A specialty epilepsy center is a program providing comprehensive diagnostic and treatment services primarily or exclusively to patients with intractable epilepsy - that is, patients whose seizures have not been brought under acceptable control using the resources available to the family physician or general neurologist. Such a program is staffed by physicians, nurses, technologists, psychologists, and others with specialized training and experience in the field. "Tertiary-level" medical centers should provide the basic range of medical, neuropsychological, and psychosocial services needed in an epilepsy referral center. Surgical services are generally not provided except on a referral or emergency basis. Eventually, tertiary-level centers will be found in many university and some large community hospitals.
"Fourth-level" medical epilepsy centers serve as regional or national referral facilities, providing services to millions of people. These centers should provide the more complex forms of intensive neurodiagnostic monitoring (INDM) and other diagnostic procedures, more extensive neuropsychological and psychosocial services, and limited neurosurgical services for epilepsy treatment. A more sophisticated staffing mix should also be found in a fourth-level center.
A "fourth-level" surgical epilepsy center should be capable of conducting complete surgical evaluations, as well as having staff with the expertise to perform a broad range of surgical procedures for epilepsy. A fourth level center may consist of separate medical and surgical programs, or there may be one combined medical and surgical program.