The rate of misdiagnosis and wide treatment choices are arguments for specialist care of epilepsy

The case of Dr Andrew Holton, consultant paediatrician at Leicester Royal Infirmary, highlights once again some of the dangers and pitfalls in the diagnosis and management of epilepsy. He has been suspended and referred to the General Medical Council after a review of 214 children seen by him showed that 171 gave definite or possible “cause for concern.” Just over a third of the children were not thought to have had epilepsy, and just under a third were thought to have been overtreated.1 Both are common pitfalls in the management of epilepsy.

The review also made clear that Dr Holton's training fell well short of what would be required for his post. Although a consultant in paediatrics, Dr Holton was not a paediatric neurologist, of whom there are just 62 in the United Kingdom. The report also points to professional isolation and under-resourcing as important mitigating factors in Dr Holton's practice. This episode graphically illustrates the potential consequences of the shortcomings identified in 2000 by the Clinical Standards Advisory Group …