IOM Report: Public Health Dimensions of the Epilepsies

Andrew N. Wilner, MD; José E. Cavazos, MD, PhD


June 06, 2012

Editor's Note:

Early in 2011, a consensus panel established by the Institute of Medicine (IOM) began to examine "the public health dimensions of the epilepsies, focusing on public health surveillance and data collection; population and public health research; health policy, health care, and human services; and education for people with the disorder and their families, health care providers, and the public." The report was published in March 2012, and the panel discussed the recommendations at the 2012 Annual Meeting of the American Academy of Neurology (AAN). In an interview with Medscape, José E. Cavazos, MD, PhD, epileptologist and Professor of Neurology, Pharmacology, and Physiology, University of Texas Health Science Center at San Antonio, discusses the impact these recommendations will have on future epilepsy research and care.

Andrew N. Wilner, MD: Dr. Cavazos, one of the hot-topic presentations at the AAN Annual Meeting was about the IOM's report on epilepsy.[1] This consensus study was commissioned by 24 nonprofit organizations and government agencies about 2 years ago. They allocated $1.5 million to establish priorities for improving the lives of people with epilepsy here in the United States. The report makes 13 specific recommendations, and the epilepsy community concurred with them.

José E. Cavazos, MD, PhD: The IOM report provides a framework for future directions to assess and influence the public health impact of epilepsy. There are many areas in healthcare outcomes research that are unanswered. Epilepsy affects individuals in their social spheres; their relationships with their families; and their ability to work, to pursue further education, and to learn about and move up in society. This report allows us to assess various consequences of epilepsy, including the cost of developing medications, the cost of application of therapy, and the cost of noncompliance, and it allows us to frame potential interventions for better healthcare delivery for people with epilepsy.

Dr. Wilner: The report itself does not provide any funding. All of these initiatives -- better education, working collaboratively, better care -- all these are going to cost money. Do you think the report will help practitioners and advocacy organizations to get this funding?

Dr. Cavazos: The IOM report can legitimize requests for particular needs. In a sense, it is a national triaging system that prioritizes particular areas and needs. Clearly, the report will not necessarily create a stream of revenue for research, healthcare delivery, or achieving better lives with epilepsy; however, most of the research that will be proposed to foundations -- to the National Institutes of Health, the Veterans Administration, and the Centers for Disease Control and Prevention, for example -- will have to align with advancing a better understanding of the goals described in the IOM report. Thus, although it does not have money associated with it, in itself the report is an incentive for aligning priorities to better the lives of people with epilepsy.

Dr. Wilner: Because of this report, has your institution begun any specific initiatives that are consistent with the 13 recommendations, such as working with other epilepsy centers or consortia, or looking at comorbidities?

Dr. Cavazos: Certainly, we have had a long-term interest in comorbidities and the effects of other medications on anticonvulsants. In addition, the recommendation to create a consortium may actually lead us to link our database with those of other centers. In particular, the National Association of Epilepsy Centers and the Epilepsy Centers of Excellence within the VA system, which has 16 centers across the United States, has developed a series of research initiatives to try to align research interests and to answer specific questions that are important for patient care.

Dr. Wilner: Dr. Cavazos, thank you very much for helping us understand the importance of the IOM report and telling us how this is going to help improve the lives of people with epilepsy.


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