Journal of Behavioral and Brain Science, 2011, 1, 75-79
doi:10.4236/jbbs.2011.12010 Published Online May 2011 (
Copyright © 2011 SciRes. JBBS
Audit of Epilepsy Clinics in South East Thames:
Ar e We NICE?
Somnath Banerjee, Sanjay Sahi
School and Child Health, Queens House, Kent, UK
Received March 28, 2011; revised April 14, 2011; accepted April 16, 2011
Background: NICE has suggested that paediatric epilepsy services should undergo regular audit. An audit
was done to gain a snapshot across South East Thames clinics. Method: Audit in South East Thames was
conducted in 2010. Results: In 86.5% seizure classification and in 42.8% a syndromic diagnosis was made.
cQT interval was calculated in 10.1% cases and 91.8% had an EEG. In 48.5% adverse effects of drugs were
communicated. 41.3% were given information leaflets/directed to the appropriate website. In 70.7% devel-
opmental/academic progress was documented. 61% had a written care plan. 70.2% had the copy letter to par-
ents/carers whereas it was sent to School & Child Health in 35.1%. 23.1% had access to specialist epilepsy
nurse. Conclusions: This audit was a snapshot. The results showed that the care of children with epilepsy is
consistent with the NICE guidelines in many aspects but patchy in the UK.
Keywords: Epilepsy in Children, Audit, NICE, SETPEG
1. Introduction
The National Institute for Health and Clinical Excellence
(NICE) has issued guidelines for diagnosis and manage-
ment of epilepsy [1]. NICE was set up as a special health
authority for England and Wales in 1999 [2]. It is an in-
dependent organisation responsible for providing na-
tional guidance on treatments and care in the National
Health Service (NHS) in England and Wales. South East
Thames Paediatric Epilepsy Group (SETPEG) has also
produced guidelines, based on best available evidence
for the local clinics run by SETPEG member [3]. There
is also guidance from the Joint Epilepsy Council Good
Practice Initiative [4]. All the guidelines have made
recommendations that paediatric epilepsy services should
undergo regular audit. A multidisciplinary audit was
conducted in South East Thames in 2010.
2. Aims and Objectives
The primary aim of this audit was to measure current
practices against NICE and local guidelines and to gain
an initial snapshot of some aspects of service quality
across South East Thames. It is hoped that the findings
will be able to contribute positively to the proposed na-
tional Epilepsy 12 audit in UK, due to commence in late
3. Audit Standards
For the purpose of this audit the standards were set
against the NICE and SETPEG guidelines in the follow-
ing categories:
1) All patients with epilepsy have a multi-axial seizure
classification and syndromic diagnosis if possible.
2) Corrected QT interval is calculated in cases of di-
agnostic uncertainty.
3) EEG is arranged for all children attending epilepsy
4) Patients and carers receive appropriate information
about adverse effect of anti epileptic drugs.
5) Patients and carers are provided with information
leaflets or directed to appropriate websites for in-
6) The records show that developmental/academic pro-
gress of the patients is documented.
7) All correspondences from the clinic to GPs are cop-
ied to parents/carers and school health (with paren-
tal consent).
8) All children with epilepsy should have a written
care plan.
9) All children should have access to an epilepsy nurse
Copyright © 2011 SciRes. JBBS
4. Methodology
4.1. Design
A case note review to audit existing practices in the epi-
lepsy clinics. Information recorded from the last clinic
letter was used for data collection. The audit proposal &
data capture form were reviewed and approved by the
SETPEG working group.
4.2. Setting and Data Source
Epilepsy clinics at secondary level in South East Thames
run by the paediatricians with an interest in epilepsy,
who were members of SETPEG.
4.3. Inclusion Criteria
Patients must have been diagnosed after 2nd January
Attending follow ups for at least 12 months at the
time of data capture.
Data collected from Monday 1st February 2010 to
Friday 26th March 2010 (eight weeks).
Aged 17 years or under at the time of referral.
4.4. Exclusion Criteria
Follow ups outside the set dates.
Age 18 years or over.
Diagnosed before January 2005.
