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Approximately 1 in 26 people will develop epilepsy at some point in their lives. Although epilepsy is one of the nation’s most common neurological disorders, public understanding is limited. A complex spectrum of disorders, epilepsy affects an estimated 2.2 million people in the United States. Living with epilepsy is about more than just seizures; it is often defined in practical terms, such as challenges, uncertainties, and limitations in school, social situations, employment, driving, and independent living. People with epilepsy are also faced with health and community services that are fragmented, uncoordinated, and difficult to obtain. The Institute of Medicine’s report, Epilepsy Across the Spectrum: Promoting Health and Understanding , examines the public health dimensions of epilepsy with a focus on: (a) public health surveillance and data collection and integration; (b) population and public health research; (c) health policy, health care, and human services; and (d) education for providers, people with epilepsy and their families, and the public. The report’s recommendations range from the expansion of collaborative epilepsy surveillance efforts, to the independent accreditation of epilepsy centers, to the coordination of public awareness efforts, to the engagement of people with epilepsy and their families in education, dissemination, and advocacy activities. Given the current gaps in epilepsy knowledge, care, and education, there is an urgent need to take action—across multiple dimensions—to improve the lives of people with epilepsy and their families. The realistic, feasible, and action-oriented recommendations in this report can help enable short- and long-term improvements for people with epilepsy.
Characterized by seizures that are unpredictable in frequency, epilepsy is a common neurological disorder that affects people of all ages, with onset most often occurring in childhood and older adulthood [2, 3]. Epilepsy is a spectrum of disorders 2—the epilepsies—with a range of severities, widely differing seizure types and causes, an array of coexisting conditions, and varying impacts on individuals and their families. Epilepsy is the fourth most common neurological disorder in the United States after migraine, stroke, and Alzheimer’s disease ; it is estimated that 150,000 new cases are diagnosed in the United States annually  and that 1 in 26 individuals will develop epilepsy at some point in their lifetime .
While seizures are well controlled with medications and other treatment options for the majority of people with epilepsy , the impact of epilepsy goes well beyond the seizures. The challenges facing the estimated 2.2 million people with epilepsy in the United States  include having access to high-quality health care, becoming informed about and coordinating health care and community services, and dealing with stigma and common public misunderstandings. Living with epilepsy, particularly for people with refractory seizures, can involve challenges in school, uncertainties about social and employment situations, limitations on driving, and questions about independent living. Epilepsy can impose an immense burden on individuals, families, and society; the estimated annual direct medical cost of epilepsy in the United States is $9.6 billion , which does not consider community service costs or indirect costs from losses in quality of life and productivity (these indirect costs are estimated to constitute the majority of the cost burden of epilepsy ). Further, epilepsy is associated with substantially higher rates of mortality than experienced in the population as a whole , with sudden unexpected death in epilepsy (SUDEP) being the most common cause of epilepsy-related deaths . Estimates indicate that 10 years of life are lost for people whose epilepsy has a known cause and 2 years are lost for people with epilepsy from an unknown cause . Additionally, estimates of the number of people with epilepsy who die of SUDEP range from 1 of every 10,000 newly diagnosed to 9 of every 1,000 candidates for epilepsy surgery .
A significant challenge for people with epilepsy, as well as for the epilepsy field, has been the multitude of ways that epilepsy is perceived and, in many cases, misperceived. The centuries of misperceptions and misinformation about epilepsy have resulted in people with epilepsy being stigmatized . As a consequence, people with epilepsy and their families may be faced with a lack of social support from extended family members; feelings of parental guilt; social isolation, embarrassment, and fear; and discrimination. Although efforts are being made to correct these misconceptions and to better inform people about the epilepsies, doing so remains a challenge.
Throughout this report, the committee emphasizes the ways in which epilepsy is a spectrum disorder. Epilepsy comprises more than 25 syndromes and many types of seizures that vary in severity . Additionally, people who have epilepsy span a spectrum that includes men and women of all ages and of all socioeconomic backgrounds and races/ethnicities, who live in all areas of the United States and across the globe. The impacts on physical health and quality of life encompass a spectrum as well, with individuals experiencing different health outcomes and having a range of activities of daily living that may be affected, including driving, academic achievement, social interactions, and employment. For some people, epilepsy is a childhood disorder that goes into remission (although the seizures may have lifelong consequences), while for others it is a lifelong burden or a condition that develops later in life or in response to an injury or other health condition. These many complexities of epilepsy make it a challenging health condition to convey to the general public to promote understanding and alleviate stigma.
