ABSTRACT
Epilepsy is a common and serious condition (prevalence 750 per 100 000) with adverse social consequences for employment, education and driving, morbidity from seizures and medication, and increased mortality. The diagnosis requires a detailed history including witness account; this is resource-intensive and requires lengthy specialist consultations. Clinicians must distinguish seizures from the two other common causes of blackouts: syncope and psychogenic attacks. Investigations such as electroencephalogram and MR brain scanning help to identify the causes and classification of epilepsy, but alone rarely provide the diagnosis. Treatment with antiepileptic medication is long-term and potentially hazardous; patients should make the decision to start treatment only following informed discussion with an epilepsy specialist. All patients require reliable written information about their condition. In particular they must know the driving regulations, and the impact of seizures on employment, education and leisure pursuits. Women must understand the potential teratogenic effects of their medication. Certain patient groups with special needs benefit from targeted epilepsy services, e.g. learning disabled, children, teenagers and the elderly. People with epilepsy require long-term specialist follow-up. Although currently provided in mainly in secondary care (including nurse-led clinics), improved liaison with primary care should enable improved access to epilepsy services for all patients. Epilepsy clinic teams aim to provide multidisciplinary and long-term care, working closely with primary care and empowering patients towards improved management of their own condition.
