Managing epilepsy: a challenge for the neurologist

Managing epilepsy is hard work. The detailed history of events, trying to work out if each seizure is the same type of event or if there are many different semiologies… not easy, not easy at all. Then there is the issue of anticonvulsants and monitoring not only their effectiveness, but also their potential adverse effects. We know about teratogenicity and we are learning more and more about bone health and fertility. However, of all the aspects of epilepsy management, it is the effects of the condition on a patient’s independence that often takes up a large part of the consultation. Only the other day, I spent a substantial period of two successive consultations in two different patients, simply listening while two young patients with epilepsy proceeded to tell me how unfair life was, or more specifically how unfair it was that they were no longer able to drive. One patient wondered if a second opinion from an epileptologist may result in them driving sooner. No, it won’t.

Then, there is the perennial question: “how long do I have to take these tablets for?”. For that question, Bonnett and colleagues http://jnnp.bmj.com/content/85/6/603.full have provided an important set of data. They have analysed data from the Standard and New Antiepileptic Drug Study (SANAD arm B) and have provided models that may help predict the chance of attaining seizure remission in a 12-month period. Variables that may be predictive include a family history of epilepsy, the number of seizures, seizure type and the treatment used. For a condition that has such a significant and serious impact on quality of life, this study provides important and clinically relevant answers that can be used in the day-to-day management and counselling of patients with epilepsy.

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