Advances in epilepsy management

Epilepsy is one of the most common neurological illnesses, and can have a damaging effect on the social, vocational, physical and psychological wellbeing of the person, as well as increase their risk of premature mortality.
This eLearning module will therefore explore the different types of seizures a person with epilepsy can have (according to the new ILAE classification framework) and how epilepsy can be managed. In particular, what to consider when choosing an antiepileptic drug for a patient, including a woman who is using hormonal contraception, pregnant or breastfeeding, and management options for patients who do not respond to drug therapy.

Relevance to General Practice

3-4% of people will develop epilepsy during their lifetime. General practitioners (GPs) will therefore treat a number of patients who have epilepsy or diagnose a new onset of epilepsy and need to be confident in helping the patient to manage their condition.

There is no single treatment that is ideal for all patients. Instead, treatment should be tailored to the patient’s characteristics and drug-related factors. This is particularly true when prescribing antiepileptic drugs (AEDs) to women of child-bearing age.

Despite there being numerous AEDs available, only about two-thirds of people with epilepsy become seizure free with AEDs. For those with drug-resistant epilepsy, GPs need to consider other existing and emerging epilepsy treatments available, including surgery, deep brain stimulation and vagal nerve stimulation.

Learning outcomes

Outline how the new classification of epileptic seizures has implications for optimisation of management.

Discuss the role and limitations of antiepileptic drugs (AEDs) and indications of when to consider other forms of treatment such as surgery for poorly controlled epilepsy and high risk individuals.

Identify specific issues to consider when prescribing AEDs to women with regards to pregnancy, breastfeeding and interactions with contraceptives.

Domains of General Practice

D1. Communication skills and the patient-doctor relationship

Ways in which health can be optimised and maintained are communicated to patients, family members and carers

D2. Applied professional knowledge and skills

Diagnosis and management is evidence-based and relevant to the needs of the patient

D3. Population health and the context of general practice

The impacts of the social determinants of health are identified and addressed

D4. Professional and ethical role

D5. Organisational and legal dimensions

Shared decision making and informed consent are explained and obtained

Curriculum Contextual Units

Adult health
Individuals with disabilities
Pregnancy care

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