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It is well established that anterior temporal lobectomy (ATL) is an effective treatment for drug-resistant temporal lobe epilepsy.1 Despite this, there is evidence from many countries that it is underused.2 One survey of Canadian neurologists reported that the perception of inadequate health care resources was the single greatest barrier to making referrals for epilepsy surgery.3 Because epilepsy surgery and the presurgical evaluation require such a major investment in health care resources, it is not enough to prove that surgery is efficacious for controlling seizures. It must also be shown that surgery results in a lower long-term cost relative to medical treatment, an improved quality of life, and a reduction of the indirect costs of epilepsy.
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