REFERRAL CENTERS AND SPECIALIZED CARE

Appropriate diagnosis and treatment and the correct use of specialized services at epilepsy referral centers make it possible to control sei zures 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 ha s a tremendous impact on quality of life. Concerns about concomitant i llnesses, seizure-related injuries, and the psychosocial effects of se izures and anticonvulsants on patients are very real and should be add ressed. An accurate diagnosis is the first step in effective seizure c ontrol, because not every patient with a seizure disorder has epilepsy . The second step is choosing an antiepileptic drug (AED) that is appr opriate for the patient and using the correct dose and dosing schedule . When seizures remain uncontrolled or are poorly controlled despite m edical 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 u ncontrolled, the patient should be evaluated as a possible candidate f or epilepsy surgery. If the patient is a good candidate, a presurgical workup that includes monitoring and imaging studies should be perform ed, ideally at an epilepsy referral center. Quality care depends on ac cess, communication, and knowledge, which involves patients who know h ow to achieve the best possible seizure control, doctors who are well informed and know what to do to ensure that their patients are receivi ng the best care, and mechanisms that permit consultation among everyo ne involved in caring for patients with epilepsy. Developing a system of quality, cost-effective care for the management of epilepsy also of fers an excellent opportunity to apply such a system to the larger are na of medical care in general.