Why Referral Timing Matters in Drug-Resistant Epilepsy

Did you know that the average time between seizure onset and epilepsy surgery has been reported to average approximately 20 years in adults? For patients with drug-resistant epilepsy, that delay represents years of ongoing seizures, medication trials and uncertainty about what other options may be available.

Understanding drug-resistant epilepsy

Drug-resistant epilepsy is generally defined as continued seizures after two appropriately selected and tolerated anti-seizure medication trials.

Once drug resistance has been established, expert consensus recommends referral to a specialized epilepsy centre so that the patient can receive surgical evaluation. However, referral is often delayed, in part because epilepsy surgery may still be viewed as a last resort.

Why early referral is crucial

Early referral to a specialized epilepsy team can help:

• Confirm the diagnosis and characterize the epilepsy type, possible cause, and seizure location.
• Assess whether a lesion or subtle structural abnormality is visible on MRI.
• Determine whether surgery, ablation, neuromodulation, continued medical treatment, or further testing should be considered.
• Address cognitive, behavioral, psychiatric, and other comorbidities earlier.
• Give patients and families a clearer understanding of the available options and next steps.

The role of imaging

A recurring bottleneck in this pathway is imaging: many patients are labeled "MRI-negative" when subtle structural abnormalities are hard to see.

At BrainScores, we are developing quantitative and interpretable neuroimaging tools designed to help make these subtle features more visible. Better evaluation starts with better information, and improving access to clearer imaging insights may help specialized teams consider the full range of options sooner. For patients with drug-resistant epilepsy, timely referral and a thorough evaluation can be an important step toward a clearer path forward.