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carbohydrate impairment. Glucagon concentrations were not investigated. Because of the potential diabetogenic properties of nifedipine plasma glucose concentrations should thus be monitored in patients receiving this drug. We thank Dr J C Henquin for invaluable discussions and critical advice, and Mrs Detaille for secretarial help. I Opie LH. Drugs and the heart. Calcium antagonists. Lancet 1980;i:806-9. 2 Koch G. Plasma renin activity, epinephrine and norepinephrine at rest and during exercise in young adults and boys. ScandJ3 Clin Lab Invest 1977;37, suppl 147:107.

Gurprit GROVER et al.

Many epilepsy patients seeking tertiary care do not need it. Access and quality of epilepsy care can be improved if there is a rational and need-based distribution of patients between primary, secondary and tertiary care. Referral systems also need to be developed and used to transition patients from one level of care to another.

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