The usual criteria employed in assessing the outcome of seizure surgery is almost always that of success in abolition of seizures. Whilst this is a logical method of assessment, experience with large series of such patients shows that this is by no means the only significant criterion. Here we examine the process of postoperative adjustment and the role it plays in determining the outcome of temporal lobectomy for refractory epilepsy. The specific domains involved in this process are examined and it is shown that in a number of cases what is thought to have been surgical success has in fact been significantly diminished by difficulties encountered in postoperative adjustment - to such an extent that total seizure abolition has not resulted in clinical advantage. Copyright 1999 Harcourt Publishers Ltd.