NICE issues guidance on use of newer drugs for epilepsy in adults

The National Institute for Clinical Excellence (NICE) has today issued guidance to the NHS in England and Wales on the use of newer drugs for the treatment of epilepsy in adults.

The NICE guidance recommends that the newer antiepileptic drugs (AEDs) [gabapentin, lamotrigine, levetiracetam, oxcarbazepine, tiagabine, topiramateand vigabatrin] should be used in the management of adults with epilepsy who have not benefited from treatment with the older AEDs (such as carbamazepine or sodium valproate), or where these are unsuitable (for example, because of contraindications, interactions with other drugs or where the person is a woman of childbearing potential).

The guidance further recommends that:

• Adults with epilepsy should be treated with just one antiepileptic drug where possible. If the first drug doesn’t prevent seizures, another can be tried.
• Adjunctive or combination therapy should only be considered when attempts at monotherapy have not resulted in seizure freedom.
• A careful assessment of the risks and benefits of treatment with individual AEDs should be undertaken, particularly in relation to women of childbearing potential.
• A person who has a seizure for the first time should see an epilepsy specialist as soon as possible, to find out exactly what type of epilepsy he or she has, so that the best treatment can be started.
• Treatment should be reviewed at regular intervals.

Epilepsy, which is a neurological disorder characterised by unprovoked recurring seizures, is the most common serious neurological condition in the UK with an estimated 400,000 people in England and Wales affected by it.

Epilepsy is not a uniform condition, but comprises many different seizure types and epilepsy syndromes. Drug therapy is the mainstay of management of people with epilepsy, the aim of which is to abolish seizures completely, while at the same time keeping the side effects of treatment to a minimum so that the person can lead as normal a life as possible.

Andrea Sutcliffe, Planning and Resources Director and Executive Lead for the appraisal, said: “By recommending the use of the newer drugs for managing epilepsy in adults, this guidance will help people in England and Wales with this condition to achieve the best possible treatment regimen in terms of improving seizure control and minimizing side effects.

The independent Appraisal Committee that advises NICE also highlighted the importance of regular monitoring to review and optimise treatment.” NICE is also producing guidance on the use of newer drugs for epilepsy in children, due for publication in April 2004. A clinical guideline on the diagnosis, management and treatment of epilepsy, which is being prepared for NICE by the National Collaborating Centre for Primary Care, is due for publication in July 2004.