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.

An audit of lamotrigine, levetiracetam and topiramate usage for epilepsy in a district general hospital.

The aim of this audit was to ascertain outcomes for people who had taken or who were still taking three "new generation" broad-spectrum antiepileptic drugs (AEDs), namely lamotrigine, levetiracetam and topiramate. Thirteen percent of people became seizure free and approximately, one-third had a reduction of greater than 50% in their seizures. Two-thirds of people were still taking their audit AED. In addition, approximately one-third of people with a learning disability derived substantial benefit, although the rate of seizure freedom was lower. All three AEDs were most successful at treating primary generalised epilepsy and least successful with symptomatic generalised epilepsy. With some reservations the data suggests that levetiracetam and topiramate are the most efficacious AEDs, but topiramate is the least well tolerated. These results mean consideration of a "general prescribing policy" is important when using and choosing these AEDs. We conclude that lamotrigine, levetiracetam and topiramate are useful additions to the armamentarium of AEDs.

Implementing good practice in epilepsy care.

Examples of evidence-based guidelines for epilepsy care exist. However, guidelines are of little use if they are not recognised, implemented and supported. The object of this study was to establish the degree to which good practice guidelines for epilepsy have been implemented and to identify positive and negative factors that affect their implementation. Semi-structured questionnaires were sent to 750 randomly selected health professionals working in primary and secondary care in England. The sample comprised nurses (200), adult consultants (including learning disability consultants) (300), paediatric consultants (150) and general practitioners (100). Aspects of good practice are being implemented in some areas, but not generally, therefore service provision is likely to remain fragmented until this is addressed. Professionals have been prevented from successful implementation of guidelines to sustain good practice due to a number of factors, most notably lack of time, workload, competing priorities and staffing levels. Factors that have promoted and encouraged the successful adoption and application of good practice include inputs from epilepsy specialist nurses (ESNs), appropriate, timely and accessible professional development opportunities and the support and enthusiasm of colleagues.