Diagnosis and management of the epilepsies in adults and children: summary of updated NICE guidance

Epilepsy is a common neurological disorder characterised by recurring epileptic seizures; it is not a single diagnosis but is a symptom with many underlying causes, more accurately termed the epilepsies. Antiepileptic drugs (AEDs) to prevent recurrence of seizures form the mainstay of treatment. Diagnosis can be challenging, making accurate prevalence estimates difficult. With a prevalence of active epilepsy of 5-10 cases per 1000,1 epilepsy has been estimated to affect between 362 000 and 415 000 people in England, but with a further 5-30% (up to another 124 500 people) misdiagnosed with epilepsy.2 Consequently, it is a physician or paediatrician with expertise in epilepsy who should diagnose and manage the condition. The 2004 guideline from the National Institute for Health and Clinical Excellence on the management of the epilepsies in adults and children was recently partially updated with regard to drug management. This article summarises the main recommendations of the updated version; new recommendations are indicated in parentheses.3 NICE recommendations are based on the best available evidence and explicit consideration of cost effectiveness. When minimal evidence is available, recommendations are based on the Guideline Development Group’s experience and opinion of what constitutes good practice. Evidence levels for the recommendations are given in italic in square brackets. ### After a first seizure