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The International League Against Epilepsy (ILAE) put forth the definition for intractable epilepsy as the persistence of seizures despite “adequate trials of two tolerated, appropriately chosen and used antiseizure drug [ASD] schedules (whether as monotherapies or in combination).”1 The definition of medically refractory epilepsy has been debated for many years,2 and expert opinion remains divergent from common practice.3 It has been well-documented that the chances of achieving seizure freedom are minimal with additional trials of ASDs and that increased duration of seizures before surgery is associated with decreased chance of long-term seizure freedom.4 The American Association of Neurology 2015 Epilepsy Quality Measures recommend that each patient should have their diagnosis and treatment plan evaluated, and a referral for presurgical evaluation should be considered to a level 4 epilepsy center for those who are medically refractory about once every 2 years.5 As part of this referral and reassessment, surgery should be considered.