The timing of surgical intervention for mesial temporal lobe epilepsy: a plan for a randomized clinical trial.

I t is estimated that 20% of patients with epilepsy have seizures that cannot be controlled by antiepileptic drug therapy. Approximately half of these patients are potential candidates for surgical treatment. Based on a prevalence of epilepsy in the United States of 0.5% to 1.0%, there should be more than 100 000 patients with poorly controlled epilepsy who might benefit from surgical intervention. Data obtained from an international conference on surgical treatment for the epilepsies held in 1992 indicated that only 1500 therapeutic surgical procedures were performed for epilepsy in the United States in 1990. With increasing interest in epilepsy surgery, this number may have doubled over the past 8 years. Nevertheless, there appears to be an extraordinary underutilization of this effective alternative treatment for a common and seriously disabling neurological disorder. Similar statistics can be found in every industrialized country, and surgical treatment for epilepsy is all but completely unavailable in the developing world.