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16-1-2012 | NICE guidelines on epilepsy updated in UK

16 January 2012
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The National Institute for Health and Clinical Excellence (NICE), the healthcare guidance body in the UK have updated their clinical guidelines for the diagnosis and management of epilepsy.

The update came into effect on January 11th. It now fully incorporates newer anti-epileptic drugs (AEDs) which have emerged in clinical practice since the original guidance was published in 2004. These newer AEDs include gabapentin, lamotrigine, levetiracetam, oxcarbazepine, tigabine, topiramate and viagabatrin.

The updated guideline specifies the different drug options that doctors should prescribe their patients, both according to their type of seizure (i.e. when a diagnosis has not yet been confirmed) and according to the epilepsy syndrome.

New recommendations include:

  • When possible, choose which AED to offer on the basis of the presenting epilepsy syndrome. If the epilepsy syndrome is not clear at presentation, base the decision on the presenting seizure type(s).
  • When prescribing sodium valproate to women and girls of present and future childbearing potential, discuss the possible risk of malformation and neuro-developmental impairments in an unborn child, particularly with high doses of the AED or when using as part of polytherapy.
  • 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 diazepam if preferred or if buccal midazolam is not available. If intravenous access is already established and resuscitation facilities are available, administer intravenous lorazepam.

For further information about NICE's clinical guideline on the diagnosis and management of the epilepsies in adults and children in primary and secondary care, see www.nice.org.uk/CG137

Reference: www.nice.org.uk

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