Referral to a Pediatric Epilepsy Center


Most children with epilepsy can be managed conjointly by a general pediatric neurologist and a general pediatrician. However, more complex cases should be referred to a pediatric epilepsy center for further evaluation. One of the biggest questions to be answered by such a referral is, “Is this child a candidate for epilepsy surgery or another precision therapy?” Early epilepsy surgery may be associated with improved developmental outcomes and earlier reduction or elimination of seizures. Indications for referral include the following (54):

  • Age younger than 2 years

  • Epilepsy is not controlled within 2 years of onset or after trials of 2 medications

  • Intolerable adverse effects are experienced

  • Disabling seizures

  • Imaging demonstrating a focal unilateral lesion consistent with seizure signs and symptoms

  • Epileptic encephalopathy, with lack of expected developmental progression, plateauing, or regression coincident with seizure onset or increase in frequency

  • An etiology that requires special dietary or medical management, eg, glucose transporter deficiency, Dravet syndrome


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