A 28-year-old woman with a 5-year history of seizures presents with a breakthrough seizure despite compliance with levetiracetam. EEG shows focal spike-wave discharges over the left temporal lobe. MRI reveals a 2 cm T2-hyperintense lesion in the left mesial temporal region. Which finding best distinguishes drug-resistant focal epilepsy from drug-responsive focal epilepsy in this patient?

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