Epilepsy update: diagnosis, classification and management

Careful clinical evaluation differentiates epileptic seizures from syncope (vasovagal or cardiogenic), dissociative seizures (non-epileptic attack disorder) and other rarer paroxysmal events. The initial diagnosis of epilepsy is incorrect in 20%–30% of patients. Investigations can include blood tests, electrocardiograms, electroencephalograms and neuro-imaging. Patients should be informed and counselled about the diagnosis. Anti-seizure medications (ASMs) are the first-line treatment for epilepsy, the choice depending on the epilepsy syndrome, seizure type, patient and their co-morbidities. Surgical options are available for refractory epilepsy. Status epilepticus is a medical emergency and all clinicians should be aware of the treatment algorithm. This update additionally explores autoimmune-related epilepsy, developments in ASMs, including cannabinoids, and automated systems for seizure detection.