Even after witnessed attacks, the diagnosis of epilepsy can be difficult. Approximately 25 percent of patients referred for neurologic assessment of epilepsy have alternative diagnoses such as syncope or psychogenic attacks. In 15 percent of patients, repeated EEGs are also normal, probably because of the sporadic nature of the condition or the location of lesions deep in the brain. Magnetic resonance imaging and newer investigative techniques may be necessary to establish the diagnosis or to identify candidates for surgical treatment. The increasing range of drugs available for epilepsy raises issues of medication selection for specific patients.
Adverse effects are also an issue.
Compliance is a major concern, but monitoring plasma drug concentrations may not be as essential as previously believed. Clinical efficacy and tolerability are the best guides to monitoring drug therapy. Patients who remain refractory to drug therapy may be candidates for surgical treatment or implantation of stimulators. Patients and their families should be counseled regarding legal restrictions, particularly concerning driving. Patients can also be counseled to avoid situations that may precipitate a seizure or in which a seizure could have serious consequences.