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Special Article
April 24, 2017
Free AccessLetter to the Editor

Practice guideline summary: Sudden unexpected death in epilepsy incidence rates and risk factors
Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology and the American Epilepsy Society

This article has been corrected.
VIEW CORRECTION
April 25, 2017 issue
88 (17) 1674-1680

Abstract

Objective:

To determine the incidence rates of sudden unexpected death in epilepsy (SUDEP) in different epilepsy populations and address the question of whether risk factors for SUDEP have been identified.

Methods:

Systematic review of evidence; modified Grading Recommendations Assessment, Development, and Evaluation process for developing conclusions; recommendations developed by consensus.

Results:

Findings for incidence rates based on 12 Class I studies include the following: SUDEP risk in children with epilepsy (aged 0–17 years) is 0.22/1,000 patient-years (95% confidence interval [CI] 0.16–0.31) (moderate confidence in evidence). SUDEP risk increases in adults to 1.2/1,000 patient-years (95% CI 0.64–2.32) (low confidence in evidence). The major risk factor for SUDEP is the occurrence of generalized tonic-clonic seizures (GTCS); the SUDEP risk increases in association with increasing frequency of GTCS occurrence (high confidence in evidence).

Recommendations:

Level B: Clinicians caring for young children with epilepsy should inform parents/guardians that in 1 year, SUDEP typically affects 1 in 4,500 children; therefore, 4,499 of 4,500 children will not be affected. Clinicians should inform adult patients with epilepsy that SUDEP typically affects 1 in 1,000 adults with epilepsy per year; therefore, annually 999 of 1,000 adults will not be affected. For persons with epilepsy who continue to experience GTCS, clinicians should continue to actively manage epilepsy therapies to reduce seizures and SUDEP risk while incorporating patient preferences and weighing the risks and benefits of any new approach. Clinicians should inform persons with epilepsy that seizure freedom, particularly freedom from GTCS, is strongly associated with decreased SUDEP risk.
This document summarizes information provided in the complete guideline, available at Neurology.org. Appendix e-6, cited in the full guideline (data supplement), is available at Neurology.org.
Sudden unexpected death in epilepsy (SUDEP) is a poorly understood and catastrophic risk of epilepsy. The sensitive nature of discussions of this infrequent but important risk with patients and families has prompted the need for evidence-based information about SUDEP. The goal of this practice guideline is to examine evidence for the SUDEP incidence rate in epilepsy populations and for prognostic factors for SUDEP occurrence. This in turn will inform an honest and balanced discussion when clinicians counsel people about SUDEP, and provide insight into areas where more clinical research is needed.
Two questions were asked:
1.
What is the incidence rate of SUDEP in different epilepsy populations?
2.
Are there specific risk factors for SUDEP?

DESCRIPTION OF THE ANALYTIC PROCESS

This practice guideline broadly follows the process delineated in the 2004 American Academy of Neurology (AAN) guideline development process manual,1 with the exception of the processes for formulating conclusions and recommendations, which follow the processes explained in the 2011 AAN guideline development process manual.2
In 2010, the AAN Guideline Development, Dissemination, and Implementation Subcommittee and the Guidelines Committee of the American Epilepsy Society convened a panel of experts to develop this practice guideline. The guideline panel engaged an independent medical librarian to search the MEDLINE and Embase databases from earliest available article to November 2010. The panel then performed an identical search in April 2015 to include articles published since November 2010. The keywords for both searches were SUDEP or (sudden and [unexplained or unexpected] and death) combined with the traditional medical subheadings (MeSH) for epilepsy (epilepsy/abnormalities or epilepsy/classification or epilepsy/complications or epilepsy/drug effects or epilepsy/drug therapy or epilepsy/epidemiology or epilepsy/ethnology or epilepsy/etiology or epilepsy/genetics or epilepsy/mortality or epilepsy/physiopathology or epilepsy/prevention and control or epilepsy/therapy) with limits of humans, plus all child: 0–18 years or all adult: 19+ years. Literature types were limited to clinical trial; randomized controlled trial; comparative study; controlled clinical trial; evaluation studies; journal article; multicenter study; research support; NIH, extramural, research support; NIH, intramural, research support; non–US gov't, research support; US gov't, non PHS, research support; or US gov't, PHS, validation studies. Finally, the guideline panel specifically searched causes implicated in SUDEP (i.e., cardiac arrhythmias and preictal autonomic dysfunction), where the hypotheses were tested.
This search yielded 1,068 abstracts, all of which were reviewed for relevance by at least 2 panel members working independently of each other; 744 abstracts were not relevant to provide answers to the questions. Of the remaining 324 abstracts, 2 panel members then obtained the full articles and reviewed them independently for inclusion. Reviewed articles were entered into a database application through an online questionnaire. Seventy articles had data for inclusion, and 254 were excluded because they failed to address the questions, employ an adequate SUDEP definition, or use an appropriate epilepsy comparison group in the prognostic studies. The available literature consisted of multiple Class I articles for incidence, and therefore articles rated Class II or lower were excluded because the Class II publications did not address populations not otherwise encompassed by the Class I articles. Several Class I and multiple Class II articles were available for prognostic questions.
Included articles were required to state that the SUDEP definition provided by Nashef,3 Annegers,4 and Leestma et al.5 was used or to describe criteria in accordance with these definitions. These definitions share the following criteria, and the guideline panel included any article that incorporated these criteria in its SUDEP definition: (1) the patient had epilepsy by reasonable criteria without reference to the criteria used for epilepsy; (2) deaths by drowning, trauma, or status epilepticus were excluded; (3) death could have occurred after a witnessed seizure; (4) other competing causes of death were excluded.
The guideline panel used 2 of the AAN's evidence-based schemes to rate articles: the screening criteria for the incidence question and the prognostic criteria for the risk factor question.

Question 1: What is the incidence of SUDEP in different epilepsy populations?

Twelve Class I studies provided incidence rate data.617 Imprecision in study findings resulted in moderate confidence in the evidence for SUDEP rates in childhood and low confidence in the evidence for SUDEP rates in adulthood and overall (table 1). Because of imprecision in the incidence study results with a lack of overlap of 95% confidence interval (CIs) between several comparable study populations, the guideline panel performed a random-effects meta-analysis to provide summary measures of the absolute or relative risk of SUDEP. In addition, to explore reasons for heterogeneity in the absolute risk of SUDEP reported, the panel conducted a meta-analysis of subgroups of studies including different groups of patients with epilepsy (e.g., children vs adults). These meta-analyses have significant unexplained heterogeneity, which may suggest the presence of other unknown or unexplored risk factors.
Table 1 Conclusions for sudden unexpected death in epilepsy (SUDEP) incidence

Rationale for recommendations 1 and 2.

Our systematic review found that the SUDEP risk in children with epilepsy is 0.22/1,000 patient-years (95% CI 0.16–0.31). The SUDEP risk increases in adults to 1.2/1,000 patient-years (95% CI 0.64–2.32). There is considerable uncertainty regarding the estimates of the adult risk.
People with epilepsy and their families prefer to be informed of the individual's risk for a catastrophic event such as SUDEP, even when the probability of the event is low.18 This preference is subject to cultural influences. After being informed of an adverse event, people commonly overestimate the risk of that adverse event happening to them.19 Such overestimation unduly increases anxiety related to an adverse event. Overestimation can be lessened by presenting the risk as the probability of both having and not having the event,20 and by using numbers in addition to words19 and frequencies rather than percentages to convey the risk.21

Incidence recommendation 1: SUDEP incidence in children.

Clinicians caring for children with epilepsy should inform the children's parents or guardians that (Level B for the following):
1.
There is a rare risk of SUDEP.
2.
In 1 year, SUDEP typically affects 1 in 4,500 children with epilepsy; in other words, annually, 4,499 of 4,500 children will not be affected by SUDEP.

Incidence recommendation 2: SUDEP incidence in adults.

Clinicians should inform adult persons with epilepsy that (Level B for the following):
1.
There is a small risk of SUDEP.
2.
In 1 year, SUDEP typically affects 1 in 1,000 adults with epilepsy; in other words, annually, 999 of 1,000 adults will not be affected by SUDEP.

