1. Local Commissioning Advocates
Commissioning in context
Care pathway
Supported by UCB Pharma through an educational grant.
UCB has no editorial control on the contents.
© Copyright Epilepsy Action 2012

2. NICE Clinical Guideline 137
(CG 137)
Update and review of CG 20 (2004)
Key priorities for implementation
The following recommendations have
been identified as key priorities for
implementation.

3. Diagnosis
• All adults with a recent-onset suspected
seizure should be seen urgently* by a
specialist**.
This is to ensure precise and early diagnosis
and initiation of therapy as appropriate to
their needs.

4. Diagnosis
• The seizure type(s) and epilepsy syndrome,
aetiology and co-morbidity should be
determined.
Aetiology: cause or origin
Co-morbidity: the presence of one or more
other disorders

5. Management
• Healthcare professionals should adopt a
consulting style that enables the adult with
epilepsy, and their family and/or carers as
appropriate, to participate as partners in all
decisions about their healthcare, and take fully
into account their race, culture and any
specific needs.

6. Management
• All adults with epilepsy should have a
comprehensive care plan that is agreed
between the individuals, their family and/or
carers as appropriate, and primary and
secondary care providers.

7. Management
• The AED (anti-epileptic drug) treatment
strategy should be individualised according to
the seizure type, epilepsy syndrome, co-
medication and co-morbidity, the individual’s
lifestyle, and the preferences of the individual,
and their family and/or carers as appropriate.

8. Review and referral
• All individuals with epilepsy should have a
regular structured review. In adults, this review
should be carried out at least yearly by either
a generalist or specialist, depending on how
well the epilepsy is controlled and/or the
presence of specific lifestyle issues.

9. Review and referral
• At the review, individuals should have access
to: written and visual information; counselling
services; information about voluntary
organisations; epilepsy specialist nurses; timely
and appropriate investigations; referral to
tertiary services, including surgery as
appropriate.

10. Review and referral
• If seizures are not controlled and/or there is
diagnostic uncertainty or treatment failure,
individuals should be referred to tertiary
services soon* for further assessment.

11. Special considerations for women of
childbearing potential
• Women with epilepsy and their partners, as
appropriate, must be given accurate
information and counselling about
contraception, conception, pregnancy, caring
for children, breastfeeding and menopause.

12. Care pathway
• What should happen
• When it should happen
• How – best practice
• By whom

13. Basic care pathway
Pre-condition
Recognition
Diagnosis
Treatment
Continuing care

14. Pre-condition
NICE CG20
Recognition
Diagnosis
MANAGEMENT
Treatment
Continuing care

15. Local Commissioning Advocates
Commissioning in context
Care pathway
Supported by UCB Pharma through an educational grant.
UCB has no editorial control on the contents.
© Copyright Epilepsy Action 2012