Epilepsy Second Opinion in Europe
Epilepsy care is becoming more urgent and more specialized across Europe. Worldwide, around 50 million people live with epilepsy, making it one of the most common neurological conditions.[1]
A distant consultation matters because epilepsy can be complex: at least 30% of people continue to have seizures despite medication, which often requires more advanced evaluation and different treatment options.[2] At the same time, research has long shown that around 20–30% of people diagnosed with epilepsy may have been misdiagnosed, meaning a careful expert review can change everything.[3]
What is a Second Opinion for Epilepsy?
It is an independent medical distant review for the case with an epilepsy diagnosis or presenting epileptic seizures.[9] That confirms whether your events are truly epileptic seizures, clarifies the exact seizure type and epilepsy syndrome, and brings treatment confirmation or revision.[10][11]
This kind of review looks at the whole picture: your seizure history and triggers, how episodes start and progress, how you respond to medications, and what past tests suggest about where seizures may be coming from in the brain. The goal is not to “start over,” but to reassess the case with fresh eyes and specialist expertise, so you leave with a more precise answer to the most practical questions.
For many people, the epilepsy second opinion process brings reassurance that the current plan is correct. For others, it leads to meaningful changes, such as refining the diagnosis, adjusting medication strategy, identifying drug-resistant epilepsy earlier, advancing on surgical options, or recognizing when advanced evaluation could be appropriate.[12][9] In all cases, the purpose is the same: reduce uncertainty and improve decision-making.
Formats
Not every distant consultation with a neurologist goes similarly. There are certain set formats, so-called types of expert epilepsy consultation. Check what it can look like and what distinguishes them below:
- Written Opinion. Distant epilepsy case review when patients have a written report as the conclusion or answer to the questions. The written format is quite common and is typically provided by all epilepsy clinics in Europe. It is faster in planning and delivery, and it is highly accurate. Among the cons is the lack of direct contact with a doctor, which might make it take longer to get follow-up questions answered.
- Distant Video Consultation. The format has the same qualities as a written opinion but includes a teleconsultation with a neurologist.[4] The process is more time-consuming, costly, and may not be available at all hospitals.[5] Among the processes are direct fast communication with a physician and quick answering of questions.[6] Typically, patients have a written report delivered at the end.
- Multidisciplinary Epilepsy Board Review. A collaborative case review involves not only a neurologist or epileptologist but also participation from other specialists, such as a neuroradiologist, neurosurgeon, neurophysiologist, and pediatrician.[7] This format is rarely used and is typically reserved for situations that warrant it, typically found in university neurology clinics.[8] Although it takes more time to organize and is more costly than other formats, it provides a comprehensive overview of an epilepsy case from multiple perspectives.
Why Europe?
The European medical second opinion market has grown as patients seek faster access to specialists, advanced diagnostics, and treatment options that may not be available locally.[13][14]
The disease is common in Europe, with over 6 million people living with the condition, so many European centers manage high case volumes and complex referrals.[15] For rare and complex epilepsies, cross-border healthcare in Europe also has an expert network (ERN EpiCARE) that connects highly specialized centers across 26 countries (including 38 full members and 12 affiliated partners).[16] This structure supports expert review, shared standards, and easier access to the right subspecialist.
Epilepsy second opinions are most valuable when you can be reviewed by a true specialist team (epileptologist-neurologist, neuroradiologist, neuropsychologist, and epilepsy surgeon). Europe has a high density of neurologists: estimates place it at 9.2 neurologists per 100,000 people, compared with 7.1 in high-income countries overall and 0.1 in low-income countries.[17]
If you're looking for a second opinion on epilepsy, EU offers a great option due to its high-volume specialist expertise, advanced testing methods, and access to a comprehensive range of treatments. This includes medication optimization, epilepsy surgery, and neuromodulation.[1] For a deep understanding of European epilepsy care capabilities, explore epilepsy treatment in Germany as an example, and what the country can offer patients.
Vetted Providers
The choice of specialized hospitals and the right doctor can significantly impact the outcome of a consultation. Patients should select facilities with proven credentials, proper certifications, and the option to obtain second medical opinions. When choosing a doctor, it is important to consult a narrow specialist with relevant experience and a strong track record of patient reviews, based on the specific medical needs.
