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Sharing Care - Epilepsy

Epilepsy is defined as a tendency to recurrent seizure.  NICE has produced a full guideline on the diagnosis and management of epilepsy in primary and secondary care and available here.  This page gives some pointers on how management might be shared between primary and secondary care.  Patients with both epilepsy and learning disability are managed by the Community Learning Disability Team.  For more information, visit the CLDT  web page.

 

Diagnosis: GP

The responsibility of the GP is to refer those with suspected epilepsy to secondary care.

It helps a great deal to have an eye-witness account of the event. Alternatively the patient can be advised to bring the eye-witness with them to Neurology outpatients. See our black out questionnaire for an eye-witness.

A degree of the level of suspicion (to help us prioritise) would be very helpful. Some tips on separating seizure and syncope are available on this website. A patient with a suspected seizure needs to be advised that an unexplained loss of consciousness must be reported to DVLA and that they must not drive for one year.

If the event is more likely to be syncopal the rules are different. In general it is preferable not to start medication until the patient has been assessed in secondary care.

 

Diagnosis: Neurology

The neurology department will see the patient rapidly, and they will be assessed by Consultant or Specialist nurse.  We will clarify whether this is likely to be epilepsy, and investigate.   EEG can be helpful in classifying seizure.  CT and MRI are used to look for a structural cause.  After diagnosis we will discuss medication, and advise patient and GP. 

Patient information leaflets concerning the commonly used anti-convulsants are available here:

Carbamazepine (tegretol)

NB: The risk of carbamazepine-induced Stevens-Johnson syndrome is strongly associated with presence of the HLA-B*1502 allele in individuals of Han Chinese, Hong Kong, Chinese, or Thai origin. It is recommended that these individuals should be screened for HLA-B*1502 before prescription of carbamazepine. Those who test positive should not start carbamazepine unless the benefits clearly outweigh the risks of Stevens-Johnson syndrome.

Sodium valproate (epilim)

Gabapentin (gabitril)

Lamotrigine (lamictal)

Topiramate (topamax)

Levetiracetam (lamictal)

Oxcarbazepine (trileptal)

Phenytoin (epanutin)

 

Follow Up:

Patients newly diagnosed with epilepsy will be followed up by the department until seizure-free for one year.  We will continue to follow those not in remission, or those in whom there is continuing seizure but therapeutic avenues have been exhausted.

 

Epilepsy and Contraception:

When prescribing contraception or anticonvulsant it is important that the effect of the anti-convulsant on the effectiveness of the contraceptive is considered.  Some authorities suggest that all women with epilepsy and of child-bearing age be advised to take regular folic acid supplements.

 

Re-referral:

Re-referral is obviously at the discretion of the GP but the following are common reasons.

1. Failure of seizure control

2. Review of need for continuing medication

3. Unacceptable side-effects of medication

 

Pregnancy:

It can be helpful and important to review the female patient with epilepsy before their decision to become pregnant.  They may wish to discuss the risks and benefits to both themselves and the baby of continuing or discontinuing a particular anti-convulsant.  If planning pregnancy we advise folic acid supplements.  Women who have epilepsy and become pregnant might also wish to join the UK epilepsy and pregnancy register.  

 

Useful links:

Community Learning Disability Team:

Epilepsy Action; www.epilepsy.org.uk

National Society for Epilepsy: www.epilepsynse.org.uk

UK Epilepsy and Pregnancy register : www.epilepsyandpregnancy.co.uk/