng217er18.tab39/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng217er18.tab39_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng217er18.tab39_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Outcomes</th><th id="hd_h_niceng217er18.tab39_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_niceng217er18.tab39_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Quality of the evidence (GRADE)</th><th id="hd_h_niceng217er18.tab39_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Relative effect (95% CI)</th></tr></thead><tbody><tr><td headers="hd_h_niceng217er18.tab39_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">SUDEP</td><td headers="hd_h_niceng217er18.tab39_1_1_1_2 hd_h_niceng217er18.tab39_1_1_1_3 hd_h_niceng217er18.tab39_1_1_1_4" colspan="3" rowspan="1" style="text-align:left;vertical-align:top;">0 – 5 seizures as reference</td></tr><tr><td headers="hd_h_niceng217er18.tab39_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>151</p>
|
|
<p>(1 study)</p>
|
|
<p>>5 years</p>
|
|
</td><td headers="hd_h_niceng217er18.tab39_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_niceng217er18.tab39_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>OR 0.70</p>
|
|
<p>(0.2 to 2.45)</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="niceng217er18.tab39_1"><p class="no_margin">Downgraded by 1 increment if the majority of the evidence was at moderate risk of bias, and downgraded by 2 increments if the majority of the evidence was at high risk of bias</p></div></dd></dl><dl class="bkr_refwrap"><dt>2</dt><dd><div id="niceng217er18.tab39_2"><p class="no_margin">Downgraded for indirectness as analysis did not adjust for at least two of the non-modifiable confounders</p></div></dd></dl><dl class="bkr_refwrap"><dt>3</dt><dd><div id="niceng217er18.tab39_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="niceng217er18.tab39_4"><p class="no_margin">Adjusted for History of generalized tonic clonic seizures, No of tonic clonic seizures in previous 3 months, Total number of anti-seizure medications, Carbamazepine usage, Supervision, Asthma</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng217er18tab40"><div id="niceng217er18.tab40" class="table"><h3><span class="label">Table 40</span><span class="title">Clinical evidence summary: eleven to twenty tonic-clonic seizures (previous 3 months)</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK586315/table/niceng217er18.tab40/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng217er18.tab40_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng217er18.tab40_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Outcomes</th><th id="hd_h_niceng217er18.tab40_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_niceng217er18.tab40_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Quality of the evidence (GRADE)</th><th id="hd_h_niceng217er18.tab40_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Relative effect (95% CI)</th></tr></thead><tbody><tr><td headers="hd_h_niceng217er18.tab40_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">SUDEP</td><td headers="hd_h_niceng217er18.tab40_1_1_1_2 hd_h_niceng217er18.tab40_1_1_1_3 hd_h_niceng217er18.tab40_1_1_1_4" colspan="3" rowspan="1" style="text-align:left;vertical-align:top;">0 – 5 seizures as reference</td></tr><tr><td headers="hd_h_niceng217er18.tab40_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>151</p>
|
|
<p>(1 study)</p>
|
|
<p>>5 years</p>
|
|
</td><td headers="hd_h_niceng217er18.tab40_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_niceng217er18.tab40_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>OR 19.40</p>
|
|
<p>(1.7 to 221.4)</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="niceng217er18.tab40_1"><p class="no_margin">Downgraded by 1 increment if the majority of the evidence was at moderate risk of bias, and downgraded by 2 increments if the majority of the evidence was at high risk of bias</p></div></dd></dl><dl class="bkr_refwrap"><dt>2</dt><dd><div id="niceng217er18.tab40_2"><p class="no_margin">Downgraded for indirectness as analysis did not adjust for at least two of the non-modifiable confounders</p></div></dd></dl><dl class="bkr_refwrap"><dt>3</dt><dd><div id="niceng217er18.tab40_3"><p class="no_margin">Adjusted for history of GTCS, number of TCS in the previous 3 months, number of ASMs, carbamazepine usage, supervision level, asthma</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng217er18tab41"><div id="niceng217er18.tab41" class="table"><h3><span class="label">Table 41</span><span class="title">Clinical evidence summary: Twenty-one to fifty tonic-clonic seizures (previous 3 months)</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK586315/table/niceng217er18.tab41/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng217er18.tab41_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng217er18.tab41_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Outcomes</th><th id="hd_h_niceng217er18.tab41_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_niceng217er18.tab41_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Quality of the evidence (GRADE)</th><th id="hd_h_niceng217er18.tab41_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Relative effect (95% CI)</th></tr></thead><tbody><tr><td headers="hd_h_niceng217er18.tab41_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">SUDEP</td><td headers="hd_h_niceng217er18.tab41_1_1_1_2 hd_h_niceng217er18.tab41_1_1_1_3 hd_h_niceng217er18.tab41_1_1_1_4" colspan="3" rowspan="1" style="text-align:left;vertical-align:top;">0 – 5 seizures as reference</td></tr><tr><td headers="hd_h_niceng217er18.tab41_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>151</p>
|
|
<p>(1 study)</p>
|
|
<p>>5 years</p>
|
|
</td><td headers="hd_h_niceng217er18.tab41_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_niceng217er18.tab41_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>OR 14.60</p>
|
|
<p>(1.3 to 163.96)</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="niceng217er18.tab41_1"><p class="no_margin">Downgraded by 1 increment if the majority of the evidence was at moderate risk of bias, and downgraded by 2 increments if the majority of the evidence was at high risk of bias</p></div></dd></dl><dl class="bkr_refwrap"><dt>2</dt><dd><div id="niceng217er18.tab41_2"><p class="no_margin">Downgraded for indirectness as analysis did not adjust for at least two of the non-modifiable confounders</p></div></dd></dl><dl class="bkr_refwrap"><dt>3</dt><dd><div id="niceng217er18.tab41_3"><p class="no_margin">Adjusted for history of GTCS, number of TCS in the previous 3 months, number of ASMs, carbamazepine usage, supervision level, asthma</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng217er18tab42"><div id="niceng217er18.tab42" class="table"><h3><span class="label">Table 42</span><span class="title">Clinical evidence summary: Over fifty tonic-clonic seizures (previous 3 months)</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK586315/table/niceng217er18.tab42/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng217er18.tab42_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng217er18.tab42_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Outcomes</th><th id="hd_h_niceng217er18.tab42_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_niceng217er18.tab42_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Quality of the evidence (GRADE)</th><th id="hd_h_niceng217er18.tab42_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Relative effect (95% CI)</th></tr></thead><tbody><tr><td headers="hd_h_niceng217er18.tab42_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">SUDEP</td><td headers="hd_h_niceng217er18.tab42_1_1_1_2 hd_h_niceng217er18.tab42_1_1_1_3 hd_h_niceng217er18.tab42_1_1_1_4" colspan="3" rowspan="1" style="text-align:left;vertical-align:top;">0 – 5 seizures as reference</td></tr><tr><td headers="hd_h_niceng217er18.tab42_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>151</p>
|
|
<p>(1 study)</p>
|
|
<p>5 years</p>
|
|
</td><td headers="hd_h_niceng217er18.tab42_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_niceng217er18.tab42_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>OR 11.70</p>
|
|
<p>(0.3 to 456.31)</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="niceng217er18.tab42_1"><p class="no_margin">Downgraded by 1 increment if the majority of the evidence was at moderate risk of bias, and downgraded by 2 increments if the majority of the evidence was at high risk of bias</p></div></dd></dl><dl class="bkr_refwrap"><dt>2</dt><dd><div id="niceng217er18.tab42_2"><p class="no_margin">Downgraded for indirectness as analysis did not adjust for at least two of the non-modifiable confounders</p></div></dd></dl><dl class="bkr_refwrap"><dt>3</dt><dd><div id="niceng217er18.tab42_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="niceng217er18.tab42_4"><p class="no_margin">Adjusted for history of GTCS, number of TCS in the previous 3 months, number of ASMs, carbamazepine usage, supervision level, asthma</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng217er18tab43"><div id="niceng217er18.tab43" class="table"><h3><span class="label">Table 43</span><span class="title">Clinical evidence summary: History of generalized tonic-clonic seizures</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK586315/table/niceng217er18.tab43/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng217er18.tab43_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng217er18.tab43_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Outcomes</th><th id="hd_h_niceng217er18.tab43_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_niceng217er18.tab43_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Quality of the evidence (GRADE)</th><th id="hd_h_niceng217er18.tab43_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Relative effect (95% CI)</th></tr></thead><tbody><tr><td headers="hd_h_niceng217er18.tab43_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">SUDEP</td><td headers="hd_h_niceng217er18.tab43_1_1_1_2 hd_h_niceng217er18.tab43_1_1_1_3 hd_h_niceng217er18.tab43_1_1_1_4" colspan="3" rowspan="1" style="text-align:left;vertical-align:top;">No history of generalized tonic clonic seizures as reference</td></tr><tr><td headers="hd_h_niceng217er18.tab43_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>151</p>
|
|
<p>(1 study)</p>
|
|
<p>>5 years</p>
|
|
</td><td headers="hd_h_niceng217er18.tab43_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_niceng217er18.tab43_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>OR 13.80</p>
|
|
<p>(6.6 to 28.85)</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="niceng217er18.tab43_1"><p class="no_margin">Downgraded by 1 increment if the majority of the evidence was at moderate risk of bias, and downgraded by 2 increments if the majority of the evidence was at high risk of bias</p></div></dd></dl><dl class="bkr_refwrap"><dt>2</dt><dd><div id="niceng217er18.tab43_2"><p class="no_margin">Downgraded for indirectness as analysis did not adjust for at least two of the non-modifiable confounders</p></div></dd></dl><dl class="bkr_refwrap"><dt>3</dt><dd><div id="niceng217er18.tab43_3"><p class="no_margin">Adjusted for history of GTCS, number of TCS in the previous 3 months, number of ASMs, carbamazepine usage, supervision level, asthma</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng217er18tab44"><div id="niceng217er18.tab44" class="table"><h3><span class="label">Table 44</span><span class="title">Clinical evidence summary: Focal seizures</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK586315/table/niceng217er18.tab44/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng217er18.tab44_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng217er18.tab44_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Outcomes</th><th id="hd_h_niceng217er18.tab44_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_niceng217er18.tab44_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Quality of the evidence (GRADE)</th><th id="hd_h_niceng217er18.tab44_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Relative effect (95% CI)</th></tr></thead><tbody><tr><td headers="hd_h_niceng217er18.tab44_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">SUDEP</td><td headers="hd_h_niceng217er18.tab44_1_1_1_2 hd_h_niceng217er18.tab44_1_1_1_3 hd_h_niceng217er18.tab44_1_1_1_4" colspan="3" rowspan="1" style="text-align:left;vertical-align:top;">Generalized seizures as reference</td></tr><tr><td headers="hd_h_niceng217er18.tab44_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>255</p>