Question 2: Are there any risk factors for SUDEP?

Six Class I14,2226 and 16 Class II articles6,7,17,23,2738 provided evidence for this question. Table 2 summarizes the results.
Table 2 Conclusions for sudden unexpected death in epilepsy (SUDEP) risk factors

Rationale for recommendation 3.

Our systematic review found that a major risk factor for SUDEP is the presence and frequency of generalized tonic-clonic seizures (GTCS). For example, people with 3 or more GTCS per year have a 15-fold increased risk of SUDEP. This relative risk increase translates to an absolute risk of up to 18 deaths per 1,000 patient-years for people with frequent GTCS.29
The large SUDEP risk increase from GTCS, coupled with epilepsy monitoring unit evidence39 demonstrating that a GTCS was always the precipitating event of SUDEP, strongly suggests that GTCS are not just associated with SUDEP but, rather, are in the causal path to SUDEP. From this, it seems reasonable to infer that improved control of an individual's GTCS will result in a reduced risk of SUDEP. Thus, a reduction in SUDEP risk is an additional benefit to the many benefits resulting from improved seizure control.
As with all benefits associated with improved seizure control, the potential benefit of SUDEP risk reduction needs to be balanced with the risks and burdens associated with antiseizure therapies.

Recommendation 3.

For persons with epilepsy who continue to experience GTCS, clinicians should continue to actively manage epilepsy therapies to reduce seizure occurrences and the risk of SUDEP while incorporating patient preferences and weighing the risks and benefits of any new approach (Level B).

Rationale for recommendation 4.

GTCS are clear risk factors for SUDEP, and nocturnal seizures may also increase risk. These findings, in conjunction with the observation that postictal respiratory depression is a major mechanism in SUDEP,39 suggest that unwitnessed nocturnal seizures and postictal respiratory depression can cause SUDEP.
Moreover, the presence in the bedroom of another individual at least 10 years of age and of normal intelligence is associated with a decreased SUDEP risk. These results imply that a bedroom observer could detect seizures, check on the patient, and provide sufficient stimulation to prevent respiratory arrest. This association does not indicate that these interventions directly mitigate the mechanism that causes SUDEP.
If it were in accordance with patient and family circumstances and values, nocturnal supervision could reduce SUDEP risk; however, providing nighttime observation might be overly burdensome and intrusive.

Recommendation 4.

For persons with frequent GTCS and nocturnal seizures, clinicians may advise selected patients and families, if permitted by their individualized epilepsy and psychosocial circumstances, to use nocturnal supervision or other nocturnal precautions, such as the use of a remote listening device, to reduce SUDEP risk (Level C).

Rationale for recommendation 5.

One of the most consistent findings of this review is that many factors that are indicators of uncontrolled epilepsy, including having GTCS, having frequent GTCS, and the absence of seizure freedom, are strongly associated with SUDEP.
Usually, people with epilepsy and their families prefer to be informed of factors that are associated with an increased risk of a catastrophic event such as SUDEP. Patients are especially interested in factors that might reduce their risk even when a causal link between the factor and a reduction in risk has not been established. Knowledge of these risk factors might suggest behaviors that could modify the risk factors (e.g., improved therapy adherence40), increase the person's sense of control, and reduce the anxiety that comes from awareness of the risk. Less severe seizure types, such as focal seizures or myoclonic seizures, are not proven to be associated with increased SUDEP risk, but individuals who have them often remain at risk for GTCS in the setting of therapy nonadherence. Therefore, therapy adherence to maintain freedom from GTCS is important even when an individual is not experiencing this severe seizure type.

Recommendation 5.

Clinicians should inform patients with epilepsy that seizure freedom, particularly freedom from GTCS (which is more likely to occur with medication adherence), is strongly associated with a decreased risk of SUDEP (Level B).

Additional conclusions (no recommendations made).

The evidence is low that the following factors are associated with altering SUDEP risk:
1.
Nocturnal seizures (associated with increased risk)
2.
Any specific antiepileptic drug (AED) (none associated specifically with increased risk)
3.
Lamotrigine use in women (associated with increased risk)
4.
Never having been treated with an AED (associated with increased risk)
5.
Number of AEDs used overall (associated with increased risk)
6.
Heart rate variability (not associated with increased risk)
7.
Extratemporal epilepsy (associated with increased risk)
8.
Intellectual disability (associated with increased risk)
9.
Male sex (associated with increased risk)
10.
Anxiolytic drug use (associated with increased risk)
The evidence is very low or conflicting that the following factors are associated with altering SUDEP risk:
1.
Overall seizure frequency when evaluated by using all seizure types
2.
Medically refractory epilepsy vs not having well-controlled seizures defined as no seizures in the last year
3.
Monotherapy vs polytherapy
4.
Carbamazepine, phenytoin, or sodium valproate levels that are above, below, or within the reference range
5.
Psychotropic drug use
6.
Mental health disorders, lung disorders, or alcohol use
7.
Lamotrigine use in people with highly refractory epilepsy
8.
Frequent changes in AEDs
9.
Therapeutic drug monitoring
10.
Undergoing a resective epilepsy surgical procedure (although current research does not rule out the possibility of a beneficial effect or, further, the potential effect of epilepsy surgery on reducing GTCS frequency and epilepsy severity on reducing SUDEP risk)
11.
Engel outcome of epilepsy surgery (although current research does not rule out the possibility of a beneficial effect and, further, the potential effect of epilepsy surgery on reducing GTCS frequency and epilepsy severity on reducing SUDEP risk)
12.
Vagus nerve stimulator use for more than 2 years (however, current research does not rule out the possibility of a beneficial effect and, further, the potential effect of epilepsy surgery on reducing GTCS frequency and epilepsy severity on reducing the risk of SUDEP)
13.
Epilepsy etiology, whether idiopathic or localization-related
14.
Structural lesion on MRI
15.
Duration of epilepsy
16.
Age at epilepsy onset
17.
Postictal EEG suppression

SUGGESTIONS FOR FUTURE RESEARCH

1.
Systematic methods should be developed to identify and report the incidence of SUDEP in different epilepsy populations in order to obtain a better understanding of the incidence and causes of this devastating condition.
2.
Educational efforts are needed to improve the forensic knowledge of SUDEP among professionals such as medical examiners, coroners, and pathologists in order to help determine, and document on death certificates, the etiology in individuals, and in order to improve overall knowledge of this condition.
3.
Research to identify preventable risk factors should be supported and encouraged so that future clinical trials will be conducted to reduce SUDEP occurrence. Of particular importance is to better understand (1) the relationship between the nature, severity, and duration of epilepsy and the occurrence of SUDEP and (2) whether current treatments affect the risk of developing SUDEP.
4.
Because of (1) risks identified with frequent GTCS, (2) the fact that one study shows more SUDEP events occur in people in placebo arms of trials, and (3) increased SUDEP risk, serious consideration should be given to avoid assigning people with frequent GTCS to placebo for long periods.

DISCLAIMER

Clinical practice guidelines, practice advisories, systematic reviews and other guidance published by the American Academy of Neurology and its affiliates are assessments of current scientific and clinical information provided as an educational service. The information: (1) should not be considered inclusive of all proper treatments, methods of care, or as a statement of the standard of care; (2) is not continually updated and may not reflect the most recent evidence (new evidence may emerge between the time information is developed and when it is published or read); (3) addresses only the questions specifically identified; (4) does not mandate any particular course of medical care; and (5) is not intended to substitute for the independent professional judgment of the treating provider, as the information does not account for individual variation among patients. In all cases, the selected course of action should be considered by the treating provider in the context of treating the individual patient. Use of the information is voluntary. AAN provides this information on an “as is” basis, and makes no warranty, expressed or implied, regarding the information. AAN specifically disclaims any warranties of merchantability or fitness for a particular use or purpose. AAN assumes no responsibility for any injury or damage to persons or property arising out of or related to any use of this information or for any errors or omissions.

