To determine if the guidelines recommendations from the Surgical Therapies Commission of the International League Against Epilepsy are being followed in the Neurology Resident Seizure Clinic, and address possible gaps in access to adequate health care in patients.

Despite advances in epilepsy surgery in controlling refractory seizures, patients in safety-net hospitals often face multiple barriers to evaluation for surgical management, directly affecting health and quality of life. We conducted a quality improvement project to identify gaps and reduce the underutilization of epilepsy surgery in this population. 

IRB-approved Quality Improvement study using retrospective analysis with data collected from a university-affiliated clinic, using EPIC from May 2024 to May 2025. Inclusion criteria: Patient with two AED in therapeutic levels with refractory seizures.

From May 2024 to May 2025, 235 patients were seen in the clinic. Of these, 49.4% were on two AED, and 101 patients (38.4%) had persistent seizures despite an adequate dose of medication. 90% of the patients with refractory epilepsy seen in the clinic were African American and Hispanic. Of those patients, about 67% discussed with their provider regarding surgical epilepsy, while in the rest there is no documentation of a discussion with their provider. Of those who didn’t undergo surgical evaluation, 33.3% of patients were not interested, 9.1% had issues with insurance and follow-up appointments. Only 33.6% of the total 101, underwent surgical intervention, and VNS was most common intervention (73.5%). Patients with commercial insurance and Medicare were more likely to have VNS placement (93.9%) than those with charity care. 

This quality improvement project highlights persistent barriers in epilepsy surgery among underserved populations, which could be driven by cultural perceptions, access to follow-up visits, and insurance limitations. Targeted interventions for physicians, patients, family members, as well as insurance navigation, are essential to advancing health equity in surgical epilepsy care.