Clinical Review

Management of chronic epilepsy

BMJ 2012; 345 doi: https://doi.org/10.1136/bmj.e4576 (Published 17 July 2012) Cite this as: BMJ 2012;345:e4576

This article has a correction. Please see:

  1. Fergus J Rugg-Gunn, consultant neurologist12,
  2. Josemir W Sander, professor of neurology123
  1. 1Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, Queen Square, London, UK
  2. 2Epilepsy Society, Chalfont St Peter, UK
  3. 3SEIN-Epilepsy Institute in the Netherlands Foundation, Heemstede, Netherlands
  1. Correspondence to: L Sander, Box 29, UCL Institute of Neurology, London WC1N 3BG, UK l.sander{at}ucl.ac.uk
  • Accepted 25 June 2012

Summary points

  • Epilepsy is common, affecting over 400 000 people in the United Kingdom

  • Epileptic seizures are associated with an increased risk of morbidity and premature mortality

  • Quality of life depends on seizure freedom and lack of adverse effects from drug treatment

  • Comorbidities and the effects on lifestyle, mood, and relationships are also important

  • Up to 75% of people with epilepsy become seizure-free on treatment

  • Choice of drug treatment should be tailored to each person, as determined by their characteristics, the epilepsy syndrome, seizure types, lifestyle issues, and cotreatments

  • Combination treatment could be needed for patients who do not respond to monotherapy

  • Review diagnosis and treatment compliance for patients who do not respond to treatment

  • Consider other treatment options, such as surgery, in people with chronic focal epilepsy

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 …

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