Guidance
This guideline covers diagnosing and managing epilepsy in children, young people and adults in primary and secondary care, and referral to tertiary services. It aims to improve diagnosis and treatment for different seizure types and epilepsy syndromes, and reduce the risks for people with epilepsy.
Valproate: In September 2024, the Medicines and Healthcare products Regulatory Agency (MHRA) published a Drug Safety Update on valproate use in men and their partners. Effective contraception (condoms, plus contraception used by the female sexual partner) is recommended throughout the valproate treatment period and for 3 months after stopping valproate. See the MHRA’s advice for healthcare professionals. NICE is assessing the impact of this alert on recommendations in this guideline.
Valproate: In January 2024, the MHRA published a Drug Safety Update on the risks associated with valproate in men and women under 55. See the MHRA’s advice for healthcare professionals to provide to patients currently taking valproate. NICE is assessing the impact of this alert on recommendations in this guideline.
Topiramate: In June 2024, the MHRA published a Drug Safety Update on topiramate. Topiramate should not be used in pregnancy for epilepsy unless there is no other suitable treatment. Topiramate should not be used in women of childbearing potential unless the conditions of the Pregnancy Prevention Programme are fulfilled. See the MHRA’s advice for healthcare professionals to provide to patients currently taking topiramate. NICE is assessing the impact of this alert on recommendations in this guideline.
Recommendations on valproate in this guideline are in line with the MHRA guidance on valproate use by women and girls. Valproate must not be used in women and girls of childbearing potential (including young girls who are likely to need treatment into their childbearing years), unless other options are unsuitable and the Pregnancy Prevention Programme is in place.
Recommendations on carbamazepine, gabapentin, lamotrigine, levetiracetam, oxcarbazepine, phenobarbital, phenytoin, pregabalin, topiramate and zonisamide in this guideline are in line with the MHRA safety advice on antiepileptic drugs in pregnancy (last updated August 2022).
Last reviewed: 27 April 2022
This guideline updates and replaces NICE guideline CG137 (January 2012) and NICE evidence summaries ESNM7, ESNM17 and ESNM37.
Next review: This guideline/guidance will be reviewed if there is new evidence that is likely to change the recommendations.
Recommendations
This guideline includes recommendations on:
- referral, assessment and diagnosis
- information and support
- principles of treatment, treating epileptic seizures and treating childhood-onset epilepsies
- non-pharmacological treatments
- status epilepticus, repeat or cluster seizures, and prolonged seizures
- managing comorbidities
- reducing the risk of epilepsy-related death
- referral to tertiary services
- epilepsy specialist nurses and transition from children’s to adults’ services
Who is it for?
- Healthcare professionals in primary, secondary and tertiary care
- Commissioners, providers and voluntary organisations
- People with epilepsy, their families and carers
Guideline development process
How we develop NICE guidelines
Your responsibility
The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service. It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian.
All problems (adverse events) related to a medicine or medical device used for treatment or in a procedure should be reported to the Medicines and Healthcare products Regulatory Agency using the Yellow Card Scheme.
Local commissioners and providers of healthcare have a responsibility to enable the guideline to be applied when individual professionals and people using services wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with complying with those duties.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.