EPILEPSY • INTERNATIONAL CASE COORDINATION
Drug-Resistant Epilepsy & Surgery Candidacy Review
Prepare seizure history, medication records, EEG or video-EEG, epilepsy-protocol MRI and previous treatment information for specialist review of epilepsy surgery, SEEG, neuromodulation and other advanced pathways.
Initial administrative response is normally within two business days. Clinical review timing depends on documentation and specialist availability.
A focused pathway for complex or ongoing seizures
This pathway is designed for patients and referring physicians who need more than general epilepsy information: a structured review of whether the diagnosis, seizure type, medication history, EEG and imaging support further specialist evaluation for surgery or another advanced treatment.
Ongoing seizures despite treatment
For cases in which seizures continue after appropriate antiseizure medication has been tried and the patient or referrer wants to clarify whether tertiary epilepsy or surgical evaluation is appropriate.
Focal, lesional or unclear cases
For MRI-positive or MRI-negative focal epilepsy, possible temporal or extratemporal onset, discordant EEG and imaging, or cases in which previous investigations have not produced a clear next step.
Not sure whether surgery fits?
You do not need to choose a procedure before submitting the case. Specialist evaluation may clarify whether the next step is further diagnosis, medication optimization, VEEG, advanced imaging, SEEG, surgery, neuromodulation, dietary therapy or continued local care.
What an epilepsy surgery review may clarify
An epilepsy surgery evaluation is a multidisciplinary assessment, not a commitment to surgery. The purpose is to determine whether the seizures can be characterized and localized sufficiently, whether additional testing is required and which treatment pathways merit discussion.
Questions for specialist review
- Are the events epileptic seizures, non-epileptic events or a mixed presentation?
- Is the epilepsy focal, generalized, multifocal or part of a defined syndrome?
- Have previous antiseizure medication trials been appropriate and adequate?
- Do seizure semiology, EEG and imaging suggest a localizable seizure-onset zone?
- Is the current file sufficient for a meaningful surgical discussion, or are further tests required?
Possible next-stage evaluations
- Specialist epileptology and epilepsy-protocol MRI review.
- Video-EEG monitoring and neuropsychological assessment.
- PET, SPECT, MEG, language or memory mapping where available and clinically appropriate.
- Invasive monitoring such as SEEG when non-invasive findings are insufficient.
- Discussion of resection, disconnection, ablation, VNS, DBS or RNS-type therapy where available, or a non-surgical pathway.
Important: Drug-resistant epilepsy is a clinical determination. It is generally assessed after adequate trials of two tolerated, appropriately chosen and used antiseizure medication schedules have failed to achieve sustained seizure freedom.
Start with the records you already have
If important EEG, imaging or treatment information is missing, Healwise can identify the gaps before the case is submitted for specialist review.
Documents usually needed for specialist review
The first goal is clinical readiness: a clear question supported by viewable source records. Reports alone may not replace original EEG or DICOM imaging when the specialist team needs the underlying files.
Seizure history and event documentation
- Timeline including age at first event, diagnosis date, seizure frequency, pattern, triggers, injuries, emergency visits and hospitalizations.
- Seizure diary documenting daytime or nocturnal events, clusters, aura, awareness, duration, recovery and postictal symptoms.
- Eyewitness descriptions from family members, carers, teachers or colleagues.
- Videos of typical events if already available and safe to obtain. Do not delay first aid or create risk in order to record an event.
- Current practical risks and goals, including falls, work, school, driving, pregnancy planning, living arrangements and caregiver concerns.
Antiseizure medication and treatment history
- Current medication: name, dose, formulation, timing, adherence, benefit and side effects.
- Previous medication schedules: dose range, duration, reason stopped, seizure response and adverse effects.
- Medication allergies, intolerances, interactions, psychiatric or cognitive effects and relevant pregnancy or contraception considerations.
- Rescue-medication or emergency plan where prescribed by the treating team.
- Previous ketogenic therapy, VNS, DBS, RNS-type device, epilepsy surgery, ablation or invasive monitoring, if applicable.
EEG, video-EEG and invasive monitoring
- Routine, sleep-deprived, ambulatory or prolonged EEG reports.
- Original EEG files or representative source material when available and requested.
- Video-EEG reports including captured event types, ictal onset, interictal findings, medication changes during monitoring and final interpretation.
- SEEG, subdural grid or strip reports and electrode-localization information if invasive monitoring has already been performed.
- Previous epilepsy MDT or surgical conference conclusions.
MRI, DICOM and advanced imaging
- Epilepsy-protocol brain MRI, preferably as complete DICOM files rather than screenshots.
- Radiology reports and earlier MRI or CT studies for comparison.
- PET, ictal or interictal SPECT, MEG, fMRI, tractography or language and memory lateralization results, if performed.
- Documentation of suspected lesions such as hippocampal sclerosis, focal cortical dysplasia, an epilepsy-associated tumor, vascular malformation or another structural cause.
Neuropsychology, comorbidities and follow-up context
- Neuropsychology reports, memory and language assessment, cognitive baseline and relevant school or developmental reports.
- Psychiatric and psychological history, including depression, anxiety, psychosis, trauma or suspected non-epileptic events.
- Genetic, metabolic, autoimmune or other etiological investigations where relevant.
- Other medical conditions, allergies, implanted devices, surgical and anesthesia history and travel-relevant risks.
