What happens if someone with mesial temporal sclerosis (mts) does not want anterior temporal lobectomy?

Your decision.: If you have a seizure disorder from mesial temporal sclerosis, anterior temporal lobectomy is just one of the treatment options that are available to help control your seizures. Taking anti-convulsant medication is another option. Speak to your neurologist and/or neurosurgeon regarding either of these options for more information.

Depends...: If you're seizure-free, surgery is generally not indicated anyway. If not seizure-free, sometimes different needs can be more effective...though MTS does tend to lead to intractable epilepsy. Another option might be a vagal nerve stimulator. You need to discuss all options with your epileptologist carefully. IMO, risks of ATL are overblown. Biggest "risk" in my book: not 100% become seizure-free.

Status quo: Surgery is but one option. Could modify meds as there are now over 20 anti-epileptic medications. Another option is a vagal nerve stimulator implantation.

With mts-or anything: Depends upon the impact of seizures upon your life, the effectiveness of previously tried treatments-VNS, anti-epileptic meds with the combinations of such available, etc. With this in mind, it seems that discussing this with your epileptologist, neurologist, neurosurgeon, as many times + for how long of a period of time; at least for now is up to you + ultimately comfort with it. Your choice.