4.5. Data Protection and Caldicott Principles
The sharing of information for this audit did not breach
Data Protection or the Caldicott Principles. The informa-
tion collected was confined to such data as should be
shared between multi-disciplinary agencies working
within the NHS and the Community. The database, for
the purposes of this review, did not contain any patient
identifiers. The permission for this audit was obtained
from the clinical audit department.
4.6. Case Identification
Patients attending clinics with a diagnosis of epilepsy
from 1st February 2010. Cases were identified by a clini-
cian in the clinic who extracted the data from the files.
Appendix 1 is the data capture form used for this audit.
Children’s notes were audited one year after the diagno-
sis of epilepsy. This is because after the publication of a
NICE guideline, National Health Service (NHS) organi-
sations in the UK has three months period to implement
NICE recommendations. For example, if a child was
given the diagnosis in March 2009 then her/his notes
were included for the audit purposes after March 2010.
This was to make sure that an appropriate multi-axial
diagnosis could be made.
5. Results
After exclusion of cases not meeting the criteria, 208 set
of case notes were audited from nine Trusts (Table 1).
There were 112 (53.8%) boys and 93 (44.7%) girls. No
information was available in the data capture form for 3
(1.4%). 17 (8.2%) children were in the age range from 1
to 3 years, 82 (39.4%) were of primary school age (be-
tween 4 to 10 years) and 79 (38%) children were of sec-
ondary school age (11 to 17 years). No information was
available in 30 (14.4%) forms. The diagnosis of epilepsy
was clear in 86% cases. The seizure classification was
done in 86.5% and 42.8% had a syndromic diagnosis.
EEG was done in 91.8% of cases. Adverse effects of
antiepileptic drugs were communicated in 48.5% and in
41.3% cases either informative leaflets on epilepsy were
provided or directed to the appropriate website. Devel-
opmental/academic progress was documented in 70.7%.
70.2% cases had a written care plan. In 70.2% cases, the
parents/carers were copied the clinic letter whereas it
was copied to school health team in 35.1% cases. The
access to the specialist epilepsy nurse was noted in
23.1%. Figure 1 describes the detailed results of this
6. Discussion
This audit demonstrated that when a child is advised to
Table 1. Participating trusts and number of patients re-
No Trust
Number of recruits
(percentage, %)
1 East Kent Hospitals 52 (25)
2 Queen Mary Hospital Sidcup 52 (25)
3 Conquest Hospital Hastings 28 (13.5)
4 Queen Elizabeth Hospital London 28 (13.5)
5 Evelina Children Hospital 22 (10.6)
6 South Downs 14 (6.7)
7 Lewisham Hospital 6 (2.9)
8 Princess Royal Bromley 5 (2.4)
9 Brighton & Hove 1 (0.4)
TotalNine trusts 208 (100)
Copyright © 2011 SciRes. JBBS
Figure 1. Setpeg audit results. ! = In another 42 (20.2%), a syndromic diagnosis was attempted; * = 2 children were not on
any AED; ~ = 15 cases had well-controlled epilepsy so a written care plan was not needed; # = 4 children were not in school.
have an antiepileptic drug, the child (if appropriate) and
parents/carers needs to be told of the possible
side-effects of medication/s and this should be docu-
mented in the notes. Children and parents/carers should
be given written literature on epilepsy or directed to the
appropriate website. Studies have shown that it is impor-
tant for the physician to give information about the
medication as this improves compliance [5,6]. The pa-
tient’s developmental/academic progress should be
documented in the notes. Children with a diagnosis of
epilepsy should have a written care plan. The clinic let-
ters of each visit should be copied to parents/carers and
the local school and child health team. Individuals with
epilepsy should be provided the appropriate information
and contact details of the support services and referred to
the epilepsy nurse specialist. In this audit, the majority of
cases did not have access to epilepsy nurse specialist.
A level three diagnosis (i.e. syndromic diagnosis)
should be made whenever possible. If not, level two
should be attained (e.g. seizure type/s). A diagnosis of
epilepsy is very rarely if ever, justified [4]. In case of
diagnostic uncertainty a 12-lead ECG should be carried
out in children [1]. Children presenting with seizure,
collapse or a worrying history needs calculation of cor-
rected QT interval (QTc = QT/ RR) and referral to the
cardiologist [3]. Incomplete data capture forms were
noted to be a common error. Implementation of national
clinical guidelines is the responsibility of each NHS
board and is an essential part of clinical governance [7].
