Guidelines for Epilepsy Centers

Levels of epilepsy care were developed by the NAEC and are a useful tool for evaluating the appropriateness and quality of specialized epilepsy care. Whether you are a patient or a healthcare provider, you should be aware of the report by the NAEC on guidelines for epilepsy centers entitled, Guidelines for Essential Services, Personnel, and Facilities in Specialized Epilepsy Centers in the United States Epilepsia, 42(6):804-812, 2001.

Level 3 Epilepsy Center. A third-level center should provide the basic range of medical, neuropsychological, and psychosocial services needed to treat patients with refractory epilepsy. Third-level medical centers provide basic neurodiagnostic evaluation, as well as basic medical, neuropsychological, and psychosocial services. These centers do not perform resective epilepsy surgery, although some may implant vagus nerve stimulators. Third level medical-surgical centers provide basic diagnostic and treatment services. In addition, these centers offer noninvasive evaluation for epilepsy surgery, straight-forward resective epilepsy surgery, and implantation of the vagus nerve stimulator. These centers do not perform intracranial evaluations or other more complex resective epilepsy surgery.

Level 4 Epilepsy Center. A fourth level center should provide the more complex forms of intensive neurodiagnostics monitoring, as well as more extensive medical, neuropsychological, and psychosocial treatment. Fourth-level centers also offer a complete evaluation for epilepsy, surgery, including intracranial electrodes, and provide a broad range of surgical procedures for epilepsy.

Referral Guidelines for seizure disorders have been established by the NAEC. Delayed or denied referral may be detrimental to the patient’s health, safety and quality of life.

  • If your seizures have not been brought under control after three months of care by a primary care provider (family physician, pediatrician), further neurologic intervention by a neurologist, or an epilepsy center if locally available, is appropriate.

  • If you are seeing a general neurologist, and your seizures have not been brought under control after 12 months, you should insist upon a referral to a specialized epilepsy center with an epileptologist.