Why send your patients to a Level 4 epilepsy center?
by Blaise Bourgeois, MD
Director, Division of Epilepsy and Clinical Neurophysiology at Boston Children's Hospital
Patients seeing a general neurologist for up to 12 months who have yet to gain control over their seizures, likely need specialized treatment from a Level 4 epilepsy center.
Diagnostic and treatment options have increased greatly for people with epilepsy over the past decade. It’s not only possible, but expected, that treatment will stop seizures and their side effects from occurring. With the abundance of resources for both health care providers and recipients, the approach to subspecialty epilepsy care has been revisited and reorganized by the National Association of Epilepsy Centers as outlined below.
Most patients with epilepsy are treated within the first two levels of care, either initially by the primary care physician or secondly by a general neurologist. If seizures persist, patients are referred to third level specialty epilepsy centers for basic medical, neuropsychological and psychosocial services. Some of these centers implant vagus nerve stimulators. They may also offer noninvasive evaluation for epilepsy surgery, but they do not perform these surgeries.
Patients needing intracranial evaluation or another complex resective epilepsy surgery must go to a Level 4 epilepsy center. Providing the highest level of care, they offer more complex forms of intensive neurodiagnostic monitoring, more extensive medical, neuropsychological, and psychosocial treatment, as well as resective epilepsy surgery and intracranial electrodes. The minimum requirements for a Level 4 epilepsy center include a staff with at least two board-certified neurologists with expertise in epilepsy, clinical neurophysiology, registered EEG or certified Long-Term-Monitoring Technologists (REEGT or CLTM), video-EEG monitoring, selection of patients for epilepsy surgery, and the pharmacology of anticonvulsant drugs.
Our highly-skilled staff at Children’s Hospital Boston exceeds these requirements, with ten epileptologists, seven EEG/LTM technologists, and an extensive care team that includes eight nurse practitioners, research nurses, clinical nurse specialist, clinic nurses, neuropsychologists, social workers and a nutritionist. Our staff, along with our state-of-the-art technology that includes 24 hour/7days a week EEG video monitoring, provides patients with the highest level of epilepsy care and treatment. We encourage physicians to send complex patients to Level 4 centers as quickly as possible because early intervention plays a crucial role in positive outcomes.