Is it necessary to define the ictal onset zone with EEG prior to performing resective epilepsy surgery?

► Neuroimaging does not always identify the site of seizure origination in patients evaluated for epilepsy surgery ► Localization of seizures with EEG is expensive, time consuming and has a modest risk, but provides additional information to localize the seizure onset zone ► Epilepsy surgery can produce life changing benefits, but has risks, and surgical failure is not rare ► Epilepsy surgery is underutilized ► When deciding whether to require seizure localization with EEG before surgery, these concerns must be taken into account