• Undertake a structured routine review of all people with epilepsy in primary care at least once a year to assess:
• Seizure control and adverse effects of treatment.
• Social or psychological issues relating to the epilepsy.
• Carers' skills in managing seizures.
• The person's information needs.
• Ensure all children and people with learning disabilities are also reviewed by a specialist at least once a year.
• Routine specialist review of other people with epilepsy is at the discretion of the specialist once they have established the diagnosis and planned the person's treatment. This review may be carried out by an epilepsy specialist nurse.

• Assess:
• Seizure control by assessing seizure frequency and severity, and changes in these since the last review.
• The tolerability of drug treatment by asking about compliance and adverse effects of treatment.
• Refer for review by an epilepsy specialist if:
• Seizure control is poor or unacceptable or drug treatment is poorly tolerated.
• The person has been seizure-free for the last 2 years and would like to consider tapering or withdrawing their treatment. Ensure that they understand:
• The risk and consequences of seizure recurrence when treatment is withdrawn.
• That they are not entitled to drive from the start of the period of withdrawal and for 6 months after stopping treatment, or if seizures recur.
• For people taking antiepileptic drugs:
• Offer lifestyle and dietary advice on how to reduce their risk of osteoporosis.
• Consider vitamin D supplementation if they are at increased risk of osteoporosis, osteopenia, and fractures caused by:
• Being immobile for long periods.
• Inadequate exposure to sunlight.
• Inadequate dietary calcium.
• At present there is a lack of evidence or published expert opinion to guide the choice of preparation or dose.
• For women and girls approaching sexual maturity ensure that they are informed about contraception, the risks of antiepileptic drugs during pregnancy, and how to reduce these risks when planning a pregnancy.
• Discuss prescribing folic acid supplements to women of child-bearing potential to reduce the risk of fetal malformation in the event of unplanned pregnancy.
• Discuss specialist referral with women who are taking sodium valproate who are of child-bearing potential to consider changing treatment to a drug with less risk of fetal malformation in the event of unplanned pregnancy.
• Ensure:
• The same drug brand is prescribed (not generic) when re-authorizing repeat prescriptions.
• The person is well informed about their treatment.
• The person understands the importance of compliance with treatment to reduce the risk of seizures and sudden unexpected death.
• Provide written information to support verbal advice.

In depth

• Assess symptoms and signs of anxiety or depression and manage appropriately.
• Assess how the person is managing their daily life with epilepsy.
• If the person is driving, or wants to drive, ensure that they are entitled to do so — see Medical Standards of Fitness to Drive.
• For people who are working or seeking work, ask about any problems they have with work relating to their epilepsy.
• Offer verbal and written advice:
• About managing the risks from epilepsy in their daily life.
• On obtaining disability living allowance and other benefits.

In depth

Ensure that the carers of the person with epilepsy:

• Have been instructed in first aid for people having a seizure.
• Are familiar with the agreed protocol for giving rectal diazepam or buccal midazolam for prolonged or recurrent seizures, and how to administer the treatment (if they have been authorized to do so).

In depth

• Ensure that people with epilepsy and their carers:
• Have a named primary healthcare professional to contact for help with problems relating to their epilepsy. This could be:
• A general practitioner, or
• A trained practice nurse, or
• An epilepsy specialist nurse, if available.
• Are aware of sources of information about epilepsy and its treatment, from groups such as:
• Epilepsy Action.
• Epilepsy Research UK.
• Joint Epilepsy Council.
• The National Society for Epilepsy.

In depth