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NICE guideline to improve epilepsy care in England and Wales

27 October, 2004

The National Institute for Clinical Excellence (NICE) have issued a clinical practice guideline on the diagnosis and management of epilepsy in children and adults. The guideline aims to ensure that people with epilepsy in England and Wales can access treatments and interventions that are based on the best available evidence.

Priorities highlighted in the guideline include:

  • All individuals with a recent onset suspected seizure should be seen urgently by a specialist to ensure precise and early diagnosis and initiation of therapy.
  • Drug therapy should be tailored to seizure type, epilepsy syndrome, co-medication, co-morbidity and individual lifestyle factors and preferences.
  • All individuals with epilepsy should have a comprehensive care plan that is agreed between the individuals, their family and/or carers and primary and secondary care providers.
  • All individuals with epilepsy should have a regular structured review at least yearly.
  • Individuals with epilepsy should be referred to a tertiary service [specialist epilepsy service] as soon as possible if their seizures are not controlled and/or there is uncertainty about their diagnosis or treatment failure.
  • Individuals with epilepsy and their carers should participate as partners in all decisions about their healthcare.
  • Women of childbearing potential should be fully informed about treatment choices and their options during pregnancy and the post-natal period to minimise risk to the child and mother.

Andrea Sutcliffe, Planning and Resources Director and Executive Lead for the guideline, said:

'The guideline, which complements recent guidance from NICE on the use of newer anti-epileptic drugs, has the potential to significantly improve the care that people with epilepsy receive. It puts people with epilepsy, their family and carers firmly at the centre of care. In doing so the guideline covers issues of real concern to people with epilepsy such as accurate and timely diagnosis, appropriate communication and the need for regular reviews of medication.'

The charity Epilepsy Action has welcomed the guideline. Kathy Bairstow, the charity's Senior Advice and Information Officer, commented:

'We have actively supported NICE in the development of this guideline and are pleased that a partnership approach to the management of the condition is stressed throughout, and that the information and support needs of people with epilepsy are also emphasised.'

Nevertheless, Epilepsy Action is concerned about the implementation of the NICE guideline. Recent unpublished research suggests that only 18 per cent of patients had their first appointment with an epilepsy specialist within two weeks of referral by their GP, meaning that care for the majority of epilepsy patients is falling short of key recommendations made in the guidance.