Epilepsy is common and has a variety of causes. This article discusses the aetiology of the epilepsies, particularly the genetic causes, and provides up-to-date information on how the condition should be diagnosed, classified, and treated. Some guidance is provided about tailoring the choice of drug treatment according to classification, and the best approach to treatment during pregnancy. Recent data from the UK Epilepsy and Pregnancy register are included. The management of patients with particularly severe and intractable epilepsies is discussed as well as the latest guidelines on the management of status epilepticus. The approach to treatment has to be modified for certain groups of patients, including teenagers and those with learning difficulties. A good service can be provided only if structures are in place to ensure that all patients have rapid and responsive access to advice and information.