Review of epilepsy out‐patients is often inadequate. Time constraints encourage a largely reactive approach to ‘follow‐ups’, with little questioning of existing diagnoses or exploration of the patient's agenda, and undue emphasis on counting seizures, adjusting medication, and restating lifestyle and driving restrictions. Compared to new cases, follow‐ups in secondary care are more likely to be delegated to less experienced team members: seeing a different doctor at each visit is dispiriting to both parties. Yet patients with epilepsy certainly require detailed and long‐term follow up, not least because the diagnosis is too often incorrect, particularly in non‐specialist hands.1 Epilepsy is diagnosed predominantly on clinical grounds, and where there is doubt, it may be necessary to retake the history (with witness accounts) over several visits. Review appointments also provide an opportunity to check patients' knowledge, understanding, expectations and beliefs about epilepsy and its lifestyle implications. Further, epilepsy generally requires long‐term medication, and this also requires long‐term supervision. The choice of treatment, and the need for medication at all, deserves repeated reconsideration. The lessons from felbamate (aplastic anaemia), vigabatrin (visual field constriction), and anti‐epileptic teratogenicity, demonstrate the dangers of complacency about the long‐term side‐effects of anti‐epileptic medication. Existing primary care guidelines recommend annual review of all patients with epilepsy, with re‐referral to specialist services when appropriate.2 However, it appears increasingly necessary to make regular specialist review available to all patients with epilepsy, even those not actively seeking medical attention. Such specialist review would have …