Guidance
Context
Epilepsy is one of the most common serious neurological disorders, affecting around 50 million people worldwide and about 533,000 in England and Wales. Of these, around 112,000 are children and young people. The incidence of epilepsy is estimated to be 50 per 100,000 per year and the prevalence of active epilepsy in the UK is estimated to be 5 to 10 people per 1,000. Epilepsy is also a common cause of people attending A&E departments. Epileptic seizures can result in injury, and may also be associated with mortality, for example, because of sudden unexpected death in epilepsy (SUDEP).
Current practice
Most people with active epilepsy (60% to 70%) have their seizures satisfactorily controlled with antiseizure medications. Other treatment options may include surgery, vagus nerve stimulation, and psychological and dietary therapies. Optimal management improves health and wellbeing, including reducing the impact of epilepsy on social activities, education and career choices, and reduces the risk of SUDEP.
The original NICE guideline on epilepsy (2004) stated that the annual estimated cost of established epilepsy was £2 billion (direct and indirect costs). However, newer and more expensive antiseizure medications are now being prescribed. With an increase in treatment costs likely in coming years, it is essential to ensure that antiseizure medications with proven clinical and cost effectiveness are identified.
The 2004 NICE guideline on epilepsies, the 2004 NICE technology appraisal guidance and the subsequent 2012 pharmacological review on newer drugs for epilepsy, failed to show a difference in effectiveness between newer and older antiseizure medications, or between the newer drugs (as monotherapy) for seizure control. The International League Against Epilepsy has proposed new definitions and a framework for classifying epilepsy, and diagnosis and investigation have become more focused on aetiology. This guideline update reflects this and considers new evidence on managing epilepsies.