Intended for healthcare professionals

Practice Clinical Updates

Practical aspects of childhood epilepsy

BMJ 2019; 367 doi: (Published 11 November 2019) Cite this as: BMJ 2019;367:l6096
  1. Maria-Christina Petropoulos, consultant paediatrician1,
  2. Karen Bonaiuto, epilepsy research nurse2,
  3. Janet Currier2 3,
  4. Deb K Pal,, professor of paediatric epilepsy, Honorary Consultant Paediatric Neurologist2 3
  1. 1University College London Hospitals NHS Trust, London, UK
  2. 2King’s College Hospital NHS Trust, London, UK
  3. 3Department of Basic & Clinical Neuroscience, Institute of Psychiatry, Psychology & Neuroscience, King’s College London; MRC Centre for Neurodevelopmental Disorders, King’s College London; Evelina London Children’s Hospital
  1. Correspondence to D K Pal deb.pal{at}; @palneurolab

What you need to know

  • Official guidance advises consistency in brand prescribing of anti-epileptic drugs

  • Sleep disorders are very common, can trigger seizures, affect the whole family, and can often be managed in primary care

  • Most children need a timely educational or neuropsychological assessment to inform an education and health care plan, and these can be initiated by parents or a special educational needs coordinator

  • Buccal midazolam is the preferred rescue drug in young people at risk of prolonged seizures

  • Routine blood tests, including monitoring of serum drug concentrations, are unnecessary

Children and adolescents with epilepsy are medically managed by paediatricians with expertise in the condition, but non-specialist doctors can also help these young people live a fuller life. In this update we focus on important issues that are sometimes misunderstood, particularly those with little published guidance or where new evidence or guidance has emerged. The advice applies mainly to children with common epilepsies attending mainstream schools. Children with complex epilepsy require specialist guidance.

Is it safe to switch between drug formulations?

Official guidance and discussions on social media are conservative on the question of switching1 between different products, while prescribers are encouraged to use cheaper generic drug treatments. On balance, we advise consistency in prescribing (in the UK it not uncommon for the pharmacy to have different formulations every time the patient goes to renew the prescription) because comparative bioavailability data are incomplete for every anti-epileptic drug.2 Only the 2016 EQUIGEN study3 showed that switching between branded and generic lamotrigine was safe. Furthermore, the different names, packaging, and appearance of alternative products may cause confusion, anxiety, or occasionally non-adherence when prescriptions are refilled.

Table 1 lists anti-epileptic drugs stratified by risk of switching, according to their therapeutic index and release characteristics.4

View this table:
Table 1

Risk categories for switching between generic and branded formulations of anti-epileptic drugs4

Missing a single dose

Management of a missed …

View Full Text

Log in

Log in through your institution


* For online subscription