|
|
<p>(1 study)</p>
|
|
<p>>5 years</p>
|
|
</td><td headers="hd_h_niceng217er18.tab44_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>⊕⊕⊕⊝</p>
|
|
<p>MODERATE<sup>1</sup><sup>,</sup><sup>2</sup></p>
|
|
<p>due to imprecision</p>
|
|
</td><td headers="hd_h_niceng217er18.tab44_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>OR 1.34</p>
|
|
<p>(0.77 to 2.33)</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="niceng217er18.tab44_1"><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>2</dt><dd><div id="niceng217er18.tab44_2"><p class="no_margin">Adjusted for age, sex, generalized tonic-clonic seizures frequency and nocturnal generalized tonic-clonic seizures last year of observation, living conditions and antiepileptic drugs.</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng217er18tab45"><div id="niceng217er18.tab45" class="table"><h3><span class="label">Table 45</span><span class="title">Clinical evidence summary: Focal and generalized seizures</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK586315/table/niceng217er18.tab45/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng217er18.tab45_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng217er18.tab45_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Outcomes</th><th id="hd_h_niceng217er18.tab45_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_niceng217er18.tab45_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Quality of the evidence (GRADE)</th><th id="hd_h_niceng217er18.tab45_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Relative effect (95% CI)</th></tr></thead><tbody><tr><td headers="hd_h_niceng217er18.tab45_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">SUDEP</td><td headers="hd_h_niceng217er18.tab45_1_1_1_2 hd_h_niceng217er18.tab45_1_1_1_3 hd_h_niceng217er18.tab45_1_1_1_4" colspan="3" rowspan="1" style="text-align:left;vertical-align:top;">Generalized seizures as reference</td></tr><tr><td headers="hd_h_niceng217er18.tab45_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>255</p>
|
|
<p>(1 study)</p>
|
|
<p>>5 years</p>
|
|
</td><td headers="hd_h_niceng217er18.tab45_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>⊕⊕⊕⊝</p>
|
|
<p>MODERATE<sup>1</sup><sup>,</sup><sup>2</sup></p>
|
|
<p>due to imprecision</p>
|
|
</td><td headers="hd_h_niceng217er18.tab45_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>OR 1.42</p>
|
|
<p>(0.49 to 4.12)</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="niceng217er18.tab45_1"><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>2</dt><dd><div id="niceng217er18.tab45_2"><p class="no_margin">Adjusted for age, sex, generalized tonic-clonic seizures frequency and nocturnal generalized tonic-clonic seizures last year of observation, living conditions and antiepileptic drugs.</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng217er18tab46"><div id="niceng217er18.tab46" class="table"><h3><span class="label">Table 46</span><span class="title">Clinical evidence summary: Undetermined seizures</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK586315/table/niceng217er18.tab46/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng217er18.tab46_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng217er18.tab46_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Outcomes</th><th id="hd_h_niceng217er18.tab46_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_niceng217er18.tab46_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Quality of the evidence (GRADE)</th><th id="hd_h_niceng217er18.tab46_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Relative effect (95% CI)</th></tr></thead><tbody><tr><td headers="hd_h_niceng217er18.tab46_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">SUDEP</td><td headers="hd_h_niceng217er18.tab46_1_1_1_2 hd_h_niceng217er18.tab46_1_1_1_3 hd_h_niceng217er18.tab46_1_1_1_4" colspan="3" rowspan="1" style="text-align:left;vertical-align:top;">Generalized seizures as reference</td></tr><tr><td headers="hd_h_niceng217er18.tab46_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>255</p>
|
|
<p>(1 study)</p>
|
|
<p>>5 years</p>
|
|
</td><td headers="hd_h_niceng217er18.tab46_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>⊕⊕⊕⊕</p>
|
|
<p>HIGH<sup>1</sup></p>
|
|
</td><td headers="hd_h_niceng217er18.tab46_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>OR 3.51</p>
|
|
<p>(1.44 to 8.56)</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="niceng217er18.tab46_1"><p class="no_margin">Adjusted for age, sex, generalized tonic-clonic seizures frequency and nocturnal generalized tonic-clonic seizures last year of observation, living conditions and antiepileptic drugs.</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng217er18tab47"><div id="niceng217er18.tab47" class="table"><h3><span class="label">Table 47</span><span class="title">Clinical evidence summary: Substance abuse</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK586315/table/niceng217er18.tab47/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng217er18.tab47_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng217er18.tab47_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Outcomes</th><th id="hd_h_niceng217er18.tab47_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_niceng217er18.tab47_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Quality of the evidence (GRADE)</th><th id="hd_h_niceng217er18.tab47_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Relative effect (95% CI)</th></tr></thead><tbody><tr><td headers="hd_h_niceng217er18.tab47_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">SUDEP</td><td headers="hd_h_niceng217er18.tab47_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>255</p>
|
|
<p>(1 study)</p>
|
|
<p>>5 years</p>
|
|
</td><td headers="hd_h_niceng217er18.tab47_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>⊕⊕⊕⊕</p>
|
|
<p>HIGH<sup>1</sup></p>
|
|
</td><td headers="hd_h_niceng217er18.tab47_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>OR 2.07</p>
|
|
<p>(1.04 to 4.01)</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="niceng217er18.tab47_1"><p class="no_margin">Adjusted for age, sex, generalized tonic-clonic seizures frequency and nocturnal generalized tonic-clonic seizures last year of observation, living conditions and antiepileptic drugs.</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng217er18tab48"><div id="niceng217er18.tab48" class="table"><h3><span class="label">Table 48</span><span class="title">Clinical evidence summary: Alcohol dependence</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK586315/table/niceng217er18.tab48/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng217er18.tab48_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng217er18.tab48_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Outcomes</th><th id="hd_h_niceng217er18.tab48_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_niceng217er18.tab48_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Quality of the evidence (GRADE)</th><th id="hd_h_niceng217er18.tab48_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Relative effect (95% CI)</th></tr></thead><tbody><tr><td headers="hd_h_niceng217er18.tab48_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">SUDEP</td><td headers="hd_h_niceng217er18.tab48_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>255</p>
|
|
<p>(1 study)</p>
|
|
<p>>5 years</p>
|
|
</td><td headers="hd_h_niceng217er18.tab48_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>⊕⊕⊕⊝</p>
|
|
<p>MODERATE<sup>1</sup><sup>,</sup><sup>2</sup></p>
|
|
</td><td headers="hd_h_niceng217er18.tab48_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>OR 2.30</p>
|
|
<p>(1.02 to 5.21)</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="niceng217er18.tab48_1"><p class="no_margin">Adjusted for age, sex, generalized tonic-clonic seizures frequency and nocturnal generalized tonic-clonic seizures last year of observation, living conditions and antiepileptic drugs.</p></div></dd></dl><dl class="bkr_refwrap"><dt>2</dt><dd><div id="niceng217er18.tab48_2"><p class="no_margin">Downgraded by 1 increment if the confidence interval crossed the null line</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng217er18tab49"><div id="niceng217er18.tab49" class="table"><h3><span class="label">Table 49</span><span class="title">Clinical evidence summary: Alcoholism</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK586315/table/niceng217er18.tab49/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng217er18.tab49_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng217er18.tab49_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Outcomes</th><th id="hd_h_niceng217er18.tab49_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_niceng217er18.tab49_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Quality of the evidence (GRADE)</th><th id="hd_h_niceng217er18.tab49_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Relative effect (95% CI)</th></tr></thead><tbody><tr><td headers="hd_h_niceng217er18.tab49_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">SUDEP</td><td headers="hd_h_niceng217er18.tab49_1_1_1_2 hd_h_niceng217er18.tab49_1_1_1_3 hd_h_niceng217er18.tab49_1_1_1_4" colspan="3" rowspan="1" style="text-align:left;vertical-align:top;">Generalized idiopathic seizures as reference</td></tr><tr><td headers="hd_h_niceng217er18.tab49_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>57</p>
|
|
<p>(1 study)</p>
|
|
<p>>5 years</p>
|
|
</td><td headers="hd_h_niceng217er18.tab49_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_niceng217er18.tab49_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>RR 1.42</p>
|
|
<p>(0.68 to 2.97)</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="niceng217er18.tab49_1"><p class="no_margin">Downgraded by 1 increment if the majority of the evidence was at moderate risk of bias, and downgraded by 2 increments if the majority of the evidence was at high risk of bias</p></div></dd></dl><dl class="bkr_refwrap"><dt>2</dt><dd><div id="niceng217er18.tab49_2"><p class="no_margin">Downgraded for indirectness as analysis did not adjust for at least two of the non-modifiable confounders</p></div></dd></dl><dl class="bkr_refwrap"><dt>3</dt><dd><div id="niceng217er18.tab49_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="niceng217er18.tab49_4"><p class="no_margin">Adjusted for seizure frequency during last year, age in years at epilepsy onset, epilepsy type, number of ASM, changes in dose of ASM per year</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng217er18tab50"><div id="niceng217er18.tab50" class="table"><h3><span class="label">Table 50</span><span class="title">Clinical evidence summary: Local symptomatic seizures</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK586315/table/niceng217er18.tab50/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng217er18.tab50_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng217er18.tab50_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Outcomes</th><th id="hd_h_niceng217er18.tab50_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_niceng217er18.tab50_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Quality of the evidence (GRADE)</th><th id="hd_h_niceng217er18.tab50_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Relative effect (95% CI)</th></tr></thead><tbody><tr><td headers="hd_h_niceng217er18.tab50_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">SUDEP</td><td headers="hd_h_niceng217er18.tab50_1_1_1_2 hd_h_niceng217er18.tab50_1_1_1_3 hd_h_niceng217er18.tab50_1_1_1_4" colspan="3" rowspan="1" style="text-align:left;vertical-align:top;">Generalized idiopathic seizures as reference</td></tr><tr><td headers="hd_h_niceng217er18.tab50_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>57</p>
