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Practice Guidelines

Diagnosis and management of the epilepsies in adults and children: summary of updated NICE guidance

BMJ 2012; 344 doi: (Published 26 January 2012) Cite this as: BMJ 2012;344:e281
  1. Vanessa Delgado Nunes, senior research fellow and project manager1,
  2. Laura Sawyer, senior health economist1,
  3. Julie Neilson, senior research fellow1,
  4. Grammati Sarri, senior research fellow1,
  5. J Helen Cross, clinical adviser to the guideline2, The Prince of Wales’s chair of childhood epilepsy3
  1. 1National Clinical Guideline Centre, Royal College of Physicians, London NW1 4LE, UK
  2. 2UCL-Institute of Child Health, Great Ormond Street Hospital for Children, London
  3. 3Young Epilepsy, Lingfield RH7 6PW, UK
  1. Correspondence to: V D Nunes vanessa.nunes{at}

Epilepsy is a common neurological disorder characterised by recurring epileptic seizures; it is not a single diagnosis but is a symptom with many underlying causes, more accurately termed the epilepsies. Antiepileptic drugs (AEDs) to prevent recurrence of seizures form the mainstay of treatment. Diagnosis can be challenging, making accurate prevalence estimates difficult. With a prevalence of active epilepsy of 5-10 cases per 1000,1 epilepsy has been estimated to affect between 362 000 and 415 000 people in England, but with a further 5-30% (up to another 124 500 people) misdiagnosed with epilepsy.2 Consequently, it is a physician or paediatrician with expertise in epilepsy who should diagnose and manage the condition. The 2004 guideline from the National Institute for Health and Clinical Excellence on the management of the epilepsies in adults and children was recently partially updated with regard to drug management. This article summarises the main recommendations of the updated version; new recommendations are indicated in parentheses.3


NICE recommendations are based on the best available evidence and explicit consideration of cost effectiveness. When minimal evidence is available, recommendations are based on the Guideline Development Group’s experience and opinion of what constitutes good practice. Evidence levels for the recommendations are given in italic in square brackets.

After a first seizure

  • Children, young people, and adults presenting to an emergency department after a suspected seizure should be screened initially for epilepsy. This should be done by an adult or paediatric physician with onward referral to a specialist when an epileptic seizure is suspected or there is diagnostic doubt. (A specialist is defined in the guidance as either a “medical practitioner with training and expertise in epilepsy” (for adults) or a “paediatrician with training and expertise in epilepsy” (for children and young people). [Based on the experience and opinion of the Guideline Development Group (GDG)] …

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