***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: CONTEXT Despite reported success , surgery for pharmacoresistant seizures is often seen as a last resort . Patients are typically referred for surgery after 20 years of seizures , often too late to avoid significant disability and premature death . OBJECTIVE We sought to determine whether surgery soon after failure of 2 antiepileptic drug ( AED ) trials is superior to continued medical management in controlling seizures and improving quality of life ( QOL ) . DESIGN , SETTING , AND PARTICIPANTS The Early R and omized Surgical Epilepsy Trial ( ERSET ) is a multicenter , controlled , parallel-group clinical trial performed at 16 US epilepsy surgery centers . The 38 participants ( 18 men and 20 women ; aged ≥12 years ) had mesial temporal lobe epilepsy ( MTLE ) and disabling seizues for no more than 2 consecutive years following adequate trials of 2 br and -name AEDs . Eligibility for anteromesial temporal resection ( AMTR ) was based on a st and ardized presurgical evaluation protocol . Participants were r and omized to continued AED treatment or AMTR 2003 - 2007 , and observed for 2 years . Planned enrollment was 200 , but the trial was halted prematurely due to slow accrual . INTERVENTION Receipt of continued AED treatment ( n = 23 ) or a st and ardized AMTR plus AED treatment ( n = 15 ) . In the medical group , 7 participants underwent AMTR prior to the end of follow-up and 1 participant in the surgical group never received surgery . MAIN OUTCOME MEASURES The primary outcome variable was freedom from disabling seizures during year 2 of follow-up . Secondary outcome variables were health-related QOL ( measured primarily by the 2-year change in the Quality of Life in Epilepsy 89 [ QOLIE-89 ] overall T-score ) , cognitive function , and social adaptation . RESULTS Zero of 23 participants in the medical group and 11 of 15 in the surgical group were seizure free during year 2 of follow-up ( odds ratio = ∞ ; 95 % CI , 11.8 to ∞ ; P < .001 ) . In an intention-to-treat analysis , the mean improvement in QOLIE-89 overall T-score was higher in the surgical group than in the medical group but this difference was not statistically significant ( 12.6 vs 4.0 points ; treatment effect = 8.5 ; 95 % CI , -1.0 to 18.1 ; P = .08 ) . When data obtained after surgery from participants in the medical group were excluded , the effect of surgery on QOL was significant ( 12.8 vs 2.8 points ; treatment effect = 9.9 ; 95 % CI , 2.2 to 17.7 ; P = .01 ) . Memory decline ( assessed using the Rey Auditory Verbal Learning Test ) occurred in 4 participants ( 36 % ) after surgery , consistent with rates seen in the literature ; but the sample was too small to permit definitive conclusions about treatment group differences in cognitive outcomes . Adverse events included a transient neurologic deficit attributed to a magnetic resonance imaging-identified postoperative stroke in a participant who had surgery and 3 cases of status epilepticus in the medical group . CONCLUSIONS Among patients with newly intractable disabling MTLE , resective surgery plus AED treatment result ed in a lower probability of seizures during year 2 of follow-up than continued AED treatment alone . Given the premature termination of the trial , the results should be interpreted with appropriate caution . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00040326 OBJECT The syndrome of medial temporal lobe epilepsy ( MTLE ) may occur in patients in whom magnetic resonance ( MR ) images demonstrate normal findings . In these patients , there is no evidence of hippocampal sclerosis on neuroimaging , and histopathological examination of the resected hippocampus does not reveal significant neuron loss . In this paper the authors describe the distinct clinical features of this MTLE subtype , referred to as paradoxical temporal lobe epilepsy ( PTLE ) . METHODS The authors selected 12 consecutive patients with preoperative findings consistent with MTLE in whom MR imaging did not demonstrate any hippocampal abnormality . Onset of hippocampal seizure was confirmed by long-term intracranial monitoring . There were six female and six male patients with a mean age of 32 + /- 11 years , ( mean + /- st and ard deviation [ SD ] ) at presentation . These patients ' seizure histories , available hippocampal volumetric measurements , and hippocampal cell densities in different subfields were review ed . Sharp electrode recordings from dentate granule cells that had been maintained in hippocampal slices provided a measure of excitation and inhibition in the tissue . We compared these data with those of a cohort of 50 r and omly selected patients who underwent anteromedial temporal resection for medial temporal sclerosis ( MTS ) during the same time period ( 1987 - 1999 ) . The duration s of follow up ( means + /- SDs ) for the PTLE and MTS groups were 51 + /- 59 months and 88 + /- 44 months , respectively . A history of febrile seizure was present less frequently in the PTLE group ( 8 % ) than in the MTS group ( 34 % ) . Other risk factors for epilepsy such as trauma , meningoencephalitis , or perinatal injuries were present more frequently in the PTLE group ( 50 % ) than in the MTS cohort ( 36 % ) . In patients in the PTLE group the first seizure occurred later in life ( mean age at seizure onset 14 years in the PTLE group compared with 9 years in the MTS group , p = 0.09 ) . Ten patients ( 83 % ) in the PTLE cohort and 23 patients ( 46 % ) in the MTLE cohort had secondary generalization of their seizures . Among patients with PTLE , volumetric measurements ( five patients ) and r and omized blinded visual inspection ( seven patients ) of the bilateral hippocampi revealed no atrophy and no increased T2 signal change on preoperative MR images . All patients with PTLE underwent anteromedial temporal resection ( amygdalohippocampectomy , in five patients on the left side and in seven on the right side ) . Electrophysiological studies of hippocampal slices demonstrated that dentate granule cells from patients with PTLE were significantly less excitable than those from patients with MTS . The mean pyramidal cell loss in the CAI subfield in patients in the PTLE group was 20 % ( range 0 - 59 % ) and that in patients in the MTS group was 75 % ( range 41 - 90 % ) ( p < 0.001 ) . Maximal neuron loss ( mean loss 38 % ) occurred in the CA4 region in six patients with PTLE ( end folium sclerosis ) . At the last follow-up examination , six patients ( 50 % ) in the PTLE group were seizure free compared with 38 patients ( 76 % ) in the MTS group . CONCLUSIONS Clinical PTLE is a distinct syndrome with clinical features and surgical outcomes different from-those of MTS Epilepsy surgery is a successful treatment for refractory temporal lobe epilepsy ( TLE ) . Reports suggest fewer seizure-free outcomes for patients with TLE and who have a negative brain MRI ( nMRI ) for mesial temporal sclerosis . Data were collected prospect ively from patients with nMRI who underwent temporal lobe surgery for TLE characterized by unilateral ictal temporal lobe seizure onset based on a scalp video electroencephalogram or invasive subdural electrode recordings . A total of 86 patients were followed for at least 24 months after surgery . Outcome was evaluated using the Engel classification . Seizure control was obtained by 55 % ( 47/86 ) of patients ( Class [CL]-I ) , 27 % ( 23/86 ) showed significant improvement ( CL-II ) and 19 % ( 16/86 ) were deemed surgical failures . Shorter duration of epilepsy , later onset of seizures , and ictal theta rhythm ( 5 - 7 Hz ) were the most significant predictors of postoperative seizure control . Although hypometabolism on positron emission tomography scan and significant memory disparity ( > 2.5/8 ) were not significant prognosticators independently , cumulatively they were predictors for favorable outcome 
    Output:
    
A shorter epilepsy duration and scalp electroencephalogram ( EEG ) signals localized precisely in the temporal lobe predicted a better seizure outcome in patients with MRI-negative temporal lobe epilepsy