Generic prescribing for epilepsy remains controversial. This study aimed to ascertain if a change occurred in the incidence of seizures or side-effects when a different pharmaceutical manufacturer's version of the same antiepileptic drug was taken (a 'switch'). Forty general practices with a list size of 350 168 were recruited. They identified 2285 people being treated for epilepsy with either carbamazepine, phenytoin or sodium valproate. A questionnaire was sent to the people with epilepsy. Those who recalled taking a different pharmaceutical manufacturer's supply of the same antiepileptic drug over the last 2 years were interviewed by their practice if they reported a problem with the control of their epilepsy after a 'switch'. One thousand, three hundred and thirty-three (58.8%) people with epilepsy responded: 251 (18.7%) had experienced a 'switch', 27 (10.8%) reported 'validated' problems; 25 (9.9%) reported unproven problems; 22 (8.8%) reported problems, but follow-up was incomplete; 177 (70.5%) reported no problems. This study suggests that money saved by generic prescribing is outweighed by negative health gain for the person with epilepsy, increased work in general practice, and increased social costs.

In the past decade there has been increasing interest in the part that general practice can play in the care of people with epilepsy. Primary care services for epilepsy vary from practice to practice. Some studies have suggested that people with epilepsy prefer secondary care services and are not keen for their epilepsy to be managed in general practice, but much of the data were collected in secondary care. This study collected data from various sources about present provision of services, patient satisfaction with services, views about service development, areas where GP knowledge may be improved and whether the site of data collection influenced the results. A questionnaire was piloted, then distributed and collected through branches of the British Epilepsy Association, general practice and secondary care clinics. Data collected were both quantitative and qualitative. One hundred and seventy-eight questionnaires were collected from three sources. The responders were a severe seizure group. Structured care in general practice was uncommon with 54% being seen only when needed. Dose and type of antiepileptic medication was rarely altered in general practice. Information about their condition was given to 44% of the responders by their GP. Sixty-one percent would prefer their epilepsy care to be 'shared' between primary and secondary services. The majority of patients were satisfied with GP services, felt they could easily discuss their epilepsy, but 58% felt they 'rarely' or 'never' received enough information about their condition in general practice. Satisfaction with GP care varied, dependent on where the data were collected. Patients would value more information and more time to discuss the effects of their epilepsy. In conclusion general practice care for epilepsy is still reactive. Patients value more information and more time to discuss implications. The data collection point affects the results; any conclusions about the organisation of epilepsy care should draw data from community patient samples.

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Examples of evidence-based guidelines for epilepsy care exist. However, guidelines are of little use if they are not recognised, implemented and supported. The object of this study was to establish the degree to which good practice guidelines for epilepsy have been implemented and to identify positive and negative factors that affect their implementation. Semi-structured questionnaires were sent to 750 randomly selected health professionals working in primary and secondary care in England. The sample comprised nurses (200), adult consultants (including learning disability consultants) (300), paediatric consultants (150) and general practitioners (100). Aspects of good practice are being implemented in some areas, but not generally, therefore service provision is likely to remain fragmented until this is addressed. Professionals have been prevented from successful implementation of guidelines to sustain good practice due to a number of factors, most notably lack of time, workload, competing priorities and staffing levels. Factors that have promoted and encouraged the successful adoption and application of good practice include inputs from epilepsy specialist nurses (ESNs), appropriate, timely and accessible professional development opportunities and the support and enthusiasm of colleagues.