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Foreword – US Neurology, 2012;8(1):8

Published Online: June 20th 2012 US Neurology, 2012;8(1):8
Authors: William H Theodore
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This issue of US Neurology includes a special focus on epilepsy, with articles on sudden unexpected death in epilepsy (SUDEP), surgery for intractable epilepsy, and a review of treatment for childhood absence. Each of these addresses an issue of special clinical importance. SUDEP is increasingly recognized as a major concern for patients and their families. Its epidemiology, etiology, and mechanisms are not well understood, but have become the focus of innovative research efforts. For patients with seizures not responsive to antiepileptic drugs, surgery, in carefully selected and evaluated patients, has been shown by several studies to offer the best chance for a seizure-free outcome. Recent data on absence have contributed to our knowledge of the best drug treatment choices, as well as seizure prognosis and comorbidities.
The importance of comorbidities in epilepsy was emphasized in the March 2012 report of the Institute of Medicine, ‘Epilepsy Across the Spectrum’, sponsored by 24 US government agencies and non-profit organizations united in the ‘Vision 20–20’ consortium. Patients suffer not only from seizures but disorders such as depression and endocrinopathies that may be part of the underlying illness, or side effects of anti-epileptic drugs, as well as persistent stigma, contributing to social isolation and poor quality of life. Our knowledge of the epidemiology of epilepsy is limited, and many patients go undiagnosed. Standards of optimal practice are ill-defined, and accreditation procedures for epilepsy centers are lacking. Insufficient professional education is highlighted by underutilization of surgery for patients with seizures not controlled by anti-epileptic drugs. As for many chronic diseases, delivery and coordination of services in the community is poor. Moreover, patients and their families have limited understanding of the disorder, making it difficult for them to seek out and obtain the best possible care. Persistent stigma, despite improvement over the last few decades, shows poor public knowledge. The Institute’s report contains a series of recommendations designed to address the problems identified. Of particular importance for neurologists, the American Epilepsy Society and the American Academy of Neurology have been identified as two of the lead organizations charged with carrying out the recommendations. There is international recognition of the need for renewed efforts to understand and treat epilepsy; The Pan American Health Organization issued a strategy and plan of action on epilepsy for the Americas in October 2011.
One effort to improve professional education carried out over several years has been development of an American Board of Psychiatry and Neurology Added Qualification in Epilepsy Medicine, as well as a fellowship training program certified by the American Board of Medical Specialties. The first examination will be offered in 2013. Additional information is available on the American Board of Psychiatry and Neurology website.
A special emphasis on epilepsy is particularly appropriate for US Neurology, and comes at an exciting time for the field. US Neurology would like to thank everyone who contributed to this edition and special thanks go to the expert authors for providing such an insightful selection of articles. ■

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