In 2010, the Institute of Medicine (IOM) was asked to examine the public health dimensions of the epilepsies with a focus on four areas:
The committee was asked not to examine biomedical research priorities because the Epilepsy Research Benchmarks, developed in 2000, continue to be updated by the National Institute of Neurological Disorders and Stroke and collaborating agencies and organizations . To accomplish its task the IOM convened the Committee on the Public Health Dimensions of the Epilepsies, which comprised 17 members with expertise in epilepsy care, health services research, epidemiology, public health surveillance, mental health services, health care services and delivery, health literacy, public health, education, and communications. The IOM study had 24 sponsors: 12 federal agencies and 12 nonprofit organizations. Many of these sponsors are part of Vision 20-20, a coalition that focuses on epilepsy research, care, services, education, and advocacy efforts.
Throughout its report, research priorities, and recommendations, the committee describes its vision for achieving a better understanding of the public health dimensions of the epilepsies and for promoting health and understanding. The committee’s vision for the future involves
Much of this vision resonates with broad goals of chronic disease management, and to achieve it, collaborative efforts with professionals and organizations involved with other conditions, especially those that are comorbidities of epilepsy, will help to maximize resources and progress.
Given the current gaps in epilepsy knowledge, care, and education, the committee believes there is an urgent need to take action—across multiple dimensions—to improve care and services for people with epilepsy and their families. With this goal in mind, the committee examined the available evidence on surveillance, epidemiology, prevention, health care, community services, and education programs and campaigns and then developed recommendations and priorities for further research to improve these fields and the programs relevant to epilepsy. The following evidence-based recommendations aim to present realistic, feasible, and action-oriented steps that a variety of stakeholders can take to enable short- and long-term improvements for people with epilepsy. The research priorities provide directions for further developing the evidence base.
Comprehensive, timely, and accurate epilepsy surveillance data are needed to provide a better understanding of the burden of the disorder, its risk factors and outcomes, and health services needs. Current data sources provide a patchwork of surveillance activity that substantially limits the ability to understand, plan, and guide the provision of policies related to health care for people with epilepsy. Improvements are necessary to enable informed and effective action in prevention; health care quality, access, and value; quality of life and community services; and education and awareness. At present, public health researchers, policy makers, and advocates are “flying blind” due to the lack of adequate epilepsy surveillance data . The nation’s data system for epilepsy can be strengthened by the collection of epilepsy-specific data and through collaborations with existing and emerging data-sharing efforts across health care providers and with other chronic diseases and disorders.
Ideally, a coordinated and comprehensive surveillance system for the epilepsies would collect data in several ways. To shed light on national trends and patient outcomes, surveillance would be longitudinal and nationally representative, enabling subgroup analysis by epilepsy type, population characteristics, and environmental factors. The nation’s data collection efforts should be sufficiently robust to support active research projects on specific topics, but large amounts of data also can be collected passively, including through the increasing use of electronic health records, where well-designed databases can be mined for new insights. Given the ambition of this goal and the current economic environment, the committee has identified several priority areas that need attention, in order to improve the collection and utilization of epilepsy data over time:
A variety of efforts is needed to accomplish comprehensive surveillance of the epilepsies, close current knowledge gaps, and adequately inform policy makers, public health agencies, health care providers, and the general public. Coordinated action on multiple fronts will ensure the collection of epilepsy-related data from a range of data sources.
The strengthened usefulness and diversity of data, as described above, would facilitate the identification of risk factors for epilepsy, comorbidities, and adverse events. Risk factor identification is an important first step in designing programs to prevent epilepsy and its most serious consequences. At present, many research questions and gaps remain where more complete information could provide a sound basis for prevention, including in public health, clinical care, education programs, and community efforts. Neurocysticercosis 3 is a growing concern in the United States [17-22] and represents a known risk factor for epilepsy —one in which fundamental improvements in education and sanitary measures could decrease a specific infection  that causes epilepsy. Continued intervention efforts are needed to prevent the occurrence of traumatic brain injury (TBI), through mechanisms such as the use of seatbelts, to prevent TBI associated with motor vehicle accidents, as well as helmets, including improved helmet design, to reduce the occurrence and severity of TBI in sports and military combat. In addition, progress in the prevention of epilepsy’s other risk factors—such as stroke, through targeted efforts to reduce risk factors, and brain infections such as meningitis, through sustained vaccination programs—will likely result in fewer new cases of epilepsy. Further options for primary prevention may come to light if epidemiologic studies identify other risk factors for epilepsies whose etiologies are currently unknown. Secondary prevention of seizures may be possible through the use of antidepressants. Prevention efforts are needed that target felt stigma and specific risk factors for death due to accidents and suicide among people with the epilepsies. Additionally, risk factors for SUDEP have been described [e.g., 25-29], but interventions to reduce the occurrence of this devastating outcome have not been evaluated in those at highest risk.