Below is a list of reputable medical centers and individual doctors who provide remote consultations for epilepsy patients.
European Epilepsy Centers
We highlight the most prominent European hospitals with specialized epilepsy centers and departments. The list includes hospitals and clinics across different countries, ranging from university-level centres to private clinics with strong epilepsy subspecialties.
Individual Neurologist-Epileptologists
Explore EU-based neurologists specializing in epilepsy care who offer remote case reviews. Please note that our focus is on neurology-epileptology specialists, although some cases may require other specializations.
Who Should Consider an Epilepsy Second Opinion?
There are various situations when an expert epilepsy consultation is particularly useful and logical. Here, we will consider typical scenarios when patients refer to an epileptologist abroad.
Uncertain Diagnosis
You should consider a second opinion if you have seizure-like episodes, but the diagnosis still feels uncertain, your symptoms do not match a typical seizure pattern, or test results and symptoms do not align.[18] Some patients require an epilepsy diagnosis review due to the wrong seizure classification and subsequent inappropriate treatment strategy.[19] This is not a rare situation. Reviews of the evidence note that misdiagnosis in unselected patients labeled with epilepsy may be around 20%, and some studies commonly cite 20–30% as a possible range.[18][19][3]
In this situation, a second opinion is often less about repeating everything and more about expert review of what you already have, especially EEG interpretation.[20][21] EEG findings can be subtle, and misread patterns (or “over-calling” normal variants) can push a patient toward an epilepsy diagnosis even when the events are not epileptic.[22]
A specialist review also checks whether the appropriate imaging was performed, including an MRI epilepsy protocol that uses dedicated sequences and planes designed to detect small structural causes (such as focal cortical dysplasia or hippocampal sclerosis) that may be missed on a standard brain MRI.[23]
A second opinion is particularly valuable if attacks continue despite treatment, because of ongoing “seizures”. Those that do not respond as expected may sometimes be non-epileptic events (for example, syncope or other seizure mimics) rather than epilepsy.[3] Getting the label right matters because it determines everything that follows: medications, driving restrictions, work limitations, and eligibility for advanced therapies.
Antiepileptic Drug Adjustment
An external neurological opinion is also appropriate when you need to adjust anti-seizure medication. That might be because of side effects, interactions with other drugs, mood or cognition changes, breakthrough seizures, or life events such as pregnancy planning.[24][25] Medication choice and dose strategy should be matched to seizure type and epilepsy syndrome; if either is uncertain, treatment can become trial-and-error.[26][27]
The good news is that many people can achieve strong seizure control with the right plan. The World Health Organization states that up to 70% of people living with epilepsy could become seizure-free with the appropriate use of anti-seizure medicines.[1] An epilepsy second opinion focuses on whether your current regimen is truly “optimized,” whether the disease type has been correctly classified, and whether alternative medications might offer a better balance of seizure control and quality of life.
Refractory Epilepsy
If seizures continue despite treatment, a repeated case review becomes especially important. The International League Against Epilepsy (ILAE) defines drug-resistant (refractory) epilepsy as failure of adequate trials of two tolerated and appropriately chosen anti-seizure medication schedules.[28] This is not a small subgroup; many modern reviews still report that seizure control remains difficult in one-third of people with epilepsy.
In this scenario, the value of an expert epilepsy consultation is that it focuses on the most common reasons seizures appear “refractory”: the diagnosis may be incomplete, the seizure type may be misclassified, medication trials may not have been truly adequate, or the events may not be epileptic seizures at all.[29][30] One of the most decisive tools here is long-term video EEG monitoring, which aims to record typical events while EEG and video are captured together, so specialists can confirm whether episodes are epileptic and identify where seizures may start.[31][32]
Many European epilepsy centers are built around this advanced assessment pathway.[33] Clinics that bring together specialists from different disciplines for multi-angle epilepsy care. For patients whose seizures persist, a distant opinion at such a center is often the step that clarifies whether the best next move is a different medication strategy, referral for surgery evaluation, or consideration of neuromodulation and other advanced options.
