This randomized, controlled trial aimed to assess the efficacy and safety of surgery for temporal-lobe epilepsy. Eighty patients were randomly assigned to either surgery (40 patients) or antiepileptic drug treatment for one year (40 patients). The primary outcome was freedom from seizures that impair awareness of self and surroundings. Secondary outcomes included seizure frequency and severity, quality of life, disability, and death. At one year, 58% of the surgical group and 8% of the medical group were free from seizures impairing awareness (P<0.001). The surgical group had fewer seizures impairing awareness and a significantly better quality of life (P<0.001 for both comparisons) compared to the medical group. Four patients (10%) experienced adverse effects of surgery, and one patient in the medical group died. The study concluded that surgery is superior to prolonged medical therapy for temporal-lobe epilepsy, and randomized trials of epilepsy surgery are feasible and provide precise estimates of treatment effects.This randomized, controlled trial aimed to assess the efficacy and safety of surgery for temporal-lobe epilepsy. Eighty patients were randomly assigned to either surgery (40 patients) or antiepileptic drug treatment for one year (40 patients). The primary outcome was freedom from seizures that impair awareness of self and surroundings. Secondary outcomes included seizure frequency and severity, quality of life, disability, and death. At one year, 58% of the surgical group and 8% of the medical group were free from seizures impairing awareness (P<0.001). The surgical group had fewer seizures impairing awareness and a significantly better quality of life (P<0.001 for both comparisons) compared to the medical group. Four patients (10%) experienced adverse effects of surgery, and one patient in the medical group died. The study concluded that surgery is superior to prolonged medical therapy for temporal-lobe epilepsy, and randomized trials of epilepsy surgery are feasible and provide precise estimates of treatment effects.