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Epilepsies: diagnosis and management

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* by a specialist. This is to ensure precise and early diagnosis and initiation of therapy as appropriate to their needs

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
  • 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
  • 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

Prolonged or repeated seizures and convulsive status epilepticus

  • Only prescribe buccal midazolam or rectal diazepam for use in the community for children, young people and adults who have had a previous episode of prolonged or serial convulsive seizures
  • Administer buccal midazolam as first-line treatment in children, young people and adults with prolonged or repeated seizures in the community. Administer rectal diazepamspan if preferred or if buccal midazolam is not available. If intravenous access is already established and resuscitation facilities are available, administer intravenous lorazepam

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

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
  • 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
  • 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§ for further assessment

 

* The Guideline Development Group considered that 'urgently' meant being seen within 2 weeks.
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.
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.
§ The Guideline Development Group considered that 'soon' meant being seen within 4 weeks.

full guideline available from…
National Institute for Health and Care Excellence, Level 1A, City Tower, Piccadilly Plaza, Manchester, M1 4BT
www.nice.org.uk/guidance/CG137

National Institute for Health and Care Excellence. Epilepsies: diagnosis and management. January 2012.

First included: February 2005, updated January 2012. Full guideline updated in February 2016.