|
|
<p>(1 study)</p>
|
|
<p>>5 years</p>
|
|
</td><td headers="hd_h_niceng217er18.tab50_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_niceng217er18.tab50_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>RR 1.15</p>
|
|
<p>(0.18 to 7.35)</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="niceng217er18.tab50_1"><p class="no_margin">Downgraded by 1 increment if the majority of the evidence was at moderate risk of bias, and downgraded by 2 increments if the majority of the evidence was at high risk of bias</p></div></dd></dl><dl class="bkr_refwrap"><dt>2</dt><dd><div id="niceng217er18.tab50_2"><p class="no_margin">Downgraded for indirectness as analysis did not adjust for at least two of the non-modifiable confounders</p></div></dd></dl><dl class="bkr_refwrap"><dt>3</dt><dd><div id="niceng217er18.tab50_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="niceng217er18.tab50_4"><p class="no_margin">Adjusted for seizure frequency during last year, age in years at epilepsy onset, epilepsy type, number of ASM, changes in dose of ASM per year</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng217er18tab51"><div id="niceng217er18.tab51" class="table"><h3><span class="label">Table 51</span><span class="title">Clinical evidence summary: Local cryptogenic seizures</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK586315/table/niceng217er18.tab51/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng217er18.tab51_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng217er18.tab51_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Outcomes</th><th id="hd_h_niceng217er18.tab51_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_niceng217er18.tab51_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Quality of the evidence (GRADE)</th><th id="hd_h_niceng217er18.tab51_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Relative effect (95% CI)</th></tr></thead><tbody><tr><td headers="hd_h_niceng217er18.tab51_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">SUDEP</td><td headers="hd_h_niceng217er18.tab51_1_1_1_2 hd_h_niceng217er18.tab51_1_1_1_3 hd_h_niceng217er18.tab51_1_1_1_4" colspan="3" rowspan="1" style="text-align:left;vertical-align:top;">Generalized idiopathic seizures as reference</td></tr><tr><td headers="hd_h_niceng217er18.tab51_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>57</p>
|
|
<p>(1 study)</p>
|
|
<p>>5 years</p>
|
|
</td><td headers="hd_h_niceng217er18.tab51_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_niceng217er18.tab51_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>RR 1.94</p>
|
|
<p>(0.27 to 13.94)</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="niceng217er18.tab51_1"><p class="no_margin">Downgraded by 1 increment if the majority of the evidence was at moderate risk of bias, and downgraded by 2 increments if the majority of the evidence was at high risk of bias</p></div></dd></dl><dl class="bkr_refwrap"><dt>2</dt><dd><div id="niceng217er18.tab51_2"><p class="no_margin">Downgraded for indirectness as analysis did not adjust for at least two of the non-modifiable confounders</p></div></dd></dl><dl class="bkr_refwrap"><dt>3</dt><dd><div id="niceng217er18.tab51_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="niceng217er18.tab51_4"><p class="no_margin">Adjusted for seizure frequency during last year, age in years at epilepsy onset, epilepsy type, number of ASM, changes in dose of ASM per year</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng217er18tab52"><div id="niceng217er18.tab52" class="table"><h3><span class="label">Table 52</span><span class="title">Clinical evidence summary: Undetermined seizures</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK586315/table/niceng217er18.tab52/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng217er18.tab52_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng217er18.tab52_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Outcomes</th><th id="hd_h_niceng217er18.tab52_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_niceng217er18.tab52_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Quality of the evidence (GRADE)</th><th id="hd_h_niceng217er18.tab52_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Relative effect (95% CI)</th></tr></thead><tbody><tr><td headers="hd_h_niceng217er18.tab52_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">SUDEP</td><td headers="hd_h_niceng217er18.tab52_1_1_1_2 hd_h_niceng217er18.tab52_1_1_1_3 hd_h_niceng217er18.tab52_1_1_1_4" colspan="3" rowspan="1" style="text-align:left;vertical-align:top;">Generalized idiopathic seizures as reference</td></tr><tr><td headers="hd_h_niceng217er18.tab52_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>57</p>
|
|
<p>(1 study)</p>
|
|
<p>>5 years</p>
|
|
</td><td headers="hd_h_niceng217er18.tab52_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_niceng217er18.tab52_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>RR 1.17</p>
|
|
<p>(0.14 to 9.78)</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="niceng217er18.tab52_1"><p class="no_margin">Downgraded by 1 increment if the majority of the evidence was at moderate risk of bias, and downgraded by 2 increments if the majority of the evidence was at high risk of bias</p></div></dd></dl><dl class="bkr_refwrap"><dt>2</dt><dd><div id="niceng217er18.tab52_2"><p class="no_margin">Downgraded for indirectness as analysis did not adjust for at least two of the non-modifiable confounders</p></div></dd></dl><dl class="bkr_refwrap"><dt>3</dt><dd><div id="niceng217er18.tab52_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="niceng217er18.tab52_4"><p class="no_margin">Adjusted for seizure frequency during last year, age in years at epilepsy onset, epilepsy type, number of ASM, changes in dose of ASM per year</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng217er18tab53"><div id="niceng217er18.tab53" class="table"><h3><span class="label">Table 53</span><span class="title">Clinical evidence summary: Anti-seizure medication therapy - monotherapy</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK586315/table/niceng217er18.tab53/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng217er18.tab53_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng217er18.tab53_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Outcomes</th><th id="hd_h_niceng217er18.tab53_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_niceng217er18.tab53_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Quality of the evidence (GRADE)</th><th id="hd_h_niceng217er18.tab53_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Relative effect (95% CI)</th></tr></thead><tbody><tr><td headers="hd_h_niceng217er18.tab53_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">SUDEP</td><td headers="hd_h_niceng217er18.tab53_1_1_1_2 hd_h_niceng217er18.tab53_1_1_1_3 hd_h_niceng217er18.tab53_1_1_1_4" colspan="3" rowspan="1" style="text-align:left;vertical-align:top;">No ASM as reference</td></tr><tr><td headers="hd_h_niceng217er18.tab53_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>255</p>
|
|
<p>(1 study)</p>
|
|
<p>>5 years</p>
|
|
</td><td headers="hd_h_niceng217er18.tab53_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>⊕⊕⊕⊝</p>
|
|
<p>MODERATE<sup>1</sup><sup>,</sup><sup>2</sup></p>
|
|
<p>due to imprecision</p>
|
|
</td><td headers="hd_h_niceng217er18.tab53_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>OR 0.79</p>
|
|
<p>(0.44 to 1.42)</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="niceng217er18.tab53_1"><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>2</dt><dd><div id="niceng217er18.tab53_2"><p class="no_margin">Adjusted for adjusted for matching variables (sex and calendar time), age, duration and type of epilepsy, living conditions (sharing bedroom), intellectual disability, substance abuse, alcohol dependence, and education level, history of GTCS, GTCS frequency in the last year and nocturnal GTCS last year</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng217er18tab54"><div id="niceng217er18.tab54" class="table"><h3><span class="label">Table 54</span><span class="title">Clinical evidence summary: Anti-seizure medication therapy – Polytherapy (≥2 medications)</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK586315/table/niceng217er18.tab54/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng217er18.tab54_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng217er18.tab54_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Outcomes</th><th id="hd_h_niceng217er18.tab54_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_niceng217er18.tab54_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Quality of the evidence (GRADE)</th><th id="hd_h_niceng217er18.tab54_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Relative effect (95% CI)</th></tr></thead><tbody><tr><td headers="hd_h_niceng217er18.tab54_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">SUDEP</td><td headers="hd_h_niceng217er18.tab54_1_1_1_2 hd_h_niceng217er18.tab54_1_1_1_3 hd_h_niceng217er18.tab54_1_1_1_4" colspan="3" rowspan="1" style="text-align:left;vertical-align:top;">No ASM as reference</td></tr><tr><td headers="hd_h_niceng217er18.tab54_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>255</p>
|
|
<p>(1 study)</p>
|
|
<p>>5 years</p>
|
|
</td><td headers="hd_h_niceng217er18.tab54_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>⊕⊕⊕⊕</p>
|
|
<p>HIGH<sup>1</sup></p>
|
|
</td><td headers="hd_h_niceng217er18.tab54_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>OR 0.48</p>
|
|
<p>(0.26 to 0.89)</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="niceng217er18.tab54_1"><p class="no_margin">Adjusted for adjusted for matching variables (sex and calendar time), age, duration and type of epilepsy, living conditions (sharing bedroom), intellectual disability, substance abuse, alcohol dependence, and education level, history of GTCS, GTCS frequency in the last year and nocturnal GTCS last year</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng217er18tab55"><div id="niceng217er18.tab55" class="table"><h3><span class="label">Table 55</span><span class="title">Clinical evidence summary: Anti-seizure medication therapy – Two anti-seizure medications</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK586315/table/niceng217er18.tab55/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng217er18.tab55_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng217er18.tab55_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Outcomes</th><th id="hd_h_niceng217er18.tab55_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_niceng217er18.tab55_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Quality of the evidence (GRADE)</th><th id="hd_h_niceng217er18.tab55_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Relative effect (95% CI)</th></tr></thead><tbody><tr><td headers="hd_h_niceng217er18.tab55_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">SUDEP</td><td headers="hd_h_niceng217er18.tab55_1_1_1_2 hd_h_niceng217er18.tab55_1_1_1_3 hd_h_niceng217er18.tab55_1_1_1_4" colspan="3" rowspan="1" style="text-align:left;vertical-align:top;">No ASM as reference</td></tr><tr><td headers="hd_h_niceng217er18.tab55_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>255</p>
|
|
