Dougall McCorry
Queen Elizabeth Hospital Birmingham
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Featured researches published by Dougall McCorry.
The Lancet | 2015
Luz Viale; John Allotey; Fiona Cheong-See; David Arroyo-Manzano; Dougall McCorry; Manny Bagary; Luciano Mignini; Khalid S. Khan; Javier Zamora; Shakila Thangaratinam
BACKGROUND Antenatal care of women with epilepsy is varied. The association of epilepsy and antiepileptic drug exposure with pregnancy outcomes needs to be quantified to guide management. We did a systematic review and meta-analysis to investigate the association between epilepsy and reproductive outcomes, with or without exposure to antiepileptic drugs. METHODS We searched MEDLINE, Embase, Cochrane, AMED, and CINAHL between Jan 1, 1990, and Jan 21, 2015, with no language or regional restrictions, for observational studies of pregnant women with epilepsy, which assessed the risk of obstetric complications in the antenatal, intrapartum, or postnatal period, and any neonatal complications. We used the Newcastle-Ottawa Scale to assess the methodological quality of the included studies, risk of bias in the selection and comparability of cohorts, and outcome. We assessed the odds of maternal and fetal complications (excluding congenital malformations) by comparing pregnant women with and without epilepsy and undertook subgroup analysis based on antiepileptic drug exposure in women with epilepsy. We summarised the association as odds ratio (OR; 95% CI) using random effects meta-analysis. The PROSPERO ID of this Systematic Reviews protocol is CRD42014007547. FINDINGS Of 7050 citations identified, 38 studies from low-income and high-income countries met our inclusion criteria (39 articles including 2,837,325 pregnancies). Women with epilepsy versus those without (2,809,984 pregnancies) had increased odds of spontaneous miscarriage (OR 1·54, 95% CI 1·02-2·32; I(2)=67%), antepartum haemorrhage (1·49, 1·01-2·20; I(2)=37%), post-partum haemorrhage (1·29, 1·13-1·49; I(2)=41%), hypertensive disorders (1·37, 1·21-1·55; I(2)=23%), induction of labour (1·67, 1·31-2·11; I(2)=64%), caesarean section (1·40, 1·23-1·58; I(2)=66%), any preterm birth (<37 weeks of gestation; 1·16, 1·01-1·34; I(2)=64%), and fetal growth restriction (1·26, 1·20-1·33; I(2)=1%). The odds of early preterm birth, gestational diabetes, fetal death or stillbirth, perinatal death, or admission to neonatal intensive care unit did not differ between women with epilepsy and those without the disorder. INTERPRETATION A small but significant association of epilepsy, exposure to antiepileptic drugs, and adverse outcomes exists in pregnancy. This increased risk should be taken into account when counselling women with epilepsy. FUNDING EBM CONNECT Collaboration.
European Journal of Obstetrics & Gynecology and Reproductive Biology | 2014
Dulcie A.J. Pirie; Bassel H. Al Wattar; Alexander M. Pirie; Victoria Houston; Ayesha Siddiqua; Manjo Doug; Manny Bagary; Lyn Greenhill; Khalid S. Khan; Dougall McCorry; Shakila Thangaratinam
OBJECTIVES Pregnant women with epilepsy have a significantly increased risk of mortality and morbidity compared to non-pregnant women. At least one in 250 pregnancies is exposed to anti-epileptic drugs (AED). Seizure deterioration occurs in up to a third of pregnant women. AED levels fall in most pregnant women, although it is uncertain that this is responsible for seizure deterioration rather than a hormonal effect. Current practice of AED monitoring is either therapeutic drug monitoring (TDM) or clinical features monitoring (CFM) to adjust the AED dose. We have systematically reviewed the effectiveness of the two monitoring regimens for AEDs, especially lamotrigine, the most commonly used AED in pregnancy on maternal and fetal outcomes. STUDY DESIGN We searched MEDLINE (1966-2012), EMBASE (1980-2012) and Cochrane, for relevant citations on the effectiveness of different monitoring strategies on seizure deterioration in pregnant women with epilepsy on lamotrigine. Study selection, quality assessment and data extraction were carried out by two independent reviewers. We calculated the rates of deterioration in seizures with the two strategies and pooled the estimates with random effects meta-analysis. RESULTS Six observational studies (n=132) evaluated the effectiveness of the two monitoring strategies on pregnant women with epilepsy on lamotrigine. There were no randomised controlled trials. The rate of seizure deterioration was 0.30 (95% CI 0.21-0.41) in women monitored by therapeutic drug monitoring (TDM) compared to 0.73 (95% CI 0.56-0.86) in those receiving clinical feature monitoring (CFM) alone. CONCLUSION Evidence based on observational data suggests that monitoring of AED levels in pregnancy reduces seizure deterioration, although the included studies have numerous sources of bias. There is paucity of evidence to make firm recommendations on optimal monitoring of AED drugs in pregnancy. Further research is needed to advise on the best clinical practice in managing AED in pregnancy.
