Epilepsy. Key management issues

Epilepsy embraces a multitude of syndromes that produce seizures as part or all of their clinical manifestations. Collectively these syndromes are common and occur across all age groups.

This article discusses diagnosis, investigations and treatment of epilepsy with an emphasis on areas that provide difficulty to both general practitioner and neurologist and introduces some of the important recent scientific advances in epilepsy research.

Syncope is often misdiagnosed as epilepsy, however, historical features are often sufficient to determine the correct answer. The electroencephalogram is not a definitive test for epilepsy but is particularly valuable in classifying the patient's seizure syndrome. When medication is advised for the patient, optimal seizure control requires reliable drug intake. Slow introduction of most antiepileptic medications improves tolerability. For patients with epilepsy refractory to medication, consideration of surgery or a vagal nerve stimulator is appropriate.