<p>(1 study)</p>
|
|
<p>>5 years</p>
|
|
</td><td headers="hd_h_niceng217er18.tab55_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>⊕⊕⊕⊝</p>
|
|
<p>MODERATE<sup>1</sup><sup>,</sup><sup>2</sup></p>
|
|
<p>due to imprecision</p>
|
|
</td><td headers="hd_h_niceng217er18.tab55_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>OR 0.59</p>
|
|
<p>(0.31 to 1.12)</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="niceng217er18.tab55_1"><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>2</dt><dd><div id="niceng217er18.tab55_2"><p class="no_margin">Adjusted for adjusted for matching variables (sex and calendar time), age, duration and type of epilepsy, living conditions (sharing bedroom), intellectual disability, substance abuse, alcohol dependence, and education level, history of GTCS, GTCS frequency in the last year and nocturnal GTCS last year</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng217er18tab56"><div id="niceng217er18.tab56" class="table"><h3><span class="label">Table 56</span><span class="title">Clinical evidence summary: Two antiseizure medications</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK586315/table/niceng217er18.tab56/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng217er18.tab56_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng217er18.tab56_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Outcomes</th><th id="hd_h_niceng217er18.tab56_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_niceng217er18.tab56_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Quality of the evidence (GRADE)</th><th id="hd_h_niceng217er18.tab56_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Relative effect (95% CI)</th></tr></thead><tbody><tr><td headers="hd_h_niceng217er18.tab56_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">SUDEP</td><td headers="hd_h_niceng217er18.tab56_1_1_1_2 hd_h_niceng217er18.tab56_1_1_1_3 hd_h_niceng217er18.tab56_1_1_1_4" colspan="3" rowspan="1" style="text-align:left;vertical-align:top;">One ASM as reference</td></tr><tr><td headers="hd_h_niceng217er18.tab56_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>57</p>
|
|
<p>(1 study)</p>
|
|
<p>>5 years</p>
|
|
</td><td headers="hd_h_niceng217er18.tab56_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_niceng217er18.tab56_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>RR 1.95</p>
|
|
<p>(0.65 to 5.58)</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="niceng217er18.tab56_1"><p class="no_margin">Downgraded by 1 increment if the majority of the evidence was at moderate risk of bias, and downgraded by 2 increments if the majority of the evidence was at high risk of bias</p></div></dd></dl><dl class="bkr_refwrap"><dt>2</dt><dd><div id="niceng217er18.tab56_2"><p class="no_margin">Downgraded for indirectness as analysis did not adjust for at least two of the non-modifiable confounders</p></div></dd></dl><dl class="bkr_refwrap"><dt>3</dt><dd><div id="niceng217er18.tab56_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="niceng217er18.tab56_4"><p class="no_margin">Adjusted for seizure frequency during last year, age in years at epilepsy onset, epilepsy type, number of ASM, changes in dose of ASM per year</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng217er18tab57"><div id="niceng217er18.tab57" class="table"><h3><span class="label">Table 57</span><span class="title">Clinical evidence summary: Three antiseizure medications</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK586315/table/niceng217er18.tab57/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng217er18.tab57_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng217er18.tab57_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Outcomes</th><th id="hd_h_niceng217er18.tab57_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_niceng217er18.tab57_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Quality of the evidence (GRADE)</th><th id="hd_h_niceng217er18.tab57_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Relative effect (95% CI)</th></tr></thead><tbody><tr><td headers="hd_h_niceng217er18.tab57_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">SUDEP</td><td headers="hd_h_niceng217er18.tab57_1_1_1_2 hd_h_niceng217er18.tab57_1_1_1_3 hd_h_niceng217er18.tab57_1_1_1_4" colspan="3" rowspan="1" style="text-align:left;vertical-align:top;">One ASM as reference</td></tr><tr><td headers="hd_h_niceng217er18.tab57_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>57</p>
|
|
<p>(1 study)</p>
|
|
<p>>5 years</p>
|
|
</td><td headers="hd_h_niceng217er18.tab57_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_niceng217er18.tab57_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>RR 10.23</p>
|
|
<p>(1.86 to 56.27)</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="niceng217er18.tab57_1"><p class="no_margin">Downgraded by 1 increment if the majority of the evidence was at moderate risk of bias, and downgraded by 2 increments if the majority of the evidence was at high risk of bias</p></div></dd></dl><dl class="bkr_refwrap"><dt>2</dt><dd><div id="niceng217er18.tab57_2"><p class="no_margin">Downgraded for indirectness as analysis did not adjust for at least two of the non-modifiable confounders</p></div></dd></dl><dl class="bkr_refwrap"><dt>3</dt><dd><div id="niceng217er18.tab57_3"><p class="no_margin">Adjusted for seizure frequency during last year, age in years at epilepsy onset, epilepsy type, number of ASM, changes in dose of ASM per year</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng217er18tab58"><div id="niceng217er18.tab58" class="table"><h3><span class="label">Table 58</span><span class="title">Clinical evidence summary: Anti-seizure medication therapy – Polytherapy (> 3 anti-seizure medications)</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK586315/table/niceng217er18.tab58/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng217er18.tab58_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng217er18.tab58_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Outcomes</th><th id="hd_h_niceng217er18.tab58_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_niceng217er18.tab58_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Quality of the evidence (GRADE)</th><th id="hd_h_niceng217er18.tab58_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Relative effect (95% CI)</th></tr></thead><tbody><tr><td headers="hd_h_niceng217er18.tab58_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">SUDEP</td><td headers="hd_h_niceng217er18.tab58_1_1_1_2 hd_h_niceng217er18.tab58_1_1_1_3 hd_h_niceng217er18.tab58_1_1_1_4" colspan="3" rowspan="1" style="text-align:left;vertical-align:top;">No ASM as reference</td></tr><tr><td headers="hd_h_niceng217er18.tab58_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>255</p>
|
|
<p>(1 study)</p>
|
|
<p>>5 years</p>
|
|
</td><td headers="hd_h_niceng217er18.tab58_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>⊕⊕⊕⊕</p>
|
|
<p>HIGH<sup>1</sup></p>
|
|
</td><td headers="hd_h_niceng217er18.tab58_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>OR 0.31</p>
|
|
<p>(0.14 to 0.69)</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="niceng217er18.tab58_1"><p class="no_margin">Adjusted for adjusted for matching variables (sex and calendar time), age, duration and type of epilepsy, living conditions (sharing bedroom), intellectual disability, substance abuse, alcohol dependence, and education level, history of GTCS, GTCS frequency in the last year and nocturnal GTCS last year</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng217er18tab59"><div id="niceng217er18.tab59" class="table"><h3><span class="label">Table 59</span><span class="title">Clinical evidence summary: three to four anti-seizure medications</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK586315/table/niceng217er18.tab59/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng217er18.tab59_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng217er18.tab59_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Outcomes</th><th id="hd_h_niceng217er18.tab59_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_niceng217er18.tab59_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Quality of the evidence (GRADE)</th><th id="hd_h_niceng217er18.tab59_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Relative effect (95% CI)</th></tr></thead><tbody><tr><td headers="hd_h_niceng217er18.tab59_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">SUDEP</td><td headers="hd_h_niceng217er18.tab59_1_1_1_2 hd_h_niceng217er18.tab59_1_1_1_3 hd_h_niceng217er18.tab59_1_1_1_4" colspan="3" rowspan="1" style="text-align:left;vertical-align:top;">One to two ASM as reference</td></tr><tr><td headers="hd_h_niceng217er18.tab59_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>151</p>
|
|
<p>(1 study)</p>
|
|
<p>>5 years</p>
|
|
</td><td headers="hd_h_niceng217er18.tab59_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_niceng217er18.tab59_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>OR 1.30</p>
|
|
<p>(0.6 to 2.82)</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="niceng217er18.tab59_1"><p class="no_margin">Downgraded by 1 increment if the majority of the evidence was at moderate risk of bias, and downgraded by 2 increments if the majority of the evidence was at high risk of bias</p></div></dd></dl><dl class="bkr_refwrap"><dt>2</dt><dd><div id="niceng217er18.tab59_2"><p class="no_margin">Downgraded for indirectness as analysis did not adjust for at least two of the non-modifiable confounders</p></div></dd></dl><dl class="bkr_refwrap"><dt>3</dt><dd><div id="niceng217er18.tab59_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="niceng217er18.tab59_4"><p class="no_margin">Adjusted for history of GTCS, number of TCS in previous 3 months, total number of ASM, carbamazepine usage, supervision, asthma</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng217er18tab60"><div id="niceng217er18.tab60" class="table"><h3><span class="label">Table 60</span><span class="title">Clinical evidence summary: Over four anti-seizure medications</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK586315/table/niceng217er18.tab60/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng217er18.tab60_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng217er18.tab60_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Outcomes</th><th id="hd_h_niceng217er18.tab60_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_niceng217er18.tab60_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Quality of the evidence (GRADE)</th><th id="hd_h_niceng217er18.tab60_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Relative effect (95% CI)</th></tr></thead><tbody><tr><td headers="hd_h_niceng217er18.tab60_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">SUDEP</td><td headers="hd_h_niceng217er18.tab60_1_1_1_2 hd_h_niceng217er18.tab60_1_1_1_3 hd_h_niceng217er18.tab60_1_1_1_4" colspan="3" rowspan="1" style="text-align:left;vertical-align:top;">One to two ASM as reference</td></tr><tr><td headers="hd_h_niceng217er18.tab60_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>151</p>
|
|
<p>(1 study)</p>
|
|
<p>>5 years</p>
|
|
</td><td headers="hd_h_niceng217er18.tab60_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_niceng217er18.tab60_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>OR 3.10</p>
|
|
