Prevention of epilepsy and its consequencies is discussed in a special article from the Department of Neurology, School of Medicine, University of Virginia, Charlottesville. Prevention should apply at various levels: 1. epileptogenesis may be prevented by a) avoidance of premature birth, in utero infection, and anoxia; b) prevention of febrile convulsions and their complications; c) avoidance of head trauma by wearing helmets when bicycling and banning of boxing as high school sport; 2. ictogenesis, individual epileptic seizures, may be prevented by identifying and controlling precipitating or provocative factors such as drugs and alcohol, sleep deprivation, AED withdrawal or poor compliance, and photic stimulation; 3) neurologic consequencies can be prevented by early and optimal treatment of seizures and avoidance of status epilepticus; 4) psychosocial consequencies could be lessened by public education, removal of stigmata, and improvement in the quality of life; and 5) treatment consequencies involving anticonvulsant side-effects, teratogenicity, and cognitive and other deficits resulting from overzealous surgical resections. [1]

COMMENT. Prevention in the management of epilepsy has been sadly neglected, and Dr Dreifuss in his synopsis draws attention to many adverse factors and aspects of etiology and treatment that could be avoided or corrected when addressed appropriately. Additional problems, especially important to the adolescent and young adult, include the permission to drive an automobile and the risk of accidents. Young drivers account for one half those with seizures at the wheel, and a complex partial seizure, usually without aura, is the most common pattern associated with accidents. Those with auras are significantly less likely to lead to accidents. Males, 19 to 30 years, in higher socioeconomic classes, form the majority continuing to drive without adequate seizure control. The monitoring of young male drivers with complex partial seizures should be close and frequent, including serum drug levels to check compliance and adequate AED dosage. (Ped Neur Briefs Oct 1987; see Progress in Pediatric Neurology I, 1991, pl29-131).

The stress and anxieties associated with the first year away at college are additional reasons for relapse and recurrence of seizures in the young adult. Seizures may be prevented by counselling and by modification of medications to cover this period.

The need for further training of physicians in preventive measures is stressed in the following article from Wales regarding the management of status epilepticus in hospitalized patients.