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  1. D Smith,
  2. D Chadwick
  1. Professor DW Chadwick, Walton Centre for Neurology & Neurosurgery, Lower Lane, Fazakerley, Liverpool L9 7LJ, UKd.w.chadwick{at}

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Epilepsy is a common, sometimes chronic, condition with physical risks and psychological and socioeconomic consequences which impair quality of life. The management of patients with epilepsy demands long term commitment from both the general practitioner (GP) and the specialist.

The prime requirements are a complete diagnosis, selection of optimal treatment, and counselling appropriate to individual needs. The majority of patients will enter remission and may be discharged to the care of their GP, while the remainder need continued care in the specialist clinic.

In the course of the condition the patient (and carer/family) should be sufficiently well informed to make decisions about choices of treatment, the need for long term treatment, and options for dealing with the drug resistant condition and its consequences.

Ideally this process will involve cooperation between the consultant and nurse specialist and the primary care physician. While, at present, these facilities are not widely available, this article focuses on this model of care.


The decision to start treatment should not be taken lightly.1 It represents a balance between the likelihood of further seizures with their attendant risks, including the small but real risk of sudden unexpected death (SUDEP),2 and the consequences, inconvenience, and risks of taking regular medication for each individual.

Prophylactic treatment

Prophylactic treatment has sometimes been advocated, notably in patients with severe head injury. While immediate treatment may reduce the risk of early post-traumatic seizures (within one week of injury) it does not influence the risk of late post-traumatic epilepsy.3 Studies addressing this issue in other neurological conditions with a high prospective risk of epilepsy (febrile seizures, craniotomy, cerebral tumours) have failed to show any evidence of benefit.

Single seizures

Patients presenting with a first seizure, where avoidable provocative factors have been excluded, represent a common clinical dilemma. Methodological differences explain the widely varying estimates …

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