Epilepsy Surgery Evaluation
When seizures remain uncontrolled despite appropriately used medications, especially if seizures are focal, that is the right time to explore surgical solutions.[34] In that setting, an epilepsy surgery evaluation is not simply about “having an operation.” It is a structured process to confirm that seizures are truly drug-resistant, identify where they start in the brain, and determine whether a targeted treatment is likely to be both safe and effective.[34][35] Patients should consider having a distant consultation with a neurosurgeon specialized in epilepsy operations instead of a neurologist.
The potential benefit can be substantial for the right candidates. In a randomized controlled trial in people with temporal-lobe epilepsy, 64% of those assigned to surgery were free of disabling seizures at one year, compared with 8% in the medical-therapy group.[36] This is why a second opinion is so valuable: it checks whether you have a surgically remediable epilepsy and whether you have been referred at the right time.
If resective surgery is not appropriate, it is because seizures arise from more than one area, from regions controlling critical functions, or from generalized epilepsy. In these cases, specialist teams may discuss device-based options that can reduce seizure frequency and severity. These include vagus nerve stimulation (VNS) and deep brain stimulation (DBS), which are typically considered for patients with persistent seizures when medications alone are not sufficient, and resection is not feasible.[37][38] The second-opinion goal is clarity: which advanced course fits your seizure type, your brain findings, and your personal risk-benefit priorities.[35]
Pediatric Epilepsy
Children should be considered for an epilepsy second opinion when seizures are hard to classify, development or learning changes appear, seizures continue despite treatment, or parents feel the overall plan is not clearly explained. Pediatric epilepsy often begins in infancy. A large population-based study shows the highest incidence during the first year of life, about 144 cases per 100,000 person-years.[39] Early brain development is rapid, so accurate diagnosis and effective treatment are crucial. This can significantly affect safety, education, and long-term outcomes.[1]
A thorough review of epilepsy diagnosis in children focuses on accuracy and thoroughness. It re-evaluates seizure descriptions and patterns. It also reviews previous EEG results and ensures imaging meets established standards, often using an MRI epilepsy protocol.[40] This approach is especially important for frequent, unusual seizures or those linked to developmental regression. In addition, certain pediatric epilepsy syndromes may require different treatment options.
A pediatric second opinion expands the conversation beyond simply deciding on the next medication. For certain types of drug-resistant childhood epilepsy, dietary therapies like the ketogenic diet may be considered by specialist teams sooner rather than later, depending on the child’s specific epilepsy type and overall health.[41] The goal is practical: to confirm the diagnosis with certainty, ensure that all necessary testing is completed, and align treatment with the child’s specific epilepsy syndrome and daily needs.
Getting a Distant Medical Opinion
A distant second opinion works best when you are clear about what you want to achieve. Before you contact a clinic, define the goal in plain terms: do you need a diagnosis check, a medication strategy review, confirmation of drug-resistant epilepsy, or guidance on whether you should be assessed for advanced therapies? A well-defined question helps the team structure the medical records review, assign the right expert, and produce a second opinion that leads to a practical decision, either treatment confirmation or revision, instead of a generic summary.[42]
Choose the Right Specialist
For epilepsy, prioritize an expert epilepsy consultation led by an epileptologist or a neurology team that regularly handles complex seizures.[43] The right match depends on your situation: uncertain diagnosis, medication side effects, ongoing seizures, surgery evaluation, or pediatric epilepsy. When possible, look for a center that can provide an epileptologist review with access to advanced diagnostics if the case requires deeper assessment. Use the Airomedical clinic search tools & doctors finder to locate a proper fit.
