Epilepsy Talk

Neurologist or epileptologist — who is best for YOU? | December 12, 2022

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

There is no strict definition of what an epileptologist is. (Although the term was first made popular by William Spratling, now regarded as North America’s first epileptologist.)

Generally speaking, an epileptologist is a neurologist who has a specific interest in, and focuses on, epilepsy.

To become a neurologist in the U.S., one must graduate from medical (or osteopathic medicine) school, and then complete a neurology residency (training) for four years.

After that, the neurologist can sub-specialize in a more specific field of neurology, including epilepsy.

(Other examples include nervous system disorders — including diseases of the brain, spinal cord, nerves, and muscles, stroke, pain, neuromuscular disease, and movement disorders).

This additional subspecialized training is referred to as a fellowship, and usually consists of one or two years of additional training.

In addition to the duration, there is great variability in the type of fellowship: the proportion of patient care versus “clinical neurophysiology” (EEG), the type of center (surgical versus not) and the volume of the clinic and epilepsy monitoring unit.

What kind of training do neurologists and epileptologists have?

Neurologists are medical doctors who have completed:

Four years of medical school

At least one to two years of pediatric residency

Three or more years of residency training in adult and child neurology

An epileptologist has: Additional fellowship training beyond residency in EEG interpretation and epilepsy.

Who needs an epileptologist?

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, difficult to diagnose or do not respond to standard therapy, as with the first two or three anti-epilepsy medications.

For those with drug resistant epilepsy, 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.

“I have 1,200 patients and they all have epilepsy,” says Dr. Elizabeth A. Thiele, M.D., Ph.D., Director of the Pediatric Epilepsy Program, Massachusetts General Hospital. But that doesn’t mean you need an epileptologist, she adds. “Most neurologists are extremely competent at treating epilepsy because they’ve seen so many cases and because epilepsy is so common.”

In most cases, a neurologist can help you find the proper medication and treatment to control seizures. When cases are particularly complex or resistant to medication, or if surgery may be indicated, a neurologist often will refer the patient to an epileptologist for evaluation.

Although epileptologists are in relatively short supply, the best place to find one is in an academic teaching hospital, specialized epilepsy center or in a private practice.

Other articles that may be of interest include:

2022 Patient Recommendations for TOP Neurologists…Epileptologists…Neurosurgeons…and Pediatric Doctors https://epilepsytalk.com/2022/01/08/2022-patient-recommendations-for-top-neurologistsepileptologistsneurosurgeonsand-pediatric-doctors/

2022-2023 Top-Ranked Hospitals for Neurology & Neurosurgery https://epilepsytalk.com/2022/07/30/2022-2023-top-ranked-hospitals-for-neurology-neurosurgery/

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Resources:

https://www.epilepsy.com/stories/what-epileptologist-and-who-needs-one

https://harveyberger.com/difference-epileptologist-vs-neurologist/

https://epilepsydisease.com/clinical/epileptologist

https://seermedical.com/blog/doctors-who-can-diagnose-epilepsy/

https://www.dukehealth.org/blog/do-i-need-epileptologist

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