GLOSSARY

AAN
American Academy of Neurology
AED
antiepileptic drug
CI
confidence interval
GTCS
generalized tonic-clonic seizures
SUDEP
sudden unexpected death in epilepsy

Data Supplement

Neurology® data supplements are not copyedited before publication. Published editorials and translations have been copyedited. © 2017 American Academy of Neurology. Files in this Data Supplement:

Footnote

Editorial, page 1598

Supplementary Material

File (harden_1674.pdf)
File (sudep_appendix_e-6_pdf.pdf)
File (sudep_full-length_guideline.pdf)
File (surges_2021_german.pdf)
File (wnl-d-18-00583.pdf)

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Edey S, Moran N, Nashef L. SUDEP and epilepsy-related mortality in pregnancy. Epilepsia 2014;55:e72–e74.
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Berg AT, Nickels K, Wirrell EC, et al. Mortality risks in new-onset childhood epilepsy. Pediatrics 2013;132:124–131.
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Nickels KC, Grossardt BR, Wirrell EC. Epilepsy-related mortality is low in children: a 30-year population-based study in Olmsted County, MN. Epilepsia 2012;53:2164–2171.
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Sillanpää M, Shinnar S. SUDEP and other causes of mortality in childhood-onset epilepsy. Epilepsy Behav 2013;28:249–255.
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Lhatoo SD, Johnson AL, Goodridge DM, MacDonald BK, Sander JW, Shorvon SD. Mortality in epilepsy in the first 11 to 14 years after diagnosis: multivariate analysis of a long-term, prospective, population-based cohort. Ann Neurol 2001;49:336–344.
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Holst AG, Winkel BG, Risgaard B, et al. Epilepsy and risk of death and sudden unexpected death in the young: a nationwide study. Epilepsia 2013;54:1613–1620.
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Aurlien D, Larsen JP, Gjerstad L, Taubøll E. Comorbid and underlying diseases: major determinants of excess mortality in epilepsy. Seizure 2012;21:573–577.
18.
Xu Z, Ayyappan S, Seneviratne U. Sudden unexpected death in epilepsy (SUDEP): what do patients think? Epilepsy Behav 2015;42:29–34.
19.
Knapp P, Raynor DK, Berry DC. Comparison of two methods of presenting risk information to patients about the side effects of medicine. Qual Saf Health Care 2004;13:176–180.
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Kahneman D, Tversky A. Choices, values, and frames. Am Psychol 1984;39:341–350.
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Bonner C, Newell BR. How to make a risk seem riskier: the ratio bias versus construal level theory. Judgment Decis Making 2008;3:411–416.
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Sillanpää M, Shinnar S. Long-term mortality in childhood-onset epilepsy. N Engl J Med 2010;363:2522–2529.
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24.
Ryvlin P, Cucherat M, Rheims S. Risk of sudden unexpected death in epilepsy in patients given adjunctive antiepileptic treatment for refractory seizures: a meta-analysis of placebo-controlled randomised trials. Lancet Neurol 2011;10:961–968.
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Letters to the Editor
20 July 2017
A community response: Advocates embrace new AAN/AES SUDEP guideline
Tom Stanton, Danny Did Foundation
Robin Harding, Phil Gattone, Daniel Friedman, Angela Geiger, Orrin Devinsky, Kari Luther Rosbeck, Vanessa Vogel-Farley, Mary Anne Meskis, Alison Singer, Amy Brin Miller, Ilene Miller

The new guideline by the American Academy of Neurology (AAN) and the American Epilepsy Society (AES) on sudden unexpected death in epilepsy (SUDEP) is a landmark. [1] The communication between medical professionals and patients about SUDEP risk remains unacceptably low. Tragically, family members often first learn about SUDEP after their loved one's death. Every patient and parent deserves to know the risks of epilepsy. For the first time, the AAN and AES recommend that neurologists inform them about SUDEP, the most common cause of epilepsy-related death. [1]

Generalized tonic-clonic seizures increase SUDEP risk; the greater their frequency, the greater the risk. [2,3] Minimizing seizures through specialized medical care and strategies to reduce breakthrough seizures can reduce risk. [2,3] Since SUDEP happens more often in sleep, [2] nighttime supervision or monitoring may help and should be part of the patient/provider conversation. While the report assigns a blanket SUDEP risk ratio to children, [1] certain pediatric populations (children with Dravet syndrome, Dup15q syndrome, etc.) face a significantly higher risk. [4,5]

All medical professionals should use these recommendations to initiate an honest and ongoing conversation tailored to their patient's risk. We urgently need accurate surveillance data and expanded research to understand the mechanisms and save lives.

1. Harden C, Tomson T, Gloss D, et al. Practice guideline summary: Sudden unexpected death in epilepsy incidence rates and risk factors: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology and the American Epilepsy Society. Neurology 2017;88:1674-1680.

2. Devinsky O, Hesdorffer DC, Thurman DJ, Lhatoo S, Richerson G. Sudden unexpected death in epilepsy: epidemiology, mechanisms, and prevention. Lancet Neurol 2016;15:1075-1088.

3. Tomson T, Surges R, Delamont R, Haywood S, Hesdorffer DC. Who to target in sudden unexpected death in epilepsy prevention and how? Risk factors, biomarkers, and intervention study designs. Epilepsia 2016;57 Suppl 1:4-16.

4. Cooper MS, Mcintosh A, Crompton DE, et al. Mortality in Dravet syndrome. Epilepsy Res 2016;128:43-47.

5. Friedman D, Thaler A, Thaler J, et al. Mortality in isodicentric chromosome 15 syndrome: The role of SUDEP. Epilepsy Behav 2016;61:1-5.

Author affiliations: TS (Danny Did Foundation); RH (CURE, Citizens United for Research in Epilepsy); PG (Epilepsy Foundation); DF (NASR: North American SUDEP Registry); AG (Autism Speaks); OD (FACES: Finding a Cure for Epilepsy and Seizures); KLR (Tuberous Sclerosis Alliance); VVF (Dup15q Alliance); MAM (Dravet Syndrome Foundation); AS (Autism Science Foundation); ABM (Child Neurology Foundation); IM (Hope For HH).

For disclosures, please contact the editorial office at [email protected].

18 September 2019
Author response: Practice guideline summary: Sudden unexpected death in epilepsy incidence rates and risk factors: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology and the American Ep
Cynthia Harden, Neurologist | Mount Sinai Beth Israel Hospital

Thank you for pointing out the error in the confidence interval for the odds ratio of presence of generalized tonic-clonic seizure (GTCS) vs lack of GTCS. The correct value for the lower limit is 7, not 17 as shown in table 2. We regret this error. We note that the confidence interval is correctly presented as 7–14 on page 39 of the full-length document, available as a data supplement at neurology.org and on the AAN website at https://www.aan.com/Guidelines/home/GetGuidelineContent/989.

Disclosure

The author reports no relevant disclosures. Contact [email protected] for full disclosures.

29 July 2019
Reader response: Practice guideline summary: Sudden unexpected death in epilepsy incidence rates and risk factors: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology and the American Ep
Puchit Sukphulloprat, Neurologist | Thammasat University hospital , Pathumthani, Thailand

In table 2 of the practice guideline summary by Harden et al.1, the values for odds ratio (confidence interval) of presence of generalized tonic-clonic seizure (GTCS) vs lack of GTCS are “10 (17–14).” I thought that this was an impossible confidence interval.

Disclosure

The author reports no relevant disclosures. Contact [email protected] for full disclosures.

Reference

  1. Harden C, Tomson T, Gloss D, et al. Practice guideline summary: Sudden unexpected death in epilepsy incidence rates and risk factors: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology and the American Epilepsy Society. Neurology 2017;88:1674–1680.

