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Seizure freedom is the goal for patients who experience seizures and the physicians and treatment teams who provide care for these patients. In 2017, the American Academy of Neurology Institute (AANI) seated a standing epilepsy quality measure development work group charged with developing appropriate quality improvement measures for patients with epilepsy who experience seizures. In 2018, the work group released an updated epilepsy quality measurement set that included the seizure frequency measure initially published in the 2014 measurement set.1,2In the 2018 publication, the work group noted that future effort was needed to move toward a more standardized capture of seizure frequency.1Specifically, a lack of uniformity and consistency in documentation of seizure frequency contributed to poor feasibility of the 2014 seizure frequency measure; this is also a barrier to uniform tracking of seizure frequency for seizure outcome measure collection.1In spring 2019, the work group determined the time was ripe to move forward to develop quality measures that would help address the gap in measuring seizure frequency for patients with epilepsy and directly capture seizure outcome data.

In nearly every US state, a large mismatch exists between the need for neurologists and neurologic services and the availability of neurologists to provide these services. Patients with neurologic disorders are rising in prevalence and require access to high-level care to reduce disability. The current neurology mismatch reduces access to care, worsens patient outcomes, and erodes career satisfaction and quality of life for neurologists as they face increasingly insurmountable demands. As a community, we must address this mismatch in the demand and supply of neurologic care in an aggressive and sustained manner to ensure the future health of our patients and our specialty. The American Academy of Neurology has multiple ongoing initiatives to help reduce and resolve the existing mismatch. With the intent of raising awareness and widening the debate nationally, we present a strategic plan that the Academy could implement to coordinate and expand existing efforts. We characterize the suggested strategies as shaping the demand, enhancing the workforce, and advocating for neurologist value. The proposed framework is based on available data and expert opinion when data were lacking. Prioritization of strategies will vary by geography, practice setting, and local resources. The time to act is now to allow concerted effort and targeted interventions to avert this looming public health crisis.

From a patient perspective, the challenges of managing life with a chronic disease are often as much about losing control as dealing with symptoms or side effects of treatment. Patients often ask us what they can do to take charge of their epilepsy, participate in their own care, and improve quality of life. In this issue of Neurology®, Streltzov et al.1examined the value of a self-management and cognitive training program in people with epilepsy (PWE) and compared the intervention using in-person and virtual platforms. They found improvements in quality of life and subjective measures of cognition in people participating in the in-person sessions but less of an effect in those using a fully virtual format. These findings raise questions of how best to engage PWE in their care, to improve self-efficacy, that is, increased sense of control over their clinical course, and to ensure that interventions have enduring effects.

To provide evidence-based recommendations for treatment of adults with an unprovoked first seizure.