Epilepsy is a common disease with significant impacts on patients. Evaluation and management can be dynamic over time. After an initial seizure, focus is on risk stratification to decide whether treatment is necessary. Once epilepsy is diagnosed, then management with antiseizure medications is first-line in treatment, with individual patient factors considered in treatment decision making. Surgical treatments and invasive neuromodulation may be used if patients fail at least 2 appropriate seizure medications.