The Centers for Disease Control and Prevention (CDC), in collaboration with professional organizations (e.g., the American Epilepsy Society [AES] and International League Against Epilepsy [ILAE]) and other federal entities, including the Centers for Medicare and Medicaid Services, Department of Defense, Veterans Administration, and National Institutes of Health (NIH), should fund demonstration projects to validate and implement standard definitions for epilepsy case ascertainment, health care and community services use and costs, and measures of quality of life for use in different data collection systems and for different specific objectives. Once validated, these definitions and criteria should be adopted by funding agencies and used in surveillance and research, which is the basis for planning and policy making.
The CDC should continue and expand its leadership in epilepsy surveillance and work with state and local public health researchers, academic researchers, and other relevant stakeholders (including other agencies within the Department of Health and Human Services). Surveillance efforts should be funded that use large, representative samples to determine the overall incidence and prevalence of epilepsy—and mortality—over time as well as in specific populations (e.g., different types of epilepsy, ages, genders, races/ethnicities, socioeconomic statuses). Data collection efforts should include the following:
The CDC should partner with the World Health Organization, ILAE, NIH, the Action Alliance for Suicide Prevention, and other stakeholders to develop and evaluate culturally appropriate and health literate prevention efforts that focus on
Improving the lives of people with epilepsy and their families, to a large extent, begins with access to high-quality, patient-centered health care that facilitates accurate diagnosis and effective treatments and management. The many challenges that people with epilepsy and their families face are so diverse, even from a medical point of view, that although treatment must continue to be held to high standards, it nevertheless should be tailored to individual patient needs and characteristics, and no single health professional discipline can provide all of the elements required for high-quality epilepsy care. Historically, persuading health professionals to work across professional boundaries has been difficult. One of the challenges for government and institutional policy makers will be to devise organizational structures and incentive systems that make it easy—even attractive—for people from multiple professions to work together.
Throughout this report, the committee has emphasized a number of important elements of epilepsy care including
Even in an ideal system of care, the epilepsies will remain complex to diagnose and treat. While significant progress has been made in developing seizure medications with fewer adverse effects, as well as in refining medical devices and surgical techniques for select types of epilepsy, much remains to be done to reduce the sometimes lengthy delays in diagnosis and referral to more advanced levels of care, to improve care for those with refractory epilepsy, and to provide a better response to comorbidities, including mental health conditions. While this committee was asked not to explore biomedical research, over time there will be advances in this field that need to move into routine care in a timely and equitable fashion. No matter how specific epilepsy treatments have improved, currently care is not uniformly accessible due to geographic, economic, and other considerations; nor is it necessarily equitable, with troubling disparities suggested in the research that are based on racial/ethnic and socioeconomic factors [e.g., 30-32]. High-quality health care for epilepsy cannot be provided on a population basis until the problems of accessibility and equity are resolved.
An important element in quality care is access to specialized epilepsy centers, especially for people with refractory epilepsy. Epilepsy centers are vital in providing specialized epilepsy care and have the potential to build on their current efforts by forming a network for health professional education, clinical research, and data collection and analysis. To ensure the ongoing quality of their work, as well as appropriate recognition for it, the centers should develop a robust external accreditation process. A national quality measurement and improvement strategy for epilepsy should be developed and implemented. Standardization and implementation of quality metrics will hold health care providers accountable for adherence to practice guidelines and will allow people with epilepsy and their families to have more information in selecting care providers.
Expanding access either to specialized epilepsy care or to high-quality care in community settings is hampered by the shortage of clinicians with adequate knowledge and skill related to epilepsy and its comorbidities. Research suggests that primary care and specialist physicians alike have significant gaps in knowledge about epilepsy [e.g., 33-36]. Further, many types of health professionals, in addition to physicians, are involved in epilepsy care. These include nurses, nutritionists, pharmacists, psychologists, and clinical social workers. Health professionals need current knowledge about many aspects of the epilepsies: seizure recognition and diagnosis; prevention strategies and treatment options; associated risks, comorbidities, and safety concerns; necessary social services; psychosocial and quality-of-life factors; and the need to counter stigma, as well as the array of educational and community resources that may be available to and needed by individual patients. The specific types and depth of knowledge required vary across professions, depending on the roles, responsibilities, and scope of practice of the professionals and the specific settings in which they work.
