The guideline covers diagnosing, treating and managing epilepsy and seizures in children, young people and adults in primary and secondary care. It offers best practice advice on managing epilepsy to improve health outcomes so that people with epilepsy can fully participate in daily life.
MHRA advice on antiepileptic drugs in pregnancy: In January 2021, the Medicines and Healthcare products Regulatory Agency (MHRA) updated safety advice on antiepileptic drugs in pregnancy. We are reviewing the recommendations on carbamazepine, gabapentin, lamotrigine, levetiracetam, oxcarbazepine, phenobarbital, phenytoin, pregabalin, topiramate and zonisamide in this guideline, and will amend them as needed. In the meantime, take account of MHRA advice when discussing treatment with women and girls of childbearing potential.
MHRA advice on valproate: We have amended recommendations in line with the MHRA guidance on valproate use by women and girls. Valproate must not be used in women and girls of childbearing potential (including young girls who are likely to need treatment into their childbearing years), unless other options are unsuitable and the pregnancy prevention programme is in place. The MHRA has published temporary advice on the valproate pregnancy prevention programme during the COVID-19 pandemic.
This guideline includes recommendations on:
- diagnosis of epilepsy and investigations to support a diagnosis
- pharmacological treatment with anti-epileptic drugs, including advice for different types of seizures
- referral to tertiary services for people with complex epilepsy or epilepsy that is not controlled by pharmacological treatment
- psychological interventions and other adjunctive therapies
- treatment of prolonged or repeated seizures and convulsive status epilepticus
- advice for specific groups of people with epilepsy, such as women and girls
- regular structured medical review of people with epilepsy
Who is it for?
- Healthcare professionals
- People who work in occupational health services, social services, educational services and the voluntary sector
- Children, young people and adults with epilepsy and their families and carers
Is this guideline up to date?
Guideline development process
This guideline updates and replaces NICE guideline CG20 (October 2004).
The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service. It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian.
All problems (adverse events) related to a medicine or medical device used for treatment or in a procedure should be reported to the Medicines and Healthcare products Regulatory Agency using the Yellow Card Scheme.
Local commissioners and providers of healthcare have a responsibility to enable the guideline to be applied when individual professionals and people using services wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with complying with those duties.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.