(精选)NHS临床指南 Melatonin, sleep and EEG教学课件.ppt

? Suggested guidelines: Standard 6: Melatonin is prescribed by the referring Paediatrician or by the Consultant Neurophysiologist at the request of the referring doctor. ? Suggested guidelines: Standard 7: Melatonin to be given at the start of the appointment. Up to 6mg may be given as first dose up to 5 years. Up to 12mg may be given in older children. The following doses are recommended: Age 12-24m Dose 3mg 2-4y 6mg 5y+ 9mg (occ 12mg) Guideline: A second dose may be given after 45 minutes if the first is unsuccessful. ? Suggested guidelines: Standard 8 : Protocols for dealing with seizures must be in place. ? Suggested guidelines: Standard 9: Should be aware of BNF guidance when melatonin is to be used to induce sleep. Contraindications: For patients younger than 18y. : Hepatic impairment, galactosaemia and autoimmune disease ??Precautions : :Glucose-galactose malabsorption, lactose intolerance and renal impairment. ? Comments/Discussion * 80% fell asleep in both groups Sleep latency was shorter in the melatonin group (p0.012) 21 (2.2 s.d.) versus 34 (7.4 s.d.) No significant difference in interictal epileptiform activity on sleep EEGs in patients with previous normal standard EEGs S Sleep deprived 5/10 had interictal epileptiform abnormalities Melatonin 9/14 * 7. What dosage of Melatonin is given in the first instance? 8. Is there an opportunity to give further dose if unsuccessful? 9. What is the MAXIMUM dose given? (mgr) 10. Do you encounter problems with the process of acquiring melatonin? Problems acquiring Melatonin Supply of Melatonin by pharmacy Not stocked in hospital pharmacy Pharmacy reluctant to stock liquid preparations Liquid or capsules often not in stock Not available in other hospitals or community pharmacies Communication difficulties Difficulty in finding prescriber (neurologist) Melatonin needs to be prescribed in advance; if not great delays in supply Difficulty