Temporal Epilepsies with Deep-Seated Epileptogenic Foci

A follow-up study of surgery in temporal lobe epilepsy

“…They argue therefore that patients who are disabled by epilepsy should be given the benefit of any doubt, for such patients may be improved through operation or at any rate not worsened. However, we would rather agree with Jasper, Arfel-Cardeville, and (Serafetinides and Falconer, 1963 and recently stated again by Fenyes, Zoltan, and Fenyes (1961).…”

“…This aspect of diagnosis will have to be amplified by further experience. It has been the subject of a recent paper by Fenyes, Zoltan, and Fenyes (1961).…”

“…The development of surgery in temporal lobe epilepsy has been reviewed by several authors (Penfield and Flanigin, 1950;Bailey and Gibbs, 1951;Bailey, 1961;Fenyes, Zoltan, and Fenyes, 1961;Rasmussen and Branch, 1962). The original papers of Penfield reported the effects of superficial temporal cortical ablations, and it was not until later that he (Penfield and Jasper, 1954) recommended the routine removal of the deeper structures including the uncus, amygdala, and anterior hippocampal region.…”

“…Our own particular contribution has been to remove the temporal lobe together with these deeper structures as far as possible in one piece Falconer et al, 1955) in order to accumulate pathological material suitable for study regarding aetiology and other factors. We do not yet know whether it is necessary to excise routinely this amount of brain tissue, although this is being increasingly recommended (Penfield and Jasper, 1954;Morris, 1956;Picaza and Guma', 1956;Fenyes, Zoltan, and Fenyes, 1961). Certainly removal of only the superficial temporal gyri is inadequate (Picaza and Guma', 1956).…”

“…Bailey (1961), who followed 60 (out of a total of 72 patients) for a minimum of five years, despite the difficulties of post-operative assessment in his material, including the unreliability of his patients' statements, reported that 18 patients (30%) were greatly improved as regards psychomotor seizures and 28 (56%) as regards grand mal. Fenyes, Zoltan, and Fenyes (1961), who followed a group of 34 patients for from two to five years, reported that good results were observed in 19 patients or 56 % (eight cured and 11 definitely improved) whereas the remaining patients were classified as poor. Rasmussen and Branch (1962) have recently reported that in a grand total of 389 patients submitted to an anterior temporal lobectomy at the Montreal Neurological Institute and followed up for periods ranging from one to 25 years (average five years) 43 % came within the 'success' group.…”