The AES and the American Academy of Neurology (AAN) should lead a collaborative effort with the wide range of relevant professional organizations (including primary care professional organizations) and federal agencies (including the CDC and Health Resources and Services Administration), and others that promote and disseminate screening programs to
The AES, in conjunction with other professional organizations involved in epilepsy care, education, and advocacy (including primary care professional organizations) should initiate the development of a national quality measurement and improvement strategy for epilepsy care. An independent organization with expertise in quality measurement and care should assist in the development of the national strategy, particularly the development of performance metrics. The national quality improvement strategy should
The National Association of Epilepsy Centers and the AES should collaborate with relevant organizations to establish accreditation criteria and processes with independent external review mechanisms for the accreditation of epilepsy centers. Accredited epilepsy centers should work together to form an Epilepsy Care Network that includes data sharing, clinical trial and other research networking, professional education, and other collaborative activities.
The AES and AAN should collaborate with relevant professional organizations that are involved in the education of the wide range of health professionals who care for people with epilepsy to ensure that they are sufficiently knowledgeable and skilled to provide high-quality, patient-centered, interdisciplinary care. In their efforts to improve health professional education, these organizations should do the following:
Because of the range of seizure types and severities and the high rate of comorbid health conditions, the ways in which quality of life is affected by epilepsy vary widely. The burden of seizures and epilepsy, particularly severe forms of epilepsy, can be overwhelming for many people with epilepsy and their families. The social and emotional toll of care can place financial and emotional strains on marriages and families and can alter roles, relationships, and lifestyles. Many speakers at the committee’s workshops emphasized that epilepsy—regardless of its level of severity—creates life challenges because of the unpredictability of seizures. This report has examined the range of community services—daycare and school, employment, transportation, housing, sports and recreation, and others directed at family support—relevant to improving quality of life for people with epilepsy. The committee urges improvements to community services and programs to ensure that they are
The CDC, state health departments, and the Epilepsy Foundation, in collaboration with state and local Epilepsy Foundation affiliates and other relevant epilepsy organizations, should partner with community service providers and epilepsy centers to enhance and widely disseminate educational and community services for people with epilepsy that encompass the range of health and human services needed for epilepsy, its comorbid conditions, and optimal quality of life. These services include support groups; vocational, educational, transportation, transitional care, and independent living assistance; and support resources, including respite care for family members and caregivers. Specific attention should be given to identifying needs and improving community services for underserved populations. These efforts should
Research consistently demonstrates that many people with epilepsy do not have a solid understanding of basic information about their condition—how it is diagnosed, seizure precipitants or triggers, types of seizures, the purpose and potential side effects of seizure medications, safety concerns, and the risks and potential consequences of seizures . Additionally, the diagnosis of epilepsy, although given to an individual, affects the entire family and its constellation of friendships and other relationships. At onset all are confronted with the immediate need to learn about the disorder, and their information needs continue throughout the course of treatment and management.
Education for people with epilepsy and their families plays an important role in adapting to life with epilepsy, developing self-confidence, and becoming competent in self-management, which entails being aware of one’s own needs and being able to access resources to meet those needs . Obtaining the requisite knowledge and skills related to epilepsy and its management can also promote optimal well-being and quality of life for people with epilepsy and their families, help prevent misconceptions about the disorder, and reduce concerns about stigma.
People with epilepsy and their families should
To ensure that all people with epilepsy and their families have access to accurate, clearly communicated educational materials and information, the Epilepsy Foundation, the Epilepsy Therapy Project, the CDC, and other organizations involved in Vision 20-20 should collaborate to do the following:
While surveys have suggested that attitudes regarding epilepsy have become less negative over time , it is not certain how contemporary attitudes compare and whether overall improvements in attitudes have affected behavior. Compelling testimony from families dealing with epilepsy and research on employment suggest that problems of stigma remain widespread. Efforts to increase public awareness and knowledge are motivated by the expectation that information that reduces misconceptions and misinformation will improve attitudes and, ultimately, behavior toward people with epilepsy and thereby reduce stigma. Stigma, whether felt or overtly experienced, has many negative consequences for both health and quality of life , and overcoming it is an important goal for the field.