<p>(1.4 to 6.86)</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="niceng217er18.tab60_1"><p class="no_margin">Downgraded by 1 increment if the majority of the evidence was at moderate risk of bias, and downgraded by 2 increments if the majority of the evidence was at high risk of bias</p></div></dd></dl><dl class="bkr_refwrap"><dt>2</dt><dd><div id="niceng217er18.tab60_2"><p class="no_margin">Downgraded for indirectness as analysis did not adjust for at least two of the non-modifiable confounders</p></div></dd></dl><dl class="bkr_refwrap"><dt>3</dt><dd><div id="niceng217er18.tab60_3"><p class="no_margin">Adjusted for history of GTCS, number of TCS in previous 3 months, total number of ASM, carbamazepine usage, supervision, asthma</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng217er18tab61"><div id="niceng217er18.tab61" class="table"><h3><span class="label">Table 61</span><span class="title">Clinical evidence summary: No anti-seizure medications</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK586315/table/niceng217er18.tab61/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng217er18.tab61_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng217er18.tab61_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Outcomes</th><th id="hd_h_niceng217er18.tab61_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_niceng217er18.tab61_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Quality of the evidence (GRADE)</th><th id="hd_h_niceng217er18.tab61_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Relative effect (95% CI)</th></tr></thead><tbody><tr><td headers="hd_h_niceng217er18.tab61_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">SUDEP</td><td headers="hd_h_niceng217er18.tab61_1_1_1_2 hd_h_niceng217er18.tab61_1_1_1_3 hd_h_niceng217er18.tab61_1_1_1_4" colspan="3" rowspan="1" style="text-align:left;vertical-align:top;">One to two ASM as reference</td></tr><tr><td headers="hd_h_niceng217er18.tab61_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>151</p>
|
|
<p>(1 study)</p>
|
|
<p>>5 years</p>
|
|
</td><td headers="hd_h_niceng217er18.tab61_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_niceng217er18.tab61_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>OR 21.70</p>
|
|
<p>(4.4 to 107.03)</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="niceng217er18.tab61_1"><p class="no_margin">Downgraded by 1 increment if the majority of the evidence was at moderate risk of bias, and downgraded by 2 increments if the majority of the evidence was at high risk of bias</p></div></dd></dl><dl class="bkr_refwrap"><dt>2</dt><dd><div id="niceng217er18.tab61_2"><p class="no_margin">Downgraded for indirectness as analysis did not adjust for at least two of the non-modifiable confounders</p></div></dd></dl><dl class="bkr_refwrap"><dt>3</dt><dd><div id="niceng217er18.tab61_3"><p class="no_margin">Adjusted for history of GTCS, number of TCS in previous 3 months, total number of ASM, carbamazepine usage, supervision, asthma</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng217er18tab62"><div id="niceng217er18.tab62" class="table"><h3><span class="label">Table 62</span><span class="title">Clinical evidence summary: Monotherapy – Carbamazepine</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK586315/table/niceng217er18.tab62/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng217er18.tab62_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng217er18.tab62_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Outcomes</th><th id="hd_h_niceng217er18.tab62_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_niceng217er18.tab62_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Quality of the evidence (GRADE)</th><th id="hd_h_niceng217er18.tab62_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Relative effect (95% CI)</th></tr></thead><tbody><tr><td headers="hd_h_niceng217er18.tab62_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">SUDEP</td><td headers="hd_h_niceng217er18.tab62_1_1_1_2 hd_h_niceng217er18.tab62_1_1_1_3 hd_h_niceng217er18.tab62_1_1_1_4" colspan="3" rowspan="1" style="text-align:left;vertical-align:top;">No ASM as reference</td></tr><tr><td headers="hd_h_niceng217er18.tab62_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>255</p>
|
|
<p>(1 study)</p>
|
|
<p>>5 years</p>
|
|
</td><td headers="hd_h_niceng217er18.tab62_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>⊕⊕⊕⊝</p>
|
|
<p>MODERATE<sup>1</sup><sup>,</sup><sup>2</sup></p>
|
|
<p>due to imprecision</p>
|
|
</td><td headers="hd_h_niceng217er18.tab62_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>OR 1</p>
|
|
<p>(0.48 to 2.08)</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="niceng217er18.tab62_1"><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>2</dt><dd><div id="niceng217er18.tab62_2"><p class="no_margin">Adjusted for adjusted for matching variables (sex and calendar time), age, duration and type of epilepsy, living conditions (sharing bedroom), intellectual disability, substance abuse, alcohol dependence, and education level, history of GTCS, GTCS frequency in the last year and nocturnal GTCS last year</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng217er18tab63"><div id="niceng217er18.tab63" class="table"><h3><span class="label">Table 63</span><span class="title">Clinical evidence summary: Monotherapy – Carbamazepine</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK586315/table/niceng217er18.tab63/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng217er18.tab63_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng217er18.tab63_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Outcomes</th><th id="hd_h_niceng217er18.tab63_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_niceng217er18.tab63_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Quality of the evidence (GRADE)</th><th id="hd_h_niceng217er18.tab63_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Relative effect (95% CI)</th></tr></thead><tbody><tr><td headers="hd_h_niceng217er18.tab63_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">SUDEP</td><td headers="hd_h_niceng217er18.tab63_1_1_1_2 hd_h_niceng217er18.tab63_1_1_1_3 hd_h_niceng217er18.tab63_1_1_1_4" colspan="3" rowspan="1" style="text-align:left;vertical-align:top;">No carbamazepine use as reference</td></tr><tr><td headers="hd_h_niceng217er18.tab63_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>151</p>
|
|
<p>(1 study)</p>
|
|
<p>>5 years</p>
|
|
</td><td headers="hd_h_niceng217er18.tab63_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_niceng217er18.tab63_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>OR 2.00</p>
|
|
<p>(1.1 to 3.64)</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="niceng217er18.tab63_1"><p class="no_margin">Downgraded by 1 increment if the majority of the evidence was at moderate risk of bias, and downgraded by 2 increments if the majority of the evidence was at high risk of bias</p></div></dd></dl><dl class="bkr_refwrap"><dt>2</dt><dd><div id="niceng217er18.tab63_2"><p class="no_margin">Downgraded for indirectness as analysis did not adjust for at least two of the non-modifiable confounders</p></div></dd></dl><dl class="bkr_refwrap"><dt>3</dt><dd><div id="niceng217er18.tab63_3"><p class="no_margin">Adjusted for history of GTCS, number of TCS in previous 3 months, total number of ASM, carbamazepine usage, supervision, asthma</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng217er18tab64"><div id="niceng217er18.tab64" class="table"><h3><span class="label">Table 64</span><span class="title">Clinical evidence summary: Monotherapy – Lamotrigine</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK586315/table/niceng217er18.tab64/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng217er18.tab64_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng217er18.tab64_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Outcomes</th><th id="hd_h_niceng217er18.tab64_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_niceng217er18.tab64_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Quality of the evidence (GRADE)</th><th id="hd_h_niceng217er18.tab64_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Relative effect (95% CI)</th></tr></thead><tbody><tr><td headers="hd_h_niceng217er18.tab64_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">SUDEP</td><td headers="hd_h_niceng217er18.tab64_1_1_1_2 hd_h_niceng217er18.tab64_1_1_1_3 hd_h_niceng217er18.tab64_1_1_1_4" colspan="3" rowspan="1" style="text-align:left;vertical-align:top;">No ASM as reference</td></tr><tr><td headers="hd_h_niceng217er18.tab64_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>255</p>
|
|
<p>(1 study)</p>
|
|
<p>>5 years</p>
|
|
</td><td headers="hd_h_niceng217er18.tab64_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>⊕⊕⊕⊝</p>
|
|
<p>MODERATE<sup>1</sup><sup>,</sup><sup>2</sup></p>
|
|
<p>due to imprecision</p>
|
|
</td><td headers="hd_h_niceng217er18.tab64_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>OR 0.93</p>
|
|
<p>(0.41 to 2.11)</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="niceng217er18.tab64_1"><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>2</dt><dd><div id="niceng217er18.tab64_2"><p class="no_margin">Adjusted for adjusted for matching variables (sex and calendar time), age, duration and type of epilepsy, living conditions (sharing bedroom), intellectual disability, substance abuse, alcohol dependence, and education level, history of GTCS, GTCS frequency in the last year and nocturnal GTCS last year</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng217er18tab65"><div id="niceng217er18.tab65" class="table"><h3><span class="label">Table 65</span><span class="title">Clinical evidence summary: Monotherapy – Valproic Acid</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK586315/table/niceng217er18.tab65/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng217er18.tab65_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng217er18.tab65_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Outcomes</th><th id="hd_h_niceng217er18.tab65_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_niceng217er18.tab65_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Quality of the evidence (GRADE)</th><th id="hd_h_niceng217er18.tab65_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Relative effect (95% CI)</th></tr></thead><tbody><tr><td headers="hd_h_niceng217er18.tab65_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">SUDEP</td><td headers="hd_h_niceng217er18.tab65_1_1_1_2 hd_h_niceng217er18.tab65_1_1_1_3 hd_h_niceng217er18.tab65_1_1_1_4" colspan="3" rowspan="1" style="text-align:left;vertical-align:top;">No ASM as reference</td></tr><tr><td headers="hd_h_niceng217er18.tab65_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>255</p>
|
|
<p>(1 study)</p>
|
|
<p>>5 years</p>
|
|
</td><td headers="hd_h_niceng217er18.tab65_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>⊕⊕⊕⊝</p>
|
|
<p>MODERATE<sup>1</sup><sup>,</sup><sup>2</sup></p>
|
|
<p>due to imprecision</p>
|
|
</td><td headers="hd_h_niceng217er18.tab65_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>OR 0.52</p>
|
|
<p>(0.2 to 1.35)</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="niceng217er18.tab65_1"><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>2</dt><dd><div id="niceng217er18.tab65_2"><p class="no_margin">Adjusted for adjusted for matching variables (sex and calendar time), age, duration and type of epilepsy, living conditions (sharing bedroom), intellectual disability, substance abuse, alcohol dependence, and education level, history of GTCS, GTCS frequency in the last year and nocturnal GTCS last year</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng217er18tab66"><div id="niceng217er18.tab66" class="table"><h3><span class="label">Table 66</span><span class="title">Clinical evidence summary: Monotherapy – Phenytoin</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK586315/table/niceng217er18.tab66/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng217er18.tab66_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng217er18.tab66_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Outcomes</th><th id="hd_h_niceng217er18.tab66_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_niceng217er18.tab66_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Quality of the evidence (GRADE)</th><th id="hd_h_niceng217er18.tab66_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Relative effect (95% CI)</th></tr></thead><tbody><tr><td headers="hd_h_niceng217er18.tab66_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">SUDEP</td><td headers="hd_h_niceng217er18.tab66_1_1_1_2 hd_h_niceng217er18.tab66_1_1_1_3 hd_h_niceng217er18.tab66_1_1_1_4" colspan="3" rowspan="1" style="text-align:left;vertical-align:top;">No ASM as reference</td></tr><tr><td headers="hd_h_niceng217er18.tab66_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>255</p>
