MGH Epilepsy Surgery Program: For Physicians

When and how to refer.

Refer as soon as drug resistance is confirmed: two appropriate antiseizure medications have failed to control seizures. Do not wait for a lesion on MRI, for a clear focal onset, or for the patient to ask. The reasons that should not delay referral are listed on the main physician page.

Early neurosurgical consultation.

Refer to the surgeon in parallel with the noninvasive workup rather than after it. Early contact with the neurosurgeon lowers patient anxiety, speeds the workup, and builds trust between the surgical team and the referring epileptologist. Patients who meet the surgeon early understand that the evaluation is a shared process and that no operation is decided until the data are in.

Jehi L, et al. Epilepsia 2022 (Table 1). Wissel BD, et al. Epilepsia 2023;64:1791-1799. Richardson RM. Decision making in epilepsy surgery. Neurosurgery Clinics of North America 2020.

How to refer.

Use our referral form. It asks you to choose between a full presurgical evaluation in our program and a direct surgical consultation for a patient whose workup is already complete. Either path leads to discussion at our multidisciplinary epilepsy surgery conference, where we agree on a primary and an alternative network hypothesis before any implant is planned. Patients and families may also use the same form to refer themselves.