For the public in general, the news and entertainment media are primary sources of health information. Unfortunately, inaccurate depictions of people with epilepsy and of severe seizures, used for dramatic effect, reinforce negative perceptions . An ongoing effort is needed to create key partnerships within the entertainment media to encourage less sensationalistic portrayals and more opportunities for the passive acquisition of accurate knowledge about epilepsy, recognizing that the entertainment media have limits as educational vehicles. Meanwhile, the news and information (versus entertainment) media can be approached with story ideas about various aspects of epilepsy and its care— new treatments, compelling personal stories, epilepsy in specific population groups (e.g., military veterans), and so on.
Using multiple forms of media, including social media and the Internet, clear messages, and diverse activities targeted to specific audiences would increase the chances of success for stigma reduction and public awareness efforts. Any such efforts should take into account the health literacy and cultural characteristics of target audiences, with different strategies developed for reaching each audience, one of which should be policy makers. Some campaigns for chronic conditions have effectively used high-profile spokespeople [42-45]. Campaigns can be local or national; the infrastructure of state and local epilepsy organizations could be a valuable resource for extending a national campaign’s reach to communities. Successful, multifaceted campaigns are expensive, need to be sustained over a period of years, must include an effective formative evaluation strategy to enable revision of messages and tactics as needed, and yet must be flexible enough to respond to unanticipated opportunities.
The CDC and other Vision 20-20 and relevant organizations should support and bolster programs that provide information to journalists and to writers and producers in the entertainment industry to improve public knowledge about epilepsy and combat stigma. Efforts to collaborate and engage with the media should include the following:
The Epilepsy Foundation and the CDC should lead a collaborative effort with relevant stakeholder groups, including other members of Vision 20-20, to continue to educate the public through awareness efforts, promotional events, and educational materials and should collaborate to do the following:
Epilepsy advocacy organizations are working to pull together diverse stakeholders in order to create a stronger, united voice for change. Efforts are being made by a number of organizations to advance research and to improve health care and human services for people with epilepsy and their families. One of the impressive collaborative efforts is the uniting of more than 20 nonprofit organizations and 3 federal agencies in the Vision 20-20 coalition, which focuses on moving the epilepsy field forward through coordinated efforts among task force members and the development of public-private partnerships. Vision 20-20 could be the driving force for developing strategies and plans for the implementation of this report’s research priorities and recommendations, including monitoring and evaluating progress over the short and long term. This coalition has the breadth and depth of expertise to take the public health agenda provided in this report and move it forward into action steps to improve the lives of people with epilepsy.
Vision 20-20 could create a framework and mechanism for continued cross-organizational collaboration by establishing a set of working groups in key areas. Such groups could monitor advances in the epilepsy field, share and disseminate information, engage a diverse spectrum of people with epilepsy and their families, and create a united voice for advancing research, care, and education. For example, a working group on health policy, health reform, and advocacy could monitor legislative and policy activities at the local, state, and national levels; activate people with epilepsy and their families to play a role in informing policy makers; and advocate for legislation and policy changes that could improve health and quality of life for people with epilepsy. A working group on surveillance and population health and health services research could develop a comprehensive strategy to encourage people with epilepsy to participate in a broad range of research efforts from population-based surveillance to research focused on self-management and education. Among other efforts, it also could request and advocate for the regular inclusion of questions targeted to epilepsy, its comorbidities, and epilepsy-related health care services in national and state health surveys.
The member organizations of Vision 20-20 should continue their collaborative endeavors and further these efforts by expanding ongoing working groups that aim to advance the field, support people with epilepsy and their families, and educate the public. They should explore partnerships with other organizations as well as with stakeholders who represent related conditions (e.g., mental health, traumatic brain injury, stroke, autism spectrum disorders). The working groups should communicate regularly, identify common goals, develop strategic plans, and, when possible, carry out joint activities. The working groups should focus on, but not limit their efforts to, the following areas:
Among the most persuasive epilepsy advocates and educators are people with epilepsy and their family members who are willing to speak out in order to provide a truer picture of the disorder and its impact. While many people may be willing to play such a role, training and support will help them do so more effectively. This may be the case regardless of whether they are advocating for improvements in care in general terms, working with support groups serving other families, or advocating for a higher level of service for themselves, a special school accommodation for their child, or a new medication regimen for their parent. People with epilepsy and their families also advance knowledge about epilepsy and its treatment when they participate in clinical research studies, surveys, and other investigations into ways to improve care and increase understanding of the meaning of epilepsy in individuals’ lives.
