Table 5.

Recommendations: Diagnostic Evaluation

23. Recommendation: All epilepsy centers should have neuropsychologist(s) with training in neuropsychometric evaluation on site or by referral to perform or supervise clinical neuropsychological evaluations for patients manifesting or expressing neurocognitive symptoms or being evaluated for epilepsy surgery. CB   Remark: The epilepsy center should have standard protocols that address which patients require neuropsychometric evaluations. CB   Remark: Clinical neuropsychologists should be board certified or pursuing board certification. CB   Remark: Centers with pediatric patients should have neuropsychologists with specific training and expertise in evaluating children. CB   Remark: Individual tests should be performed by neuropsychologists, qualified psychometricians, or clinical staff with formal training in the   administration   of these tests. CB

24. Recommendation: All epilepsy centers should have CT and MRI with optimized epilepsy-specific MRI protocols. CB   Remark: Centers that serve children should have the capability of performing studies, while the patient is under anesthesia with appropriate safety   monitoring. CB

25. Recommendation: For centers that perform surgery, PET, SPECT, and/or MEG should be used when appropriate to increase the yield of presurgical localization of the seizure focus and assist in surgical decision-making. CB   Remark: The multidisciplinary surgical planning team should make the decision regarding which specific imaging modality to use. CB   Remark: Centers that perform surgery but do not have these imaging modalities should have the capability to arrange referrals for surgical patients. CB   Remark: Centers that serve children should have the capability of performing studies while the patient is under anesthesia with appropriate safety   monitoring. CB

26. Recommendation: For centers that perform surgery, fMRI, MEG, other functional mapping modalities, and/or Wada tests with cerebral angiography should be available to assist in localization of eloquent functions. CB   Remark: Centers that perform surgery but do not have these imaging modalities should have the capability to arrange referrals for surgical patients as   appropriate. CB

27. Recommendation: Centers that perform diagnostic imaging should have studies interpreted by personnel with appropriate specialty training and certification. CB   Remark: Centers that serve children should have studies interpreted by neuroimaging specialists with specific training and expertise in pediatric studies. CB

28. Recommendation: All epilepsy centers should use genetic testing as part of the diagnostic workup for patients with intractable epilepsy of unknown etiology. CB   Remark: Genetic testing is useful in evaluation of surgical candidates. CB   Remark: Testing can be performed by an external laboratory. CB

29. Recommendation: All epilepsy centers should have an established protocol to identify those patients who would most likely benefit from genetic testing, even if their seizures are well controlled. CB   Remark: Protocols should identify populations with a higher risk for genetic disorders, including early-onset epilepsy, developmental and epileptic   encephalopathy, neurodevelopmental disabilities, and family history of epilepsy. CB

30. Recommendation: All epilepsy centers should offer genetic counseling from a certified genetic counselor either within the program or by referral. CB   Remark: All pediatric centers should have access to medical genetics consultation on site or by referral. CB

Abbreviations: CB = consensus based; MEG = magnetoencephalography.