Introduction

Abstract

The earliest scientific surgical approaches to the control of the epileptic discharge were aimed at defining the focus of origin and then its ablation by open operative surgery. The contributions of Penfield and his colleagues in Montreal to this field of work are notable for painstaking study and additions to knowledge. The problem has been, however, that the results of focal ablation are not always satisfactory except in temporal lobe epilepsy where the results are conspicuously better. There is also the difficulty of unequivocal definition of the focus of discharge in many instances and even when it is defined and satisfactorily excised the epileptic problem may remain because of established secondary foci which may be inaccessible to ablation by open operation. We then still have the possibility of the existence or not of a primary subcortical focus for the origin of the epileptic discharge: so-called centrencephalic epilepsy, e.g. petit mal. This remains unproven and consequently speculative.