Triage Of Epileptic Conditions
Most people with epilepsy have seizures that are easy to treat, respond to relatively low doses of all appropriate AEDs, and can usually be managed by primary care physicians. The majority of patients with these types of epilepsy will experience no disability if treatment is initiated appropriately, and for some, seizures will eventually remit and medication will no longer be necessary. In reality, ~40% of patients with epilepsy have epileptic seizures that are difficult to control, but for many of these, more intensive phar-macotherapy, or alternative treatments, particularly surgery, will result in seizure freedom. In developed countries, these patients usually require referral to a tertiary epilepsy center to accurately diagnose the epilepto-genic abnormality and to initiate effective medical or surgical treatment. Truly refractory epilepsy requires supportive care, at times involving institutionalization where such facilities are available. For these patients, specialized pharmacotherapeutic, and in some cases surgical or other alternative treatments, as well as psychosocial services offered by a tertiary epilepsy center, can greatly reduce the disability associated with residual seizures and maximize quality of life. It is essential that primary care physicians and general neurologists distinguish between these three types of epileptic conditions and effect timely referrals when specialized expertise is necessary and available. Where these services are absent, family counseling to provide a safe environment, and the establishment of local support groups, can be extremely beneficial.
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