Epilepsy management at primary health care level - Full guideline

Objective. Epilepsy may present in a variety of clinical forms. The guideli ne aims to improve the recognition and diagnosis of the different clinical types of epilepsy and to guide and assist in the management of epilepsy pat ients of all ages presenting to health care workers at a primary level espe cially at clinics and in rural areas. This management needs to be rational, cost-effective, comprehensive and holistic. Outcomes. The complete control of seizures with minimal or no drug side-eff ects and the achievement of a reasonable family, social and occupational li festyle. Evidence. Evidence was gathered from current literature on the sub ject and was discussed at meetings and via correspondence with the above pr ofessionals. Values. To treat as many untreated epilepsy patients as possible, using rat ional and cost-effective care. Benifits, harms and costs. Reductions in soc ial impairments at educational, home and work levels. The major precautions and contraindications to each anticonvulsant drug recommended are discusse d. Recommendations. Correct diagnosis of the seizure type or epileptic syndrom e. It is important to differentiate symptomatic from unprovoked epileptic s eizures. The diagnosis of epilepsy needs to be incontrovertible before cons idering initiation of therapy. It needs to be emphasised that epilepsy is p rimarily a clinical diagnosis and is dependent on a reliable history. Clini cal factors are evaluated for the possible presence of an underlying organi c cerebral lesion. Patients are counselled on lifestyle modification, educa tion and employment. Evidence. Detailed literature review. The literature used was graded accord ing to quality. Validation. Endorsed by The Neurological Association of South Africa, the S outh African Medical Association (SAMA) and all who attended a multidiscipl inary consensus meeting to consider the draft guideline. Financial sponsor. Development was supported by an unrestricted educational grant by the Novartis Foundation to SAMA.