guidance recommends the newer anti-epileptic drugs for the management
of epilepsy in children who have not benefited from treatment with the
older anti-epileptic drugs, or for whom the older anti-epileptic drugs
The newer anti-epileptic drugs - gabapentin, lamotrigine,
oxcarbazepine, tiagabine, topiramate, and vigabatrin (as an 'add-on'
therapy for partial seizures) - are recommended, within their licensed
indications, for children who have not benefited from treatment with
the older anti-epileptic drugs such as carbamazepine or sodium
valproate, or for whom the older anti-epileptic drugs are unsuitable
(for example, because of side effects, interactions with other drugs or
where the child is of childbearing age or is likely to need treatment
into her childbearing years).
The guidance also recommends that:
- Vigabatrin is used as a first-line therapy for the management of infantile spasms (West's syndrome).
- Children should be treated with a single anti-epileptic drug
(monotherapy) wherever possible. If the initial treatment is
unsuccessful, then monotherapy using another drug can be tried.
- Combination therapy (adjunctive or ‘add-on' therapy) should only be
considered when attempts at monotherapy with anti-epileptic drugs have
not resulted in seizure freedom.
- In girls of childbearing age and in younger girls who are likely to
need treatment into their childbearing years, the risk of the drugs
causing harm to an unborn child, and the possibility of interaction
with oral contraceptives, should be discussed with the child and/or
their carer, and an assessment made as to the risks and benefits of
treatment with individual drugs. Specific caution is advised in the use
of sodium valproate because of the risk of harm to the unborn child.
- All children who have a non-febrile 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
Andrea Sutcliffe, Planning and Resources Director and Executive Lead for the appraisal, said:
impact of epilepsy on children is wide ranging. It can delay their
educational and social development and in the long term it may limit
their choices of employment and thus their opportunities in later life.
This guidance represents an important step in enabling children with
epilepsy to have a better chance of enjoying their childhood and
improving their opportunities into adulthood.'
A spokeswoman for the charity Epilepsy Action commented:
welcome the NICE's guidelines but they really only reflect current best
practice. The real test will be in GP's and specialists' implementation
of the guidelines and how this is monitored and best practice is