Parting Advice on Managing Patients With Epilepsy

Michael R. Sperling, MD: I think we’ll close by just posing a straightforward question, and then we’ll end. When should people be referred to an epilepsy center? Perhaps Dr. Resnick can do that.

Trevor J. Resnick, MD: I think if patients failed 2 drugs, that’s a good reason for them to be referred. Now, some community neurologists are very comfortable treating epilepsy, and depending on the scenario, they may have failed because of adverse effects as opposed to effectiveness. Under those circumstances certainly it’s worthwhile trying alternative therapies.

There are also scenarios where you need to start thinking about either surgery or other treatments early on. For example, autoimmune epilepsy due to autoimmune disease or due to a specific genetic mutation. And under those circumstances, I think the knee-jerk response to refer comes earlier. But in general, it’s, I can’t control this patient, so I need someone else to look at it.

Michael R. Sperling, MD: And certainly the data for autoimmune disease are that treatment implemented within this first 6 months has a reasonable chance of help. Waiting beyond 6 months, the chances of benefit are small. And the last comment in that regard, too, would be that we may all be assuming that the patient has epilepsy and he or she does not have epilepsy. And certainly in monitoring units, our psychogenic seizure patients all comprise a sizable number. Well, I’d like to thank everyone here. I think it’s been a very informative and interesting session, certainly for me. Before we end this discussion, I’d like to get final thoughts from each of our panelists. Dr. Davis?

Kathryn A. Davis, MD, MS, FAES: I’ve really enjoyed the panel today. I think the last point, and getting back to the guidelines, 1 of the AAN [American Academy of Neurology] guidelines is that a patient be referred if they’ve failed 2 or more seizure medicines and are still having seizures. And that remains in my mind a big unmet need in our epilepsy patients. And many of these patients can be cared for very well outside of an epileptologist’s office. But I think there are many patients that are currently not being referred still to specialists. And that’s an area for improvement.

Michael R. Sperling, MD: Dr. Resnick, any final thoughts?

Trevor J. Resnick, MD: No. This was a really enjoyable conversation. I learned a lot, and thank you. It’s good to be with all of you.

Michael R. Sperling, MD: And Pina-Garza, you get the last word.

Jesus E. Pina-Garza, MD: Well, I really enjoyed the interaction. Thanks for having me here. And for patients, or doctors, and families too, if we’re treating epilepsy, don’t settle for being controlled but still having adverse effects. Right to have your best outcomes. And even if you have the worst scenario, there are patients who have terrible epilepsies that you rescue. So try to get those patients out of the knife and back into life.

Michael R. Sperling, MD: Thank you all for your contributions to this discussion. On behalf of our panel, we thank you, the audience, for joining us and hope you found that this Peer Exchange discussion to be useful and informative.