Epileptology

Epileptology is the medical subspecialty of neurology focused on epilepsy, a chronic brain disorder defined by recurrent unprovoked seizures. Epileptologists diagnose, evaluate, and manage people with epilepsy across the lifespan, coordinating care with radiology, neurophysiology, neurosurgery, psychiatry, and rehabilitation services. The field also addresses related issues such as seizure-related injuries, cognitive and psychiatric comorbidities, and the risk of sudden unexpected death in epilepsy (SUDEP).

Diagnosis relies on detailed seizure history, electroencephalography (EEG), and neuroimaging, often including video-EEG monitoring and high-resolution magnetic resonance imaging. Genetic and metabolic testing may be employed in selected patients. Epilepsy classifications are periodically updated by international groups to reflect evolving knowledge about seizure types and epilepsy syndromes.

Management centers on antiseizure medications (AEDs) as first-line therapy. A substantial proportion of people achieve seizure control with appropriately chosen AEDs, but a notable minority have drug-resistant epilepsy, defined after failure of two tolerated, adequately chosen trials. For these patients, multidisciplinary evaluation may consider surgical options (resective surgery, laser therapies, or disconnective procedures when applicable), neurostimulation (vagus nerve stimulation, responsive neurostimulation, deep brain stimulation), and dietary therapies (ketogenic or modified Atkins diets) in selected individuals.

Research in epileptology covers genetics, advanced imaging, neurophysiology, and novel therapies, aiming to improve diagnostic precision, personalize treatment, and reduce seizure burden and SUDEP risk. Specialized epilepsy centers adhere to international guidelines to provide comprehensive care, including long-term follow-up and psychosocial support.