The Pharmaceutical Journal
Vol 273 No 7323 p633
30 October 2004

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NICE issues guidance on epilepsy management

New guidelines on the diagnosis and management of the epilepsies in primary and secondary care were issued this week by the National Institute for Clinical Excellence and the National Collaborating Centre for Primary Care. They include a large section on treatment with anti-epileptic drugs, but do not specifically outline a role for pharmacists.

The guidelines follow recommendations on the use of newer drugs for treating epilepsy, published earlier this year (PJ, 27 March, p371 and 1 May, p534).

The new guidelines recommend that drug therapy is tailored to seizure type, epilepsy syndrome, co-medication, co-morbidity and individual lifestyle factors and preferences. They say that the decision to start treatment should be made after full discussion of the risks and benefits, after which some adults may choose not to take the drugs.

Charles Tugwell, clinical pharmacist, neurology/neurosurgery at the Royal London Hospital, pointed out that the guidelines state that treatment should be initiated by an epilepsy specialist who should also plan continuation of treatment. And, providing management is straightforward, then drug therapy can be prescribed in primary care “if local circumstances and/or licensing allow”.

He said: “Drug therapy is the key component of treatment, and the document emphasises the need for ensuring that full details of drug therapy are included in an individual patient’s treatment plan. It also states the importance of not changing brands of anti-epileptic drugs and the need for ongoing monitoring.”

The guidelines recommend that monotherapy should be used whenever possible, and combination therapy should be considered if seizures continue after attempts with monotherapy of other drugs.

If a drug has failed because of adverse effects or continued seizures, an alternative first-line or second-line drug should be started and built up to an adequate or maximum-tolerated dose before the first drug is tapered off slowly.

Newer anti-epileptic drugs are recommended for adults who have not benefited from treatment with older drugs (eg, carbamazepine or valproate) or when older drugs are unsuitable because of contraindications, potential interactions or poor tolerance.

Mr Tugwell added: “Recently, a health minister has announced that pharmacists have an important role in the ongoing management of patients’ drug therapy, for example, repeat prescriptions without patient visits to their GP. I feel it a shame that pharmacists are not mentioned among the health care professionals cited in the document.”