This guideline covers diagnosing and managing epilepsy in children, young people and adults in primary and secondary care, and referral to tertiary services. It aims to improve diagnosis and treatment for different seizure types and epilepsy syndromes, and reduce the risks for people with epilepsy.
MHRA advice on antiepileptic drugs in pregnancy: Recommendations in this guideline on carbamazepine, gabapentin, lamotrigine, levetiracetam, oxcarbazepine, phenobarbital, phenytoin, pregabalin, topiramate and zonisamide are in line with the MHRA updated safety advice on antiepileptic drugs in pregnancy.
MHRA advice on valproate: Recommendations on valproate are 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.
August 2023: The MHRA issued new safety advice on risks associated with valproate for the under 55s in December 2022. The valproate recommendations in this guideline will be reviewed once further advice from the MHRA is available. People currently taking valproate should not stop taking it unless they are advised by a specialist to do so.
This guideline includes recommendations on:
- referral, assessment and diagnosis
- information and support
- principles of treatment, treating epileptic seizures and treating childhood-onset epilepsies
- non-pharmacological treatments
- status epilepticus, repeat or cluster seizures, and prolonged seizures
- managing comorbidities
- reducing the risk of epilepsy-related death
- referral to tertiary services
- epilepsy specialist nurses and transition from children’s to adults’ services
Who is it for?
- Healthcare professionals in primary, secondary and tertiary care
- Commissioners, providers and voluntary organisations
- People with epilepsy, their families and carers
Guideline development process
This guideline updates and replaces NICE guideline CG137 (January 2012) and NICE evidence summaries ESNM7, ESNM17 and ESNM37.
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.