Approach to epilepsy: overview and update of diagnosis and management

Epilepsy is a prevalent chronic neurological disorder marked by recurrent seizures, affecting over 70 million people worldwide. This review offers an up-to-date guide for general physicians, general practitioners and general neurology trainees on diagnosing and managing epilepsy, emphasising the importance of early referral to specialist teams. It discusses the epidemiology, significant societal burden and common comorbidities-including cognitive, psychiatric and cardiovascular conditions-which contribute to reduced quality of life and increased mortality, including sudden unexpected death in epilepsy. The article outlines a structured approach to first seizures and their mimics, emphasising the role of electroencephalography and neuroimaging in diagnosis. Medical management centres on seizure control through anti-seizure medications (ASMs), but up to one-third of patients develop drug-resistant epilepsy, necessitating specialist interventions such as epilepsy surgery or neuromodulation. Accurate seizure classification and tailored treatment plans, including consideration of ASM teratogenicity in women of childbearing age, are essential. Case vignettes illustrate complex scenarios requiring specialist multidisciplinary evaluation. This review reinforces that timely specialist input can significantly enhance outcomes in patients with challenging or refractory epilepsy.