Information & Authors

Information

Published In

Neurology®
Volume 88Number 17April 25, 2017
Pages: 1674-1680
PubMed: 28438841

Publication History

Received: June 24, 2016
Accepted: November 2, 2016
Published online: April 24, 2017
Published in print: April 25, 2017

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Conflict of Interest

The American Academy of Neurology and the American Epilepsy Society are committed to producing independent, critical, and truthful practice guidelines. Significant efforts are made to minimize the potential for conflicts of interest to influence the recommendations of this practice guideline. To the extent possible, the AAN and the AES keep separate those who have a financial stake in the success or failure of the products appraised in the practice guidelines and the developers of the practice guidelines. Conflict of interest forms were obtained from all authors and reviewed by an oversight committee prior to project initiation. AAN and AES limit the participation of authors with substantial conflicts of interest. The AAN and the AES forbid commercial participation in, or funding of, practice guidelines projects. Drafts of the practice guidelines have been reviewed by at least 3 AAN committees, at least 1 AES committee, a network of neurologists, Neurology® peer reviewers, and representatives from related fields. The AAN Guideline Author Conflict of Interest Policy can be viewed at aan.com. For complete information on this process, access the 2004 AAN process manual.1

Disclosure

C. Harden has received royalties from Wiley and UpToDate and has served as a contributing editor for Epilepsy Currents. T. Tomson has served as the associate editor of Epilepsia; is a member of the editorial boards of Epilepsy Research, Epileptic Disorders, and the European Journal of Clinical Pharmacology; has received honoraria from Sun Pharmaceuticals, UCB, Eisai, and Bial; has served as a member of an expert panel for sudden unexpected death in epilepsy (SUDEP) adjudication in clinical trials of lamotrigine sponsored by GlaxoSmithKline; and has received research support from UCB, GlaxoSmithKline, Bial, Eisai, Novartis, Stockholm County Council, and Citizens United in Research for Epilepsy (CURE). D. Gloss serves as an evidence-based medicine consultant for the American Academy of Neurology (AAN) and has served as an associate editor (risk of bias classification) for Neurology®. J. Buchhalter has received funding for travel from the AAN; serves on an editorial advisory board for Pediatric Neurology and Epilepsy Currents; has served as a consultant to UCB, Upsher-Smith Laboratories, and Eisai; and has performed clinical procedures/imaging studies related to the content of this practice guideline, including EEG and video EEG (25%) and epilepsy surgery evaluation. J. Cross has served as a member of the editorial boards of Developmental Medicine, Child Neurology, and the European Journal of Child Neurology; has a patent for C10 in the treatment of epilepsy; has received royalties for a chapter on childhood epilepsy in Brain Diseases of the Nervous System and as editor of Paediatric Epilepsy; has received research support from the UK National Institute for Health and Research (NIHR), the European Framework FP7, the Charles Wolfson Foundation, Action Medical Research, and Sparks; and has sat on advisory boards for Vitaflo, Sanofi, Eisai, Viropharma, and Zogenix, for which remuneration is paid to her department. E. Donner has received research support from the Canadian Institutes of Health Research, Dravet Canada, and SUDEP Aware. J. French has served as a consultant for Acorda, Biotie, Eisai Medical Research, GlaxoSmithKline, Impax, Johnson & Johnson, Lewis County General Hospital, Marinus, Novartis, Pfizer, Sunovion, SK Life Science, Supernus Pharmaceuticals, UCB, Upsher-Smith, and Vertex; has received grants from Eisai Medical Research, the US Epilepsy Research Foundation, the Epilepsy Study Consortium, the Epilepsy Therapy Project of the Epilepsy Foundation, Lundbeck, Pfizer, and UCB; and is president of the Epilepsy Study Consortium. All consulting is done on behalf of the Consortium, and fees are paid to the Consortium. New York University receives salary support from the Consortium. A. Gil-Nagel has received personal compensation from Bial, Eisai, GSD Pharma Consulting, UCB Pharma, and Pfizer; has received funding for travel from Bial, Eisai, and GlaxoSmithKline; has served as an editor for Seizure, Neurologia, and Revista de Neurologia; has served on speakers bureaus for Bial, Eisai, GlaxoSmithKline, and UCB Pharma; and asserts that the information he provides his patients in his epilepsy clinic may be influenced by the results of this practice guideline. D. Hesdorffer is a member of the SUDEP Institute and of the Executive Committee of the North American SUDEP Registry; has served on scientific advisory boards for Upsher-Smith and Acorda; has served as a consultant for Cyberonics; has received funding for travel from the International League Against Epilepsy; has served as an associate editor of Epilepsia; has served on the editorial board for Epilepsy and Behavior; has served as a contributing editor for Epilepsy Currents; and has received funding from the NIH, the Centers for Disease Control and Prevention, the Epilepsy Consortium, the Patient Centered Outcome Research Institute, Finding a Cure for Epilepsy, The Epilepsy Study Consortium, and the Icahn School of Medicine at Mount Sinai (for consulting work on an injury prevention grant). W. Smithson has served on a scientific advisory board for the Sanofi UK consensus guidelines on women with epilepsy, has received travel funding for the Partners Against Mortality in Epilepsy conference on SUDEP (Washington 2016), has received publishing royalties from Blackwell Publishing for the ABC of Epilepsy, has received financial support in the form of funding for a general practice research infrastructure from the NIHR (UK), and has given expert witness testimony for the Fatal Accident Inquiry Dundee 2012 (2 cases of SUDEP). M. Spitz has received personal compensation and honoraria for serving on an advisory board for UCB, has received travel funding from Cyberonics (to see the site/factory), has received financial support for a US Department of Defense Study on closed head injury, and has given expert testimony, prepared an affidavit for, and acted as a witness or consultant regarding a legal proceeding. T. Walczak serves on a scientific advisory panel tracking incidence of SUDEP in follow-up of patients treated with the NeuroPace RNS System. Compensation goes directly to his academic department and does not increase his salary. J. Sander is based at University College London/University College London Hospitals, which receives funding from the UK Department of Health's NIHR Biomedical Research Centres; has served on advisory boards for UCB and Eisai; has received speaker honoraria from GlaxoSmithKline, Eisai, UCB, Lundbeck, and Teva; serves on the editorial board of the Lancet Neurology; and receives research support from the Dr. Marvin Weil Epilepsy Research Fund, the Epilepsy Society (UK), the Netherlands Epilepsy Fund, Eisai, GlaxoSmithKline, WHO, and EU FP7. His current position is endowed by the Epilepsy Society (UK). P. Ryvlin has served as a chair of the Scientific Advisory Committee for the annual meeting of the French League Against Epilepsy; has received travel funding and honoraria from GlaxoSmithKline, Eisai, Janssen Cilag Pty. Ltd., Cyberonics, Medtronic, and UCB Pharma (in order to participate on industry-funded advisory boards or symposia); has served as a journal editor for Epilepsia, Epilepsy Research, Epileptic Disorders, and Epilepsy Research and Treatment; has served on speakers bureaus for Eisai, GlaxoSmithKline, and UCB Pharma for a symposium at the European and International Epilepsy Congress (in order to participate on advisory boards or symposia); and has received financial support in the form of a European FP7 grant (EURIPIDES) and grant/research program funding from national (French) entities, including 2 PHRC (Programme Hospitalier de Recherche Clinique), 1 INSERM-DHOS (Institut National de la Santé et de la Recherche Médicale-Direction de l'Hospitalisation et de l'Organisation des Soins) Translationnelle, and 1 Contrat d'Interface INSERM. Go to Neurology.org for full disclosures.

Study Funding

This guideline was developed with financial support from the American Academy of Neurology. Authors who serve as AAN subcommittee members or methodologists (C.H., D.G., J.A.F.) were reimbursed by the AAN for expenses related to travel to subcommittee meetings where drafts of manuscripts were reviewed.

