The difference between a specialty epilepsy clinic and a comprehensive epilepsy program (CEP) is highlighted in this section. CEPs are different from epilepsy centers. Epilepsy centers can be places for the long-term residential treatment of people with seizures, or they can be places where a patient goes for specialized treatment. Specialized centers for the long-term care of people with epilepsy have essentially disappeared from the United States. When patients with epilepsy require long-term care, it is usually because of associated conditions: Severe brain damage, severe psychiatric problems, or mental retardation. Patients with epilepsy who have these conditions are usually cared for in residential centers or small residential programs whose treatment is directed at the primary problem causing the disability.

In the best sense of the term, a CEP is one in which a multispecialty team (physicians, psychologists, nurses, social workers, and specialized technical help) is brought together to provide an organized approach to the management of people with complex problems related to epilepsy.¹

There is no organization in the United States that accredits a specialized epilepsy center or a CEP (although efforts are underway to establish one). Any physician with any training can print up stationery that says “Comprehensive Epilepsy Program,” mount a sign on the door, and go into business. There are documented cases of physicians without specialized training doing just that. CEPs in the United States vary greatly in quality and organization.

CEPs were originally developed under the aegis of the United States Public Health Service as part of the so-called 314(e) program in the early 1960s. One of the first was established in 1964, at the St. Paul Ramsey Hospital in St. Paul, Minnesota, and evolved into what is now called MINCEP Epilepsy Care. In that sense, the MINCEP program is the oldest in the United States. Nonetheless, major university centers devoted to specialized treatment (but without the full, comprehensive approach of medical, surgical, educational, psychologic, social, and community organization) have been in existence for many years.

The National Association of Epilepsy Centers (NAEC) was established in 1986 to help with the development of CEPs. A recent survey indicates that more than 130 places in the United States refer to themselves as epilepsy centers. Some of these consist of no more than a single neurologist with a particular interest in epilepsy. Others are CEPs in the fullest sense. The NAEC has published guidelines for classifying epilepsy centers and for the services to be rendered. Member centers (there were 116 in 2007) self-designate and affirm that they meet these guidelines. For more information, consult www.naec-epilepsy.org.