British Journal of Obstetrics and Gynaecology | 2017
Bh Al Wattar; K Tamilselvan; R Khan; A Kelso; A Sinha; Alexander M. Pirie; Dougall McCorry; Khalid S. Khan; Shakila Thangaratinam
To develop a set of core outcomes for studies on pregnant women with epilepsy.
European Journal of Obstetrics & Gynecology and Reproductive Biology | 2015
Bassel H. Al Wattar; Anna Placzek; Joy Troko; Alexander M. Pirie; Khalid S. Khan; Dougall McCorry; Javier Zamora; Shakila Thangaratinam
Studies on pregnant women with epilepsy should evaluate both neurological and pregnancy outcomes. We undertook a systematic review of the literature of studies on pregnant women with epilepsy to collate the outcomes reported, and the quality of outcomes report in these studies. We searched major electronic databases (from 1999 until January 2015). Two independent reviewers selected studies and extracted data on study design, the risk of bias of the studies, journal impact factor and the quality of reported outcomes. We assessed the quality outcomes report using a six items standardised tool (score range 0-6). There were 70 different outcomes reported in 232 studies (maternal neurological (13/70, 19%), fetal and neonatal (28/70, 40%), and obstetric outcomes (29/70, 41%)). Most studies reported on major congenital fetal abnormalities (103/232, 44%), followed by live birth (60/232, 26%). Quality of the reported outcomes was poor (mean 1.54, SD 1.36). It was associated with journal impact factor (p=0.007), but not with study design (p=0.60), or risk of bias (p=0.17). The outcomes reported in studies on pregnant women with epilepsy varied widely, and the quality of the outcomes report was poor. There is a need to identify a set of core outcome to harmonise reporting in future clinical studies.
Seizure-european Journal of Epilepsy | 2015
Mitesh Patel; Manny Bagary; Dougall McCorry
PURPOSE Convulsive Status Epilepticus (CSE) is a common neurological emergency with patients presenting with prolonged epileptic activity. Sub-optimal management is coupled with high morbidity and mortality. Continuous electroencephalogram (EEG) monitoring is considered essential by the National Institute for Health and Care Excellence (NICE) in the management of Convulsive Refractory Status Epilepticus (CRSE). The aim of this research was to determine current clinical practice in the management of CRSE amongst adults in intensive care units (ICU) in the UK and establish if the use of a standardised protocol requires re-enforcement within trusts. METHODS 75 randomly selected UK NHS Trusts were contacted and asked to complete a questionnaire in addition to providing their protocol for CRSE management in ICU. RESULTS 55 (73%) trusts responded. While 31 (56% of responders) had a protocol available in ICU for early stages of CSE, just 21 (38%) trusts had specific guidelines if CRSE occurred. Only 23 (42%) trusts involved neurologists at any stage of management and just 18 (33%) have access to continuous EEG monitoring. CONCLUSION This study identifies significant inconsistency in the management of CSE in ICUs across the UK. A minority of ICU units have a protocol for CRSE or access to continuous EEG monitoring despite it being considered fundamental for management and supported by NICE guidance.
