Epilepsy

 

An epileptic seizure is the transient occurrence of signs or symptoms due to abnormal electrical activity in the brain. This manifests itself as a disturbance of consciousness, behaviour, emotion, motor function, or sensation.  About two thirds of people with epilepsy in the UK do not have an anatomically identifiable cause. This is described as 'idiopathic epilepsy' and is the most common cause of epilepsy in younger people.  About a third of people with epilepsy in the UK have an anatomically identifiable cause, and/or clinical features indicative of an underlying disease or condition. This is described as 'symptomatic epilepsy' and is the most common cause of epilepsy in older people.  There are about 600,000 people in the UK with a diagnosis of epilepsy taking antiepileptic drug treatment and about 32,000 people in the UK are newly diagnosed with epilepsy each year

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Risk factors

Risk factors causing a predisposition for epilepsy include:

  • A family history of epilepsy
  • A genetic condition that is known to be associated with epilepsy, such as childhood epilepsy syndromes, or neurocutaneous syndromes such as tuberous sclerosis or neurofibromatosis
  • Previous febrile seizures in childhood — population-based studies indicate that 2–7% of children with febrile seizures will go on to develop epilepsy with afebrile seizures, the risk being higher with complicated febrile convulsions
  • Previous intracranial infections, brain trauma (especially a penetrating brain injury), or surgery
  • Comorbid conditions such as cerebrovascular disease or cerebral tumours

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Assessment and when to refer

Please directly refer patients who present with features strongly suggestive of an epileptic seizure for an assessment by Neurology within 2 weeks

Seizure markers include:

  • Unconsciousness for more than 5 minutes
  • Amnesia greater than 5 minutes
  • Injury
  • Bitten tongue
  • Incontinence
  • Unusual posturing
  • Prolonged limb jerking, rhythmic or non-random (brief seizure like activity can occur during an uncomplicated faint)
  • Consciousness with confused behaviour
  • Post event headache
  • Head turning to one side during TLOC

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  1. Document all seizure markers in referral letter
  2. If collapse is not suggestive of an epileptic seizure, click here for the Syncope pathway
  3. Inform patients with attacks of loss of consciousness of uncertain origin they must stop driving and inform the DVLA pending clarification of the diagnosis

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Routine Epilepsy Review

NOTEUndertake a routine review of all people with epilepsy in primary care at least once a year

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  1. Ensure the person and their carers are aware of who to contact if there are problems relating to their epilepsy, such as a named epilepsy specialist nurse
  2. Assess seizure control by asking about seizure frequency and severity, and any changes since the person was last reviewed.  For people who have more than one type of seizure, identify how frequently they have each seizure type, using a seizure diary if helpful
  3. Ask about how epilepsy is affecting the person's daily functioning and quality of life, and provide advice on sources of  information and support  for the person, their family and/or carers
  4. Ensure that any carer for a person with epilepsy is aware how to recognize and manage a seizure, including when and how to give buccal midazolam or rectal diazepam for prolonged or recurrent seizures, if appropriate
  5. Ask about any adverse effects and compliance with antiepileptic drug treatment. Ensure the person understands the importance of compliance to reduce the risk of seizures and sudden unexpected death in epilepsy (SUDEP)
  6. For people taking antiepileptic drugs whose seizures are controlled, advise about the increased risk of osteoporosis when taking long-term carbamazepine, phenytoin, primidone, or sodium valproate
  7. For women and girls of childbearing age, ensure that they are informed about contraception options, the risks of antiepileptic drugs during pregnancy, and how to reduce these risks when planning a pregnancy

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When to seek specialist advice

Seek specialist advice if a person with confirmed epilepsy has:

  1. Poor or unacceptable seizure control, or drug treatment is poorly tolerated
  2. Previously had a tonic–clonic seizure lasting more than 5 minutes, or more than three seizures in an hour, and they have not previously been prescribed buccal midazolam or rectal diazepam for carers to treat future episodes
  3. Possible cognitive impairment secondary to epilepsy and/or its drug treatment
  4. Been seizure-free for the last 2 years and would like to consider tapering or withdrawing from drug treatment. Ensure the person understands:
    1. The risks and consequences of seizure recurrence when treatment is withdrawn
    2. That they are not entitled to drive from the start of the period of withdrawal and for 6 months after stopping treatment, or if seizures recur

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Adult Epilepsy Nursing Team

The Adult Epilepsy Nursing Team run by Kent Community Health NHS Foundation Trust (KCHFT) consists of specialist epilepsy nurses who can support people with epilepsy to live with their condition.  Through nurse-led clinics, the team offers counselling, education and support for people living with epilepsy who have experienced seizures within the year prior to referral.  The team also provides a comprehensive assessment of the person’s epilepsy, offering education, advice and support to help achieve seizure control or optimal control

To access this service a patient will need to be referred to the SCS Referral Point by a consultant neurologist via their GP:

SCS referral point - Tel:  0300 123 3167 | E-mail:  kentchft.scs.referralpoint@nhs.net | Website:  Adult Epilepsy Nursing Team

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Community Children's Epilepsy Nursing Team

Click here for the Community Children's Epilepsy Nursing Team webpage

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Patient help and support - Epilepsy Here

Epilepsy Here is a charity based in East Kent.  It aims to help and support all those in the area with an interest in epilepsy whether as patients, parents, spouses, carers, teachers or health professionals

Members come from Ashford, Swale, Canterbury, Thanet, Dover, and Shepway Districts

Whitstable United Reformed Church, Middle Wall, Whitstable, Kent CT5 1BW

Tel: 01227 788211 | E-mail: office@takeoff.works| Website: www.epilepsyhere.org.uk

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Advice and Guidance is being made available for all specialties, and is being provided by consultant specialists at East Kent Hospitals.  To make a request or to check to if a query has been answered, you will need to log in via the electronic Referral System (eRS)

Click here for the "how to access" e-Referral Advice and Guidance Manual for instructions on how to make a request and check responses

Have a question or query?

Get in touch