Referral centers and specialized care. Based on a presentation by Ronald P. Lesser, MD.

Appropriate diagnosis and treatment and the correct use of specialized services at epilepsy referral centers make it possible to control seizures relatively quickly in a large number of patients. Timeliness is extremely important, however, because delaying treatment decreases the likelihood of achieving complete remission from seizures. Epilepsy has a tremendous impact on quality of life. Concerns about concomitant illnesses, seizure-related injuries, and the psychosocial effects of seizures and anticonvulsants on patients are very real and should be addressed. An accurate diagnosis is the first step in effective seizure control, because not every patient with a seizure disorder has epilepsy. The second step is choosing an antiepileptic drug (AED) that is appropriate for the patient and using the correct dose and dosing schedule. When seizures remain uncontrolled or are poorly controlled despite medical therapy, the patient should be reevaluated to ascertain why the drug or drug combination is not working. The reason may be the wrong diagnosis, the wrong drug, or the wrong dose. If the seizures remain uncontrolled, the patient should be evaluated as a possible candidate for epilepsy surgery. If the patient is a good candidate, a presurgical work-up that includes monitoring and imaging studies should be performed, ideally at an epilepsy referral center. Quality care depends on access, communication, and knowledge, which involves patients who know how to achieve the best possible seizure control, doctors who are well informed and know what to do to ensure that their patients are receiving the best care, and mechanisms that permit consultation among everyone involved in caring for patients with epilepsy. Developing a system of quality, cost-effective care for the management of epilepsy also offers an excellent opportunity to apply such a system to the larger arena of medical care in general.