Management of chronic epilepsy

#### Summary points Epilepsy can be defined pragmatically as the occurrence of at least two unprovoked epileptic seizures. It is the commonest serious neurological condition in adults, directly affecting over 400 000 people in the United Kingdom and up to 60 million people worldwide.1 Prevalence of epilepsy in developed countries is about 0.5%; however, the lifetime risk of a person having a non-febrile epileptic seizure is much higher at 2-5%, implying, for most patients, remittance of the condition or premature death. Risk of a second seizure occurring within two years of the first event is about 50%. Early treatment with antiepileptic drugs after the first seizure does not affect the long term prognosis, with 75-80% achieving remission at five years, irrespective of whether treatment began after the first seizure or only after a recurrence.2 3 Treatment is therefore typically reserved for people who have had at least two seizures; the risk of a third seizure in these patients is over 70%. A tailored approach to treatment should always be adopted, since there could be circumstances in which …