Authors

Affiliations & Disclosures

Cynthia Harden, MD
From the Department of Neurology (C.H.), Mount Sinai Health System, New York, NY; Department of Clinical Neuroscience (T.T.), Karolinska Institutet, Stockholm, Sweden; Department of Neurology (D.G.), CAMC Physicians, Charleston, WV; Departments of Pediatrics and Clinical Neurosciences (J.B.), Alberta Children's Hospital, University of Calgary, Canada; Department of Clinical Neurosciences, Institute of Child Health (J.H.C.), and Institute of Neurology (J.W.S.), University College London; Great Ormond Street Hospital for Children NHS Foundation Trust (J.H.C.), London, UK; Department of Paediatrics (E.D.), Division of Neurology, The Hospital for Sick Children, University of Toronto, Canada; Department of Neurology (J.A.F.), New York University Langone Comprehensive Epilepsy Center, New York; Department of Neurology (A.G.-N.), Hospital Ruber Internacional, Madrid, Spain; Gertrude H. Sergievsky Center and Department of Epidemiology (D.C.H.), Columbia University Medical Center, New York, NY; Department of General Practice (W.H.S.), University College Cork, Ireland; Anschutz Outpatient Pavilion (M.C.S.), University of Colorado Health, Aurora; Neurology Clinic (T.S.W.), University of Minnesota, Minneapolis; Stichting Epilepsie Instellingen Nederland (SEIN) (J.W.S.), Heemstede, the Netherlands; and the Department of Clinical Neurosciences (P.R.), CHUV, Lausanne, Switzerland.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
Torbjörn Tomson, MD, PhD
From the Department of Neurology (C.H.), Mount Sinai Health System, New York, NY; Department of Clinical Neuroscience (T.T.), Karolinska Institutet, Stockholm, Sweden; Department of Neurology (D.G.), CAMC Physicians, Charleston, WV; Departments of Pediatrics and Clinical Neurosciences (J.B.), Alberta Children's Hospital, University of Calgary, Canada; Department of Clinical Neurosciences, Institute of Child Health (J.H.C.), and Institute of Neurology (J.W.S.), University College London; Great Ormond Street Hospital for Children NHS Foundation Trust (J.H.C.), London, UK; Department of Paediatrics (E.D.), Division of Neurology, The Hospital for Sick Children, University of Toronto, Canada; Department of Neurology (J.A.F.), New York University Langone Comprehensive Epilepsy Center, New York; Department of Neurology (A.G.-N.), Hospital Ruber Internacional, Madrid, Spain; Gertrude H. Sergievsky Center and Department of Epidemiology (D.C.H.), Columbia University Medical Center, New York, NY; Department of General Practice (W.H.S.), University College Cork, Ireland; Anschutz Outpatient Pavilion (M.C.S.), University of Colorado Health, Aurora; Neurology Clinic (T.S.W.), University of Minnesota, Minneapolis; Stichting Epilepsie Instellingen Nederland (SEIN) (J.W.S.), Heemstede, the Netherlands; and the Department of Clinical Neurosciences (P.R.), CHUV, Lausanne, Switzerland.
Disclosure
Scientific Advisory Boards:
1.
UCB Pharma and Eisai, honorarium to my department
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
(1) UCB, speaker honorarium (paid to department); (2) Eisai, Inc., speaker honorarium (paid to department)
Editorial Boards:
1.
(1) Epilepsia, Associate Editor, 2008-2013; (2) Epilepsy Research, Editorial Board, 2007-2015; (3) Epileptic Disorders, Associate Editor, 2013-present
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
As chair of the central project commission of EURAP, an international antiepileptic drugs and pregnancy registry, I have on behalf of the project received research grants from Bial, Eisai, GlaxoSmithKline, Novartis, and UCB annually the past two years GlaxoSmithKline research support for case-control study of SUDEP
Research Support, Government Entities:
1.
(1) ALF (Stockholm County Council) 2009-2016
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
(1) CURE, 2010, 2015
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
David Gloss, MD, MPH&TM
From the Department of Neurology (C.H.), Mount Sinai Health System, New York, NY; Department of Clinical Neuroscience (T.T.), Karolinska Institutet, Stockholm, Sweden; Department of Neurology (D.G.), CAMC Physicians, Charleston, WV; Departments of Pediatrics and Clinical Neurosciences (J.B.), Alberta Children's Hospital, University of Calgary, Canada; Department of Clinical Neurosciences, Institute of Child Health (J.H.C.), and Institute of Neurology (J.W.S.), University College London; Great Ormond Street Hospital for Children NHS Foundation Trust (J.H.C.), London, UK; Department of Paediatrics (E.D.), Division of Neurology, The Hospital for Sick Children, University of Toronto, Canada; Department of Neurology (J.A.F.), New York University Langone Comprehensive Epilepsy Center, New York; Department of Neurology (A.G.-N.), Hospital Ruber Internacional, Madrid, Spain; Gertrude H. Sergievsky Center and Department of Epidemiology (D.C.H.), Columbia University Medical Center, New York, NY; Department of General Practice (W.H.S.), University College Cork, Ireland; Anschutz Outpatient Pavilion (M.C.S.), University of Colorado Health, Aurora; Neurology Clinic (T.S.W.), University of Minnesota, Minneapolis; Stichting Epilepsie Instellingen Nederland (SEIN) (J.W.S.), Heemstede, the Netherlands; and the Department of Clinical Neurosciences (P.R.), CHUV, Lausanne, Switzerland.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
Neurology, LOE Review Team
Patents:
1.
NONE
Publishing Royalties:
1.
(1) Neurology for the Specialty Boards, Lippincott Williams and Wilkins, 2006
Employment, Commercial Entity:
1.
(1) Charleston Area Medical Center, Charleston, WV 25311
Consultancies:
1.
(1) I am an Evidence-based medicine consultant for the American Academy of Neurology
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
Jeffrey Buchhalter, MD, PhD
From the Department of Neurology (C.H.), Mount Sinai Health System, New York, NY; Department of Clinical Neuroscience (T.T.), Karolinska Institutet, Stockholm, Sweden; Department of Neurology (D.G.), CAMC Physicians, Charleston, WV; Departments of Pediatrics and Clinical Neurosciences (J.B.), Alberta Children's Hospital, University of Calgary, Canada; Department of Clinical Neurosciences, Institute of Child Health (J.H.C.), and Institute of Neurology (J.W.S.), University College London; Great Ormond Street Hospital for Children NHS Foundation Trust (J.H.C.), London, UK; Department of Paediatrics (E.D.), Division of Neurology, The Hospital for Sick Children, University of Toronto, Canada; Department of Neurology (J.A.F.), New York University Langone Comprehensive Epilepsy Center, New York; Department of Neurology (A.G.-N.), Hospital Ruber Internacional, Madrid, Spain; Gertrude H. Sergievsky Center and Department of Epidemiology (D.C.H.), Columbia University Medical Center, New York, NY; Department of General Practice (W.H.S.), University College Cork, Ireland; Anschutz Outpatient Pavilion (M.C.S.), University of Colorado Health, Aurora; Neurology Clinic (T.S.W.), University of Minnesota, Minneapolis; Stichting Epilepsie Instellingen Nederland (SEIN) (J.W.S.), Heemstede, the Netherlands; and the Department of Clinical Neurosciences (P.R.), CHUV, Lausanne, Switzerland.
Disclosure
Scientific Advisory Boards:
1.
Observational Safety Monitoring Board- NIH, Benign Epilepsy of Childhood with Central Temporal Spikes DSMB- NINDS, Established Status Epilepticus Therapy Trial Charlie Foundation Scientific Advisory Board IDIC 15 Scientific Advisory Board
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
AAN, webinar series,honoraria AAN, course director, honoraria AAN, Medical Economics & Management Committee AAN, Practice Committee AAN, Child Neurology Quality Measures Work Group Eisai Ltd, honorarium for webinar series, speaking, consulting Lundbeck, honorarium for speaking, consulting Upsher-Smith Labs, honorarium for consulting
Editorial Boards:
1.
Clinical Neurology News, editorial advisory board, 2010-15
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
Lundbeck Inc., Eisai Ltd., UCB, and Upsher-Smith
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
Alberta Health Services- CMO Quality Improvement grant, principle investigator, 1 year
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
J. Helen Cross, MB, ChB, PhD
From the Department of Neurology (C.H.), Mount Sinai Health System, New York, NY; Department of Clinical Neuroscience (T.T.), Karolinska Institutet, Stockholm, Sweden; Department of Neurology (D.G.), CAMC Physicians, Charleston, WV; Departments of Pediatrics and Clinical Neurosciences (J.B.), Alberta Children's Hospital, University of Calgary, Canada; Department of Clinical Neurosciences, Institute of Child Health (J.H.C.), and Institute of Neurology (J.W.S.), University College London; Great Ormond Street Hospital for Children NHS Foundation Trust (J.H.C.), London, UK; Department of Paediatrics (E.D.), Division of Neurology, The Hospital for Sick Children, University of Toronto, Canada; Department of Neurology (J.A.F.), New York University Langone Comprehensive Epilepsy Center, New York; Department of Neurology (A.G.-N.), Hospital Ruber Internacional, Madrid, Spain; Gertrude H. Sergievsky Center and Department of Epidemiology (D.C.H.), Columbia University Medical Center, New York, NY; Department of General Practice (W.H.S.), University College Cork, Ireland; Anschutz Outpatient Pavilion (M.C.S.), University of Colorado Health, Aurora; Neurology Clinic (T.S.W.), University of Minnesota, Minneapolis; Stichting Epilepsie Instellingen Nederland (SEIN) (J.W.S.), Heemstede, the Netherlands; and the Department of Clinical Neurosciences (P.R.), CHUV, Lausanne, Switzerland.
Disclosure
Scientific Advisory Boards:
1.
I have sat on scientific advisory boards for Eisai,GSK Zogenix, Sanofi, Shire, Takeda and UCB for which remuneration has been paid to my department
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
J Helen Cross is on the Editorial Board for Epilepsy Research
