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NICE in new clash on epilepsy drugs

Guidance on new epilepsy drugs published by NICE last week has clashed with the advice of the Scottish Intercollegiate Guidelines Network (SIGN) issued last year.

While SIGN suggested the new drugs lamotrigine and oxcarbazepine should be used first-line alongside the older sodium valproate and carbamazepine for partial and secondary generalised seizures, NICE advises that all the

new drugs should be used

only as second-line therapy.

SIGN also suggested lamotrigine should be used alongside sodium valproate for primary generalised seizures or where there was doubt about the seizure type.

NICE also recommends women of childbearing age should have other new anti-seizure drugs rather than sodium valproate.

The NICE technology appraisal of seven new anti-epileptic drugs says they should be used where older drugs such as sodium valproate have not worked, are poorly tolerated or are contraindicated. Monotherapy was suggested wherever possible, with patients switching drugs before trying adjunctive therapy.

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