Setting

This audit was done in relation to out-patients served by four consultant psychiatrists specialising in intellectual disability (ID). The standards of care are the same for a non-ID population, so this audit could be adapted to any population for whom the clinician has a responsibility for managing epilepsy.

Background

Epilepsy is a chronic illness which poses a challenge in the balance between sideeffects and effective treatment. It is particularly relevant to an ID population as the prevalence is higher in this group than in the general population. The risks to the individual are high if the wrong balance is struck, leaving the patient either with frequent seizures and the increased risk of sudden unexplained death in epilepsy (SUDEP) or exposed to harmful side-effects.

Standards

The guidance on epilepsy in adults and children produced by the National Institute for Health and Clinical Excellence (NICE) (Stokes et al, 2004) presents 17 standards. All these could be audited, but key minimum standards which should be easily addressed through this type of audit would be the following:

ᐅ The records show that all individuals have had their seizures and/or epilepsy syndrome classified using a multi-axial classification scheme.

ᐅ The records show that combination anti-epileptic drug therapy, if prescribed, followed an adequate trial of monotherapy.

ᐅ The records show that all individuals with epilepsy have had a review in the previous 12 months.

ᐅ The records show that seizure frequency has been documented in the past 12 months.

Method

Data collection

A sample of the departmental case-load was systematically assessed and all cases of epilepsy were identified. Notes were examined in reverse chronological order. In all notes, the following information was sought:

ᐅ description of seizures (ictal phenomenology)

ᐅ seizure type

ᐅ syndrome

ᐅ aetiology

ᐅ reference to the number of anti-epileptic drugs taken and, where more than one drug was being taken, documentation of at least two periods of monotherapy that failed to gain adequate results

ᐅ review of epilepsy at least every 12 months

ᐅ review of seizure frequency at least every 12 months.

Data analysis

Database software was used to evaluate the proportion of patients meeting the above criteria.