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3.4.1 Protocol for reviewing the patient

1. Assess seizure control

  • People who experience seizures, who have not been recently reviewed (within the last 12 months) by an epilepsy specialist, may benefit from a specialist opinion.
  • Obtaining seizure descriptions and documents in notes may help in selecting appropriate therapy.
  • consider the reader's level of comprehension and ability to read
  • Adherence to AED treatment is key to good seizure control and GPs are well positioned to manage medication, explore adherence and advise about the risks associated with abrupt withdrawal.1

2. Try to assess how adherent the patient is with their medication

Non-adherence to prescribed medication is recognised to be an important cause of poor seizure control.2

Where patients are not taking their medication in accordance with the prescription, it is important to explore the reasons behind this. This should be done in a non-confrontational way and the implications discussed. Patients will often have very good reasons for not adhering to prescribed medicine, which make good sense to them.

  • People who are non-adherent to prescribed medication may require a specialist review for the purpose of exploring the reasons behind this.

3. Assess side-effects

Patients must be fully involved in decisions about their treatment. Their views on treatment, such as achieving the right balance between side-effects and seizure control, should be taken into account when considering medication changes.1

People who experience side-effects from medication may benefit from a medication review by an epilepsy specialist.

4. List driving and employment status

Patients who work for the NHS should be sign posted to their website which provides information for employers, to help put their employees' health first. www.nhsemployers.org

5. If the patient is a woman of childbearing potential, discuss contraception, conception and pregnancy

Contraception: several AEDs induce hepatic enzymes. Discuss any potential interactions and how it will affect the effectiveness of her contraceptive treatment, or risk of side-effects (see A.12 and A.13).

Conception: there is an increased risk of malformations with several AEDs. Reinforce the importance of planning conception and refer to a specialist as required.

Pregnancy: discuss balance of risks of AED treatment and seizures during pregnancy (both to mother and child).

6. List the decision to re-refer or not and the appointment date

7. Offer a seizure diary if appropriate

A seizure diary is a very useful tool for the patient to complete. See A.11: Seizure diary.

8. Provide relevant information to the patient, including useful addresses, and make notes of information provided

This website contains information that could be provided to the patient (see A.14: Information checklist and useful addresses).

9. Ask for feedback from the patient, carer or guardian

This will enable you to improve your service if required and can be used when compiling a practice report (see A.14: Patient feedback form).

References

1 Baker G et al. 2011. Primary Care Guidance for the Management of Women with Epilepsy. London: The Royal Society of Medicine Press.

2 Leppik IE. 1988. Compliance During Treatment of Epilepsy. Epilepsia. 29 Suppl 2: S79-84

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