In their draft guidance,
the Technology Appraisal team of the UK National
Institute for Clinical Excellence (NICE) recommend the use of the
newer antiepileptic drugs: gabapentin, lamotrigine, levetiracetam,
tiagabine, topirimate and vigabatrin in people with epilepsy who have
not benefited from treatment with an older antiepileptic drug such as
carbamazepine or sodium valproate.
The newer drugs are also recommended
for people with epilepsy in the following circumstances:
- where there are
contraindications to the old drugs
- where they could
interact with other drugs the person is taking (particularly contraceptives)
- where they are
already known to be poorly tolerated in the individual
- where the person
is a woman of childbearing potential
seven newer drugs assessed by NICE are all licensed for use in conjunction
with the older drugs. In addition, lamotrigine, topiramate
and oxcarbazepine are licensed for use on their own.
The charity Epilepsy Action,
which has been involved in the consultation process and responded to
previous draft documents, has given a cautious
welcome to the Guidance.
the charity's Deputy Chief Executive, said:
"We are pleased that many of our recent submissions, particularly
in relation to the issues surrounding women and anti-epileptic drugs,
have been incorporated in the Guidance. We believe the draft guidelines
broadly reflect current good clinical practice. However, we do have some
concerns about how the recommendations will be implemented, as there
appears to be room for interpretation in certain areas".
"Issues surrounding treatment
and anti-epileptic drugs are crucial for people with epilepsy. More
research is needed, but, in the meantime,
it is vital that all available data is made available to enable health
professionals and their patients to make informed decisions about their
The final Technology Appraisal is expected to published in December.