|
|
<p>(1 study)</p>
|
|
<p>>5 years</p>
|
|
</td><td headers="hd_h_niceng217er18.tab66_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>⊕⊕⊕⊝</p>
|
|
<p>MODERATE<sup>1</sup><sup>,</sup><sup>2</sup></p>
|
|
<p>due to imprecision</p>
|
|
</td><td headers="hd_h_niceng217er18.tab66_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>OR 0.56</p>
|
|
<p>(0.17 to 1.84)</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="niceng217er18.tab66_1"><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>2</dt><dd><div id="niceng217er18.tab66_2"><p class="no_margin">Adjusted for adjusted for matching variables (sex and calendar time), age, duration and type of epilepsy, living conditions (sharing bedroom), intellectual disability, substance abuse, alcohol dependence, and education level, history of GTCS, GTCS frequency in the last year and nocturnal GTCS last year</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng217er18tab67"><div id="niceng217er18.tab67" class="table"><h3><span class="label">Table 67</span><span class="title">Clinical evidence summary: Monotherapy – Levetiracetam</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK586315/table/niceng217er18.tab67/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng217er18.tab67_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng217er18.tab67_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Outcomes</th><th id="hd_h_niceng217er18.tab67_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_niceng217er18.tab67_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Quality of the evidence (GRADE)</th><th id="hd_h_niceng217er18.tab67_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Relative effect (95% CI)</th></tr></thead><tbody><tr><td headers="hd_h_niceng217er18.tab67_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">SUDEP</td><td headers="hd_h_niceng217er18.tab67_1_1_1_2 hd_h_niceng217er18.tab67_1_1_1_3 hd_h_niceng217er18.tab67_1_1_1_4" colspan="3" rowspan="1" style="text-align:left;vertical-align:top;">No ASM as reference</td></tr><tr><td headers="hd_h_niceng217er18.tab67_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>255</p>
|
|
<p>(1 study)</p>
|
|
<p>>5 years</p>
|
|
</td><td headers="hd_h_niceng217er18.tab67_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>⊕⊕⊕⊕</p>
|
|
<p>HIGH<sup>1</sup></p>
|
|
</td><td headers="hd_h_niceng217er18.tab67_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>OR 0.1</p>
|
|
<p>(0.02 to 0.5)</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="niceng217er18.tab67_1"><p class="no_margin">Adjusted for adjusted for matching variables (sex and calendar time), age, duration and type of epilepsy, living conditions (sharing bedroom), intellectual disability, substance abuse, alcohol dependence, and education level, history of GTCS, GTCS frequency in the last year and nocturnal GTCS last year</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng217er18tab68"><div id="niceng217er18.tab68" class="table"><h3><span class="label">Table 68</span><span class="title">Clinical evidence summary: Monotherapy – Oxcarbazepine</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK586315/table/niceng217er18.tab68/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng217er18.tab68_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng217er18.tab68_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Outcomes</th><th id="hd_h_niceng217er18.tab68_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_niceng217er18.tab68_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Quality of the evidence (GRADE)</th><th id="hd_h_niceng217er18.tab68_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Relative effect (95% CI)</th></tr></thead><tbody><tr><td headers="hd_h_niceng217er18.tab68_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">SUDEP</td><td headers="hd_h_niceng217er18.tab68_1_1_1_2 hd_h_niceng217er18.tab68_1_1_1_3 hd_h_niceng217er18.tab68_1_1_1_4" colspan="3" rowspan="1" style="text-align:left;vertical-align:top;">No ASM as reference</td></tr><tr><td headers="hd_h_niceng217er18.tab68_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>255</p>
|
|
<p>(1 study)</p>
|
|
<p>>5 years</p>
|
|
</td><td headers="hd_h_niceng217er18.tab68_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>⊕⊕⊕⊝</p>
|
|
<p>MODERATE<sup>1</sup><sup>,</sup><sup>2</sup></p>
|
|
<p>due to imprecision</p>
|
|
</td><td headers="hd_h_niceng217er18.tab68_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>OR 0.58</p>
|
|
<p>(0.09 to 3.74)</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="niceng217er18.tab68_1"><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>2</dt><dd><div id="niceng217er18.tab68_2"><p class="no_margin">Adjusted for adjusted for matching variables (sex and calendar time), age, duration and type of epilepsy, living conditions (sharing bedroom), intellectual disability, substance abuse, alcohol dependence, and education level, history of GTCS, GTCS frequency in the last year and nocturnal GTCS last year</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng217er18tab69"><div id="niceng217er18.tab69" class="table"><h3><span class="label">Table 69</span><span class="title">Clinical evidence summary: Monotherapy – Topiramate</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK586315/table/niceng217er18.tab69/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng217er18.tab69_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng217er18.tab69_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Outcomes</th><th id="hd_h_niceng217er18.tab69_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_niceng217er18.tab69_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Quality of the evidence (GRADE)</th><th id="hd_h_niceng217er18.tab69_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Relative effect (95% CI)</th></tr></thead><tbody><tr><td headers="hd_h_niceng217er18.tab69_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">SUDEP</td><td headers="hd_h_niceng217er18.tab69_1_1_1_2 hd_h_niceng217er18.tab69_1_1_1_3 hd_h_niceng217er18.tab69_1_1_1_4" colspan="3" rowspan="1" style="text-align:left;vertical-align:top;">No ASM as reference</td></tr><tr><td headers="hd_h_niceng217er18.tab69_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>255</p>
|
|
<p>(1 study)</p>
|
|
<p>>5 years</p>
|
|
</td><td headers="hd_h_niceng217er18.tab69_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>⊕⊕⊕⊝</p>
|
|
<p>MODERATE<sup>1</sup><sup>,</sup><sup>2</sup></p>
|
|
<p>due to imprecision</p>
|
|
</td><td headers="hd_h_niceng217er18.tab69_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>OR 2.02</p>
|
|
<p>(0.29 to 14.07)</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="niceng217er18.tab69_1"><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>2</dt><dd><div id="niceng217er18.tab69_2"><p class="no_margin">Adjusted for adjusted for matching variables (sex and calendar time), age, duration and type of epilepsy, living conditions (sharing bedroom), intellectual disability, substance abuse, alcohol dependence, and education level, history of GTCS, GTCS frequency in the last year and nocturnal GTCS last year</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng217er18tab70"><div id="niceng217er18.tab70" class="table"><h3><span class="label">Table 70</span><span class="title">Clinical evidence summary: Monotherapy – Other anti-seizure medication</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK586315/table/niceng217er18.tab70/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng217er18.tab70_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng217er18.tab70_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Outcomes</th><th id="hd_h_niceng217er18.tab70_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_niceng217er18.tab70_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Quality of the evidence (GRADE)</th><th id="hd_h_niceng217er18.tab70_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Relative effect (95% CI)</th></tr></thead><tbody><tr><td headers="hd_h_niceng217er18.tab70_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">SUDEP</td><td headers="hd_h_niceng217er18.tab70_1_1_1_2 hd_h_niceng217er18.tab70_1_1_1_3 hd_h_niceng217er18.tab70_1_1_1_4" colspan="3" rowspan="1" style="text-align:left;vertical-align:top;">No ASM as reference</td></tr><tr><td headers="hd_h_niceng217er18.tab70_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>255</p>
|
|
<p>(1 study)</p>
|
|
<p>>5 years</p>
|
|
</td><td headers="hd_h_niceng217er18.tab70_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>⊕⊕⊕⊝</p>
|
|
<p>MODERATE<sup>1</sup><sup>,</sup><sup>2</sup></p>
|
|
<p>due to imprecision</p>
|
|
</td><td headers="hd_h_niceng217er18.tab70_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>OR 1.32</p>
|
|
<p>(0.39 to 4.47)</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="niceng217er18.tab70_1"><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>2</dt><dd><div id="niceng217er18.tab70_2"><p class="no_margin">Adjusted for adjusted for matching variables (sex and calendar time), age, duration and type of epilepsy, living conditions (sharing bedroom), intellectual disability, substance abuse, alcohol dependence, and education level, history of GTCS, GTCS frequency in the last year and nocturnal GTCS last year</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng217er18tab71"><div id="niceng217er18.tab71" class="table"><h3><span class="label">Table 71</span><span class="title">Clinical evidence summary: Nonadherence</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK586315/table/niceng217er18.tab71/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng217er18.tab71_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng217er18.tab71_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Outcomes</th><th id="hd_h_niceng217er18.tab71_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_niceng217er18.tab71_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Quality of the evidence (GRADE)</th><th id="hd_h_niceng217er18.tab71_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Relative effect (95% CI)</th></tr></thead><tbody><tr><td headers="hd_h_niceng217er18.tab71_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">SUDEP</td><td headers="hd_h_niceng217er18.tab71_1_1_1_2 hd_h_niceng217er18.tab71_1_1_1_3 hd_h_niceng217er18.tab71_1_1_1_4" colspan="3" rowspan="1" style="text-align:left;vertical-align:top;">Adherence as reference</td></tr><tr><td headers="hd_h_niceng217er18.tab71_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>255</p>
|
|
<p>(1 study)</p>
|
|
<p>>5 years</p>
|
|
</td><td headers="hd_h_niceng217er18.tab71_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>⊕⊕⊕⊕</p>
|
|
<p>HIGH<sup>1</sup></p>
|
|
</td><td headers="hd_h_niceng217er18.tab71_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>OR 2.75</p>
|
|
