Data from the National Association of Epilepsy Centers (NAEC) show the number of accredited epilepsy centers increased by nearly 60% — from 161 in 2012 to 256 in 2019, with the largest increases occurring among centers dedicated to caring for only adults or only children.
There was also an increase in the complexity of surgical cases and procedure volume, including laser interstitial thermal therapy (LITT). However, overall surgical volume in the US remained stable or declined for most procedure types.
“Overall, centers are meeting the needs of persons with epilepsy as data emerge regarding the care of special populations, such as women with epilepsy and those who may benefit from the ketogenic diet or surgery,” study investigator Adam P. Ostendorf, MD, an attending pediatric neurologist at Nationwide Children’s in Columbus, Ohio, told Medscape Medical News.
The findings were published online December 8 in Neurology.
More Procedures, Expanded Services
About 30% of patients with epilepsy do not respond to treatment with antiseizure medication and may benefit from surgical procedures, dietary therapies, or participation in clinical trials, the investigators note.
The American Academy of Neurology recommends patients with epilepsy also undergo evaluation at a comprehensive epilepsy center; most of these take place at centers that are members of the NAEC. These institutional members send annual reports to NAEC about the services they provide, procedure volumes, and staffing.
In previous research, investigators examined reports submitted from 2003-2012 and identified trends in epilepsy centers. Since that time, NAEC has created a procedure for accreditation, and the number of member centers has expanded.
To examine recent changes in NAEC member centers, the investigators analyzed data from reports submitted in 2012, 2016, and 2019. They focused on level 3 and level 4 NAEC epilepsy centers, which have the most resources and expertise.
Although the number of centers increased, median center size, defined as the number of epilepsy monitoring unit (EMU) beds and admissions, did not change. EMU admissions per 1 million people increased from 11.7 to 30.3 (+159%) in level 3 centers and from 193 to 259 (+34%) in level 4 centers.
In addition, the number of EMU beds per 1 million people increased from 0.3 to 0.9 (200%) in level 3 centers and from 3.6 to 4.3 (19%) in level 4 centers.
The number of epileptologists per 1 million people likewise increased from 0.2 to 0.5 (150%) in level 3 centers and from 2.0 to 4.1 (105%) in level 4 centers.
The availability of testing and specialized services also increased at level 3 and level 4 centers. The areas with the greatest growth included complementary and alternative medicine, ketogenic diet (in level 3 and adult centers), and genetic testing and counseling.