What’s the Difference Between General Neurologists and Epileptologists?

Seeking epilepsy care

Experiencing your first seizure can feel scary and confusing. You may have more than one kind of seizure, and your seizure triggers may vary. You may be asking questions like:

• Who do I see for a seizure diagnosis?
• Should I call my family doctor, a neurologist, or another specialist?
• What type of doctor treats epilepsy?
• How is epilepsy diagnosed?

Some people receive seizure care for the first time in a hospital emergency room. Many others turn first to their primary care provider for answers. Your family physician, pediatrician, or nurse practitioner may be able to diagnose epilepsy based on your medical history and symptoms.

Your provider may recommend a skilled specialist, such as a general neurologist or epileptologist (epilepsy specialist). Both types of specialists have extensive training in conditions that affect the brain, including epilepsy. They also must have valid state medical licenses and complete ongoing medical education.

There’s a key difference, however: While all epileptologists are neurologists, not every neurologist is an epileptologist. Neurology is the broader category of medicine. Epileptology is a specialty within that field.

It’s not easy to know which specialist to see, and when to seek their care. Here’s some information to help you decide:

What is a neurologist?

General neurologists are doctors who focus on disorders of your brain and nervous system. They treat many conditions, from Alzheimer’s disease and stroke to concussion and sleep disorders. They do not perform surgery, like neurosurgeons do.

Becoming a neurologist requires more than eight years of medical training. This typically includes:

• Four years in medical school
• One year as an internal medicine or medicine intern
• Three years of specialized neurology training in an accredited residency program

An epilepsy diagnosis begins with a neurologist reviewing your medical history. As a first step, they typically use standard testing, such as electroencephalogram (EEG). This non-invasive test monitors your brain activity to detect seizures.

Neurologists often work closely with your primary care provider to manage your seizures with medications. In most cases, medications help control seizures, but they often have side effects.

What is an epileptologist?

An epileptologist is a type of neurologist who focuses on diagnosing and treating epilepsy and seizure disorders. Epileptologists first train as neurologists and then receive an additional 1 to 3 years of specialized training in the field, called a fellowship.

An epileptologist has extensive knowledge of types of seizures, their causes, and treatment options. They also have specialized expertise working with difficult-to-control seizures or drug-resistant epilepsy.

Some further specialize in caring for children, older adults, or women with epilepsy. While not required, epileptologists usually seek board certification in neurology or pediatric neurology.

Epileptologists are skilled in:

• Advanced testing procedures and analysis, such as video-EEG monitoring and single-photon emission computerized tomography (SPECT) scans
• Helping to guide surgical decisions about removing the source of seizures or implanting neurostimulation devices
• Latest developments in epilepsy research and treatment options
• Managing anti-seizure medications and their side effects
• Reducing the risks of sudden unexpected death from epilepsy (SUDEP)

When should I see an epileptologist?

Many people with epilepsy can control their seizures with medication and the support of their primary care provider and neurologist. However, about one-third of people experience drug-resistant epilepsy, which means medication cannot control their seizures.

If you have tried two anti-seizure medications at correct doses but continue to have seizures, an epileptologist at a comprehensive epilepsy center can help. CECs offer specialized services and have the team and resources you need. They offer the most advanced diagnostic testing and treatments, such as the RNS® System.

It’s a good idea to consult an epileptologist if you want a second opinion about your seizures, epilepsy diagnosis, or epilepsy treatment. The National Association of Epilepsy Centers (NAEC) also advises you to see an epileptologist if you:

• Experience drug-resistant seizures
• Have unwanted side effects from epilepsy medications
• Have seizures that are not controlled after three months of care from your primary care physician or one year of care by a general neurologist
• Have seizures that are not under control after trying two or three different medications
• Are pregnant or wish to start a family
• Have other medical conditions or factors that may be affected by epilepsy

What are the benefits of comprehensive epilepsy center care?

An evaluation by an epileptologist can give you detailed information, including where your seizures start and what treatments might help control them.

One study of 200 people with drug-resistant epilepsy suggested that those who received care from a specialized epilepsy center experienced fewer seizures and were more often seizure-free.¹ (Individual results may vary.) The difference was not related to the type of anti-seizure drug(s) participants took, the study showed.

Epileptologists at CECs can also help you manage epilepsy alongside other conditions or life changes, such as a disability or pregnancy. They work with you to reduce medication side effects, overcome treatment challenges, and improve your overall quality of life.

How can I find an epilepsy specialist at a CEC?

The American Epilepsy Society (AES) and the NAEC list member neurologists, epileptologists, and CEC locations by ZIP code or state. You can also ask your primary care provider for a referral to a CEC or specific epileptologist.

If you need guidance, our epilepsy nurse educators at NeuroPace can help you find the next steps in your treatment journey. With a specialized care team behind you, you can reduce the impact of epilepsy and live the life you enjoy.

References

1. Szaflarksi et. al., 2008. BMC Health Services Research.