NICE gives guidance on use of new antiepileptic drugs in children
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《英国医生杂志》
London
Newer antiepileptic drugs should be considered for treating epilepsy in children who have not benefited from older drugs, or where use of the older drugs is unsuitable, says guidance issued this week to the NHS in England and Wales.
The National Institute for Clinical Excellence (NICE) recommends that the newer antiepileptic drugs—gabapentin, lamotrigine, oxcarbazepine, tiagabine, topiramate, and vigabatrin (as an adjunctive treatment for partial seizures)—be used, within their licensed indications, for managing epilepsy in children who have not benefited from treatment with the older antiepileptic drugs, such as carbamazepine and sodium valproate.
The guidance also recommends the newer drugs when the older drugs are unsuitable for children (because of contra-indications or interactions with other drugs) and in girls who are already of childbearing age or are likely to need treatment into their childbearing years.
The guidance also advises that children be treated with a single antiepileptic drug wherever possible. If initial monotherapy is unsuccessful, then monotherapy with another drug should be tried rather than adding other drugs (combination or adjunctive treatment). Adjunctive treatment should be considered only when monotherapy with antiepileptic drugs has not resulted in freedom from seizures.
A further recommendation is that all children who have a non-febrile seizure for the first time should see an epilepsy specialist as soon as possible, to find out exactly what type of epilepsy they have, so that the best treatment can be started.
Barbara Pinder, a spokeswoman for the UK patients' organisation Epilepsy Action, said: "We broadly agree with the guidance. Our concern is how well it will be implemented." She considered that the guidance represented what many doctors who are providing high quality care were already doing.
"More initiatives are needed to ensure that all children with epilepsy receive specialist care," she added, pointing out that there were too few paediatric epilepsy specialists to see all children with non-febrile seizures quickly. "More funding and training are needed to improve the number of epilepsy specialists and specialist nurses," she said.
? Other NICE guidance, for women with heavy menstrual bleeding, recommends endometrial ablation using fluid filled thermal balloons or microwave treatment as options when the woman and her clinician consider that surgical intervention is appropriate. These treatments will be alternatives to hysterectomy and other treatments currently available for the condition.
The guidance goes on to recommend that the choice of surgical treatment should be made jointly by the woman and the clinician after an informed discussion, taking into account the desired outcome of the treatment (such as reduced menstrual bleeding or complete cessation of menstrual bleeding), the relative benefits of all other treatment options and the adverse events associated with them, and the specific medical circumstances of the woman (her condition, her suitability for the different surgical treatments, and her wishes).(Susan Mayor)
Newer antiepileptic drugs should be considered for treating epilepsy in children who have not benefited from older drugs, or where use of the older drugs is unsuitable, says guidance issued this week to the NHS in England and Wales.
The National Institute for Clinical Excellence (NICE) recommends that the newer antiepileptic drugs—gabapentin, lamotrigine, oxcarbazepine, tiagabine, topiramate, and vigabatrin (as an adjunctive treatment for partial seizures)—be used, within their licensed indications, for managing epilepsy in children who have not benefited from treatment with the older antiepileptic drugs, such as carbamazepine and sodium valproate.
The guidance also recommends the newer drugs when the older drugs are unsuitable for children (because of contra-indications or interactions with other drugs) and in girls who are already of childbearing age or are likely to need treatment into their childbearing years.
The guidance also advises that children be treated with a single antiepileptic drug wherever possible. If initial monotherapy is unsuccessful, then monotherapy with another drug should be tried rather than adding other drugs (combination or adjunctive treatment). Adjunctive treatment should be considered only when monotherapy with antiepileptic drugs has not resulted in freedom from seizures.
A further recommendation is that all children who have a non-febrile seizure for the first time should see an epilepsy specialist as soon as possible, to find out exactly what type of epilepsy they have, so that the best treatment can be started.
Barbara Pinder, a spokeswoman for the UK patients' organisation Epilepsy Action, said: "We broadly agree with the guidance. Our concern is how well it will be implemented." She considered that the guidance represented what many doctors who are providing high quality care were already doing.
"More initiatives are needed to ensure that all children with epilepsy receive specialist care," she added, pointing out that there were too few paediatric epilepsy specialists to see all children with non-febrile seizures quickly. "More funding and training are needed to improve the number of epilepsy specialists and specialist nurses," she said.
? Other NICE guidance, for women with heavy menstrual bleeding, recommends endometrial ablation using fluid filled thermal balloons or microwave treatment as options when the woman and her clinician consider that surgical intervention is appropriate. These treatments will be alternatives to hysterectomy and other treatments currently available for the condition.
The guidance goes on to recommend that the choice of surgical treatment should be made jointly by the woman and the clinician after an informed discussion, taking into account the desired outcome of the treatment (such as reduced menstrual bleeding or complete cessation of menstrual bleeding), the relative benefits of all other treatment options and the adverse events associated with them, and the specific medical circumstances of the woman (her condition, her suitability for the different surgical treatments, and her wishes).(Susan Mayor)