Epilepsy is a common neurological condition characterised by recurring seizures. Epileptic seizures can be broadly categorised into 2 main types: partial and generalised. Partial seizures (also known as 'focal' seizures) are epileptic seizures in which the neuronal discharge begins in, or is restricted to, a localised part of the brain. Generalised seizures are characterised by more diffuse neuronal discharges involving both hemispheres of the brain at the same time (see the NICE clinical guideline on epilepsy and the NICE technology appraisal final scope on retigabine for the adjunctive treatment of partial onset seizures in epilepsy).
It is estimated that 34,000 children and young people in England with a diagnosis of epilepsy are currently receiving anti-epileptic drugs (see the NICE quality standard on the epilepsies in children and young people).
The NICE clinical guideline on epilepsy advises that children, young people and adults with newly diagnosed partial (focal) seizures should be offered monotherapy with carbamazepine or lamotrigine as first-line treatment. If carbamazepine and lamotrigine are unsuitable or not tolerated, the person should be offered monotherapy with levetiracetam, oxcarbazepine or sodium valproate (bearing in mind the teratogenic risks of sodium valproate).If the first anti-epileptic drug tried is ineffective, an alternative from these 5 anti-epileptic drugs should be offered.
According to the NICE clinical guideline on epilepsy, if first-line treatments are ineffective or not tolerated, adjunctive treatment with carbamazepine, clobazam, gabapentin, lamotrigine, levetiracetam, oxcarbazepine, sodium valproate or topiramate should be offered to children, young people and adults with partial (focal) seizures.
If adjunctive treatment is ineffective or not tolerated, the guideline recommends that advice should be sought from a tertiary epilepsy specialist. Anti-epileptic drugs that may be considered by the tertiary epilepsy specialist are eslicarbazepine acetate, lacosamide, phenobarbital, phenytoin, pregabalin, tiagabine, vigabatrin and zonisamide. The NICE technology appraisal guidance on retigabine for the adjunctive treatment of partial onset seizures in epilepsy (NICE technology appraisal guidance 232) recommends retigabine as a treatment option for adults aged 18 years and over at this point.
Prescribers should be aware that not all the drugs mentioned above currently have a UK marketing authorisation for use for the particular indication or population mentioned (for example, depending on the age of the person). In line with the guidance from the General Medical Council (GMC), it is the responsibility of the prescriber to determine the clinical need of the patient and the suitability of using drugs outside their authorised indications.