Abstract
Drug-resistant epilepsy (DRE) presents a major clinical and economic challenge, particularly in lowand middle-income countries (LMICs), where healthcare resources are limited and treatment gaps remain significant. Although epilepsy surgery remains the most effective intervention for eligible DRE patients, outcomes are variable, with success rates ranging from 30% to 70%. Emerging evidence suggests that genetic biomarkers can inform patient selection, predict surgical outcomes, and guide treatment planning. This review explores the potential of integrating genetic testing into presurgical evaluation protocols in LMICs. It examines the role of specific gene mutations in pharmacoresistance, seizure localization, and structural brain abnormalities, with a focus on improving surgical success rates and reducing unnecessary interventions. Incorporating genetic stratification into clinical decision-making could enhance cost-effectiveness, minimize the burden on healthcare systems, and support the development of personalized treatment pathways. Advancing genetic research and building capacity in precision neurology are essential steps toward improving DRE management in resource-constrained settings.