What is your treatment method for a patient with drug-resistant focal epilespy that arises from both temporal lobes but already has an anterior temporal lobectomy?

If the epileptogenic focus is clearly mesial temporal, by EEG, interictal SPECT, neuropsych, and imaging, I would wonder if the amygdala/hippocampus has been adequately resected. If not I would remove these with hippocampal resection ~ 2.5 cm from the anterior hippocampal margin. This should produce...

Depending on the location of seizure onset in the remaining temporal lobe, we would generally recommend RNS with a depth electrode traversing the medial structures and a strip electrode over the lateral temporal neocortex.