Clinical Review Fortnightly review

Drug treatment of epilepsy

BMJ 1999; 318 doi: http://dx.doi.org/10.1136/bmj.318.7176.106 (Published 09 January 1999) Cite this as: BMJ 1999;318:106
  1. >Morgan Feely, senior lecturer. (mfeely@ulth.northy.nhs.uk)
  1. Clinical Pharmacology Unit, Division of Medicine, University of Leeds, General Infirmary, Leeds LS1 3EX

    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

    • In treating epilepsy, the drug chosen needs to be matched to the individual patient and the type of epilepsy

    • Often, the most suitable treatment regimen can be established only by trial and error

    • The wide range of treatments now available offers most patients good seizure control without unacceptable side effects and offers patients with refractory epilepsy a chance of better control

    • Many patients with epilepsy still do not seem to be getting the treatments that are most appropriate for them

    Methods

    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 …

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