Surgery as a curative approach for drug-resistant epilepsy shows promising results in rendering the afflicted individuals seizure-free. In this case report, we present a young patient with drug-resistant focal epilepsy with epigastric auras and impaired consciousness who was referred to a tertiary epilepsy center for presurgical evaluation. Whereas clinical semiology and EEG as well as PET were suitable for temporal lobe onset, the imaging with structural MRI was incongruent, showing changes at the transition of the right frontal to insular cortex. The further care of the patient and details of the presurgical management will be discussed.