Guidance

Terms used in this guideline

Terms used in this guideline

This section defines terms that have been used in a particular way for this guideline.

The definitions for the epilepsy syndromes and seizure types are based on the International League Against Epilepsy's proposed new definitions and framework for classifying epilepsy.

Drug-resistant epilepsy

Epilepsy in which seizures persist and seizure freedom is very unlikely to be attained with further manipulation of antiseizure medication. Defined by the International League Against Epilepsy as 'failure of adequate trials of 2 tolerated and appropriately chosen and used antiseizure medication schedules (whether as monotherapy or in combination) to achieve sustained seizure freedom'.

MRI protocols

An MRI scan produces sets of images of the brain, or 'sequences', each with a particular appearance. An epilepsy MRI protocol is made up of a group of sequences, put together to improve the sensitivity and specificity in demonstrating possible structural abnormalities of the brain that cause epilepsy. The use of a regionally agreed, standardised protocol aims to maximise diagnostic quality and deliver consistency in scan quality.

Suboptimal MRI

An MRI scan would be deemed suboptimal if:

  • it gives an inappropriate or inadequate set of sequences

  • image quality is poor, for example, because of patient movement.

Tertiary epilepsy service

A service provided by epilepsy specialists who are adult or paediatric neurologists who undertake continuing professional development in the investigation, diagnosis and management of complex epilepsy. It offers:

  • Access to additional specialist assessments, including:

    • neuropsychology

    • neuropsychiatry

    • specialised neuroimaging, including 3T MRI

    • specialised neurophysiology, including video electroencephalogram (EEG) telemetry.

  • Specialised assessment and management of particular patient groups, including:

    • people with learning disability

    • pregnant women

    • people transitioning between services

    • older people with epilepsy.

  • Access to:

    • specialised non-surgical treatments, for example, cannabidiol, ketogenic diet

    • genetic diagnosis and counselling

    • specialised assessment for surgery

    • vagus nerve stimulation

    • participation in relevant clinical trials and research studies.

Unprovoked seizure

A seizure that is not caused by a particular event such as a fever, head injury or consumption of alcohol or drugs.

Unsuccessful treatment

Treatment is unsuccessful if it does not reduce or stop seizures, or if side effects are intolerable for the person with epilepsy.