People with epilepsy and their families should, to the extent possible, work to educate themselves and others about the epilepsies, participate in research, and be active advocates for improvements in care and services for themselves, their family members, and other people with epilepsy. Given their interests and to the extent possible, people with epilepsy and their families should
Much can be done to improve the lives of people with epilepsy. This review of the public health dimensions of the epilepsies highlights numerous gaps in knowledge about and management of epilepsy and also presents opportunities to move the field forward. Improvements in surveillance methods and electronic health records hold promise for more precise information about the epilepsies, which could enable better identification of high-risk groups and better matching of treatments to individuals. There are a number of opportunities for the public health community to improve efforts to prevent epilepsy and its consequences. The growing emphasis on quality of care, as well as access and cost containment, in the U.S. health care system offers an opportunity to improve care for this large patient group. Preparing health professionals to provide better epilepsy care, although a challenge, will help improve quality and reduce costs. Consistent delivery of accurate, clearly communicated health information can better prepare people with epilepsy and their families to cope with the disorder and its consequences. Efforts aimed at raising awareness about epilepsy among the general public will reduce stigma and enable the full participation of people with epilepsy in society. Through collaboration and commitment over time, the bold goals outlined throughout this report can be accomplished.
To improve surveillance and prevention of epilepsy and its consequences, the following areas should be considered priorities for future research:
aPreviously known as idiopathic or cryptogenic.
To improve health care for people with epilepsy, the following areas should be considered priorities for future research:
To improve health professional education about epilepsy, the following areas should be considered priorities for future research:
To improve quality of life and community resources for people with epilepsy, the following areas should be considered priorities for future research:
To improve the education of people with epilepsy and their families, the following areas should be considered priorities for future research:
To improve public awareness and knowledge, the following areas should be considered priorities for future research:
1This summary is an excerpted version of the report’s Summary chapter and Chapter 9. Full-text versions of these chapters and the entire report are available as PDFs at www.iom.edu/epilepsy. The members of the report’s authoring committee, the Committee on the Public Health Dimensions of the Epilepsies, are listed at the end of this article.
2This summary does not include definitions of terminology used throughout the report; discussion of various epilepsy disorders, syndromes, or comorbidities; or explanations of the derivation of statistics that are presented. In-depth discussion of these areas and the supporting evidence for the committee’s recommendations and research, along with complete reference lists, appear in subsequent chapters of the report.
3Neurocysticercosis is a parasitic brain infection that can cause epilepsy (see Chapter 3 of the report; www.iom.edu/epilepsy).
COMMITTEE ON THE PUBLIC HEALTH DIMENSIONS OF THE EPILEPSIES
MARY JANE ENGLAND, M.D. (Chair), Boston University, Massachusetts
JOAN KESSNER AUSTIN, Ph.D., R.N., FAAN, Indiana University School of Nursing, Indianapolis
VICKI BECK, M.S., Beck Communications, Carlsbad, California
CHARLES E. BEGLEY, Ph.D., University of Texas Health Science Center, Houston
MALACHY L. BISHOP, Ph.D., CRC, University of Kentucky, Lexington
LIONEL CARMANT, M.D., Université de Montréal, Canada
CAROLYN COCOTAS, R.T., M.P.A., CHC. CHPC, F·E·G·S Health and Human Services System, New York
SANDRA CUSHNER-WEINSTEIN, P.T., LICSW, LCSW-C, Children’s National Medical Center, Washington, DC
RAMON DIAZ-ARRASTIA, M.D., Ph.D., Uniformed Services University of the Health Sciences, Rockville, Maryland
DAVID GRANT, Ph.D., University of California, Los Angeles
CHRISTIANNE N. HECK, M.D., M.M.M., University of Southern California, Los Angeles
DALE C. HESDORFFER, Ph.D., M.P.H., Columbia University, New York
GREGORY L. HOLMES, M.D., Dartmouth Medical School, Hanover, New Hampshire
PAUL E. JARRIS, M.D., M.B.A., Association of State and Territorial Health Officials, Arlington, Virginia
DILIP V. JESTE, M.D., University of California, San Diego
PATRICIA OSBORNE SHAFER, R.N., M.N., Beth Israel Deaconess Medical Center, Boston, Massachusetts
JOSEPH I. SIRVEN, M.D., Mayo Clinic, Scottsdale, Arizona
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