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 extend the deadline (GP) and the specialist.
The prime requirements are a complete abstract deadline 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 extend the deadline and abstract deadline 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.
Starting treatment deadline extended
The decision to start treatment should not be abstract deadline taken lightly extend the deadline. 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 has sometimes been abstract deadline advocated, notably in patients with severe head injury. While immediate treatment may reduce the risk of early post-traumatic seizures deadline extended (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 extend the deadline
Patients presenting with a first seizure, where abstract deadline avoidable provocative factors have been excluded, represent a common clinical dilemma. Methodological differences explain the widely varying estimates of risk of recurrence. Meta-analysis of prospective studies indicate an overall two year risk of 30–40%. The lowest risk (24%) is in patients with no identified cause who have a normal electroencephalogram (EEG), and the highest risk (65%) is in those with a remote abstract deadline neurological insult and an epileptiform EEG4
Treatment after a first tonic-clonic seizure halves the two year risk of seizures from approximately 40% to 20%.5 However deadline extended, this is not associated with any improvement in longer term outcomes such as proportions of patients achieving a one year remission.
While most neurologists do not advocate abstract deadline treatment routinely, patients who have a high risk of recurrence which would have significant social implications should be given the option and may elect to start treatment.
The decision to start treatment is much more straightforward abstract deadline in a patient with recurrent abstract deadline seizures and a clear cut diagnosis of epilepsy, especially if he or she has an identifiable syndrome with a abstract deadline extended predictable prognosis—for example, juvenile myoclonic epilepsy.