Reader response: Assessment and effect of a gap between new-onset epilepsy diagnosis and treatment in the US.

Abstract

I read with interest the study by Kalilani et al.1 that identified the treatment gap in patients with newly diagnosed epilepsy in the United States and the excellent accompanying editorial by Drs. Berg and Feyissa.2 Hindsight is said to be 20/20 and, as a physician, one is able to evaluate past choices and decisions more clearly than at the time when the choice first presented. Epilepsy is no different; at the time of pathologic onset or clinical presentation, it is difficult to evaluate the course the disease will take in an individual patient. Epilepsy is also unique in that it requires long-term, at times lifelong, treatment with an anticonvulsant drug (many with potentially serious side effects). That, in my view, is a common reason why physicians may choose not to treat epilepsy at the time of clinical presentation in favor of a watchful waiting approach.