Care of patients with epilepsy in the community: will new initiatives address old problems?

Epilepsy is a serious neurological condition that has important medical, psychological and social consequences. Up to 90% of patients with epilepsy are not under hospital supervision at any one time; the role of the general practitioner is therefore of central importance. There seems little doubt that community care of people with epilepsy must be improved. This article reviews the research findings on the quality of care of people with epilepsy, examines the barriers to effective community care, and looks at local and national initiatives to improve the care of patients with epilepsy in the community. Finally, the review considers how care can best be provided in an efficient, effective and acceptable manner within the resources of present day general practice. A patient-centred model is proposed that would tailor care to the needs of the individual patient.