impact report 2014 - medical
Epilepsy Society’s medical expertise is globally renowned. In 2014 we were able to share that expertise at grass roots level thanks to the appointment of the first ‘national’ nurse consultant
We know that medical services for people with epilepsy are variable. Those who receive ‘gold standard’ care are the most likely to gain seizure control. The appointment of our national nurse consultant working with health commissioners is the first step towards improving and developing epilepsy services at a local level. In her first year, nurse consultant Juliet Ashton has designed service models for commissioning groups, audit toolkits for GP practices and an impact tool for epilepsy nurses to provide evidence of their value.
‘I am mapping what services are provided, identifying gaps in provision and establishing how to redesign services for the better. To do this I analyse data, look at the evidence relating to best practice and make the business case.
‘In one region I calculated that employing an epilepsy specialist nurse could save about 80 inappropriate emergency hospital admissions a year, effectively paying for the cost of the new post plus making a saving of £40,000.’
Understanding how an epilepsy drug behaves in the body is vital to ensuring maximum seizure control and minimum side effects.
Our Therapeutic Drug Monitoring unit is the only one of its kind in the country monitoring all 23 licensed anti-epileptic drugs. Not only does it measure drug levels in the blood, but is increasingly testing saliva to measure drug concentrations, which is painless and less stressful.
Therapeutic drug monitoring and pregnancy
It is known that levels of anti-epileptic drugs can fall dramatically during pregnancy and that an increase in dose is invariably required. It is important that every woman is monitored regularly to maintain optimum seizure control. Our Therapeutic Drug Monitoring unit is frequently called on to provide this vital service.
Dr Fergus Rugg-Gunn describes the experience of one of his patients:
‘Jenny (not her real name) was planning to start a family. She was taking 150mg of lamotrigine twice a day and her seizures were well controlled. We decided it would be wise to check her individual therapeutic range before she fell pregnant so that we had a baseline for comparison during pregnancy.
Once Jenny became pregnant, we checked the concentration of lamotrigine in her blood again, suspecting that if the levels fell, she could be at risk of a seizure. As expected, her drug levels had fallen and, guided by therapeutic drug monitoring, we gradually increased her prescription to 250mg twice a day through to the end of her pregnancy. Jenny remained seizure free and gave birth to a happy, healthy baby. After delivery her drug concentration levels were again checked and her dosage was adjusted back to 150mg twice a day.
During her second pregnancy, we again monitored Jenny’s drug concentration levels and again she remained seizure free throughout.
Some epilepsy drug levels fall during pregnancy and it is important that every woman is monitored regularly to ensure that appropriate dosage adjustments are made so that optimum seizure control is maintained. This should be carried out at least every trimester and more frequently if concentration levels continue to fall.’
Photo: RCN publishing/Tim George