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About one third of patients with focal epilepsy experience seizures despite adequate medical treatment. In this population, successful epilepsy surgery improves life expectancy and health-related quality of life, while reducing health care costs as a result of reduced hospital admissions, emergency department visits, and use of antiepileptic drugs. The effectiveness of epilepsy surgery and low incidence of surgical complications have been established by numerous studies over several decades. The International League Against Epilepsy recently issued a definition of drug-resistant epilepsy for early identification of patients who are unlikely to be treated successfully with medical therapy alone. Potential surgical candidates are identified through a detailed seizure and medical history, physical examination, and the use of video electroencephalography and neuroimaging. A presurgical evaluation should be considered as soon as drug resistance becomes evident.