Patents:
1.
I am part of a submission for patent for Betashot (Vitaflo); a C10 compund developed for nutritional purposes
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
She works as Clinical Advisor to the National Children?s Epilepsy Surgery Service
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
Participating in clinical trials for GW Pharma, Zogenix, Vitaflo, for which remuneration is made to my department
Research Support, Government Entities:
1.
1. National Institute for Health and Research Senior Investigator 2016-2020 2. Research grant funding from National Institute for Health and Research 3. European Union FP7
Research Support, Academic Entities:
1.
Holds an endowed Chair through the University College, London
Research Support, Foundations and Societies:
1.
1. Action Medical Research 2. SPARKS 3. Charles Wolfson Foundation
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
Elizabeth Donner, MD
From the Department of Neurology (C.H.), Mount Sinai Health System, New York, NY; Department of Clinical Neuroscience (T.T.), Karolinska Institutet, Stockholm, Sweden; Department of Neurology (D.G.), CAMC Physicians, Charleston, WV; Departments of Pediatrics and Clinical Neurosciences (J.B.), Alberta Children's Hospital, University of Calgary, Canada; Department of Clinical Neurosciences, Institute of Child Health (J.H.C.), and Institute of Neurology (J.W.S.), University College London; Great Ormond Street Hospital for Children NHS Foundation Trust (J.H.C.), London, UK; Department of Paediatrics (E.D.), Division of Neurology, The Hospital for Sick Children, University of Toronto, Canada; Department of Neurology (J.A.F.), New York University Langone Comprehensive Epilepsy Center, New York; Department of Neurology (A.G.-N.), Hospital Ruber Internacional, Madrid, Spain; Gertrude H. Sergievsky Center and Department of Epidemiology (D.C.H.), Columbia University Medical Center, New York, NY; Department of General Practice (W.H.S.), University College Cork, Ireland; Anschutz Outpatient Pavilion (M.C.S.), University of Colorado Health, Aurora; Neurology Clinic (T.S.W.), University of Minnesota, Minneapolis; Stichting Epilepsie Instellingen Nederland (SEIN) (J.W.S.), Heemstede, the Netherlands; and the Department of Clinical Neurosciences (P.R.), CHUV, Lausanne, Switzerland.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
Biocodex, honoraria
Editorial Boards:
1.
Editorial Board, Epilepsia Open
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
Ontario Brain Institute, EpLink Grant PI, 2013-2018
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
CURE, 2009 Dravet Canada, 2016
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
Jacqueline A. French, MD
From the Department of Neurology (C.H.), Mount Sinai Health System, New York, NY; Department of Clinical Neuroscience (T.T.), Karolinska Institutet, Stockholm, Sweden; Department of Neurology (D.G.), CAMC Physicians, Charleston, WV; Departments of Pediatrics and Clinical Neurosciences (J.B.), Alberta Children's Hospital, University of Calgary, Canada; Department of Clinical Neurosciences, Institute of Child Health (J.H.C.), and Institute of Neurology (J.W.S.), University College London; Great Ormond Street Hospital for Children NHS Foundation Trust (J.H.C.), London, UK; Department of Paediatrics (E.D.), Division of Neurology, The Hospital for Sick Children, University of Toronto, Canada; Department of Neurology (J.A.F.), New York University Langone Comprehensive Epilepsy Center, New York; Department of Neurology (A.G.-N.), Hospital Ruber Internacional, Madrid, Spain; Gertrude H. Sergievsky Center and Department of Epidemiology (D.C.H.), Columbia University Medical Center, New York, NY; Department of General Practice (W.H.S.), University College Cork, Ireland; Anschutz Outpatient Pavilion (M.C.S.), University of Colorado Health, Aurora; Neurology Clinic (T.S.W.), University of Minnesota, Minneapolis; Stichting Epilepsie Instellingen Nederland (SEIN) (J.W.S.), Heemstede, the Netherlands; and the Department of Clinical Neurosciences (P.R.), CHUV, Lausanne, Switzerland.
Disclosure
Scientific Advisory Boards:
1.
On the scientific advisory board or consultant for Epilepsy Foundation, Acorda, Alexza, Anavex, BioPharm Solutions, Concert, Eisai, Georgia Regents University, GW Pharma, Marathon, Marinus, Neurelis, Novartis, Pfizer, Pfizer-Neusentis, Pronutria, Roivant, Sage, SciFluor, SK Life Sciences, Takeda, UCB Inc., Ultragenyx, Upsher Smith, Xenon Pharmaceuticals, Zynerba Epilepsy Study Consortium,
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
Paid travel to present findings at scientific meetings, present at investigators meetings attend advisory boards or give lectures from Acorda, Alexza, Biogen, UCB, Eisai, Inc., Johnson and Johnson, Glaxo Smith-Kline, Marinus, SK Corporation, Upsher-Smith Laboratories, Inc., Novartis, Pfizer Inc, LCGH, Takeda, Supernus,Sage Epilepsy Foundation, Zynerba,Zogenix
Editorial Boards:
1.
2) Lancet Neurology,Editorial Board, 2 years 3) Neurology Today, Editorial board 4) Epilepsy Currents, Editorial Board
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
President, Epilepsy Study Consortium, that recieves money from multiple pharmaceutical companies. I consult for a number of companies, on behalf of the Epilepsy Study consortium. A fixed 30% of my NYU salary is paid by the study consortium, and some of this money may come from consulting fees. Companies involved include Acorda,Adamas Alexza, Anavex, BioPharm Solutions, Biogen, Concert, Eisai, Georgia Regents University, GW Pharma,Glaxo Smith-Kline, Marathon, Marinus, Neurelis, Novartis, Pfizer, Pfizer-Neusentis, Pronutria, Roivant, Sage, SciFluor, SK Life Sciences, Takeda, UCB Inc., Ultragenyx, Upsher Smith, Xenon Pharmaceuticals, Zynerba, Zogenix
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
1)Alexza 2) Adamas 3)Acorda 4)LCGH 5) Eisai Medical Research 6)Lundbeck 7) Pfizer 8) SK life sciences 9) Sunovion 10) UCB 11 ) Upsher-Smith
Research Support, Government Entities:
1.
NIH 1 R01 NS053998-01A1, Coinvestigator, 2007-2011
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
1) Epilepsy Foundation 2) Epilepsy Research Foundation 3) Epilepsy Study Consortium
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
Anthony Gil-Nagel, MD, PhD
From the Department of Neurology (C.H.), Mount Sinai Health System, New York, NY; Department of Clinical Neuroscience (T.T.), Karolinska Institutet, Stockholm, Sweden; Department of Neurology (D.G.), CAMC Physicians, Charleston, WV; Departments of Pediatrics and Clinical Neurosciences (J.B.), Alberta Children's Hospital, University of Calgary, Canada; Department of Clinical Neurosciences, Institute of Child Health (J.H.C.), and Institute of Neurology (J.W.S.), University College London; Great Ormond Street Hospital for Children NHS Foundation Trust (J.H.C.), London, UK; Department of Paediatrics (E.D.), Division of Neurology, The Hospital for Sick Children, University of Toronto, Canada; Department of Neurology (J.A.F.), New York University Langone Comprehensive Epilepsy Center, New York; Department of Neurology (A.G.-N.), Hospital Ruber Internacional, Madrid, Spain; Gertrude H. Sergievsky Center and Department of Epidemiology (D.C.H.), Columbia University Medical Center, New York, NY; Department of General Practice (W.H.S.), University College Cork, Ireland; Anschutz Outpatient Pavilion (M.C.S.), University of Colorado Health, Aurora; Neurology Clinic (T.S.W.), University of Minnesota, Minneapolis; Stichting Epilepsie Instellingen Nederland (SEIN) (J.W.S.), Heemstede, the Netherlands; and the Department of Clinical Neurosciences (P.R.), CHUV, Lausanne, Switzerland.
Disclosure
Scientific Advisory Boards:
1.
(1) Bial (2) Eisai (3) UCB Pharma
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
(1) Bial (2) Eisai (3) UCB Pharma
Editorial Boards:
1.
(1) Epileptic Disorders (2) Seizure (3) Neurolog?a (4) Frontiers in Neurology
Patents:
1.
NONE
Publishing Royalties:
1.
Handbook of Neurological Therapy, Oxford University Press, Published in 2015
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
(1) Bial (2) Eisai (3) UCB Pharma
Speakers' Bureaus:
1.
(1) Bial (2) Eisai (3) UCB Pharma
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
Hospital Ruber Internacional, Madrid, Spain. Video-EEG monitoring 40% of time since 1998
Research Support, Commercial Entities:
1.
Bial
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
(1) Fundaci?n INCE, Madrid, Spain (2) Fundaci?n GMP
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
Dale C. Hesdorffer, PhD
From the Department of Neurology (C.H.), Mount Sinai Health System, New York, NY; Department of Clinical Neuroscience (T.T.), Karolinska Institutet, Stockholm, Sweden; Department of Neurology (D.G.), CAMC Physicians, Charleston, WV; Departments of Pediatrics and Clinical Neurosciences (J.B.), Alberta Children's Hospital, University of Calgary, Canada; Department of Clinical Neurosciences, Institute of Child Health (J.H.C.), and Institute of Neurology (J.W.S.), University College London; Great Ormond Street Hospital for Children NHS Foundation Trust (J.H.C.), London, UK; Department of Paediatrics (E.D.), Division of Neurology, The Hospital for Sick Children, University of Toronto, Canada; Department of Neurology (J.A.F.), New York University Langone Comprehensive Epilepsy Center, New York; Department of Neurology (A.G.-N.), Hospital Ruber Internacional, Madrid, Spain; Gertrude H. Sergievsky Center and Department of Epidemiology (D.C.H.), Columbia University Medical Center, New York, NY; Department of General Practice (W.H.S.), University College Cork, Ireland; Anschutz Outpatient Pavilion (M.C.S.), University of Colorado Health, Aurora; Neurology Clinic (T.S.W.), University of Minnesota, Minneapolis; Stichting Epilepsie Instellingen Nederland (SEIN) (J.W.S.), Heemstede, the Netherlands; and the Department of Clinical Neurosciences (P.R.), CHUV, Lausanne, Switzerland.
