Neurology New Epilepsy Pathway ED Review Paramedics Epilepsy

Neurology New Epilepsy Pathway ED Review Paramedics Epilepsy Specialist Nurse +/investigations GP/ICT referral via e-RS Key ED – Emergency department ICT – Integrated Care Team SUDEP – sudden unexpected death in epilepsy AED – Antiepileptic drug NEAD – Non epileptic attack disorder Paediatrics – known epilepsy New to area – known epilepsy Consultant Triage Other specialities e. g. Cardiology Care of the Elderly Psychiatry First fit clinic Epilepsy Consultant Pregnant with epilepsy referred in by GP/Midwife/Obstetrics Epilepsy clinic Epilepsy Consultant Transition clinic (Paediatrician initiated at appropriate age) Epilepsy Consultant Paediatric consultant Epilepsy Specialist Nurse Pregnancy Pathway Epilepsy Consultant Epilepsy Specialist Nurse Consultant Obstetrician and midwife Review 1 st, 2 nd and 3 rd trimester and 6 weeks post partum

Key ED – Emergency department ICT – Integrated Care Team SUDEP – sudden unexpected death in epilepsy AED – Antiepileptic drug NEAD – Non epileptic attack disorder FIRST FIT APPOINTMENT Consultant Neurologist 2 weeks to be reviewed Investigations MRI/EEG/Bloods/ECG/24 hr tape (as per NICE guidelines) Diagnosis Syncope Discharge with advice NEAD Consultant psychiatrist and psychologist ED pathway care plan for frequent attenders Cardiogenic syncope Cardiology review (Ideally combined clinic monthly) Single seizure Discharge with 1. DVLA advice 2. First aid advice 3. Risks inc SUDEP 4. Plan for 1 st line AED if further seizures 5. Advice-line contact with open access if further seizure in next 24 months Epilepsy Start 1 st line AED Plan for 2 nd line Epilepsy Specialist Nurse review in 4 weeks Specialist Pharmacist review for drug titration and side effects To epilepsy pathway Support and education throughout for patients, their families and carers from Epilepsy Action UK Clinical assessment Witness account Risk factors

1. 2. 3. 4. 5. 6. 7. Key EPILEPSY CLINIC Consultant Neurologist Current seizure frequency AED side effects Plan for AED titration Plan for next line AED Confirm diagnosis Emergency management plan for prolonged seizures (IBIS entry if appropriate) Review bone health, pregnancy information and other needs Controlled seizures Ongoing seizures ED – Emergency department ICT – Integrated Care Team SUDEP – sudden unexpected death in epilepsy AED – Antiepileptic drug NEAD – Non epileptic attack disorder Chronic epilepsy (seizure freedom is unlikely AED trials finished) Epilepsy Specialist Nurse Specialist Pharmacist review for drug titration + side effects When seizure free for 12 month discharge 1. Plan for AED titration in event of further seizures 2. Contraception and pregnancy advice 3. Advice re: medication withdrawal 4. Advice-line contact with open access follow up 24 months 5. Advice on bone health 6. Annual mental health screening Please refer to pathway guidance for psychology service description Consultant psychiatrist and psychologist Ongoing seizures to Plan B Epilepsy Consultant review Plan C: AED and consider tertiary review and epilepsy surgery Epilepsy Specialist Nurse Annual review 1. Acceptable seizure frequency 2. Emergency management plan 3. When to contact advice-line 4. Contraception and pregnancy advice 5. Advice-line contact with open access follow up 24 months 6. Advice on bone health 7. Annual mental health screening and referral if necessary ACCESS AS NEEDED TO Consultant Obstetrician and midwife LD psychiatrist and specialist nurse ONGOING REVIEW care plan ED GP/ICT Pharmacist

Epilepsy Pathway Guidance Consultant triage Advice line 9 am-5 pm Mon to Fri Band 4 pathway navigator Epilepsy consultant Epilepsy specialist Nurse Specialist pharmacist Consultant psychiatrist and psychologist Consultant obstetrician and midwife LD psychiatrist and specialist nurse Social worker For guidance on investigations required prior to referral and primary care management please see NICE guidance https: //www. nice. org. uk/guidance/ cg 137 Psychology interventions Epilepsy specific Psychological interventions within an MDT context are identified as necessary within NICE guidelines. These interventions are not provided within standard mental health services e. g. IAPT and Community Mental health Services. 1. Psychological consultation to Epilepsy Nurse Specialists and the rest of the team in identifying, assessing and formulating the psychological aspects of seizure management and the psychological challenges associated with living with epilepsy. Ensuring that psychological wellbeing is embedded within each aspect of the epilepsy pathway. In line with NICE recommendations 2. Identifying and treating the psychological challenges associated with epilepsy. E. g. improving self management, using evidence based psychological approaches alongside AED to aim to reduce seizure frequency – in particular where seizure control is inadequate. identifying situations where mental health is impacting on seizure frequency and seizure management and treating this. (NICE Guidance). 3. Facilitating access to and building pathways with relevant local agencies to ensure that people with epilepsy have access to and are not excluded from relevant services e. g. IAPT or CMHRS and those services are equipped to be able to adapt their interventions to the needs of people with epilepsy.