Topiramate

TUESDAY, June 18, 2024 -- The U.S Preventive Services Task Force (USPSTF) recommends that clinicians refer children aged 6 years or older with a high body mass index (BMI) to comprehensive intensive behavioral interventions. These recommendations form the basis of a final recommendation statement published online June 18 in the Journal of the American Medical Association . Elizabeth A. O'Connor, Ph.D., from the Kaiser Permanente Evidence-based Practice Center in Portland, Oregon, and colleagues examined the benefits and harms of weight management interventions initiated in health care settings among children aged 2 to 18 years with high BMI. Data were included from 58 randomized clinical trials with 10,143 participants. The researchers found that after six to 12 months, behavioral interventions were associated with small reductions in BMI and other weight outcomes. In interventions with higher contact hours and that offered physical activity sessions, larger effects were seen. For outcomes other than BMI, reporting was sparse, with few significant findings. The largest effect on BMI was seen for semaglutide and phentermine/topiramate. The few studies that assessed outcomes after discontinuation of medication showed immediate weight regain. Based on these findings, the USPSTF concludes there is a moderate net benefit to providing or referring children and adolescents aged 6 years or older with a high BMI (≥95th percentile for age and sex) to comprehensive, intensive behavioral interventions (B recommendation). "There are a variety of effective intensive behavioral interventions available that can help kids with a high BMI achieve a healthy weight, while improving quality of life," USPSTF member John M. Ruiz, Ph.D., said in a statement. Evidence Report Final Recommendation Statement Editorial 1 (subscription or payment may be required) Editorial 2 (subscription or payment may be required) Whatever your topic of interest, subscribe to our newsletters to get the best of Drugs.com in your inbox.

AAN, AES and SMFM Collaborate to Develop Updated Guidance MINNEAPOLIS, May 15, 2024 /PRNewswire/ -- A new guideline has been issued to help neurologists and other clinicians determine the best antiseizure medications for people with epilepsy who may become pregnant. The guideline is published in the May 15, 2024, online issue of Neurology®, the medical journal of the American Academy of Neurology (AAN), and was developed through a collaboration between the AAN, the American Epilepsy Society (AES) and the Society for Maternal-Fetal Medicine (SMFM). It was endorsed by the Child Neurology Society. The guideline partially updates two 2009 AAN and AES guidelines on the management of epilepsy during pregnancy, specifically regarding malformations at birth and the development of children born to people with epilepsy. "Most children born to people with epilepsy are healthy, but there is a small risk of pregnancy-related problems, partly due to seizures and partly due to the effects of antiseizure medications," said author Alison M. Pack, MD, MPH, of Columbia University in New York City, a Fellow of the American Academy of Neurology and a member of the American Epilepsy Society. "This guideline provides recommendations regarding the effects of antiseizure medications and folic acid supplementation on malformations at birth and the development of children during pregnancy so that doctors and people with epilepsy can determine which treatments may be best for them." The guideline recommendations are based on a review of all available evidence on the topic. Risks can include major congenital malformations, or birth defects, fetal growth issues and neurodevelopmental effects such as autism or lower IQ scores. The guideline states when treating people with epilepsy who may become pregnant, doctors should recommend medications and doses that optimize both seizure control and fetal development at the earliest possible opportunity before pregnancy. During pregnancy, it recommends minimizing the occurrence of tonic-clonic seizures, seizures with full body spasms, to minimize risks to the parent and fetus. It also says stopping medications during pregnancy may increase the frequency of seizures, which may harm the parent and fetus. For medications, the guideline recommends using lamotrigine, levetiracetam or oxcarbazepine when appropriate to minimize risk of major birth defects. It recommends avoiding valproic acid, phenobarbital and topiramate when possible. To reduce the risk of poor neurodevelopmental outcomes, including autism spectrum disorder and lower IQ scores, the guideline recommends clinicians avoid prescribing valproic acid, when possible, to people with epilepsy who may become pregnant. The guideline recommends that people with epilepsy who may become pregnant take at least 0.4 milligrams of folic acid daily before and during pregnancy to decrease the risk of neural tube defects and possibly improve neurodevelopmental outcomes. However, it notes further studies are needed to clarify the optimal dose and timing of folic acid supplementation. "People with epilepsy who may become pregnant want to ensure the best health of their child while still managing and minimizing their seizures," said Pack. "This is why it is important to discuss plans for pregnancy with your doctor before becoming pregnant and notify your doctor as soon as possible if you discover you are pregnant. Don't stop or change your medications. Talk with your doctor about any concerns you have about your medications." There are some medications that did not have enough evidence to be evaluated and need more research about their associated risk. The guideline was funded by the American Academy of Neurology. About the American Academy of Neurology The American Academy of Neurology is the world's largest association of neurologists and neuroscience professionals, with over 40,000 members. The AAN's mission is to enhance member career fulfillment and promote brain health for all. A neurologist is a doctor with specialized training in diagnosing, treating and managing disorders of the brain and nervous system such as Alzheimer's disease, stroke, concussion, epilepsy, Parkinson's disease, multiple sclerosis, headache and migraine. For more information about the American Academy of Neurology, visit AAN.com or find us on Facebook, Twitter, Instagram, LinkedIn and YouTube. About the American Epilepsy Society Founded in 1936, the American Epilepsy Society is a medical and scientific society whose members are dedicated to advancing research and education for preventing, treating and curing epilepsy. AES is an inclusive global forum where professionals from academia, private practice, not-for-profit, government and industry can learn, share and grow to eradicate epilepsy and its consequences. About the Society for Maternal-Fetal Medicine (SMFM) The Society for Maternal-Fetal Medicine (SMFM), founded in 1977, is the medical professional society for maternal-fetal medicine subspecialists, who are obstetricians with additional training in high-risk pregnancies. SMFM represents more than 7,000 members who care for high-risk pregnant people and provides education, promotes research, and engages in advocacy to advance optimal and equitable perinatal outcomes for all people who desire and experience pregnancy. For more information, visit SMFM.org. SOURCE American Academy of Neurology