Background. Developing countries, home to 80% of epilepsy patients, do not have comprehensive epilepsy surgery programs. Considering these needs we set up first epilepsy surgery center in Pakistan. Methods. Seventeen teleconferences focused on setting up an epilepsy center at the Aga Khan University (AKU), Karachi, Pakistan were arranged with experts from the University of Alberta Hospital, Alberta, Canada and the University of West Virginia, USA over a two-year period. Subsequently, the experts visited the proposed center to provide hands on training. During this period several interactive teaching sessions, a nationwide workshop, and various public awareness events were organized. Results. Sixteen patients underwent surgery, functional hemispherectomy (HS) was done in six, anterior temporal lobectomy (ATL) in six, and neuronavigation-guided selective amygdalohippocampectomy (SAH) using keyhole technique in four patients. Minimal morbidity was observed in ATL and, SAH groups. All patients in SAH group (100%) had Grade 1 control, while only 5 patients (83%) in ATL group, and 4 patients (66%) in HS group had Grade 1 control according to Engel’s classification, in average followups of 12 months, 24 months and 48 months for SAH, ATL, and HS, respectively. Conclusion. As we share our experience we hope to set a practical example for economically constrained countries that successful epilepsy surgery centers can be managed with limited resources. 1. Introduction A patient with epilepsy, whose seizures cannot be controlled after at least two years having tried and failed two major antiepileptic drugs (AEDs) with demonstrated therapeutic levels, is regarded as medically refractory [1–3]. Approximately 35% of patients with epilepsy are refractory to medical therapy [4]. In such cases where medical management has failed, surgery is generally considered as the next step in the management of their ailment. Surgery is indicated in lesion-related symptomatic epilepsy syndromes such as temporal lobe epilepsy (TLE) with mesial temporal sclerosis (MTS), intracranial tumors, and cortical dysplasias. The number of medically refractory patients as well as lesion-related epilepsy patients is higher in the developing countries due to the higher incidence of infections and perinatal asphyxia leading to greater cortical pathologies. Regrettably, many of the developing countries do not have comprehensive epilepsy centers, leaving patients to suffer with incapacitating seizures and other lifelong comorbidities. In 1997 the World Health Organization, the International League
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