The challenges of establishing centers for the surgical management of epilepsy in low- and middle-income countries

Epilepsy affects over 50 million individuals globally, with more than 80 % residing in resource-limited countries. While the majority of patients achieve seizure control with antiseizure medications, approximately one-third are diagnosed with drug-resistant epilepsy (DRE). For these individuals, epilepsy surgery represents a potentially effective therapeutic option. Expert consensus from the Surgical Therapies Commission of the International League Against Epilepsy (ILAE) recommends prompt referral for surgical evaluation upon diagnosis of DRE. Nevertheless, despite substantial supporting evidence, such referrals are frequently delayed—particularly in low- and middle-income countries (LMICs). This article examines the barriers to timely surgical evaluation and explores strategies to facilitate the development of epilepsy surgery programs in resource-constrained settings.