Introduction

Medical management with anti-epileptic drugs (AEDs) is the first-line intervention for patients with epilepsy. However, 30-40% of patients have seizures that cannot be adequately controlled by AEDs.¹ Drug-resistant epilepsy (DRE) is diagnosed when seizures persist after two or more appropriate AED trials.² DRE is associated with impaired quality of life as well as higher rates of depression, anxiety, suicidality, and long-term mortality.^3,4 As a group, patients with DRE account for ~80% of all epilepsy-related costs in the US.^5,6

Surgical resection of the epileptogenic zone is the most effective treatment option for controlling seizures and improving life quality in patients with DRE.⁷ Several randomized controlled trials (RCTs) and meta-analyses demonstrate that epilepsy surgery offers the best chance of seizure control when ≥2 AED trials have failed.^8-11 Although postsurgical seizure freedom rates vary with many patient factors, approximately 40-80% of patients with DRE who undergo epilepsy surgery enjoy sustained seizure relief compared to <10% of those receiving continued AED therapy.^12-14

Prior to epilepsy surgery, patients undergo a comprehensive assessment to determine their surgical candidacy and to plan the intervention. Th...