Guideline 70: Diagnosis and management of epilepsy in adults

Diagnosis and management of epilepsy in adults
Update to printed guideline

20 Oct 2005

Section 3.11.1 changed should read -

Recommendations for treatment are based on two large prospective, randomised trials of the management of status epilepticus^173,174 and on small or uncontrolled studies, physiological principles and pharmacokinetic considerations.^167,175-180 Intravenous lorazepam and diazepam are both effective and safe in controlling tonic-clonic status epilepticus, when administered by paramedics, prior to transport to hospital, with a trend in favour of lorazepam.¹⁷³ Intravenous lorazepam, phenobarbital and diazepam plus phenytoin are all effective initial treatments on hospital admission, with a trend again in favour of lorazepam, which is significantly more effective than phenytoin alone.¹⁷⁴ Lorazepam has the advantage over diazepam of a much longer duration of action, but its use in the community is limited by the need for refrigerated storage. There should be a high level of awareness of the risk of respiratory depression. Additional maintenance treatment is required following initial use of either benzodiazepine. Fosphenytoin is less irritant to veins than phenytoin and can be administered more rapidly (but still needs to be given slowly).

(From 7 Jul 2004 to 20 Oct 2005 website version incorrect)

20 Feb 2004

Section 6.2 Epilepsy Bereaved changed from

Epilepsy Bereaved (for the relatives of people who have died from epilepsy)
PO Box 112, Wantage, Oxon OX12 8XT
Bereavement Support Contact Line -24 hour answering service: 01235 772852
Tel: 01235 772850
Website: ds.dial.pipex.com/epilepsybereaved

Section 6.2 Epilepsy Connections changed from

Epilepsy Connections
Unit 18, Chapel Street Industrial Estate, Chapel Street, Glasgow G20 9BD
Tel: 0141 945 6444
Website: www.epilepsyconnections.org.uk

Epilepsy Connections
100 Wellington Street, Glasgow G2 6DH
Tel: 0141 248 4125 Fax: 0141 248 5887
Website: www.epilepsyconnections.org.uk

14 Jul 2003

Section 4.1.3 of the guideline should state that levonorgestrel should be given12 hours apart (not six hours apart). The guideline development group's opinion is that no harm would result from this typographical error and the desired outcome would be achieved if the doses are given six hours apart as recommended by the guideline. More recent guidance from the Faculty of Family Planning and Reproductive Health Care on emergency contraception recommends that, where there is concern about adherence, the two doses of levonorgestrel should be given at the same time.²⁹⁶

Section 4.1.3 changed from

Levonorgestrel 750micrograms two tablets six hours apart has been reported to be inadequate emergency contraception for women taking enzyme-inducing AEDs.²²⁶ Evidence level 4

The dose of levonorgestrel for emergency contraception should be increased to 1.5mg and 750micrograms six hours apart in women taking enzyme-inducing AEDs.

Levonorgestrel 750micrograms two tablets taken not more than 12 hours apart is probably inadequate emergency contraception for women taking enzymeinducing AEDs.^{226, 296} Evidence level 4

The dose of levonorgestrel for emergency contraception should be increased to 1.5mg and 750micrograms 12 hours apart in women taking enzyme-inducing AEDs.

Section 4.4.1 changed from

If there is doubt whether a seizure in labour is due to eclampsia or epilepsy, then, in addition to intravenous lorazepam or diazepam, a slow intravenous bolus of 4mg magnesium sulphate over three to five minutes followed by 1mg/hour for 24 hours is recommended.

If there is doubt whether a seizure in labour is due to eclampsia or epilepsy, then, in addition to intravenous lorazepam or diazepam, a slow intravenous bolus of 4grams magnesium sulphate over three to five minutes followed by 1gram/hour for 24 hours is recommended.

Reference 296 added

296 Faculty of Family Planning and Reproductive Health Care Clinical Effectiveness Unit. FFPRHC Guidance: emergency contraception (April 2003). J Fam Plann Reprod Health Care 2003;29:9-16. [cited 10 Jul 2003]. Available from url http://www.ffprhc.org.uk/clinical_effect/EC%20revised%20PDF%2019.06.03.pdf

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