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GEM - epilepsy incorporating NICE guidance

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

Epilepsy GPnotebook Educational Module (GEM)

"...Epilepsy is one of the commonest serious neurological disorders seen in general practice, in A & E and in hospital. Managing diabetes presents similar challenges to managing epilepsy, and specialists have created teams that educate and link up care in the community. However, patients with epilepsy have frequently not been advised and monitored by their GP or any other doctor... Approximately 10% of people with epilepsy have attacks that are difficult to control, and poor management has been implicated in the fact that people with epilepsy are at three times the risk of suffering sudden unexpected death... Good pro-active advice in the context of an integrated service provided by doctors and nurses may reduce A & E attendance, unnecessary hospitalisation and mortality from epilepsy..." (1)

Introductory knowledge base:

  • what is the lifetime prevalence of a person having one or more non-febrile seizures?
  • what are the two most common types of seizure pattern recognised?
  • what is the most common cause of epilepsy?
  • can you think of any metabolic causes associated with seizure development?
  • if a child has a febrile convulsion, what is the lifetime risk of developing epilepsy?
  • what clinical assessment/investigations are indicated if an adult has a first non-febrile fit?

Regarding diagnosis and management of epilepsy:

  • according to NICE guidance:
    • who is responsible for diagnosis of epilepsy?
    • should anticonvulsant treatment be initiated in primary care?
  • monitoring of drug levels
    • what are the indications for checking anticonvulsant blood levels?
    • is the routine monitoring of sodium valproate supported?
    • when monitoring phenytoin levels, when are peak levels achieved?
  • stopping anticonvulsant treatment:
    • when can stopping of anticonvulsant treatment be considered?
    • GPN reference

Activities of daily living:

  • what information should the primary clinician disseminate about activities such as bathing a baby and swimming?
  • what guidance should be given following a diagnosis of epilepsy and group 1 driving entitlement?
  • GPN reference
  • what guidance should be given following a first fit and group 1 driving entitlement?

Contraception:

  • how does the use of anticonvulsant medication affect the use of the combined oral contraceptive pill?
  • how does the use of sodium valproate compare to the use of phenytoin when considering use of the combined contraceptive pill?
  • does the use of anticonvulsant medication affect the use of the progestogen only pill?
  • GPN reference
  • how does anticonvulsant medication affect the use of emergency contraception?

Pregnancy:

  • what are the implications of anticonvulsant use during pregnancy?

Additional information:

Reference:

  1. Royal College of General Practitioners. Curriculum Statement 15.7 Neurological problems.

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