The prevalence of epilepsy is estimated to be 1% worldwide. In a young male army cohort in Singapore, the cumulative incidence up to age 18 was 0.5%. It is a common neurological disorder affecting millions of people worldwide and causing considerable morbidity. The field of epilepsy has made great strides in the past 5 years. Major breakthroughs in diagnostics, therapeutics, genetics and neurobiology have reduced much of the (probably unwarranted) nihilism associated with the management of epilepsy. Epilepsy care is a shared responsibility borne by tertiary centres such as the National Neuroscience Institute as well as the primary care physician. The purpose of this article is to provide the busy GP with a quick update on epilepsy, emphasizing new treatment modalities, advances in genetics, and local developments relevant to the GP, in particular the revised MOH Clinical Practice Guidelines for Epilepsy.   New antiepileptic drugs (AEDs) The epilepsy neurologist now has several tricks up his or her sleeve for the treatment of epilepsy. There are over 10 new AEDs in the market, complementing the familiar quartet of first line drugs (see table). The newer AEDs that are commonly used locally include lamotrigine, topiramate, gabapentin and levetiracetam. Patients who do not respond to first line AEDs may sometimes respond to these newer agents as add-on therapy, and some of these newer drugs can now considered for first line treatment.   Commonly used antiepileptic drugs in Singapore 1st Line Drugs 2nd Line Drugs Phenytoin Lamotrigine Phenobarbitone Gabapentin  Sodium valproate Topiramate Carbamazepine  Levetiracetam   New treatment modalities for epilepsy There is now good evidence from a well-conducted trial showing that epilepsy surgery is effective. In patients with temporal lobe epilepsy (a common focal epilepsy syndrome in adults) who underwent temporal lobectomy, more than half (58%) were free of disabling seizures, compared to only 8% in those who received medical treatment. Epilepsy surgery is now performed in many centres worldwide including our National Neuroscience Institute. Besides epilepsy surgery, there are also other treatment modalities such as the vagal nerve stimulator (VNS). This device, which is implanted under the skin much like a pacemaker, stimulates the left vagus nerve and reduces seizure frequency. The VNS however is usually reserved for those with medically refractory epilepsy due to its cost.   Genetics Over 10 genes have now been discovered for familial epilepsies inherited in a Mendelian manner, though these are rare in clinical practice.   Example of a pedigree with familial epilepsy   Progress however is being made in discovering genes for the common types of epilepsy we encounter in daily practice and this field is maturing very rapidly. The common epilepsies are believed to be genetically complex diseases in which multiple susceptibility genes and the environment combine to result in epilepsy. For example, you may develop juvenile myoclonic epilepsy if you have genes A, C, D and F. In contrast, you may not develop epilepsy if you instead have genes A, B, E and F. In addition, there are also new genes that have been linked to anti-epileptic drug response, as well as side effects (such as drug rashes). This is the brave new world of pharmacogenomics, and as epilepsy treatment is still fundamentally reliant on AEDs, this raises the future prospect of individualising AED treatment based on a person’s genetic profile.   Epilepsy FAQs for Patients and GPs The Singapore Epilepsy Foundation is a non-profit organisation that has a website (www.epilepsy.com.sg) with useful information about epilepsy for patients, caregivers and the public, including a FAQ. The SEF also organises regular meetings and publishes a newsletter for its members. A panel of neurologists, in partnership with primary care physicians, is also in the midst of revising the existing MOH Clinical Practice Guidelines for Epilepsy with the primary care perspective in mind. We are planning to adopt a FAQ format in response to common questions from GPs such as "Can I stop anti-epileptic drugs after 2 years of seizure freedom?", and we aim to release the updated Guidelines by year-end. In conclusion, major advances in treatment of common epilepsies, as well as insights into the genetic basis of epilepsy have led to renewed optimism for neurologists and primary care physicians. The release of the updated MOH Guidelines should further clarify and answer questions from GPs about diagnosis, treatment and management of epilepsy in the primary care setting. The National Neuroscience Institute runs dedicated Epilepsy clinics at both Tan Tock Seng Hospital and Singapore General Hospital, staffed by neurologists with an interest in epilepsy, and GPs can refer in cases with suspected epilepsy or diagnosed epilepsy for evaluation.