Seizure-european Journal of Epilepsy | 2017
J.P. Leach; Philip E. M. Smith; John Craig; Manny Bagary; D. Cavanagh; S. Duncan; A.R.C. Kelso; Anthony G Marson; Dougall McCorry; Lina Nashef; Catherine Nelson-Piercy; R. Northridge; K. Sieradzan; Shakila Thangaratinam; Matthew C. Walker; Janine B Winterbottom; Markus Reuber
Between 2009 and 2012 there were 26 epilepsy-related deaths in the UK of women who were pregnant or in the first post-partum year. The number of pregnancy-related deaths in women with epilepsy (WWE) has been increasing. Expert assessment suggests that most epilepsy-related deaths in pregnancy were preventable and attributable to poor seizure control. While prevention of seizures during pregnancy is important, a balance must be struck between seizure control and the teratogenic potential of antiepileptic drugs (AEDs). A range of professional guidance on the management of epilepsy in pregnancy has previously been issued, but little attention has been paid to how optimal care can be delivered to WWE by a range of healthcare professionals. We summarise the findings of a multidisciplinary meeting with representation from a wide group of professional bodies. This focussed on the implementation of optimal pregnancy epilepsy care aiming to reduce mortality of epilepsy in mothers and reduce morbidity in babies exposed to AEDs in utero. We identify in particular -What stage to intervene - Golden Moments of opportunities for improving outcomes -Which Key Groups have a role in making change -When - 2020 vision of what these improvements aim to achieve. -How to monitor the success in this field We believe that the service improvement ideas developed for the UK may provide a template for similar initiatives in other countries.
Epilepsy and behavior case reports | 2015
Sonia Kumari; Tom Hayton; Pauline Jumaa; Dougall McCorry
New-onset refractory status epilepticus (NORSE) is a syndrome of new-onset drug resistant status epilepticus that often has a catastrophic outcome. A 30-year-old man of Somali origin presented with refractory status to a district general hospital. A clinical diagnosis of NORSE syndrome was made, and he was transferred to the regional epilepsy center for immunomodulatory treatment and consideration for cyclophosphamide treatment. After transfer to the regional epilepsy center, his repeat cerebrospinal fluid tested strongly positive for syphilis, indicating a diagnosis of neurosyphilis, and the patient was treated with high-dose intravenous (IV) benzylpenicillin. His status epilepticus abated 24 h later. New-onset refractory status epilepticus syndrome is a diagnosis of exclusion. Before instigation of potentially harmful neuromodulatory therapies, treatable causes such as neurosyphilis should be considered. We advocate the early transfer of refractory status patients to a specialist epilepsy center for both seizure management and cause determination.
Journal of Neurology, Neurosurgery, and Psychiatry | 2010
Fizzah Ali; M Bagary; L Greenhill; Dougall McCorry; Hugh Rickards; Andrea E. Cavanna
Aims Varying linguistic profiles between patients with epilepsy and patients with non-epileptic attack disorder (NEAD) may reflect underlying variations in subjective seizure experience (Plug et al 2009). We hypothesised that exploration of subjective seizure symptoms could enhance knowledge of the differing natures between epilepsy and NEAD. We performed a quantitative evaluation of both the contents of consciousness and the general level of awareness during seizures using the Ictal Consciousness Inventory (ICI) (Cavanna et al 2008). Methods Ninety-one adult out-patients attending general neuropsychiatry/epilepsy clinics (Department of Neuropsychiatry, BSMHFT and University of Birmingham) with established diagnoses of either epilepsy (n=62) or NEAD (n=29) completed an ICI for each witnessed seizure. A total of 155 questionnaires (epilepsy: n=111; NEAD=44) were generated. ICI-Level (ICI-L) and ICI-Content (ICI-L) scores were calculated. Results Mann-Whitney U Test demonstrated statistically significant higher ICI-L and ICI-C scores in NEAD (p=0.01). Conclusions Subjective reports of consciousness experiences vary between NEAD/epilepsy. Patients with NEAD report significantly greater levels of general awareness/responsiveness and higher degrees of subjective content during attacks. Larger cohorts are required to confirm evidence for the potential usefulness of the ICI in enhancing understanding of subjective seizure experiences and supporting differential diagnosis. References—Cavanna AE, Mula M, Servo S, Strigaro G, Tota G, Barbagli D, Collimedaglia L, Viana M, Cantello R, Monaco F. Measuring the level and contents of consciousness during epileptic seizures: the Ictal Consciousness Inventory. Epilepsy and Behaviour 2008;13:184–188. Plug L, Sharrack B, Reuber M. Seizure metaphors differ in patients’ account of epileptic and psychogenic nonepileptic seizures. Epilepsia
Discovery Medicine | 2010
Andrea E. Cavanna; F Ali; He Rickards; Dougall McCorry
Diabetologia | 2017
George E. Dafoulas; Konstantinos A. Toulis; Dougall McCorry; Balachadran Kumarendran; G. Neil Thomas; Brian H. Willis; Krishna Gokhale; George Gkoutos; Parth Narendran; Krishnarajah Nirantharakumar