Disclosure
Scientific Advisory Boards:
1.
(1) Commercial entity: Acorda, Upsher Smith, Cyberonics (2) Wiley Epilepsia Associate Editor
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
Acorda, Upsher Smith: Covered travel and hotel for Advisory Board meetings International League Against Epilepsy: Funding to attend a meeting
Editorial Boards:
1.
Associate Editor, Epilepsia 2013-present Editorial Board, Epilepsy and Behavior 2011-present;
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
Mount Sinai Medical Center, Injury prevention center grant, paid advisor
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
1. CDC, U01 DP006089 PI of Columbia subcontract 2015-2018 2. NINDS, NS04320, Co-I (PI of Columbia subcontract), 2003- 2018; 3. NINDS, NS078419, Co-I, 2012-2015 4. NINDS, NS078419, Co-I 2012-2016 5. PCORI, PPRN-1306-045777, Co-PI 2014-2018 6. FACES, PI of subcontract 2015-2016 7. The Epilepsy Study Consortium. PI of subcontract 2013- 2018
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
W. Henry Smithson, MB, ChB, MD
From the Department of Neurology (C.H.), Mount Sinai Health System, New York, NY; Department of Clinical Neuroscience (T.T.), Karolinska Institutet, Stockholm, Sweden; Department of Neurology (D.G.), CAMC Physicians, Charleston, WV; Departments of Pediatrics and Clinical Neurosciences (J.B.), Alberta Children's Hospital, University of Calgary, Canada; Department of Clinical Neurosciences, Institute of Child Health (J.H.C.), and Institute of Neurology (J.W.S.), University College London; Great Ormond Street Hospital for Children NHS Foundation Trust (J.H.C.), London, UK; Department of Paediatrics (E.D.), Division of Neurology, The Hospital for Sick Children, University of Toronto, Canada; Department of Neurology (J.A.F.), New York University Langone Comprehensive Epilepsy Center, New York; Department of Neurology (A.G.-N.), Hospital Ruber Internacional, Madrid, Spain; Gertrude H. Sergievsky Center and Department of Epidemiology (D.C.H.), Columbia University Medical Center, New York, NY; Department of General Practice (W.H.S.), University College Cork, Ireland; Anschutz Outpatient Pavilion (M.C.S.), University of Colorado Health, Aurora; Neurology Clinic (T.S.W.), University of Minnesota, Minneapolis; Stichting Epilepsie Instellingen Nederland (SEIN) (J.W.S.), Heemstede, the Netherlands; and the Department of Clinical Neurosciences (P.R.), CHUV, Lausanne, Switzerland.
Disclosure
Scientific Advisory Boards:
1.
SUDEP Action non-profit entity
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
ABC of Epilepsy Wiley pubs 2012
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
Mark C. Spitz, MD
From the Department of Neurology (C.H.), Mount Sinai Health System, New York, NY; Department of Clinical Neuroscience (T.T.), Karolinska Institutet, Stockholm, Sweden; Department of Neurology (D.G.), CAMC Physicians, Charleston, WV; Departments of Pediatrics and Clinical Neurosciences (J.B.), Alberta Children's Hospital, University of Calgary, Canada; Department of Clinical Neurosciences, Institute of Child Health (J.H.C.), and Institute of Neurology (J.W.S.), University College London; Great Ormond Street Hospital for Children NHS Foundation Trust (J.H.C.), London, UK; Department of Paediatrics (E.D.), Division of Neurology, The Hospital for Sick Children, University of Toronto, Canada; Department of Neurology (J.A.F.), New York University Langone Comprehensive Epilepsy Center, New York; Department of Neurology (A.G.-N.), Hospital Ruber Internacional, Madrid, Spain; Gertrude H. Sergievsky Center and Department of Epidemiology (D.C.H.), Columbia University Medical Center, New York, NY; Department of General Practice (W.H.S.), University College Cork, Ireland; Anschutz Outpatient Pavilion (M.C.S.), University of Colorado Health, Aurora; Neurology Clinic (T.S.W.), University of Minnesota, Minneapolis; Stichting Epilepsie Instellingen Nederland (SEIN) (J.W.S.), Heemstede, the Netherlands; and the Department of Clinical Neurosciences (P.R.), CHUV, Lausanne, Switzerland.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
Thaddeus S. Walczak, MD
From the Department of Neurology (C.H.), Mount Sinai Health System, New York, NY; Department of Clinical Neuroscience (T.T.), Karolinska Institutet, Stockholm, Sweden; Department of Neurology (D.G.), CAMC Physicians, Charleston, WV; Departments of Pediatrics and Clinical Neurosciences (J.B.), Alberta Children's Hospital, University of Calgary, Canada; Department of Clinical Neurosciences, Institute of Child Health (J.H.C.), and Institute of Neurology (J.W.S.), University College London; Great Ormond Street Hospital for Children NHS Foundation Trust (J.H.C.), London, UK; Department of Paediatrics (E.D.), Division of Neurology, The Hospital for Sick Children, University of Toronto, Canada; Department of Neurology (J.A.F.), New York University Langone Comprehensive Epilepsy Center, New York; Department of Neurology (A.G.-N.), Hospital Ruber Internacional, Madrid, Spain; Gertrude H. Sergievsky Center and Department of Epidemiology (D.C.H.), Columbia University Medical Center, New York, NY; Department of General Practice (W.H.S.), University College Cork, Ireland; Anschutz Outpatient Pavilion (M.C.S.), University of Colorado Health, Aurora; Neurology Clinic (T.S.W.), University of Minnesota, Minneapolis; Stichting Epilepsie Instellingen Nederland (SEIN) (J.W.S.), Heemstede, the Netherlands; and the Department of Clinical Neurosciences (P.R.), CHUV, Lausanne, Switzerland.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
SUDEP adjudication committee Neuropace. Reviewed all deaths occurring during followup of patients entered in pivotal studies of Neuropace RNS device to determine whether the cases met criteria for SUDEP or not. $1000 per year given to practice in first several years of participation; I am not sure whether this continued after I joined a new practice in 2013.
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
Josemir W. Sander, MD, PhD, FRCP
From the Department of Neurology (C.H.), Mount Sinai Health System, New York, NY; Department of Clinical Neuroscience (T.T.), Karolinska Institutet, Stockholm, Sweden; Department of Neurology (D.G.), CAMC Physicians, Charleston, WV; Departments of Pediatrics and Clinical Neurosciences (J.B.), Alberta Children's Hospital, University of Calgary, Canada; Department of Clinical Neurosciences, Institute of Child Health (J.H.C.), and Institute of Neurology (J.W.S.), University College London; Great Ormond Street Hospital for Children NHS Foundation Trust (J.H.C.), London, UK; Department of Paediatrics (E.D.), Division of Neurology, The Hospital for Sick Children, University of Toronto, Canada; Department of Neurology (J.A.F.), New York University Langone Comprehensive Epilepsy Center, New York; Department of Neurology (A.G.-N.), Hospital Ruber Internacional, Madrid, Spain; Gertrude H. Sergievsky Center and Department of Epidemiology (D.C.H.), Columbia University Medical Center, New York, NY; Department of General Practice (W.H.S.), University College Cork, Ireland; Anschutz Outpatient Pavilion (M.C.S.), University of Colorado Health, Aurora; Neurology Clinic (T.S.W.), University of Minnesota, Minneapolis; Stichting Epilepsie Instellingen Nederland (SEIN) (J.W.S.), Heemstede, the Netherlands; and the Department of Clinical Neurosciences (P.R.), CHUV, Lausanne, Switzerland.
Disclosure
Scientific Advisory Boards:
1.
1) UCB Pharma - membership of Advisory Board 2) Eisai - membership of Advisory Board
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
1) Lancet Neurology - member of Editorial Board
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
1) UCB Pharma - membership of Speakers' Bureau 2) Teva - membership of Speakers' Bureau 3) Lundbeck - membership of Speakers' Bureau
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
1) UCB Pharma - research grant to my department 2) GSK - research grant to my department 3) Eisai - research grant to my department
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
1) Nationaal Epilepsie Fonds Nederland Projectnumber: 10-07. PI, 2010 ? 2013
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
Philippe Ryvlin, MD, PhD
From the Department of Neurology (C.H.), Mount Sinai Health System, New York, NY; Department of Clinical Neuroscience (T.T.), Karolinska Institutet, Stockholm, Sweden; Department of Neurology (D.G.), CAMC Physicians, Charleston, WV; Departments of Pediatrics and Clinical Neurosciences (J.B.), Alberta Children's Hospital, University of Calgary, Canada; Department of Clinical Neurosciences, Institute of Child Health (J.H.C.), and Institute of Neurology (J.W.S.), University College London; Great Ormond Street Hospital for Children NHS Foundation Trust (J.H.C.), London, UK; Department of Paediatrics (E.D.), Division of Neurology, The Hospital for Sick Children, University of Toronto, Canada; Department of Neurology (J.A.F.), New York University Langone Comprehensive Epilepsy Center, New York; Department of Neurology (A.G.-N.), Hospital Ruber Internacional, Madrid, Spain; Gertrude H. Sergievsky Center and Department of Epidemiology (D.C.H.), Columbia University Medical Center, New York, NY; Department of General Practice (W.H.S.), University College Cork, Ireland; Anschutz Outpatient Pavilion (M.C.S.), University of Colorado Health, Aurora; Neurology Clinic (T.S.W.), University of Minnesota, Minneapolis; Stichting Epilepsie Instellingen Nederland (SEIN) (J.W.S.), Heemstede, the Netherlands; and the Department of Clinical Neurosciences (P.R.), CHUV, Lausanne, Switzerland.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
UCB pharma: Funding for travel and speaker honoraria Eisai: Funding for travel and speaker honoraria Cyberonics: Funding for travel and speaker honoraria
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE

