NHS临床指南 Melatonin, sleep and EEGPPT.ppt

Melatonin, sleep and EEG;MELATONIN ;What is melatonin?;Light exposure tends to inhibit the pineal MT secretion while darkness promotes it. The SCN is a critically important small paired structure containing about 10000 scattered neurons with a circadian rhythm in vivo and in vitro. It gives rhythmicity to MT secretion, sleep, temperature, and cortisol, but it also has such widespread physiological circadian actions through MT that its main function appears to be the changing of the processes in the body from daytime to nighttime in a well coordinated manner. MT feeds back to the SCN and can advance or delay sleep onset;Non –sleep actions melatonin;Adverse effects;Adverse Effects;“In clinical trials the rate of patients with adverse events per 100 patient weeks was higher for Placebo than Circadin (5.743placebo vs. 3.013 Circadin)” (From advert Circadin seen in “Prescriber”);Melatonin as sleep inducer Rx;Series 5 children ; ;Melatonin: –sleep induction for EEG ;Melatonin –Sleep EEG in children;Literature Review 2010;Melatonin vs Sleep deprivation;;Studies since 2010;Studies since 2010;Studies since 2010;Studies since 2010;Studies since 2010;Studies since 2010;BCH Audits;Audit- The use of melatonin in EEGs in young children;Birmingham Children’s Hospital Audits2005: Pre-protocol change;Questions Addressed;Number of patients that slept after melatonin administration;Ages of patients that did/did not sleep;Results: EEG sensitivity ;References;Current Practice BCH;EEG Sleep Achieved Rates- BCH 2011- 2014;EEG Sleep Achieved Rates -BCH;Process/Protocols in use- my personal experience;Royal Preston until 2009- not prescribed, in either of 2 departments, dosage by age and recorded in controlled drugs book by pharmacy-trained techs (checked by another tech) After 2009- outpatient prescription by consultant, only in main Neurophysiology dept, otherwise same protocol;RPH sleep audit;Melatonin dosage protocol ;Adult Sleep EEG before and after change in protocol ;Numbe