Collect Your Medical Records
A strong second opinion depends on complete documentation. Gather a clear timeline of events and bring the most important materials for a structured medical records review: prior clinic letters, medication history with doses and dates, seizure descriptions, EEG reports (and raw EEG files if available), MRI reports and images (files in DICOM format), and any hospital discharge notes.[44][45] If you have seizure videos recorded safely, they can be helpful context.[47] It's also recommended to include a brief note on the seizure frequency and duration, as well as possible triggers based on self-observation.[46]
Specialist Review Process
During the neurologist review, the specialist typically checks three things: whether the diagnosis is correct, whether the seizure type and syndrome are accurately defined, and whether prior treatment trials were adequate. They also look for gaps - tests that were incomplete, imaging that was not done with an epilepsy-focused approach, or signs that persistent events may not be epileptic seizures. The aim is a clean clinical conclusion and a defensible next-step plan.[44]
Report Delivery & Action Plan
The outcome should be a written second opinion report that answers your main question directly and translates the findings into actions.[42] This usually includes a diagnostic conclusion (or differential diagnosis), clear reasoning, and recommended next steps. The action plan should be practical: medication adjustments, additional testing, referral to a specialized center, or escalation to advanced evaluation, with explicit treatment confirmation or revision as appropriate based on the review.
Follow-Up Questions or Further Planning
After you receive the report, plan a short follow-up to clarify what to do first and what to monitor. Use the appointment to confirm priorities, timelines, and “decision points” (for example, how long to trial a medication change before moving to further testing). If the plan involves your local neurologist, ask the specialist to frame their recommendations so your treating doctor can implement them safely and efficiently.
Cost Ranges
Understanding the cost of an epilepsy second opinion in Europe is important because expenses can vary widely depending on the complexity of the case, the level of specialist review needed, and the type of service used. On top of that, prices vary widely by country.
| Country | Written Opinion | Video Consultation | Multidisciplinary Board |
|---|---|---|---|
| Germany | €600-1,300 | €700-1,400 | From €2,000 |
| Spain | €450-1,200 | €600-1,300 | From €1,500 |
| Italy | €470-1,150 | €650-1,300 | From €1,800 |
| Czechia | €250-900 | From €350 | Limited |
| Switzerland | €750-1,500 | From €900 | From €2,700 |
| Austria | €600-1,300 | €700-1,500 | From €1,900 |
| Poland | €200-800 | From €300 | Limited |
| Hungary | €180-650 | From €250 | Limited |
FAQ
Can epilepsy be misdiagnosed?
Yes. Seizure-like events can be caused by other conditions (for example, fainting or psychogenic non-epileptic seizures), and studies commonly report meaningful misdiagnosis rates in people labeled with epilepsy. A specialist epilepsy diagnosis review often focuses on history, EEG interpretation, and imaging quality to confirm the diagnosis.
Do I need a video-EEG to change treatment?
Not always. Medication changes can be made based on clinical history and prior test results. However, long-term video-EEG is especially useful when the diagnosis is uncertain, events are unusual, or seizures persist despite treatment, and the team needs to capture a typical event to guide a major treatment decision.
Can I get a second opinion without traveling?
Yes. Many European epilepsy centers offer remote medical records review and an expert epilepsy consultation based on your documents, EEG/MRI data, and a detailed seizure history. Travel is usually only needed if the plan includes advanced testing or inpatient monitoring.
How long does a surgical evaluation take?
It varies by center and complexity. The initial record review and consultation can be relatively quick, while a full pre-surgical workup (video-EEG monitoring, imaging, neuropsychology, and team conference) often takes weeks to a few months, depending on scheduling and whether additional tests are needed.
What if my seizures are non-epileptic?
That is a meaningful outcome of a second opinion. If events are non-epileptic, the plan typically shifts away from anti-seizure escalation toward the correct diagnosis and referral track (e.g., syncope workup or PNES-focused care). This can reduce unnecessary medication and speed up appropriate treatment.
Does it make sense of distant epilepsy tests?
Remote second opinions are very useful for interpreting existing data and deciding what tests are truly necessary. But some tests cannot be “done remotely” in a meaningful way, especially long-term video-EEG monitoring or specialized imaging, so the distant review is often used to avoid unnecessary travel and to plan the most targeted in-person evaluation if it becomes needed.
How to choose the right epilepsy centre?
Choose a center that provides an epileptologist review, has experience with your specific situation, and can offer the diagnostics you may need. Practical signals include clear guidelines for second opinions, transparent documentation requirements, and a structured second-opinion report with an action plan. Eplore Airomedical clinics & doctors searching tools to find the right match.
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