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What is an Epileptologist and Who Needs One?

Epilepsy neural modeling

Do you have a neurologist? Or is your epilepsy followed by you primary care physician? Should you see an epileptologist? And what is an epileptologist anyway?

Epilepsy affects roughly 1% of the population and is one of the most common neurologic diseases. Ideally patients with epilepsy (recurrent seizures) are treated and followed by a neurologist. Many patients, who are doing well and on stable doses of medications, can even be followed by their primary care physician, perhaps seeing their neurologist infrequently. But who should be treated by an epileptologist?

There is no strict definition of what an epileptologist is. Generally speaking, an epileptologist is a neurologist who has a specific interest in, and focuses on, epilepsy. To become a neurologit in the US, one must graduate from medical (or osteopathic medicine) school, and then complete a neurology residency (training) for 4 years. After that, the neurologist can sub-specialize in a more specific filed of neurology, including epilepsy. (Other examples include stroke, pain, neuromuscular disease, and movement disorders). This additional subspecialized training is referred to as fellowship, and usually consist of 1 or 2 years of additional training. In addition to the duration, there is great variability in the type of fellowship: the proportion of patient care vs "clinical neurophysiology" (EEG), the type of center (surgical vs not) and the volume of the clinics and epilepsy monitoring unit.

So, who should see an epileptologist? As discussed in more depth in a previous column titled "The next level of care", most patients with epilepsy do not need an epileptologist and should be followed by a general neurologist. The ones that do are the (roughly) 30% whose seizures are not controlled with the first 2 or 3 medications. For those, it is important that they be given specialized care, which typically begins with EEG-video monitoring, and can result in the rectification of a wrong diagnosis, change in medications, or surgical procedures. Other reasons that may justify an expert (epileptologist) opinion include medication side effects, pregnancy, and complicated issues related to disability or driving.

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