Management of epilepsy

Acutely, the treatment of epilepsy involves placing the patient in the recovery position and ensuring that they cannot hurt themselves.

Afterwards, a key dilemma that should be addressed in the management of a patient who has had a fit is whether drug therapy should be instigated. Diagnosis of epilepsy requires specialist review as soon as possible. NICE have recommended review within two weeks (1).

Management of a patient including starting and stopping medication should be overseen by a specialist, under shared care protocols with primary care (2)

• all patients with epilepsy should have a comprehensive care plan which should include lifestyle issues as well as medical issues
• epilepsy specialist nurses (ESNs) should be an integral part of the network of care of a patient with epilepsy (1).

Routine structured review of all patients with epilepsy should be carried out at least annually (frequency of review will be determined by the person’s epilepsy and their wishes) in primary care but depending on the person’s wishes, circumstances and epilepsy, the review may be carried out by the specialist (1,2). During the review:

• assess the patient’s care plan with the patient and/or carers
• note on any seizures and any factors which might have precipitated the attack
• check drug compliance and any side effects of drugs
• appropriate advice on contraception, pregnancy, employment issues and benefits (2)

Reference:

• (1) National Clinical Guideline Centre (NCGC) 2012. The epilepsies: the diagnosis and management of the epilepsies in adults and children in primary and secondary care (Updated April 2018).
• (2) Alarcon G, Simon C. The annual epilepsy review. InnovAiT 2009;2(4):213 – 221
• (3) Hopkins A, Garman A, Clarke C. The first seizure in adult life: value of clinical features, electroencephalography, and computerised tomographic scanning in prediction of seizure recurrence. Lancet 1988; 1:721-6.