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Background Seizure recurrence after a fit has implications for both individuals and healthcare providers guiding neurologic prognosis, treatment, and driving and work restrictions. A systematic review of long-term seizure recurrence after eclampsia will help to quantify recurrence risk in this setting. Objective To evaluate the long-term recurrence of seizures after eclampsia. Search strategy After PROSPERO registration, Medline (Ovid), Embase, and Cochrane Library were searched by using the terms (eclampsia OR eclamp* OR eclamptic seizure* OR eclamptic fit*) AND (recur* OR recurrent fit* OR recurrent seizure*) for studies published up until December 2019. Selection criteria Studies describing long-term seizure recurrence after a diagnosis of eclampsia were included. Data collection and analysis Data were extracted from studies independently by two authors. Pooled prevalence was calculated and weighted based on sample size with a 95% confidence interval (CI). Main results Initially, 1754 unique studies were identified and 4 were included in the final analysis. The studies involved 1896 women, of whom 7 (0.37%) were affected by a further seizure. The weighted pooled prevalence of seizure recurrence was 0.18% (95% CI, 0.03-1.02). Conclusion The absolute rate of long-term seizure recurrence after eclampsia is extremely low and within safe limits for driving.

Key content The importance of guideline development. The gap between knowledge and practice. Evidence for implementation strategies. Learning objectives To understand how simple guidelines fail to promote change. To understand the evidence for implementation tools. To understand the range of implementation tools, such as: integrated care pathways, care bundles (venous thromboembolism [VTE] risk assessment), equipment boxes (e.g. eclampsia), decision stickers (e.g. cardiotocography [CTG] analysis), safety briefings/structured ward rounds. How to go about designing an implementation project. How to effect change.