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Practice Guidelines

Epilepsies in children, young people, and adults: summary of updated NICE guidance

BMJ 2022; 378 doi: https://doi.org/10.1136/bmj.o1446 (Published 05 July 2022) Cite this as: BMJ 2022;378:o1446
  1. Eva Gonzalez-Viana, senior systematic reviewer1 2,
  2. Arjune Sen, consultant neurologist, associate professor3 4,
  3. Alexandra Bonnon, health economist5,
  4. J Helen Cross, Prince of Wales’s chair of childhood epilepsy6 7
  5. on behalf of the Guideline Committee
  1. 1(Until 31 March 2022) National Guideline Alliance, Royal College of Obstetricians and Gynaecologists, London, UK
  2. 2Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
  3. 3Department of Clinical Neurology, John Radcliffe Hospital, Oxford, UK
  4. 4Oxford Epilepsy Research Group, NIHR Biomedical Research Centre, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
  5. 5National Institute for Health and Care Excellence, Manchester, UK
  6. 6UCL NIHR BRC Great Ormond Street Institute of Child Health, Great Ormond Street Hospital for Children, London, UK
  7. 7Young Epilepsy, Lingfield, UK
  1. Correspondence to Arjune Sen arjune.sen{at}ndcn.ox.ac.uk and J Helen Cross h.cross{at}ucl.ac.uk

What you need to know

  • Epilepsy is a common condition that associates with substantial risk of morbidity and mortality owing to, for example, sudden unexpected death in epilepsy

  • Working together, primary, secondary, and tertiary care can offer holistic care to people with epilepsy to improve seizure control, impact positively on comorbidities that people with epilepsy may experience, and reduce mortality risk

  • A diagnosis of epilepsy should be made by a specialist experienced in the management of epilepsies

  • Specific consideration should be given to the appropriate anti-seizure medication for women and girls who are able to have children

  • New diagnostic and management options mean that all people with uncontrolled seizures should be referred to a specialist epilepsy centre that has access to epilepsy surgery and other non-pharmacological treatments

Epilepsy is one of the most common and serious neurological disorders worldwide, affecting about 50 million people, and more than 600 000 people in the UK.1 Epilepsy is a symptom of different underlying causes. Many different types of epilepsy and epilepsy syndromes exist, varying in terms of presentation, management, and prognosis. Epilepsy represents far more than seizures alone, and is associated with complex cognitive, developmental, psychological, and psychosocial comorbidities.2 Seizures also have significant risks, including injuries and premature mortality.3 Epilepsy consequently has high socioeconomic costs. The holistic care of people with epilepsy could be improved through a standardised approach underpinned by a comprehensive guideline.

The National Institute for Health and Care Excellence (NICE) initially published guidance on the management of people with epilepsy in 2004, with a limited update (to pharmacological treatment) in 2012.4 Since then, important advances have occurred in the diagnosis, treatment, and holistic management of people with epilepsy, highlighting the need for an update to the guideline.

Although specialist teams commonly manage epilepsy, primary care and non-specialists play a vital role in …

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