The nature of epilepsy in the general population. II. Medical care.

The medical care received by an unselected population of patients with epilepsy identified from the lists of 119 general practitioners in the UK was evaluated and compared with established standards. The study was carried out by questionnaire distributed to the patients and their general practitioners. Information was collected about hospital referral patterns, the doctor responsible for follow-up, investigations performed, attendances at Accident and Emergency (A&E) departments, hospital admissions, medication, and the information supplied to patients. Eighty-one per cent of patients had been referred to a hospital outpatient clinic, and 28% were under continuing hospital follow-up. Only 6% had been seen in a specialist epilepsy clinic. The majority had had an electroencephalogram (EEG), but less than half a CT scan. Forty-three per cent had attended an A&E department on account of epilepsy, and 47% had required hospital admission. Sixty-five per cent of patients were on monotherapy, mostly phenytoin, carbamazepine or sodium valproate: a significant proportion also took phenobarbitone. Except for the issues of free prescriptions and driving, patients could remember being given little information about epilepsy, and this was the most common source of dissatisfaction. The study suggests many accepted recommendations about the care of people with epilepsy are not followed, with hospital referral patterns, a shortage of specialists epilepsy clinics, and lack of patient information being areas of concern.