A randomized, controlled trial was conducted to assess the efficacy and safety of surgery for temporal-lobe epilepsy. Eighty patients with temporal-lobe epilepsy were randomly assigned to either surgery or treatment with antiepileptic drugs for one year. The primary outcome was freedom from seizures impairing awareness, with results showing that 58% of patients in the surgical group were free of such seizures at one year, compared to 8% in the medical group (P<0.001). Patients in the surgical group also had fewer seizures and a significantly better quality of life than those in the medical group. Four patients had adverse effects of surgery, and one patient in the medical group died. The study found that surgery was superior to prolonged medical therapy for temporal-lobe epilepsy. Randomized trials of surgery for epilepsy are feasible and appear to yield precise estimates of treatment effects. Epilepsy is a serious health problem affecting people of all ages and backgrounds, with a global burden similar to that of breast cancer in women and lung cancer in men. Temporal-lobe epilepsy can cause seizures that impair awareness, and surgery may not only control seizures but also prevent untimely death. However, surgery is grossly underused, with only 1500 of the nearly 100,000 eligible patients in the United States undergoing such procedures each year. The absence of robust evidence supporting the safety and efficacy of surgery for epilepsy has contributed to the underuse of the procedure. Previous studies have lacked the methodological rigor needed to draw strong conclusions. This trial demonstrated that surgery is effective and safe for temporal-lobe epilepsy, with significant improvements in seizure control and quality of life. The results support the notion that patients with temporal-lobe epilepsy should be evaluated for surgery to prevent unnecessary disability and even death. However, the trial did not address the optimal timing of surgery. The study was conducted at the London Health Sciences Centre, University of Western Ontario, Canada, and was approved by the institutional review board. The results highlight the importance of randomized trials in evaluating surgical treatments for epilepsy.A randomized, controlled trial was conducted to assess the efficacy and safety of surgery for temporal-lobe epilepsy. Eighty patients with temporal-lobe epilepsy were randomly assigned to either surgery or treatment with antiepileptic drugs for one year. The primary outcome was freedom from seizures impairing awareness, with results showing that 58% of patients in the surgical group were free of such seizures at one year, compared to 8% in the medical group (P<0.001). Patients in the surgical group also had fewer seizures and a significantly better quality of life than those in the medical group. Four patients had adverse effects of surgery, and one patient in the medical group died. The study found that surgery was superior to prolonged medical therapy for temporal-lobe epilepsy. Randomized trials of surgery for epilepsy are feasible and appear to yield precise estimates of treatment effects. Epilepsy is a serious health problem affecting people of all ages and backgrounds, with a global burden similar to that of breast cancer in women and lung cancer in men. Temporal-lobe epilepsy can cause seizures that impair awareness, and surgery may not only control seizures but also prevent untimely death. However, surgery is grossly underused, with only 1500 of the nearly 100,000 eligible patients in the United States undergoing such procedures each year. The absence of robust evidence supporting the safety and efficacy of surgery for epilepsy has contributed to the underuse of the procedure. Previous studies have lacked the methodological rigor needed to draw strong conclusions. This trial demonstrated that surgery is effective and safe for temporal-lobe epilepsy, with significant improvements in seizure control and quality of life. The results support the notion that patients with temporal-lobe epilepsy should be evaluated for surgery to prevent unnecessary disability and even death. However, the trial did not address the optimal timing of surgery. The study was conducted at the London Health Sciences Centre, University of Western Ontario, Canada, and was approved by the institutional review board. The results highlight the importance of randomized trials in evaluating surgical treatments for epilepsy.