The challenges in establishing and Upholding an adult Level III epilepsy center in an underserved area in the United states

Despite vast improvement, even today, care of people with epilepsy (PWE) in many parts of the USA remains unevenly distributed and disjointed. We reviewed the experience of the Kern Medical Epilepsy Center (KMEC) to highlight the challenges in establishing and maintaining an epilepsy center in an underserved region of Southern California. We analyzed the prospectively collected data from 2018 through 2021 of KMEC, a National Association of Epilepsy Centers Level III accredited facility that serves PWE people residing in Central Valley, California. During the study period, there were 246 admissions to the Epilepsy Monitoring Unit, KMEC for detailed evaluation of difficult to treat epilepsy. Most patients were either of Hispanic descent or Caucasian. Thirty-seven patients underwent surgical interventions (8 resective surgery, and 23 vagus nerve stimulators and 6 responsive neurostimulators) with favorable outcomes in the majority. Many of them required referrals to the Level IV center at University of Southern California, Los Angeles, which were hindered by difficulties with getting appointments, transportation, insurance coverage, payment for treatment, and sluggish treatment processes. Our experience demonstrates that, despite considerable challenges, epilepsy care can be coordinated across complex and competing health systems separated by large geographic distances through creative, physician-driven strategies of resource sharing and goal alignment across the health care ecosystem. We hope that our experience will facilitate future efforts to integrate epilepsy care beyond this region in the USA, and elsewhere in the world. sluggish treatment processes. and elsewhere in the world.