<p>(1.58 to 4.79)</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="niceng217er18.tab71_1"><p class="no_margin">Adjusted for adjusted for matching variables (sex and calendar time), age, duration and type of epilepsy, living conditions (sharing bedroom), intellectual disability, substance abuse, alcohol dependence, and education level, history of GTCS, GTCS frequency in the last year and nocturnal GTCS last year</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng217er18tab72"><div id="niceng217er18.tab72" class="table"><h3><span class="label">Table 72</span><span class="title">Clinical evidence summary: One to two changes in dose of antiseizure medication (per year)</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK586315/table/niceng217er18.tab72/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng217er18.tab72_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng217er18.tab72_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Outcomes</th><th id="hd_h_niceng217er18.tab72_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_niceng217er18.tab72_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Quality of the evidence (GRADE)</th><th id="hd_h_niceng217er18.tab72_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Relative effect (95% CI)</th></tr></thead><tbody><tr><td headers="hd_h_niceng217er18.tab72_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">SUDEP</td><td headers="hd_h_niceng217er18.tab72_1_1_1_2 hd_h_niceng217er18.tab72_1_1_1_3 hd_h_niceng217er18.tab72_1_1_1_4" colspan="3" rowspan="1" style="text-align:left;vertical-align:top;">No changes as reference</td></tr><tr><td headers="hd_h_niceng217er18.tab72_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>57</p>
|
|
<p>(1 study)</p>
|
|
<p>>5 years</p>
|
|
</td><td headers="hd_h_niceng217er18.tab72_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_niceng217er18.tab72_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>RR 0.69</p>
|
|
<p>(0.26 to 1.83)</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="niceng217er18.tab72_1"><p class="no_margin">Downgraded by 1 increment if the majority of the evidence was at moderate risk of bias, and downgraded by 2 increments if the majority of the evidence was at high risk of bias</p></div></dd></dl><dl class="bkr_refwrap"><dt>2</dt><dd><div id="niceng217er18.tab72_2"><p class="no_margin">Downgraded for indirectness as analysis did not adjust for at least two of the non-modifiable confounders</p></div></dd></dl><dl class="bkr_refwrap"><dt>3</dt><dd><div id="niceng217er18.tab72_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="niceng217er18.tab72_4"><p class="no_margin">Adjusted for seizure frequency during last year, age in years at epilepsy onset, epilepsy type, number of ASM, changes in dose of ASM per year</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng217er18tab73"><div id="niceng217er18.tab73" class="table"><h3><span class="label">Table 73</span><span class="title">Clinical evidence summary: Three to five changes in dose of antiseizure medication (per year)</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK586315/table/niceng217er18.tab73/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng217er18.tab73_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng217er18.tab73_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Outcomes</th><th id="hd_h_niceng217er18.tab73_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_niceng217er18.tab73_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Quality of the evidence (GRADE)</th><th id="hd_h_niceng217er18.tab73_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Relative effect (95% CI)</th></tr></thead><tbody><tr><td headers="hd_h_niceng217er18.tab73_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">SUDEP</td><td headers="hd_h_niceng217er18.tab73_1_1_1_2 hd_h_niceng217er18.tab73_1_1_1_3 hd_h_niceng217er18.tab73_1_1_1_4" colspan="3" rowspan="1" style="text-align:left;vertical-align:top;">No changes as reference</td></tr><tr><td headers="hd_h_niceng217er18.tab73_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>57</p>
|
|
<p>(1 study)</p>
|
|
<p>>5 years</p>
|
|
</td><td headers="hd_h_niceng217er18.tab73_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_niceng217er18.tab73_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>RR 9.32</p>
|
|
<p>(1.95 to 44.54)</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="niceng217er18.tab73_1"><p class="no_margin">Downgraded by 1 increment if the majority of the evidence was at moderate risk of bias, and downgraded by 2 increments if the majority of the evidence was at high risk of bias</p></div></dd></dl><dl class="bkr_refwrap"><dt>2</dt><dd><div id="niceng217er18.tab73_2"><p class="no_margin">Downgraded for indirectness as analysis did not adjust for at least two of the non-modifiable confounders</p></div></dd></dl><dl class="bkr_refwrap"><dt>3</dt><dd><div id="niceng217er18.tab73_3"><p class="no_margin">Adjusted for seizure frequency during last year, age in years at epilepsy onset, epilepsy type, number of ASM, changes in dose of ASM per year</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng217er18tab74"><div id="niceng217er18.tab74" class="table"><h3><span class="label">Table 74</span><span class="title">Clinical evidence summary: Antipsychotic medication</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK586315/table/niceng217er18.tab74/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng217er18.tab74_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng217er18.tab74_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Outcomes</th><th id="hd_h_niceng217er18.tab74_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_niceng217er18.tab74_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Quality of the evidence (GRADE)</th><th id="hd_h_niceng217er18.tab74_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Relative effect (95% CI)</th></tr></thead><tbody><tr><td headers="hd_h_niceng217er18.tab74_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">SUDEP</td><td headers="hd_h_niceng217er18.tab74_1_1_1_2 hd_h_niceng217er18.tab74_1_1_1_3 hd_h_niceng217er18.tab74_1_1_1_4" colspan="3" rowspan="1" style="text-align:left;vertical-align:top;">No antipsychotic medication as reference</td></tr><tr><td headers="hd_h_niceng217er18.tab74_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>57</p>
|
|
<p>(1 study)</p>
|
|
<p>>5 years</p>
|
|
</td><td headers="hd_h_niceng217er18.tab74_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_niceng217er18.tab74_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>RR 2.14</p>
|
|
<p>(0.90 to 5.09)</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="niceng217er18.tab74_1"><p class="no_margin">Downgraded by 1 increment if the majority of the evidence was at moderate risk of bias, and downgraded by 2 increments if the majority of the evidence was at high risk of bias</p></div></dd></dl><dl class="bkr_refwrap"><dt>2</dt><dd><div id="niceng217er18.tab74_2"><p class="no_margin">Downgraded for indirectness as analysis did not adjust for at least two of the non-modifiable confounders</p></div></dd></dl><dl class="bkr_refwrap"><dt>3</dt><dd><div id="niceng217er18.tab74_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="niceng217er18.tab74_4"><p class="no_margin">Adjusted for seizure frequency during last year, age in years at epilepsy onset, epilepsy type, number of ASM, changes in dose of ASM per year</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng217er18tab75"><div id="niceng217er18.tab75" class="table"><h3><span class="label">Table 75</span><span class="title">Clinical evidence summary: Anxiolytic medication</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK586315/table/niceng217er18.tab75/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng217er18.tab75_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng217er18.tab75_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Outcomes</th><th id="hd_h_niceng217er18.tab75_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_niceng217er18.tab75_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Quality of the evidence (GRADE)</th><th id="hd_h_niceng217er18.tab75_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Relative effect (95% CI)</th></tr></thead><tbody><tr><td headers="hd_h_niceng217er18.tab75_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">SUDEP</td><td headers="hd_h_niceng217er18.tab75_1_1_1_2 hd_h_niceng217er18.tab75_1_1_1_3 hd_h_niceng217er18.tab75_1_1_1_4" colspan="3" rowspan="1" style="text-align:left;vertical-align:top;">No anxiolytic medication as reference</td></tr><tr><td headers="hd_h_niceng217er18.tab75_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>57</p>
|
|
<p>(1 study)</p>
|
|
<p>>5 years</p>
|
|
</td><td headers="hd_h_niceng217er18.tab75_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_niceng217er18.tab75_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>RR 3.00</p>
|
|
<p>(1.16 to 7.76)</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="niceng217er18.tab75_1"><p class="no_margin">Downgraded by 1 increment if the majority of the evidence was at moderate risk of bias, and downgraded by 2 increments if the majority of the evidence was at high risk of bias</p></div></dd></dl><dl class="bkr_refwrap"><dt>2</dt><dd><div id="niceng217er18.tab75_2"><p class="no_margin">Downgraded for indirectness as analysis did not adjust for at least two of the non-modifiable confounders</p></div></dd></dl><dl class="bkr_refwrap"><dt>3</dt><dd><div id="niceng217er18.tab75_3"><p class="no_margin">Adjusted for seizure frequency during last year, age in years at epilepsy onset, epilepsy type, number of ASM, changes in dose of ASM per year</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng217er18tab76"><div id="niceng217er18.tab76" class="table"><h3><span class="label">Table 76</span><span class="title">Clinical evidence summary: Asthma</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK586315/table/niceng217er18.tab76/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng217er18.tab76_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng217er18.tab76_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Outcomes</th><th id="hd_h_niceng217er18.tab76_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_niceng217er18.tab76_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Quality of the evidence (GRADE)</th><th id="hd_h_niceng217er18.tab76_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Relative effect (95% CI)</th></tr></thead><tbody><tr><td headers="hd_h_niceng217er18.tab76_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">SUDEP</td><td headers="hd_h_niceng217er18.tab76_1_1_1_2 hd_h_niceng217er18.tab76_1_1_1_3 hd_h_niceng217er18.tab76_1_1_1_4" colspan="3" rowspan="1" style="text-align:left;vertical-align:top;">No asthma as reference</td></tr><tr><td headers="hd_h_niceng217er18.tab76_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>151</p>
|
|
<p>(1 study)</p>
|
|
<p>>5 years</p>
|
|
</td><td headers="hd_h_niceng217er18.tab76_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_niceng217er18.tab76_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>OR 0.20</p>
|
|
<p>(0.1 to 0.4)</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="niceng217er18.tab76_1"><p class="no_margin">Downgraded by 1 increment if the majority of the evidence was at moderate risk of bias, and downgraded by 2 increments if the majority of the evidence was at high risk of bias</p></div></dd></dl><dl class="bkr_refwrap"><dt>2</dt><dd><div id="niceng217er18.tab76_2"><p class="no_margin">Downgraded for indirectness as analysis did not adjust for at least two of the non-modifiable confounders</p></div></dd></dl><dl class="bkr_refwrap"><dt>3</dt><dd><div id="niceng217er18.tab76_3"><p class="no_margin">Adjusted for history of TCS, number of TCS in previous 3 months, total number of anti-seizure medications, carbamazepine usage, supervision, asthma</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng217er18tab77"><div id="niceng217er18.tab77" class="table"><h3><span class="label">Table 77</span><span class="title">Clinical evidence summary: Sharing household but not sharing a bedroom</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK586315/table/niceng217er18.tab77/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng217er18.tab77_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng217er18.tab77_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Outcomes</th><th id="hd_h_niceng217er18.tab77_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_niceng217er18.tab77_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Quality of the evidence (GRADE)</th><th id="hd_h_niceng217er18.tab77_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Relative effect (95% CI)</th></tr></thead><tbody><tr><td headers="hd_h_niceng217er18.tab77_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">SUDEP</td><td headers="hd_h_niceng217er18.tab77_1_1_1_2 hd_h_niceng217er18.tab77_1_1_1_3 hd_h_niceng217er18.tab77_1_1_1_4" colspan="3" rowspan="1" style="text-align:left;vertical-align:top;">Sharing household and bedroom as reference</td></tr><tr><td headers="hd_h_niceng217er18.tab77_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>255</p>
