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NICE recommends cheaper epilepsy drugs as first-line

The National Institute for Clinical Excellence has recommended that old antiepileptic drugs be used as first-line for epilepsy instead of their newer, more-expensive counterparts, except in specific circumstances.

But the guidelines stop short of giving definitive advice on treating women of childbearing age and have been branded unrealistic in their demand for patients suffering a first seizure to be seen quickly by a specialist ­ when there is a national shortage of neurologists.

NICE reviewed studies on seven newer drugs and found they did not improve quality of life or seizure control, compared with the older treatments ­ but they cost up to £100 for a month's course compared with £12.

NICE states newer drugs should only be used where sodium valproate or carbamazepine are unsuitable due to contraindications, complications with other drugs or in women of childbearing age.

It states: 'In women of childbearing potential, the possibility of interaction with oral contraceptives and the risk of the drugs causing harm to an unborn child should be discussed and an assessment made as to the risks and benefits of treatment with individual drugs.' But it highlights that there is not enough data on risks to the unborn child.

The guidelines urge 'specific caution' in the use of sodium valproate. This follows advice from the Committee on Safety of Medicines that GPs should not prescribe val- proate to women of childbearing age without specialist

advice.

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