Epilepsy

Epilepsy - Rationale for Inclusion of Indicator Set
Epilepsy is the most common serious neurological condition, affecting about 5 to 10 per 1000 of the population at any one time. Few epilepsies are preventable, but much of the handicap that results could be prevented by appropriate clinical management.

Epilepsy Indicator 1
The practice can produce a register of patients receiving drug treatment for epilepsy

Epilepsy 1.1 Rationale
The clinical indicators of epilepsy care cannot be checked unless the practice has a register of patients with epilepsy. The phrase 'receiving treatment' has been included in order to exclude the large number of patients who had epilepsy in the past, and may have been off treatment and fit-free for many years. Some patients may still be coded as 'epilepsy' or 'history of epilepsy' and will be picked up on computer searches. Patients who have a past history of epilepsy who are not on drug therapy should be excluded from the register.
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It is proposed that the disease register includes patients aged 16 and over as care for younger patients is generally undertaken by specialists.

Epilepsy 1.2 Preferred Coding
Epilepsy F25%

Drugs on repeat prescription will be picked up on search.

Epilepsy 1.3 Reporting and Verification
The practice reports the number of patients aged 16 and over on its epilepsy disease register and the number of patients aged 16 and over on its epilepsy disease register as a proportion of total list size.

Verification - PCOs may compare the expected prevalence with the reported prevalence.

Epilepsy Indicator 2
The percentage of patients aged 16 and over on drug treatment for epilepsy who have a record of seizure frequency in the previous 15 months

Epilepsy 2.1 Rationale
Epilepsy is often poorly managed in general practice, and there are insufficient specialist resources to provide specialist supervision for most patients.

It is recommended that the following information should be recorded routinely in patients' notes at each review:

- Seizure type and frequency, including date of last seizure
- Antiepileptic drug therapy and dosage
- Any adverse drug reactions arising from antiepileptic drug therapy
- Key indicators of the quality of care ie topics discussed and plans for future review

Grade C Recommendation SIGN 21

Further information:http://www.sign.ac.uk/pdf/sign21.pdf

No recommendation has been made by SIGN on the frequency of the review. A pragmatic decision has been made to set this as annual.

Epilepsy 2.2 Preferred Coding
Seizure Frequency recorded 6675

Epilepsy 2.3 Reporting and Verification
Practices should report the percentage of patients on the epilepsy register who have a record of seizure frequency in the last 15 months.

Epilepsy Indicator 3
The percentage of patients aged 16 and over on drug treatment for epilepsy who have a record of medication review in the previous 15 months

Epilepsy 3.1 Rationale
See Epilepsy 2.1

Epilepsy 3.2 Preferred Coding
Epilepsy medication review 667..

Epilepsy 3.3 Reporting and Verification
Practices should report the percentage of patients on their epilepsy register who have had a medication review in the last 15 months.

Epilepsy Indicator 4
The percentage of patients aged 16 and over on drug treatment for epilepsy who have been seizure free for the last 12 months recorded in the last 15 months

Epilepsy 4.1 Rationale
Seizure control gives some indication of how effective the management of epilepsy is.

However, it is recognised that fit control is often under the influence of factors outside the general practitioner's control. It is expected that exception-reporting in the epilepsy data set will be more common than in other chronic conditions (eg for brain damaged patients whose fits cannot be controlled, patients who find the side effects of medication intolerable etc).

The top level in this indicator has been deliberately set at a lower level in order to encourage general practitioners to record the frequency of convulsions as accurately as possible.

Epilepsy 4.2 Preferred Coding
No coding available

Epilepsy 4.3 Reporting and Verification
Practices should report the percentage of patients with epilepsy who have been seizure free in the preceding 12 months, recorded in patients in the last 15 months.