In temporal-lobe epilepsy, surgery is superior to prolonged medical therapy. Randomized trials of surgery for epilepsy are feasible and appear to yield precise estimates of treatment effects.

Recent investigations indicate a site of cardiac representation within the left insular cortex of the rat. Moreover, the results of lesion studies suggest left-sided insular dominance for sympathetic cardiovascular effects. It is unclear whether similar representation exists within the human insular cortex. Five epileptic patients underwent intraoperative insular stimulation prior to temporal lobectomy for seizure control. On stimulation of the left insular cortex, bradycardia and depressor responses were more frequently produced than tachycardia and pressor effects (p less than 0.005). The converse applied for the right insular cortex. We believe this to be the first demonstration of cardiovascular changes elicitable during insular stimulation in humans, and of lateralization of such responses for a cortical site. In humans, unlike the rat, there appears to be right-sided dominance for sympathetic effects. These findings may be of relevance in predicting the autonomic effects of stroke in humans and in the explanation of sudden unexpected epileptic death.

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Electrical stimulation of the occipital cortex resulted in discrete photic sensations or "phosphenes" in two volunteers who had been totally blind for 7 and 28 years, respectively. Stimulation of multiple electrodes allowed one patient to recognize simple patterns, including letters. Both patients made an uneventful recovery, and the success of these experiments reinforces the hope that a functional visual prosthesis can be developed, although many problems remain to be solved.