Summary of guidance relevant to general practice in January 2012
Epilepsy (Update of CG20)
New recommendations on the use of anti-epileptic drugs (AEDs) for the treatment of adults and children with epilepsy have been set out, in updated NICE guidelines.
NICE first published guidance on epilepsy in 2004 that included recommendations on the use of AEDs, as well as advice on the diagnosis, treatment and further management of the condition.
As recent years have seen a rise in the number of AEDs being prescribed, NICE has now updated this clinical guideline to provide information on newer AEDs.
The update describes how and when newer AEDs should be considered alongside older medicines, and can help GPs ensure they are prescribing treatments that are effective both clinically and cost effective.
NICE recommends that when possible, clinicians should choose which AED to offer on the basis of the presenting epilepsy syndrome. If the epilepsy syndrome is not clear at presentation, base the decision on the presenting seizure type(s).
When prescribing sodium valproate to women and girls of present and future childbearing potential, GPs should discuss the possible risk of malformation and neuro-developmental impairments in an unborn child. This is particularly the case with high doses of the AED or when using it as part of polytherapy.
Buccal midazolam or rectal diazepam should only be used in the community for children, young people and adults who have had a previous episode of prolonged or serial convulsive seizures, says NICE.
In addition, buccal midalozam should be administered as first-line treatment in children, young people and adults with prolonged or repeated seizures in the community.
GPs should prescribe rectal diazepam, if this is preferred, or if buccal midazolam is not available.
If intravenous access is already established, and resuscitation facilities are available, intravenous lorazepam should be administered.
Elsewhere, the updated guideline contains a new recommendation on use of the ketogenic diet - a diet that is high in fat but low in carbohydrates and protein.
NICE says that if a child or young person with epilepsy has seizures that have not responded to appropriate AEDs, GPs should refer them to a tertiary paediatric epilepsy specialist to be considered for the ketogenic diet.
Support tools to help you put this guidance into practice
NICE has produced a range of tools to help support the implementation of this guideline, including a baseline assessment tool, clinical audit tools and a range of pharmacological treatment tables.
The guideline is also available to view as a NICE Pathway - our new online tool that provides quick and easy access to guidance recommendations.
25 January 2012