Epilepsy (NICE guidelines)
Epilepsy overview
The prevalence for epilepsy in the UK is 5-10 cases per 1000.
Seizure types are divided into:
Partial/focal seizures only involve a localised part of the brain, whereas generalised seizures involve the whole of both hemispheres. The term 'secondary generalisation' may be used to describe a partial seizure that later spreads to the whole of the cortex and becomes generalised.
Temporal lobe epilepsy accounts for 60-70% of all focal epilepsies.
General information from the guideline
In 60% of people with epilepsy there is no identifiable aetiology.
Approximately 70% of people with epilepsy achieve remission (no seizures for 5 years on or off treatment).
60% of people with epilepsy have convulsive seizures. Of these 2/3 have focal epilepsies and secondary generalised seizures and the other 1/3 have generalised tonic-clonic seizures.
Recommendations regarding medication
Treatment with AED (antiepileptic drug) therapy is generally recommended after a second epileptic seizure.
Offer carbamazepine or lamotrigine as first-line treatment to children, young people and adults with newly diagnosed focal seizures. Offer levetiracetam, oxcarbazepine or sodium valproate if carbamazepine and lamotrigine are unsuitable or not tolerated.
Offer sodium valproate as first-line treatment to children, young people and adults with newly diagnosed GTC (generalised tonic-clonic) seizures. Offer lamotrigine if sodium valproate is unsuitable.
Offer ethosuximide or sodium valproate as first-line treatment to children, young people and adults with absence seizures.
Offer sodium valproate as first-line treatment to children, young people and adults with newly diagnosed myoclonic seizures.
Offer sodium valproate as first-line treatment to children, young people and adults with tonic or atonic seizures.
The prevalence for epilepsy in the UK is 5-10 cases per 1000.
Seizure types are divided into:
- Focal onset (simple focal, complex focal and secondary generalised tonic-clonic seizures)
- Generalised onset (categorised as generalised tonic-clonic, absence, myoclonic, tonic and atonic seizures)
Partial/focal seizures only involve a localised part of the brain, whereas generalised seizures involve the whole of both hemispheres. The term 'secondary generalisation' may be used to describe a partial seizure that later spreads to the whole of the cortex and becomes generalised.
Temporal lobe epilepsy accounts for 60-70% of all focal epilepsies.
General information from the guideline
In 60% of people with epilepsy there is no identifiable aetiology.
Approximately 70% of people with epilepsy achieve remission (no seizures for 5 years on or off treatment).
60% of people with epilepsy have convulsive seizures. Of these 2/3 have focal epilepsies and secondary generalised seizures and the other 1/3 have generalised tonic-clonic seizures.
Recommendations regarding medication
Treatment with AED (antiepileptic drug) therapy is generally recommended after a second epileptic seizure.
Offer carbamazepine or lamotrigine as first-line treatment to children, young people and adults with newly diagnosed focal seizures. Offer levetiracetam, oxcarbazepine or sodium valproate if carbamazepine and lamotrigine are unsuitable or not tolerated.
Offer sodium valproate as first-line treatment to children, young people and adults with newly diagnosed GTC (generalised tonic-clonic) seizures. Offer lamotrigine if sodium valproate is unsuitable.
Offer ethosuximide or sodium valproate as first-line treatment to children, young people and adults with absence seizures.
Offer sodium valproate as first-line treatment to children, young people and adults with newly diagnosed myoclonic seizures.
Offer sodium valproate as first-line treatment to children, young people and adults with tonic or atonic seizures.
