Drug treatment of epilepsy

It is conventional to speak of someone having epilepsy, but it might be better—particularly in relation to promoting better drug treatment—if we were to think in terms of one of the epilepsies.Appropriate management requires not only that doctors differentiate between epilepsy and other similar attacks but also that they identify correctly patients' seizure types and, in some cases, the syndrome (for example, juvenile myoclonic epilepsy). A detailed discussion of the differential diagnosis is outside the scope of this review. However, it is worth emphasising that the diagnosis is usually made from the description of the episodes obtained from the patient or eyewitnesses, or both. This information is often, but not always, supported or supplemented by findings from electroencephalography. Information on diagnosis, investigations, and general principles of treatment can be found in textbooks, 1 2 and videos illustrating different types of seizure are now fairly readily available. Ideally, the diagnosis should be made or confirmed by a specialist, who will also advise on treatment. Nonetheless, doctors who do not have a specialist interest in epilepsy will often be required to take a hand in treatment. This brief review is intended primarily for them. #### Summary points As a clinical pharmacologist with some training in neurology, I have been running an epilepsy clinic for many years. This review is based on a synthesis of my …