How will primary care physicians, specialists, and managed care treat epilepsy in the new millennium?

Epilepsy is a complex disorder that requires specialized knowledge for correct diagnosis, classification, and treatment. As we enter the millennium, changes in the health-care environment have created potential problems and opportunities as managed care organizations (MCOs), primary care practitioners (PCPs), and specialists work to improve the diagnosis and treatment of patients with seizure disorders. In the United States, only 17% of patients with new-onset epilepsy are examined by neurologists. Consequently, PCPs have a significant role in the care of patients with seizures. However, these practitioners may not be aware of newer diagnostic and therapeutic measures. Although practice guidelines have been promoted by MCOs as a cost-control and quality measure, their existence provides a cautionary note about the importance of consultations in patients with epilepsy. Specialists in epilepsy constitute an important resource to ensure that patients are correctly diagnosed and adequately treated. Consultation of a seizure-disorder patient by a specialist should be encouraged and never questioned by MCOs. The patient's best interests are served when PCPs, specialists, and MCOs establish a cooperative relationship and respect and recognize each other's expertise and common goals. This approach should help to deliver the best medical care to patients with epilepsy as we enter the next millennium.