27 October 2008
Scottish Intercollegiate Guidelines Network - National Government Agency [Non-U.S.]
Summary,


GUIDELINE OBJECTIVE(S)

To provide evidence based recommendations on the diagnosis and treatment of epilepsy, including recommendations on initial antiepileptic drug (AED) treatment, management of drug-resistant epilepsy, management of status epilepticus, management of provoked seizures, management of people with learning disability and epilepsy, and contraception, pregnancy, and menopause

Note: Epilepsy in the elderly is addressed only indirectly. Other text exists detailing the management of epilepsy in the elderly and after stroke.

TARGET POPULATION

Adult patients with epilepsy or status epilepticus

INTERVENTIONS AND PRACTICES CONSIDERED

Diagnosis

1. Patient history, including what occurred before, during, and after the attack
2. Electroencephalography (EEG)
3. Magnetic resonance imaging (MRI)
4. Computed tomography (CT) scanning

Treatment

1. Antiepileptic drugs (AEDs), such as carbamazepine, sodium valproate, lamotrigine, and oxcarbazepine monotherapy
2. Combination therapy of AEDs
3. Short-term benzodiazepine treatment
4. Psychological treatments
5. Referral for assessment for neurosurgical treatment
6. Intravenous (IV) lorazepam or diazepam for immediate treatment of generalised tonic-clonic status epilepticus
7. Fosphenytoin with electrocardiography (ECG) monitoring or phenytoin with electrocardiography monitoring or phenobarbital for sustained control if seizures continue in generalised tonic-clonic status epilepticus
8. Rectal diazepam

Note: Liver function and full blood count should not be monitored routinely.)

Contraception, Pregnancy, and Menopause Management

1. Oral contraception with oestrogen
2. Barrier methods of contraception
3. Folic acid
4. Vitamin K1 intramuscularly at birth for infant born to mother taking enzyme-inducing AEDs
5. Betamethasone for women taking enzyme-inducing AEDs with preterm labour threat
6. Intravenous lorazepam or diazepam for seizures during labour

Note: The progesterone-only contraceptive is not recommended for women taking enzyme-inducing AEDs.

Note: Progesterone implants are not suitable for women taking enzyme-induced AEDs.

Note: Hormone replacement therapy [HRT] should be prescribed for the same indications as in women who do not have epilepsy.

MAJOR OUTCOMES CONSIDERED

* Seizure frequency
* Seizure severity scales
* Adverse events
* Neuropsychological assessment
* Quality of life
* Seizure control
* Neurological disability
* Mortality