Institute for Clinical Excellence (NICE) has issued guidance to the National
Health Service in England and Wales on the use
of newer drugs for the treatment of epilepsy in adults.
The NICE guidance recommends that the newer antiepileptic drugs (AEDs)
[gabapentin, lamotrigine, levetiracetam, oxcarbazepine, tiagabine, topiramate and
vigabatrin] should be used in the management of adults with epilepsy
who have not benefited from treatment with the older AEDs (such as carbamazepine
or sodium valproate), or where these are unsuitable (for example, because
of contraindications, interactions with other drugs or where the person
is a woman of childbearing potential).
The guidance further
with epilepsy should be treated with just one antiepileptic drug
possible. If the first drug doesn't prevent seizures,
another can be tried.
- Adjunctive or combination therapy should only be considered when attempts
at monotherapy have not resulted in seizure freedom.
- A careful assessment
of the risks and benefits of treatment with individual AEDs should
be undertaken, particularly in relation to women of childbearing
- A person who has a seizure for the first time should see an epilepsy
specialist as soon as possible, to find out exactly what type of epilepsy
he or she has, so that the best treatment can be started.
- Treatment should be reviewed at regular intervals.
Campaigners who have been lobbying for more attention to be paid to
the particular needs of women with epilepsy welcome the guidance and
are hoping that it will lead to more women having access to the most
Philip Lee, Chief
Executive of Epilepsy Action, said:
this guidance which allows clinicians to maintain the widest choice
in treatment options. As epilepsy is such an individual condition it
vital that patients have access to the most appropriate medication
and treatment programme.
"We are particularly
pleased that NICE have incorporated
some important issues, highlighted by Epilepsy Action, surrounding
the treatment of women with epilepsy. Our 'Women Matter' campaign
is calling for minimum standards of care to be established at a local
we now have more evidence than ever to support this goal."