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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…

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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…

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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…

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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…

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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…

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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…

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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…

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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…

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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…

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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…

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