As a direct result of this audit a standardized proforma
at first and subsequent clinic visits including investiga-
tions, multi-axial classification, and information and care
plan checklists are now available in SETPEG website for
the members. A leaflet for parents which aims to em-
power them to ask questions and provides details of fur-
ther sources of information is also available in the web-
site. The results of this audit have been made available to
the national epilepsy 12 audit due to commence later this
year and commissioned by Health Quality Improvement
Partnership, Royal College of Paediatrics and Child
Health, British Paediatric Neurology Association, British
Society for Clinical Neurophysiology, Royal College of
Nursing, Epilepsy Scotland, Epilepsy action and Quality
Improvement Scotland.
7. Recommendations
1) More stress on syndromic diagnosis needed.
2) Corrected QT interval is calculated in diagnostic
3) Adverse effects of anti-epileptic drugs need to be
communicated to patents and parents/carers.
4) Information leaflets/appropriate website addresses
should be given to parents/carers.
5) Developmental/academic progress should be docu-
mented in the notes.
6) A written care plan should be in place.
7) Copy of the clinic letter of each clinic visit to be
Copyright © 2011 SciRes. JBBS
sent to School & Child Health.
8) Access to the specialist epilepsy nurse needs to be
8. Acknowledgements
Authors are grateful to the SETPEG members who com-
pleted the data capture form for this audit.
9. References
[1] National Institute of Clinical Excellence, “The Epilepsies:
Diagnosis and Management of the Epilepsies in Children
and Young People in Primary and Secondary Care,”
Clinical Guideline 20, 2004.
[2] J. Raftery, “NICE: Faster Access to Modern Treatments?
Analysis of Guidance on Health Technologies,” British
Medical Journal, Vol. 323, No. 7324, 2001, pp. 300-303.
[3] E. Hughes and R. Williams, “Epilepsy Guidelines,” South
East Paediatric Epilepsy Interest Group, London, 2007.
[4] S. Frost, P. Crawford, S. Mera and B. Chappell, “Na-
tional Statement of Good Practice for the Treatment and
Care of People Who Have Epilepsy,” Joint Epilepsy
Council, 2002.
[5] D. Webb, H. Coleman, A. Fielder and C. Kennedy, “An
Audit of Paediatric Epilepsy Care,” Archives of Disease
in Childhood, Vol. 79, No. 2, 1998, pp. 145-148.
[6] A. A. Asadi-Pooya, “Drug Compliance of Children and
Adolescents with Epilepsy,” Seizure, Vol. 14, No. 6,
2005, pp. 393-395.
[7] Scottish Intercollegiate Guidelines Network, “Diagnosis
and Management of Epilepsies in Children and Young
People. A National Clinical Guideline 81,” 2005.
Copyright © 2011 SciRes. JBBS
Appendix 1
Audit on Epilepsy in the Paediatric Clinics in South Thames East
Q. 1 Site -------------------------------------------------------
Q. 2 Age of the child -------------------------------------------------------
Q. 3 Gender: Male Female
Standard I
Q. 4.1 Seizure classification
Yes No
Q. 4.2 Syndromic diagnosis
Yes No Attempted
Standard II
Q. 5.1 Diagnosis not clear
Yes No
Q. 5.2 Corrected QT Interval calculated
Yes No
Q. 5.3 EEG done
Yes No
Standard III
Q. 6 Adverse Effects of drugs communicated
Yes No
Standard IV
Q. 7 Information Leaflets provided or directed to appropriate website for information
Yes No
Standard V
Q. 8 Developmental/academic progress documented
Yes No
Standard VI
Q. 9.1 Written care plan
Yes No NA
Q. 9.2 Correspondence copied to parents
Yes No
Q. 9.3 Correspondences copied to school health team
Yes No
Standard VII
Q. 10 Access to epilepsy nurse specialist
Yes No
Thank you for completing this form. Please return to: Dr S Banerjee, Community Paediatrician, School & Child
Health, Queens House, Queen Street, Ramsgate, Kent CT11 9DH by Wednesday 15 April 2010.