Expedited epilepsy surgery for patients seen in a first seizure clinic.

INTRODUCTION: First seizure evaluation clinics (FSCs) provide rapid, specialized assessment of patients with a suspected new-onset seizure. Their role in identifying patients who may benefit from epilepsy surgery has not been well described. We evaluated the frequency, timing, and outcomes of epilepsy surgery among patients diagnosed with epilepsy through a dedicated FSC. METHODS: We performed a retrospective review of adults evaluated in a weekly FSC at a comprehensive epilepsy center from March 2021-September 2025. Patients with a prior diagnosis of epilepsy were excluded. Clinical, imaging, electrographic, surgical, and postoperative outcome data were collected and analyzed by a board-certified epileptologist. RESULTS: Among 650 patients evaluated, 591 had no prior diagnosis of epilepsy and 250 (42.3%) were newly diagnosed with epilepsy. Twenty patients (8.0%) were identified as epilepsy surgery candidates, including 17 (85%) with lesional epilepsy. Over half (9/17, 52.9%) of the lesional surgical candidates had not yet developed drug-resistant epilepsy (DRE). Fifteen patients (6.0%) ultimately underwent epilepsy surgery, including resection (n = 12), laser interstitial thermal therapy (LITT) (n = 3), and responsive neurostimulation (n = 1), with one patient undergoing both resection and LITT. Median time from initial FSC evaluation to surgery was 153 days (IQR 56.5-511.5). At the most recent postoperative follow-up, all patients were classified as Engel Class I. CONCLUSION: The FSC facilitated early identification of surgical candidates and timely referral for epilepsy surgery. Over half of lesional surgical candidates were identified before developing DRE, supporting early surgical evaluation in appropriately selected patients with lesional epilepsy.