Seizure control is critical, and chronic epilepsy may lead to psychological disorders, increased psychosocial stress, inability to drive, poor employment, decreased quality of life, physical impairment, increased mortality from drowning and other accidents, persistent epilepsy, and accidental death due to epilepsy. While 60-70% of patients with epilepsy have their seizures controlled with antiepileptic drugs, another 30%-40% of patients require other means such as vagus nerve stimulation, repetitive electrical nerve stimulation, deep brain stimulation, ketogenic and modified Atkins diets, complementary and alternative therapies, and epilepsy surgery. A recent Medscape article states that surgical control of seizures is superior to other treatments. Treatment Although vagus nerve stimulation, repetitive electrical nerve stimulation, and deep brain stimulation can reduce the frequency and extent of seizures, it is difficult to completely end seizures. Dietary therapies are poorly adhered to and are mainly used in children with severe epilepsy and developmental disorders. Complementary and alternative therapies await further confirmation of safety or efficacy. 2 randomized controlled trials have confirmed the superiority of epilepsy surgery over drug therapy, and despite its clinical effectiveness, its use is not well promoted. Indications Indications for epilepsy surgery are: patients with drug-refractory epilepsy, that is, patients whose seizures cannot be controlled after attempts to give 2 tolerable and appropriate antiepileptic drugs, either as monotherapy or in combination. In this group of patients, seizures are difficult to control with medication, and in one randomized trial, 58% of patients achieved seizure cessation with temporal lobe surgery, while only 8% of patients achieved seizure termination with continued medication. The benefits and risks of epilepsy surgery 58% of patients in the randomized trial had seizure termination and experienced substantial improvements in quality of life, employment status, and school applications. However, 5% of patients in Professor Wiebe and colleagues’ study had postoperative memory impairment, and the risk of depression was similar in the surgical group as in the drug-treated group, with no hemiparesis or death. The risk of serious complications from temporal lobectomy is usually <5%. Long-term prognosis Not all patients will achieve complete seizure termination with surgical treatment, depending on the type of epilepsy surgery and, in particular, the individual patient. Even for those patients whose seizures cease immediately after epilepsy surgery, there is a risk of recurrence. A recent Swiss study showed that 87% of adults and children whose seizures had been terminated 2 years after surgery remained seizure-free at 5- and 10-year follow-up. The best prognosis for temporal lobectomy was that 44% of adults and 55% of children achieved persistent seizure termination. However, 3 percent of adults and 8 percent of children may experience exacerbation of seizures. In this prospective study, only 13% of patients with seizure termination at 2 years after surgery had a recurrence at 5-10 years follow-up, suggesting that the vast majority of patients have durable seizure control with surgical treatment, and more than 50% of patients with seizure termination can be taken off antiepileptic medication. Epilepsy surgery can be successful in long-term seizure control in patients with drug-resistant epilepsy, and surgery may be considered when patients cannot control their seizures with optimal antiepileptic drug therapy.