Supplementary Material for: Epilepsy Surgery in Drug-Resistant Epilepsy Facilitated by Artificial Intelligence: A Case of Left Temporal Encephalocele

Epilepsy surgery remains substantially underutilised despite strong evidence supporting its efficacy for appropriately selected patients with drug resistant epilepsy. We describe the case of a 23 year old woman with a four year history of refractory focal impaired awareness seizures, experiencing up to four episodes per week despite multiple appropriately trialled antiseizure medications at maximally tolerated doses. Initial investigations including MRI, EEG, and paraneoplastic screening were unremarkable, and she was managed as having non lesional left temporal lobe epilepsy. As part of an artificial intelligence driven research initiative, a natural language processing based random forest algorithm reviewing free text neurology clinic documentation identified her as a potential surgical candidate. Complementary large language model analysis supported extraction of clinically relevant seizure and imaging information. This prompted re-evaluation of the case, with PET demonstrating left temporal hypometabolism and repeat MRI revealing a previously unrecognised encephalocele. She subsequently underwent left temporal lobe polectomy with encephalocele disconnection. The procedure was successful, and she has remained seizure free for one year post operatively, allowing initiation of ASM weaning and the possibility of long term cure.
This case illustrates both the transformative potential of epilepsy surgery for individuals with drug resistant epilepsy and the promising role of artificial intelligence augmented triage systems in reducing delays to surgical referral. Given the substantial morbidity, mortality, and economic burden associated with drug resistant epilepsy, timely surgical evaluation should be considered the standard of care for eligible patients. Integrating artificial intelligence enabled tools into clinical workflows may help overcome longstanding barriers to access and ensure that life changing interventions are offered earlier in the disease course.