National Institute for Health and Clinical Excellence (NICE)
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NICE updates epilepsy drug advice

From today (Wednesday 11 January), doctors will have new advice on the drugs they should prescribe their patients who have epilepsy. This comes as the National Institute for Health and Clinical Excellence (NICE), the healthcare guidance body, updates the pharmacological recommendations from its clinical guideline on the diagnosis and management of the condition.

The guideline has been revised to fully incorporate newer anti-epileptic drugs (AEDs) which have emerged in UK clinical practice since the original guidance was published in 2004.

Dr Fergus Macbeth, Director of the Centre for Clinical Practice at NICE said: "Since we published our original clinical guideline eight years ago, the number of anti-epileptic drugs available in the UK has increased. This means healthcare professionals may not know whether these newer medicines bring any additional clinical benefits for their price, compared to what is already available, or when they should consider them in the treatment pathway.

"We have updated our clinical guideline so that healthcare professionals can be sure that they are prescribing the most clinically and cost effective treatments for their patients."

The updated guideline specifies the different drug options that doctors should prescribe their patients, both according to their type of seizure (i.e. when a diagnosis has not yet been confirmed) and according to the epilepsy syndrome. New recommendations include:

  • When possible, choose which AED to offer on the basis of the presenting epilepsy syndrome. If the epilepsy syndrome is not clear at presentation, base the decision on the presenting seizure type(s).
  • When prescribing sodium valproate to women and girls of present and future childbearing potential, discuss the possible risk of malformation and neuro-developmental impairments in an unborn child, particularly with high doses of the AED or when using as part of polytherapy.
  • Only prescribe buccal midazolam or rectal diazepam for use in the community for children, young people and adults who have had a previous episode of prolonged or serial convulsive seizures.
  • Administer buccal midazolam as first-line treatment in children, young people and adults with prolonged or repeated seizures in the community. Administer rectal diazepam if preferred or if buccal midazolam is not available. If intravenous access is already established and resuscitation facilities are available, administer intravenous lorazepam.

Professor Helen Cross, Clinical Advisor to the independent group of experts that developed the guidance on NICE's behalf, said: "Although many people who have epilepsy are able to have their seizures controlled with medication, it can take a little time to find the right treatment before a satisfactory outcome can be reached.

"The update to the guidance outlines how and when doctors should consider treatment for different types of epilepsy, taking into consideration the newer anti-epileptic drugs alongside the more established medicines. We hope that this will enable doctors to continue to provide the best possible care for individuals with epilepsy."

Notes to Editors

About the updated guidance

1. For further information about NICE's clinical guideline on The diagnosis and management of the epilepsies in adults and children in primary and secondary care, please visit:

2. Epilepsy is a common neurological disorder characterised by recurring seizures. The condition is estimated to affect between 260,000 and 416,000 people in England and Wales. Two thirds of people with active epilepsy can effectively control their seizures with a class of medication known as anti-epileptic drugs (AEDs).

3. The "newer" AEDs mentioned in the updated guideline, include gabapentin, lamotrigine, levetiracetam, oxcarbazepine, tigabine, topiramate and viagabatrin.

About NICE

1. The National Institute for Health and Clinical Excellence (NICE) is the independent organisation responsible for providing national guidance and standards on the promotion of good health and the prevention and treatment of ill health

2. NICE produces guidance in three areas of health:

  • public health - guidance on the promotion of good health and the prevention of ill health for those working in the NHS, local authorities and the wider public and voluntary sector
  • health technologies - guidance on the use of new and existing medicines, treatments, medical technologies (including devices and diagnostics) and procedures within the NHS
  • clinical practice - guidance on the appropriate treatment and care of people with specific diseases and conditions within the NHS.

3. NICE produces standards for patient care:

  • quality standards - these reflect the very best in high quality patient care, to help healthcare practitioners and commissioners of care deliver excellent services
  • Quality and Outcomes Framework - NICE develops the clinical and health improvement indicators in the QOF, the Department of Health scheme which rewards GPs for how well they care for patients

4. NICE provides advice and support on putting NICE guidance and standards into practice through its implementation programme, and it collates and accredits high quality health guidance, research and information to help health professionals deliver the best patient care through NHS Evidence.


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