Care in people 60 years of age and over with chronic or recently diagnosed epilepsy: a note review in United Kingdom general practice.

AIM: To ascertain present United Kingdom (UK) management processes for epilepsy in older people. METHOD: This was a general practice notes review of people being treated for epilepsy 60 years and over. RESULTS: The cohort of 110 was from six practices. Seizure frequency in older people with epilepsy appears lower than in general; 75% are seizure free. This compares with 40-60% of people in other general practice note reviews and audits, where age is not a factor. Out of the people still having seizures over half have less than one seizure per month. Monotherapy rates are similar to the population in general. Nobody was taking more than two AEDs. There is evidence of new AED use, especially lamotrigine; it is the most commonly prescribed AED in those diagnosed in later life. Geriatricians appear to receive virtually no referrals for the diagnosis of epilepsy. General physicians, psychiatrists and neurologists receive many more. Geriatricians and general physicians appear never to follow up older people with epilepsy; GPs following up 91%, and neurologists and specialist nurses 9%. CONCLUSIONS: Seizure frequency in older people with epilepsy is generally low. Geriatricians appear to receive virtually no referrals for the diagnosis or management of epilepsy in older people. Follow up is mainly undertaken by GPs. Although lamotrigine has a difficult dosing schedule, which may be confusing for some older people, its use is high perhaps reflecting recent guidelines and evidence. These results may be peculiar to the geographical area used, so other work is needed to confirm or refute these findings.

Problems that mothers' with epilepsy experience when caring for their children.

Women with epilepsy who were service users of Epilepsy Action in the United Kingdom (UK) completed a questionnaire on the risks of caring for their baby and whether they were provided with useful information on fulfilling their caring role (Epilepsy Action is the trading name of the British Epilepsy Association a major UK charity for those with epilepsy). The cohort of 84 all reported some problems. The following were rated as being the most problematic; caring for their baby outside the home and bathing, whereas breastfeeding was rated as much less problematic. Some problems were rated as severe, which meant some babies were put at undue risk. Approximately 50% had been provided with information about caring and managing risk. Eighty-six percent found this information useful. The main conclusion is that more extensive, well-planned research is needed on this topic. There is virtually nothing in the academic literature to guide practice and this is needed. Present guidelines tend only to cover what the women rate as less problematic, e.g. breastfeeding, whereas what they rate highly problematic is often not covered. This needs attention in updates.