The role of the neurologist in the management of epilepsy: Guidelines and tools for patient care

BACKGROUND - The neurologist plays a central role in the care of the patient with epilepsy by 1) establishing an effective physician-patient interaction, 2) collaborating on an overall management plan, 3) assessing the indications and advantages of antiepileptic drug (AED) monotherapy vs. polypharmacy, 4) monitoring the patient's progress, 5) addressing quality-of-life issues, and 6) determining the appropriate grounds for referral to a tertiary epilepsy center. REVIEW SUMMARY - The cornerstone of an effective management strategy is a positive physician-patient interaction based on clear and comprehensible communication. Good communication lays the groundwork for establishing a diagnosis and formulating a management strategy. The medical and psychosocial histories will address the patient as a whole, taking into account the potential scholastic, occupational, social, and psychological impact of epilepsy on the patient and his or her quality of life. AED selection is based on the patient's seizure type, adverse effect profile, possible drug-drug interactions, convenience of administration, AED serum levels and other physiologic parameters, and blood level monitoring and other laboratory studies. With the development of several newer AEDs, a broad array of effective agents are available for use as monotherapy or in rational polypharmacy. CONCLUSIONS - The neurologist plays a significant role in the life of the person with epilepsy, acting as an educator, advocate, and resource for information. In addition to medical follow-up, the neurologist endeavors to counsel the patient regarding the benefits and risks of AED therapy, the consequences of noncompliance, and guidelines for overall good health, as well as empowering the patient to ask questions and participate in his or her own health care. Optimal management lies in treating the entire patient and improving overall quality of life.