- Local follow-up capacity, including neurologist, epilepsy specialist, device clinic, rehabilitation and referring physician.
How epilepsy case coordination works
The objective is to move from scattered records to a clinically reviewable case and an attributable specialist decision about the next step.
Key questions in advanced epilepsy review
Is the diagnosis and seizure classification sufficiently clear?
Not every seizure-like event is epilepsy. Specialist review may need to distinguish epileptic seizures from syncope, sleep disorders, metabolic or cardiac events, migraine, movement disorders, psychogenic non-epileptic seizures or a mixed presentation. Treatment planning also depends on whether the epilepsy is focal, generalized, multifocal or syndromic.
Is the case MRI-positive or MRI-negative focal epilepsy?
A structural lesion does not automatically make surgery appropriate; seizure history, EEG, imaging and functional risk must align. Conversely, a normal or previously negative MRI does not automatically end the surgical discussion. Selected cases may require repeat epilepsy-protocol MRI, expert neuroradiology review, functional imaging, neuropsychology or invasive monitoring.
Can a treatment target be defined safely?
Temporal, frontal, insular, extratemporal and multilobar cases require different evaluation strategies. When the suspected seizure network is near language, memory, motor, sensory or visual cortex, additional mapping and risk-benefit assessment may be required before resection, ablation or disconnection is considered.
What if resective surgery is not suitable?
The specialist team may discuss medication or diagnostic optimization, VNS, DBS, RNS-type therapy where available, ketogenic dietary therapy in selected cases, safety planning or continued local management. Every advanced pathway requires realistic goals and a long-term follow-up plan.
Advanced pathways that may be discussed
The suitable next step depends on diagnosis, seizure type, medication response, EEG and imaging concordance, functional risk, age, comorbidities and patient goals.
Diagnostic and medication review
Some patients first need seizure reclassification, updated EEG or imaging, review of medication selection and adherence, neuropsychology, genetic assessment or another diagnostic step.
Surgery, ablation or disconnection
Selected focal cases may be assessed for resection, lesionectomy, laser or other ablation, disconnection, or staged evaluation with SEEG or another invasive monitoring method. Evaluation does not guarantee a procedure.
Neuromodulation and diet
When resection is not suitable, VNS, DBS, RNS-type therapy where available or ketogenic dietary therapy in selected cases may be discussed as part of a specialist-led pathway.
When local urgent assessment comes first
International coordination is not emergency care. Follow the patient’s prescribed seizure emergency plan and seek urgent local medical help for a prolonged seizure, repeated seizures without recovery, concern for status epilepticus, a first seizure with high-risk features, major injury, new neurological deficit, pregnancy-related concern, breathing or aspiration risk, severe confusion, suspected infection or another acute deterioration.
How Healwise supports the pathway
- Organizes seizure history, medication schedules, EEG and imaging, previous treatment and the requested specialist decision.
- Checks whether source files are accessible and identifies missing records before submission.
- Prepares a structured case summary for the receiving specialist team.
- Coordinates communication, appointments, additional diagnostic requests and provider handoffs.
- If an in-person pathway is recommended, supports admission and travel preparation where required and follow-up handover afterwards.
Clinical role boundaries
Healwise does not diagnose epilepsy, prescribe or change medication, provide emergency seizure care, interpret EEG or imaging for the patient, or determine surgical or device eligibility.
Diagnosis, candidacy, additional testing, treatment recommendations, informed consent and risk-benefit decisions remain with licensed healthcare professionals and the receiving epilepsy specialist team.
Frequently asked questions
Does Healwise decide whether I am eligible for epilepsy surgery?
No. Healwise prepares and coordinates the case. Surgical or device candidacy and treatment recommendations are determined by the receiving licensed epilepsy specialist and multidisciplinary team after reviewing the necessary clinical information.
Does epilepsy surgery evaluation mean I will have surgery?
No. Evaluation may identify a need for further diagnostic clarification, medication review, VEEG, advanced imaging, neuropsychology or invasive monitoring. It may also conclude that surgery is not appropriate and that another pathway should be considered.
Can MRI-negative epilepsy still be reviewed for surgery?
Potentially, yes. A previously normal MRI does not automatically exclude further evaluation, but meaningful review may require epilepsy-protocol imaging, expert neuroradiology, EEG correlation, functional imaging or other specialist-directed investigations.
Can the complete assessment be done remotely?
Records and source files can often be reviewed remotely to clarify the next step. Final candidacy may require inpatient video-EEG, updated MRI, neuropsychology, functional mapping, SEEG or an in-person multidisciplinary assessment.
What if EEG or imaging files are missing?
Submit the reports and records currently available. Healwise can identify which source files or additional documents are normally required before requesting specialist review.
How quickly will I receive a response?
Healwise normally provides an initial administrative response within two business days. Clinical review, diagnostics and treatment timing depend on document completeness, urgency, specialist availability and provider requirements.
Clinical Pathways
Explore other coordinated specialist pathways for complex neurological and neurosurgical cases.
For Referring Physicians
Submit a structured epilepsy case or discuss the source records needed for specialist review.
About Healwise
Learn how Healwise prepares and coordinates complex international cases while clinical decisions remain with licensed providers.
Prepare an epilepsy case for specialist review
Submit the records currently available, or ask which EEG, imaging and treatment documents are needed for an advanced epilepsy review.
