Diagnosis and management of the epilepsies are routinely performed by primary care physicians. In the United States, only 17% of patients with new-onset epilepsy are examined by neurologic specialists, and even fewer patients employ neurologists for their ongoing care. With the changes dictated by the evolving health care system in the United States, the responsibilities for the treatment of patients with epilepsies by primary care physicians will continue to increase. At the same time, there has been an explosion of new information about the diagnosis, evaluation, natural history, and neurobiologic aspects of epilepsy. New medical and surgical treatments are being introduced with a quickening pace. Finally, the concept that certain epilepsies may be progressive and that early identification and aggressive treatment represent one's best chance for establishing control for these patients has gained widespread confirmation from both clinical and animal model studies. The past standard of care is quickly ending. No longer should a patient or a physician accept only partial seizure control. This monograph attempts to lay the basis for improved understanding of epilepsy so that our patients will be seizure free without side effects and will be able to fully participate in our society.
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