Epilepsy is one of the most common neurologic illnesses, affecting over 50 million people across the globe. A question that is often asked when it comes to epilepsy, is who should see a neurologist, who should see an epileptologist, and what the difference between the two actually is. Let’s take a closer look at what differentiates these two types of physicians and what factors may lead someone with epilepsy to seek out an epileptologist. 

What is a Neurologist? 

To understand the difference between an epileptologist and a neurologist, we must first understand what neurology is. To put it simply, neurology is the discipline of medicine that deals with the anatomy, functions, and organic disorders of nerves and the nervous system. The nervous system is a sophisticated system that controls and directs physiological functions. A neurologist is a doctor who specializes in (and is an expert in) the medical field of neurology.

Before becoming fully qualified, neurologists must complete over eight years of training, including four years of medical school resulting in an M.D or D.O (doctor of medicine or doctor of osteopathy degree), a one-year internship in either internal medicine or medicine and at least three years of specialty training in an accredited neurology residency program.

A neurologist can help with a variety of problems that affect the brain, spinal cord, and nerves such as: epilepsy, Alzheimer’s disease, dementia, Parkinson’s disease, neuromuscular disease, movement disorders, spinal cord disorders, infections of the brain, speech and language disorders, cerebrovascular disease (strokes), as well as the different medical and surgical options available to treat those illnesses. While neurologists should have a working knowledge of what medication-assisted and surgical options are available, it’s important to note that surgical procedures are not performed by neurologists. Any operation involving the brain or nervous system  is performed by a neurosurgeon who generally requires at least another three years of post-graduate training..

 

What is An Epileptologist? What are the Key Differences Between the Two? 

Where some physicians may choose to become general neurologists (which means they will treat a broad range of nervous system disorders), others may opt to specialize in a single condition and only see patients with that condition. An epileptologist is a neurologist that specializes in epilepsy research, diagnosis, and treatment. 

Because epileptologists are first trained as neurologists, their education and training is similar but ends in an additional one to three years of training which is referred to as a fellowship. These fellowships can vary in type, duration, proportion of patient care, type of center, and volume of patients treated. During the fellowship, the physician learns from expert epileptologists and is further trained in the field of epileptic diagnostic and treatment methods. Some epileptology fellowships require doctors to conduct research on a topic related to their field of study (comparable to a dissertation). Some epileptologists receive even further training and are actively involved in the study of specific patient populations. These subspecialties include pediatric and geriatric epileptologists, as well as epilepsy specialists for women.

Although board certification from the American Board of Psychiatry and Neurology is not required, most epileptologists do seek board certification. That being said, epileptologists (like all other doctors) must have a valid state medical license and participate in continuing medical education.

The key difference between an epileptologist and a neurologist is that an epileptologist’s training typically extends for several years through post-graduate work with a unique focus on all aspects of diagnosing and treating epilepsy. An epileptologist is typically consulted later in the process when an epilepsy patient  has not responded to the first rounds of treatment, although they may be brought on early if a person’s epilepsy is more complex.

Who Should See an Epileptologist?

Many people with epilepsy are able to control their seizures with the help of medication and can be followed by their primary care physician with only some visits to their neurologist over the course of their disease.. However, around one-third of patients with epilepsy experience seizures that are resistant to treatment (referred to as “refractory” or “drug-resistant epilepsy”). In cases where a person’s epilepsy is not controlled effectively within the first four to six  months of treatment, it is important to see an epileptologist. 

An expert (epileptologist) opinion may be required for a variety of reasons, including the choice of medication combinations, managing adverse effects due to the medications, pregnancy, and other difficulties related to disability or driving. In order to further understand a person’s specific case of epilepsy, an epileptologist will often recommend starting with EEG-video monitoring, which can lead to the correction of diagnosis, medication adjustments, or surgical procedures where needed.

Signs it’s time to consult with an epileptologist:  

• If you’re looking for a second opinion or would like to confirm your epilepsy diagnosis
• If your seizures are not controlled after three months of care from your primary care physician or one year of care from a general neurologist
• If your seizures are not manageable by medication, despite trying multiple courses of treatment
• If you’re experiencing side effects from your current epilepsy medications 
• If you have any other medical conditions or factors that influence/ are affected by epilepsy
• If you have epilepsy and you’re expecting a child or wish to start a family

 

Benefits of Being Treated By An Epileptologist?

An epileptologist has advanced specialized training and is an expert when it comes to seizures and epilepsy and may be better equipped to optimize treatment options and ensure that patients and families are aware of the risks of epilepsy, even if effectively treated. Sudden death from epilepsy (known as SUDEP) is not widely discussed by generalists, and it’s very important to be aware of the risks and ways to prevent it.  Even if more advanced testing is needed, an epileptologist will have extensive experience with these procedures. This expertise can make the difference between having controllable and uncontrollable seizures, improving the patient’s quality of life overall.

It’s important to note that none of these criteria for seeing an epileptologist and seeking further care are fixed.  Many specialists believe that all children and most adults who have seizure disorders should be seen regularly by epileptologists.  

For more information on epilepsy, consider my most recent affiliation: The Cameron Boyce Foundation, which aims to cure epilepsy via research, education, and awareness campaigns in honor of Cameron Boyce’s legacy: https://www.thecameronboycefoundation.org/.