When should epilepsy be treated?

Epilepsy is not a single condition but a group of disorders with differing diagnostic criteria, management pathways and outcomes. In recent years our understanding and knowledge of the childhood epilepsies has improved. An evidence-based approach may help us provide the best treatment for our patients although randomised trials remain limited. The National Institute for Clinical Excellence guidelines, introduced in 2004, have provided a benchmark for the diagnosis and management of the epilepsies and are due for review in 2009. In this paper, we review the current definitions and guidelines and suggest a practical approach to treatment decisions in children with epilepsy.