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Like most common chronic conditions epilepsy is managed at the interface between primary and secondary care. In 1990 the cost to the health service for each person with epilepsy was pounds sterling600 in the year in which the diagnosis was made, this figure falling to less than pounds sterling200 in subsequent years, when seizures are well controlled.1 The cost of social services was five to 10 times higher, depending on the frequency of seizures. Better care and fewer seizures might therefore lead to a net gain for both patients and society. Most of that improvement needs to be made in the social aspects of care.
People who experience one or more seizures take different pathways through the medical care system. Most initially see their general practitioner, who will, if epilepsy seems probable, refer them to a specialist. For their first appointment
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