The American Board of Psychiatry and Neurology has voted to create a new epilepsy subspecialty, potentially helping to improve the quality of care for epilepsy patients while better training physicians in an area that has become increasingly complex, with multiple new advances in diagnosis and management.
The epilepsy subspecialty, officially created in November by the American Board of Medical Specialties (ABMS), becomes the 13th subspecialty within the fields of neurology and psychiatry. Physicians who receive subspecialty certification in epilepsy will need to understand the pathophysiology, genetics, pathology, diagnosis, and treatment of seizure disorders at a level far beyond that of a general or child neurologist, the American Board of Psychiatry and Neurology (ABPN) said.
Dr. Joseph Drazkowski
Neurologists who treat large numbers of epilepsy patients realized the need for subspecialty training specifically in epilepsy because of the incredible increase in potential diagnostic tools and treatments for the disorder, said Dr. Joseph Drazkowski, director of the electroencephalography laboratory at the Mayo Clinic in Scottsdale, Ariz.
"Therapies have evolved over the years – they’ve become more effective, and at the same time more complicated," Dr. Drazkowski said in an interview. "The seizures themselves haven’t changed, but the number of seizure meds has grown exponentially."
At the same time, diagnostic procedures and surgical procedures for epilepsy have grown much more technical, he said, adding, "not everybody can do those technical procedures."
In addition, more devices to diagnose and treat epilepsy are under development, which likely will make epilepsy care even more complex. Any time there’s this type of increase in complexity surrounding diagnosis and treatment, "there’s a need for standards," Dr. Drazkowski said. "Those standards should be created and those standards should be met."
The American Academy of Neurology requested that ABPN consider the new subspecialty, Dr. Larry Faulkner, ABPN’s president and CEO, said in an interview. The board has very specific requirements, including training specific to the new subspecialty and "a critical mass of people practicing" in that area.
Now that the ABMS has approved the new specialty, a panel of epilepsy experts, chaired by Dr. Patricia Crumrine, director of EEG and the medical epilepsy program at Children’s Hospital of Pittsburgh, will develop the outline for the new subspecialty and the questions for the new board exam, Dr. Faulkner said.
At the same time, ABPN will ask the Accreditation Council for Graduate Medical Education to begin developing guidelines for residency training in epilepsy. New residency programs are at least 4 or 5 years away, Dr. Faulkner said.
Dr. Crumrine said in an e-mail interview that she anticipates neurologists whose primary practice involves patients with epilepsy to sit for the new exam during the grandfather period, when physicians can take the exam without going through an epilepsy residency program.
Despite the new subspecialty, there will be many areas in the country where patients won’t have access to subspecialists, she said. "In these regions, the general neurologist will still see patients with epilepsy. Additionally, not every patient with epilepsy will need to see a subspecialist all the time. For many patients, the epilepsy will be easily managed by the primary care physician or general neurologist. The subspecialist will most likely see those patients who do not respond to initial therapies."
The new subspecialty will help patients who have especially difficult-to-control epilepsy, Dr. Crumrine said. "This subspecialty provides the medical community with a population of specialists who are trained in the field of epilepsy [and] knowledgeable of the most up-to-date therapies and side effects of these treatments."
Of course, the downside of having a subspecialty is that some patients won’t have access to an epilepsy subspecialist, Dr. Drazkowski said. "A good number of epilepsy patients come from lower socioeconomic brackets, and a lot have access issues."
Still, the new subspecialty represents a positive development overall, he said, adding that he will be taking the board exam as soon as it is available.