|
|
<p>(1 study)</p>
|
|
<p>>5 years</p>
|
|
</td><td headers="hd_h_niceng217er18.tab77_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>⊕⊕⊕⊕</p>
|
|
<p>HIGH<sup>1</sup></p>
|
|
</td><td headers="hd_h_niceng217er18.tab77_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>OR 2.28</p>
|
|
<p>(1.14 to 4.56)</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="niceng217er18.tab77_1"><p class="no_margin">Adjusted for age at onset, duration of epilepsy, type of epilepsy, causes of epilepsy, living conditions, highest education</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng217er18tab78"><div id="niceng217er18.tab78" class="table"><h3><span class="label">Table 78</span><span class="title">Clinical evidence summary: Living alone</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK586315/table/niceng217er18.tab78/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng217er18.tab78_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng217er18.tab78_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Outcomes</th><th id="hd_h_niceng217er18.tab78_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_niceng217er18.tab78_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Quality of the evidence (GRADE)</th><th id="hd_h_niceng217er18.tab78_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Relative effect (95% CI)</th></tr></thead><tbody><tr><td headers="hd_h_niceng217er18.tab78_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">SUDEP</td><td headers="hd_h_niceng217er18.tab78_1_1_1_2 hd_h_niceng217er18.tab78_1_1_1_3 hd_h_niceng217er18.tab78_1_1_1_4" colspan="3" rowspan="1" style="text-align:left;vertical-align:top;">Sharing household and bedroom as reference</td></tr><tr><td headers="hd_h_niceng217er18.tab78_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>255</p>
|
|
<p>(1 study)</p>
|
|
<p>>5 years</p>
|
|
</td><td headers="hd_h_niceng217er18.tab78_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>⊕⊕⊕⊕</p>
|
|
<p>HIGH<sup>1</sup></p>
|
|
</td><td headers="hd_h_niceng217er18.tab78_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>OR 5.01</p>
|
|
<p>(2.93 to 8.57)</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="niceng217er18.tab78_1"><p class="no_margin">Adjusted for age at onset, duration of epilepsy, type of epilepsy, causes of epilepsy, living conditions, highest education</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng217er18tab79"><div id="niceng217er18.tab79" class="table"><h3><span class="label">Table 79</span><span class="title">Clinical evidence summary: Secondary education</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK586315/table/niceng217er18.tab79/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng217er18.tab79_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng217er18.tab79_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Outcomes</th><th id="hd_h_niceng217er18.tab79_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_niceng217er18.tab79_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Quality of the evidence (GRADE)</th><th id="hd_h_niceng217er18.tab79_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Relative effect (95% CI)</th></tr></thead><tbody><tr><td headers="hd_h_niceng217er18.tab79_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">SUDEP</td><td headers="hd_h_niceng217er18.tab79_1_1_1_2 hd_h_niceng217er18.tab79_1_1_1_3 hd_h_niceng217er18.tab79_1_1_1_4" colspan="3" rowspan="1" style="text-align:left;vertical-align:top;">Post-secondary education as reference</td></tr><tr><td headers="hd_h_niceng217er18.tab79_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>255</p>
|
|
<p>(1 study)</p>
|
|
<p>>5 years</p>
|
|
</td><td headers="hd_h_niceng217er18.tab79_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>⊕⊕⊕⊝</p>
|
|
<p>MODERATE<sup>1</sup><sup>,</sup><sup>2</sup></p>
|
|
<p>due to imprecision</p>
|
|
</td><td headers="hd_h_niceng217er18.tab79_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>OR 1.59</p>
|
|
<p>(0.78 to 3.24)</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="niceng217er18.tab79_1"><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>2</dt><dd><div id="niceng217er18.tab79_2"><p class="no_margin">Adjusted for age at onset, duration of epilepsy, type of epilepsy, causes of epilepsy, living conditions, highest education</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng217er18tab80"><div id="niceng217er18.tab80" class="table"><h3><span class="label">Table 80</span><span class="title">Clinical evidence summary: Primary education</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK586315/table/niceng217er18.tab80/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng217er18.tab80_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng217er18.tab80_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Outcomes</th><th id="hd_h_niceng217er18.tab80_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_niceng217er18.tab80_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Quality of the evidence (GRADE)</th><th id="hd_h_niceng217er18.tab80_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Relative effect (95% CI)</th></tr></thead><tbody><tr><td headers="hd_h_niceng217er18.tab80_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">SUDEP</td><td headers="hd_h_niceng217er18.tab80_1_1_1_2 hd_h_niceng217er18.tab80_1_1_1_3 hd_h_niceng217er18.tab80_1_1_1_4" colspan="3" rowspan="1" style="text-align:left;vertical-align:top;">Post-secondary education as reference</td></tr><tr><td headers="hd_h_niceng217er18.tab80_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>255</p>
|
|
<p>(1 study)</p>
|
|
<p>>5 years</p>
|
|
</td><td headers="hd_h_niceng217er18.tab80_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>⊕⊕⊕⊝</p>
|
|
<p>MODERATE<sup>1</sup><sup>,</sup><sup>2</sup></p>
|
|
<p>due to imprecision</p>
|
|
</td><td headers="hd_h_niceng217er18.tab80_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>OR 1.21</p>
|
|
<p>(0.58 to 2.52)</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="niceng217er18.tab80_1"><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>2</dt><dd><div id="niceng217er18.tab80_2"><p class="no_margin">Adjusted for age at onset, duration of epilepsy, type of epilepsy, causes of epilepsy, living conditions, highest education</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng217er18tab81"><div id="niceng217er18.tab81" class="table"><h3><span class="label">Table 81</span><span class="title">Clinical evidence summary: Same room supervision at night</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK586315/table/niceng217er18.tab81/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng217er18.tab81_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng217er18.tab81_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Outcomes</th><th id="hd_h_niceng217er18.tab81_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_niceng217er18.tab81_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Quality of the evidence (GRADE)</th><th id="hd_h_niceng217er18.tab81_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Relative effect (95% CI)</th></tr></thead><tbody><tr><td headers="hd_h_niceng217er18.tab81_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">SUDEP</td><td headers="hd_h_niceng217er18.tab81_1_1_1_2 hd_h_niceng217er18.tab81_1_1_1_3 hd_h_niceng217er18.tab81_1_1_1_4" colspan="3" rowspan="1" style="text-align:left;vertical-align:top;">No supervision at night as reference</td></tr><tr><td headers="hd_h_niceng217er18.tab81_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>151</p>
|
|
<p>(1 study)</p>
|
|
<p>>5 years</p>
|
|
</td><td headers="hd_h_niceng217er18.tab81_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_niceng217er18.tab81_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>OR 0.10</p>
|
|
<p>(0.03 to 0.3)</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="niceng217er18.tab81_1"><p class="no_margin">Downgraded by 1 increment if the majority of the evidence was at moderate risk of bias, and downgraded by 2 increments if the majority of the evidence was at high risk of bias</p></div></dd></dl><dl class="bkr_refwrap"><dt>2</dt><dd><div id="niceng217er18.tab81_2"><p class="no_margin">Downgraded for indirectness as analysis did not adjust for at least two of the non-modifiable confounders</p></div></dd></dl><dl class="bkr_refwrap"><dt>3</dt><dd><div id="niceng217er18.tab81_3"><p class="no_margin">Adjusted for history of TCS, number of TCS in previous 3 months, total number of anti-seizure medications, carbamazepine usage, supervision, asthma</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng217er18tab82"><div id="niceng217er18.tab82" class="table"><h3><span class="label">Table 82</span><span class="title">Clinical evidence summary: Special supervision at night (regular checks throughout the night or the use of a listening device)</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK586315/table/niceng217er18.tab82/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng217er18.tab82_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng217er18.tab82_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Outcomes</th><th id="hd_h_niceng217er18.tab82_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_niceng217er18.tab82_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Quality of the evidence (GRADE)</th><th id="hd_h_niceng217er18.tab82_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Relative effect (95% CI)</th></tr></thead><tbody><tr><td headers="hd_h_niceng217er18.tab82_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">SUDEP</td><td headers="hd_h_niceng217er18.tab82_1_1_1_2 hd_h_niceng217er18.tab82_1_1_1_3 hd_h_niceng217er18.tab82_1_1_1_4" colspan="3" rowspan="1" style="text-align:left;vertical-align:top;">No special precautions for supervision at night as reference</td></tr><tr><td headers="hd_h_niceng217er18.tab82_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>151</p>
|
|
<p>(1 study)</p>
|
|
<p>>5 years</p>
|
|
</td><td headers="hd_h_niceng217er18.tab82_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_niceng217er18.tab82_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">OR 0.40 (0.2 to 0.8)</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="niceng217er18.tab82_1"><p class="no_margin">Downgraded by 1 increment if the majority of the evidence was at moderate risk of bias, and downgraded by 2 increments if the majority of the evidence was at high risk of bias</p></div></dd></dl><dl class="bkr_refwrap"><dt>2</dt><dd><div id="niceng217er18.tab82_2"><p class="no_margin">Downgraded for indirectness as analysis did not adjust for at least two of the non-modifiable confounders</p></div></dd></dl><dl class="bkr_refwrap"><dt>3</dt><dd><div id="niceng217er18.tab82_3"><p class="no_margin">Adjusted for history of TCS, number of TCS in previous 3 months, total number of anti-seizure medications, carbamazepine usage, supervision, asthma</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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