MRCGP Update - Overview of epilepsy

Current situation

- Epilepsy affects about 400,000 people in the UK. In 60-70 per cent of patients, seizures can be rapidly controlled.

- People with epilepsy are two to three times more likely to die prematurely.

However, there is still a general lack of awareness of epilepsy among the medical profession. It has been estimated that 400 deaths a year are avoidable.

- GPs play a major role in the initial diagnosis and in long-term monitoring of epilepsy.

- Epilepsy is a clinical domain in the GMS quality framework. It attracts a total of 16 points for maintaining a register of patients, medicine reviews and patients being seizure free.

What is the evidence?

- A change in the type of medication can lead to breakthrough seizures in 1-2 per cent of patients because of minor differences in the components of the products (BMJ 2005; 331: 720).

The International Bureau for Epilepsy states that doctors should ensure that patients stay on the same type of antiepilepsy drug, branded or generic, to avoid further seizures.

- Despite efforts to maintain patients on the same drug, pharmacists in the UK are changing patients' treatments from branded to generic drugs without telling them or their neurologist or GP (Epilepsy and Behaviour 2005; 7: 98).

- Access to nurse specialists improves patients' management of the condition (Seizure 2004; 13: 303).

- A history of epilepsy increases risk for schizophrenia and schizophrenia-like psychosis (BMJ 2005; 331: 23).

Implications for practice

- NICE guidance states that suspected cases should be seen urgently by a specialist and be given tailored treatment. However, there are not enough neurologists to meet demand.

- A combined oral contraceptive pill containing at least 50mu g oestrogen should be used if an enzyme-inducing drug is prescribed.

The progestogen-only pill should be avoided in women taking enzyme-inducing drugs, as should levonorgestrel implants.

- Routine monitoring of antiepileptic drug levels is not generally recommended.

- Long-term remission occurs in more than 50 per cent of patients.

FURTHER READING

- The NSF for long-term conditions (March 2005) aims to transform the way health and social care services support people living with long-term neurological conditions.

- PCTs should ensure that all patients have a named person to co-ordinate their care and develop an individual care plan.

Patients should also be allowed to self-refer if their needs change.

USEFUL WEBSITES
www.nice.org.uk - NICE.
www.jointepilepsycouncil.org.uk - Joint Epilepsy Council.
www.dh.gov.uk/PolicyAndGuidance/HealthAndSocialCareTopics/LongTermConditions/fs/en - the long-term conditions NSF.

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