RCGP Clinical Priority for Epilepsy: The top five tips for improving epilepsy health care provision

greg rogersDr Greg Rogers is a GP in Lymington, Hampshire, he has a special interest in epilepsy and was the recently appointed RCGP clinical Champion for Epilepsy. Greg was a member of the guideline development groups for the NICE Epilepsy Update, 2012 and the NICE epilepsy quality standards and commissioning framework, 2013. Prior to that he was a member of the NICE Transient Loss of Consciousness Guideline, 2010.

Epilepsy was chosen to be a clinical priority for RCGP for 2013 – 2015, partly in response to numerous reports which provided evidence of the need to improve services for epilepsy. The All Party Parliamentary Group reports that whilst only around 50% of the population with epilepsy are currently seizure free it is usually possible to achieve seizure freedom rates of 70%. This highlights that there is 20% treatment gap.

Seizure freedom reduces the standardised mortality rate to nearing that of the general population. Uncontrolled epilepsy has a high cost in terms of social and physical well-being as well as generating unnecessary expense to the NHS. In the recent CCG-Outcome Indicator Set epilepsy ranked the fifth highest long term ambulatory condition to require unplanned admission to hospital. It is not surprising then to discover that amongst the findings are:
• 400 avoidable deaths a year from epilepsy
• 69,000 people living with unnecessary seizures
• 74,000 people taking drugs they do not need
• £189 million needlessly spent each year.

These are the top five tips suggested by Dr Greg Rogers, Clinical Champion for Epilepsy 2013-15, which GPs can follow to help reduce the impact of those affected by epilepsy and improve epilepsy health care provision.
1. Seizure freedom: If a person has ongoing seizures, with or without loss of awareness and has not been reviewed and given a management plan by specialist care, offer referral to the local epilepsy service.

2. Psychosocial support: General practice is about holistic care. Reducing the psychosocial consequences of epilepsy can be identified by GPs being aware of the increase likelihood of depression and anxiety in this group. The pros and cons of SSRI treatment and referral to the local counselling services can be offered. Sign posting to the voluntary services and support for this can be found on Epilepsy Action’s website. https://www.epilepsy.org.uk/info/depression

3. Women and girls with epilepsy: The MHRA have altered the guidance for sodium valproate following new further evidence of its teratogenicity and advise that all women at risk should have a discussion with an epilepsy specialist involving assessment of the risk/ benefit.

4. Knowledge of Epilepsy: Undergraduate and postgraduate education on epilepsy can be scanty and one of the best ways to remedy this is through eLearning. An ideal package is the BMJ Learning ‘Epilepsy: diagnosis and management in primary care’. http://learning.bmj.com/learning/module-intro/.html?moduleId=10048059

5. Epilepsy in the elderly, especially those with dementia: The prevalence of active epilepsy in the elderly population is up to 1.5%, but among nursing home residents may exceed 5%. Atypical presentations may also include altered mental status, periods of staring, unresponsiveness, brief losses of consciousness, inattention, memory lapses or confusion. Should major seizures occur, their characteristics are similar to those in younger people – important markers being lateral tongue biting, waking in an ambulance or in hospital, or significant injuries.

For more information please refer to the RCGP Epilepsy Resources page. http://www.rcgp.org.uk/clinical-and-research/clinical-resources/epilepsy.aspx

References
A Critical Time for epilepsy in England: 22 January 2013
2 ‘Wasted Money , Wasted Lives ; The Human and Economic
Cost of Epilepsy in England 2008’
3 CCG Outcomes Indicator Set: Emergency Admissions NHS Information Centre march 2013 https://catalogue.ic.nhs.uk/publications/hospital/outcomes/ccg-indi-mar-13/ccg-ind-toi-mar-13-v4.pdf
4 https://www.gov.uk/drug-safety-update/medicines-related-to-valproate-risk-of-abnormal-pregnancy-outcomes
5 http://www.medscape.com/viewarticle/733423_1

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