Epilepsies: Diagnosis and Management (NICE NG217, 2022 update)

NICE NG217 covers the diagnosis and management of epilepsy across all ages, including antiseizure medication selection, surgical referral, and special populations.

Key Recommendations

• Refer to epilepsy specialist within 2 weeks of suspected first seizure
• Focal onset seizures: lamotrigine or levetiracetam first-line
• Generalised onset: sodium valproate first choice (not in women of childbearing potential — see valproate guidance)
• Women of childbearing potential: lamotrigine or levetiracetam (lower teratogenicity)
• Consider referral for surgery if 2 antiseizure medications have failed
• Driving regulations: inform DVLA of all seizures; 1-year seizure-free before driving
• Sudden unexpected death in epilepsy (SUDEP): discuss risk annually with all patients