Medial temporal lobe epilepsy is the most common form of partial epilepsy in adults. hippocampal sclerosis is the most common and most specific cause of medial temporal lobe epilepsy, seen in approximately 70% of refractory temporal lobe epilepsy. The main manifestation of medial temporal lobe epilepsy is temporal lobe seizure symptoms, also known as complex partial seizures and psychomotor seizures. 93% of patients with medial temporal lobe epilepsy have seizure aura, such as a burning or rising sensation in the abdomen, fear, déjà vu or unfamiliarity. Further development of seizures with impaired consciousness may result in motor arrest, staring, or double vision (temporal lobe disorientation), often accompanied by reactive automatism, oral automatism (e.g., sucking, smacking, chewing, swallowing, etc.), or stereotyped automatism of the hands (e.g., groping, reaching, gesturing, etc.). A few patients may have aggressive behaviors such as destroying objects and hurting others during seizures. Motor seizures include head and eye deviation to one side, localized tonic incomplete movements or clonic movements. It can be followed by generalized tonic-clonic seizures. The seizures are followed by a prolonged hazy state with automaticity, disorientation, language impairment or drowsiness. Patients with longer duration of disease often have varying degrees of cognitive impairment and psychiatric, behavioral, and personality disorders. Typical medial temporal lobe epilepsy is characterized by interictal spike-wave, spike-wave, or focal slow activity in one or both anterior temporal regions. More than 1/3 of patients may have spike-wave, spike-wave, and sometimes intermittent slow activity in the temporal region with independent bilateral emission. Spike and sharp waves are also often seen in the prefrontal region or abnormal discharges in both frontal and temporal regions, so the scalp EEG has a limited role in localizing interictal discharges. Pterygoid electrodes closer to the medial temporal lobe may increase the chance of detecting spike and sharp waves. Preoperative evaluation of epilepsy requires simultaneous recording of medial temporal lobe potentials with bilateral deep electrodes and frontal lobe electrical activity with cortical electrodes to record spike wave rhythmic discharges in the medial temporal lobe during seizures to further establish the diagnosis. Intra-temporal lobe epilepsy, drug-refractory predominantly, if regular antiepileptic treatment for 2 years is not effective, and preoperative evaluation confirms the diagnosis of unilateral temporal lobe origin with limited and fixed lesions, early surgical treatment should be actively pursued with generally good outcome and overall efficiency >90%.