epilepsy quick

epilepsy quick

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Issue date: October 2004
Quick reference guide
The epilepsies: diagnosis and
management of the epilepsies
in adults in primary and
secondary care
D U LT S
·A ·A
TS
DU
L
TS · ADU
LT S
· AD
L
DU
UL
TS
·A ·A
D U LT S
Clinical Guideline 20
October 2004
Developed by the National Collaborating Centre for Primary Care

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Contents
Contents
Information about this guide 2
Key priorities for implementation 2
Grading of the recommendations 2
Outline care algorithm 3
Diagnosis, investigation and classification 4
Treatment and care 6
Referral to tertiary care 14
Regular structured review 14
Prolonged or repeated seizures 15
Information for adults with epilepsy and their family and/or carers 16
Women with epilepsy 17
Special groups 18
Implementation Back cover
Further information Back cover
Ordering information Back cover
Abbreviations used in this guide
AED anti-epileptic drug ESN epilepsy specialist nurse…read more

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Information about this guide
Key priorities for implementation
This quick reference guide summarises the recommendations in the NICE guideline for the care of adults
(people aged 18 or oldera) with epilepsy. The NICE guideline (www.nice.org.uk/CG020NICEguideline) also
contains recommendations for the care of children and young people with epilepsy, which are summarised in a
separate quick reference guide (see www.nice.org.uk/CG020childrenquickrefguide).…read more

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Outline care algorithm
Outline care algorithm
Suspected seizure
A&E
Primary care (protocols in place for assessment)
Initial screening by physician
Information obtained about the event GPP
Physical examination C Diagnostic doubt
Treatment with AEDs only in
Suspected epileptic Referral to epilepsy
exceptional circumstances:
seizure specialist or other
see page 6
specialist
(e.g.…read more

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Diagnosis, investigation and classification
Diagnosis, investigation and classification
Diagnosis should be made by a specialist in the epilepsies C
Detailed history of the attack:
· from the person who had the attack + symptoms B
· from eye-witness(es) to the attack
Prospective recording (video and written) can be useful GPP
Do not base the diagnosis on presence or absence of single features B
Supporting investigations (EEG, neuroimaging) ­ see below
Give the person with epilepsy and their family and/or carers as appropriate an opportunity to…read more

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CT
Diagnosis, investigation and classification continued
· CT is an alternative to MRI: C
­ if MRI is contraindicated or unavailable C
­ in an acute situation, to determine whether a seizure has been caused by an acute neurological lesion or
illness. GPP
Other tests and assessments
· Consider blood tests (e.g. plasma electrolytes, glucose, calcium) to identify potential causes or significant co-
morbidity. GPP
· Perform a 12-lead ECG. GPP
­ Refer to a cardiologist in cases of diagnostic uncertainty.…read more

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Treatment and care
Treatment and care
Empowering people to manage their condition
· Adults with epilepsy and their families and/or carers should be empowered to manage their condition as
well as possible. GPP
· Adults should receive appropriate information and education about all aspects of epilepsy (see page 16). This
may be best achieved and maintained through structured self-management plans. A
· If individuals wish to manage their condition more effectively, highlight the Expert Patients Programme
(www.expertpatients.nhs.uk).…read more

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Choice of AED
Treatment and care continued
Choice of drug
Factors to consider when tailoring treatment strategy to the individual
· Seizure type · Co-morbidity
· Epilepsy syndrome · Lifestyle
· Co-medication · Preferences of the individual (and their family and/or carers, as appropriate)
See pages 8­12 for further details A
Monotherapy and combination therapy
· Use monotherapy whenever possible. N
· If the first treatment is unsuccessful, try monotherapy with another drug. GPP
· Consider combination therapy if seizures continue after attempts with monotherapy.…read more

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Withdrawing treatment
Treatment and care continued
· Discuss continuing or withdrawing AED treatment with adults who have been seizure free for at least
2 years. (Appendix H of the full guideline has tables for the prognosis of remission of seizures ­ see
www.nice.org.uk/CG020fullguideline) A
· The decision to withdraw medication should be taken by the individual, their family and/or carers (as
appropriate), and the specialist after a full discussion of the risks and benefits of withdrawal.…read more

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Treatment and care continued
Table 1 Drug options by seizure type
Other drugs that Drugs to be avoided
Seizure type First-line drugs Second-line drugs may be considered (may worsen seizures)
Generalised Carbamazepinea Clobazam Acetazolamide Tiagabine
tonic­clonic Lamotrigineb Levetiracetam Clonazepam Vigabatrin
Sodium valproate Oxcarbazepinea Phenobarbitala
Topiramatea,b Phenytoina
Primidonea,c
Absence Ethosuximide Clobazam Carbamazepinea
Lamotrigineb Clonazepam Gabapentin
Sodium valproate Topiramatea Oxcarbazepinea
Tiagabine
Vigabatrin
Myoclonic Sodium valproate Clobazam Carbamazepinea
Clonazepam Gabapentin
Lamotrigine Oxcarbazepinea
Levetiracetam Tiagabine
Piracetam Vigabatrin
Topiramatea
Tonic Lamotrigineb Clobazam Acetazolamide Carbamazepinea
Sodium valproate Clonazepam Phenobarbitala Oxcarbazepinea
Levetiracetam…read more

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