The clinical effectiveness and cost effectiveness of newer drugs for epilepsy in children

This guidance has been replaced by CG137 Epilepsy

NICE has made the following recommendations about the use of newer drugs to treat children with epilepsy.

If the older drugs do not stop the child from having seizures, one of the newer drugs can be tried, as long as it is suitable for the type of epilepsy the child has, and for the child’s age. Lamotrigine, oxcarbazepine and topiramate can be given to children as their only treatment for epilepsy. They can also be given with another drug when that drug on its own does not stop a child’s seizures (this is called combination therapy). Gabapentin, tiagabine and vigabatrinare generally used as combination therapy with another drug.

A newer drug can also be tried if the older drugs are unsuitable for the child. This could be because there is a reason why the child cannot take the older drugs (for example, some drugs are not suitable for people with liver disease), or because they cause unwanted effects that the child cannot tolerate. The older drugs might also be unsuitable if they affect another drug the child is taking. For young women with epilepsy, and girls who will probably need treatment into their adult life, some antiepileptic drugs are unsuitable because they might harm an unborn child.

NICE has recommended that vigabatrin is a suitable first treatment for young children with a rare type of epilepsy called infantile spasms or West’s syndrome.

NICE recommends that children should be treated with just one antiepileptic drug where possible. If the first drug doesn’t stop the child having seizures, another can be tried instead. The child’s doctor will need to take special care when changing over from one drug to another. If the child has tried different drugs that are appropriate for the type of seizures he or she has, and none of them stops the seizures on its own, another drug can be added. This is called adjunctive or combination therapy.

If the first combination does not work, other combinations can be tried. If none of them completely stops the seizures, the child should take the single drug or combination of drugs that works best for him or her. The decision on what drug or drugs a child takes will depend on the drugs’ unwanted effects as well as how good they are at preventing his or her seizures.

Particular care is needed when deciding what drug to use for young women and girls who will need treatment into their adult life. When women take antiepileptic drugs during pregnancy, this can sometimes harm the baby. There is not yet enough information to say what precise effects the newer drugs have on an unborn child. The choice of antiepileptic drug may also affect a young woman’s choice of contraceptive so this needs to be discussed as well. Specific caution is advised in the use of sodium valproate because of the risk of harm to the unborn child.

A child who has a seizure for the first time should see an epilepsy specialist as soon as possible, unless the seizure is a type called a febrile seizure, which only happens when the child has a fever The specialist will try to find out exactly what type of epilepsy the child has, so that the best treatment can be started.

Children with epilepsy should see a doctor regularly to make sure they are taking the drug or combination of drugs that works best for them, and that they are taking it correctly.

NICE’s recommendations apply to all children with epilepsy, including children with learning disabilities.

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