Epilepsy in a Doncaster practice: audit and change over eight years.

The results of active management and the findings of repeated audits of epilepsy care over the period 1978-86 in a general practice are described. It was found that about one-fifth of epileptic patients continued to have frequent seizures, usually complex partial, about half had few seizures, and many with mild epilepsy remitted early.By 1980 attempts to reduce polypharmacy, change treatment and achieve optimal use of anticonvulsant drugs in epileptic patients with frequent seizures or side effects had led to an overall improvement in seizure control in 27%, a reduction of polypharmacy in 24% and an improvement in well-being in many patients. Subsequently it proved possible to maintain this improvement, to achieve similar results in epileptic patients joining the practice and to avoid misdiagnosis and polypharmacy in newly diagnosed patients.General practitioners can make a considerable contribution to the care of patients with epilepsy but improved overall care requires better collaboration between neurologists and other clinicians. A district epilepsy service, based on a local clinic, which actively pursues a collaborative approach is suggested as the model for providing optimum care to epilepsy patients.