Surgical therapy for epilepsy should be considered in patients with:

A. Seizures poorly controlled with antiepileptic medications.

B. A single epileptic focus.

DISCUSSION: Because seizure surgical procedures can never be guaranteed to alleviate seizures, it is only undertaken when medical therapy fails to control the patient's seizures at doses that do not produce intolerable side effects. Most surgical procedures are aimed at removing a single epileptogenic area of cerebral cortex and are rarely employed in patients with multiple areas of epileptogenic cortex. Eloquent areas of cerebral cortex such as those subserving speech or hand functions generally are not intentionally resected in an attempt to achieve seizure control.