Superimposed on the interplay of assessment and surgical and pharmacological treatment of epilepsy-intertwined with behavioral, psychiatric, and neurological conditions-are the fiduciary responsibilities and regulatory supervision necessary to protect the rights of developmentally disabled patients. Federal law, state regulations, interpretative material, and legal precedents contribute to a cumbersome, confusing, and frequently demoralizing guide to psychiatric care of mentally ill and developmentally disabled individuals. The Code of Federal Regulation governs people living in long-term residential facilities. Using examples from Wisconsin law, clinical and legal concepts are illustrated. Annual seizure graphs are used for frequent monitoring, better trend analysis, and reduced polypharmacy. An experienced board-certified psychiatrist ensures that an initial comprehensive psychiatric assessment, diagnosis, treatment plan, and quarterly treatment plan update-essential items for the Department of Justice's CRIPA review-are conducted. Most states have legislation designed to provide guidelines for the use of psychotropic medications to minimize abuse.
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