Critical to decision analysis studies are measures of outcome utilities. In epilepsy surgery the benefit versus risk ratio is of particular interest in neocortical resections. Using the standard gamble, we measured preferences of 30 epilepsy patients for 10 outcome states specific to neocortical epilepsy surgery. Although considered preliminary, the findings suggest that the value of being seizure-free may be greater than that of continued disabling seizures, even if some deficits typical of "eloquent" cortex injury are incurred with surgery. Seizure freedom achieved with polytherapy medical management may be less desirable than that achieved with surgery and monotherapy. © Wiley Periodicals, Inc. © 2011 International League Against Epilepsy.