Diagnosis:

• How confident are we about the diagnosis? Could it be something else?

• What etiologies are suspected and how are they being further clarified?

  
  Precipitants and Precautions:

• What precautions should the patient take to reduce the chances of experiencing a seizure?

• What should the patient do if a dose of medication is missed?

• What is the role of stress?

• Can the patient drink alcohol?

• Can the patient take herbs or other alternative medicine treatments?

  
  Tests:

• What tests are indicated?

• What are the different varieties of EEG testing and which one is indicated? (e.g. sleep-deprived routine EEG, inpatient video-EEG, ambulatory EEG)

• Is lumbar puncture or neuroimaging indicated?

  
  Treatments:

  
  Medications:

• Is a medication necessarily needed?

• Why was this specific treatment selected? What other choices were considered and what are their advantages and disadvantages?

• What can the patient reasonably expect to achieve by taking this drug?

• What specific side effects should the patient be on alert for? When should the physician be notified? What precautions can be taken to reduce the chances of side effects?

• How does the current antiepileptic drug affect my mood? Are there any alternative medication that may help my mood?

• How long will it take to know that the drug is working?

• Blood levels: When, why and how medication levels should be checked? Discuss schedule and reasoning behind checking blood counts and chemistries.

• Is an extended-release form of the drug indicated?

• What should be done if a medication dose is missed?

• What will be done if the antiepileptic drug doesn't work?

• Drug interactions

• Benefits and deficits of generic vs. brand formulation

• Cost considerations

• How long will the patient be on this antiepileptic drug? Can the drug be discontinued?

• Are there any investigational trials that should be considered?

• Is the patient compliant with medications?

  
  Surgery for Epilepsy:

• Surgical options (e.g., resective surgery, corpus callosotomy, vagal nerve stimulation)

• Is the patient a candidate for surgical treatment?

• Where should the patient receive a presurgical evaluation?

• What does an evaluation for epilepsy surgery entail?

• What can be expected from epilepsy surgery?

• What are the risks?

• What is the vagal nerve stimulator?

  
  Other Treatments:

• Ketogenic diet?

• Do herbal treatments work?

• Acupuncture and relaxation therapy?

  
  Prognosis:

• Will epilepsy be a life-long condition? Will medications be needed for the patient?s entire life?

• Risks of subsequent epilepsy in children with febrile seizures.

• What are the chances of recurrence after a single seizure?

• Is the seizure harmful?

• If the patient has been recently seizure-free, what are the chances of remaining seizure free? Can medication be reduced or eliminated?

  
  First-aid:

• What should the patient or others do if a seizure occurs?

• Does a seizure recurrence necessarily warrant going to the emergency room?

• Should the patient inform the physician about every seizure?

  
  Impact of Epilepsy on Lifestyle:

  The psychosocial complications of disorders like epilepsy are often under-recognized and usually receive suboptimal attention during the typical medical office visit.

• What activities should be restricted?

• Can the patient drive? How long does the patient need to be seizure-free until driving is permitted?

• Does the patient or physician need to report information to the state department of motor vehicles?

  
  Questions about the psychological impact of epilepsy and its treatments would include:

• Is there evidence of depression or anxiety? Is further evaluation and treatment indicated?

• Is there a risk for lowering of the seizure threshold with a specific psychotropic agent that is being administered?

• Could mood or behavioral aberrations be related to an antiepileptic therapy? Is a revision in treatment indicated because of this complication?

• Discuss areas of possible sexual difficulties such as fear of intimacy, lack of sexual drive, difficulty attaining erection or orgasm.

  
  Pregnancy issues:

• What do we know about the risk of teratogenicity with current or future recommended antiepileptic agents?

• What is the nature of the potential birth defects?

• What can be done to minimize the risks of teratogenicity and what precautions can be taken to avoid pregnancy or birth defects in an inadvertent pregnancy?

• Are there special precautions or treatments applicable at each trimester or when the patients goes into labor?

• Can the patient breast-feed?

  
  Additional resources:

• What additional resources are available to help the patient learn more about epilepsy?

• What societies or foundations can help the patient by advocating for legal rights, obtaining insurance, and benefits?