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Introduction: Although early detection and surgery are crucial for positive outcomes in individuals with drug-resistant epilepsy (DRE), a minority of qualifying patients receive it in the US. This retrospective study investigates why some DRE patients who undergo complete pre-surgical assessment end up not receiving surgery.

Methods: We analyzed 211 EPIC charts from all of Jefferson Comprehensive Epilepsy Center's patients who underwent DRE surgical evaluation from 2017 through 2019. To that end, we characterized the DRE surgery timeline and collected data on age, onset of seizures and drug resistance, surgery dates, surgical modalities, and notes that elucidated the reasoning behind surgical decisions. We analyzed the data by comparing the surgery completion rates and breaking them down by surgery modality and decision reason.

Results: Of the 211 patients, 130(61.6%) received surgery, and 81(38.4%) did not. The two most frequent reasons for patients not receiving surgery were the patient's loss of interest in surgery (34.6%) and the need for further antiepileptic drug trials (14.8%) to confirm DRE status. Within the non-interested group, 13(46.4%) patients were thought to benefit from resection or ablation, and 10(35.7%) from phase 2 invasive monitoring.

Discussion: The biggest reason for patients not receiving life-improving DRE surgery is the individual's lack of interest in the procedure even after full evaluation and planning. We hope this information gets us a step closer to targeting the low DRE surgical rates and helps physicians better guide their patients through the surgery process, delivering earlier surgeries, and improving outcomes.