From lateral to mesial: the quest for a surgical cure for temporal lobe epilepsy.
OBJECTIVE
A gap of more than a hundred years occurred between the first accounts of mesial temporal sclerosis and recognition of its role in the pathogenesis of psychomotor seizures. This paper reviews how the understanding and surgical treatment of temporal lobe epilepsy developed, particularly from the work of Penfield, Jasper, and their associates at the Montreal Neurological Institute (MNI).


METHODS
Publications on EEG and surgery for temporal lobe seizures from 1935 to 1953 were reviewed and charts of selected patients operated on at the MNI in the same period were examined. Attention was focused on the evolution of surgical techniques for temporal lobe epilepsy.


RESULTS
In the late 1930s, some EEG findings suggested deep-lying disturbances originating in the temporal lobe. However, it took another two decades before the correlation of clinical, neurophysiological, and anatomical findings provided evidence for the involvement of the mesial structures in psychomotor or temporal lobe seizures. From 1949 and onward, Penfield and his associates applied this evidence to extend the surgical resections to include the uncus and the hippocampus.


CONCLUSIONS
The collaborative work of a team led by Penfield and Jasper at the MNI helped to define the role of neurophysiological studies in epilepsy surgery. As a result, the importance of removing the mesial structures in order to obtain better seizure control in patients with temporal lobe epilepsy became firmly established.
de Almeida
Antonio Nogueira
AN
Departamento de Neurologia do Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil. almeidaan@globo.com
Teixeira
Manoel Jacoben
MJ
Feindel
William Howard
WH
D000047:Academies and Institutes / Q000266:history; D000679:Amygdala / Q000503:physiopathology; D038481:Anterior Temporal Lobectomy / Q000266:history; D002170:Canada; D003299:Cooperative Behavior; D004569:Electroencephalography / Q000266:history; D017029:Epilepsy, Complex Partial / Q000473:pathology / Q000601:surgery; D004833:Epilepsy, Temporal Lobe / Q000266:history / Q000473:pathology / Q000601:surgery*; D006624:Hippocampus / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D049673:History, 20th Century; D006801:Humans; D009462:Neurology / Q000266:history; D009482:Neurophysiology / Q000266:history; D019635:Neurosurgical Procedures / Q000266:history*; D012598:Sclerosis; D013702:Temporal Lobe / Q000473:pathology / Q000601:surgery*