Deciphering the surgical treatment gap for drug-resistant epilepsy (DRE): A literature review

Elena Solli, Nicole A. Colwell, Irene Say, Rebecca Houston, Anmol S. Johal, Jayoung Pak, Luke Tomycz

Research output: Contribution to journalReview articlepeer-review

29 Scopus citations


Patients with drug-resistant epilepsy (DRE) rarely achieve seizure freedom with medical therapy alone. Despite being safe and effective for select patients with DRE, epilepsy surgery remains heavily underutilized. Multiple studies have indicated that the overall rates of surgery in patients with DRE have stagnated in recent years and may be decreasing, even when hospitalizations for epilepsy-related problems are on the rise. Ultimately, many patients with DRE who might otherwise benefit from surgery continue to have intractable seizures, lacking access to the full spectrum of available treatment options. In this article, we review the various factors accounting for the persistent underutilization of epilepsy surgery and uncover several key themes, including the persistent knowledge gap among physicians in identifying potential surgical candidates, lack of coordinated patient care, patient misconceptions of surgery, and socioeconomic disparities impeding access to care. Moreover, factors such as the cost and complexity of the preoperative evaluation, a lack of federal resource allocation for the research of surgical therapies for epilepsy, and difficulties recruiting patients to clinical trials all contribute to this multifaceted dilemma.

Original languageEnglish
Pages (from-to)1352-1364
Number of pages13
Issue number7
StatePublished - 1 Jul 2020
Externally publishedYes


  • barriers to care
  • drug-resistant epilepsy
  • epilepsy
  • epilepsy surgery
  • medically resistant epilepsy
  • underutilization


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