Key priorities for implementation

The following recommendations have been identified as priorities for implementation.

Diagnosis

  • All children, young people and adults with a recent onset suspected seizure should be seen urgently[1] by a specialist[2]. This is to ensure precise and early diagnosis and initiation of therapy as appropriate to their needs. [2004]

Management

  • Healthcare professionals should adopt a consulting style that enables the child, young person or adult with epilepsy, and their family and/or carers as appropriate, to participate as partners in all decisions about their healthcare, and take fully into account their race, culture and any specific needs. [2004]

  • All children, young people and adults with epilepsy should have a comprehensive care plan that is agreed between the person, their family and/or carers as appropriate, and primary and secondary care providers. [2004]

  • The AED (anti-epileptic drug) treatment strategy should be individualised according to the seizure type, epilepsy syndrome, co-medication and co-morbidity, the child, young person or adult's lifestyle, and the preferences of the person, their family and/or carers as appropriate. [2004]

Prolonged or repeated seizures and convulsive status epilepticus

  • Only prescribe buccal midazolam or rectal diazepam[3] for use in the community for children, young people and adults who have had a previous episode of prolonged or serial convulsive seizures. [new 2012]

  • Administer buccal midazolam as first-line treatment in children, young people and adults with prolonged or repeated seizures in the community. Administer rectal diazepam[3] if preferred or if buccal midazolam is not available. If intravenous access is already established and resuscitation facilities are available, administer intravenous lorazepam. [new 2012]

Special considerations for women and girls of childbearing potential

  • Women and girls with epilepsy and their partners, as appropriate, must be given accurate information and counselling about contraception, conception, pregnancy, caring for children, breastfeeding and menopause. [2004]

Review and referral

  • All children, young people and adults with epilepsy should have a regular structured review. In children and young people, this review should be carried out at least yearly (but may be between 3 and 12 months by arrangement) by a specialist. In adults, this review should be carried out at least yearly by either a generalist or specialist, depending on how well the epilepsy is controlled and/or the presence of specific lifestyle issues. [2004]

  • At the review, children, young people and adults should have access to: written and visual information; counselling services; information about voluntary organisations; epilepsy specialist nurses; timely and appropriate investigations; referral to tertiary services, including surgery if appropriate. [2004]

  • If seizures are not controlled and/or there is diagnostic uncertainty or treatment failure, children, young people and adults should be referred to tertiary services soon[4] for further assessment. [2004]



[1] The Guideline Development Group considered that 'urgently' meant being seen within 2 weeks.

[2] For adults, a specialist is defined throughout as a medical practitioner with training and expertise in epilepsy. For children and young people, a specialist is defined throughout as a paediatrician with training and expertise in epilepsy.

[3] At the time of publication (January 2012), this drug did not have UK marketing authorisation for this indication and/or population (see appendix E for details). Informed consent should be obtained and documented in line with normal standards in emergency care.

[4] The Guideline Development Group considered that 'soon' meant being seen within 4 weeks.

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