Diagnosis and management of epilepsy in adults

Keeping up to date

The guideline was updated in 2018 to take account of new advice on the safety of valproate in girls or women who may become pregnant.

Since then, the MHRA has issued revised regulatory measures regarding the prescribing of valproate:

Valproate must not be started in new patients (male or female) younger than 55 years unless two specialists independently agree and document that there is no other effective and tolerated treatment.
At their next annual specialist review, female patients of childbearing potential and girls should be reviewed using the latest valproate Risk Acknowledgement Form, which will include the need for a second signatory if the patient is to continue with valproate and further annual review.

Further information is available: Valproate: reminder of current Pregnancy Prevention Programme requirements; information on new safety measures to be introduced in the coming months - GOV.UK (www.gov.uk)

In June 2024 the MHRA issued new safety measures for the use of topiramate during pregnancy due to risks to the unborn child:

Topiramate should not be used in women of childbearing potential unless the conditions of the Pregnancy Prevention Programme are fulfilled. This aims to ensure that all women of childbearing potential:

are using highly effective contraception
have a pregnancy test to exclude pregnancy before starting topiramate
are aware of the risks from use of topiramate.

Further information is available: Topiramate (Topamax): introduction of new safety measures, including a Pregnancy Prevention Programme

Remit and target users

The guideline makes evidence-based recommendations covering all aspects of diagnosis and management of adults with epilepsy including a completely revised section on epilepsy and women’s health and new sections covering psychiatric comorbidity, sleep, and mortality (including sudden unexpected death in epilepsy). It also provides information for discussion with people with epilepsy and their carers.

This guideline will be of interest to general practitioners, practice nurses, epilepsy specialist nurses, general physicians, emergency department specialists, neurologists, obstetricians, clinical neuropsychologists and psychiatrists.

How this guideline was developed

This guideline was developed using a standard methodology based on a systematic review of the evidence. Further details can be found in SIGN 50: A Guideline Developer’s Handbook.

Current 3-7 years