The Early Randomized Surgical Epilepsy Trial (ERSET) evaluated whether early surgery (anteromesial temporal resection) plus antiepileptic drugs (AEDs) was more effective than continued AED treatment in controlling seizures and improving quality of life (QOL) in patients with drug-resistant mesial temporal lobe epilepsy (MTLE). The study enrolled 38 participants (18 men, 20 women, aged ≥12 years) who had disabling seizures for no more than 2 consecutive years after adequate trials of two brand-name AEDs. Participants were randomized to either continued AED treatment or surgery plus AED treatment and followed for 2 years. The trial was halted early due to slow recruitment. At the 2-year follow-up, 0 of 23 participants in the medical group and 11 of 15 in the surgical group were seizure-free, indicating a significantly lower probability of seizures in the surgical group. When data from the medical group after surgery was excluded, the surgical group showed a significant improvement in QOL (12.8 vs 2.8 points). However, the sample size was too small to definitively conclude differences in cognitive outcomes. Adverse events included a postoperative stroke and three cases of status epilepticus. Surgery was associated with a small but significant decline in memory, consistent with literature, but not statistically significant. Surgery also improved health-related QOL, particularly in cognitive and psychosocial domains, though not in physical health. The study found that early surgery significantly improved QOL and social adaptation, but the results should be interpreted cautiously due to the premature termination of the trial. The study supports the recommendation for early surgical intervention in patients with newly intractable MTLE, as it offers a better chance of preventing long-term disability. However, the results may not generalize to all patients with TLE, especially those not meeting the strict inclusion criteria. The study highlights the importance of early surgical intervention to prevent adverse psychological and social consequences and premature death. Despite the small sample size, the results suggest that early surgery is highly beneficial for patients with newly intractable MTLE.The Early Randomized Surgical Epilepsy Trial (ERSET) evaluated whether early surgery (anteromesial temporal resection) plus antiepileptic drugs (AEDs) was more effective than continued AED treatment in controlling seizures and improving quality of life (QOL) in patients with drug-resistant mesial temporal lobe epilepsy (MTLE). The study enrolled 38 participants (18 men, 20 women, aged ≥12 years) who had disabling seizures for no more than 2 consecutive years after adequate trials of two brand-name AEDs. Participants were randomized to either continued AED treatment or surgery plus AED treatment and followed for 2 years. The trial was halted early due to slow recruitment. At the 2-year follow-up, 0 of 23 participants in the medical group and 11 of 15 in the surgical group were seizure-free, indicating a significantly lower probability of seizures in the surgical group. When data from the medical group after surgery was excluded, the surgical group showed a significant improvement in QOL (12.8 vs 2.8 points). However, the sample size was too small to definitively conclude differences in cognitive outcomes. Adverse events included a postoperative stroke and three cases of status epilepticus. Surgery was associated with a small but significant decline in memory, consistent with literature, but not statistically significant. Surgery also improved health-related QOL, particularly in cognitive and psychosocial domains, though not in physical health. The study found that early surgery significantly improved QOL and social adaptation, but the results should be interpreted cautiously due to the premature termination of the trial. The study supports the recommendation for early surgical intervention in patients with newly intractable MTLE, as it offers a better chance of preventing long-term disability. However, the results may not generalize to all patients with TLE, especially those not meeting the strict inclusion criteria. The study highlights the importance of early surgical intervention to prevent adverse psychological and social consequences and premature death. Despite the small sample size, the results suggest that early surgery is highly beneficial for patients with newly intractable MTLE.