Notes

Correspondence to American Academy of Neurology: [email protected]
Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
Approved by the Guideline Development, Dissemination, and Implementation Subcommittee on November 7, 2015; by the AAN Practice Committee on January 17, 2016; by the AES Guidelines Committee on November 11, 2016; by the AES Council on Clinical Activities on November 11, 2016; by the AES Executive Committee on November 14, 2016; by the AES Board of Directors on November 30, 2016; and by the AAN Institute Board of Directors on January 11, 2017. This practice guideline was endorsed by the International Child Neurology Association on August 27, 2016.

Author Contributions

Dr. Harden: study concept and design, acquisition of data, analysis or interpretation of data, drafting/revising the manuscript, critical revision of the manuscript for important intellectual content, study supervision. Dr. Tomson: study concept and design, acquisition of data, analysis or interpretation of data, drafting/revising the manuscript, critical revision of the manuscript for important intellectual content. Dr. Gloss: study concept and design, acquisition of data, analysis or interpretation of data, drafting/revising the manuscript, critical revision of the manuscript for important intellectual content. Dr. Buchhalter: study concept and design, acquisition of data, analysis or interpretation of data, drafting/revising the manuscript, critical revision of the manuscript for important intellectual content. Dr. Cross: study concept and design, acquisition of data, analysis or interpretation of data, drafting/revising the manuscript, critical revision of the manuscript for important intellectual content. Dr. Donner: study concept and design, acquisition of data, analysis or interpretation of data, drafting/revising the manuscript, critical revision of the manuscript for important intellectual content. Dr. French: analysis or interpretation of data, drafting/revising the manuscript, critical revision of the manuscript for important intellectual content. Dr. Gil-Nagel: study concept and design, acquisition of data, analysis or interpretation of data, drafting/revising the manuscript, critical revision of the manuscript for important intellectual content. Dr. Hesdorffer: study concept and design, acquisition of data, analysis or interpretation of data, drafting/revising the manuscript, critical revision of the manuscript for important intellectual content. Dr. Smithson: study concept and design, acquisition of data, analysis or interpretation of data, drafting/revising the manuscript, critical revision of the manuscript for important intellectual content. Dr. Spitz: study concept and design, acquisition of data, analysis or interpretation of data, drafting/revising the manuscript, critical revision of the manuscript for important intellectual content. Dr. Walczak: analysis or interpretation of data, drafting/revising the manuscript, critical revision of the manuscript for important intellectual content. Dr. Sander: analysis or interpretation of data, drafting/revising the manuscript, critical revision of the manuscript for important intellectual content. Dr. Ryvlin: analysis or interpretation of data, drafting/revising the manuscript, critical revision of the manuscript for important intellectual content.

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