Medically intractable epilepsy of extra-temporal origin can represent a difficult therapeutic challenge. Our Epilepsy Service has managed these patients using standard investigative methods as well as ictal SPECT and intracranial electrode recording. In the present series of patients, image-guided surgery was used for all electrode implantation and resective surgery. Seizure localization and successful resection were achieved in 70-80% of 42 patients with follow-up of at least one year. Normal MRI and previous failed intracranial investigation were not associated with poorer outcome. Copyright (C) 2002 S. KargerAG, Basel.