Any patient who continues to have complex partial seizures following an adequate trial of antiepileptic drugs (AEDs) should be considered for evaluation for surgery in a comprehensive epilepsy center. Investigations should include 24-hour electroencephalographic (EEG) monitoring, a high-resolution magnetic resonance imaging (MRI) study, and neuropsychological assessment. Surgery is most effective in patients with unilateral hippocampal atrophy or a structural lesion and concordant EEG findings. With modern microsurgical techniques, surgery is associated with a low rate of major morbidity. The vagal nerve stimulator is a device recently approved by the United States Food and Drug Administration that may offer control equivalent to that of AEDs in patients who are not candidates for surgical resection.
