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The ideal candidate for epilepsy surgery is the patient with medically intractable seizures who has unilateral hippocampal sclerosis and atrophy on magnetic resonance imaging (MRI) with concordant seizures recorded on video electroencephalography. Two randomized trials determined clear advantages of anterior temporal lobectomy (ATL) over the best medical or delayed surgical therapy.1,2 The American Academy of Neurology published guidelines that recommend surgical evaluation for patients with intractable epilepsy.3
Quigg M. The Reliability of Intraoperative Electrocorticography in Magnetic Resonance Imaging–Negative Temporal Lobe EpilepsySpikes Mark the Spot. JAMA Neurol. 2014;71(6):681-682. doi:10.1001/jamaneurol.2014.584