Epilepsy management

Making the correct diagnosis of epilepsy is important as there are many mimics, some of which are life threatening. A good history, including an eyewitness account, is crucial as investigations may be unhelpful. Once a positive diagnosis is made, management requires attention to provoking factors or underlying disease together with antiepileptic drugs (AEDs). Thoughtful prescribing is required as some AEDs exacerbate some seizure types. Surgery and vagal nerve stimulation are considered in intractable cases. Status epilepticus is a medical emergency with significant mortality. Women of childbearing age with epilepsy have particular needs as some AEDs interact with hormonal contraceptives. Pregnancy can lead to an increase in seizure frequency through various mechanisms. There is a risk of teratogenicity with AEDs. Prepregnancy counselling is therefore important. Lifestyle issues, particularly driving, need careful discussion in the newly diagnosed patient.